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PubMed2005

[Antibiotic resistance transformation in community-acquired urinary infections].

OBJECTIVE: To detect the prevalence of uropathogens in community-acquired urinary tract infection in our environment, and the degree of sensitivity to antibiotics used as empirical treatment. PATIENTS AND METHOD: Retrospective longitudinal study on 16,392 consecutive urine cultures collected in the emergency department of Hospital del Mar, between January 1997 and December 2001. Resistance rates were compared through variance analysis. RESULTS: 8,743 urine cultures with significant count were obtained. 6,062 Escherichia coli (69.3%), 517 Proteus mirabilis (5.9%) and 390 Klebsiella pneumoniae (4.5%) were identified. Escherichia coli showed progressive growth rate and significant resistances to most of antibiotics evaluated, especially to quinolones which came close to 30%. Fosfomycin showed the least resistance rate (0.9%) and remained stable along the years studied. CONCLUSIONS: These results suggest that higher rate of resistance to quinolones does not advise its use as empirical in community-acquired urinary tract infection treatment in our environment. According to our experience, fosfomycin can be an excellent option for cystitis treatment in patients without risk factors, while for the treatment of parenchymatous urinary tract infection, complicated urinary tract infections, and urinary tract infections associated to risk factors, preference could be second or third generation oral cephalosporins, or amoxicillin-clavulanic acid.

Adolescent↗
PubMedDate not supplied

Antibiotic susceptibility of Serratia marcescens and Serratia liquefaciens.

BACKGROUND: Over a period of 20 years, a total of 1,603 Serratia isolates were recovered from clinical specimens and examined for susceptibility to 29 antimicrobial drugs using the Bauer-Kirby agar disk diffusion test. Serratia marcescens was recovered most frequently (n = 1,409), followed by S. liquefaciens (n = 172); other Serratia species were scarce. During the 2-decade observation period there occurred 35 putative episodes/clusters of nosocomial cross-infection and 1 pseudo-outbreak due to S. marcescens, but none due to S. liquefaciens. METHODS: The antimicrobial susceptibility data for S. marcescens and S. liquefaciens were subdivided into two observation periods: I = 1980-1993, and II = 1993-1999. The crude data (series A) obtained for S. marcescens were corrected in two ways: by the omission of repetitive patient isolates (series B) and the additional removal of outbreak isolates except for index case isolates (series C). RESULTS AND CONCLUSIONS: Comparison of data obtained in series IC and IIC disclosed an increase in the susceptibility of S. marcescens to ampicillin + sulbactam, cefotaxime, chloramphenicol, doxycycline, fosfomycin, gentamicin, piperacillin, piperacillin + tazobactam, timentin and tobramycin during observation period II. Conversely, there was a decrease in susceptibility to ciprofloxacin, nalidixic acid and trovafloxacin, and slightly diminished susceptibility to norfloxacin and ofloxacin during observation period II as compared with the previous period. The crude data obtained for S. liquefaciens required no correction, as there were only a few repeat isolates. There was an increase in susceptibility to ampicillin, ampicillin + sulbactam, cefuroxime, doxycycline, fosfomycin, nitrofurantoin and polymyxin B (clear inhibition zones). However, there was an inexplicable decrease in susceptibility to piperacillin + tazobactam. Cocarde growth around polymyxin B disks was noted with 55.8% of the S. marcescens isolates as compared with 6.8% of the S. liquefaciens isolates. Slime around fluoroquinolone inhibition zones was produced by 83.4% of the S. marcescens isolates. Slime production around carbapenem inhibition zones was noted with 52% of the S. liquefaciens isolates, but with only a single isolate of S. marcescens.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comparative susceptibility of clinical group A, B, C, F, and G beta-hemolytic streptococcal isolates to 24 antimicrobial drugs.

