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PubMed1987

An immunological study of otitis media with effusion. Antibodies directed against coagulase-negative staphylococci in the effusion fluid.

From 14 chronic middle ear effusions (MEEs), 17 strains of coagulase-negative staphylococci (CS) were isolated. We then used an ELISA method to determine the antibody titers against these microorganisms in the corresponding effusion fluids and the blood sera of the patients and compared them to the antibody titers against a group of standard CS. In most cases, no specific immune response could be detected against the infecting CS in either the effusion fluids or in the sera. Our results can be explained by the inability of most CS strains to provoke a specific immune response in chronically inflamed middle ears due to their inhibition by non-specific antibodies, which reach the middle ear cavity by plasma leakage. The non-specific antibody titer against Staphylococcus hominis, however, seems to be much lower than against the other CS species. We found a high specific antibody titer against the infecting CS in the effusion fluid of a single case, but not in the serum. This finding supports the hypothesis that the middle ear mucosa has the ability to produce autonomous, local antibodies which are independent of a systemic immune response.

Adolescent↗

PubMed1978

Taxonomy of coagulase-negative staphylococci: a comparison of two widely used classification schemes.

In a comparative study 351 strains of Micrococcus subgroups 1-3 (Baird-Parker, 1963, 1965, 1974) were classified according to the Kloos and Schleifer scheme (1975b). The results showed that Micrococcus subgroups 1, 2 and 3 are heterogeneous groups in the Kloos and Schleifer scheme. Strains belonging to Micrococcus subgroups 1 and 2 were mostly classified by the Kloos and Schleifer criteria as Staphylococcus hominis, Micrococcus subgroup 3 strains from the skin as S. cohnii, while Micrococcus subgroup 3 strains from urinary infections were classified mainly as S. saprophyticus. The correlation of novobiocin resistant S. saprophyticus biotype III (Baird-Parker, 1974) with S. saprophyticus (Kloos and Schleifer, 1975a, 1975b) when isolated from urine, was 80%. Although the Kloos and Schleifer scheme provides more information about biochemical characters, doubts are expressed about the validity of some of the species so delineated.

Bacteriological Techniques↗

PubMed2002

Detection and characterization of erythromycin-resistant methylase genes in Gram-positive bacteria isolated from poultry litter.

The epidemiology of four erythromycin-resistant methylase ( erm) genes, ermA, ermB, ermC and msrA, was determined in erythromycin-resistant staphylococci, enterococci and streptococci isolated from poultry litter. All isolates were resistant to multiple antibiotics. Southern hybridization indicated that 4 of the 20 staphylococci contained the ermC gene on plasmids: on a 2.2 kb plasmid in Staphylococcus hominis and S. sciuri, on a 6.0 kb plasmid in S. xylosus, and on a 7.0 kb plasmid in S. lentus. In 16 of the 20 staphylococci, the ermA gene was harbored exclusively on the chromosome, as a double chromosomal insert on 8.0 and 6.2 kb EcoRI fragments. None of the staphylococci harbored the msrA gene. Dot-blot analysis indicated that all enterococci and streptococci hybridized with a biotinylated ermB gene probe. Southern hybridization indicated that only 2 of the 19 erythromycin-resistant enterococci contained the ermB gene on plasmids. The gene was localized on 4.0 kb and 5.9 kb plasmids, respectively, in two Enterococcus faecium isolates. Results from our studies indicate that the patterns of occurrence of erm genes, the sizes of the plasmids and the copy numbers of the inserts were different from the existing information on the presence of erm genes in clinical strains of Staphylococcus spp.

Animals↗

PubMed1990

Peripheral teflon catheters. Potential source for bacterial contamination of orthopedic implants?

To detect low numbers of bacterial cells on Teflon catheters removed from peripheral veins, 74 catheter tips were incubated in thioglycollate media for up to ten days. Fifteen (20.3%) of the catheters were found to be culture-positive. Propionibacterium acnes was isolated from seven, Staphylococcus epidermidis from six, and Staphylococcus haemolyticus and Staphylococcus hominis from one each, all common skin organisms associated with infection of implants. An increase in documentation of bacterial contamination resulted from incubating greater than 72 hours; this allowed the slower-replicating Propionibacterium acnes to grow to detectable numbers. Because of these findings and those of others, attention is focused on the peripheral vein conduit as a potential source for hematogenous seeding of implants with bacterial cells. Changing peripheral catheters within 24 hours is recommended to reduce the constant risk of occult bacteremia.

