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A comparison of side effects of levofloxacin to other agents concerning the ecological and microbiological effects on normal human flora.

The safety of levofloxacin was compared to that of non-fluoroquinolone alternatives used for respiratory tract infections. Results from five randomised controlled trials revealed that the incidence of any adverse events possibly associated with levofloxacin ranged from 5.8% to 22.7%, whereas that of comparators (ceftriaxone, cefuroxime axetil, clarithromycin and amoxicillin-clavulanic acid) ranged from 8.5% to 39.3%. The rate of adverse drug reactions (ADRs) was lower for levofloxacin in all trials. The most common adverse events for all agents tended to be gastrointestinal in nature. Levofloxacin was associated with a mild effect on the normal microflora, reaching a maximum at four days of therapy, with complete recovery being achieved by seven days post-therapy. No colonisation with resistant strains was observed during the period of levofloxacin therapy. Amoxicillin-clavulanic acid administration selected for resistant strains of Enterobacteriaceae, and ampicillin administration was associated with both resistant strains of Enterobacteriacae as well as Candida spp. Ceftriaxone selected resistant strains of Clostridium difficile and Candida spp. Thus, microflora effects favoured levofloxacin over all of the agents tested, including macrolides and tetracyclines. These results confirm that the ecological impact of levofloxacin is markedly less than that associated with non-fluoroquinolone comparators.

Anti-Infective Agents↗

Relative value of surrogate indicators for detecting pathogens in lakes and reservoirs.

This study investigated the relative behavior of pathogens, fecal indicator organisms, and particles of varying size during transport through a reservoir following a storm event inflow in Myponga Reservoir, South Australia. During the inflow, samples were collected from the river and at various locations within the reservoir to determine the fate and transport of microroganisms as they progressed through the water body. Microbiological analysis included the indicator organisms Escherichia coli, enterococci, Clostridium perfringens, aerobic spores, and somatic coliphages, the protozoan pathogens Cryptosporidium spp. and Giardia spp., and the potential physical surrogates of pathogen contamination including particle size and turbidity. Of the microbial indicator groups, C. perfringens spores were the most highly correlated with Cryptosporidium spp. concentrations (Spearman Rho = 0.58), closely followed by enterococci (Spearman Rho = 0.57). Cryptosporidium spp. oocysts were predominantly associated with small sized particles (range of 14.3-27.7 microm). All of the microbial indicator groups tested were associated with larger sized particle ranges (> 63.3 microm) except C. perfringens spores which were associated with particles in the size range of 45.5-63.3 microm. Although indicators may rank correlate with Cryptosporidium spp., the variation in settling rates of different microorganisms has significant implications for the use of surrogates to estimate pathogen attenuation within reservoirs. For example, concentrations of Cryptosporidium spp. oocysts were reduced by a factor of 3 on reaching the dam wall, whereas enterococci were reduced by a factor of 10.

Animals↗

Patterns of wound colonisation in patients with peripheral vascular disease.

The bacterial colonisation of ulcers related to vascular disease, amputation sites and sites of surgical vascular repair was studied in 122 patients with vascular disorders. Wounds were graded clinically on the basis of inflammation, oedema and exudate. They were sampled at weekly intervals in order to determine the duration of colonisation. The significance of potential pathogens was assessed. Vascular ulcers were of low mean wound grade (1.87), short duration (1.58 weeks) and potential pathogens were isolated from 82% of 38 wounds. Amputation sites were of a higher mean wound grade (2.48) and longer duration (2.52 weeks) when compared to vascular ulcers. Potential pathogens were isolated from 69% of 42 amputation sites. Sites of surgical vascular repair were similar to amputation sites with respect to mean wound grade (2.33) but of a mean duration (1.69 weeks) similar to that of vascular ulcers. Potential pathogens were isolated from 50% of 42 surgical vascular repair sites but they were not evenly distributed among limb (33%), groin (55%) and abdominal wounds (71%). Coliforms were isolated from similar numbers of all wounds. Pseudomonas spp., Staphylococcus aureus and Streptococcus faecalis were evenly distributed with respect to the site of isolation. Pseudomonas spp. and S. aureus were associated more commonly with vascular ulcers and S. faecalis with sites of surgical vascular repair. The use of topical antiseptics and/or systemic antimicrobial agents had a minimal effect in reducing colonisation/infection in the wounds studied.