A total of 312 clinical beta-hemolytic streptococcal isolates (Streptococcus pyogenes, group A = 63; Streptococcus agalactiae, group B = 145; group C = 50; group F = 27; group G = 27) were examined for susceptibility to 23 and 24 antimicrobial drugs with the Bauer-Kirby agar disk diffusion and the agar dilution method, respectively. Sheep blood Mueller-Hinton agar served as the reference medium. Wilkins-Chalgren agar supported optimal growth of group A and B, but not of all group C, F, and G streptococci. The group A streptococci were susceptible to all beta-lactam antibiotics, clindamycin, chloramphenicol, rifampin, teicoplanin, and vancomycin, but resistant to cotrimoxazole, fusidic acid, and, except for 2 strains, to fosfomycin. Resistance (R)/intermediate susceptibility (I) rates (R/I%) to ciprofloxacin (0/2%), ofloxacin (1/2%), erythromycin (1.6/0%), and clarithromycin (0/1%) were low. Higher resistance rates were noted with tetracyclines (doxycycline 23.8/15.9%; tetracycline 39.7/3.2%). Among the group B streptococcal isolates, one strain was resistant against oxacillin and of intermediate susceptibility to penicillin G and cefoxitin. All isolates were susceptible to teicoplanin and rifampin. Conversely, all group B isolates were resistant to cotrimoxazole and fusidic acid; 69% and 51% of these isolates were susceptible to fosfomycin and rifampin, respectively. R/I rates of the group B streptococcal isolates were low for ciprofloxacin and ofloxacin (0/0.7%), clindamycin (0.7/0%), erythromycin (1.4/ 3.5%), clarithromycin (1.4/0%), and chloramphenicol (0.7/0%). Resistance to tetracyclines was significant (doxycycline: 72.4/2.1%; tetracycline; 74.5/1.4%). Among the non-A, non-B beta-hemolytic streptococci, 2 group C strains were resistant to oxacillin and showed intermediate susceptibility to penicillin G. All isolates were susceptible to third and fourth-generation cephalosporins, imipenem, chloramphenicol, rifampin, teicoplanin, and vancomycin. R/I rates to the other antimicrobial drugs were: ciprofloxacin (3.9/1.9%), ofloxacin (2.9/1.9%), clindamycin (2.9/1%), erythromycin (5.8/0%), clarithromycin (3.8/2.9%), and cotrimoxazole (16.4/3.9%). Resistance against tetracyclines was more frequent (doxycycline: 18.3/2.9%; tetracycline: 20.2/6.7%). On the basis of various minor discrepancies between MIC and disk diffusion test results, it is proposed that the current NCCLS inhibition zone (diameter, mm) criteria indicative of intermediate susceptibility of beta-hemolytic streptococci be changed for the following antimicrobial drugs: ampicillin: 22-27 mm (only for group A and B beta-hemolytic streptococci); ciprofloxacin: 16-18 mm; clindamycin: 15-18 mm; doxycycline: 17-19 mm; tetracycline: 17-19 mm, and erythromycin: 14-19 mm.

Anti-Bacterial Agents↗
PubMedDate not supplied

Susceptibility of Moraxella catarrhalis to 21 antimicrobial drugs: validity of current NCCLS criteria for the interpretation of agar disk diffusion antibiograms.

Ninety-four clinical isolates of Moraxella catarrhalis were examined for susceptibility to 21 antimicrobial drugs; 67 isolates (= 71.3%) produced beta-lactamase(s). In terms of antibiotic resistance, the number of isolates resistant to penicillin G, ampicillin, and cotrimoxazole were 56, 32, and 1, respectively. The number of isolates with intermediate susceptibility to penicillin G, ampicillin, ciprofloxacin, ofloxacin, cotrimoxazole, and fosfomycin were 11, 34, 1, 2, 2, and 47, respectively. All 94 isolates proved susceptible to ampicillin + 10 micrograms/ml of sulbactam, amoxicillin + 4 micrograms/ml of clavulanic acid, cefuroxime, cefotaxime, cefepime, cefepime, cefixime, imipenem, meropenem, chloramphenicol, doxycycline, tetracycline, fusidic acid, erythromycin, clarithromycin, and rifampin, as based on currently valid NCCLS criteria, where applicable. There were no very major or major discrepancies between agar dilution and agar disk diffusion test results. There were only a few minor discrepancies between test results, specifically: penicillin G (category IV = 4, category VI = 1); ampicillin (category IV = 4, category V = 1, category VI = 7), amoxicillin + clavulanic acid (category III = 11), cotrimoxazole (category IV = 1, category V = 1, category VI = 1), ciprofloxacin (category V = 1), and ofloxacin (category VI = 2). The sole exception was fosfomycin, with a total of 25 minor discrepancies encountered (category III = 14, category V = 9, category VI = 2). Wilkins-Chalgren agar compared favorably with Mueller-Hinton agar following examination with 11 selected antimicrobial drugs against 31 representative isolates of M. catarrhalis.

