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Use of rapid, nonradioactive DNA probes in culture confirmation tests to detect Streptococcus agalactiae, Haemophilus influenzae, and Enterococcus spp. from pediatric patients with significant infections.

Acridinium ester-labeled, chemiluminescent DNA probe tests (Accuprobe; Gen-Probe, Inc.) for culture confirmation of Streptococcus agalactiae, Haemophilus influenzae, and Enterococcus spp. were compared with conventional identification techniques. The probe is a DNA oligomer that is a complementary to the RNA of the target. The DNA-RNA hybrids are measured in a luminometer. The 40-min assay requires one reaction tube and the addition of three reagents. When two colonies were used to add a sample of the reaction tube, 325 of 327 isolates were detected by the probe. Isolates of 404 nonprobe target organisms did not hybridize with the probe.

Child, Preschool

Laboratory detection of high-level aminoglycoside-aminocyclitol resistance in Enterococcus spp.

Methods for detection of high-level resistance to aminoglycoside-aminocyclitol antibiotics were evaluated using 104 blood isolates of enterococci (97 Enterococcus faecalis and 7 Enterococcus faecium). Kanamycin was used to predict resistance to amikacin. Discrepancies between methods were resolved by time-kill studies. Four methods (MicroScan, macrotube, microtiter, and disk diffusion) for detecting resistance to gentamicin and streptomycin were compared, using 51 consecutive strains. There were 13 gentamicin-resistant strains, all of which were detected by macrotube, microtiter, and disk diffusion. MicroScan detected 2 (15%) of the 13. Of the 18 streptomycin-resistant strains, 17 (93%) were detected by disk diffusion, 16 (89%) by microtiter, 9 (50%) by macrotube, and 6 (33%) by MicroScan. An additional 53 consecutive strains were examined only by disk diffusion and microtiter for resistance to gentamicin, streptomycin, and kanamycin. The entire population of 104 strains contained 35 gentamicin-, 22 streptomycin-, and 54 kanamycin-resistant enterococcal isolates. All 35 gentamicin-resistant strains were detected by both methods. Of the 22 streptomycin-resistant strains, 1 was detected only by microtiter, 2 only by disk diffusion, and 19 by both methods. Of the 54 kanamycin-resistant strains, 1 was detected only by microtiter, 2 only by disk diffusion, and 51 by both methods. One additional strain which was resistant only by disk diffusion was susceptible to amikacin plus penicillin by time-kill studies. Disk diffusion is a suitable method for detection of high-level aminoglycoside-aminocyclitol resistance in E. faecalis and is well suited for sporadic testing. Additional data are necessary to determine the suitability of these tests for E. faecium.

Anti-Bacterial Agents

Evaluation of a commercial microtiter system (MicroScan) using both frozen and freeze-dried panels for detection of high-level aminoglycoside resistance in Enterococcus spp.

The MicroScan system was compared with agar dilution screen plates for the detection of high-level aminoglycoside resistance in 182 enterococcal isolates. Both the frozen Gram-Positive Combo Type 2 and the freeze-dried Type 5 panels were evaluated. The specificity of both panels for the detection of streptomycin and gentamicin resistance was 100%. However, the sensitivities for the detection of gentamicin and streptomycin resistance were 84 and 31%, respectively, for the Type 2 panels and 90 and 41%, respectively, for the Type 5 panels. The sensitivities of these panels for the detection of enterococcal high-level aminoglycoside resistance are inadequate for routine use.

Anti-Bacterial Agents

Cefixime: spectrum of antibacterial activity against 16,016 clinical isolates.

