Analysis of regulatory region of ermAM genes in streptococci and enterococci highly resistant to macrolides and lincosamides.
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One hundred and forty isolates were identified using the GPI Card (Vitek Systems) and a conventional biochemical scheme. Agar dilution susceptibility testing was performed and isolates were screened for beta-lactamase production. The GPI Card was accurate in identifying Enterococcus faecalis, but discrepant results were obtained for seven (29.1%) of the 24 non-Enterococcus faecalis isolates. Ampicillin resistance was present in 2.9% of isolates and there were no beta-lactamase producers. There was no vancomycin resistance but 12.1% of isolates showed high-level resistance to gentamicin.
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Two cases of endocarditis, one caused by high-level gentamicin-resistant Enterococcus durans and the other by high-level gentamicin- and glycopeptide-resistant Enterococcus faecalis. successfully treated with a combination of ampicillin and a fluoroquinolone are reported. Both strains were susceptible to ampicillin. Enterococcus faecalis was susceptible to ciprofloxacin and to ofloxacin, but Enterococcus durans was moderately resistant to these agents. Microbiological and clinical cure was obtained with a 6-week course of ampicillin plus ciprofloxacin in one case and with ofloxacin in the second case due to intolerance to ciprofloxacin. The efficacy of the treatment was predicted in vitro by time-kill studies and by adequate serum bactericidal titres.