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PubMed1989

World-wide antibiotic resistance in methicillin-resistant Staphylococcus aureus.

Antibiotic resistance patterns were determined for 106 strains of methicillin-resistant Staphylococcus aureus (MRSA) from 21 countries. Resistance to gentamicin, tobramycin, netilmicin, amikacin, streptomycin, or erthromycin was recorded in more than 90% of strains. Resistance to the other compounds tested was as follows: tetracycline 86%, minocycline 76%, trimethoprim 69%, clindamycin 66%, neomycin 59%, chloramphenicol 39%, rifampicin 26%, fosfomycin 22%, ciprofloxacin 17%, fusidic acid 12%, bacitracin 2%, and novobiocin 1%. All the stains were sensitive to mupirocin, pristinamycin, ramoplanin, teicoplanin, and vancomycin. There were geographical patterns of resistance: MRSA from the UK and Australia were predominantly resistant to trimethoprim, whereas many strains from centres in Europe and the USA were sensitive. MRSA that were resistant to ciprofloxacin were of French and German origin. 15 strains, 12 of which came from France, Turkey, or Brazil, were resistant either to thirteen or to fourteen agents.

Administration, Topical↗
PubMed2004

[Infectious cellulitis and Shewanella alga septicemia in an immunocompetent patient].

BACKGROUND: Shewanella alga is a Gram-negative bacilla often found in water or soil. Clinical infections in humans are rare, with serious infections described generally in immunocompromised hosts. CASE REPORT: A 66 year-old man with a heel wound had developed, after numerous sea baths in the Atlantic ocean (Oleron island, France), an infectious cellulitis of the leg with Shewanella alga septicemia. Despite the absence of immunodeficiency in this patient, infectious cellulitis and septicemia occurred via a wound to the skin and contact with sea water. Healing was seen after treatment with cefotaxime, ciprofoxacin and gentamicin IV, relayed with ciprofloxacin and erythromycin. Shewanella alga was also susceptible to ticarcillin, piperacillin and ceftazidime but was resistant to ampicillin, amoxicilline-clavulanate, colistin, cyclines, fosfomycin and cefsulodin. No immunological anomaly was found. DISCUSSION: We report a case of infectious cellulitis with Shewanella alga septicemia. This has not previously been described in an immunocompetent patient. Antibiotic therapy must be longer than usual treatment for streptococcal erysipelas and first-line antibiotherapy with ampicillin alone may not be sufficient.

Acute Disease↗
PubMed2000

Identification and expression of the gene encoding phosphonopyruvate decarboxylase of Streptomyces hygroscopicus.

The first step of C-P compound biosynthesis is a C-P bond formation reaction catalyzed by phosphoenolpyruvate phosphomutase, but this reaction favors the cleavage of the C-P bond. This C-P bond forming reaction is driven by the following reaction catalyzed by phosphonopyruvate (PnPy) decarboxylase. We have cloned and sequenced the gene (bcpC) encoding PnPy decarboxylase, a key enzyme of C-P compound biosynthesis, from the bialaphos (BA) producing microorganism Streptomyces hygroscopicus by complementation methods using Streptomyces wedmorensis NP-7, which is a mutant of a fosfomycin producing strain deficient in this step. The location of this gene in the BA biosynthetic gene cluster was determined by using the expression system in Streptomyces lividans. DNA sequencing of this gene revealed a 1203-bp open reading frame encoding a polypeptide of 401 amino acids.

Bacterial Proteins↗
PubMed2003

Susceptibility of Listeria monocytogenes isolated from food in Italy to antibiotics.

The susceptibility of 148 strains of Listeria monocytogenes isolated from food to antibiotics currently used in veterinary and human therapy was determined by standard agar dilution and disk diffusion methods. The antibiotics included amikacin, amoxicillin, cefazolin, chloramphenicol, erythromycin, flumequine, fosfomycin, gentamicin, kanamycin, lincomycin, oxytetracycline, rifampicin, spiramycin, streptomycin, tetracycline, tobramycin and vancomycin. Soussy's breakpoints and MIC(50)-MIC(90) values were used to classify the strains into sensitive, moderately sensitive and resistant groups. This work is part of a wider surveillance program on listeriosis started in Italy in 1995.

