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PubMed1981

Toxic shock associated with tampon usage.

A case of a 30-year-old woman who developed fever, diarrhoea and vomiting during the third and fourth days of menstruation, during which she was using tampons, is presented. The patient was admitted to hospital on the fifth day in shock , semicomatose, and with a generalized erythroderma. A presumptive diagnosis of toxic shock syndrome was made. Aggressive resuscitative and antibiotic therapy achieved a favourable outcome. An unused tampon from the same packet grew a Staphylococcus aureus of the same antibiogram and phage type as that isolated from the vaginal culture.

Adult↗
PubMed1990

Endocarditis associated with prosthetic cardiac valves.

Clinical features, microbiology, therapy and outcome of 26 episodes of prosthetic valve endocarditis occurring at Westmead Hospital from 1979 to 1989 were examined retrospectively. Presentation with a new or changed cardiac murmur was associated with early onset infection (within 12 months of prosthetic valve insertion; P = 0.0033). Corynebacteria were the commonest cause of early onset endocarditis (4 of 11 episodes) and Streptococcus viridans of late onset endocarditis (4 of 15 episodes). Nine of 11 episodes responded to antimicrobial therapy and 12 of 15 to medical-surgical therapy. There was a trend towards increased mortality in patients with early onset endocarditis presenting with a new or changed cardiac murmur (4 of 9 v. 1 of 17, P = 0.068), suggesting early surgery should be considered in this group. Analysis of antibiograms and published reports indicated that vancomycin and an aminoglycoside should be recommended as empirical therapy for endocarditis occurring 12 to 18 months after prosthetic valve insertion.

Aminoglycosides↗
PubMed1999

Molecular epidemiology in the care of patients.

Several different epidemiologic typing methods have been applied in studies of microbial pathogens. These methods include the more traditional nonmolecular approaches as well as the more sophisticated molecular typing methods. Application of traditional epidemiologic typing methods, such as antibiogram, serotyping, biotyping, and phage typing, have occasionally been useful in describing the epidemiology of infectious diseases. However, these methods have generally been considered to be too variable, labor intensive, and slow to be of practical value in epidemiologic investigations. In response to these limitations, several techniques have been adopted from the molecular biology field for use as epidemiologic typing methods and have been applied in studies of bacteria, fungi, viruses, and protozoa. The most widely used molecular typing methods are the DNA-based methods, such as plasmid profiling, restriction endonuclease analysis of plasmid and genomic DNA, Southern hybridization analysis using specific DNA probes, and chromosomal DNA profiling using either pulsed-field gel electrophoresis or polymerase chain reaction-based methods. The various molecular typing methods may be applied to the investigation of outbreaks of infections or may be used in the context of epidemiologic surveillance. For outbreak investigation, typing methods are used to compare isolates from a suspected outbreak to delineate clonally related and unrelated strains with the goal of short-term control of transmission. In the context of epidemiologic surveillance, molecular typing methods may be used to monitor geographic spread and prevalence shifts of epidemic and endemic clones with the goal of long-term evaluation of preventive strategies or for the detection and monitoring of emerging and reemerging infections. The specific typing method selected may vary with the task at hand; however, the typing studies must always be used to supplement, rather than replace, careful epidemiologic investigation.

Bacterial Infections↗
PubMed1982

Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection.

A burn patient with a multiply antibiotic-resistant Staphylococcus aureus infection was transferred to Harborview Medical Center from a burn unit in another state. Despite standard wound precautions, transmission to 34 patients occurred during the subsequent 15 months. Twenty-seven of the patients were infected. Disease included pneumonia, empyema, bacteremia, endocarditis, osteomyelitis, and burn and wound infections. Seventeen of the 34 patients died. Phage typing and plasmid analysis showed the spread of multiply resistant S. aureus from the burn unit to the surgical intensive care unit where a study evaluating the use of chloramphenicol in cases of bowel sepsis was in progress. During this period the organism became resistant to chloramphenicol by acquiring either of two chloramphenicol R-plasmids. Using plasmid profiles and antibiograms, four epidemic strains were identified that assisted in identifying patient and personnel reservoirs. The outbreak was controlled only after rifampin was added to vancomycin treatment of infected patients, which correlated with eradication of the carrier state.

