Septicaemias caused by a strain of Staphylococcus haemolyticus exhibiting intermediate susceptibility to teicoplanin in multiple intensive care unit patients.
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Anti-Bacterial Agents↗
Biomedical subjects
C P van Boven
Publications and source records attributed to C P van Boven.
Performance of phenotypic and genotypic methods to determine the clinical relevance of serial blood isolates of staphylococcus epidermidis in patients with septicemia.
Five typing methods, including biotyping (API ID32; BioMérieux, Marcy l'Etoile, France), quantitative antibiogram typing based on actual zone sizes, plasmid typing, randomly amplified polymorphic DNA (RAPD) analysis (with primer M13 and primer set ERIC-2-1026), and pulsed-field gel electrophoresis (PFGE), were compared with a previously performed method of DNA fingerprinting by AFLP (amplified fragment length polymorphism analysis) for their performance in the typing of blood isolates of Staphylococcus epidermidis. Sixteen epidemiologically unrelated strains and 11 sets of four blood culture isolates from 11 patients with septicemia were used. The stabilities and reproducibilities of the patterns, the discriminatory capacities of the methods, and the ability to apply the methods to blood culture isolates were used as performance criteria. All strains tested were typeable by each method, and the patterns were stable and reproducible. The numbers of different types within the collection of 16 epidemiologically different isolates were 5 by biotyping, 14 by antibiogram typing, 4 by plasmid typing, 9 by the RAPD assay (combination of results with primer M13 and primer set ERIC-2-1026), and 16 by PFGE. Within the 11 sets of four blood culture isolates the types found by quantitative antibiogram typing, plasmid typing, and PFGE were unique for each set, whereas by biotyping and RAPD analysis some types were observed in more than one set. The results of biotyping did not correspond with the results of the other methods or the results of AFLP. For 6 of the 11 sets, the results of all methods except those of biotyping corresponded completely. Quantitative antibiogram typing, PFGE, and AFLP proved to be the most accurate of the six typing methods tested.
Bacteremia↗
Acinetobacter junii causes life-threatening sepsis in preterm infants.
Acinetobacter junii caused sepsis in six preterm infants in our neonatal unit within 48 h. Each infant with clinical signs of systemic infection and activation of the acute phase response had two positive blood cultures with Acinetobacter junii. The sudden onset, the short duration of the outbreak and the fact that none of the infants were colonized by A. junii suggested a common source of A. junii administered directly into the blood. The only feature shared by all six affected newborns was an intravenous fat emulsion (Intralipid 10%), which was shown to be an excellent growth medium for A. junii. Sepsis did not occur in four infants with 20% fat emulsion or amino acids only. Vaminolact did not support growth of the outbreak strain. The immediate source of the outbreak could not be identified: samples of the actual feeds given were not available for investigation, but A. junii was not isolated from parenteral solutions with identical batch numbers used in the septic infants. We conclude that Acinetobacter junii can cause a life-threatening infection in preterm neonates. Contaminated intravenous fat emulsion is implicated as a possible source of the infection. As a part of rigid infection control, intravenous feedings should be prepared under aseptic conditions.
Acinetobacter Infections↗
AFLP typing of Staphylococcus epidermidis in multiple sequential blood cultures.
AFLP is a novel high-resolution PCR-based DNA fingerprinting method generating complex banding patterns that can be used for comparative analysis. In the present study, the applicability of AFLP in fingerprinting Staphylococcus epidermidis isolates was investigated. The criteria considered were stability of patterns, reproducibility, discriminatory capacity and consistency with epidemiological context. Repeated testing of strains and investigation of subcultures showed that AFLP patterns were reproducible and stable with an intrastrain similarity of S > or = 94% as determined by analysis of digitized patterns. Fifteen unrelated strains were heterogeneous, with a level ranging from 78-93%. The applicability of AFLP in epidemiological studies of S. epidermidis was tested on 11 sets of four blood isolates each, from 11 patients with suspected septicaemia. Nine sets had indistinguishable or highly similar AFLP patterns for each isolate per set, while two sets had heterogeneous patterns. These results show that AFLP has high discriminatory power for strain identification in S. epidermidis.
Bacteremia↗
Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii: an unexpected difference in epidemiologic behavior.
