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PubMed2000

Staphylococcal infections in the intensive care unit.

Staphylococcus aureus and coagulase-negative staphylococci are among the most common causes of nosocomial infections in the intensive care unit (ICU). The clinical presentation of staphylococcal device-related infections, pneumonias, or surgical wound infections is not unique. However, treatment of these infections is increasingly problematic because of the resistance of clinical isolates to a widening number of antimicrobial agents. The confluence of critically ill patients and the need for multiple invasive procedures, as well as the use of broad-spectrum antimicrobial agents in the ICU, set the stage for the emergence of these multidrug-resistant staphylococci. In the past 10 years, there has been a progressive increase in the overall resistance of staphylococci to antimicrobial agents. Conventional infection control measures, such as handwashing and isolation precautions, to prevent the spread of staphylococcal infections in the ICU setting remain of critical importance. New approaches, including the prophylactic use of topical antistaphylococcal agents to eliminate nasal colonization in high-risk ICU patients and the development of antistaphylococcal vaccines, are currently being investigated.

Cross Infection↗
PubMed1984

The combination of oxacillin with rifampicin in staphylococcal infections: a review of laboratory and clinical studies of the Institut Jules Bordet.

In-vitro study of the combination of oxacillin with rifampicin has shown that a complex interaction occurs between the two drugs: a high oxacillin/rifampicin ratio was associated with antagonism, a low ratio was more likely to result in synergy--the combination acquired a higher rate of killing. Oxacillin significantly prevented or delayed the regrowth of rifampicin-resistant mutants, and antagonism for high oxacillin/rifampicin ratios only affected rifampicin-susceptible strains. The two clinical studies that we have performed suggested that the addition of rifampicin to standard treatment improved the clinical outcome of the patients with staphylococcal infections, and this was particularly true for the most severe infections. Failures were not associated with the emergence of rifampicin-resistant strains; the combination was not associated with more superinfections nor with more toxicity or intolerance. Serum bactericidal activities reflected a similar complex interaction to that observed in vitro by time-kill curves or checkerboard techniques.

Adolescent↗
PubMed1985

[Treatment of severe staphylococcal infections. Failure of rifampicin in combination therapy. 4 cases].

Seven patients with severe methicillin-resistant Staphylococcus aureus infections (5 with bacterial endocarditis, 1 with mediastinitis and 1 with meningitis and septicaemia) were treated with rifampicin combined with vancomycin in 6 cases and with gentamicin in 1 case. The 7 strains initially isolated from haemocultures were resistant to methicillin and sensitive to rifampicin. In 4 of these patients (3 of whom received vancomycin and 1 gentamicin) clinical and bacteriological failure was observed, with selection of rifampicin-resistant mutants. Bactericidal activity was always mediocre in both serum and cerebrospinal fluid, with insufficient vancomycin and gentamicin concentrations in 3 patients. An in vitro study of the combined antibiotics by the chequer-board method suggested antagonism in 3 of these 4 cases. Thus, in spite of its excellent activity and unquestionable effectiveness, rifampicin should be used with caution in severe staphylococcal infections.

Anti-Bacterial Agents↗
PubMed2000

A novel polymorphism in the toll-like receptor 2 gene and its potential association with staphylococcal infection.

The toll-like receptor 2 (TLR2) has gained importance as a major mammalian receptor for lipoproteins derived from the cell wall of a variety of bacteria, such as Borrelia burgdorferi, Treponema pallidum, and Mycoplasma fermentans. We were interested in identifying mutations in the TLR2 gene that might prove to be associated with altered susceptibility to septic shock. We performed a mutation screen of the TLR2 gene using single-stranded conformational polymorphism in 110 normal, healthy study subjects and detected an Arg753Gln mutation in three individuals. No other missense mutations were detected in the TLR2 open reading frame. Functional studies demonstrate that the Arg753Gln polymorphism, in comparison to the wild-type TLR2 gene, is significantly less responsive to bacterial peptides derived from B. burgdorferi and T. pallidum. In a septic shock population, the Arg753Gln TLR2 polymorphism occurred in 2 out of 91 septic patients. More importantly, both of the subjects with the TLR2 Arg753Gln polymorphism had staphylococcal infections. These findings suggest that a mutation in the TLR2 gene may predispose individuals to life-threatening bacterial infections.

Amino Acid Sequence↗
PubMed1976

[Prevention and treatment of staphylococcal infections and their complications, in surgical practice with biological products].

In the clinic 307 patients with suppurative lesions were observed, in 183 of them (the main group) staphylococcic anatoxin was administered with prophylactic and therapeutic purposes, 124 patients (the control group) were treated with antibiotics, including 231 patients with acute appendicitis, 23--with osteomyelitis, 48--with mastitis and 5 patients with various purulent complications of staphylococcic etiology. Among 231 patients with acute appendicitis 125 comprised the main group who were injected staphylococcic anatoxin, and 106--the control group. In the latter the incidence of the operative wound suppuration was observed thrice as frequently.

Antitoxins↗
PubMedDate not supplied

The role of antibodies against alpha-toxin and teichoic acid in the diagnosis of staphylococcal infections.

An enzyme-linked immunosorbent assay (ELISA) was used with purified alpha-toxin and teichoic acid preparations to measure the IgG and IgM response in Staphylococcus aureus infections. After determining antibodies in a normal population, cut-off levels were set for all age groups. ELISA with alpha-toxin was more sensitive than the antistaphylolysin neutralization test (ASTA). Determining IgM antibodies with the two antigens was found to be of limited diagnostic value. Positive IgG titers against alpha-toxin were found in 21 of 27 patients (78%) with endocarditis, 11 of 14 (79%) with complicated septicemia, eight of 20 (40%) with uncomplicated septicemia and in 12 of 22 (54%) with chronic osteomyelitis. The IgG responses to teichoic acid and alpha-toxin were somewhat different when measured by ELISA, and the parallel performance of the two assays resulted in improved serological diagnostics. The number of positive patients increased to 89%, 86%, 65% and 64%, respectively, in the four groups with a diagnostic specificity of 93%. In septicemic staphylococcal infections, the diagnosis could be established in all patients (28 of 28) with adequately spaced paired samples.

Adolescent↗
PubMed1989

Staphylococcal infection and the limbus: study of the cell-mediated immune response.

The relationship between enhanced cell-mediated immunity (CMI) to staphylococcal antigens, expressed as delayed hypersensitivity (DH), and the development of catarrhal infiltrates at the limbus in the rabbit has been explored by others. This DH is required for infiltrates to develop in the rabbit cornea when it is exposed to conjunctival inoculation with live Staphylococcus aureus cells. Similar investigations have not been pursued in the human, although St. aureus has been isolated from lids of patients with sterile marginal ulcers. We have tested 69 patients with blepharitis, eleven with and 58 without associated symptomatic marginal keratitis, for DH to killed whole cells of St. aureus and St. epidermidis and protein A; quantitative cultures have also been collected from lids and conjunctivae. Preliminary findings show that nine out of 11 patients with symptomatic marginal keratitis, requiring treatment with steroids, have enhanced DH to St. aureus cell wall antigens. We suggest the hypothesis that this type of marginal keratitis in the human is the result of enhanced CMI at the limbus to St. aureus cell wall antigens.

Adult↗