The spectrum of antibacterial activity of cefixime was defined by reviewing data from two multicenter studies and three independent studies that we performed within the past 3 years. Microdilution tests were performed with 16,016 bacterial isolates. An isolate was considered susceptible to cefixime if the minimal inhibitory concentration was less than or equal to 1.0 microgram/ml and resistant if the minimal inhibitory concentration was greater than or equal to 4.0 micrograms/ml. Cefixime was effective against the Enterobacteriaceae (87.7% susceptible to 1.0 microgram/ml) as well as against pathogenic Neisseria spp. (including penicillin-resistant gonococci), Haemophilus influenzae (including ampicillin-resistant strains), penicillin-susceptible Streptococcus pneumoniae and other Streptococcus species (minimal concentration inhibiting 90% of organisms less than or equal to 0.25 micrograms/ml). Species resistant to cefixime included penicillin-resistant pneumococci, Staphylococcus spp., Enterococcus spp., Listeria spp., Acinetobacter spp. and Pseudomonas spp.

Bacteria

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1988). II. Background of patients].

Clinical background was investigated on 916 bacterial strains isolated from patients with urinary tract infections (UTIs) in 9 hospitals during the period from June to November, 1988. 1. Distribution of sexes, ages and infections: Among males, fifties and older were most frequent and most of them had complicated UTIs. Among females, most cases among twenties or thirties were uncomplicated UTIs. Forties and older cases were most frequent and complicated UTIs were more frequent among them than among patients in twenties and thirties. 2. Distribution of sexes, ages and pathogens isolated from UTIs: In males, Pseudomonas spp. and Enterococcus spp. were frequently isolated. In contrast, in females, Escherichia coli was the most frequent. In thirties, E. coli was not the most frequently isolated bacterium. Frequency of Pseudomonas spp., other non-fermented Gram-negative rods and Enterococcus spp. were greater among patients with higher ages. 3. Administration of antibiotics and pathogens isolated from UTIs: (1) Before administration: In uncomplicated UTIs, E. coli accounted for the majority of causative organisms. In complicated UTIs, particularly in those cases with indwelling catheter, Enterococcus spp. and Pseudomonas spp. were rather frequently isolated. (2) After administration: In complicated UTIs, higher number of pathogens were isolated. Pseudomonas spp. and Enterococcus spp. were the most frequent. Distribution of pathogens isolated from complicated UTIs without indwelling catheter was similar to that before antibiotic administration.

Adult

[Antibiotic susceptibility of bacteria isolated from surgical infection (second report)].

Isolated bacteria from infections in general surgery in 1984 and 1985 have been investigated to find bacterial composition and their susceptibilities to antibiotics in a joint research in which 6 university hospitals in Japan participated. A summary of findings from the investigation is as follows. 1. One hundred and seventy-two (1984) and 211 (1985) cases were included in the study. Cases in which bacteria were detected were 147 and 174 in the respective years. The detection rate was higher than 80% in either year. 2. Total numbers of strains isolated in 1984 and 1985 were 267 and 293, respectively; major sources of these strains were intraperitoneal infection exudates in either year. 3. The most frequent isolate from primary infection cases in both years was Escherichia coli (15-21%), followed by Bacteroides spp. and Staphylococcus spp., in that order. The most frequently isolated from postoperative infection cases were Enterococcus spp. (16-22%), followed by Pseudomonas spp. The diversity of isolated species, as well as the similarity of incidences of different species were noted in cases of postoperative infections. It is suspected that a certain species, even if its pathogenicity is essentially low, may become to be a causative organism once its number increases due to its survival through a perioperative prophylactic use of antibiotics, and also due to the decreased host resistance to infections caused by underlying diseases or surgical stress. 4. Staphylococcus spp. was the most frequent isolate from postoperative infections occurring after clean operations, while Enterococcus spp. and Pseudomonas aeruginosa were major isolates from infections after clean-contaminated operations. Isolates from infections occurring after contaminated operations included Enterococcus spp. greater than E. coli greater than Klebsiella pneumoniae, P. aeruginosa, Bacteroides spp. (1985). 5. In cases without the presence of clinical factors cause by depressed host defense, E. coli and Bacteroides spp. were major isolates, while in cases with the factors, a wide variety of bacterial population tended to be found. 6. Before an administration of antibiotics in primary infections, E. coli, Staphylococcus spp. Bacteroides spp. and Klebsiella spp. were most commonly isolated, while after a chemotherapy, Enterococcus spp. were the most frequent isolates, followed by P. aeruginosa during 1985. These findings reflected the antibacterial spectrum of cephems usually used in surgical field.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1984). II. Background of patients].