Amputation Stumps↗

In-vitro activity of four new fluoroquinolones.

The in-vitro activities of four new fluoroquinolones, E-4749, E-4874, E-4884 and E-4904, were compared with that of ciprofloxacin and sparfloxacin against 1106 clinical isolates. Against majority of Enterobacteriaceae, general antibacterial activities of E-4749 (MIC90s 0.06-1 mg/L), E-4874 (MIC90s, 0.03-0.25 mg/L) and E-4884 (MIC90s 0.01-0.5 mg/L) were comparable or slightly lower than those of ciproloxacin (MIC90s 0.01-0.25 mg/L) and sparfloxacin (MIC90s 0.01-1 mg/L). The activity of E-4904 (MIC90s 0.06-2 mg/L) was lower than those of its analogues. Most of the Escherichia coli which were resistant to ciprofloxacin (MIC > or = 2 mg/L) and Serratia spp., were resistant to the new fluoroquinolones. beta-Lactamase producing strains of Moraxella catarrhalis were very susceptible to these compounds (MICs < or = 0.008 mg/L). Most of Pseudomonas aeruginosa, non-aeruginosa Pseudomonas spp., Xanthomonas maltophilia, and Acinetobacter spp. were resistant to the new quinolones (MIC90s 8- > 16 mg/L). On the contrary, these new antimicrobials were active against the majority of the Aeromonas spp. (MIC90s < or = 0.5 mg/L). E-4749, E-4874, E-4884 and E-4904 remained active (MIC90s < or = 0.25 mg/L) against Staphylococcus aureus strains susceptible to methicillin. However, its activity was two- to eight-fold lower than that of ciprofloxacin (MIC90 0.03 mg/L) and sparfloxacin (MIC90 0.06 mg/L). Against S. aureus resistant to methicillin or ciprofloxacin, activity of these new compounds and comparators agents, was very low (MIC90s 2- > 16 mg/L). Most of the strains of Enterococcus faecalis were resistant (MIC90s > 16 mg/L). The activity of E-4874, E-4904 and sparfloxacin (MIC90 1 mg/L for each one) was higher than that of the rest of the agents tested. E-4874 (MIC90 0.25 mg/L) was four-fold more active than the other antibacterials tested (MIC90 2 mg/L) against Listeria monocytogenes. No new quinolone was active against Bacteroides fragilis (MIC90s 4-16 mg/L), Bacteroides thetaiotaomicron (MIC90s 8- > 16 mg/L), and other B. fragilis group (MIC90s 16- > 16 mg/L). Ciprofloxacin (MIC90s > 16 mg/L), and sparfloxacin (MIC90s 8-16 mg/L) also were inactive. E-4874 (MIC90 4 mg/L) was the most active quinolone tested against B.fragilis.

Anti-Infective Agents↗

[Effect of delay of blood cultures on positive detection by automated blood culture system].

