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Effect of carbapenem administration on establishment of intestinal colonization by vancomycin-resistant enterococci and Klebsiella pneumoniae in mice.

In a mouse model, ertapenem inhibited the anaerobic intestinal microflora and promoted overgrowth of enterococci, whereas imipenem-cilastatin had no effect on the indigenous microflora. Ertapenem, but not imipenem-cilastatin, promoted modest overgrowth of vancomycin-resistant enterococci when exposure occurred during treatment. Neither agent promoted colonization with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.

Animals↗

[Methods for studying the motility in the small intestine, colon and recto-anal area].

Small bowel and colonic motility can be studied either indirectly by the determination of the transit time or directly in recording bowel contractions. Small bowel transit time is usually assessed with the H2-breath test when colonic transit time is mainly determined fluoroscopically in studying the progression of radiopaque markers along the large bowel. Scintigraphic techniques are promising but not routinely used techniques. In the small bowel, gut contractions are recorded with manometric probes. To study colonic movements, electromyography is more usual than manometry. In both cases, whatever the technique employed, the large inter- and intra (topographic and nycthemeral) variability need to be considered for the interpretation of the motor patterns. Rectoanal studies led to consider two aspects: how the rectum acts as a reservoir and anal function. The ability of the rectum to be a reservoir is assessed either by the volume remaining in the rectum during the rectal perfusion with saline or by the determination of the maximal tolerable volume of distension. Manometry and/or electromyography test anal function at rest and during a rectal distension, straining or a voluntary contraction.

Anal Canal↗

Role of Escherichia coli P fimbriae in intestinal colonization in gnotobiotic rats.

Adherence via P fimbriae is associated with long-term persistence of Escherichia coli in the human large intestine, but a causal relationship has not been proven. In the present study, germfree rats were colonized with a mixture of two isogenic E. coli strains, one P fimbriated and the other type 1 fimbriated. Both types of fimbriae conferred adherence to rat colonic epithelial cells. With two mutant strains from a pyelonephritogenic isolate of serotype O75:K5:H-, the P-fimbriated strain 824 attained much higher numbers than its type 1-fimbriated counterpart when colonized in vivo for 2 weeks (10(10) versus 10(6) bacteria per g, respectively; P < 0.0001). The expression of P fimbriae by 824 was also retained during colonization. With transformant isogenic strains obtained from a normal fecal isolate incapable of phase variation, no benefit of P fimbriae was seen and most bacteria lost their plasmids during in vivo colonization. When the pyelonephritogenic mutant and fecal transformant strains were combined, the former colonized at high levels while the latter were suppressed. In contrast, no suppression was seen when the transformant E. coli strains colonized in combination with Lactobacillus acidophilus or Peptostreptococcus sp. The results indicate that P fimbriae, but also other bacterial traits linked to uropathogeneicity, could play an important role for persistence in the gut normal microbiota. Neither P nor type 1 fimbriae seemed to contribute to the ability to translocate to the mesenteric lymph nodes.

Animals↗

Effects of daptomycin, linezolid, and vancomycin on establishment of intestinal colonization with vancomycin-resistant enterococci and extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae in mice.

In mice, vancomycin and linezolid treatment disrupted the anaerobic intestinal microflora, based on denaturing gradient gel electrophoresis analysis, and promoted colonization by Klebsiella pneumoniae and vancomycin-resistant enterococci. However, the effects varied depending on dose and duration of treatment. Daptomycin treatment did not disrupt the anaerobic microflora or promote either pathogen.

Acetamides↗

Mutation of toxB and a truncated version of the efa-1 gene in Escherichia coli O157:H7 influences the expression and secretion of locus of enterocyte effacement-encoded proteins but not intestinal colonization in calves or sheep.

Enterohemorrhagic Escherichia coli (EHEC) strains comprise a broad group of bacteria, some of which cause attaching and effacing (AE) lesions and enteritis in humans and animals. Non-O157:H7 EHEC strains contain the gene efa-1 (referred to in previous publications as efa1), which influences adherence to cultured epithelial cells. An almost identical gene in enteropathogenic E. coli (lifA) mediates the inhibition of lymphocyte proliferation and proinflammatory cytokine synthesis. We have shown previously that significantly lower numbers of EHEC O5 and O111 efa-1 mutants are shed in feces following experimental infection in calves and that these mutants exhibit reduced adherence to intestinal epithelia compared with isogenic wild-type strains. E. coli O157:H7 strains lack efa-1 but encode a homolog on the pO157 plasmid (toxB/l7095) and contain a truncated version of the efa-1 gene (efa-1'/z4332 in O island 122 of the EDL933 chromosome). Here we report that E. coli O157:H7 toxB and efa-1' single and double mutants exhibit reduced adherence to cultured epithelial cells and show reduced expression and secretion of proteins encoded by the locus of enterocyte effacement (LEE), which plays a key role in the host-cell interactions of EHEC. The activity of LEE1, LEE4, and LEE5 promoters was not significantly altered in E. coli O157:H7 strains harboring toxB or efa-1' mutations, indicating that the effect on the expression of LEE-encoded secreted proteins occurs at a posttranscriptional level. Despite affecting type III secretion, mutation of toxB and efa-1' did not significantly affect the course of fecal shedding of E. coli O157:H7 following experimental inoculation of 10- to 14-day-old calves or 6-week-old sheep. Mutation of tir caused a significant reduction in fecal shedding of E. coli O157:H7 in calves, indicating that the formation of AE lesions is important for colonization of the bovine intestine.