Anti-Bacterial Agents↗
PubMed2005

[Abrupt visual loss in children. Three case studies of ocular bartonellosis].

PURPOSE: To evaluate the severity and progression of neuroretinitis in children caused by Bartonella. PATIENTS AND METHODS: Retrospective study of three consecutive cases. Patients underwent ophthalmological, medical, and radiological evaluations. Bartonella serology was positive. Intravenous treatment was started immediately with antibiotics and steroids. Patients were re-evaluated after visual acuity recovery. RESULTS: Progression was quickly positive with fosfomycin and fluoroquinolones in all cases. CONCLUSION: Bartonella induces neuroretinitis even without systemic signs of cat-scratch disease, with sometimes sudden bilateral blindness. Long-term progression is good but urgent medical treatment is necessary.

Adolescent↗
PubMed2000

Extended high-frequency ototoxicity induced by the first administration of cisplatin.

The ototoxicity induced by cisplatin results in high-frequency hearing loss. The sound-pressure thresholds at extended high frequencies of 8 to 20 kHz were measured in 12 patients with head and neck cancer before and after the first administration of cisplatin. Ototoxicity was defined statistically by the newly introduced regression-line analysis. This analysis revealed that the threshold of 1 of the 12 patients increased evenly from 8 to 10 kHz, and the damage to the hearing system of this patient was permanent. The reasons for such a low rate of ototoxicity might be the long-term administration of low doses of cisplatin and the addition of fosfomycin.

Adult↗
PubMed1998

Streptococcus pyogenes hospital-acquired infection within a dermatological ward.

Seventeen strains of Streptococcus pyogenes were isolated from 17 patients in the Dermatological Ward of Gunma University Hospital in Japan between June 1994 and March 1995. Of these 17 strains, 14 were isolated from the pus of skin infections, two from blood, and one from ascitic fluid. The strains showed the same minimum inhibitory concentrations; 4 mg/L of minomycin, 4 mg/L of ofloxacin and 16 mg/L of fosfomycin. T-antigen typing of the strains indicated they were T11 type. The restriction endonuclease digestion patterns of chromosomal DNA from the 17 strains were all identical. The vinyl sheet covering the bed on which the patients were treated was found to be contaminated with S. pyogenes. This strain showed identical characteristics to the strains derived from the patients. These results suggest that S. pyogenes was transmitted to patients in the Dermatological Ward from the surface of the vinyl sheet covering the bed.

Bedding and Linens↗
PubMedDate not supplied

[Microbial sensitivity of Escherichia coli in community-acquired urinary tract infections].

OBJECTIVE: For effective empiric therapy of urinary tract infections in the extra-hospital setting the susceptibility pattern of uropathogens should be considered. Moreover, the evolution in sensitivity can be observed when comparing with susceptibility patterns in the previous years. This paper presents an analysis of our experience with Escherichia coli. MATERIAL AND METHODS: During 2002 and 1998, 895 and 595 strains of Escherichia coli respectively, isolated from extrahospitalary bacteriurias were collected in ten health centers in Bierzo (León, Spain). Sensitivity to nine most commonly antibiotics used in the clinical practise was determined. The existence of significant differences of susceptibility among years (2002-1998) was analyzed by the chi square test. RESULTS: Escherichia coli accounted for 63.4% of all isolates in 2002 and 50.8% in 1998. The prevalence of in-vitro susceptibilities to antibiotics were (2002-1998): fosfomycin (99.2%-99.3%; p = NS*), cefixime (98.3%-92.9%; p < 0.001), cefuroxime (96.5%-94.1%; p < 0.05), nitrofurantoin (94.5%-86.9%; p < 0.001), amoxycillin-clavulanic acid (93.1%-90.1%; p < 0.05), ciprofloxacin (77.1%-81.6%; p < 0.05), norfloxacin (75.8%-80.3%; p < 0.05), cotrimoxazole (71.5%-73.4%; p = NS*) and ampicillin (44%-41.4%; p = NS*). (*NS = No significant differences). CONCLUSION: The knowledge of the sensitivity of uropathogens to antimicrobians in a specific medium can allow us to use antibiotics rationally and initiate empirical therapy.