Anti-Bacterial Agents↗
PubMed2005

Antimicrobial susceptibility patterns of contemporary pathogens from uncomplicated urinary tract infections isolated in a multicenter Italian survey: possible impact on guidelines.

During 2004 four Italian Laboratories assessed the prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female out-patients. A total of 600 urine samples from individuals aged 18-65 were studied. The overall prevalence of Escherichia coli was 85.3%. Klebsiella pneumoniae, Staphylococcus saprophyticus, Proteus mirabilis, Enterococcus faecalis and other rarer species were far less represented. Determination of the antibiotic susceptibility pattern of the entire collection of E. coli (512 organisms) revealed that among the drugs analyzed ampicillin was the least active molecule with only 62.5% of the strains being inhibited. Amoxicillin-clavulanate and cefuroxime displayed a higher potency (87.7% and 89.2% respectively). Cotrimoxazole inhibited only 70.1% of the uropathogens. The three fluoquinolones tested had comparable activity ranging from 83.0% for ciprofloxacin, to 83.6% for levofloxacin and 84.9% for prulifloxacin, indicating an identical spectrum of cross resistance. Nitrofurantoin (96.7%) and fosfomycin (98.6%) were the most potent drugs. Against the whole collection of uropathogens, only cefuroxime, nitrofurantoin and fosfomycin overcame the threshold of 90% activity, with the fluoroquinolones and amoxicillin-clavulanate suffering from about 15% resistance. The results of this survey strongly support the conclusions of recent Italian guidelines concerning the best empiric treatment of UTI in this country today.

Adolescent↗
PubMed2006

Antibiotic susceptibility tests directly on urine samples using Uro-Quick, a rapid automated system.

During the period June 2003-March 2004, 12,579 urine samples were examined employing the Uro-Quick system. Positive samples (1,948) were subsequently Gram-stained and processed by standard procedures for microorganism identification and antibiotic susceptibility determination by the disk diffusion method. Results of this latter test were compared with those obtained employing the new rapid Uro-Quick method. Antibiotics were introduced in vials containing 2 ml of Mueller-Hinton broth, then 0.5 ml of urine or a bacterial suspension in broth were added; a vial without drug was used as control. After 3 and 5 hours of incubation (for Gram-negative and Gram-positive strains respectively) the instrument showed the results. No growth and a growth curve like the control indicated susceptible and resistant strains respectively. Overall 1,590 Gram-negative strains were tested against ciprofloxacin, nitrofurantoin, amoxicillin-clavulanate, ceftazidime, fosfomycin, imipenem, amikacin, trimethoprim-sulfamethoxazole, and piperacillin-tazobactam, while 358 Gram-positive bacteria were assessed against ciprofloxacin, nitrofurantoin, amoxicillin-clavulanate, ampicillin, fosfomycin, gentamicin, oxacillin and trimethoprim-sulfamethoxazole. Against the major urinary tract pathogens (Escherichia. coli, enterococci, Klebsiella spp. and Proteus spp.) agreement between the Uro-Quick system and the disk diffusion test generally was >90% for all antibiotics tested. On the basis of these results the system appears useful not only for bacteriuria screening, but also to rapidly test the antibiotic susceptibility of common uropathogens.