Adult↗
PubMed2000

Retrospective and longitudinal study of salmonellosis in captive wildlife in Trinidad.

Morbidity and mortality of captive wildlife at the Emperor Valley Zoo, Trinidad from 1993 to 1996 were analysed to determine involvement of Salmonella spp. A 6 mo longitudinal study was conducted to determine the frequency of isolation of Salmonella spp. from apparently healthy, sick and dead wild mammals, birds, and reptiles. The antibiograms of Salmonella isolates were determined using the disc diffusion method. Fecal samples randomly selected from animal enclosures and cloacal swabs of snakes were cultured for Salmonella spp. following enrichment in tetrathionate and selenite cystine broths. For the 1993-96 period, Salmonella spp. was implicated in 17 (12%) of 141 sick or dead animals and the predominant serotype was S. typhimurium. During the 6 mo prospective study in a mean animal population of 1,186, there were 20 (2%) and 14 (1%) animals that were sick and died respectively; Salmonella spp. was implicated in only one mortality. Overall, of 1,012 samples from apparently healthy wildlife cultured, 66 (7%) yielded 24 serotypes of Salmonella. The predominant serotype were S. seigburg (16 isolates), S. gaminara (6 isolates), and S. thompson (6 isolates). None of the samples yielded S. typhimurium. The frequency of isolation of Salmonella spp. in reptiles (14%) was significantly higher than found in either mammals (7%) or birds (3%). Sixty-five (99%) of 66 Salmonella spp. isolates exhibited resistance to one or more of the nine antimicrobial agents tested. Resistance was high to cephalothin (92%), moderate to streptomycin (35%) and tetracycline (29%), but significantly low to gentamicin (2%), chloramphenicol (0%), and sulphamethoxazole/trimethoprim (0%). The prevalence of asymptomatic infections by Salmonella spp. in zoo animals was high and the very high prevalence of antimicrobial resistance could be a problem when treating salmonellosis.

Animals↗
PubMed2006

[Antimicrobial susceptibility and mechanism of resistance to antibiotics for Escherichia coli O157 and verotoxin-producing E. coli isolated in northern Kyushu and Yamaguchi area].

The purpose of this study was to investigate the biochemical characteristics and antimicrobial susceptibility of Escherichia (E.) coli O157 and verotoxin-producing E. coli isolates from the Northern Kyushu Island and Yamaguchi area of Japan. A total of 54 isolates- 50 E. coli O157, 3 verotoxin-producing E. coli O26 and 1 verotoxin-producing E. coli O111 - were used in this study. Regarding H antigen, H7 type in E. coli O157 accounted for 98% (49/50), and residual 1 strain of E. coli O157 was untypable H type. Two of 3 E. coli O26 isolates were H11 type, residual 1 strain of E. coli O26 was untypable H type, and E. coli O111 isolate was non-motile strain. All 54 isolates were susceptible to cephems, fosfomycin, kanamycin, amikacin and co-trimoxazole. Tetracycline-resistant isolates existed in 13 of all 54 isolates, 5 of those 13 isolates had tetA, and the other 7 isolates had tetB. Eight amoxicillin-resistant isolates had TEM-1 beta-lactamase. Four of the 5 isolates that had tetA also had TEM-1 beta-lactamase. Nalidixic acid and 6 fluoroquinolone used had no insensitive or resistant isolates. Kanamycin-resistant isolates, fosfomycin- and nalidixic acid-insensitive isolates have been reported, so we must notice the antibiogram of such strains. It is important that the surveillance of antimicrobial susceptibility of enterohemorragic E. coli should be continued after this.