Anti-Bacterial Agents↗
PubMed2000

[Do urocultures change our therapy approach?].

OBJECTIVE: To describe to what extent the results of urocultures modify approaches to therapy and the factors linked to this change. DESIGN: Cross-sectional, descriptive study by means of review of records. SETTING: Primary care. PARTICIPANTS: 222 adult urocultures requested at 8 health centres between March and May 1999. INTERVENTIONS: We extracted from the records age, sex, symptoms, risk factors, and approach to therapy before and after the uroculture. We discarded 358 urocultures because of not finding the clinical record or because the episode or data on the change in approach to therapy was lacking in the record. RESULTS: The urocultures belonged to patients with a mean age of 54.2, 73.1% of whom were women. 34.7% presented no risk factor for UTI. 44% had no symptoms of UTI. 21.2% of urocultures were positive, with E. coli the most frequently isolated bacteria (69.4%). Empirical antibiotic treatment was called for in 44.6% (70.1% quinolones, 9.3% fosfomycin). After receipt of the result, there was a change of approach in 25 cases (11.4%, SE 2.1%), of whom 15 did not receive empirical treatment (6 with symptoms and 9 without). The antibiotic was changed in 9 of the 99 cases treated empirically (always because of resistance). Among those with change of approach, there was a higher percentage of risk factors (84% against 62%, p < 0.05, chi 2 = 4.47). There were no differences for age, sex, symptoms or bacteria between the two groups. CONCLUSIONS: There is a quite considerable percentage of urocultures that lead to a change in approach to therapy, although most of the patients had linked risk factors and/or did not receive empirical antibiotic treatment.

Cross-Sectional Studies↗
PubMed1985

[Current treatment of Staphylococcus aureus infections].

The Staphylococcus aureus infections seen in general practice still respond relatively well to the usual treatments, including penicillin M, first generation cephalosporins or synergistins. Those seen in hospitals are highly resistant to oxacillin (14 to 43 h depending on individual hospital units) and should be treated from the start with major antistaphylococcal drugs, such as vancomycin, fosfomycin in combination therapy or pefloxacine.

Anti-Bacterial Agents↗
PubMed2001

[Antibiotic resistance of Staphylococcus aureus in urban experience: 6 month study in Aquitaine].

Antibiotic resistance of Staphylococcus aureus has been surveyed by eight city laboratories of the Aquitaine area, during a six month-period (january to june 1998). Antibiotic susceptibility testing has been performed by the disk diffusion method, and the results have been collected and analysed using the SIRscan system. After elimination of the redundant strains, a total of 747 isolates has been retained. They were mainly isolated from pus (64%) collected from patients of the community (40%) or hospitalized in 30 private clinics or nursing homes. The percentages of resistant strains (community/institutions) were: benzylpenicillin: 90% (87/92%), oxacillin: 39% (23/50%), kanamycin: 37% (22/47%); gentamicin: 13% (8/16%), tobramycin: 37% (21/47%), amikacin: 21% (13/27%); netilmicin: 6% (5/7%), erythromycin: 33% (30/35%), spiramycin: 72% (77/69%), lincomycin: 24% (17/29%), pristinamycin: 2% (1/2%), tetracycline: 17% (14/19%); pefloxacin: 40% (25/50%), fosfomycin: 9% (6/12%), rifampicin: 10% (7/13%), fusidic acid: 14% (11/15%), cotrimoxazole and vancomycin: 0%. Meticillin-susceptible strains of S. aureus were mostly sensitive to other antibiotics (< or = 6% resistant strains, except for erythromycin: 22%). Among meticillin-resistant S. aureus, heterogeneous strains with a KT phenotype, and various resistance patterns to the remaining antibiotics were predominant (61%), compared to the homogeneous strains with a KTG phenotype and multiresistant to the other antibiotics (32%). The frequencies of resistant strains were highly variable depending on the specimen, the laboratory and the health care institution, except for cotrimoxazole and vancomycin which were always active.