Anti-Bacterial Agents↗
PubMed2002

In vitro susceptibility of four serotypes of enterohaemorrhagic Escherichia coli to antimicrobial agents.

We evaluated the in vitro susceptibility of four serotypes of enterohaemorrhagic Escherichia coli (E. coli 026, E. coli O111, E. coli O157, and E. coli O165) with diverse DNA patterns to antimicrobial agents. The minimum inhibitory concentrations (MIC) determined in a total of 83 strains using Mueller-Hinton agar under aerobic and anaerobic conditions were 0.015-0.12 microg/ml for ciprofloxacin, 0.06-1 microg/ml for norfloxacin, 2-64 microg/ml for fosfomycin without glucose-6-phosphate (G-6-P), 0.25-32 microg/ml for fosfomycin with G-6-P, 2- > or = 256 microg/ml for kanamycin, 0.125-2 microg/ml for cefoperazone, and 0.06-1 microg/ml for ceftazidime. The MIC of ciprofloxacin, norfloxacin, cefoperazone, and ceftazidime were low in all strains examined.

Anti-Bacterial Agents↗
PubMed2003

Relative risk of vaginal candidiasis after use of antibiotics compared with antidepressants in women: postmarketing surveillance data in England.

BACKGROUND: Vaginal candidiasis is a common infection in women. The microflora of the vagina are influenced by a number of factors, including pregnancy, oral contraceptive use, menses and diabetes mellitus. Previous antibiotic use is generally accepted to be a risk factor for vaginal candidiasis but the published evidence to support this is limited. AIM: To determine the relative risk of vaginal candidiasis following the use of antibiotics compared with antidepressants in prescription-event monitoring (PEM) studies. METHODS: Using data from postmarketing surveillance studies of six antibiotics and six antidepressants, conducted using the observational cohort technique of PEM, the number of reports of vaginal candidiasis was determined in women aged > or =16 years, in each of the first 7 weeks following a prescription for one of these drugs. The relative risks for vaginal candidiasis following the use of these antibiotics and for each of the individual antibiotics compared with antidepressants were calculated for each week and for the overall 7-week period. Women treated with antidepressants were the most suitable comparator group from the PEM database, as they were of a similar age range and the studies were conducted at a similar time period to those of the antibiotics. Also, there was no pharmacological plausibility for vaginal candidiasis being associated with antidepressants. RESULTS: There were 188 reports of vaginal candidiasis in 31 588 women, aged > or =16 years, treated with antibiotics and 70 in the 45 492 treated with antidepressants. The relative risk for vaginal candidiasis (antibiotic/antidepressants), was highest in the second week, 10.70 (95% CI 4.86-23.55) but was also significantly greater in the first and third weeks after the start of treatment. The risk was also higher in each of the 3 weeks after starting the course for five of the antibiotics, compared individually to the group treated with antidepressants, the exception being fosfomycin, which had a much smaller cohort. CONCLUSION: This study shows a significant increase in the risk of developing vaginal candidiasis following the use of the antibiotics studied (ciprofloxacin, ofloxacin, norfloxacin, cefixime, azithromycin and fosfomycin) compared with that after taking the antidepressants fluvoxamine, fluoxetine, paroxetine, sertraline, venlafaxine and nefazodine in these PEM studies.

Adult↗
PubMedDate not supplied

[Aetiology and bacterial resistance in urinary infections of outpatients].

