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PubMed2000

In vitro activity of 19 antimicrobial agents against 3513 nosocomial pathogens collected from 48 Canadian medical centres. The Canadian Antimicrobial Study Group.

Antimicrobial resistance is a global concern. Differentiation between susceptibility rates for nosocomial versus community pathogens is important epidemiologically because it impacts on the appropriate empirical selection of antimicrobial therapy for infected patients. We studied resistance rates for 3513 nosocomial pathogens from 48 Canadian medical centres tested against 19 antimicrobial agents. The following are percent susceptibility for ceftazidime, ceftriaxone, ciprofloxacin, imipenem, netilmicin, and ticarcillin/clavulanic acid, respectively: Enterobacteriaceae 95, 95, 97, 99 98, 89; Escherichia coli, all 99 except ticarcillin/clavulanic acid (91); Enterobacter spp. 78, 78, 96, 99, 99, 71; Citrobacter spp. 79, 80, 89, 100, 94, 73; Proteus spp. 99, 88, 99, 88, 99, 98; Pseudomonas aeruginosa 88, 20, 82, 88, 81, 36; Staphylococcus aureus, all > 95; Enterococcus spp. 4, 9, 62, 95, 43, 38. Susceptibility rates for other species of microorganisms and agents tested varied considerably. Some institutions had higher than average resistance rates for some pathogens (i.e. P. aeruginosa) and some agents. Detection and continued surveillance of antimicrobial resistance amongst nosocomial pathogens is vital to patient care and health care resources. The control of antimicrobial resistance can help maintain antibiotic usage and costs associated with the use of ever more potent drugs and the treatment of increasingly resistant infections.

Canada↗
PubMed2001

In vitro susceptibility to 15 antibiotics of vibrios isolated from penaeid shrimps in Northwestern Mexico.

The sensitivity of 144 isolates of Vibrio spp isolated from shrimp was compared using common antibiotics and those used in the shrimp industry. The in vitro susceptibility of the isolates was studied using amikacin, ampicillin, carbenicillin, cephalothin, cefotaxime, ceftriaxone, chloramphenicol, gentamicin, netilmicin, nitrofurantoin, pefloxacin, trimethoprim-sulphamethoxazole, enrofloxacin, oxytetracycline and florfenicol. The relationship between the minimum inhibitory concentration and the disk inhibition zone was also studied for some antibiotics.

Animals↗
PubMed2003

Evolution of aminoglycoside resistance phenotypes of four Gram-negative bacteria: an 8-year survey in a University Hospital in Greece.

In order to determine the resistance patterns and evolution trends of four common Enterobacteriaceae (Escherichia coli, Proteus spp., Klebsiella spp. and Enterobacter spp.), aminoglycoside resistance phenotypes of 8917 non-repetitive strains, isolated over an 8-year period, were analysed. Phenotypes were defined by examining the susceptibility of the strains to a panel of aminoglycosides, using disk diffusion method. A large diversity of different resistance phenotypes was encountered. A significant progressive increase in the proportions of wild-type E. coli strains was noted. Among resistant strains of Enterobacter spp. and Klebsiella spp., the incidence of phenotype KTANt (kanamycin, tobramycin, amikacin and netilmicin), indicative of AAC(6')-I production, was very high (66.7 and 46.5%, respectively). Phenotypes indicative for gentamicin-modifying enzymes as well as broad-spectrum combinations (combinations of gentamicin-modifying enzymes with AAC(6')-I) were infrequent.

Aminoglycosides↗
PubMed1998

Susceptibility of adherent organisms from Pseudomonas aeruginosa and Staphylococcus aureus strains isolated from burn wounds to antimicrobial agents.