Anti-Bacterial Agents↗
PubMed2003

Identification and characterization of a diamide sensitive mutant of Mycobacterium smegmatis.

A mutant, T7, highly sensitive to oxidative stress as caused by diamide was isolated from a Mycobacterium smegmatis mc(2)155 transposon mutant library. While wild-type M. smegmatis is able to grow well on solid media supplemented with 10 mM diamide, T7 is only able to grow on solid media containing up to 1 mM diamide. This mutant is also sensitive to other thiol modifying agents such as iodoacetamide and chlorodinitrobenzene. By sequencing the genomic DNA flanking the transposon, T7 was found to be mutated in the region upstream of the homolog of M. tuberculosis Rv0274 open reading frame. Sequence analysis revealed that Rv0274 is a member of a superfamily of metalloenzymes comprising enzymes such as extradiol dioxygenases, glyoxalases, and fosfomycin resistant glutathione transferases. Cloning and epichromosomal expression of M. tuberculosis Rv0274 in the mutant resulted in complementation of the sensitivity to diamide.

Amino Acid Sequence↗
PubMed2003

Moellerella wisconsensis: identification, natural antibiotic susceptibility and its dependency on the medium applied.

The present study establishes a data compilation on biochemical features and natural antibiotic susceptibilities of Moellerella wisconsensis strains. 17 moellerellae isolated from humans (n = 11), food (n = 5) and water (n = 1) were tested. Identification was carried out using two commercially available systems and conventional tests. MIC determinations of 74 antibiotics were performed applying a microdilution procedure in Cation-adjusted Mueller Hinton broth and IsoSensitest broth. M. wisconsensis was naturally sensitive to doxycycline, minocycline, all tested aminoglycosides, numerous beta-lactams, all fluoroquinolones, folate-pathway inhibitors, chloramphenicol and nitrofurantoin. Natural resistance was found with oxacillin, penicillin G, all tested macrolides, lincomycin, streptogramins, ketolides, glycopeptides, fusidic acid, linezolid and rifampicin. Medium-dependent differences in susceptibility affecting clinical assessment criteria were seen with tetracycline, clindamycin and fosfomycin. From the data of the present study it is possible that some moellerellae are misidentified as Klebsiella pneumoniae subsp. ozaenae.

Anti-Bacterial Agents↗
PubMed1998

Identification and natural antibiotic susceptibility of Morganella morganii.