Groups of bacteria were isolated from patients with infections of urinary tracts, and backgrounds of these isolates and patients have been studied in terms of the sexual distribution, and distributions of sexes versus age of the patients relationships between bacterial types and sexual and age distribution of the patients from whom the isolates were obtained correlation ages of patients and types of infections, the association of certain types of bacteria with certain infections and the effect of antibacterial treatments on these types of bacteria, approximately 20% of simple infections of urinary tracts occurred in males and approximately 80% in females on average from 1981 to 1984. This ratio showed hardly any changes during this period. Likewise, male patients comprised approximately 60-70% of all the cases with complicated infections of urinary tracts regardless of indwelling or without indwelling of catheters. In terms of age, the ratio of urinary tract infections was almost universally observed, e.g., for patients in 40's: 10.0% in 1981, 11.0% in 1984, while in those in 70's: 25.5% and 21.2%, respectively. Consequently, background factors of the cases with infections of urinary tracts, such as sexes, age, or simple or complicated, remained almost stable, whereas bacteria involved showed considerable variations. In 1982 and 1983, the frequency of isolations of Enterococcus spp. was approximately 8% in both males and females. However, in 1984, the frequency of isolation of Enterococcus spp. was 22.5% in the males 17.9% in the females. The frequency of isolation of Enterococcus spp. increased in all age groups, but the frequency was not particularly high among the aged. A study on variations and isolation frequencies of bacteria before the administration of antibiotic agents revealed that isolation frequencies of Enterococcus spp. sharply increased in 1983, and this high frequency remained in 1984. The frequency of isolation of E. coli tended to decrease year after year. This finding represents that the frequency of isolations of E. coli from materials of cases with simple infections of urinary tracts has decreased, showing that pathogenic bacteria from simple infections of urinary tracts were becoming similar to that of the complicated infections of urinary tracts. These findings seem to be worth mentioning here. In cases receiving administrations of antibacterial and antibiotic agents for more than 8 days. Frequencies of isolation from cases without catheter retention and from those with catheter retention were similar.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult

Cefpodoxime: comparative antibacterial activity, influence of growth conditions, and bactericidal activity.

The antimicrobial activity of cefpodoxime, the active metabolite of the new cephalosporin ester cefpodoxime proxetil, in comparison to cefixime, cefotiam, cefuroxime, and cefotaxime was determined against a broad spectrum of freshly isolated gram-positive and gram-negative bacterial strains. Cefpodoxime was demonstrated to be inhibitory at concentrations of less than or equal to 1 mg/l against 90% of strains of Moraxella catarrhalis, Haemophilus influenzae, Escherichia coli (beta-lactamase- negative strains), Klebsiella spp., Serratia spp., Proteus mirabilis, Proteus vulgaris, Providencia spp., and Salmonella spp. This antimicrobial activity of cefpodoxime was generally superior to that of cefuroxime and similar to that of cefixime. Cefpodoxime was active at less than or equal to 1 mg/l against 50% of the members of beta-lactamase-producing Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Citrobacter spp., and Morganella morganii. Cefpodoxime proved to be highly inhibitory against group A, B, and G streptococci and Streptococcus pneumoniae (MIC90 less than 0.015 mg/l). The MICs of cefpodoxime and those of the other cephalosporins were less than 2 mg/l for greater than or equal to 90% of the strains of Staphylococcus aureus and Staphylococcus epidermidis, with the exception of cefixime which had no activity with MICs below 8 mg/l against these bacteria. Pseudomonas spp., Acinetobacter spp., and Enterococcus spp. were resistant to cefpodoxime. The antibacterial activity of cefpodoxime was only to a minor degree influenced by different growth conditions with the exception of high inoculum sizes against some beta-lactamase producing strains of gram-negative bacilli.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Urinary

Occurrence of drug-resistant bacteria in communal well water around Port Harcourt, Nigeria.

