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[Epidemiology of S. aureus cross-infections in dermatological wards].

Over a three-year period, 196 of 3115 patients admitted in a dermatological department became infected with S. aureus (6,2 %). 205 strains of S. aureus were isolated. Serologic typing, phage-typing and antibiotic sensitivity tests revealed 3 epidemic and 2 endemic strains. The 3 epidemic strains infected 24 patients: 12 from july to november 1972 were infected with a serotype 66438 S. aureus resistant to fusidic acid. 6 patients (male) were infected with a serotype III in february and march 1972; 8 patients were contaminated with a serotype 18 S. aureus from december 1973 to february 1974, after staying in a surgical department. Of the 2 endemic strains 1, phage-pattern 53/79, is non-typable by serologic-typing; this strain has been observed only in the dermatological department and 20 patients were infected with, from january to october 1974. The second endemic strain, phage-pattern 81/+ serotype I, cross-infected 16 patients during this three-year survey; 12 of them were admitted repeatedly. During this three-year survey, it could be proved that, at least, 1 out of 3 patients is infected with an epidemic or an endemic strain. We can suggest that the factors enhancing cross-infection in dermatological department are: the sex of patients (80 % were male); presence of a tween splitting enzyme by S. aureus promotes growth of Staphylococci on the skin; patients transfered from a department to another or repeatedly admitted are more often infected. But, as they are source of some outbreaks, they need special measures (asepsis and hygiene); corticoïds or immunodepressors enhance cross-infection; antibiotics must not be only limited but varied too.

Cross Infection↗

In-vitro activity of piperacillin and tazobactam combination against clinically significant bacteria.

The in-vitro activity of piperacillin/tazobactum which is not among the routinely tested antibiotic at the Public Health Bacteriology Laboratory, Parirenyatwa Hospital, Harare, Zimbabwe was evaluated for its activity against bacterial pathogens using the Kirby-Bauer disk diffusion method. Piperacillin/tazobactum showed superior in-vitro activity against both gram positive and gram negative bacteria when compared with routinely tested antibiotics such as gentamicin, erythromycin, tetracycline, penicillin, chloramphenicol, fusidic acid and clindamycin and the difference was statistically significant (p < 0.05). Ciprofloxacin showed in-vitro activity comparable to that of tazobactam/piperacillin. Specifically, 96% of gram positive isolates (comprising Streptococcus pyogenes, Staphylococcus aureus, coagulase negative staphylococci and Streptococcus pneumoniae were sensitive to piperacillin/tazobactam. For gram negative organisms, 98% of Haemophilus influenzae Shigella spp, Klebsiella spp were also sensitive to the combination. The broad spectrum of activity of piperacillin/tazobactam shows that the potential of the drug combination for the treatment of infections caused by diverse microorganisms should not be underestimated. We recommend its inclusion in routine antibiotic sensitivity testing in our hospital.

Drug Evaluation, Preclinical↗

[Drug resistance in nosocomial strains of staphylococci to methicillin].

The aim of the present study was the analysis of drug susceptibility of MRSA and MRCNS strains isolated from patients hospitalized in 14 wards of the State Clinical Hospital No 1 in Warsaw. The strains were identified (ID 32 STAPH), and their susceptibility to antimicrobial agents (ATB STAPH) was determined in ATB system (bioMérieux, France). Four methods were applied to confirm the resistance to methicillin: ATB-plus system, disc-diffusion method (Oxa 1 microgram, Oxoid, U.K.), Crystal MRSA ID (Becton Dickinson-BBL, USA) and agar screen test in TSA medium (Difco, USA) with methicillin (25 mg/l, Sigma, USA). 108 Staphylococcus spp. strains were found in 300 clinical specimens. 56 strains were methicillin-resistant (52%). Among methicillin-resistant strains 13 MRSA, 28 MRSE and 15 of other species were found. All MRSA strains were susceptible to vancomycin, teicoplanin and fusidic acid. MRCNS were susceptible first of all to vancomycin (43/43), minocycline (42/43) and pristinamycin (42/43). On the basis of the obtained results it can be stated that methicillin-resistant staphylococci occur in hospital wards. The greatest number of methicillin-resistant strains was cultured from patients hospitalized in surgery wards (32), methicillin-resistant strains much more frequently occur among coagulase-negative staphylococci, especially in Staphylococcus epidermis. Glycopeptide antibiotics are most active against isolated MRSA strains. The most active therapeutic agent against MRCNS is vancomycin.

Cross Infection↗

Staphylococcus colonization in atopic dermatitis treated with fluticasone or tacrolimus with or without antibiotics.

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization and infection by Staphylococcus aureus. Treatment with topical anti-inflammatory drugs alone can reduce S. aureus colonization. OBJECTIVES: To compare the clinical severity of AD and the S. aureus colonization rate between AD patients treated with topical glucocorticoids and those treated with tacrolimus and to evaluate the effects of complementary topical antistaphylococcal antibiotic therapy and the development of fusidic acid-resistant S. aureus. METHODS: Sixty AD patients were enrolled in a prospective, parallel, randomized study of an 8-week treatment with topical 0.05% fluticasone propionate or 0.03% tacrolimus, with or without complementary fusidic acid. Disease severity scoring of AD based on SCORing of Atopic Dermatitis (SCORAD), colonization rate and density of S. aureus on the skin, and antibiotic susceptibility of S. aureus isolates were evaluated. RESULTS: The reduction in SCORAD scores correlated with the reduction of S. aureus numbers. Treatment with topical tacrolimus resulted in a comparable reduction in SCORAD scores to fluticasone but a slower eradication of S. aureus. Complementary fusidic acid had no additional benefit compared with fluticasone or tacrolimus alone. Two patients developed fusidic acid-resistant S. aureus after 8 weeks of fusidic acid treatment. CONCLUSION: Tacrolimus is an appropriate alternative treatment for chronic AD. Topical anti-inflammatory therapy alone to improve the allergic skin inflammation of AD can reduce S. aureus colonization of the skin. Topical antibiotics should be reserved for short-term use in obvious secondary bacterial infection.