Bacteria↗

PubMed1987

The measurement of C-reactive protein and immune complexes in endocarditis caused by coagulase-negative staphylococci.

Coagulase-negative staphylococci are a major cause of early endocarditis following the insertion of prosthetic heart valves but rarely cause endocarditis in natural valves. From a 2-year prospective study we report seven cases: six with endocarditis related to prosthetic valves and one with endocarditis related to a natural valve. Each isolate of coagulase-negative staphylococcus was identified biochemically (six Staphylococcus epidermidis; one Staphylococcus hominis) and characterised by bacteriophage typing. Six isolates were also examined for slime production and for extracellular toxins and enzymes: all produced toxin but enzyme and slime production was variable. Concentrations of immune complexes and C-reactive protein in the serum were measured in six of the patients. Our results suggest that measuring C-reactive protein may be useful but measuring immune complexes is not helpful and takes more time.

Antigen-Antibody Complex↗

PubMed2002

In vitro activity of quinupristin/dalfopristin, linezolid, telithromycin and comparator antimicrobial agents against 13 species of coagulase-negative staphylococci.

OBJECTIVES: To determine in vitro susceptibilities of a large series of speciated coagulase-negative staphylococci (CNS) against three new antibiotics, linezolid, quinupristin/dalfopristin and telithromycin. METHODS: Susceptibilities to three new antibiotics and oxacillin, vancomycin, clindamycin and erythromycin were determined by the agar dilution method, as described by the NCCLS. RESULTS: Resistance to linezolid was not observed in any isolates, although MIC90 values varied between species. Fifteen of 658 (2.3%) isolates were resistant to quinupristin/dalfopristin, but < 1% of the clinically most important isolates of Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis demonstrated resistance to this agent. Susceptibility to clindamycin correlated with susceptibility to quinupristin/dalfopristin; however, resistance to clindamycin did not predict quinupristin/dalfopristin resistance. Telithromycin was the least active of the new agents tested, showing activity similar to that of clindamycin. Susceptibility and resistance to clindamycin were predictive of susceptibility and resistance to telithromycin. CONCLUSION: Clindamycin susceptibility can be used as a surrogate marker for susceptibility to quinupristin/dalfopristin and telithromycin. Quinupristin/dalfopristin and linezolid show good activity against both mecA-positive and -negative CNS.

Acetamides↗

PubMed2000

Clonal spread of staphylococci among patients with peritonitis associated with continuous ambulatory peritoneal dialysis.

BACKGROUND: Peritonitis is the most important complication of continuous ambulatory peritoneal dialysis (CAPD). Coagulase-negative staphylococci (CNS) are the most common causes of peritonitis, only limited information is available regarding the distribution and epidemiology of different CNS species associated with CAPD peritonitis. METHODS: CNS isolated from dialysis effluent from CAPD patients with peritonitis was identified by species and further analyzed with pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 216 microorganisms (206 bacteria and 10 Candida species) were isolated from 196 consecutive culture-positive CAPD samples obtained from 75 patients. One hundred and twenty-one (56%) isolates represented staphylococci. The four most frequently isolated staphylococcal species were Staphylococcus epidermidis (70 isolates), Staphylococcus aureus (31 isolates), Staphylococcus hemolyticus (10 isolates), and Staphylococcus hominis (4 isolates). PFGE analysis revealed the clonal spread among patients of three different clones of S. epidermidis and one clone of S. aureus among the investigated patients. Indistinguishable isolates of either S. epidermidis, S. hominis, or S. aureus were also isolated in repeated samples from several patients. CONCLUSION: PFGE is a useful method for the epidemiological evaluation of staphylococci-associated CAPD infections and should replace older and less accurate methods, such as antibiotic sensitivity patterns. We recommend that CNS isolates from patients with CAPD-associated peritonitis should be saved for future investigations and typing, which would aid in the management of this patient category.

Ascitic Fluid↗

PubMedDate not supplied

Production of pro- and anti-inflammatory cytokines of human placental trophoblasts in response to pathogenic bacteria.

