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Interactions of guanosine triphosphate analogues with elongation factor G of Escherichia coli.

Previous studies from this laboratory have shown that the GTP analogue guanosine 3'-diphosphate 5'-triphosphate (pppGpp) was almost without activity in the translocation reaction catalyzed by elongation factor G (EF-G), while it was fully active with elongation factor T (EF-T) and initiation factor 2 (IF-2). To assess the importance of the 3'-ribose hydroxyl itself in the translocation reaction, we examined polyphenylalamine synthesis and EF-G-dependent formation of N-acetylphenylalanylphenylalanylpuromycin (Ac-Phe2-puromycin) supported by 3'-deoxyguanosine 5'-triphosphate (3'dGTP) and 3'-deoxy-3'-aminoguanosine 5'-triphosphate (3'dNH2GTP). Like pppGpp, these nucleotides were similar to GTP in EF-T and IF-2dependent reactions. We also examined the ability of the dialcohol derived from GTP by periodate oxidation and borohydride reduction (rroGTP) and of ITP to support translocation. These compounds had shown significant, although reduced, activity with EF-T and IF-2. A spectrum of activity was found with these compounds in both poly(Phe) synthesis and Ac-Phe2-puromycin formation. All had significantly reduced activity relative to GTP, but all were significantly more active than pppGpp. A surprising finding was that the activities of all analogues relative to GTP were dependent on the reaction temperature in both poly(Phe) synthesis and Ac-Phe2-puromycin formation; these relative activities were significantly lower at 8 degrees C after than 37 degrees C. Furthermore, the extent of poly(Phe) synthesis with the analogues relative to GTP could be significantly affected by the amounts of EF-G and EF-T in the reaction mixture. Differences were minimized in the presence of rate-limiting EF-T and saturating EF-G and maximized in the presence of rate-limiting EF-G and saturating EF-T. This effect of reducing the level of EF-G in the reaction mixture thus mimicked the effect of lowering the incubation temperature, and a similar observation was made for Ac-Phe2-puromycin formation. GTP-supported formation of Ac-Phe2-puromycin at 8 degress C could be inhibited by 3'dNH2GTP, 3'dGTP, pppGpp, and ITP: these compounds were better inhibitors than they were substrates. Inhibition by other nucleotides was also noted. The GTP analogues were compared to GTP as substrates in EF-G-dependent reactions uncoupled from protein synthesis. Fusidic-acid-dependent binding of nucleotides to ribosomes and ribosome-dependent catalytic nucleotide hydrolysis were both examined, and the activity of the nucleotides as substrates in these ractions showed little correlation with their ability to support translocation.

Escherichia coli↗

The changing pattern of severe neonatal staphylococcal infection: a 10-year study.

Forty-two cases of severe staphylococcal infection occurring over a 10-year period in the neonatal unit at Queen Mary Hospital are described. There was a 4.5-fold increase in incidence in the latter half of the study period, when methicillin-resistant Staphylococcus aureus (MRSA) emerged. The isolated MRSA were also resistant to gentamicin, but sensitive to vancomycin, fusidic acid, co-trimoxazole and amikacin. Comparison between MRSA and methicillin-sensitive cases showed that the former was associated with a longer hospital stay after diagnosis. Overall mortality was 9.5%. Two cases with meningitis died. MRSA is at least as virulent as its methicillin-sensitive counterparts. The treatment implications of severe neonatal staphylococcal infection are discussed.

Acute Disease↗

Antibiotics currently used in the treatment of infections caused by Staphylococcus aureus.

Staphylococcal infections are a common and significant clinical problem in medical practice. Most strains of Staphylococcus aureus are now resistant to penicillin, and methicillin-resistant strains of S. aureus (MRSA) are common in hospitals and are emerging in the community. Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) remain the antibiotics of choice for the management of serious methicillin-susceptible S. aureus (MSSA) infections, but first generation cephalosporins (cefazolin, cephalothin and cephalexin), clindamycin, lincomycin and erythromycin have important therapeutic roles in less serious MSSA infections such as skin and soft tissue infections or in patients with penicillin hypersensitivity, although cephalosporins are contra-indicated in patients with immediate penicillin hypersensitivity (urticaria, angioedema, bronchospasm or anaphylaxis). All serious MRSA infections should be treated with parenteral vancomycin or, if the patient is vancomycin allergic, teicoplanin. Nosocomial strains of MRSA are typically multi-resistant (mrMRSA), and mrMRSA strains must always be treated with a combination of two oral antimicrobials, typically rifampicin and fusidic acid, because resistance develops rapidly if they are used as single agents. Most community-acquired strains of MRSA in Australia and New Zealand are non multiresistant (nmMRSA), and lincosamides (clindamycin, lincomycin) or cotrimoxazole are the antibiotics of choice for less serious nmMRSA infections such as skin and soft tissue infections. New antibiotics such as linezolid and quinupristin/dalfopristin have good antistaphylococcal activity but are very expensive and should be reserved for patients who fail on or are intolerant of conventional therapy or who have highly resistant strains such as hVISA (heterogenous vancomycin-intermediate S aureus).