The effect of entry delayed blood culture bottles until the start of incubation for mechanical detection of organism were compared using 2 major blood culture systems; BACTEC 9240 system and BacT/ALERT 3D system. Total of 13 bacterial strains; 5 gram-positive cocci, 7 gram-negative bacilli and Candida parapsilosis which were isolated mainly from blood cultures were used as the test strains. BACTEC 92F, 93F and BacT/ALERT FA, FN bottles were used as the blood culture bottles. All the bottles inoculated with the test strains were incubated and evaluated immediately after standing at room temperature for 24, 42, 48, 54 or 72 hours, using the respective automated blood culture systems. All the bottles were subcultured. The effect of entry delay the blood culture bottles for the mechanical detection was observed in many gram-negative organisms in BACTEC 9240 system. The blood cultures were evaluated not to be positive in 4 of the 10 samples on delaying for 24 hours or in any of the samples on delaying for 42 hours in the BACTEC 92F bottles inoculated with Escherichia coli. In Serratia marcescens, the blood cultures were evaluated not to be positive in 5 of the 10 samples on delaying for 24 hours or in any of the samples on delaying for 42 hours in the BACTEC 92F bottles. In Klebsiella pneumoniae, the blood cultures were evaluated not to be positive in 9 of the 10 samples on delaying for 42 hours. In Enterococcus faecalis, Pseudomonas aeruginosa and Proteus mirabilis, the blood cultures were evaluated not to be positive in 5-6 of the 10 samples on delaying for 42 hours. On the other hand, the blood cultures were evaluated to be positive in most of the samples of Acinetobacter calcoaceticus (except 3 of the 10 samples which were evaluated not to be positive) on delaying for 42 hours in BacT/ALERT 3 D system. The samples except part of Streptococcus spp. were detected by subculture in both the bottles. These results indicate that the delayed time of blood culture bottles before inoculation with the test bacterial samples affects the positive detection of blood cultures markedly in the blood culture system. Therefore, the immediate incubation was considered to be necessary.

Blood↗

[Analysis of aerobic and anaerobic bacterial flora colonizing drains after surgical abdominal incisions].

Aerobic and anaerobic bacterial flora of post-operative incisions with drainage were examined. From each of 28 patients three specimens were taken; during operation (smear from peritoneal cavity), liquid from drain (taken at 3-th day after operation) and smear from drain taken at the end of drainage. Enterococci, Enterobacteriaceae spp. and anaerobes, especially Bacteroides spp. were most often isolated from specimens taken during operation. Enterococci and coagulase negative Staphylococci-often resistant to methicillin, were most often isolated from specimens taken at the end of drainage.

Abdominal Muscles↗

The influence of bacterial inoculants on the microbial ecology of aerobic spoilage of barley silage.

The aerobic decomposition of barley silage treated with two inoculants (LacA and LacB) containing mixtures of Lactobacillus plantarum and Enterococcus faecium was investigated over a 28-day period. Initially, yeast and bacterial populations were larger in silage inoculated with LacA than in silage treated with LacB or water alone (control). Differences in the succession of yeasts in silage treated with LacA were observed relative to the other two treatments. From silage treatment with LacA, Issatchenkia orientalis was the most prevalent yeast taxon over all of the sample times, and the filamentous fungus Microascus brevicaulis was also frequently isolated at later sample dates (> or = 14 days). In contrast, Saccharomyces exiguus was the most prominent yeast recovered from silage treated with LacB and water alone on days 2 and 4, although it was supplanted by I. orientalis at later sample times. Successional trends of bacteria were similar for all three treatments. Lactobacillus spp. were initially the most prevalent bacteria isolated, followed by Bacillus spp. (primarily Bacillus pumilus). However, the onset of Bacillus spp. prominence was faster in LacA silage, and Klebsiella planticola was frequently recovered at later sample times (> or = 14 days). More filamentous fungi were recovered from LacA silage on media containing carboxylmethylcellulose, pectin, or xylan. The most commonly isolated taxa were Absidia sp., Aspergillus flavus, Aspergillus fumigatus, Byssochlamys nivea, Monascus ruber, Penicillium brevicompactum, Pseudoallescheria boydii, and M. brevicaulis. The results of this study indicated that the two bacterial inoculants incorporated into barley at the time of ensilage affected the microbial ecology of silage decomposition following exposure to air. However, neither of the microbial inoculants effectively delayed aerobic spoilage of barley silage, and the rate of decomposition of silage treated with one of the inoculants (LacA) was actually enhanced.

Aerobiosis↗

Transferable plasmid-mediated antibiotic resistance in Listeria monocytogenes.