OBJECTIVE: We studied the production of cytokines in purified cultures of human term trophoblasts in the presence of pathogenic strains of Escherichia coli, Bacteroides fragilis, Mycoplasma hominis, Staphylococcus aureus, and Streptococcus agalactiae, which have been identified in intrauterine infections. METHODS: Human villous trophoblasts were isolated from term placentas after cesarean section and purified by several steps. After 6, 12, and 24 hours of incubation with the different heat-inactivated bacteria, interleukin-1beta (IL-1beta), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) as well as tumor necrosis factor-alpha (TNF-alpha) were measured from supernatants by commercially available enzyme-linked immunosorbent assay. Expression of cytokine mRNAs was determined by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: In nonstimulated cultures, low (IL-1beta and TNF-alpha) and high (IL-6, IL-8, and IL-10) basal secretion of cytokines was detectable. The pathogenic microorganisms induced a dose- and time-dependent release of IL-1beta, IL-6, IL-8, and IL-10, whereas TNF-alpha secretion was not elevated. E coli was the most potent inducer followed by B fragilis, S agalactiae, S aureus, and M hominis. Transcripts encoding IL-1beta, IL-6, IL-8, or IL-10 were elevated in the RT-PCR reactions, suggesting that transcriptional mechanisms contribute to elevated cytokine expression. CONCLUSION: Pathogenic microorganisms stimulated mRNA expression and polypeptide release of pro- and anti-inflammatory cytokines from placental trophoblasts. Induction of both inflammation-promoting and inflammation-inhibiting cytokines by bacterial products could play a role in modulating the inflammatory response associated with chorioamnionitis.

Bacterial Infections↗

PubMed1998

The Staphylococcus aureus and Staphylococcus epidermidis transferrin-binding proteins are expressed in vivo during infection.

Staphylococci express a 42 kDa cell-wall-associated protein which functions as a receptor for the mammalian iron-binding glycoprotein transferrin. To determine whether this transferrin-binding protein (TBP) is expressed during infection, Staphylococcus aureus and Staphylococcus epidermidis were grown in vivo in chambers implanted intraperitoneally in rats. SDS-PAGE and Western blotting of cell wall proteins prepared from staphylococci recovered directly from the chambers revealed the presence of both the TBP and bacterial-surface-associated rat transferrin. To obtain evidence for the in vivo expression of the staphylococcal TBPs in humans, sera and human peritoneal dialysate (HPD) from non-infected patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and sera from healthy human volunteers were screened for anti-TBP antibodies. Western immunoblots revealed that three out of ten samples from the latter group, seven out of ten HPD samples and ten of ten CAPD patient serum samples contained antibodies to the TBP of both S. aureus and S. epidermidis. To gain further insights into the appearance of TBP antibodies, HPD samples were collected over time from CAPD patients whose HPD samples taken immediately after catheter insertion lacked anti-TBP antibodies. In two of these patients, each of whom experienced an episode of peritonitis due to S. epidermidis or Staphylococcus hominis, antibodies to the TBP appeared in the HPD collected immediately post-infection. To determine whether such TBP antibodies were capable of blocking interactions between transferrin and its staphylococcal receptor, HPD immunoglobulin fractions were purified using protein A-Sepharose beads. In competition assays, these immunoglobulins blocked the binding of 125I-labelled transferrin both to whole bacteria and to the isolated 42 kDa TBPs of S. aureus and S. epidermidis. These provide evidence to show that staphylococcal TBPs are expressed in vivo during infection.

Animals↗

PubMed1996

The bacteriology of hidradenitis suppurativa.

BACKGROUND: Bacteria have been suggested as a possible cause of hidradenitis. Different species have been found in several small studies, and particularly the presence of Streptococcus milleri has been linked to disease activity. OBJECTIVE: To investigate the possible role of bacteria in hidradenitis. METHODS: Cultures of active lesions and serological analysis of circulating IgG antibodies were studied in 41 patients. RESULTS: Bacteria were found in 49% (20/41) of all lesions: Staphylococcus aureus, 8; S. milleri, 1; Staphylococcus epidermidis, 11; Staphylococcus hominis, 1. Corynebacterium spp., Acinetobacter and Lactobacillus spp. were found once each and considered as contaminants. Patients in whom S. aureus was found had a shorter duration of disease (mean 1.7 vs. 9.7 years for sterile lesions). No other significant correlations were found between location of disease or antibody response and the bacterial species found. CONCLUSION: S. milleri appears to be an unusual pathogen, and bacteria are only found in approximately 50% of all active hidradenitis lesions. It is suggested that S. aureus may play a temporary role in the early phase of the disease, but additional longitudinal studies of cohorts of patients are needed to clarify this point.