Anti-Bacterial Agents↗

Wound infections following posterior spinal instrumentation for paralytic scoliosis.

OBJECTIVES: To investigate in a prospective study the infection rate, the bacteriology and the outcome of wound infections following posterior spinal instrumentation in children and young adolescents during 1993-96. METHODS: Fifty patients, who underwent spinal instrumentation because of paralytic scoliotic deformity, were followed by the surgeon, the clinical microbiologist and the infection control nurse. In those patients with clinical and laboratory findings suggesting wound infection, multiple swabs and tissue biopsies were obtained from deep within the infected wound and were cultured on appropriate media. Microorganisms were identified by conventional methods. RESULTS: Ten of 50 patients (20%) developed early deep wound infections, most of them polymicrobial, 3-9 days after the operation. Coagulase-negative staphylococci (70.0%), Enterobacteriaceae (17.3%), anaerobes (5.4%) and Staphylococcus aureus (3.7%) were isolated from the wound specimens. S. epidermidis strains were the predominant isolates. All coagulase-negative staphylococci were multiresistant to beta-lactams, aminoglycosides, fusidic acid and co-trimoxazole, while most of them were susceptible to rifampicin and quinolones. All wounds healed uneventfully with aggressive debridement and prolonged antimicrobial therapy. CONCLUSIONS: Postoperative wound infection is a significant complication of spinal instrumentation. Multiresistant coagulase-negative staphylococci are the predominant pathogens. Successful treatment includes wound debridement and prolonged antimicrobial therapy.

Journal Article↗

Methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to glycopeptides (GISA) in 63 French general hospitals.

Clinical isolates of methicillin-resistant Staphylococcus aureus (n = 1070) collected from 63 French general hospitals during June 2000 (n = 1070) were screened initially for reduced susceptibility to glycopeptides (GISA) on brain-heart infusion agar containing teicoplanin 6 mg/L. Glycopeptide MICs were determined for the 145 isolates that grew on the screening plates. Of the 1070 isolates, 1.4% were GISA on Mueller-Hinton agar, and 2.9% by Etest with a high inoculum, while 0.7% and 2.9% were GISA by vancomycin and teicoplanin population analysis profiles, respectively. Most isolates were resistant to gentamicin and rifampicin or fosfomycin or fusidic acid, as determined by disk diffusion. Pulsed-field gel electrophoresis of the 31 GISA isolates identified four clones, with dissemination of one predominant clone. In these French hospitals there was a low incidence of GISA and hetero-GISA.

Anti-Bacterial Agents↗

Natural antimicrobial susceptibility patterns and biochemical profiles of Leclercia adecarboxylata strains.

Leclercia adecarboxylata is an opportunistic human pathogen that phenotypically resembles Escherichia coli. The natural susceptibilities of 101 Leclercia strains to 70 antimicrobial agents were investigated. MICs were determined with a microdilution procedure in cation-adjusted Mueller-Hinton broth (all strains) and IsoSensitest broth (some strains). Natural susceptibility patterns were assessed using German (DIN) standards (when applicable). In addition, biochemical properties recommended for the phenotypic identification of L. adecarboxylata were evaluated, applying two commercially available identification systems for Enterobacteriaceae and seven conventional tests. L. adecarboxylata strains were naturally sensitive to tetracyclines, aminoglycosides, all but two beta-lactams, quinolones, folate pathway inhibitors, chloramphenicol, nitrofurantoin and azithromycin. They were naturally resistant to penicillin G, oxacillin, erythromycin, roxithromycin, clarithromycin, ketolides, lincosamides, streptogramins, linezolid, glycopeptides, rifampicin, fusidic acid and fosfomycin. There were only minor medium-dependent differences in susceptibility to most antibiotics. Lysine decarboxylase, malonate assimilation and acid production from arabitol and cellobiose, but not from adonitol and sorbitol, allowed definitive separation of L. adecarboxylata from E. coli. The results of this study form a database that can be applied to validate forthcoming antibiotic susceptibility tests of L. adecarboxylata, and might contribute to its reliable identification. Susceptibility patterns did not indicate obvious therapeutic difficulties for treatment of Leclercia infections. Special attention should be paid to biochemically aberrant leclerciae. Apart from biochemical features, fosfomycin susceptibility might be useful to differentiate between L. adecarboxylata and E. coli.

