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PubMed1979

Physical characterization of ten R plasmids obtained from an outbreak of nosocomial Klebsiella pneumoniae infections.

Gentamicin resistance in Klebsiella pneumoniae involved in an outbreak at the Minneapolis Veterans Administration Hospital was due to a transmissible R plasmid. In addition to gentamicin, this plasmid conferred resistance to tobramycin, kanamycin, ampicillin, carbenicillin, cephalothin, chloramphenicol, and sulfathiazole. R plasmids which transferred this complex antibiogram were identified in several clinical isolates, including four different serotypes of K. pneumoniae, Escherichia coli, Enterobacter cloacae, and Proteus morganii. The covalently closed circular form of all R plasmids isolated had a sedimentation coefficient of 76S to 77S, corresponding to a molecular weight of 58 x 10(6). The possibility that a single R plasmid was responsible for the dissemination of multiple drug resistance among all of these different clinical strains was examined by characterizing the plasmids by using EcoRI restriction endonuclease. The same 15 fragments were obtained from each of the 10 plasmids analyzed. Their molecular weights ranged from 4 x 10(5) to 11 x 10(6). Thus, we conclude that each of the 10 plasmids present in the various clinical strains isolated from the hospital over a 7-month period originated from a common source and that R plasmid transfer was important in their spread.

Anti-Bacterial Agents↗
PubMed1979

Ureolytic Escherichia coli of human origin: serological, epidemiological, and genetic analysis.

Forty-five strains of ureolytic Escherichia coli of human origin, isolated in the United States between 1956 and 1977, were characterized by geographical distribution, site of infection, serotype, resistance to antibiotics, and biochemical reactions. All strains were studied for the ability to generate clones of nonureolytic E. coli (segregants), and a subset of these were selected for plasmid analysis and a variety of bacterial matings. There did not appear to be a common geographical distribution, serotype, antibiogram, or other aberrant biochemical reactions other than the hydrolysis of urea among these strains. The predominance of urinary tract isolates (46.7% total) may reflect a relationship between urea hydrolysis and pathogenesis at this site. Ten of the strains (22.2%) did segregate nonureolytic E. coli colonies, and all possessed at least one common plasmid species with a molecular weight of about 65 X 10(6). Only strain 1138-77 serotype O16:H6 conjugally transfered the ability to hydrolyze urea, ferment sucrose, and resist inhibition by sulfadiazide simultaneously. The resulting, recombination-deficient E. coli K-12 tranconjugant was found to possess a plasmid with a molecular weight of about 80 X 10(6) to 90 X 10(6).

Anti-Bacterial Agents↗
PubMed1975

Unusual Enterobacteriaceae: lactose-positive Salmonella typhimurium which is endemic in São Paulo, Brazil.

Since 1971 a lactose-positive (lac+) Salmonella typhimurium variety Copenhagen has been endemic in the city of Sao Paulo. The strain is a strong lactose fermenter and resembles Escherichia coli on primary plating media and in triple sugar iron agar. Although most isolates of the strain have uniform properties, some have slightly different antigens, antibiograms, phage types, or fermentation patterns. Most isolates have come from stools of infants under 1 year of age and are probably hospital acquired; however, other isolates are probably community acquired. Eighteen other lac+ Salmonella isolated in the United States were also studied. Most of these strains resembled E. coli on primary plates and triple sugar iron agar; thus their identification would pose a problem for most clinical laboratories. A simple procedure for detecting lac+ Salmonella mixed with lac+ E. coli consists of touching 12 colonies in succession with a straight wire and then inoculating a peptone iron agar tube. H2S production is apparent from lac+ Salmonella even if 11 E. coli and one Salmonella colony are picked. If a positive peptone iron agar tube is observed, then individual colonies are tested to rule out other strong H2S producers. The true incidence of lac+ Salmonella is unknown because they are not isolated and identified in most laboratories.

Antigens, Bacterial↗
PubMed1976

Polymicrobic bacteriuria: significant association with bacteremia.