Acinetobacter↗

PubMed2001

Survey of methicillin-resistant coagulase-negative staphylococci in the hospitals of central Greece.

A sample of 450 consecutive, non-replicated coagulase-negative staphylococci (CoNS), collected from clinical specimens during the period 2000-2001 from the five major hospitals of Thessaly district (Central Greece) were investigated for resistance to methicillin. Most of the isolates had been collected in a sporadic fashion from the intensive care units and the surgical wards of the participating hospitals. The majority of the isolates (76%) were Staphylococcus epidermidis (50%), Staphylococcus haemolyticus (14.8%) and Staphylococcus hominis (11.1%). All 316 isolates (70%) were classified as resistant according to NCCLS breakpoints (MIC > or =0.5 mg/l); 268 (59.5%) of them were mecA-positive in a PCR-based assay. All isolates with MIC > or =8 mg/l carried the gene, while, only 23.8% of isolates with MIC, 0.5-4 mg/l were carriers. Only 9% of the mecA-positive isolates were found to be sensitive to various non-beta-lactams, while 41.8% of the isolates were resistant to more than three antimicrobial groups apart from beta-lactams. Molecular typing by PFGE showed apparent heterogeneity among isolates of each species and the absence of predominant clones.

Coagulase↗

PubMed1994

Relatedness of coagulase-negative staphylococci causing bacteremia in low-birthweight infants.

OBJECTIVE: To investigate coagulase-negative staphylococcus (CONS) causing bacteremia in a neonatal intensive care unit (NICU). DESIGN: A 14-month retrospective review of 47 infants in the NICU with CONS bacteremia was undertaken to determine CONS glycocalyx production, plasmid pattern, total DNA restriction fragment polymorphism, and clinical risk factors. RESULTS: The isolates included 32 Staphylococcus epidermidis, six Staphylococcus haemolyticus, four Staphylococcus warneri, four Staphylococcus saprophyticus, and one Staphylococcus hominis. Sixty-five percent of S epidermidis produced glycocalyx; other species did not. Oxacillin resistance (52%) and the antibiograms of the CONS were consistent with other units in the hospital. Five similar CONS plasmid patterns were found among 16 isolates; 31 isolates had unique patterns. Extractions of total DNA from these isolates were digested using HindIII, HaeIII, and BstEII. Those with similar restriction fragment length patterns could not linked as nosocomially transmitted among infants with bacteremia. CONCLUSION: Our observations suggest that multiple strains of CONS infect infants in the NICU who have similar risk factors. Although current infection control practices limit transmission of a pathogen, they do not prevent CONS bacteremias.

Bacteremia↗

PubMed1996

Emergence of teicoplanin-resistant coagulase-negative staphylococci.

Over a period of 5 years we have recovered 32 clinical isolates of coagulase-negative staphylococci (CoNS) exhibiting either decreased levels of susceptibility or true resistance to teicoplanin (MICs, 16 to 128 micrograms/ml); these isolates make up 0.55% of the total CoNS isolated by us. Twenty-nine of the strains were also methicillin resistant, and all were susceptible to vancomycin. Fourteen of the strains were Staphylococcus epidermidis, fourteen were Staphylococcus haemolyticus, and four were Staphylococcus hominis. In one case, a strain of S. haemolyticus was isolated with a vancomycin-resistant, teicoplanin-resistant Enterococcus faecalis strain. All strains were nosocomially acquired and were isolated from 17 different wards. Teicoplanin resistance occurred as a sporadic phenomenon, and none of the isolates were epidemiologically related. The isolates were from 30 patients, 13 of whom presented with true infections (43%). Five (38%) of the 13 patients with true infections had been previously treated with vancomycin. None of the infected patients were previously treated with teicoplanin. The in vivo development of resistance to teicoplanin among CoNS strains limits the therapy of infections by these microorganisms. There is a need for surveillance of nosocomial isolates of CoNS to determine resistance to glycopeptides.