BACKGROUND: Knowledge of the etiological agents of infections of the urinary tract and of the map of the antimicrobial sensitivity of each geographic zone is a practice recommended for improving the use of antibiotics and for facilitating the choice of empirical treatment. The aim of this study is to provide up-to-date information on the pathogen flora of outpatients urinary infections in our health area and their sensitivity to antimicrobials, based on the urinary cultivations carried out in the Microbiology laboratory of the Solchaga Outpatient Surgery during the last four years. MATERIAL AND METHODS: Between 1996 and 1999, we carried out 92,816 urinary cultivations of outpatients. The urine specimens were sown on plaques with chocolate agar and MacKonkey agar with calibrated loop. The antibiogram was carried out using the Kirby-Bauer method. RESULTS: The percentage of positive urinary cultivations was 17%. Gram-negative bacilli represented 88.9% of the isolations, Gram-positive cocci 11% and yeasts 0.1%. Escherichia coli was the most frequently isolated germ (71%). The sensitivity studies show that amoxycillin-clavulanic acid, first generation cephalosporins and fosfomycin maintain a sensitivity above 80%. CONCLUSIONS: Up-to-date knowledge of the most common pathogen flora and their sensitivity to antimicrobials makes it possible for a more suitable selection to be made of the antibiotic treatment when the sensitivity pattern of the responsible germ is unavailable. In the light of the results we can conclude that amoxycillin-clavulanic acid, first generation cephalosporins and fosfomycin show a good activity in vitro, and should be considered as empirical treatments for infections of the urinary tract.

English Abstract↗
PubMed2004

Urinary tract infections associated with multidrug resistant enteric bacilli: characterization and genetical studies.

Urinary tract infections (UTIs) are among the most commonly prevalent infections in clinical practice. Escherichia coli is the causative agent in about 85% of community-acquired UTIs, followed by Klebsiella that accounts for 6 to 17% of such infections. Present study is based on the isolation-identification and antibiotic resistance pattern of about 60 indigenous bacterial isolates from UTI patients. Prevalence rates were consistent with those from major recent studies reported in the literature, i.e. 73% isolates were identified as E. coli, 16% as K. pneumoniae and 11% as Proteus sp. Bases of identification included morpho-cultural and biochemical characteristics. To assess the breadth of multidrug resistance among these isolates, culture medium incorporation method was employed using ampicillin, fosfomycin, chloramphenicol, tetracycline, and three aminoglycosides (kanamycin, gentamicin, and streptomycin). Of these isolates, 30% offered multidrug resistance to three or more agents. Among multidrug resistant isolates, 100% were resistant to ampicillin, 47% to streptomycin, 41% to chloramphenicol, gentamicin and tetracycline, 35% offered resistance to kanamycin while only 6% showed resistance to fosfomycin. After curing treatment with acridine orange, some of the isolates lost their resistance, thereby indicating the extrachromosomal location of the resistance determinants. Plasmid DNA (bearing multidrug resistant genes) was isolated from the uncured cells, and was stably transformed into the competent cured recipient cells.

Journal Article↗
PubMed1990

[Antibacterial activity of imipenem in combination with ampicillin against methicillin-resistant strains of Staphylococcus aureus].

UNLABELLED: Imipenem (IPM) and beta-lactams have been reported to possess a synergistic relationship in their activities against methicillin (DMPPC)-resistant strains of Staphylococcus aureus (MRSA). The purpose of this study was to determine activities of IPM and ampicillin (ABPC) singly and in combination against MRSA. Activities of the 2 antibiotics against 19 strains of S. aureus resistant to DMPPC were investigated by means of the checkerboard method, the disk diffusion technique and the killing-curve method. MICs of DMPPC against these strains determined using the agar dilution method were greater than or equal to 100 micrograms/ml and MICs of IPM and ABPC ranged from 12.5 to 100 micrograms/ml and from 12.5 to 50 micrograms/ml, respectively, when used singly. The following results were obtained with the checkerboard method: Synergistic effects and additive effects were found against 13/19 and against 6/19 strains, respectively, and no antagonistic effect was found according to the FIC (fractionary inhibitory concentration) index. The disk diffusion technique indicated synergistic results. Killing-curves with the following drug concentration combinations were examined in Mueller-Hinton broth against 5 fosfomycin(FOM)-resistant and 5 FOM-susceptible stains: (1) IPM 12.5 micrograms/ml, (2) ABPC 25 micrograms/ml, (3) IPM 12.5 micrograms/ml + ABPC 25 micrograms/ml, (4) IPM 6.25 micrograms/ml + ABPC 25 micrograms/ml, (5) IPM 6.25 micrograms/ml + ABPC 12.5 micrograms/ml, (6) IPM 6.25 micrograms/ml + ABPC 12.5 micrograms/ml + FOM (fosfomycin) 25 micrograms/ml, (7) IPM 12.5 micrograms/ml + ABPC 25 micrograms/ml + FOM 50 micrograms/ml, (8) FOM 50 micrograms/ml. The following results were obtained with the killing-curve method; (1) Synergistic effects were found against 8/10 strains and no antagonistic effect was found with the combinations of IPM and ABPC. (2) Synergistic effects were found against 3/5 strains and no antagonistic effect was found with the combinations of IPM, ABPC and FOM against 5 FOM-susceptible strains. CONCLUSIONS: IPM in combination with ABPC produced synergistic effects against MRSA. This combination therapy should be evaluated in treating MRSA infections.