BACKGROUND: The Dutch guideline on hospital policy for the prevention of nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA) states that patients transferred from hospitals abroad must be placed in strict isolation immediately on admission to a hospital in the Netherlands. Three patients colonized with both MRSA and a multiresistant Acinetobacter were transferred from hospitals in Mediterranean countries to 3 different hospitals in the Netherlands. Despite isolation precautions, Acinetobacter spread in 2 of the 3 hospitals, whereas nosocomial spread of MRSA did not occur. METHODS: For outbreak analysis, the Acinetobacter isolates, identified as Acinetobacter baumannii by the use of amplified ribosomal DNA restriction analysis, were comparatively typed by 4 methods. Comparison of isolation measures in the hospitals was performed retrospectively. RESULTS: In the 2 hospitals in which nosocomial spread of Acinetobacter occurred, most of the epidemiologically related isolates were indistinguishable from the index strains. In these 2 hospitals, isolation measures were in concordance with those recommended for the prevention of contact transmission. The precautions of the hospital in which no outbreak occurred included the prevention of airborne transmission. CONCLUSIONS: Precautions recommended for multiresistant gram-negative organisms are insufficient for the prevention of nosocomial spread of multiresistant Acinetobacter. The airborne mode of spread of acinetobacters should be taken into account, and guidelines should be revised accordingly.
Acinetobacter Infections↗
Changing susceptibilities of coagulase-negative staphylococci to teicoplanin in a teaching hospital.
The susceptibility of two collections of coagulase-negative staphylococci (CNS) isolated from clinical specimens for teicoplanin and vancomycin were compared. They comprised 91 and 101 isolates, collected in 1985 and 1994 respectively, from different departments of a teaching hospital. MICs of vancomycin and teicoplanin were determined by a modified Etest method. Additionally, a disc diffusion test was performed for teicoplanin. All isolates were susceptible to vancomycin (MIC < or = 4 mg/L). Two of the 91 isolates collected in 1985 were intermediate to teicoplanin (MIC between 8 and 32 mg/L), whereas in 1994 the number of intermediate isolates was 20 out of 101 (P < 0.01). The correlation between MICs, as determined by the modified Etest assay, and disc diffusion zones was poor (r = -0.35). Results show that resistance to teicoplanin in CNS has increased in the study hospital over a period of 9 years. This increase is likely to be correlated with the introduction of teicoplanin. Furthermore, a disc diffusion method does not appear to be the first method of choice for detection of strains of CNS with diminished susceptibility to teicoplanin.
Anti-Bacterial Agents↗
Effectiveness of resins in neutralizing antibiotic activities in bactec plus Aerobic/F culture medium.
Incorporating resins in blood culture media can effectively reduce the activities of several antibiotics. It was shown that the activities of some generally used antibiotics decreased by 80 to 90% within 2 h in Bactec Plus Aerobic/F resin-containing culture medium. Bactec vials containing resins were still found to be positive for bacteria when antibiotics were present. The addition of beta-lactamase shortened the detection time irrespective of the presence of resins.
Anti-Bacterial Agents↗
Outbreak of septicaemia in neonates caused by Acinetobacter junii investigated by amplified ribosomal DNA restriction analysis (ARDRA) and four typing methods.
Septicaemia caused by Acinetobacter occurred in six infants in the neonatal unit. A total of 18 acinetobacters were isolated from blood cultures, cultures of intravascular catheters, and surveillance cultures. Twelve isolates from the six affected infants were identified as Acinetobacter junii by the use of a novel method, amplified ribosomal DNA restriction analysis (ARDRA). Typing of the organisms using the biochemical profiles of the API 20NE system, antibiogram typing, cell envelope protein electrophoresis, and PCR fingerprinting with two primer sets, ERIC1/ERIC2 and ERIC2/ 1026, showed that these 12 isolates were indistinguishable, whereas the remaining six isolates were different. The six infants recovered after therapy with ciprofloxacin alone in five cases and with a combination of ciprofloxacin and gentamicin in one case. This study showed that A. junii is capable of causing a serious, though non-fatal infection in neonates. The combined use of genotypic and phenotypic methods allowed the rapid separation of epidemic from non-epidemic isolates. It is concluded that for a better understanding of the role of the various Acinetobacter genomic species in human pathology, identification of acinetobacters according to the recent taxonomy is imperative.
Acinetobacter↗
Serratia marcescens infections in neonatal departments: description of an outbreak and review of the literature.
An outbreak of colonization and infection with Serratia marcescens occurred in a neonatal intensive care unit (NICU). S. marcescens was isolated from five preterm infants (gestational age 25-30 weeks). Two infants developed septicaemia, which were both fatal, and one infant (the presumed index case) had conjunctivitis due to S. marcescens. Two infants were colonized without clinical signs of infection. All infants were treated with antibiotic regimens including ciprofloxacin and gentamicin. The DNA fingerprints of isolates were determined by enterobacterial repetitive intergenic consensus primers by the polymerase chain reaction. This showed that a single strain had spread in the NICU. An extensive investigation pointed to an infant born from a mother with an intra-uterine infection after prolonged rupture of foetal membranes as a presumed source of the outbreak. A reservoir, other than the infected or colonized infants and their immediate vicinity, was not found, with the sole exception of the waste jar of a Na+/ K(+)-analysis apparatus. Containment of the outbreak was achieved by closure of the NICU for new admissions, strict hygienic measures and cohort nursing of the infected and colonized infants. It was considered especially important to handle the infants with gloves, since frequent hand carriage of staff with S. marcescens was found when gloves were not used.