Amoxicillin↗
PubMed1976

[Bacteriological studies on the bile in different conditions of surgical interest].

A bacteriological study was carried out on bile taken, during the course of surgery, from 235 patients suffering from a wide variety of diseases, both benign and malignant, concerning the bile ways. The investigation, initially directed to the aerobic bile flora, was afterwards extended to include germs growing in strict anaerobiosis. The highest incidence of bactibilia was found in repeat operations for post-operative stenosis of the hepatocholedochus, followed by neoplasias of the gall-bladder or main bile duct, and calculosis of the gall-bladder. For germs growing in compulsory anaerobiosis the responses to the cultural test were all negative, while in two cases microaerophilic streptococci were isolated. Finally the results of the antibiograms made on the isolated microbial species are reported.

Bacteria↗
PubMed1994

Concurrent ceftazidime DUE with clinical pharmacy intervention.

Ceftazidime use at our institution, a 580-bed county teaching hospital, has steadily increased since its addition to the formulary in 1986. In response to this increased use and because the institutional antibiogram showed increased resistance by Pseudomonas aeruginosa (from 10 to 28% resistant), the P & T Committee requested that a drug use evaluation (DUE) of ceftazidime be conducted. Analysis of this retrospective pilot study showed that 87% of ceftazidime use was inappropriate. To further evaluate ceftazidime use, to identify problems not assessed during retrospective review, and to correct problems while patients were receiving the drug, a concurrent ceftazidime use evaluation was conducted. The methods and results of the concurrent review are presented below.

Ceftazidime↗
PubMed1998

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a Dublin paediatric hospital.

Klebsiella pneumoniae resistant to third-generation cephalosporins and gentamicin was isolated from two patients in a paediatric intensive care unit within a two-week period. The double-disc diffusion test indicated the presence of an extended-spectrum beta-lactamase (ESBL). The unit was closed to admissions, and stringent infection control procedures were implemented. Environmental screening and screening of staff and patients on the unit were commenced. Two weeks later, K. pneumoniae with an identical antibiogram was isolated from the urine of a patient in a different ward. Blood-culture isolates possessed the K16 antigen, while the urine isolate was non-typeable. The isolates were shown to be similar when banding patterns of XbaI chromosomal DNA digests were compared. The resistance to the extended-spectrum cephalosporins was shown to be transferable in association with a large plasmid > 98 mDa. Resistance to gentamicin always co-transferred with beta-lactamase resistance and appeared to be encoded by the same plasmid.

Child, Preschool↗
PubMedDate not supplied

[Prevention and treatment of infections in open heart surgery (author's transl)].

The incidence of bacterial infections in 207 patients who underwent cardiopulmonary bypass surgery is reported. The effectiveness of various prophylactic antibiotic therapies is debated on the basis of performed antibiograms and the results are compared with that obtained by other Authors using different treatments.

Anti-Bacterial Agents↗
PubMed1989

A multicenter model for examining in vitro susceptibilities of bacteria to antibiotics.

In vitro bacterial susceptibility data are often considered in both hospital formulary and antibiotic prescribing decisions. In this multicenter study, susceptibility data from 105 United States hospitals resulted in a database containing 211,142 isolates for 31 different bacteria and 38 antibiotics. To identify susceptibility patterns of bacteria to antibiotic alternatives, this computerized database was subjected to confidence interval analysis, while controlling for potential sources of random error. This paper describes the multicenter study design and provides several examples of the type of information the analysis can provide to P & Committee members and to practitioners who ultimately must make decisions regarding antibiotic use, sometimes without the benefit of complete hospital-specific historical antibiogram data. Limitations on the interpretation of aggregate in vitro susceptibility data gained from multiple institutions are also discussed.

Anti-Bacterial Agents↗
PubMed1999

[Trends in resistant bacteria isolated from a tube smear in intubated patients in intensive care].