To assess the bactericidal effects of ciprofloxacin, netilymicin, and polymyxin B on adherent Pseudomonas aeruginosa organisms and also the bactericidal effects of ciprofloxacin, vancomycin and teicoplanin on adherent Staphylococcus aureus cells, a simple end-point microplate assay, based on the method described by Miyake et al. was used in the present study. As results of the assay, the minimal inhibitory concentration (MICADH) values are taken, which express the susceptibility of the bacterial cells spontaneously released from the surface of adherent microcolonies to antimicrobial agents. Also, a minimal bactericidal concentration (MBCADH) value was read, which is defined as the lowest antibiotic concentration required to kill the sessile bacterial cells. For twenty P. aeruginosa strains and nineteen S. aureus strains isolated from burn wounds, an enhanced resistance against bactericidal action of the applied antibiotics was observed when bacterial cells were attached to polystyrene surface. The MICADH values were comparable with the conventional MIC values only for ciprofloxacin and netilmicin for P. aeruginosa strains. The MBCADH values exceeded many times the conventional MBC values for the majority of strains. The validity of the assay was estimated in the experiment designed to determine the concentration of ciprofloxacin that should be released topically from the collagen dressing to prevent the biomaterial from microbial colonization and allow the decontamination of the wound.

Anti-Bacterial Agents↗
PubMed1999

A multi-centre study of nosocomial methicillin-resistant Staphylococcus aureus in Greece. Greek MRSA Study Group.

All 105 non-replicate consecutive Staphylococcus aureus strains isolated in 1997 from seven Greek hospitals, were found to be susceptible to vancomycin, teicoplanin and chloramphenicol, but only five (8%) were susceptible to all 16 antibiotics tested. Forty-three (41%) isolates were methicillin-resistant, 58% homogeneously (homMRSA) and 42% heterogeneously (hetMRSA). Resistance of homMRSA strains to other antibiotics was generally high (88-100%), although only one strain was resistant to netilmicin. Resistance in hetMRSA (6-39%) or in MSSA (5-11%) was significantly lower. Consequently, the majority (76%) of homMRSA were multi-drug resistant, while the dominant phenotype of hetMRSA and MSSA was resistance to penicillin (50% and 76%, respectively). Comparison of these strains with isolates from 1994 showed higher resistance rates to erythromycin among MSSA, to erythromycin and amikacin among hetMRSA and to rifampicin among homMRSA strains.

Anti-Bacterial Agents↗
PubMed2000

Susceptibility of Polish clinical strains of Yersinia enterocolitica serotype O3 to antibiotics.

A total of 199 clinical strains of Yersinia enterocolitica serotype O3, biotype 4 were tested for their susceptibility to antibiotics (158 strains carried the virulence plasmid pYV and 41 strains did not). A total of 114 isolates were tested by a standard disk diffusion method for 21 antibiotics. Almost all strains tested were resistant to ampicillin and cefazolin and susceptible to amoxycillin/clavulanate, cefaclor, cefamandole, cefuroxime, cefotaxime, ceftriaxone, aztreonam, imipenem, gentamicin, amikacin, netilmicin, tetracycline, doxycycline, chloramphenicol, ciprofloxacin, sulphamethoxazole, trimethoprim, co-trimoxazole and furazolidone. In addition, minimal inhibitory concentrations of 15 antibiotics were determined by the agar dilution method for all 199 strains (158 carrying plasmid pYV and 41 strains that did not). Third-generation cephalosporins such as cefotaxime and ceftriaxone and a fluoroquinolone (ciprofloxacin) were the most active antimicrobial agents tested followed by aztreonam, imipenem, trimethoprim, tetracycline, gentamicin, chloramphenicol, amoxycillin/clavulanate, cefaclor, cefuroxime, amikacin, furazolidone and sulphamethoxazole. The present study demonstrated a high susceptibility of clinical strains of Y. enterocolitica to most of the tested antibiotics. In general there was no significant difference between susceptibility to antibacterial agents of strains with or without plasmid pYV.

Drug Resistance, Microbial↗
PubMed2000

[Meningitis and interferon-alpha in the cereprospinal fluid. What diagnostic and therapeutic approach? A case report].

BACKGROUND: In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis. The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult. The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude. CASE REPORT: A six-week-old infant, exclusively breast-fed, was hospitalized for fever. The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia. The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative. The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams. The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis. CONCLUSION: In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification.