Our data should elucidate whether or not natural antibiotic susceptibility can be used as an aid for subspecies or biovar discrimination of Morganella morganii (II). Furthermore, our goal was to create a database of the natural susceptibility of M. morganii (III) and we were interested in the relative frequency of the recently described subspecific taxa (I). On the basis of trehalose fermentation (TRE), ornithine decarboxylase (ODC), and lysine decarboxylase (LDC) activities, we determined the biovar for 90 clinical isolates of M. morganii. Within these strains we examined the natural antibiotic susceptibility of 53 morganellae to 70 antibiotics by determination of the MICs with a microdilution procedure. (I): 80 strains (89%) of all morganellae belonged to M. morganii ssp. morganii (TRE-), with biovar A (LDC-, ODC+) predominating (67 strains). The remaining strains of this subspecies were identified as biovar B (LDC+, ODC+; 12 strains) and biovar C (LDC-, ODC-, one strain). Ten strains of M. morganii ssp. sibonii (TRE+) were found: four strains belonged to biovar F (LDC variable, ODC-) and six strains to biovar G (LDC-, ODC). (II): With one exception we found no significant differences in antibiotic susceptibility between different biovars. M. morganii ssp. morganii strains are more susceptible to tetracycline than strains of M. morganii ssp. sibonii, but there is no evidence that this parameter could be useful to differentiate biovars within a subspecies. It could be shown that 8 of 30 strains of biovar A and 2 of 12 strains of biovar B were tetracycline resistant. However, one M. morganii ssp. sibonii strain was clinically susceptible to tetracycline according to French and American standards. (III): The natural population of M. morganii is primarily (naturally) resistant to certain penicillins like benzylpenicillin, oxacillin, and amoxicillin, first and second generation cephalosporins (excluding cefoxitin), cefpodoxime, all antibiotics of the ML group (macrolides and lincosamides), sulfamethoxazole, glycopeptides, fosfomycin, and fusidic acid, naturally sensitive to aminoglycosides, piperacillin, mezlocillin, ticarcillin, third and fourth generation cephalosporins, carbapenems, aztreonam, quinolones, trimethoprim, cotrimoxazole, and chloramphenicol. M. morganii is naturally resistant to a wide range of antibiotics. The natural resistance pattern is useful for validation of sensitivity tests. Susceptibility to antibiotics is an unsuitable parameter for the discrimination of the described subspecific taxa of M. morganii. M. morganii strains that do not belong to biovar A are rare.

Anti-Bacterial Agents↗
PubMed2003

The current management strategies for community-acquired urinary tract infection.

Acute uncomplicated UTI is one of the most common problems for which young women seek medical attention and accounts for considerable morbidity and health care costs. Acute cystitis or pyelonephritis in the adult patient should be considered uncomplicated if the patient is not pregnant or elderly, if there has been no recent instrumentation or antimicrobial treatment, and if there are no known functional or anatomic abnormalities of the genitourinary tract. Most of these infections are caused by E. coli, which are susceptible to many oral antimicrobials, although resistance is increasing to some of the commonly used agents, especially TMP-SMX. In women with risk factors for infection with resistant bacteria, or in the setting of a high prevalence of TMP-SMX-resistant uropathogens, a case can be made for using a fluoroquinolone or nitrofurantoin. Use of nitrofurantoin for the empiric treatment of mild cystitis is supportable from a public health perspective in an attempt to decrease uropathogen resistance because it does not share cross-resistance with more commonly prescribed antimicrobials. Beta-lactams and fosfomycin should be considered second-line agents for empiric treatment of cystitis. Acute pyelonephritis in an otherwise healthy woman may be considered an uncomplicated infection. Fluoroquinolone regimens are superior to TMP-SMX for empiric therapy because of the relatively high prevalence of TMP-SMX resistance among uropathogens causing pyelonephritis. TMP-SMX, effective for patients with mild to moderate disease, is an appropriate drug if the uropathogen is known to be susceptible. It is reasonable to use a 7- to 10-day oral fluoroquinolone regimen for outpatient management of mild to moderate pyelonephritis in the setting of a susceptible causative pathogen and rapid clinical response to therapy. Most women with acute uncomplicated pyelonephritis are now managed safely and effectively as outpatients. Acute uncomplicated cystitis or pyelonephritis in healthy adult men is very uncommon but is generally caused by the same spectrum of uropathogens with the same antimicrobial susceptibility profile as that seen in women. The choice of antimicrobials is similar to that recommended for cystitis in women except that nitrofurantoin is not considered a good choice. Treatment duration should generally be longer than that recommended for women.

Anti-Infective Agents↗
PubMed2000

Resistance of bacteria in urinary tract infections.

