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[In vitro evaluation of antibacterial substances produced by bacteria isolated from different marine organisms].

Bacteria from several groups of marine organisms were isolated and, using direct antibiograms, identified those that produce antibacterial substances, using a human pathogenic strain of Staphylococcus aureus ATCC6538 as revealing microorganism. Bacteria which produce substances that inhibited S. aureus growth were identified through morphological, physiological and biochemical tests. Out of 290 bacteria, 54 (18.6%) inhibited the growth of S. aureus, but only 27 survived for identification. Bivalves, sponges and corals were the most represented from which 41.2, 33.3 and 29.7%, respectively, produced antibacterial substances of the isolated bacteria in each group. The marine species with highest proportions of these bacteria were the hard coral Madracis decactis (62.5%), the sponges Cliona sp. (57.1%) and the octocoral Plexaura flexuosa (50.0%). Out of the 27 strains that produced antibacterial substances, 51.8% were Aeromonas spp. and 14.8% Vibrio spp. Marine bacteria that produce antibacterial substances are abundant, most belong in the Vibrionacea group and were isolated mainly from corals and bivalve mollusks.

Animals↗

[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↗

[Antibiotic management of bacterial bile-duct and gallbladder infections].

The sensitivity to antibiotics of the various bacterium strains has been studied in the bile samples of 373 patients with gallbladder and/or biliary duct infection and the clinical effect of antibiotic therapy applied to 325 instances was recorded. The antibiograms suggested an increased resistance mainly of the intestinal bacteria isolated from the bile samples. An increase in the ratio of polyresistant strains was observed. Gentamycin, neomycin, polymixin and kanamycin were the most potent in vitro. Parenterally administered chloramphenicol and oxytetracycline acted favourable in most cases of biliary infection. This therapy was successful even against pathogens resistant in vitro to chloramphenicol and oxytetracycline. The higher efficacy of aimed antibiotic therapy compared to randomly applied treatment is stressed and confirmed by numerical data.

Anti-Bacterial Agents↗

Microbiology of chronic suppurative otitis media in Singapore.

The objective of the study was to study the microflora and the antibiograms of patients with chronic suppurative otitis media (CSOM) in Singapore. Ninety patients with CSOM were prospectively studied. They had chronic ear discharge and had not received antibiotics for the previous five days. Swabs were taken, and cultured for bacteria. Antibiotic testing was done using modified Kirby Bauer disk diffusion method. In addition to the usual antibiotics, the three most common topically available antibiotics (chloramphenicol, gentamicin and neomycin) were tested. There were 135 positive cultures for organisms from the 90 patients. The most common causal organisms isolated were Pseudomonas aeruginosa (33.3%) and Staphylococcus aureus (33.3%) followed by coagulase negative Staphylococcus (21.1%). Fungi accounted for 8.8% of isolates while 6.6% were anaerobes. Of the three antibiotics commonly available as topical eardrops, gentamicin has the highest susceptibility rate (82.6%), followed by neomycin (67.8%) and chloramphenicol (62.8%).

Adolescent↗

Epidemiological analysis of Staphylococcus aureus strains from nasal carriers in a teaching hospital.

The present study was conducted to assess the epidemiological relation of Staphylococcus aureus isolates from nasal carriers of hospital staff. Nasal swabs were taken from each of 327 personnel. After culturing on blood agar for overnight, probable staphylococcal isolates were identified and subjected to tube coagulase test. After a two-week interval, second nasal swabs were taken from the subjects whose first cultures were positive for S. aureus. Nasal carriage was defined in 58 (17.7%) personnel with positive culture for both sampling time. Antibiogram typing and arbitrarily-primed polymerase chain reaction (AP-PCR) with M13 primer were used for typing of the strains. Antibiotyping distinguished seven types and three subtypes, and 85% of the isolates were clustered in one group. AP-PCR, in contrast, identified 12 distinct patterns with 13 variants. A specific profile was not found among the isolates obtained from the personnel in a particular clinic. These results indicate that antibiotyping has poor discrimination power and heterogeneity among the nasal S. aureus strains in the hospital personnel screened is high.

Bacterial Typing Techniques↗

[Antibiotypes of bacterial strains isolated from patients at the intensive care units].

The indiscriminate use of antibiotics in intensive care units has permitted the selection of multiple resistant bacterial strains in the hospital setting. Antibiograms present the sensitivity or resistance of these strains to drugs in current use. In this study, 100 bacterial strains were isolated from patients on medical and surgical ICU wards. The strains were identified by API-20E and sensitivity testing was performed by the E-test procedure. MIC were further analyzed with the WHONET software wich permits the identification of antibiotypes. Acinetobacter anitratus, Pseudomona aeruginosa and Enterobacter cloacae were the most resistant strains. Nine antibiotypes were determinated for A. Anitratus. Predominant strain presented antibiotypes with multiple resistance to ten antibiotics. P. aeruginosa presented 10 antibiotypes, the predominant one being CTX, CRO, CTX. Antibiotype determination allows phenotypic identification or resistance patterns in particular species as well as facilitates follow up and recognition of its epidemiological distribution.