Aged↗

PubMed2000

Is hospital-acquired intravascular catheter-related sepsis associated with outbreak strains of coagulase-negative staphylococci?

Macrorestriction fragment profile analysis by pulsed field gel electrophoresis was used to type strains of coagulase-negative staphylococci (CNS) isolated from 30 patients with catheter-related sepsis at the University Hospital Birmingham NHS Trust, UK. Twenty-three infections were hospital-acquired. A total of 56 CNS were isolated from the patients and identified by API as Staphylococcus epidermidis (54), Staphylococcus lugdunensis (1) and Staphylococcus hominis (1). The micro-organisms were further characterized by antibiograms and restriction digestion using SmaI. Analysis of the macrorestriction fragment profiles demonstrated that the isolates from 24 patients were distinct, whereas a common genotype of S. epidermidis was isolated from the blood cultures of six patients, all of whom had acquired this infection in hospital. Three of these patients were located in a haematology ward, two on an intensive care unit and one on a dialysis unit. The data from this current study suggests that specific strains of S. epidermidis may be an important cause of nosocomial catheter-related sepsis resulting from cross-infection, and that this association would not be detected by conventional typing methods including biotyping and antibiograms.

Catheterization, Central Venous↗

PubMed1995

In vitro modulation of keratinocyte-derived interleukin-1 alpha (IL-1 alpha) and peripheral blood mononuclear cell-derived IL-1 beta release in response to cutaneous commensal microorganisms.

The ability of a range of skin commensal microorganisms to modulate interleukin-1 (IL-1) release by cultured human keratinocytes and peripheral blood mononuclear cells (PBMCs) was investigated by a combination of enzyme-linked immunosorbent assays and bioassays. Three fractions (formaldehyde-treated whole cells, culture supernatants, and cellular fractions) were prepared from Propionibacterium acnes, Propionibacterium granulosum, Staphylococcus epidermidis, Staphylococcus capitis, Staphylococcus hominis, and Malassezia furfur serovar B. The levels of immunochemical IL-1 alpha released by cultured keratinocytes during coincubations with these microbial fractions ranged from 0 to 136 pg/ml and were maximal after 72 h. No microbial fraction consistently upregulated immunochemical IL-1 alpha release by freshly isolated keratinocytes from two donors and a transformed cell line, all of which produced the cytokine constitutively to various extents. Bioassays revealed that most of the IL-1 released was biologically inactive. In contrast, whole cells of formaldehyde-treated P. granulosum and S. epidermidis significantly stimulated release of IL-1 beta by PBMCs from three donors compared with the negative control (culture medium). Release was maximal at 24 h. Coincubation with intact cells of the yeast M. furfur significantly decreased levels of IL-1 beta below the values for the negative control by PBMCs from all three donors. There was good correlation between bioassay data and immunoassay data for IL-1 beta, and the depressive effect of M. furfur cells on cytokine production by all three cultures of PBMCs was mirrored in the levels of bioactive cytokine. This reduction in IL-1 beta release by PBMCs by M. furfur may provide an explanation why dermatoses thought to be caused by this yeast are essentially noninflammatory or only mildly inflammatory.

Humans↗

PubMed2004

The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis.

OBJECTIVE: Blood cultures and cultures of disc material are required to identify and treat bacterial agents responsible for septic spondylodiscitis, but these methods have limited sensitivities. We undertook this study to compare nonculture amplification-based DNA analysis with conventional culture of disc aspirate. METHODS: Nineteen patients with spondylodiscitis, including 11 with a history of spinal surgery, presented with negative blood cultures and underwent percutaneous disc or epidural abscess puncture for bacterial diagnosis. Amplification by polymerase chain reaction was performed on 16S ribosomal DNA universal target genes and femA staphylococci-specific target genes in all patients, and on the upstream p34 mycobacterial gene in 1 patient. Species identification relied on amplicon sequencing and comparison with templates from GenBank. Amplification of the femA gene led to subsequent testing for methicillin resistance by amplification of the mecA gene. Further assessment using a staphylococci- and methicillin resistance-specific DNA array was performed on 3 samples. RESULTS: Microbiologic and molecular assays identified the causative organism in 14 of 19 patients (74%) and 19 of 19 patients (100%), respectively. In culture-positive patients, DNA-based and microbiologic results were highly correlated. Five agents (Staphylococcus simulans, Staphylococcus sciuri, Brucella species, Actinomyces israelii, and Mycobacterium tuberculosis complex) were identified only by DNA-based methods. In 1 sample, Corynebacterium jeikeium and coagulase-negative Staphylococcus were both cultured, whereas DNA analysis identified only Staphylococcus hominis. CONCLUSION: DNA-based methods are highly sensitive and specific. They can usefully complement standard microbiologic methods for identifying the cause of infectious spondylodiscitis and contribute to species-specific therapeutic orientation in patients with negative blood and disc aspirate cultures.

