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PubMed1979

Bacteriocin typing of Serratia marcescens. A simplified system.

The authors describe a simplified system for the detection of bacteriocin production by Serratia marcescens with the use of six indicator strains, which include Escherichia coli, Klebsiella pneumoniae, Citrobacter diversus, Enterobacter aerogenes (two strains), and Serratia rubidaea grown on arabinose minimal medium plates. Of the 64 possible bacteriocin types, 11 were observed; 66% of the isolates tested were found to be one of three types. Occasionally more than one bacteriocin type was observed in an individual specimen; however, serotyping or antibiograms, or both, also indicated this was a different strain. The marcescin types were stable markers. With the use of this technic, different endemic strains of Serratia were shown to predominate in various areas of the hospital. In addition, when urinary tract isolates were compared with respiratory tract isolates, significant differences were found in the predominate types. The typing of these isolates by bacteriocin production was supported by serotype and antibiotype findings. The results suggest that this simple system may be a useful tool in a general hospital.

Bacteriocins↗
PubMedDate not supplied

Nosocomial infection due to Pseudomonas pseudomallei: two cases and an epidemiologic study.

Pseudomonas pseudomallei was recovered from urine specimens of two patients who acquired the organism after they were admitted to a hospital in a region in which it is endemic. Both patients were diabetic and both had urethral catheters passed while they were hospitalized. samples of soil taken from the hospital grounds yielded an isolate of P. pseudomallei that was identical biochemically and by antibiogram to the two isolates recovered from the urine specimens of the two patients. The two patients stayed in wards located in separate hospital blocks, which were geographically distinct but connected by a walkway. The relevant clinical histories of the two patients and the epidemiologic and microbiologic characteristics of the P. pseudomallei isolates were studied. Sera from both patients showed a significant rise in titers of antibody specific for P. pseudomallei. These two patients are considered to represent the first reported cases of hospital-acquired infection due to P. pseudomallei.

Aged↗
PubMed1992

Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia.

In 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.

Bacteremia↗
PubMed1995

Persistence of a multiresistant clone of Staphylococcus epidermidis in a neonatal intensive-care unit for a four-year period.

A cluster of cases of Staphylococcus epidermidis bacteremia in a neonatal intensive-care unit (NICU) during 1991 raised the question of whether these infections were caused by a single strain. Sixty-seven isolates of S. epidermidis from blood cultures of 56 neonates treated in the NICU between 1986 and 1992 and 54 control strains from other patients with bacteremia were characterized by three typing methods: antibiogram, plasmid profile, and ribotype. Plasmid profiles and ribotype patterns indicated that 11 (16%) of the 67 episodes of S. epidermidis bacteremia in the NICU were caused by a single strain. Although this epidemic strain did not account entirely for the increase in the incidence of bacteremia in the NICU, it did persist for 4 years during the study period. Other clones responsible for smaller outbreaks were also found. These results suggest that S. epidermidis cross-infections are very common in the NICU setting.

Bacteremia↗
PubMed1995

Familial carriage of methicillin-resistant Staphylococcus aureus and subsequent infection in a premature neonate.

During routine surveillance of patients in a Neonatal Intensive Care Unit (NICU), an alert infection-control practitioner confirmed the relationship of the index patient (sibling 3) who had a methicillin-resistant Staphylococcus aureus (MRSA) infection to an infant sibling (sibling 2) who had been admitted to the hospital 7 months previously with an MRSA infection. Cultures of nasal specimens obtained from the index patient's parents and two other siblings also yielded MRSA for two of the family members, the mother and sibling 1. The strains were typed by antibiogram, plasmid analysis, and genomic DNA typing. The isolates from sibling 1, sibling 2, the mother, and one isolate from sibling 3 were found to be identical by all techniques. The other isolates from sibling 3 shared the same genomic type but had no detectable plasmids. These findings suggest that transmission of this strain occurred at least three times within this family and that at least one family member was colonized with the same strain for 7 months or more. Recognition that family members may serve as reservoirs for nosocomial infections with MRSA raises important issues for infection control.