Anti-Bacterial Agents↗

Antibiotic resistance in Staphylococcus aureus colonising the intestines of Swedish infants.

Staphylococcus aureus has become a frequent coloniser of the intestinal tract of infants, but the health effects of such colonisation are not clear. In this study, the antibiotic resistance patterns of 116 S. aureus strains from the commensal intestinal microflora were determined. The strains were obtained from 81 Swedish infants who had been followed with regular stool samples and registration of antibiotic usage during their first year of life. The faecal population levels of the individual strains and the duration of their persistence in the microflora had been determined previously. The prevalence of antibiotic resistance among the 116 strains was modest: methicillin, 0%; penicillin G, 78%; erythromycin A, 3%; tetracycline, 2%; clindamycin, 0.9%; and fusidic acid, 0.9%. Colonisation by antibiotic-resistant strains was unrelated to antibiotic consumption by individual infants. Antibiotic-resistant strains were as capable of persisting in the intestinal microflora and reaching high faecal population levels as fully susceptible strains. No strain lost or acquired resistance during the colonisation period. Thus, antibiotic-resistant strains of S. aureus seem to be as fit for competition in the large bowel microflora as susceptible strains, even in the absence of selective pressure from antibiotics. This may aggravate the ecological consequences of antibiotic resistance development.

Anti-Bacterial Agents↗

Antimicrobial drug resistance in Staphylococcus aureus isolated from cattle in Brazil.

Isolates of Staphylococcus aureus obtained from apparently healthy cattle in the State of Paraiba, Brazil were characterized in relation to resistance to 21 antimicrobial agents. Among the 46 isolates obtained, resistance to penicillin was most frequent, followed by resistance to cadmium, streptomycin, arsenate, tetracycline, mercury, erythromycin and kanamycin/neomycin. All isolates were susceptible to fusidic acid, ethidium bromide, cetrimide, chloramphenicol, benzalkonium chloride, doxycycline, gentamicin, methicillin, minocycline, novobiocin, rifamycin, tylosin and vancomycin. Only six isolates were susceptible to all the drugs tested. With respect to the antibiotics, multi-resistant isolates were uncommon. These results are probably a consequence of the peculiarities of local drug usage pressures. In relation to metal ions, resistance to mercury was rare while resistance to arsenate was relatively frequent, which contrasts with the situation for human Staph. aureus strains. After treatment with ethidium bromide, elimination of resistance to penicillin, tetracycline, streptomycin, erythromycin and cadmium was observed, which was consistent with the genetic determinants being plasmid-borne.

Animals↗

Characteristics of sheep-rumen isolates of Pseudomonas aeruginosa inhibitory to the growth of Escherichia coli O157.

Screening facultative sheep-rumen bacteria which inhibit growth of Escherichia coli produced 11 strains of Pseudomonas aeruginosa. The isolates showed three different pulsed-field gel electrophoresis patterns and strains from different sheep produced pyocins that varied in strain specificity. Representative strains were resistant to ampicillin, methicillin, erythromycin, fusidic acid and augmentin, but not to tetracycline or nalidixic acid. Tested strains attached in large numbers to cultured rumen epithelial cells, potentially providing a means of survival in this ecosystem.

Animals↗

Contact sensitivity to topical antimicrobials. (II). Sensitizing potentials of some topical antimicrobials.

A predictive study comparing the sensitizing potentials of some topical antimicrobials, using a modified Beuhler's technique, showed that over-the-counter (OTC) antimicrobials were more sensitizing than prescribed topical antibiotics. Among OTC antimicrobials, proflavine was the most potent sensitizer (4/10 guinea pigs); parachlorometaxylenol, benzalkonium chloride and propamidine isethionate moderate sensitizers (2/10 guinea pigs); iodine a weak sensitizer (1/10 guinea pigs); and chlorhexidine and cetrimide very weak sensitizers (0/10 guinea pigs). Among prescribed topical antibiotics, neomycin was a moderate sensitizer (2/10 guinea pigs); gentamycin and chloramphenicol weak sensitizers (1/10 guinea pigs); kanamycin, clioquinol, polymyxin B, bacitracin, tetracycline, sodium fusidate and fusidic acid very weak sensitizers (0/10 guinea pigs). There was good correlation between sensitizing potentials in animal studies and clinical experience of contact allergy to these topical antimicrobials.

