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Identification of Enterobacteriaceae: report of the British Society for Multipoint Technology collaborative study.

Under the auspices of the British Society for Multipoint Technology, 84 strains of Enterobacteriaceae were identified by multipoint inoculation techniques in eight laboratories. Results were compared to assess the inter-laboratory reproducibility and reliability of each test. Identity of the test strains was also determined by use of two commercially produced kits. Most test strains were identified by the multipoint inoculation systems, which were cost effective and generally accurate, although some laboratories performed better than others. Reproducibility of some test results was variable.

Bacteriological Techniques↗

[New Enterobacteriaceae found in medical bacteriology Moellerella wisconsensis, Koserella trabulsii, Leclercia adecarboxylata, Escherichia fergusonii, Enterobacter asbutiae, Rahnella aquatilis].

Characteristics of 6 "new" Enterobacteriaceae species, occasionally isolated from human sources: Moellerella wisconsensis, Koserella trabulsii, Leclercia adecarboxylata, Escherichia fergusonii, Rahnella aquatilis, Enterobacter asburiae are described and compared with those of closely related species.

Drug Resistance, Microbial↗

In vitro activity of tigemonam against multiresistant nosocomial Enterobacteriaceae.

Tigemonam, an oral monobactam that exhibits beta-lactamase stability similar to that of aztreonam, was tested in vitro against 240 species of Enterobacteriaceae (50 Escherichia coli, 48 Klebsiella pneumoniae, 52 Enterobacter cloacae, 32 Proteus mirabilis, 22 Proteus indole-positive [Providencia sp.], 24 Serratia sp., and 12 Citrobacter sp. All strains were resistant to ampicillin and first-generation cephalosporins. In addition, 77.4% were resistant to amoxicillin plus clavulanic acid, 46.8% to cefuroxime, 23.3% to ceftriaxone, 22.2% to aztreonam, 46.9% to cotrimoxazole, and 0.9% to norfloxacin. Tigemonam at a concentration of 4 micrograms/mL or less inhibited 72.7% of the strains with minimum inhibitory concentrations ranging from 0.03 or less to more than 512 micrograms/mL. The highest intrinsic activity was observed against Proteus sp. Tigemonam proved to be a bactericidal antibiotic. Cross-resistance was chiefly observed with aztreonam and ceftriaxone. It is concluded that tigemonam should play an important role in the treatment of nosocomial infections that do not require parenteral therapy and in the treatment of multiresistant community-acquired infections.

Aztreonam↗

Comprehensive evaluation of ciprofloxacin in combination with beta-lactam antibiotics against Enterobacteriaceae and Pseudomonas aeruginosa.

1-cyclopropyl-6-fluoro-1, 4-dihydro-4-oxo-7-piperazine-1-ylquinoline-3-carboxylic acid (ciprofloxacin, Bay o-9867, Bay q-3939) was evaluated by checkerboard assay in combination with ampicillin, ticarcillin, mezlocillin, azlocillin, piperacillin, cefamandole, cefoxitin, cefotaxime, and ceftazidime. A total of 220 clinical isolates of enterobacteriaceae and Pseudomonas aeruginosa (11 species, 20 strains each) were examined. Predominantly additive combination effects were seen with all antibiotic combinations tested. Synergy was obtained with only a few test strains while antagonistic drug interactions were not observed at all. Time-kill experiments which were performed to assess the bactericidal activities, confirmed these findings. The antibiotic combinations were also evaluated in vivo using a model of experimental thigh muscle infection in neutropenic mice. In-difference or additive therapeutic effects resulted when the beta-lactam compounds and ciprofloxacin were given in combination at doses which were also effective alone. Subinhibitory doses of azlocillin and mezlocillin, on the other hand, appeared to increase the efficacy of ciprofloxacin. The influence of various application schedules was examined by time-kill experiments and in mice. Sequential administration of the drugs at intervals of 2 h did not alter the combination effects regardless of the sequence of administration.

Animals↗

[Activity of 9 beta-lactam antibiotics combined with clavulanic acid or sulbactam against the strains of broad-spectrum beta-lactamase (CTX-1) producing Enterobacteriaceae isolated at the Henri Mondor Hospital].