A strain of Listeria monocytogenes, isolated from a patient with meningoencephalitis, was resistant to chloramphenicol, erythromycin, streptomycin, and tetracycline. The genes conferring resistance to these antibiotics were carried by a 37-kb plasmid, pIP811, that was self-transferable to other L monocytogenes cells, to enterococci-streptococci, and to Staphylococcus aureus. The efficacy of transfer and the stability of pIP811 were higher in enterococci-streptococci than in the other gram-positive bacteria. As indicated by nucleic acid hybridisation, the genes in pIP811 conferring resistance to chloramphenicol, erythromycin, and streptomycin were closely related to plasmid-borne determinants that are common in enterococci-streptococci. Plasmid pIP811 shared extensive sequence homology with pAM beta 1, the prototype broad host range resistance plasmid in these two groups of gram-positive cocci. These results suggest that emergence of multiple antibiotic resistance in Listeria spp is due to acquisition of a replicon originating in enterococci-streptococci. The dissemination of resistance to other strains of L monocytogenes is likely.

Chloramphenicol Resistance↗

A comparison of the levels of faecal indicator bacteria in water and human faeces in a rural area of a tropical developing country (Sierra Leone).

The levels of faecal coliforms (FC), indole-positive FC (presumptive Escherichia coli), faecal streptococci (FS), Streptococcus faecalis and Clostridium perfringens in the natural water sources used by 29 rural settlements in Sierra Leone were investigated. Levels of the same indicators in human faeces were also investigated. The incidence of Salmonella spp. in both habitats and the temperature, pH and conductivity of water sources were also recorded. All water sources were contaminated with the indicator bacteria, mean numbers of which occurred in the relationship FC greater than presumptive E. coli congruent to FS congruent to C. perfringens greater than S. faecalis. FC were also predominant in human faeces, the relationship of means being FC congruent to presumptive E. coli greater than FS greater S. faecalis greater than C. perfringens. The need for confirmation of FC counts obtained from water sources was indicated by the large number of positive tubes produced in the FC multiple-tube dilution test from some samples which could not be confirmed as presumptive E. coli. Salmonella spp. Were isolated from 13 water sources and 6% of faecal samples. Mean water temperature was high (26.2 degrees C), pH low (5.04) and conductivity low (34 microS cm-1). Presumptive E. coli was considered the most appropriate indicator of faecal pollution of the types of water investigated.

Bacteria↗

Distribution and mobility of the tetracycline resistance determinant tetQ.

We tested 34 American Type Culture Collection (ATCC) and 168 clinical bacterial isolates, from the human urogenital and oral tracts and streptococci isolated from cows with mastitis, for the presence of the tetQ gene using a polymerase chain reaction (PCR) assay and DNA-DNA hybridization. The identities of PCR products were confirmed by Southern blot hybridization of whole-cell DNA. Eleven of the ATCC strains were positive for tetQ, including five Bacteroides spp., five Prevotella spp. and a single isolate of Mitsuokella multiacidus. Twenty-eight (29%) of the 95 clinical Gram-negative isolates carried the tetQ gene, while eight (11%) of the 73 clinical Gram-positive isolates carried the tetQ gene. This is the first description of tetQ in Gram-positive species. All isolates except one Peptostreptococcus sp. carried tetQ integrated into the chromosome. The tetQ gene could be transferred from Prevotella bivia, Bacteroides ovatus, Bacteroides fragilis, Bacteroides vulgatus and Bacteroides distasonis into an Enterococcus faecalis recipient at frequencies of 10(-7)-10(-9) per recipient. In contrast, tetQ failed to transfer from two isolates of Prevotella intermedia, two isolates of Porphyromonas gingivalis, one isolate of Mobiluncus curtisii and one isolate of Peptostreptococcus sp. The latter two are Gram-positive species. The PCR assay was used to screen 198 proteinase K-treated biopsies of prostate, periprostate and bladder from 84 men with prostatitis. Thirty-four (40%) of the patients had one or more positive samples, suggesting that the PCR assay could be of value in screening patient material directly for the presence of bacteria.

Animals↗

In vitro activity of ramoplanin against vancomycin-resistant gram-positive organisms.