Amoxicillin↗
PubMed2000

Serotype, antimicrobial susceptibility and clone distribution of Pseudomonas aeruginosa in a university hospital.

To study the epidemiology of Pseudomonas (P.) aeruginosa, serotyping and antibiotic susceptibility testing were performed on 208 clinical isolates. Sixteen of these isolates were additionally examined by pulsed-field gel electrophoresis (PFGE) of chromosomal DNA. All 208 isolates belonged to 13 of the 16 described serotypes. Thirty isolates (14.4%) belonged to serotype O6, 75 (36%) to serotype O11 and 53 (25.6%) to other serotypes, 42 (20.2%) were polyagglutinating and eight (3.8%), autoagglutinating. Twenty-six per cent of isolates were resistant to piperacillin, 9.1% to ceftazidime, 9.6% to imipenem, 45.7% to ciprofloxacin, 39.9% to amikacin, 51% to gentamicin, 48.6% to netilmicin and 45.2% to tobramycin. Antibiotic resistance varied according to serotype and was highest in serotype O11. Sixteen isolates were analysed by PFGE; nine were multiresistant serotype O11 isolates recovered in four hospital units, while seven were susceptible serotype O6 or O11 isolates from a single unit. The multiresistant serotype O11 isolates had two PFGE patterns indicating that they were capable of spreading: one PFGE pattern was shared by the isolates recovered in spring and the other by those recovered in autumn 1997. The seven susceptible O6 and O11 isolates from a single unit had seven different PFGE patterns. Our results have shown that serotype O11 was the most prevalent P. aeruginosa serotype in our hospital and that its antibiotic resistance was high. The discriminatory power of serotyping is inadequate to permit the tracing of different strains. Macrorestriction analysis of chromosomal DNA was found to provide the best means of strain discrimination.

Anti-Bacterial Agents↗
PubMed1991

Susceptibilities of motile Aeromonas sp. to antimicrobial agents.

Resistance to antimicrobial agents of 106 isolates of motile Aeromonas sp. was characterized. The results indicated that in vitro susceptibilities among the three species of the motile Aeromonas sp. were similar, and only the distribution of susceptibility to cephalothin was different. The percentage of resistance of A. sobria strains was lower than the percentage of the resistant strains of A. hydrophila and A. caviae. All of the isolates were susceptible to kanamycin, nalidixic acid, tobramycin, amikacin, netilmicin, cefuroxime, ceftriaxone, cefoperazone and cefotaxime. Three of the tested strains (two A. hydrophila and one A. caviae) transferred resistance plasmids to the Aeromonas hydrophila recipient.

Aeromonas↗
PubMed2000

Evolution of antimicrobial prophylaxis in cardiovascular surgery.

OBJECTIVE: To examine the optimal duration of antibiotic prophylaxis in major cardiovascular surgery. MTHODSs: In the past 15 years, four prospective randomized, controlled studies, conducted by the same group of authors, compared seven prophylactic antimicrobial regimens in 2970 patients undergoing major cardiovascular surgery. In 1980/81, a 4-day cefazolin (CFZ) prophylaxis was compared with a 2-day cefuroxime (CFX) administration (n=566). In 1982/83, a 2-day CFX prophylaxis was compared with a two shot ceftriaxone (CRO) prophylaxis (n=512). In 1984/87, a 1-day CFZ prophylaxis was compared with a single shot prophylaxis of CRO (n=883). In 1994/1995, a 4 day combination of amoxicillin (AM) and netilmicin (NET) prophylaxis was compared with a single shot prophylaxis of CFX (n=1009). RESULTS: Total infection rate varied between 4.5 and 5.7%, despite different antimicrobial regimen used and their varying duration. Wound infection rate was 1.1% (range 0.4-2.5%), sepsis rate was 0.8% (range 0.4-1.6%), pneumonia rate 2% (0.7-2.9%), urinary tract infection rate 0.4% (range 0-1.4%), and central venous catheter-related infection rate was 0.4% (0-1%). The 30-day mortality rate was 1.3% (range 0.4-2%). All these differences were not statistically significant. CONCLUSIONS: A low infection rate (range 4.5-5.7%) occurred despite changes in duration of various prophylactic antibiotic regimen with cephalosporins of first, second or third generation. As a single shot prophylaxis could nowadays successfully be used in cardiovascular surgery, no postoperative antibiotics should be used, unless an intraoperative or a postoperative infection is documented or in presence of major perioperative complications.