Adult↗
PubMed1996

The positive predictive value of isolating coagulase-negative staphylococci from blood cultures.

We used four criteria to define true bloodstream infections after isolation of coagulase-negative staphylococci (CNS) from Isolator (Wampole Laboratories, Cranbury, NJ) blood cultures: (1) the patient's temperature was > or = 38 degrees C, (2) appropriate treatment was administered, (3) the physician diagnosed bloodstream infection or criteria for nosocomial bloodstream infection were met, and (4) at least one clinical sign or laboratory value was consistent with infection. Sixty (26.4%) of 227 episodes met these four criteria. By logistic regression, variables associated with meeting the definition of infection were admission to a service other than the surgical intensive care unit, the biotype of the Staphylococcus epidermidis isolates, the log of the weighted average of the total number of bacteria per milliliter of blood in all positive cultures, resistance to at least six antimicrobial agents, and the positivity of a BACTEC blood culture specimen that was drawn with the first positive Isolator culture specimen. In a high-risk population, 26% of Isolator blood cultures positive for CNS represented infections, a rate two to four times greater than that reported in the literature. Information regarding the species, biotype, antibiogram, and number of organisms per milliliter of blood might help physicians distinguish between CNS bloodstream infections and contamination.

Adult↗
PubMed1996

Nosocomial outbreak of gastroenteritis due to Salmonella senftenberg.

We describe a prolonged nosocomial outbreak of Salmonella senftenberg, an uncommon human pathogen. We detected 22 cases of infection due to S. senftenberg that occurred from March 1993 through November 1994 and involved 18 patients and four healthy employees. All infected persons had consumed food prepared by the hospital kitchen. The estimated attack rate for the period of the outbreak was 0.19-0.23 cases per 100,000 meals served. Infection control interventions included observation of food preparation, disinfection of kitchen devices, and education of food handlers. The consumption of lettuce (11 of 15 patients who could recount extended dietary histories vs. 4 of 20 controls; P = .005), cauliflower (5 of 15 vs. 0/20; P = .02), cottage cheese (4 of 15 vs. 0/20; P = .03), and deli turkey (8 of 15 vs. 0/20; P < .001) was associated with S. senftenberg infection. The isolates had identical antibiograms and pulsed-field gel electrophoretic patterns. Cultures of stool samples from food handlers as well as food items, kitchen devices, and kitchen surroundings were negative for S. senftenberg. Interruption of the outbreak occurred coincidentally with the institution of infection control measures. This prolonged outbreak of salmonellosis was probably related to contamination in the kitchen from turkey, with cross-contamination via equipment.

Adult↗
PubMed1989

Minimal andrological requirements for in-vitro fertilization.

The ejaculate used for in-vitro fertilization of human oocytes must fulfil minimum requirements. Based on the results of experimental investigations, total concentrations of spermatozoa must be greater than 5 million spermatozoa/microliters with progressive motilities of at least 30% and also a normal morphology of at least 30%. Furthermore, in sperm preparations used for inseminating human oocytes, the concentration of pathogenic microorganisms must not be less than 10(4). If there are positive bacteriological findings, the treatment of both partners is mandatory according to the antibiogram. According to the information gathered to date, the hamster oocyte penetration test can only provide additional information if it is positive, but acceptance into an IVF programme should not depend on this test. According to the results presented so far, the swell test developed by Jeyendran shows quite good correlation with the fertilization of human oocytes.

Female↗
PubMed1975

Antimicrobial resistance and R-factor transfer among isolates of Salmonella in the northeastern United States: a comparison of human and animal isolates.