A total of 108 raw water samples was collected from 36 wells at nine shanty settlements around Port Harcourt, Nigeria, over a period of 7 months. Samples were analysed for their bacteriological quality. Selected bacterial strains isolated from the samples were tested for their susceptibility to ten commonly used antibiotics. The organisms isolated include Pseudomonas spp., Klebsiella spp., Staphylococcus spp., Proteus spp., Enterococcus faecalis, Aeromonas spp., Escherichia coli, Chromobacterium spp., Flavobacterium spp., and Serratia spp. Out of 300 strains tested, 23 (6.9%) were susceptible to all the antibiotics, 277 (92.3%) were resistant to at least one antibiotic and 232 (77.3%) were resistant to two or more antibiotics. The epidemiological significance of these results is discussed.

Bacteria

LY164846 in vitro antimicrobial activity testing, including disk diffusion susceptibility tests using 30-microgram disks.

A new oral cephalosporin, LY164846 (Eli Lilly & Co., Indianapolis, Ind.), was found to have a unique antimicrobial spectrum confined to methicillin-susceptible Staphylococcus spp., streptococci (except Enterococcus spp.), Haemophilus influenzae, Branhamella catarrhalis, and some anaerobes. Cephalothin in vitro tests (30-microgram disks or dilution) can represent LY164846 for laboratory testing if comparable interpretive breakpoints are applied to strains within the spectrum of LY164846. Organisms not inhibited by LY164846 (MICs greater than or equal to 32 micrograms/ml) were members of the family Enterobacteriaceae, Pseudomonas spp., Acinetobacter spp., enterococci, and some strains of Staphylococcus haemolyticus and of the Bacteroides fragilis group.

Anti-Bacterial Agents

Perinephric abscess. Modern diagnosis and treatment in 47 cases.

The records of 47 patients with a perinephric abscess diagnosed from 1975 to 1986 at 8 San Francisco Bay Area hospitals were reviewed. The mean age was 51 years. Fifty-five percent were females and 45%, males. The left kidney was affected in 47% of cases, the right kidney in 40%, both in 4%, and a transplanted pelvic kidney in 9%. Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal pain (40%), and nausea or vomiting (32%) were the most common presenting symptoms. About half the patients had symptoms for 1 week or less and 12% had no symptoms. Fever was documented before diagnosis in 88% of patients. Abdominal mass (13%) or tenderness (49%), and flank mass (9%) or tenderness (42%) were seen less frequently, and 11% of patients did not have fever, flank, or abdominal findings. The most frequent underlying conditions included previous urologic surgery (45%), previous urinary tract infection (38%), diabetes mellitus (36%), and urinary tract stones (36%). Cultures of perinephric abscesses yielded gram-negative aerobes in 52% of patients, primarily Escherichia coli. Staphylococcus aureus was isolated in 26% of patients and anaerobes in 17%. A single pathogen was isolated in 71% and multiple isolates in 29%. Of interest and great potential therapeutic importance was culture of anaerobes, primarily Bacteroides spp. in 17%, Enterococcus spp. in 7%, and Candida albicans in 7%. Positive blood and urine cultures identified perinephric abscess organisms exactly in 58% and 37% of cases, respectively. Routine laboratory tests such as the white blood cell count and urinalysis were insensitive and non-specific for perinephric abscess. Leukocytosis and anemia at admission were seen in slightly more than half of the patients. For radiologic diagnosis, computerized tomographic scanning was most helpful. Ultrasound and intravenous pyelography were falsely negative in about one-third of cases. Mortality (13%) was low in this series when compared with earlier studies, and probably reflects modern medical care. Six patients (13%) died during hospitalization, 2 of whom had diagnosis of PNA established only at autopsy. Drainage of the perinephric abscess was carried out by open surgical drainage in 64% of patients, percutaneous drainage in 19%, and both in 13%. The initial procedure, whether open surgical drainage or percutaneous catheter drainage, was usually successful. Late complications included nephrocutaneous fistulas in 3 patients and disseminated candidiasis in 1 patient.