Bacterial infection of the urinary tract is a common health problem in young women but also the most common nosocomial infection (>33%) contributing to the mortality of patients, and increasing the duration and cost of hospitalization. Escherichia coli is the most predominant organism and its prevalence varies in different studies. The high consumption of inappropriately prescribed antibiotics, combined with multiple pathology and frequent use of invasive devices, is a major factor contributing to high levels of resistance. There is a serious decrease in susceptibility of E. coli strains to amoxycillin, due to the presence of R-TEM enzymes, to cotrimoxazole and trimethoprim. Nitrofurantoin and fosfomycin-trometamol remain highly active against urinary Enterobacteriaceae, with over 90% of E. coli being susceptible. Knowledge of the most likely causative organisms and the prevalence of resistance pathogens to antimicrobial agents is essential to select antibiotics and to establish guidelines for the empirical treatment of urinary tract infections.

Drug Resistance, Microbial↗
PubMed2003

Natural antibiotic susceptibility of strains of Serratia marcescens and the S. liquefaciens complex: S. liquefaciens sensu stricto, S. proteamaculans and S. grimesii.

The natural susceptibility of 77 strains of Serratia marcescens and 41 strains of the S. liquefaciens complex (S. liquefaciens sensu stricto (n=21), S. grimesii (n=10), S. proteamaculans (n=10)) to 70 antibiotics was examined using a microdilution procedure in Isosensitest broth (all strains) and cation-adjusted Mueller Hinton broth (some strains). All species were naturally resistant to benzylpenicillin, oxacillin, cefaclor, cefazolin, cefuroxime, numerous macrolides, lincosamides, streptogramins, glycopeptides, rifampicin and fusidic acid. Uniform natural sensitivity was found to most aminoglycosides, several acylureidopenicillins, ticarcillin, newer cephalosporins, carbapenems, aztreonam, quinolones and antifolates. Species-related differences in susceptibility affecting clinical assessment criteria were found for several agents. S. marcescens was less susceptible to some aminoglycosides than species of the S. liquefaciens group. It was the only species that was uniformly naturally resistant to tetracycline, amoxycillin, amoxycillin/clavulanate and loracarbef. Species of the S. liquefaciens group were naturally resistant and intermediate or naturally intermediate to the latter agents. Differences in susceptibility among the species of the S. liquefaciens complex were generally small. S. proteamaculans was most susceptible to sulphamethoxazole. S. liquefaciens sensu stricto was less susceptible than S. grimesii and S. proteamaculans to tetracyclines, chloramphenicol and nitrofurantoin; it was the only species uniformly naturally resistant to fosfomycin. This study suggested that all species examined probably express chromosomally-encoded AmpC beta-lactamases, but the amount of enzyme may vary from species to species. The naturally-occurring low-level expression of the S. marcescens aminoglycoside 6'-acetyltransferase AAC(6')-Ic and its absence in other Serratia spp. was supported by the data. All species of the S. liquefaciens complex should be considered as probable agents of human diseases.

Anti-Bacterial Agents↗
PubMed2003

Empirical treatment of acute cystitis in women.

Empirical antimicrobial treatment for acute cystitis in women requires continuing reassessment as the antimicrobial susceptibility of community isolates of Escherichia coli evolves. Current recommendations for 3 days trimethoprim or trimethoprim/sulphamethoxazole are compromised by increasing resistance of community E. coli to these agents. Fluoroquinolones are an alternate 3-day therapy, but increasing resistance is being reported from some countries, and widespread community use may promote resistance, limiting effectiveness of these agents for more serious infections. Alternate regimens supported by recent clinical trials suggest pivmecillinam given twice daily for 7 days is as effective as 3 days of quinolone therapy, while microbiological cure is 80% with 3 days therapy twice daily, and 90% with 3 days therapy thrice daily. Nitrofurantoin given for 7 days has a cure rate of 80-85%. Fosfomycin trometamol as a single dose has cure rates of 75-85%. All these agents are effective, but a compromise in efficacy or duration of therapy compared with current 3-day regimens may have to be considered.

Acute Disease↗