Minimal inhibitory concentrations (MICs) of seven cephalosporins: cefotaxime (CTX), ceftriaxone (CRO), ceftazidime (CAZ), latamoxef (MOX), cefoxitin (FOX), cefotetan (CTT) and CM 40876 (CM), of aztreonam (ATM) and imipenem (IPM) were evaluated by agar dilution with and without 5 mg/l of clavulanic acid (AC) or sulbactam (SB) for 28 strains isolated in 1986 (15 K. pneumoniae, 3. K. oxytoca, 4 E. coli, 4 E. cloacae, 1 E. aerogenes and 1 C. freundii). Comparatively to MICs of sensitive strains and to those of cured variants, MICs of these strains were very increased for CTX, CRO, ATM (mode MIC: 1 mg/l), and CAZ (2); weakly increased for MOX and CTT (0.25), and identical for IMP (0.12-0.25), CM (0.06) and FOX (2-4), except for Enterobacter and Citrobacter (64). Association with AC or SB did not modify MICs of FOX, CM and IMP. For the other antibiotics, MICs were reduced by addition of AC: Klebsiella: 5 log2 for CTX and CRO, 4 for CAZ and ATM, 2 for MOX and CTT; E. coli: 4 log2 for CTX and ATM, 3 for CRO and CAZ, 1 for MOX and CTT; Enterobacter and Citrobacter 2 log2 for CTX, CRO, CAZ and ATM, 1 for MOX and CTT. With SB, decrease of MICs was two to for fold lesser than with AC. AC, and less efficiently SB, restored activity of CTX, CRO, CAZ and ATM on CTX-1 producing Enterobacteriaceae, particularly Klebsiella and E. coli. It was the same for MOX and CTT, weakly affected by this resistance. AC and SB had not effect on FOX, CM and IPM which remained active on these strains.

Anti-Bacterial Agents↗

[Current status of aminoglycoside resistance in hospital Enterobacteriaceae].

We studied the susceptibility of Enterobacteriaceae to four aminoglycosides (gentamicin, tobramycin, netilmicin et amikacin). We determined their phenotypes of resistance by taking into account both the critic concentrations of the CFA (french committee for antibiogram) and the MIC of the main susceptible population of each species. The most frequent phenotypes were GTNt, TNtA and GTNtA. Amikacin resistance including phenotypes were essentially found in Klebsiella and Serratia (35% and 53% of the strains, respectively); with respect to amikacin, the phenotype expression may be insufficient to exceed the sensitive critic concentration of the CFA. Amikacin resistant strains were isolated from chronically infected patients with devices, such as urinary catheters or tracheal cannula. These results suggest a strains or plasmids outbreak.

Amikacin↗

[The role of 4-quinolones and antibiotics in the elimination of virulence plasmids of Enterobacteriaceae].

Twenty-six antibiotics belonging to thirteen different chemical families had been tested on seven Enterobacteriaceae harbouring a virulence plasmid (Shigella sonnei, S. flexneri, S. dysenteriae, Escherichia coli (two plasmids). Yersinia and Salmonella dublin). Novobiocin and rifampicin were found to be most efficient eliminating three plasmids of which two come from Shigella. Clindamycin, cotrimoxazole, nifurzide, ciprofloxacin, and tilbroquinol were also efficient, but at lower rate. Four virulence plasmids (from the three Shigella sp and Y. pestis) were eliminated by one or several antibiotics. The frequency of elimination was low (at best 10% bacteria per generation). The plasmid pWR105 from S. sonnei was the less stable.

Anti-Bacterial Agents↗

Antimicrobial activity of cefotiam combinations against Enterobacteriaceae moderately susceptible or resistant to this new cephalosporin.

The interaction of cefotiam with each of the four aminoglycosides gentamicin, tobramycin, netilmicin and amikacin were studied by the broth microdilution method ("checkerboard" technique) against 36 strains of Enterobacteriaceae chosen for their moderate susceptibility (MIC: 4-32 mg/l) or resistance (MIC: 64-512 mg/l) to cefotiam. A high rate of synergistic combinations was found with all the aminoglycosides: 81% with gentamicin, 76% with amikacin, 67% with tobramycin and netilmicin. The therapeutic value of these interactions appeared excellent.

Amikacin↗

Comparison of the Minitek test system with a conventional screening procedure for identification of Enterobacteriaceae.

A Minitek basic 9 disc/11 test system plus arabinose, inositol and rhamnose was compared with a conventional six tube screening system for identification of members of the family Enterobacteriaceae. Correlation varied from 88.3 to 100% with the various substrates when studied against 737 strains of these and other gram-negative bacteria recently isolated in our clinical laboratory. Two discs, citrate and ornithine, which originally gave a correlation of 88.3 and 95.5% respectively were modified so that a final correlation of 99.4 and 96.3% was obtained. The average correlation using the eleven discs was 97%.

Bacteriological Techniques↗

Third-generation cephalosporins resistance in clinical isolates of Enterobacteriaceae.

Seven clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins were investigated in order to assess the role played in resistance by permeability barrier and by beta-lactamase production. The addition of subinhibitory concentrations of EDTA increased susceptibility to ceftriaxone in five strains showing that the permeability barrier is involved. All strains produced different amounts of beta-lactamases that were always increased by cefoxitin induction. Hydrolytic activity of investigated enzymes varied in different cephalosporins; ceftriaxone and ceftazidime are the most stable compounds.

Cephalosporins↗

Performance of enterobacteriaceae identification systems. An analysis of College of American Pathologists Survey data.