Current clinical practice states that a urine culture yielding three or more isolates must be considered a contaminated specimen and discarded. The validity of this practice was tested by reviewing all patients at the West Haven Veterans Administration Hospital with positive blood cultures for 1 year to determine how many were associated with polymicrobic bacteriuria (two or more urine isolates each present at greater than 10(5) colonies/ml). During 1973 there were 18 patients who had bacteremia associated with a urinary tract infection in which the same organism with the identical antibiogram was found in both the blood and the urine of these 18 patients with monomicrobic bacteremia 11(61%) had polymicrobic bacteriuria, with a mean of an additional 1.75 urinary pathogens present in significant quantities. In these patients with polymicrobic bacteriuria, an indwelling bladder catheter was present for a mean period of 4.4 months before the episode of bacteremia. Only 5 of the 11 patients with polymicrobic bacteriuria had temporally associated urinary tract manipulation. Monomicrobic bacteriuria occurred in seven patients (39%). The mean indwelling bladder catheter time was 0.9 days, and urinary tract manipulation near the time of bacteremia occurred in all seven patients. Prospectively, nine other patients with polymicrobic bacteriuria were recultured by one of us to be certain that appropriate collection and transportation methods were used; the presence of polymicrobic bacteriuria was repeatedly demonstrated in 7(78%). This study illustrates the clinical importance of polymicrobic bacteriuria.

Aged↗
PubMed1992

Epidemiologic typing of Staphylococcus aureus by DNA restriction fragment length polymorphisms of rRNA genes: elucidation of the clonal nature of a group of bacteriophage-nontypeable, ciprofloxacin-resistant, methicillin-susceptible S. aureus isolates.

Analysis of DNA restriction fragment length polymorphisms of rRNA genes (ribotyping) was employed to assist in the epidemiologic investigation of the emergence and spread of ciprofloxacin-resistant Staphylococcus aureus at the Atlanta VA Medical Center because many isolates of interest were nontypeable by phages and harbored few plasmids useful as strain markers. Chromosomal DNAs of selected S. aureus isolates were digested initially with 20 different restriction enzymes. EcoRI appeared to give the best discrimination of hybridization banding patterns (ribotypes) and was used with all study isolates. Overall, 15 different ribotypes were seen among the 50 S. aureus isolates studied (7 ribotypes among 13 methicillin-susceptible S. aureus [MSSA] isolates and 9 ribotypes among 37 methicillin-resistant S. aureus [MRSA] isolates). Seven of eight ciprofloxacin-resistant MSSA (CR-MSSA) patient isolates had identical antibiograms, were nontypeable by phages, and had a single 22-MDa plasmid. Six of these seven CR-MSSA isolates had an identical ribotype pattern. Ribotyping distinguished this CR-MSSA strain or clone from MRSA and other MSSA isolates, including nontypeable isolates that contained a 22-MDa plasmid. Five ciprofloxacin-susceptible MSSA isolates studied had five ribotypes; one pattern was identical to the CR-MSSA clone. Twenty-three CR-MRSA isolates recovered from the Atlanta VA Medical Center had four different ribotypes. Ribotyping proved to be a useful molecular epidemiologic tool in the study of S. aureus because it differentiated isolates which were indistinguishable by more traditional methods. In addition, this technique demonstrated that at our institution, ciprofloxacin resistance emerged in multiple strains of MRSA, as opposed to primarily a single strain or clone of MSSA.

Bacterial Typing Techniques↗
PubMed1978

Pseudomonas vesicularis from cervical specimens.

Biochemical characteristics and antibiotic susceptibilities of five strains of Pseudomonas vesicularis isolated from cervical cultures are reported. The organisms were recovered from Thayer-Martin medium, which, because of its inhibitory properties, restricts over-growth by most other species. Our findings agree with those of Kaltenbach and associates (J. Clin. Microbiol., 1:339--344, 1975) on the importance of esculin hydrolysis, maltose oxidation, and pigmentation in the identification of P. vesicularis. Comparative carbohydrate oxidation studies showed agreement in three of four methods (oxidative attack, buffered single substrate, King oxidative/fermentative medium). No oxidation of carbohydrates was observed in commercial oxidative/fermentative medium. In addition to biochemical characteristics, antibiograms can be useful auxiliary aids in the identification of P. vesicularis and in its differentiation from P. diminuta, a closely related species.

Anti-Bacterial Agents↗
PubMed1979

Serotypes and antibiotic susceptibilities of Pseudomonas aeruginosa isolates from single sputa of cystic fibrosis patients.