Long standing antibiotics therapy has resulted in growing bacteria resistance. We took a tube smear and prepared culture with antibiogram from the fifty intubated patients in the Intensive care unit in the war period. Gram-negative germs were the dominant ones in total sum, and among them the Acinetobacter calcoaceticus (No 21), Pseudomonas aeruginosa (No 18), Klebsiella pneumoniae (No 18), were isolated most frequently. Pseudomonas aeruginosa showed high resistance to Gentamicin (64%), Amikacin (35%), Trimethoprim (66%), Pefloxacin (20%), Ofloxacin (25%), Ciprofloxacin (25%). Klebsiella pneumoniae is resistant to Gentamicin (68%), Amikacin (22%), Cephalosporin (100%), Trimethoprim (31%), but it showed no resistance to chinolones. Acinetobacter calcoaceticus is resistant to Gentamicin (73%), Amikacin (36%), Cephalosporin (100%), Trimethoprim (63%), Pefloxacin (33%), Ofloxacin (67%), Ciprofloxacin (46%). Staphylococcus aureus was the most frequent among Gram-positive germs and it was resistant to Penicillin (100%), Gentamicin (40%), Lincocin (18%), Trimethoprim (5%), Pefloxacin (13%), Methicillin (21%), Cephalosporin (8%). The appearance of resistance on the antibiotics demands attentive follow-up aiming to influence the empirical application of antibiotics schemes depending on resistance.

Bacteria↗
PubMed1999

[Dissolution of ammonium-magnesium phosphate lithiasis with medical systemic treatment. Report of a case].

Presentation of one case of ammonium-magnesium phosphate calculi breakdown using systemic medical treatment with oral Acetohydroxamine acid dosed at 125 mg/8 h and antibiotic therapy based on the antibiogram results. This type of treatment is generally used in an attempt to eradicate the infection, and as prophylaxis of relapse following surgical treatment or SWEL in these difficult to eradicate calculi due to their high tendency to recur.

Aged↗
PubMed1999

[Outbreak of methicillin-resistant Staphylococcus aureus in general hospital intensive care unit].

Mantes' hospital polyvalent intensive care unit (ICU) experienced an outbreak episode caused by methicillin resistant Staphylococcus aureus (MRSA). Suspicion of physicians was strengthened by observing the weekly reading of multiresistant germs and the significative increase of MRSA carriers incidence rate, compared with the number of admission in the ICU: 5.5% to 11.3%. This outbreak was surprising: it happened immediately after the installation in a new hospital and the reinforcement of nosocomial infection surveillance (systematic screening of every patient admitted to the I.U.C., his isolation if he presents risk factors to multiresistant germs, increasing of handwashing stations). The overlapping period of hospitalisation concerning the 13 patients being reported as SARM carrier, having the same antibiogram, and the epidemic curve suggested a cross contamination. The index case was a MRSA carrier the day of her admission and have had a recent hospitalisation in a high risk unit. MRSA has always been isolated in nasal swab. Six patients among the thirteen carriers developed an infection and have been treated by vancomycin: two systemic infections and four pulmonary infections. The mortality rate was 33% and only one of them seemed to be directly due to MRSA. Area samples were all negative. The clinical staff have been screened with nasal swab. We identified only one nasal MRSA carrier. The pulsed-field gel electrophoresis study showed that 9/11 which have been analysed were identical. This outbreak brought about staff, more sensibilisation to the nosocomial infection and updating of plain hygien rules leaded to its stop five months later.

Adult↗
PubMed1999

[Neisseria meningitidis and meningitis].