Antibiotic Prophylaxis↗
PubMed2003

Infections with rapidly growing mycobacteria: report of 20 cases.

OBJECTIVES: A series of cases infected with rapidly growing mycobacteria was studied to determine the spectrum of disease, antimicrobial susceptibility, treatment, and outcome. METHODS: The cases identified as infections with rapidly growing mycobacteria in Ramathibodi Hospital from January 1993 to December 1999 were retrospectively studied. RESULTS: Most of the cases had no underlying disease. Only two cases were HIV-infected patients. The presenting clinical features were lymphadenitis (seven cases), skin and/or subcutaneous abscess (seven cases), localized eye infection (four cases), pulmonary infection (one case), and chronic otitis media (one case). Four of seven cases with lymphadenitis had Sweet's syndrome, and one had psoriasis as an associated skin manifestation. Anemia was present in five cases, and improved with treatment of the primary disease. The organisms were Mycobacterium chelonae/abscessus group (17 cases) and Mycobacterium fortuitum group (three cases). Susceptibility patterns of the organisms showed susceptibility to amikacin, netilmicin, and imipenem. M. fortuitum group was susceptible to more antibiotics than M. chelonae/abscessus group. The clinical responses corresponded to the antimicrobial susceptibility. Combinations of two or more drugs were used for the medical treatment. Surgical resection was performed where possible, to reduce the load of the organism, especially in cases with very resistant organisms. CONCLUSIONS: Infections with rapidly growing mycobacteria can occur in apparently normal hosts. The clinical syndrome is variable. The pathology is nonspecific. Clinical responses varied, but seemed to correlate with the in vitro susceptibility result. More studies are needed to enable us to deal with this infection effectively.

Adolescent↗
PubMed1986

Speciation, serotyping, antimicrobial sensitivity and plasmid content of Proteeae from the environment of calf-rearing units in South West England.

A survey was undertaken of the occurrence, serotype, antimicrobial sensitivity and plasmid content of members of the tribe Proteeae in the environment of two calf-rearing units in the county of Avon in South West England. Examples of the following species were found: Proteus mirabilis, Prot. vulgaris, Prot. vulgaris Biogroup 2, Morganella morganii, Providencia stuartii, Prov. alcalifaciens and Prov. rettgeri. A wide range of serotypes was found, many having been previously reported from nosocomial isolates. A total of 15% of isolates carried plasmids; six pairs of isolates were identified which had identical serotypes but different patterns of plasmid carriage. The antimicrobial sensitivity of the isolates was generally similar to isolates of Proteeae from humans. Although no truly aminoglycoside-resistant isolates were found, some isolates of Prov. stuartii and Prov. rettgeri had MIC's higher than the other isolates to gentamicin and netilmicin, suggesting the presence of low levels of the enzyme AAC 2'. The study demonstrates that there is a considerable diversity of species and types of Proteeae associated with calves and their environment. It seems likely that a potential cause of colonization of the human gut by Proteeae is the consumption of meat.

Animals↗
PubMed1992

Apramycin resistance plasmids in Escherichia coli: possible transfer to Salmonella typhimurium in calves.

An outbreak of salmonellosis in calves was monitored for persistence of Salmonella typhimurium excretion in faeces and the effect of treatment with apramycin. Prior to treatment apramycin-resistant Escherichia coli were present but all S. typhimurium isolates were sensitive. Following the treatment of six calves with apramycin, apramycin-resistant S. typhimurium were isolated from two treated calves and one untreated calf. Plasmid profiles of E. coli and S. typhimurium were compared and plasmids conferring resistance to apramycin and several other antibiotics were transferred by conjugation in vitro from calf E. coli and S. typhimurium isolates to E. coli K-12 and from E. coli to S. typhimurium. The plasmids conjugated with high frequency in vitro from E. coli to S. typhimurium, and hybridized to a DNA probe specific for the gene encoding aminoglycoside acetyltransferase 3-IV (AAC(3)-IV) which confers resistance to apramycin, gentamicin, netilmicin and tobramycin.