The antimicrobial susceptibility of 718 isolates of Salmonella from humans and of 688 isolates from animals was examined. Of the 46 different serotypes among the isolates from humans, Salmonella typhimurium accounted for 34%. Thirty percent of isolates were resistant to one or more antibiotic(s). Resistance to streptomycin was most common; resistance to tetracycline was next most common. Over 50% of isolates of S. typhimurium and Salmonella newport were resistant to four antibiotics. Resistance to tetracycline, kanamycin, and ampicillin has increased steadily during the past decade. Most strains possessed R-factors, and resistance to ampicillin, streptomycin, sulfisoxazole, tetracycline, chloramphenicol, and kanamycin (but not that to cephalothin) was transferable. Among the salmonellae commonly isolated from humans, only Salmonella enteritidis showed limited resistance to antibiotics (5.8%). Antibiotic resistance of isolates of S. typhimurium, Salmonella saint-paul, and Salmonella heidelberg from animals was similar to the resistance of isolates from humans. Resistance to kanamycin increased markedly over the level noted in previous studies. R-factor prevalence was high. Antibiograms of the isolates from animals and humans were similar, although some patterns were seen only in isolates from one source. Ampicillin resistance was more common in human isolates, and resistance to tetracycline, sulfonamide, and streptomycin was more common in animal isolates. Salmonellae of serotypes other than S. typhimurium that came from humans were less resistant to all antibiotics than were isolates from animals.

Animals↗
PubMed1977

Pseudomonas species bacteremia caused by contaminated normal human serum albumin.

In May and June 1973, 11 patients on the surgical service at the University of Maryland Hospital had bacteremia caused by Pseudomonas species. Seven of the isolates recovered from blood cultures had the same antibiogram (sensitive only to chloramphenicol and tetracycline). Ten of the 11 patients were given 25% normal serum albumin (human) shortly before the onset of symptoms. In contrast, only two of seven patients with bacteremia due to Psuedomonas aeruginosa in May and June (P =0.013) and only nine of 20 patients located in surgical special care units during these months (P =0.014) were given this product. When cultured, the albumin in one of 54 previously unopened vials from the implicated lot yielded Pseudomonas cepacia sensitive only to chloramphenicol, tetracycline, and nalidixic acid. Subsequent investigation showed that five more patients in four other hospitals had symptoms of bacteremia shortly after the infusion of different lots of albumin from the same manufacturer, and in four cases P. cepacia was cultured from the suspect albumin. Since sterility testing by manufacturers may not detect low-frequency contamination, surveillance of nosocomial infections, investigation of unusual disease clusters, and prompt reporting of suspect reactions are essential in the control of such outbreaks.

Chloramphenicol↗
PubMed1980

Molecular analysis of R-factors from multiresistant nosocomial isolates.

During an epidemic of infections at the Seattle Veterans Hospital, Washington, due to a multiresistant strain of Serratia marcencens, other enteric species were isolated that had antibiograms nearly identical to those of the epidemic S. marcescens. In 11 instances, these multiresistant species were isolated from specimens that also contained the epidemic serratia strain. All isolates of the epidemic serratia strain contained a conjugative 45-megadalton R-factor (pLST1000) coding for intermediate resistance to three amino-glycosides (minimal inhibitory concentrations, 4--8 micrograms/ml) and high-level resistance to ampicillin, carbenicillin, cephalothin, streptomycin, and sulfonamide. With the use of agarose gel electrophoresis and restriction endonuclease cleavage patterns after digestion with EcoRI, BamH1, and HindIII, it was determined that eight different enteric strains of six different species isolated from the patients contained an R-factor that was molecularly identical to the one isolated from the epidemic strain of S. marcescens. Thus, the epidemic of multiresistant infections at this hospital was caused both by the spread of an epidemic strain and an "epidemic plasmid." The molecular characteristics of pLST1000 appear to be different from previously described multiresistant plasmids.

Aminoglycosides↗
PubMed1984

Incidence of trimethoprim-sulfamethoxazole-resistant enterobacteriaceae among transplant recipients.

