The surveillance of infection of an inpatient gynecology service.
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The use of masks was related to the acquisition from patients of beta-haemolytic streptococci and Staphylococcus aureus in the nose/throat of staff in a burns unit. The study took place over 10 weeks; wearing multi-layer operating room masks for every visit to patient rooms had no effect on nose or throat carriage rates, although airborne dispersal from patients was high.
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The aim of this study was to determine the in vitro antimicrobial activity of recently licensed quinupristin/dalfopristin and linezolid which have not yet been in clinical use in Turkey against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) strains isolated from various clinical specimens by using the Etest. The results showed that all MRSA strains were fully susceptible to both the new compounds. All strains were inhibited by 1 mg/l quinupristin/dalfopristin (mode MIC 0.38 mg/l) and by 3 mg/l linezolid (mode MIC 1.5 mg/l). Four strains of Enterococcus faecium showed an increase of resistance of 2-3 mg/l to quinupristin/dalfopristin (susceptible mode MIC 0.38 mg/l). With linezolid, all strains except two fell within the range 0.75-2.0 mg/l.
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Bacterial lung infections determine the prognosis for most cystic fibrosis patients. The antibacterial therapy is difficult because of the host-bacterium interaction and altered pharmacokinetics. The new insights in the working mechanisms of antibiotics that may lead to better treatment results have been discussed, and guidelines for treatment of lung infections in cystic fibrosis patients were given.
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A case of osteomyelitis of the maxilla in a healthy infant is presented, the etiology of which seems to have been an upper respiratory tract infection. There was no evidence of lowered resistance and immunologic studies did not reveal any abnormality. Lincomycin seems to be the antibiotic drug of choice. In the present case, it was used, effectively, in conjunction with other antibiotics and surgical drainage.
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing. Since most published data are on nosocomial MRSA, our goal was to identify the antimicrobial susceptibility profile and resistance mechanisms of pretreatment MRSA isolates obtained from adult subjects participating in recent clinical treatment trials of community respiratory infections. Out of 465 S. aureus isolates, 43 were identified as MRSA. Antimicrobial susceptibility testing indicated susceptibility rates to: vancomycin (100%), gentamicin (86%), clindamycin (39%), quinolones (49%), and erythromycin (12%). Among our MRSA isolates, the MLS constitutive phenotype and ermA were more prevalent than the MLS inducible phenotype and ermC. No isolates had ermB or msrA. All ciprofloxacin resistant isolates had an amino acid change in GyrA and GrlA. The relatedness of our MRSA strains was assessed by ribotyping. Our results indicate that MRSA from adult subjects with community respiratory infections have similar antimicrobial susceptibility profiles and resistance mechanisms as nosocomial MRSA, and represent a genetically diverse group.
We reviewed all patients with Staphylococcus aureus lower respiratory tract infections treated with vancomycin at our institution in 1998, to see how this antimicrobial is performing. We found that approximately 40% of evaluable patients were considered treatment failures, even though the S. aureus was still reported as being susceptible to vancomycin. We report in detail two example patients that failed to respond clinically to vancomycin and summarize the clinical characteristics of the 23 additional patients that failed. The first case was treated four times in the intensive care unit with vancomycin. Each course, after approximately 14 days therapy, the vancomycin was discontinued and his infection relapsed soon thereafter. The second was treated with vancomycin for 10 days initially. She relapsed, was restarted on vancomycin once more, but her condition deteriorated, and she died of refractory sepsis 20 days after admission. The cost of care for each patient ranged from $50,000 to over $100,000. With trends such as these, alternative therapies are needed to control resistant Gram-positive infections.