Bacteria↗

Analysis of an outbreak due to Chryseobacterium meningosepticum in a neonatal intensive care unit.

The aim of this study was to describe the epidemiological and clinical features of an outbreak due to Chryseobacterium meningosepticum. During a 11-day period, the outbreak was observed among four newborns in a neonatal intensive care unit (NICU) in a teaching hospital. All patients yielded C. meningosepticum in their blood cultures, in addition one was colonised in the throat. Antimicrobial susceptibility assay showed complete resistance to penicillins, cephalosporins, aminoglycosides, imipenem, aztreonam, and tetracycline, sensitivity to ciprofloxacin and trimethoprim-sulfamethoxazole. All patients were empirically treated with amikacin and meropenem. The neonate who was the first to develop sepsis died before the culture result. When C. meningosepticum was identified, antimicrobial therapy was changed to a combination of ciprofloxacin, rifampicin and vancomycin, and three neonates were treated successfully. Environmental screening recovered C. meningosepticum from two venous catheter lines and one nutritional solution that was opened by health care staff and used for two neonates. Arbitrary primed polymerase chain reaction and antibiogram typing indicated that all isolates were epidemiologically related. This study demonstrates that rapid selection of appropriate antibiotics is critical for clinical cure and standard precautions should be reconsidered to limit the spread of this bacterium on the NICU in our hospital.

Cross Infection↗

Phenotypic & genotypic variants of Pseudomonas aeruginosa isolated from children with cystic fibrosis in India.

BACKGROUND & OBJECTIVES: Pseudomonas aeruginosa is the leading cause of morbidity and mortality in patients with cystic fibrosis (CF). With increase in the chronicity of the disease, there is a diversification of the organism into different colony morphological types. The antimicrobial susceptibility of the organism varies with its colony morphology. The present work was carried out to study the different morphotypes of P. aeruginosa isolated from patients of cystic fibrosis. METHODS: We studied 38 children with CF attending the Paediatric Chest Clinic at the All India Institute of Medical Sciences, New Delhi, India during October 2000-January 2001 who were regularly followed up at the clinic. Patients were divided into 2 groups, Group 1 included all patients chronically infected with P. aeruginosa and Group 2 included patients who were infrequently colonized with this organism. Different colony morphological types of P. aeruginosa on culture media were identified. They were characterized by phenotypic methods using antibiograms and genotypic methods using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction and PCR-ribotyping. RESULTS: Fourteen of the 38 patients were colonized at least once with P. aeruginosa. Eight patients belonged to Group 1 and 42 isolates were obtained from these patients. Group 2 had 6 patients and 9 isolates were obtained from them. All patients in Group 1 harboured different colony morphotypes (Types 1-6) while all 6 patients in Group 2 showed a single type of colony morphology (Type 1). The isolates from Group 1 patients showed higher antimicrobial resistance as compared to Group 2 patients. Molecular typing of the isolates revealed 10 ERIC-PCR patterns and 2 PCR-ribotyping patterns among Group 1 and 2 ERIC-PCR and 1 PCR-ribotyping pattern among patients of Group 2. INTERPRETATION & CONCLUSION: The frequency of different morphotypes of P. aeruginosa and antibiotic resistance was higher among Group 1 patients. On molecular typing, more than one genotype was isolated from Group 1 patients while only one genotype was isolated from patients in Group 2. We conclude that at a given time, chronically infected patients can be colonized by phenotypically and genotypically distinct strains of P. aeruginosa which has an implication in the management of these patients.

Adolescent↗

Study of fungal and bacterial infections of the diabetic foot.

Microbiological study for aerobic organisms, anaerobic organisms and fungi from 105 cases of diabetic foot ulcers was carried out to determine the aetiological agents and their antibiograms. Out of 265 microbial isolates obtained, 160 were aerobes, 50 anaerobes and 55 fungal strains. Polymicrobial infection was observed in 73 (69.5%) cases. The most frequently isolated aerobic microorganisms were Staphylococcus aureus and Pseudomonas aeruginosa. Among the anaerobes Bacteroides melaninogenicus and Bacteroides fragilis were most common. Candida species were preponderant among the fungal isolates. Antimicrobial sensitivity pattern of the isolates is discussed in detail.

Adult↗

[The HVR genotypes and their relationship with the resistance of methicillin-resistant staphylococci].