Of 114 recipients of pancreatic, renal, and bone marrow transplants who were given trimethoprim-sulfamethoxazole (TMP-SMZ) for antimicrobial prophylaxis, 44 (39%) had a total of 52 fecal isolates of TMP-SMZ-resistant gram-negative bacilli. In most of these 44 patients, the resistant isolate was found at a concentration of greater than or equal to 10(6) organisms/ml of feces. Escherichia coli was the most frequent of the isolates, and Citrobacter freundii was the next most frequent. Eight of the 114 transplant recipients had gram-negative bacteremia; in six of these eight patients, a TMP-SMZ-resistant gram-negative bacillus was the etiologic agent of bacteremia. Four of the latter six patients had stool cultures analyzed prior to the detection of bacteremia; all four had high concentrations (greater than or equal to 10(8)/ml) of fecal TMP-SMZ-resistant E. coli one to 20 days before they were found to have E. coli bacteremia. In each of these instances, the E. coli isolates from the stool and the blood had similar antibiograms. These findings indicated that resistance to TMP-SMZ is becoming more prevalent and that the screening of patients for the presence of fecal TMP-SMZ-resistant Enterobacteriaceae prior to initiation of long-term therapy with this antimicrobial agent may be worthwhile.

Bone Marrow Transplantation↗
PubMed1987

Characterization and use of a DNA probe as an epidemiological marker for Pseudomonas aeruginosa.

We used DNA restriction fragments, derived from the exotoxin A gene and surrounding sequences, as an epidemiological marker for Pseudomonas aeruginosa. Using these DNA fragments as probes in Southern blot hybridizations and/or total genomic digestions, we were able to distinguish greater than 100 different strains of P. aeruginosa. The stability of the marker in vitro was established by using well-characterized strains, which were stored under different conditions and subjected to chemical mutagenesis. The stability of the marker within a given strain in vivo was established during experimental infection in the chronic rat lung model of pseudomonas pneumonia. P. aeruginosa serially cultured from individual patients with cystic fibrosis were examined by using this marker. Isolates that varied in colonial morphology, serotype, and biotype were identical when analyzed by Southern blot hybridization using the fragment as a probe. Indistinguishable isolates (by serotyping, biotyping, and antibiograms) cultured from two unrelated patients were easily distinguished by using Southern blot analysis.

ADP Ribose Transferases↗
PubMed1987

Children with trimethoprim- and ampicillin-resistant fecal Escherichia coli in day care centers.

We conducted a cross-sectional study of 79 children attending seven day care centers in Houston, Texas, to detect fecal gram-negative bacilli resistant to trimethoprim (TMPr) and ampicillin (AMPr). Fifteen children (19%) were colonized with TMPr Escherichia coli; all but one strain were also resistant to sulfonamides. Most of the children with TMPr E. coli were clustered in center A, where 11 (37%) of 30 children were colonized; only four (8%) of 49 children in the other six centers were colonized with TMPr E. coli (P less than .005). The TMPr E. coli isolates from 10 of the 11 children in Center A had a similar antibiogram, which included resistance to sulfonamides, ampicillin, and streptomycin; eight had a similar total plasmid pattern, an observation suggesting spread within the day care center. Children colonized with AMPr E. coli were present in all centers, although a higher percentage of children in center A were colonized than in the other centers combined (70% vs. 35%; P less than .01).

Ampicillin Resistance↗
PubMed1991

Rapid development of ciprofloxacin resistance in methicillin-susceptible and -resistant Staphylococcus aureus.