Ampicillin↗
PubMedDate not supplied

[Resistance profiles of the various species of the genus Staphylococcus to 15 clinically-used antimicrobials].

A total of 78 strains of 11 species of Staphylococcus genus (29 S. aureus, 48 Staphylococcus coagulase-negative and 1 S. intermedius strain,) were studied in order to determine the resistance patterns to fifteen commonly used antimicrobial agents. Out of 48 Staphylococcus coagulase-negative strains studied, 8 (4/15 S. epidermidis, 1/10 S. hominis, 1/6 S. haemolyticus, 2/3 S. xylosus) showed resistance patterns similar to that of S. aureus strains against beta-lactam antibiotics, aminoglycosides, chloramphenicol and fosfomycin, and 10 exhibit beta-lactamase-activity. Although the 7 S. saprophyticus strains assayed were beta-lactamase-negative by the chromogenic cephalosporin method after induction, the penicillin G minimal inhibitory concentration values were slightly higher than those obtained with other beta-lactamase-negative species. The susceptibilities to erythromycin and clindamycin suggested that macrolides-lincosamides-streptogramin type B (MLS) resistance was present in a large number of Staphylococcus coagulase-negative strains. In all the Staphylococcus genus, the aminoglycosides resistance seems to be mediated by the same aminoglycosides modifying-enzymes. Vancomycin was very active against the 11 species assayed. Rifampicin was effective with all Staphylococcus coagulase-negative strains. The S. aureus rifampicin-resistant were also resistant to oxacillin, and variable against aminoglycosides, chloramphenicol, fosfomycin, erythromycin and clindamycin. Only 5 strains were resistant to trimethoprim-sulfamethoxazole (TMS), 1 S. aureus oxacillin-susceptible, 1 S. aureus oxacillin-resistant, 2 S. xylosus and 1 S. warneri strains.

Drug Resistance, Microbial↗
PubMed1987

Urinary pathogens and bacterial sensitivity in hospitalized urological patients based upon clinical aspects.

For a total of 396 hospitalized urological patients with complicated and/or hospital-acquired urinary tract infections (UTI) urinary pathogens with colony counts of 10(5)/ml or more were determined, several species were then subclassified by epidemiological markers. The minimal inhibitory concentrations (MIC) were measured using the agar dilution method for seven penicillins and for four penicillin combinations, for six oral and 14 parenteral cefalosporins, for three older and five newer quinolones, for two aminoglycosides, for two monobactams, for trimethoprim alone and in combination with sulfamethoxazole, for fosfomycin and for imipenem. Sensitivity and resistance of the strains were defined using breakpoints according to DIN 58.940 or analogous concentrations. The bacterial spectrum and the rate of resistant strains were correlated to clinical aspects pertaining to sexual status, age and underlying abnormalities within the urinary tract. There was a statistical difference in the frequency of E. coli and enterococci between patients with (complicated UTI) and without (uncomplicated UTI) abnormalities. Within the group of complicated UTI Proteus spp. were found significantly more often in patients with urolithiasis, Klebsiella spp. and staphylococci in patients with prostatic tumours (benign and malignant), enterococci in patients with prostatic and other tumours and E. coli in patients with abnormalities other than urolithiasis or tumours. Almost all antibiotics tested could be used in patients with uncomplicated UTI for empiric or calculated therapy if a rate of resistance of up to 10% is acceptable. In patients with urolithiasis only the newer acylaminopenicillins, the newer (fluoro-)quinolones, trimethoprim in combination with sulfamethoxazole, fosfomycin and imipenem fulfill this criterion. In order to treat complicated UTI with underlying tumours within the urinary tract empirically only piperacillin, apalcillin, imipenem and some of the newer quinolones (ofloxacin, ciprofloxacin and pefloxacin) could be recommended. The same was true for patients with indwelling catheters still present or recently removed.