Administration, Topical↗

[Treatment of erysipelas in Germany and Austria--results of a survey in German and Austrian dermatological clinics].

BACKGROUND: Erysipelas is a severe soft tissue infection usually caused by streptococci. The infection is restricted to the dermis and subcutaneous tissues. Treatment with antibiotics is essential. Many different therapeutic regimens are recommended, based mainly on empirical data and only partly proven by clinical studies. MATERIAL AND METHODS: Our aim was to evaluate the treatment of erysipelas in Germany and Austria by means of a questionnaire and to derive treatment recommendations from this data. RESULTS AND CONCLUSION: The majority of clinics treat patients with erysipelas as inpatients with intravenous antibiotics. The usual first line treatment is group G penicillin (80%). Other choices include amino-penicillins (11%), cephalosporins (16.5%) and anti-staphylococcal penicillins (6.9%) are used. As second line antibiotics macrolides (63.5%), clindamycin (52.5%), penicillins (18.5%), cephalosporins (40%) and fluoroquinolones (20.5%) are mentioned. Carbapenems, tetracyclines, nitroimidazoles, glycopeptides, aminoglycosides, cotrimoxazole, fusidic acid and fosfomycin are used rarely. The median treatment duration is 10 days. Adjuvant measures are anticoagulation, non-steroidal anti-inflammatory agents, dressings, immobilization and treatment of local predisposing factors such as interdigital tinea.

Ambulatory Care Facilities↗

Susceptibility testing of Danish isolates of Capnocytophaga and CDC group DF-2 bacteria.

Twelve Capnocytophaga and seven DF-2 strains were tested for their susceptibility to 14 antimicrobial agents using an agar dilution and an agar diffusion method. Twenty-three other antibiotics were evaluated using the diffusion test only. All strains were fully susceptible to penicillin, ampicillin, cefuroxime, cefotaxime, erythromycin, clindamycin, chloramphenicol, doxycycline, rifamycin and ofloxacin using both methods. Clindamycin, rifamycin and cefotaxime were most active. Using agar dilution some strains were susceptible to gentamicin, but agar diffusion showed total resistance. One Capnocytophaga strain was susceptible and another moderately susceptible to metronidazole, other strains were resistant. The agar diffusion test showed that both Capnocytophaga and DF-2 were resistant to most other aminoglycosides, to fosfomycin, polymyxin and trimethoprim. All strains of both taxa were fully susceptible to piperacillin, cefoxitin, imipenem and fusidic acid and showed different susceptibilities to the other agents. Susceptibility testing by means of agar diffusion using an enriched chocolate agar and 5% CO2 atmosphere could be used to test Capnocytophaga and DF-2 strains and gives sufficient accuracy for routine use, when revised inhibition zone breakpoints are employed.

Animals↗

Antibiotics and human monocyte function. II. Phagocytosis and oxidative metabolism.

The influence of thirteen commonly used antibacterial drugs on the phagocytic and oxidative burst responsiveness of human blood monocytes in vitro was investigated. Cefotaxime and rifampicin produced a significant inhibition of monocyte oxidative metabolism at therapeutic concentrations with increasing inhibition at higher concentrations. The effect of rifampicin was irreversible, which may reflect intracellular accumulation of the drug. Tetracycline, clindamycin, chloramphenicol and tobramycin at high concentrations produced a significant inhibition of monocyte superoxide anion release after stimulation, whereas normal therapeutic concentrations produced insignificant inhibition. Benzylpenicillin, ampicillin, fusidic acid, metronidazole, ofloxacin, sulfamethoxazole and trimethoprim did not alter monocyte oxidative metabolism in vitro. Phagocytosis of yeast cells was significantly suppressed by high concentrations of tobramycin, but otherwise unaffected by the drugs mentioned. These observations suggest that cefotaxime and rifampicin may interfere with blood monocyte oxidative metabolism in vivo, whereas it can be expected that at normal dosage it is unlikely that the other drugs will affect monocyte phagocytosis and oxidative burst activity.