Commercial systems designed and marketed for evaluation of Enterobacteriaceae are used in many clinical microbiology laboratories. Evaluations of these systems have been reported from several large laboratories. Identifications with one or more of these systems were compared with those obtained by conventional methods with many strains of organisms. The Microbiology Resource Committee of the College of American Pathologists designed two surveys to evaluate the performances of commercial systems with identical strains of organisms submitted to a large number of participants. The surveys used were the Special Bacteriology Survey D-D and the Comprehensive Microbiology Survey B-D submitted during 1975--1976. Single strains of Klebsiella pneumoniae and Serratia marcescens in pure culture were submitted in the Comprehensive Survey and the same strains of these organisms plus one strain each of Pseudomonas stuartii and Citrobacter freundii in the Special Survey. The data obtained from participants permitted comparisons to be made between the API-20E, Enterotube, and r/b systems. These comparisons included individual biochemical test results shared by at least two systems as well as the ability of each to identify the unknown organisms to genus alone and to both genus and species. The results are presented and subjected to statistical analysis.

Bacteriological Techniques↗

R plasmids in enterobacteriaceae from the hospital environment.

R plasmids have been demonstrated in several group of strains of enterobacteriaceae from hospital environment. R + enteropathogenic strains of Escherichia coli were isolated from several items of baby-care as well as from the pre-prepared baby food in a newborn unit. Strains from environmental samples are thought to be identical with those causing nosocomial gastroenteritis of babies. From hospital waste waters of another larger country hospital we could isolate R + strains of Salmonella typhimurium and R + protei, both associated with occurence of gastrointestinal or urological hospital infections. R-factor-carrying strains of E. coli have been isolated also from surface water samples from the area surrounding the hospital monitored.

Cross Infection↗

[Aromatic amino acid metabolism in Enterobacteriaceae microorganisms].

The authors revealed phenylalanine deaminase (PAD) in the majority of the Citrobacter strains investigated; the activity of PAD varied within a rather considerable range (0.3--4.58 micrometer of phenylpiruvate in 1 hr per 1 mg of bacterial protein). The presence of this enzyme thus served as an auxiliary biochemical test characterising this group of conditionally pathogenic microbes of the Enterobacteriacea family. Tyrosine decarboxylase was absent in 26 of 50 strains of Citrobacter examined. In the rest of the strains the activity of this enzyme was low. Consequently, tyrosine decarboxylase could not be used for identification of microorganisms of the Citrobacter genus.

Amino Acid Oxidoreductases↗

The antibiotic effect of the anti-depressive drug femoxetine and its stereo-isomeric analogs on diarrhoea producing enterobacteriaceae.

The present investigation has been undertaken to illustrate the antibacterial effect on 20 diarrhoea producing enterobacteriaceae of an anti-depressive drug available as femoxetine and its three analogs. It has been shown that the stereo-isomeric trans forms of femoxetine are more than twice as active as the cis forms and inhibited all the strains below 400 microgram/ml (1.2 mM). The two cis compounds only inhibited 11 and 9 of the 20 strains respectively in the investigated area 100 microgram/ml - 800 microgram/ml (0.3 mM - 2.4 mM). Our investigations point out that the bacterial cell has a target for psychopharmacologically active agents. Thus the known psychopharmaca and their stereo-isomeric analogs may represent a pool of potentially new antimicrobial drugs. Furthermore the bacterial model may be useful as a model system in the study of the interaction of neuropharmacological agents and other membrane active compounds with biological membranes.

Anti-Bacterial Agents↗

[Characteristics of microbial associations represented by the Enterobacteriaceae family isolated from the feces of healthy children and children with salmonellosis].

Associations formed by microorganisms of the family Enterobacteriaceae in feces have been studied using the principles of ecological investigation. The study has revealed that the associations isolated from children with salmonellosis sharply differ from those isolated from healthy children in the number of species and in the variety of their combinations, as well as in changes in the proportion of different species, observed in multiple investigations.

Child↗

[Use of a computer for the purpose of identifying bacteria of the family Enterobacteriaceae and the determination of the minimal set of differential tests].

Algorhythm and a program for identification of bacteria of the Enterobacteriaceae family, based on Edwards and Ewing's diagnostic scheme, were worked out. Use of this program permitted to analyze different sets of abbreviated biochemical tests. To determine the genera and species of enterobacteria a minimal set of 11 tests is suggested, including indol formation, Voges-Proskauer's reaction, the presence of urease enzymes, gelatinase, lysine decraboxylase, phenylalanine deaminase, glucose fermentation (gas), or lactose, inosite, sorbit, arabinose, rhamnose. The program admits increase of both the biochemical tests, and toxonomic groups of bacteria, this permitting to consider several families. The presence of strains deviating by properties from this scheme points to the necessity of further improvement of diagnostic schemes for the enterobacteria identification.

Bacteriological Techniques↗