A phenotypic characterization of Pseudomonas aeruginosa from single sputum samples of 21 typical cystic fibrosis patients indicated a high frequency of heterogeneity among isolates on the basis of differences in antibiotic resistance, colony morphology, pigmentation, and serotype. Two or more isolates with different but stable susceptibilities to carbenicillin, gentamycin, streptomycin, tetracycline, chloramphenicol, and sulfamethoxazole plus trimethoprim were detected in 38% of the sputa. Differences generally were independent of the mucoid state of the strain. O-antigen group determination with the Difco typing set showed that two or more serologically distinct strains were present in 10/21 sputum specimens. Nonmucoid derivatives of mucoid isolates almost always retained both the antibiotic susceptibilities and serotype of their parent strain. These data suggest that cystic fibrosis patients may be cocolonized/coinfected by different strains of P. aeruginosa more frequently than generally believed. Alternatively, phenotypically distinct strains from a single patient might arise as phenotypic dissociants from a single infecting strain. Because of the frequency and multiplicity of phenotypically distinct P. aeruginosa isolates which we obtained from our cystic fibrosis patients, it is important to select multiple isolates from sputum cultures for antimicrobial susceptibility testing so as to assess adequately the susceptibility of this organism to antibiotic therapy in cystic fibrosis. We recommend that several colonies of each distinguishable colony type of P. aeruginosa be pooled for the antibiogram.

Adolescent↗
PubMed1977

Improving the performance of anaerobic bacteriology in a hospital laboratory.

A comparison was made of the performance of a newly established anaerobic section of a clinical laboratory and the routine diagnostic section in terms of isolation and identification of anaerobic bacteria. Both sections attempted to isolate obligate anaerobes from the same clinical specimens which were not transported in anaerobic containers. Anaerobic and diagnostic sections isolated anaerobes from 35% and 6% respectively of clinical specimens. The use of antibiograms greatly improved the identification of anaerobic organisms.

Anaerobiosis↗
PubMed1977

Fosfomycin in infantile acute gastroenteritis.

A clinical test was carried out on 83 children suffering from infectious diarrhoeal processes who were treated with fosfomycin with the oral and paranteral route. Coproculture was carried out in all the children before the beginning of treatment and in 51 of them it was repeated at the end of treatment. Antibiograms were made on the isolated germs and their MIC to fosfomycin studied. Tolerance and secondary effects of the medicament were also studied. The study was considered insufficient in 13 patients so that the evaluation was based on 70, making 4 failures and 60 clinical cures. Administration of fosfomycin causes the eradication of serotypeable E. coli and is followed by an increase in the number of Proteus sp. and Klebsiella/Enterobacter. The sensitivity of the faecal flora to fosfomycin has been very high, except for the strains of Proteus sp. and Klebsiella/Enterobacter. The accumulative percentage of the MIC to fosfomycin of all the strains isolated shows that more than 75% of them are inhibited at concentrations under 32 mug/ml. Tolerance was good and no secondary effects were observed except for the sporadic rise in the SGPT of the children.

Acute Disease↗
PubMed1976

[Treatment of urinary tract infections caused by unknown bacteria (author's transl)].

The treatment of acute febrile urinary tract infections in urological patients has to start in most cases without knowledge of bacteria and their sensitivity. The results of 2,000 antibiograms and clinical observations showed good efficiency in initial therapy if combined treatment with gentamycin and cephalothin was used. Using recommeneded doses in permanent control of serum creatinine and blood-urea nitrogen, no decrease of renal function was observed in 131 patients treated with this combined therapy.

Bacteria↗
PubMed1976

Effect of dietary oxytetracycline on microorganisms in turkey feces.

Thirty-six two-day old male turkey poults were divided into three groups and fed three levels of oxytetracycline; 0, 110 or 440 mg. per kg. of ration, respectively, for nine weeks. The poults were given an oral spectinomycin plus vitamin treatment at the hatchery but were not fed before the start of the experiment. Defecated feces from each group were sampled at weekly intervals and analyzed for bacteriological content, especially for members of the Enterobacteriaceae. Total aerobic counts of 3 x 10(8) and total anaerobic counts of 2 x 10(9) were obtained. The majority of the Enterobacteriaceae were Escherichia coli but some Klebsiella sp., the Bethesda-Ballerup group of paracolon bacteria and Arizona sp. were also isolated. Antibiograms of the enteric isolates indicated that an increase in multiple antibiotic resistance occurred when increased amounts of antibiotic were fed.

Ampicillin↗
PubMed1979

New aid to management of septicaemia: rapid direct antibiotic susceptibility testing.