Adult↗

Coagulase-negative staphylococci in a major Danish university hospital: diversity in antibiotic susceptibility between wards.

Over a one-year period, all coagulase-negative staphylococci (CoNS) from blood cultures, cerebrospinal fluids and peritoneal effluents from patients in a major Danish university hospital were investigated for susceptibility to penicillin G; methicillin; gentamicin; netilmicin; amikacin; erythromycin; clindamycin; fusidic acid; rifampicin; tetracycline; chloramphenicol; ciprofloxacin; teicoplanin; and vancomycin. Among the CoNS-isolates, 56% were resistant to methicillin, 51% to gentamicin, 28% to ciprofloxacin, and 5% to teicoplanin. Blood culture CoNS-isolates from patients with a central venous catheter (CVC) were more often resistant to various antibiotics compared to CoNS-isolates from patients without a CVC, e.g. methicillin (72% vs 21%), gentamicin (65% vs 22%) (p<0.00000001). Great diversity in antibiotic resistance between the wards was found; methicillin resistance (in most cases multiple antibiotic resistance) was in particular associated with consumption of broad-spectrum beta-lactams, quinolones, and total antibiotic consumption in a ward. Thus, the antibiotic policy of a ward is an important factor for antibiotic resistance among CoNS.

Coagulase↗

Antimicrobiol susceptibility of Propinibacterium acnes and related microbial species.

The minimal inhibitory concentrations of 32 antimicrobial agents were established for 73 strains of Propionibacterium acnes and four related species (P. granulosum, P. avidum, Corynebacterium minutissimum, and C. parvum). Most strains showed good susceptibility to those agents usually considered active against gram-positive organisms. With the exception of C. minutissimum, the strains tested revealed more or less identical susceptibility ranges. The lowest minimal inhibitory concentrations were observed with benzylpenicillin, ampicillin, cephalothin, rifampin, erythromycin, clindamycin, and minocycline. C. minutissimum was more susceptible to gentamicin, sisomicin, tobramycin, and fusidic acid but more resistant to most other drugs than were the other species examined.

Anti-Bacterial Agents↗

Binding of antibiotics to bovine and ovine serum.

The degree of binding of 37 antibiotics to bovine and ovine serum, after treatment at therapeutic doses, was determined by equilibrium dialysis and ultrafiltration methods. In general, binding values obtained by the two methods were comparable. The extent of binding varied from 0% for cephaloridine and kanamycin to >95% for novobiocin and fusidic acid. Of the 37 drugs studied, one-fourth were less than 25% bound, one-fourth were more than 75% bound, and the percentage binding of about half of the antibiotics ranged from 25 to 75%. Animal to animal variations in the extent of binding of a particular antibiotic were very small. The capacity of bovine or ovine serum to bind antibiotics was, with a few exceptions, similar to the reported capacity of human serum. At drug concentration ranges usually achieved during therapy, variations in drug levels in serum did not influence the degree of binding except with cephalexin, lincomycin, clindamycin, and chloramphenicol. With these antibiotics, the extent of binding increased two- to sevenfold with the decrease in drug concentration in serum.

Animals↗

In vitro susceptibility patterns of methicillin-resistant and-susceptible Staphylococcus auerues strains in a population of parenteral drug abusers from 1972 to 1981.

Since 1980, infections caused by methicillin-resistant (MR) Staphylococcus aureus have been epidemic among Detroit-area parenteral drug abusers. Because of the increasing importance of this pathogen, in vitro susceptibilities were compared for 39 isolates of MR S. aureus from 1980 to 1981, and for 56 strains of methicillin-susceptible (MS) S. aureus from 1972 to 1981, recovered from drug abusers with community-acquired infections. Agar dilution studies were performed at 35 degrees C, and minimal inhibitory concentrations were determined after incubation for 18 and 48 h. MR S. aureus exhibited cross-resistance to other beta-lactam antibiotics which frequently required 48 h for expression. MR S. aureus isolates were also resistant to tetracycline, clindamycin, tobramycin, and amikacin. All MR S. aureus isolates investigated synthesized an aminoglycoside 4'-nucleotidyltransferase. Emergence of resistance to cefotaxime, tetracycline, and clindamycin was noted among current MS S. aureus isolates. Vancomycin, fusidic acid, trimethoprim/sulfamethoxazole, and rifampin were the most active agents against MR S. aureus and were equally effective against MS S. aureus.

Anti-Bacterial Agents↗