Abscess

Antimicrobial Resistance in Nontyphoidal Salmonella and Clinically Relevant Enterococcus From Faecal Samples of Conservation-Priority Captive Ungulates in a United Arab Emirates Urban Zoo: A Cross-Sectional Baseline Study.

Antimicrobial resistance (AMR) is a One Health challenge driven by microbial exchange among humans, animals and the environment. Zoological institutions offer useful settings for environmental AMR surveillance. This single-zoo cross-sectional study examined the occurrence, antimicrobial susceptibility and genomic characteristics of nontyphoidal Salmonella enterica (NTS) and clinically relevant Enterococcus spp. in faecal samples from 101 clinically healthy captive ungulates representing seven conservation-priority species at a major urban zoo in the United Arab Emirates. NTS was detected in 4/101 samples (3.9%), including serovars Schwarzengrund (n = 2), Kentucky (n = 1) and Chester (n = 1). Among the four recovered NTS isolates, all met the study MDR definition within the tested panel, including a Salmonella Kentucky ST198 isolate carrying multiple resistance genes and quinolone-associated mutations. Enterococcus spp. were detected in 77/101 samples (76.2%), dominated by Enterococcus faecium and Enterococcus casseliflavus (each 41.5%). Among 33 E. faecium/Enterococcus faecalis isolates tested phenotypically, resistance was generally low, with erythromycin and ciprofloxacin resistance each observed in 9.1%. One clinically important E. faecium isolate showed glycopeptide resistance and genetic markers associated with reduced daptomycin susceptibility. These single-institution cross-sectional data provide an initial regional baseline for AMR-relevant enteric bacteria in conservation-managed ungulates and identify priorities for broader longitudinal and interface-based surveillance.

Animals

A selective and diagnostic medium for use in the enumeration of Listeria spp. in foods.

A new medium, called RAPAMY agar, has been elaborated for the isolation from and the enumeration of Listeria spp. in foods. It is based on Ralovich's nalidixic acid-trypaflavin-agar with the following modifications: (i) the slight inhibitory properties of that medium were overcome by the use of Columbia Blood agar base instead of tryptose agar and the addition of 0.05% ferric ammonium citrate and 2.5% egg yolk emulsion; (ii) selectivity was improved by the addition of 0.25% 2-phenyl ethanol and incubation under microaerobic conditions; (iii) the medium was provided with two diagnostic traits by the addition of (a) aesculin + ferric ammonium citrate; and (b) D-mannitol and phenol red. The growth of Enterococcus spp., the only organisms other than Listeria spp. which grow on RAPAMY agar, was not inhibited by the addition of 20 microgram.ml-1 Cefoxitin (Moxolactam). Higher levels inhibited some Listeria spp., but not the enterococci. The medium recovered Listeria spp. quantitatively and allowed recovery from foods colonized by Enterococcus spp. at levels upto 10(2) per g.

Colony Count, Microbial

[Evaluation of usefulness of the PYR-Wellcome test for identifying microorganisms from the genus enterococcus].

The study was aimed at evaluation of usefulness of PYR-Wellcome test in bacteriological diagnostic. Results of identification of enterococcal strains by application of the above test were performed on 157 strains of Enterococcus spp., 15 strains of Streptococcus pyogenes and 12 of Streptococcus bovis. Application of test for PYR-ase production results in shortening of diagnostic procedure. Basing on morphological features, including type of hemolysis, lack of catalase production and presence in the bacterial cell of a peptidase hydrolyzing L-pirrolidonyl-beta-naphthylamide, it is possible to classify with high probability the investigated microorganism to the Enterococcus spp. The Shortened procedure is satisfactory for routine identification of enterococcal strains in diagnostic laboratories.