A rapid and reliable method of performing direct antibiotic susceptibility tests on positive blood cultures has been developed. A result is now available five hours after laboratory confirmation of septicaemia. An evaluation involving 55 blood-culture isolates demonstrated an over-all correlation of 97.8% when results obtained by the rapid direct Autobac l method were compared to those obtained by definitive testing procedures. The method is particularly applicable to isolates of Staphyloccus aureus, Pseudomonas aeruginosa, and the Enterobacteriaceae. It is especially significant because of the recent emergence of multiple antibiotic resistance amongst hospital strains of these bacteria with many isolates showing resistance to antibiotics frequently used in the empirical treatment of septicaemia. The rapid availability of a reliable antibiogram is important in allowing early appropriate chemotherapy and, hence, in the reduction of septicaemia-associated morbidity and mortality, and the length of stay in hospital.

Anti-Bacterial Agents↗
PubMed1976

[Bacteriological studies on the bile in different conditions of surgical interest].

A bacteriological study was carried out on bile taken, during the course of surgery, from 235 patients suffering from a wide variety of diseases, both benign and malignant, concerning the bile ways. The investigation, initially directed to the aerobic bile flora, was afterwards extended to include germs growing in strict anaerobiosis. The highest incidence of bactibilia was found in repeat operations for post-operative stenosis of the hepatocholedochus, followed by neoplasias of the gall-bladder or main bile duct, and calculosis of the gall-bladder. For germs growing in compulsory anaerobiosis the responses to the cultural test were all negative, while in two cases microaerophilic streptococci were isolated. Finally the results of the antibiograms made on the isolated microbial species are reported.

Bacteria↗
PubMedDate not supplied

[Prevention and treatment of infections in open heart surgery (author's transl)].

The incidence of bacterial infections in 207 patients who underwent cardiopulmonary bypass surgery is reported. The effectiveness of various prophylactic antibiotic therapies is debated on the basis of performed antibiograms and the results are compared with that obtained by other Authors using different treatments.

Anti-Bacterial Agents↗
PubMed1975

Frequency distribution of S. typhi-murium phage types in various countries.

The phage type and antibiogram of 5199 S. typhi murium strains from 13 countries and of 4949 strains from The Netherlands was determined. For a number of countries it could be established that types predominating in pigs or calves predominate also in humans in that country. However, the predominant phage types were not the same in the various countries. Type 505 predominated in The Netherlands and, to a lesser degree, also in Belgium and the German Federal Republic. Type 131 predominated in Poland and was also frequently found in the German Democratic Republic. In the German Democratic Republic, type 450 was the most frequently found type. Phage patterns not accepted as a type and occurring one country only, were found to predominate in Italy, Hungary, Israel and Sweden. The majority of antibiotic-resistant strains belonged to a limited number of phage types only.

Animals↗
PubMed1975

[Relation of intrahospital morbidity from staphylococcal infections to some properties of hospital strains].

Analysis of staphylococcus infection morbidity in a large obstetrical hospital for 5 years offered a possibility of establishing an association between the severity of the course of staphylococcus infections in patients, the bacteriophage type of the causative agent and its resistance to antibiotics. The qualitative changes in morbidity in the direction of the prevalence of minor forms and mild course ocurred in parallel with the changes of the leading bacteriophage type from the epidemic 75/77 and 80/81 to the nonepidemic bacteriophage types of the III bacteriophage group and the changes of the antibiograms of the causative agents in the direction of an increase in the number of strains sensitive to antibiotics. Since the severity of the course of staphylococcus infection characterized the pathogenicity of the strain of the causative agent a conclusion could be drawn on the association between the sign of virulence and determinants of the medicinal resistance and definite prophages in the hospital strains of staphylococcus.

Adult↗
PubMed1975

[Clinical experiences with a new multi-effective penicillin "spectacillin", gained in the gynecological and obstetrical therapy (author's transl)].

With the new semi-synthetic ampicilline-derivate, we treated 28 female patients of gynecological, and 22 of obstetrical indications. Owing to bacterial infections by grampositive/gramnegative germs, in these cases an antibiotic therapy was indicated. The target therapy was based on clinical findings, the germ analysis and the antibiogram. Considering the degree of disease, the intravenous (3 x 2 grams per day) or the oral treatment (4 to 6 grams a day) has been effected during 6 days at least and 13 days as a maximum duration. The evaluation of the therapeutical results was made by means of the clinical cours as well as the germ findings. These two parameters showed the reliable effectiveness of "Spectacillin", whereas the low exanthemic rate must be emphasized.

Abortion, Septic↗