Animals↗
PubMed1994

Apramycin-resistant Escherichia coli isolated from pigs and a stockman.

Escherichia coli serotype O147:K89:K88a,c was found to be associated with outbreaks of diarrhoea in preweaner pigs of up to 4 weeks of age on a pig unit. Resistance to apramycin, gentamicin, netilmicin, tobramycin and other antibiotics was associated with conjugative plasmids of approximately 62 kb. The presence of a gene which encoded for the aminoglycoside acetyltransferase enzyme AAC(3)IV was confirmed by DNA hybridization. Samples collected during the following 12 months revealed widespread dissemination of these resistance plasmids in non-serotypable, non-haemolytic E. coli throughout the farm. Apramycin-resistant E. coli were also isolated from a stockman and it appeared from plasmid profile analysis and antibiotic sensitivity testing that the human isolates carried the same plasmid as that carried by the porcine E. coli. Klebsiella pneumoniae, with a slightly smaller conjugative plasmid and similar resistance pattern, was isolated from the stockman's wife.

Agricultural Workers' Diseases↗
PubMed1993

Human isolates of apramycin-resistant Escherichia coli which contain the genes for the AAC(3)IV enzyme.

Gentamicin-resistant Escherichia coli isolated at different periods from patients in two hospitals were tested for resistance to the aminoglycoside antibiotic apramycin. Twenty-four of 93 (26%) gentamicin-resistant isolates collected from the Royal Liverpool Hospital between 1981 and 1990 were resistant to apramycin. Thirteen isolates were highly resistant to apramycin (minimal inhibitory concentration (MIC) > or = 1024 micrograms/ml), were also resistant to gentamicin, netilmicin and tobramycin, and hybridized with a DNA probe derived from the aminoglycoside acetyltransferase (3)IV (AAC(3)IV) gene. The proportion of gentamicin-resistant isolates which had high level resistance to apramycin increased from 7% in 1981-5 to 24% in 1986-90. Twelve gentamicin-resistant E. coli from Guy's and St Thomas's Hospital isolated between 1977 and 1980 were also tested for resistance to apramycin. For five of these isolates the MICs of apramycin was 32-256 micrograms/ml. None was shown to have a conjugative plasmid carrying resistance to apramycin and only one hybridized with the DNA probe for the AAC(3)IV enzyme.

Acetyltransferases↗
PubMed1979

Renal tubular transport of gentamicin in the rat.

The renal handling of gentamicin in the rat was examined by clearance, microinjection, and renal cortical-slice techniques. The steady-state renal clearance of 14C-gentamicin, when corrected for the 7.5% binding to plasma protein, was not significantly different from that of 3H-inulin. At the end of the renal clearance experiments, the cortical concentration of gentamicin was 93 +/- 7 microgram/g of tissue (N = 7), a concentration threefold greater than that of the medulla and 20-fold greater than that of serum. Absorption of 3H-gentamicin along the proximal convoluted tubule and loop of Henle was demonstrated by the tubular microinjection technique. No reabsorption of 3H-gentamicin was detected beyond the early distal convoluted tubule. The tubular absorption of 3H-gentamicin was load dependent. Fractional absorption of 3H-gentamicin averaged 30.1 +/- 2.7% when the dose of 3H-gentamicin injected into early proximal tubular convolutions averaged 132 +/- 17 pg. It was decreased to 13.6 +/- 2.6% when the microinjected dose of gentamicin was increased to 1996 +/- 388 pg. No evidence of transtubular absorption of 3H-gentamicin was detected during the microinjection experiments. Microperfusion of pertubular capillaries failed to demonstrate urinary precession of 3H-gentamicin over 14C-inulin, a finding which argues against a rapid transtubular secretory flux of gentamicin. Significant uptake of gentamicin was demonstrated by renal cortical slices incubated in medium containing 14C-gentamicin. The accumulation of 14C-gentamicin by renal cortical slices was not inhibited by probenecid or N1-methylnicotinamide but was inhibited by netilmicin and tobramycin. These data support the conclusion that the renal accumulation of gentamicin reflects transport of gentamicin across both the apical and basolateral membranes of proximal tubular epithelium.