Aminoglycosides↗
PubMed1986

[Sensitivity of 858 strains of staphylococci to 27 antibiotics].

Susceptibility to 27 antimicrobial agents of 858 strains of staphylococci was determined. Tested strains belonged to the following species: S. epidermidis, S. saprophyticus, S. haemolyticus, S. hominis, S. simulans, S. warneri, S. cohnii, S. xylosus and S. intermedius. The antibiotics were: penicillin G, amoxycillin, augmentin, oxacillin, streptomycin, kanamycin, tobramycin, dibekacin, amikacin, gentamicin, sisomycin, netilmicin, doxycycline, minocycline, chloramphenicol, erythromycin, josamycin, clindamycin, pristinamycin, rifampin, fusidic acid, fosfomycin, trimethoprim, sulfamethoxazole, cotrimoxazole, and vancomycin. The ATB system was used, with the criteria for categorization recommended by the Antibiotic Sensitivity Testing Committee. Penicillin-resistance, that was found in all species, was high for hospital-acquired strains (67 to 75%) but also for some other strains (32% for S. simulans). Oxacillin-resistance varied across species (0% for the least prevalent hospital strains, 6% for S. epidermidis and 28% for S. haemolyticus). All strains were susceptible to vancomycin. For some drugs, resistance was a characteristic of the species: resistance to fosfomycin was often found for S. saprophyticus, S. haemolyticus, S. warneri, S. cohnii, and S. capitis; resistance to trimethoprim was common for S. simulans, and S. haemolyticus. S. haemolyticus was the most resistant species, a fact that justifies routine identification of this pathogen in clinical specimens.

Anti-Bacterial Agents↗
PubMed1994

[Epidemiological studies of the susceptibility of Pseudomonas aeruginosa to antibiotics].

The susceptibility to antibiotics of 1367 non-replicate strains of Pseudomonas aeruginosa isolated at Beaujon Hospital between 1990 and 1992 was investigated and compared with the serogroup O and the strain origin (ward, sample). Five betalactam resistance patterns were distinguished according to susceptibility to ticarcillin, piperacillin, ceftazidime and aztreonam,: 1 = SSSS, 2 = RRSS, 3 = RRRR, 4 = RSSR, 5 = RRSR. The other antibiotics studied were imipenem, tobramycin, amikacin, ciprofloxacin and fosfomycin. Resistance to all antibiotics, fosfomycin excepted, was higher in intensive care units than in other wards. The respective frequencies of the phenotypes were: 70.3%, 4.3%, 11.8%, 10.2% and 3.4%. The frequency of pattern 3 steadily increased between 1990 and 1992 at the expense of pattern 1, whereas patterns 2, 4 and 5 remained stable. The most common serogroups were O6 (15.8%), O11 (14.5%) and O1 (9.9%). The O11 strains were more widespread in intensive care units than in other wards and were more resistant to antibiotics. Most of the O12 strains displayed pattern 2 and were highly resistant to antibiotics.

Anti-Bacterial Agents↗
PubMed1993

[Vancomycin in meningitis caused by penicillin G resistant Streptococcus pneumoniae].