Conjunctivitis, Bacterial↗
Penicillin tolerance and treatment failure in group A streptococcal pharyngotonsillitis.
Failure of treatment of group A streptococcal pharyngitis and tonsillitis is well documented. One of the possible explanations for treatment failure is penicillin tolerance in group A streptococci. Reports on the prevalence of penicillin tolerance among group A streptococci (0-100%) and the presumed relationship with therapeutic failure vary considerably. Therefore, it appears worthwhile to review pharyngotonsillitis studies, devoting special attention to the variables of MIC-MBC laboratory determinations such as inoculum preparation, composition and volume of test medium, and the criteria used to define penicillin tolerance. Alternative methods (gradient-replica plate method, beta-lactamase disk test, time-kill assay, and cell-lysis assay) are discussed. It is concluded that technical factors and the definitions used influenced the reported rates of penicillin tolerance. The epidemiological data suggest that tolerance is not limited to a single streptococcal serotype. Furthermore, there is not sufficient data to support a correlation between in vitro penicillin tolerance of group A streptococci and treatment failure, either in clinical cases or in animal studies. On the other hand, evidence to exclude penicillin tolerance as a cause of treatment failure is also not available. Therefore, at present penicillin tolerance cannot be ruled out as a cause of penicillin treatment failures.
Drug Tolerance↗
A proposed standard for MIC-MBC laboratory techniques to detect penicillin tolerance in group A streptococci.
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Bacteriological Techniques↗
Evaluation of the ability of a commercial system to identify Acinetobacter genomic species.
A collection of 130 Acinetobacter strains identified by DNA hybridization to 18 different genomic species was used to assess the ability of the API 20NE system (bioMérieux, France) to identify Acinetobacter genomic species and to determine its accuracy. Fifty-eight (87%) of the 67 strains of genomic species defined in the database (version 5.1) were identified to the appropriate genomic species. The Acinetobacter baumannii strains and the Acinetobacter haemolyticus strains were all identified correctly. Three of five Acinetobacter junii strains, three of eight Acinetobacter johnsonii strains, and 11 of 13 Acinetobacter lwoffii strains were also identified correctly. The 58 correctly identified strains represented 45% of the total 130 strains. Thirty-six of the 72 inappropriately identified strains were designated Acinetobacter baumannii. Thirty-one of these 36 strains belonged to genomic species 1 (Acinetobacter calcoaceticus), 3, or 13TU. Analysis of the profiles showed that the API system does not discriminate between genomic species 1, 2, 3, and 13TU. Lumping of these groups into the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in the API 20NE database would make the system considerably more accurate. Incorporation of these data into the database may improve identification of the remaining genomic species, including some that are not defined. However, the discriminative power of the tests in the API galleries is insufficient for correct identification of all Acinetobacter genomic species.
Acinetobacter↗
Genotypic and phenotypic analysis of Borrelia burgdorferi isolates from The Netherlands.
Sixty-three Borrelia burgdorferi isolates recovered from Ixodes ricinus ticks collected in 17 locations in The Netherlands and three Dutch human skin isolates were characterized by rRNA gene restriction fragment length polymorphism, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and Western blotting (immunoblotting). All three human isolates belonged to B. burgdorferi group VS461. Of the tick isolates, 29 (46%) were B. burgdorferi sensu stricto, 2 (3%) were group VS461, 19 (30%) were Borrelia garinii, and 13 (21%) were different from any previously described genomic species. On the basis of the criteria described, 12 isolates formed a distinct genomic group, designated M19. rRNA gene restriction patterns of the group M19 isolates resembled but were not identical to the B. garinii patterns. Hybridization of digested DNA with a flagellin probe confirmed the separation of group M19 from the B. garinii isolates. One isolate, M63, was different from all the others. In conclusion, the occurrence of B. burgdorferi sensu stricto, B. garinii, and B. burgdorferi group VS461 in ticks from The Netherlands corresponds with the occurrence of these genomic species among tick isolates from other European countries. However, our findings suggest that B. burgdorferi sensu lato probably contains more than three genomic species.
Animals↗
[Report of the first joint meeting of the (Dutch-Flemish) Society for Infectious Diseases and the Indonesian Society of Tropical Medicine and Infectious Diseases (PETRI) in Bandung, Indonesia].
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Belgium↗
Evaluation of nine serological tests for diagnosis of Lyme borreliosis.