In vitro activity of ramoplanin, a cyclic lipoglycopeptide, against 92 vancomycin-resistant gram-positive organisms was evaluated. Ramoplanin demonstrated potent activity against many highly vancomycin-resistant organisms including enterococci (MICs for 90% of strains tested of 0.5 micrograms/ml) and against Lactobacillus spp., Leuconostoc spp., and Pediococcus spp., all of which were inhibited at concentrations of < or = 0.25 micrograms/ml. This drug or a derivative compound merits further investigation as a potential therapeutic agent for infections due to vancomycin-resistant enterococci.

Anti-Bacterial Agents↗

Bacteriological evaluation of dog and cat diets that claim to contain probiotics.

Nineteen commercial pet foods claiming to contain probiotics were evaluated. Selective bacterial culture was performed to identify organisms that were claimed to be present. Twelve diets claimed only to contain specific bacterial fermentation products, which does not necessarily indicate that live growth would be expected, but these products also included the term "probiotic" somewhere on the package, suggesting that live, beneficial organisms were present. No products contained all of the listed organisms, while 1 or more of the listed contents were isolated from 10 out of 19 products (53%). Eleven products contained additional, related organisms including Pediococcus spp, which was isolated from 4 products. No relevant growth was present in 5 (26%) products. Average bacterial growth ranged from 0 to 1.8 x 10(5) CFU/g. Overall, the actual contents of the diets were not accurately represented by the label descriptions.

Animal Feed↗

In vitro activity of the new glycopeptide decaplanin.

The activity of decaplanin, a new glycopeptide, was compared to that of vancomycin, teicoplanin and daptomycin. Decaplanin was two- to four-fold less active than vancomycin, telcoplanin and daptomycin against Staphylococcus aureus and Staphylococcus epidermidis, with an MIC90 of 2 micrograms/ml for methicillin-susceptible and 4 micrograms/ml for methicillin-resistant isolates. Decaplanin had activity similar to that of vancomycin against Streptococcus pyogenes, Streptococcus agalactiae, group C and G streptococci, with an MIC90 of 0.12 micrograms/ml. It was less active than the other agents against the viridans group streptococci (MIC90 4 micrograms/ml). The activity of decaplanin against enterococci (MIC90 4 micrograms/ml) was similar to that of vancomycin. Clostridium spp. were inhibited by 0.5 micrograms/ml, peptostreptococci and peptococci by 0.25 microgram/ml. Decaplanin was active from pH 5.5 to 7.5. Inoculum size had a minimal effect on MICs, and increased concentrations of Ca2+ and Mg2+ and 50% serum did not alter MICs or MBCs.

Anti-Bacterial Agents↗

The seasonality of bacterial quality of water in a tropical developing country (Sierra Leone).

Natural water sources used as drinking-water supplies by rural settlements in Sierra Leone were examined monthly over a one-year period to detect any seasonal variations in bacterial quality. The 37 degrees C colony count, levels of selected faecal indicator bacteria and the incidence of Salmonella spp. were monitored. A seasonality was demonstrated for all the variables, counts generally increasing with the progression of the dry season, culminating in peaks at the transition from dry to wet season. Some complications with respect to the interpretation of counts of faecal indicator bacteria from raw tropical waters are noted.

Clostridium perfringens↗

Predominant pathogens in hospital infections.