Animals↗

Failure of norfloxacin to eradicate intestinal colonization of non-typhoidal salmonella in infants.

Infant colonization with non-typhoidal Salmonella (NTS) is common and eradication is problematic. Oral norfloxacin has promising properties for solving this problem, though it has potential toxicity to infants. The drug has been available in Thailand since 1987. Since then, some infants who had diarrhea or NTS colonization were treated with oral norfloxacin 15-20 mg/kg/day for 3-5 days on individual physician's judgement. This observational study was performed in infants and children who had NTS in stool, seen at Ramathibodi hospital from September 1987 to February 1988, in order to give preliminary information. Sixteen of 48 infants received oral norfloxacin treatment. Nine infants had established failure of NTS eradication from follow-up rectal swab cultures. Five infants did not have follow-up rectal swab culture, and two had negative culture once on day 7 after treatment. Considering that 7 infants who did not have evidence of bacteriologic failure were free from colonization, the excretion rate during the first two weeks could be estimated as 56 per cent which is not less than the natural history of this disease. This observation suggests failure of oral norfloxacin, 15 mg/kg/day given in 2 divided doses for 3 days, in eradication NTS colonization in infants.

Humans↗

Intestinal colonization of neonatal animals by Campylobacter fetus subsp. jejuni.

Neonatal mice (2.3 to 2.8 g) were inoculated intragastrically with different human isolates of Campylobacter fetus subsp. jejuni. At weekly intervals thereafter, mice were sacrificed and dilution plate counts were performed on segments of the gastrointestinal tract. Mice were uniformly colonized by some strains for 2 weeks, whereas other strains were being cleared at that time. One strain (BO216) persisted in some mice for 3 weeks. The greatest number of organisms (10(7)) was recovered from the cecum and large intestine. The small intestine had from 10(2) to 10(5) colony-forming units. Colonization of the stomach was not found consistently. One strain killed 13% of the infected mice. Deaths occurred between 1 and 5 days postinfection. Two other strains killed a smaller percentage of challenged animals, and two additional strains killed none. Retarded weight gain was noticed in some, but not all, of the infected mice. The intestines of neonatal rats and rabbits were colonized much the same as those of mice, whereas hamsters were resistant to colonization. Preweanling mice, up to about 6.5 to 7.0 g, could be colonized with C. fetus subsp. jejuni after intragastric challenge, but weanling mice of larger weight (9.8 g) and young adult mice (18.3 g) could not. Scanning electron photomicrographs of the lower ileum showed campylobacters in and below the dried mucous gel that lines the intestines. The use of this model for additional studies is discussed.

Animals↗

Intestinal colonization of symptomatic and asymptomatic schoolchildren with Blastocystis hominis.

A study of single stool specimens was done to determine the prevalence of intestinal parasites among 1,000 primary school children. A questionnaire was completed by each child's parents. Specimens were examined by using wet-mount preparation, formaline-ether concentration, and Sheather's flotation technique. Trichrome and acid-fast stains were done. Blastocystis hominis was observed in 203 (20.3%) of the specimens examined, and 175 specimens contained this organism in the absence of other pathogenic parasites. Older children had fewer B. hominis infections (6 to 7 years old, 50% infection rate; 8 to 9 years, 27.5%; 10 to 12 years, 9.5%). The most common complaints reported by 75 children harboring the parasite were a mild recurrent diarrhea, abdominal pain, nausea, anorexia, and fatigue. Blastocystosis is quite common among schoolchildren. Contaminated drinking water is suspected to be the source of infection.

Animals↗

Comparison of direct plating and broth enrichment culture for the detection of intestinal colonization by glycopeptide-resistant enterococci among hospitalized patients.

The results of prevalence studies on glycopeptide-resistant enterococci (GRE) in the intestine may be influenced by the detection methods applied. In most studies different media, different concentrations of antibiotics, and different methods are used, and these differences result in differences in recovery rates. In this cross-sectional study on the carrier state of GRE among patients at the University Hospital Antwerp, Antwerp, Belgium, performed on 21 May 1996, direct plating and broth enrichment were compared by using the same media. Stool samples (n = 213) or rectal swabs (n = 122) were plated directly on Enterococcosel agar (bioMérieux) and after enrichment in Enterococcosel broth. The prevalence of GRE was 12.8%. Direct plating recovered 53.4% of the GRE isolates, and broth enrichment recovered an additional 46.5% of them; in the latter test the isolates were thus present at less than 10(3) CFU per g of feces. The prevalence of GRE among dialysis patients was higher than among the other patients, but the difference was not significant (P = 0.06), possibly as a result of the small numbers of dialysis patients examined. The GRE species isolated included 19 E. gallinarum (44.2%), 13 E. faecium (30.2%), 6 E. faecalis (13.9%), and 5 E. casseliflavus (11.6%) isolates. All E. faecalis and E. faecium strains isolated carried the vanA gene, and E. gallinarum and E. casseliflavus carried the vanC1 and vanC2 gene, respectively. The majority of isolates were polyclonal. Our data indicate that the rate of detection of GRE from both stool samples and rectal swabs is significantly increased with enrichment cultures.

Anti-Bacterial Agents↗