The fluoroquinolones, particularly ciprofloxacin, have been suggested to treat methicillin-resistant Staphylococcus aureus (MRSA) infections and colonization and methicillin-susceptible S. aureus (MSSA) infections. The development of ciprofloxacin resistance in MRSA and MSSA was prospectively evaluated. After 3 months of ciprofloxacin use, high-level resistance (MIC90, 64 micrograms/ml) developed in MRSA and increased at an alarming rate, from none to 79% over a 1-year period. High-level ciprofloxacin resistance also developed in MSSA, increasing to 13.6% over the same period. Antibiograms, phage typing, and plasmid profile analysis suggest that more than one clone of MRSA developed resistance and that ciprofloxacin resistance is not associated with the acquisition of a new plasmid. Most patients had nosocomial acquisition and about one-half had a history of previous ciprofloxacin use. Ciprofloxacin resistance can develop rapidly in S. aureus; thus, ciprofloxacin appears to have limited usefulness in treating staphylococcal infections and colonization, especially those due to MRSA.

Ciprofloxacin↗
PubMed1995

A universal approach to bacterial molecular epidemiology by polymerase chain reaction ribotyping.

Oligonucleotide primers complementary to conserved regions of the 16S and 23S ribosomal RNA genes were used to amplify the 16S-23S intergenic spacer region of bacterial pathogens. The amplification patterns produced were compared for their potential use in molecular epidemiologic analysis. This method, polymerase chain reaction (PCR) ribotyping, was applied to isolates of Staphylococcus aureus, Enterococcus faecium, Escherichia coli, and Enterobacter species. Length polymorphisms in the amplified DNA distinguished unrelated strains of all bacteria. The banding patterns of 3 S. aureus isolates from the blood of 1 patient on 3 consecutive days were identical. Plasmid analysis, biotyping, and antibiograms were also obtained on the Enterobacter isolates. All three of these methods showed considerable variability after in vitro passage of bacteria, but PCR ribotypes remained stable. Results demonstrate the utility of the conserved primers for PCR ribotyping, a widely applicable method for the molecular epidemiology of genetically diverse bacteria.

Bacterial Typing Techniques↗
PubMed1985

Laboratory studies on coagulase-negative staphylococci from CAPD-associated peritonitis.

This study compared the static and kinetic activities, in both broth and used-dialysate, of selected antibiotics against 23 strains of coagulase-negative staphylococci causing peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). Vancomycin was shown to be effective against all isolates with similar rates of kill to flucloxacillin and cefuroxime, although a few strains were found to be resistant to cefuroxime. Gentamicin was rapidly bactericidal for sensitive strains which accounted for 60% of the strains tested. Fusidic acid was associated with significant resistance and lack of bactericidal activity in the kinetic studies. Emergence of resistance occurred with rifampicin. The combinations clavulanic acid/amoxycillin and sulbactam/ampicillin generally showed good static activity. In addition a broad range of biotypes and phage types were demonstrated among these organisms with biotype SII (Staphylococcus epidermidis) predominating. There was no correlation between biotype and antibiogram.

Anti-Bacterial Agents↗
PubMed1986

A comparison of agar dilution, identification of beta-lactamases and disc diffusion methods for assessing the sensitivity to ticarcillin-clavulanic acid.

The in-vitro antibacterial activity of Timentin has been evaluated with a view to proposing valid criteria for sensitivity and resistance. Minimal inhibitory concentrations (MIC) were determined for 284 strains including Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp., staphylococci and enterococci. The same strains were also used for the determination of inhibition zones around discs containing 75 micrograms ticarcillin and 10 micrograms clavulanic acid, and a straight regression line was drawn correlating MIC with inhibition zones. The bacterial population was subsequently grouped according to the diameters of inhibition zones of the antibiogram for 2427 strains of Enterobacteriaceae classified by phenotypes. The comparison of MICs of Timentin and ticarcillin for these strains shows that for penicillinase-producing strains, the Timentin MIC is lower than for ticarcillin whereas cephalosporinase-producing strains have equal MICs for the two. Finally strains that produce many different beta-lactamases are not affected by the presence of clavulanic acid. These results should make it possible to propose provisional zone diameters for determining sensitivity and resistance to Timentin.

Agar↗