Adult↗

PubMed2005

Antimicrobial activity and tightness of a DCPD-CaO-based hydraulic calcium phosphate cement for root canal filling.

Calcium hydroxide is currently used in dentistry for endodontic treatments where its main advantage is its antibacterial and anti-inflammatory activity. However, it also has some drawbacks such as pulp necrosis, slight solubility, slow and insufficient hardening, and retraction on drying. In consequence, it is used only as temporary material for root canal disinfection. By mixing calcium hydrogen phosphate dihydrate (CaHPO4 . 2H2O, also called dicalcium phosphate dihydrate, DCPD) and calcium oxide with a sodium phosphate buffer as liquid phase, we obtained a CPC with better mechanical properties than calcium hydroxide pastes. The setting reaction produced either hydroxyapatite (HA) or a mixture of HA and calcium hydroxide depending on the relative masses of DCPD and CaO in the cement powder. The presence of calcium hydroxide a priori confers antimicrobial properties to this cement which were investigated in agar plates (diffusion method) against Streptococcus mutans, Lactobacillus acidophilus, Candida albicans, Enterococcus faecalis, Staphylococcus hominis (clinical isolates), and a preparation of polymicrobial flora isolated from dental plaque. The cement samples tested were prepared at molar calcium-to-phosphate ratios (Ca/P) of 1.67 to 2.75. A pure calcium hydroxide paste was used as reference material. Clear and reproducible bacterial growth inhibition was observed for cement samples with Ca/P > or = 2 against all the microorganisms tested. With Ca/P = 2.5, this cement alkalinizes dentinal tubules and provides a fluid-tight sealing that well compares with sealing obtained using a zinc oxide-eugenol cement without gutta-percha point. DCPD-CaO-based cement is therefore a potential root canal filler.

Anti-Bacterial Agents↗

PubMed1992

Epidemiological role of arthropods detectable in health facilities.

A total of 161 arthropod specimens were collected from 55 sites in a health care facility during July and September 1990. Of the 116 bacterial isolates obtained from their body surfaces 6% were from parasites (mosquitoes), 59% from eusynanthropic arthropods (Tenebrionid beetles, flies, German cockroaches, wasps), 16% from hemisynanthropic arthropods (ants, spiders) and 19% from occasionally encountered insects (non-biting midges, moths, beetles). Most (88%) of the isolated bacteria were Gram-negative rods of the species E. coli, Enterobacter, Klebsiella, Citrobacter, Proteus, Serratia, Pseudomonas and Acinetobacter. Gram-positive cocci accounted for 13% of isolates and were primarily represented by coagulase-negative staphylococci. The highest isolation rates were from body surfaces of flies, German cockroaches, non-biting midges (Chironomids) and Tenebrionid beetles. About one third of all isolates were resistant to more than three antimicrobials using a standard disc diffusion assay. The presence of multiple resistance to antibiotics was observed in two thirds of Enterobacter isolates, namely those of Enterobacter cloacae from the body surface of Germany cockroaches, in 13% of Citrobacter spp and in 8% of Klebsiella spp as well as Acinetobacter calcoaceticus strains. Strains of Morganella and Hafnia species were very infrequent but all of them shared resistance to the antibiotics tested. In contrast, strains of Serratia spp were relatively antibiotic-sensitive. The group of isolated Gram-positive organisms was represented by two strains of Staphylococcus hominis and one strain of Enterococcus sp, all of them were multiply-resistant to antimicrobials.

Animals↗