Two hundred serum specimens including 13 sera from patients with early Lyme borreliosis, 21 patients with late Lyme borreliosis, 15 rheumatoid factor positive sera, 31 sera from patients with syphilis and 84 sera from healthy controls were used to evaluate the following assays for the detection of antibodies to Borrelia burgdorferi: two in-house enzyme immunoassays (EIAs), two in-house immunofluorescent antibody assays (IFAs), a commercial haemagglutination assay (HA) (Diagast) and four commercial EIAs (Diagast, Dako, Diamedix, Whittaker Bioproducts). In early and late Lyme borreliosis sera sensitivity ranged from 8% to 62% and from 62% to 86% respectively. With the exception of the Dako EIA, which was signifcantly more sensitive in early Lyme borreliosis (62%) than the Diagast HA (8%) (p = 0.05), differences in sensitivity were not significant. In healthy controls the specificity was > or = 95% for all tests. Taking into account sensitivity, specificity, intra-test and inter-test precision, ease of performance and cost, the Dako EIA and Diamedix EIA were shown to be good alternatives to the in-house EIA and in-house IFA. Because of its low sensitivity in diagnosis of both early and late Lyme borreliosis, use of the Diagast HA should be discouraged.
Costs and Cost Analysis↗
Effect of transport medium and transportation time on culture of Helicobacter pylori from gastric biopsy specimens.
To determine whether transportation time and use of a low budget transport medium (NaCl 0.9%) would influence culture of Helicobacter pylori from gastric biopsy specimens, upper gastrointestinal endoscopy was performed on 42 patients. The specimens were cultured and examined histologically, and H pylori antibodies were determined using an ELISA technique. Patients were regarded as H pylori positive when culture was positive or when histology or IgG anti-H pylori antibodies indicated H pylori infection. Rapid transportation of gastric biopsy specimens in NaCl 0.9%, at room temperature resulted in a high diagnostic yield (23 H pylori positive cultures in 26 patients with H pylori infection). A 24 hour delay in plating gastric biopsy specimens after transportation in NaCl 0.9%, at room temperature, did not seriously affect results (22 instead of 23 H pylori positive cultures). The culture results after transportation in Cairy-Blair medium were comparable with those after transportation in NaCl 0.9%, but because of availability, low cost, and ease of handling in the endoscopy department, NaCl 0.9% was preferred as transport medium. This study shows that for culture of H pylori from gastric biopsy specimens sterile saline is an adequate medium, and that transportation can be delayed for 24 hours without a significant loss of diagnostic yield.
Adult↗
Cytomegalovirus infection induces vascular injury in the rat.
The role of cytomegalovirus (CMV) in the early development of atherosclerosis was studied in a rat model. Arterial samples derived from virus-infected normo- and hypercholesterolaemic animals were investigated by light microscopy at 1, 4, 8 and 16 weeks post infection. Early atherogenic lesions comparable to those seen in non-infected hypercholesterolaemic rats were found in CMV-infected normocholesterolaemic and hypercholesterolaemic animals, starting at 1 week post infection. The changes consisted of minimal endothelial cell damage, as shown by the en face technique, and a more than 10-fold increase in the number of leukocytes adhering to the aortic intima. The increased adhesion of leukocytes was observed in infected normocholesterolaemic rats but only in the non-infected rats which were hypercholesterolaemic. The infection of hypercholesterolaemic rats did not enhance this effect although it resulted in increased migration of the leukocytes into the subendothelial space. CMV infection of normocholesterolaemic rats induced lipid accumulation in the endothelium. In these animals approximately 1% of the endothelial cells contained lipid at 1 week post infection. In the non-infected hypercholesterol-fed animals 10% of the cells contained lipid. CMV infection in these rats induced an extra increase of the lipid-containing endothelial area. The changes in the CMV infected animals largely corresponded with the intimal injury observed in the hypercholesterolaemic rats. These results support the hypothesis that CMV may be one of the factors involved in atherogenesis.
Animals↗
[Prevalence of Lyme borreliosis in The Netherlands].
In the autumn of 1989 a seroepidemiological study was carried out among 440 owners of hunting dogs and 1052 blood donors from different regions in the Netherlands. To detect IgG antibodies to Borrelia burgdorferi an enzyme-linked immunosorbent assay was performed. The prevalence of antibodies to B. burgdorferi in owners of hunting dogs was 15%, which was significantly higher than in blood donors (9%). In both groups the prevalence of seropositivity increased with age. There was no difference between men and women. The prevalence of antibodies to B. burgdorferi in blood donors from different regions varied significantly, ranging from 2% to 17%. Only 3% of the owners of hunting dogs could recall having had symptoms most likely to be due to Lyme borreliosis. Of the 68 seropositive hunters 64 (94%) were asymptomatic. The results of this study indicate that in the Netherlands asymptomatic infections with B. burgdorferi are common in individuals highly exposed to ticks and that there is considerable variation in the prevalence of seropositivity in the general population. Hence caution is called for in the clinical interpretation of IgG test results.
Adolescent↗