Animals↗
PubMed2001

Effect of some fractions of alveolar surfactant (phospholipids and SP-A) on the bactericidal activity of different antimicrobials against some respiratory pathogens.

OBJECTIVES: To investigate the effects of physiologic concentrations, at alveolar level, of some fractions of pulmonary surfactant (phospholipids and SP-A) on the bactericidal activity of different antimicrobials against some respiratory pathogens. METHODS: The antimicrobial agents cefdinir, sparfloxacin, clarithromycin, teicoplanin, cefepime, ciprofloxacin, netilmicin and tobramycin, depending on their specific activity, were investigated against Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae and Pseudomonas aeruginosa. Killing curves were carried out with antimicrobials at 0.5 and 2 MIC, SP-A at 1 and 5 mg/L and phospholipids at 50 mg/L. RESULTS: Time-kill experiments showed that while SP-A never modified the activity of antimicrobials, phospholipids exerted, in some cases, a weak antagonistic effect. Among antibacterials and pathogens investigated, phospholipids were able to decrease the rate of killing of cefepime and ciprofloxacin only on P. aeruginosa, both at 0.5 and at 2 MIC, with an increase of about 1 log in CFU. The combination of SP-A and phospholipids never modified the effect observed in the presence of lipids alone. CONCLUSIONS: The paucity of data only allow us to observe that the examined antibiotics do not have substantially reduced activity against respiratory pathogens studied in the presence of physiologic concentrations of some fractions of surfactant. Cefepime alone already exerted a small effect, and ciprofloxacin at 2 MIC, even in the presence of phospholipids, retained its bactericidal activity.

Anti-Bacterial Agents↗
PubMed2002

Transferable plasmid mediating resistance to multiple antimicrobial agents in Klebsiella pneumoniae isolates in Greece.

OBJECTIVE: To investigate the underlying resistance mechanisms in 10 Klebsiella pneumoniae isolates. METHODS: Ten K. pneumoniae strains according to distinct bacteriocin typing and REP-PCR, were examined for their plasmid content, their ability to transfer their resistance to aminoglycosides and third-generation cephalosporins, and their production of aminoglycoside-modifying enzymes and beta-lactamases. RESULTS: Transfer of resistance to the above-mentioned antibiotics as well as to co-trimoxazole and tetracycline in Escherichia coli strain RC 85 at a frequency of 5-106 was achieved for all strains by conjugation. Similar strains harbor a self-transferable multiresistant plasmid (80 kb) with similar EcoRI and HindIII restriction patterns. This plasmid encodes an extended-spectrum beta-lactamase which confers high-level resistance to third-generation cephalosporins and aztreonam. It produces SHV-5 beta-lactamase, as demonstrated by isoelectric focusing and DNA sequencing. Aminoglycoside resistance was co-transferred, and AAC(6')-I, mediating resistance to gentamicin, tobramycin, netilmicin and amikacin, and AAC(3)-I, mediating resistance to gentamicin and sisomycin, were encoded in all isolates and their transconjugants, while APH(3')-I, mediating resistance to kanamycin and neomycin, was encoded in seven strains. CONCLUSIONS: It appears that a multiresistant transferable plasmid encoding the SHV-5 beta-lactamase, causing unusually high resistance to ceftazidime and aztreonam, and the combination AAC(6')-I + AAC(3)-I of acetylating enzymes causing, also resistance to all clinically available aminoglycosides, is established in K. pneumoniae in Greece.

Anti-Bacterial Agents↗