To determine the distribution of pathogens causing nosocomial infections in United States hospitals, we analysed data from the National Nosocomial Infections Surveillance (NNIS) System. From October 1986 to December 1990, amongst hospitals conducting hospital-wide surveillance, the five most commonly reported pathogens were Escherichia coli (13.7%), Staphylococcus aureus (11.2%), enterococci (10.7%), Pseudomonas aeruginosa (10.1%), and coagulase-negative staphylococci (9.7%). The commonest pathogens reported by site included, bloodstream: coagulase-negative staphylococci, S. aureus, enterococci, E. coli, and Candida spp.; lower respiratory tract infection: S. aureus, P. aeruginosa and Enterobacter spp.; surgical wound infection: S. aureus, enterococci and coagulase-negative staphylococci; and urinary tract infection: E. coli, enterococci, and P. aeruginosa. Among hospitals conducting intensive care unit (ICU) surveillance, the commonest pathogens were P. aeruginosa (12.4%), S. aureus (12.3%), coagulase-negative staphylococci (10.2%), Candida spp. (10.1%), Enterobacter spp. and enterococci (8.6% each). In the ICUs, the commonest pathogens found in the bloodstream were coagulase-negative staphylococci, S. aureus, and enterococci; in lower respiratory tract infections P. aeruginosa, S. aureus, and enterococci; in surgical wound infections enterococci, coagulase-negative staphylococci, and Enterobacter spp. and in urinary tract infections Candida spp., E. coli, enterococci, P. aeruginosa, and Enterobacter spp. These data show that S. aureus, E. coli and P. aeruginosa remain important nosocomial pathogens, that coagulase-negative staphylococci, enterococci and C. albicans are pathogens of increasing importance, and that the distribution of pathogens differs by site and hospital location.

Adult↗

Seasonal occurrence and distribution of microbial indicators and pathogens in the Rhode River of Chesapeake Bay.

The seasonal incidence and occurrence of indicator organisms and pathogens were studied at four sites in the Rhode River, a subestuary of Chesapeake Bay. The highest frequency of occurrence of total and fecal coliforms and fecal streptococci was in Muddy Creek, a marsh area receiving pasture land runoff. Second highest frequency of occurrence of these bacteria was in Cadle Creek, a populated area. Lowest measurements of these parameters were obtained at stations in the central portion of the Rhode River. No Salmonella spp. were detected by the methods employed in this study. However, it is concluded that if these organisms are present, the concentrations are less than or equal to 1 organism per liter. The presence of Clostridium botulinum was detected in 12% of the samples tested.

Cell Count↗

Quantitative studies on the salivary flora.

In a quantitative bacteriological study of the salivary flora from 50 children the following aerobic organisms were identified and enumerated: alpha-haemolytic streptococci, beta-haemolytic streptococci, Streptococcus faecalis, pneumococci, Staphylococcus aureus, Staph. albus and Staph. citreus, Neisseria spp, N. meningitidis, corynebacteria, aerobic lactobacilli, B. subtilis, H. influenzae, coliform organisms, and Candida spp. Many of the known potentially pathogenic members were present in large numbers. It is suggested that knowledge of the relative numbers of the organisms that comprise the salivary flora will lead to a greater understanding of the ecology of the mouth and of the pathogenesis of oral infections.

Aerobiosis↗

In-vitro activity of enoxacin against aminoglycoside-resistant gram-negative bacilli and other clinical isolates.

The in-vitro activity of enoxacin was tested against 500 clinical isolates of Gram-negative bacilli that were resistant to one or more of gentamicin, tobramycin and amikacin, and against 1060 recent consecutive clinical isolates of Gram-negative bacilli and Gram-positive cocci. Enoxacin was active against staphylococci (MICs less than or equal to 4 mg/l) but less active against Streptococcus faecalis (MICs mostly 8 mg/l). It was active against Pseudomonas aeruginosa (MICs 0.5-4 mg/l) and very active against Enterobacteriaceae. In the series of consecutive isolates 97% of Enterobacteriaceae had MICs less than or equal to 1 mg/l. The aminoglycoside-resistant series of Enterobacteriaceae included more strains with higher MICs (13% were 2-4 mg/l and 10% were greater than or equal to 8 mg/l); the majority of the isolates with MICs greater than or equal to 8 mg/l); the majority of the isolates with MICs greater than or equal to 8 mg/l were Serratia marcescens and Providencia spp. Among the non-fermenting species the least sensitive were Acinetobacter calcoaceticus and Ps. maltophilia. Enoxacin-resistant strains of Enterobacteriaceae were resistant to nalidixic acid, but nalidixic acid-resistant strains ranged from fully sensitive to highly resistant to enoxacin.

Aminoglycosides↗