Adolescent↗

PCR-based ordered genomic libraries: a new approach to drug target identification for Streptococcus pneumoniae.

Described here are the development and validation of a novel approach to identify genes encoding drug targets in Streptococcus pneumoniae. The method relies on the use of an ordered genomic library composed of PCR amplicons that were generated under error-prone conditions so as to introduce random mutations into the DNA. Since some of the mutations occur in drug target-encoding genes and subsequently affect the binding of the drug to its respective cellular target, amplicons containing drug targets can be identified as those producing drug-resistant colonies when transformed into S. pneumoniae. Examination of the genetic content of the amplicon giving resistance coupled with bioinformatics and additional genetic approaches could be used to rapidly identify candidate drug target genes. The utility of this approach was verified by using a number of known antibiotics. For drugs with single protein targets, amplicons were identified that rendered S. pneumoniae drug resistant. Assessment of amplicon composition revealed that each of the relevant amplicons contained the gene encoding the known target for the particular drug tested. Fusidic acid-resistant mutants that resulted from the transformation of S. pneumoniae with amplicons containing fusA were further characterized by sequence analysis. A single mutation was found to occur in a region of the S. pneumoniae elongation factor G protein that is analogous to that already implicated in other bacteria as being associated with fusidic acid resistance. Thus, in addition to facilitating the identification of genes encoding drug targets, this method could provide strains that aid future mechanistic studies.

Anti-Bacterial Agents↗

Identification by photo-affinity labeling of the proteins in Escherichia coli ribosomes involved in elongation factor G-dependent GDP binding.

Guanosine diphosphate esterified at the beta-phosphate group with the photolabile 4-azidophenol [1-(4-azidophenyl)-2-(5'-guanyl)pyrophosphate] was found to inhibit GDP binding to the ribosomes of E. coli. UV-irradiation of the fusidic acid-stabilized complex among ribosomes, elongation factor G, and the azidophenyl-GDP, results in selective attachment of the photo-affinity label to the proteins L5, L11, L13, L18, and L30. In addition, a substantial reduction of the amount of L16 present in irradiated ribosomes was found. Except for L13, no significant reaction of azidophenyl-GDP with the ribosomal proteins was observed when fusidic acid was omitted from the irradiation mixture. The results strongly suggest that L5, L11, L18, and L30 are involved in GDP binding. The possibility of a transient binding of GDP to L13 followed by migration to the actual GTPase site is discussed.

Azides↗

Fungal metabolite gliotoxin inhibits assembly of the human respiratory burst NADPH oxidase.

Reactive oxygen species are a critical weapon in the killing of Aspergillus fumigatus by polymorphonuclear leukocytes (PMN), as demonstrated by severe aspergillosis in chronic granulomatous disease. In the present study, A. fumigatus-produced mycotoxins (fumagillin, gliotoxin [GT], and helvolic acid) are examined for their effects on the NADPH oxidase activity in human PMN. Of these mycotoxins, only GT significantly and stoichiometrically inhibits phorbol myristate acetate (PMA)-stimulated O2- generation, while the other two toxins are ineffective. The inhibition is dependent on the disulfide bridge of GT, which interferes with oxidase activation but not catalysis of the activated oxidase. Specifically, GT inhibits PMA-stimulated events: p47phox phosphorylation, its incorporation into the cytoskeleton, and the membrane translocation of p67phox, p47phox, and p40phox, which are crucial steps in the assembly of the active NADPH oxidase. Thus, damage to p47phox phosphorylation is likely a key to inhibiting NADPH oxidase activation. GT does not inhibit the membrane translocation of Rac2. The inhibition of p47phox phosphorylation is due to the defective membrane translocation of protein kinase C (PKC) betaII rather than an effect of GT on PKC betaII activity, suggesting a failure of PKC betaII to associate with the substrate, p47phox, on the membrane. These results suggest that A. fumigatus may confront PMN by inhibiting the assembly of the NADPH oxidase with its hyphal product, GT.

Aspergillus fumigatus↗

Resistance of Staphylococcus aureus to sulphamethoxazole and trimethoprim.

Strains of Staphylococcus aureus isolated from the lesions of hospital patients were surveyed for resistance to sulphamethoxazole and to trimethoprim. Of 675 strains tested, 18.5% were resistant to sulphamethoxazole and 1.6% to trimethoprim. All the trimethoprim-resistant strains were resistant to sulphamethoxazole and to a 1:20 mixture of the two drugs. Trimethoprim-resistant strains were on average more resistant to sulphamethoxazole than were trimethoprim-sensitive strains. They were all resistant to several other antimicrobial agents. Most of them had the phage-typing pattern 84/85, 84, or 85.

Anti-Bacterial Agents↗