Enterococcus

Effect of imipenem-cilastatin therapy on fecal flora.

Alteration of fecal flora was prospectively studied in 21 children receiving imipenem-cilastatin therapy under protocol for therapy of infections. Although no profound reduction in facultative or anaerobic flora was observed, qualitative and quantitative increases in organisms which were resistant or less susceptible to imipenem occurred. Of 21 patients, 13 (62%) had increases in counts of Enterococcus spp. of at least 10(3) organisms per g (wet weight) of stool, and 7 (33%) had acquisition of or similar increases in counts of Candida species. No change in susceptibility of isolates to imipenem was demonstrable during therapy. However, the MICs for 50 and 90% of the strains of Enterococcus spp. (2 and 8 micrograms/ml, respectively) were higher than those previously reported.

Adolescent

[Antibacterial activity and beta-lactamase stability of eleven oral cephalosporins].

Oral cephalosporins (cefixime, cefdinir, cefetamet, ceftibuten, cefpodoxime, loracarbef, cefprozil, cefuroxime, cefaclor, cefadroxil and BAY 3522) were compared by their antibacterial profile including stability against new beta-lactamases. Both activity and antibacterial spectrum of compounds structurally related to third generation parenteral cephalosporins (of the oximino class) were superior to established compounds. Activity against staphylococci was found to be highest for cefdinir, cefprozil and BAY 3522. Cefetamet, ceftibuten and cefixime demonstrate no clinically meaningful antistaphylococcal activity while the other compounds investigated demonstrate intermediate activity. The antibacterial spectrum was broadest for cefdinir and cefpodoxime. New oral cephalosporins are equally inactive as established compounds against Enterobacter spp., Morganella, Listeria, Pseudomonas and Acinetobacter spp., methicillin-resistant staphylococci, Enterococcus spp., penicillin-resistant pneumococci and anaerobes. New extended broad-spectrum betalactamases (TEM-3, TEM-5, TEM-6, TEM-7, SHV-2, SHV-3, SHV-4, SHV-5, CMY-1, CMY-2, and CTX-M) are active against the majority of oral cephalosporins. Ceftibuten, cefetamet, cefixime and cefdinir were stable against some of these enzymes even to a higher extent than parenteral cephalosporins. New oral cephalosporins should improve the therapeutic perspectives of oral cephalosporins due to their higher activity against pathogens marginally susceptible to established compounds (higher multiplicity of maximum plasma concentrations over MICs of the pathogens) and furthermore by including in their spectrum organisms resistant to established absorbable cephalosporins (e.g. Proteus spp., Providencia spp., Citrobacter spp., and Serratia spp.).

Administration, Oral

[Severe infections associated with chronic lymphoid leukemia. 159 infectious episodes in 60 patients].

This retrospective hospital study concerns 159 infectious episodes observed in 60 patients with chronic lymphoid leukaemia (CLL) staged A, B or C on first admission. The most frequent site of infection was pulmonary (33%), followed by ENT and stomatological infections (15%), septicaemia (9%), urinary and genital tracts infections (9%), herpes virus infections (9%), skin and soft tissue purulent sepsis (8%), digestive tract (3%) and meningeal (1%) infections and isolated fever (8%). Seventy nine bacteria were isolated, including 35 Gram-positive cocci (Staphylococcus spp. 12, Streptococcus spp. 13, D. pneumoniae 5, Enterococcus spp. 5), 43 Gram-negative bacilli (Enterobacteriaceae 36, Pseudomonas spp. 5, Haemophilus influenzae 2) and 1 M. tuberculosis. The other documented infections were: candidiasis 11, viral infections 19 (including 17 of the herpes group) and 2 parasitoses (1 pneumocystosis, 1 toxoplasmosis). Sixteen patients died of toxic -infectious shock (9 cases, including 1 meningitis) or pneumonia (7 cases, including one chicken-pox). Stage C leukaemia and granulopenia (less than 1 X 10(9) PN/l) were associated with significantly more frequent and severe infections.

Adult