Meningococcal meningitis epidemics can occur anywhere in the world. However this risk is particularly high during the dry season in the sub-Saharan zone of Africa known as the Lapeyssonnie meningitis belt. This area characterized by hyperendemicity that regularly gives rise to epidemics. Multilocus enzyme electrophoresis has made possible identification and monitoring of the progression of virulent clones of Neisseria meningitidis strains in the world. Monitoring is now possible by multilocus sequence typing and data bank on the Internet. Vaccination is a major prophylactic modality. The usefulness of plain group A plus C polysaccharide vaccines is limited because of poor effectiveness in young children who constitute the highest risk group. During epidemics, mass vaccination should be carried out as early as possible according to the state of alert defined for the area. More recent conjugate vaccines against group A and C, which are effective in young children and provide long-term protection by induction of immunologic memory, may allow routine vaccination in the future. Although clinical signs are often apparent, not all cases are diagnosed by clinical examination unless gravity is taken into account. Untreated the disease is always fatal. The only hope of survival is early institution of appropriate antimicrobial therapy (even prior to hospitalization). Several strains resistant to chloramphenicol have been reported and the number of strains with reduced sensitivity to penicillin is rising constantly. Although treatment remains feasible, the existence of resistant forms raises the need to monitor the sensitivity of meningococci using standardized of antibiograms.

Adult↗
PubMed1998

Comparison of detection of extended-spectrum beta-lactamases by agar dilution method, E-test ESBL screen and double disk test.

The extended-spectrum beta-lactamases (ESBL) are derived from TEM-or SHV-enzymes. They mediate resistance to broad-spectrum beta-lactams and can cause infectious outbreaks in hospitals. Rapid recognition and diagnosis are important for the clinician to prescribe more effective treatment. In the present study, a group of 52 probable ESBL-producing Klebsiella pneumoniae and Escherichia coli having a suspected resistant antibiogram phenotype were included. The E-test ESBL screen and the double disk test were performed for these isolates for detection of ESBL-producing strains, as compared with the conventional agar dilution method. The agreement between the E-test ESBL screen or the double disk test and the conventional agar dilution method was good and the degree of agreement were 86.5% and 92.3% respectively. The results showed that both the E-test ESBL screen and the double disk test were useful and convenient for detection of ESBLs.

Agar↗
PubMedDate not supplied

Mycobacterium resistance to antimycobacterial reagent.

This study was carried out in the tuberculosis laboratory of the Institut National d'Hygiène in Rabat, Morocco, in 1997. The aim was to determine the percentages of drug-resistant strains by using 150 antibiograms. Six antimycobacterial medications were used as tuberculosis treatment: isoniazid (INH), streptomycin (STM), rifampicin (RIF), ethambutol (EMB), kanamycin (KAN) and p-amino-salicylic acid (PAS). The cultures were plated onto a simple agar (Lowenstein-Jensen) plate containing different concentrations of drugs. This test demonstrated the presence of major antimycobacterial (INH, RIF, STM)-resistant strains of Mycobacterium tuberculosis in the following percentages respectively: 34.6 per cent, 33.1 per cent and 26.1 per cent and 80 per cent, 70 per cent and 40 per cent in the case of atypical mycobacteria. The association of INH/RIF showed the highest percentage (27.6 per cent) for Mycobacterium tuberculosis and 70 per cent for atypical strains, whereas, when we associate INH/RIF/STM, the resistance rate becomes 17.69 per cent for Mycobacterium tuberculosis and 25 per cent for atypical mycobacteria. The resistance in question was a secondary or acquired resistance because the tested strains were isolated from patients who had not responded to standard tuberculosis treatment.

Aminosalicylic Acid↗
PubMedDate not supplied

Klebocin typing of Klebsiella species isolated from nosocomial infection in intensive care unit.

Klebocin typing and antibiotic resistance have been studied for 518 strains of Klebsiella pneumoniae, [106 from intensive care unit (ICU) sites, 182 from ICU staff flora, 192 from patient flora and 38 from clinical specimens]. The overall typability was 71.62%. The most common mnemonic types among various sources were 111, 211, and 112. Of the total strains tested, 28.37% strains were found to be untypable. These strains are labelled as "444". When klebocin typing was used in association with antibiogram, in 86.84% cases of clinical infection probable source of infection could be detected. Thus a combination of two typing methods poses a significant contribution in epidemiological studies.

Bacteriocins↗