We report two cases of penicillin G-resistant pneumococcal meningitis in adults, with clinical and bacteriological failure of amoxicillin and negative or incomplete response to third generation cephalosporins. Meningitis occurred in a man treated for myeloma and in an elderly woman under prolonged intermittent amoxicillin therapy for chronic otitis. Such situations are known as exposing to pneumococcal meningitis and to resistance of the strain involved to penicillin G. Both patients were cured by vancomycin in continuous infusion associated with rifampicin or fosfomycin. Contrary to third generation cephalosporins, which have higher minimal inhibitory concentrations, vancomycin and rifampicin are still fully active against penicillin G-resistant pneumococcal strains. Thus, vancomycin administered in continuous infusion and associated with rifampicin and fosfomycin deserves to be tried as first-line treatment of pneumococcal meningitis in patients at risk of resistance to penicillin G.

Aged↗
PubMed1993

In vitro activity of fleroxacin in combination with other antimicrobial agents.

The trifluoroquinolone fleroxacin inhibits the majority of Enterobacteriaceae at concentrations < or = 1 micrograms/mL and most Pseudomonas aeruginosa and staphylococci at < or = 2 micrograms/mL. The purpose of this study was to determine the effect of the combination of fleroxacin with other antimicrobial agents. Previous studies that used checkerboard assay, fixed concentrations, and killing curves were reviewed, and these methods were used to evaluate the combination of fleroxacin and agents that had not been previously studied. The combination of fleroxacin with such aminoglycosides as gentamicin, amikacin, and tobramycin is indifferent against most Enterobacteriaceae, as is the combination of fleroxacin with penicillins, cephalosporins, rifampin, clindamycin, and metronidazole. Combinations of fleroxacin with penicillins, cephalosporins, imipenem, aminoglycosides, clindamycin, metronidazole, and rifampin are indifferent against P. aeruginosa. Fosfomycin and fleroxacin acted synergistically against P. aeruginosa. Against staphylococci, combinations of fleroxacin with oxacillin, rifampin, or fosfomycin had synergistic or additive effects, whereas combinations of fleroxacin with vancomycin, gentamicin, or metronidazole have shown indifference. No synergy or antagonism has been found for combinations of fleroxacin with penicillin, vancomycin, erythromycin, clindamycin, or rifampin against streptococci or enterococci. The combination of fleroxacin and metronidazole has proved synergistic against various Bacteroides species. In general, combinations of fleroxacin with other antimicrobial agents display indifference and rarely synergy. Thus, fleroxacin can be combined with other antibiotics to enlarge the spectrum of activity.

Anti-Bacterial Agents↗
PubMed1997

[Analysis of genome-type, serovar and antibiotic susceptibility of Pseudomonas aeruginosa isolated in Beijing Hospital China in 1991 to 1993].

We analyzed the in vitro antibiotic susceptibility pattern and serovar for 192 strains of Pseudomonas aeruginosa isolated at Beijing Hospital(China) from October 1991 to October 1993. The frequency of resistant strains was high, more than 15%, for ceftazidime, cefsulodin, cefoperazone, aztreonam, gentamicin, tobramycin, tosufloxacin, ofloxacin and fosfomycin. The incidence of resistants against piperacillin and imipenem was significantly low. Among the 192 strains, 16 were designated as being multi-drug resistant strains(i.e.; resistant to more than 8 drugs out of 11 drugs), and all of the multi-drug resistant strains were isolated from inpatients. Predominant serovar of 192 strains were 60(31.3%) for G, 28(14.7%) for E, and 24(12.5%) for I. Multi-drug resistant strains have no characteristic serovar. Restriction enzyme SpeI digestion analysis(using pulse field electrophoresis) of P. aeruginosa-genome yielded several common patterns, and was shown to be useful for tracing the route of nosocomial infection. Further, isolates with closely related genome type, in which the size of one digested band was different, showed a different minimum inhibitory concentration of fosfomycin in one genome type or new quinolones in the other genome type. Analysis of genome type and antibiotic susceptibility pattern may exhibit the antibiotic resistant gene.

Anti-Bacterial Agents↗