OBJECTIVE: To investigate the HVR-PCR genotype of methicillin-resistant Staphylococci in local hospitals and compare it with the antibiograms, with aview to selecting effective antibacterial agents, moreover, to discuss preliminarily its role in molecular epidemiology. METHODS: The minimal inhibitory concentrations(MICs) of 86 MRSA, 10 MRSE(Mc'S. epidemidis), 5 MSSE(Mc'S. epidemidis), 8 MRSH(Mc'S. haemolyticus) and 5 MSSH(Mc'S. haemolyticus) clinical isolates collected from 4 local hospitals were tested by serial two-fold agar dilution method; their DNA were extracted by moved basic lytic method, whose polymerase chain reaction(PCR) products amplified, based on the size of mec-associated hypervariable region(HVR) were analyzed by PAG vertical and agarose gel electrophoresis. RESULTS: MRSA, MRSE and MRSH were grouped into 4, 3 and 2 HVR genotypes respectively according to the size of the PCR products. The PCR products amplified from 9 of 10 MRSE isolates were the same as the products amplified from MRSA isolates. MRSA strains in this study were mainly HVR genotypes A and D, which accounted for 52.32% and 39.53%; Genotypes B and C were the most multi-drug resistant, but genotype D was multi-sensitive. The I genotype of MRSE was multi-drug resistant, but its genotype III was multi-drug sensitive. The genotype a of MRSH was more resistant than genotype b. CONCLUSION: These results suggest that HVR-PCR genotype method is an easy and fast method for epidemiological investigation of nosocomial infections caused by MRSA, and it is helpful for clinical selection of antibacterial agents. This method can compare the mec determinants of MRSA and Mc'CNSt isolates and hence to search for the origin of the mec determinant.

Complementarity Determining Regions↗

[Hemophilus influenzae meningitis- the experience of infectious diseases department between 1984-2001].

Our paper presents a clinico-biological and therapeutical study of the cases admitted in Infectious Diseases Hospital between January 1984-December 2001. We studied the records of all the patients that suffered from meningitis with Haemophilus influenzae. In above mentioned period 40 cases of Haemophilus influenzae meningitis was admitted; 6 patients (15%) died. A number of 13 cases was registered for the first five years, mainly in the childhood-32 cases (80%) for infants. Bacteriological diagnosis was made by bacterioscopia for 16 patients, bacteriological cultures-30 patients, latex test, performed in the last five years, in 8 cases. In patients who died, the bacteriologic culture was positive in 5 cases and bacterioscopia in 4 cases. The therapy was performed in resonance with antibiograme results for the involved strains. The Haemophilus influenzae meningitis is an acute and severe disease of the childhood, with an important risk of death, despite the rigorous therapeutical measures.

Aged↗

Antibiotic selective pressure for the maintenance of antibiotic resistant genes in coliform bacteria isolated from the aquatic environment.

Coliform bacteria isolated from the aquatic environment were investigated for antibiotic susceptibility and detailed structures of class 1 integrons. A high proportion of isolates were found to be resistant to sulfamethoxazole, aminoglycosides, and beta-lactams. The 750 (53.6%) isolates were resistant to one or more of the antibiotics tested out of 1,400 coliform bacteria. Based on the MIC of antibiotics and antibiogram, 150 isolates were selected and further studied for class 1 integrons. The intI1 gene was found in 36 (24.0%) of the 150 isolates. Twelve isolates carried the gene cassettes responsible for antibiotic resistance, while no gene cassettes were found in 24 isolates. Seven different genes, dfrA5, dfrA7, dfrA12, dfrA17, aaA2, aaA5, and aad(3'), were detected in gene cassettes. The dfrA and aad genes located on class 1 integrons were responsible for resistance to trimethoprim and aminoglycosides. The remaining 24 coliform bacteria had the incomplete or non-functional class 1 integrons. These results indicated that antibiotic selective pressures may play an important role to maintain gene cassettes of class 1 integrons and in the absence of sustained antibiotic pressures, such as the aquatic environment, coliform bacteria may carry empty or non-functional class 1 integrons.

Drug Resistance, Microbial↗

[Chronic endophthalmitis in pseudophakic patients caused by bacillus subtilis].

OBJECTIVE/METHODS: We present two cases of patients with chronic endophthalmitis. The treatment included intraocular lens exchange, total capsulectomy and posterior vitrectomy through the limbus. In both cases, samples of the vitreous were taken and sent to the laboratory together with the intraocular lens and remmants of posterior capsule for culture and antibiogram. RESULTS/CONCLUSIONS: Microbiologic examination and culture were positive in two cases for Bacillus subtilis, which is not actually identified in literature as an etiologic agent for chronic endophthalmitis.

Aged↗

Laboratory aspects of asymptomatic bacteriuria in pregnancy.

A total of 1,661 pregnant women aged between 13 and 45 years were screened for bacteriuria by urine culture. Of the 1,661 culture results, 615 (37%) yielded no growth; 728 (43.8%) yielded no significant growth (presence of <10(5) organisms/ml urine of one or more types of bacteria); 286 (17.2%) yielded mixed growth (presence of >10(5) organisms/ml urine of more than one type of bacteria) and only 32 (1.9%) showed significant growth (presence of >10(5) organisms/ml urine of a single bacterium). Urine microscopy was also conducted. Two hundred and twenty-four (13.5%) specimens had >10 white blood cells/ml urine, of which 66 had >100 white blood cells; 13 were from the significant growth group. Three hundred and seventy-four (22.5%) specimens showed the presence of bacteria, 42 (2.5%) had red blood cells, 370 (22.3%) had epithelial cells, 58 (3.5%) had crystals, and 14 (0.8%) had yeasts. The most common bacterium isolated was Escherichia coli (12; 40%); the others included group B Streptococcus (5; 15%), Klebsiella spp (5; 15%), Diphtheroids (2), and Candida albicans (2). Fifty-two percent of tested strains were sensitive to ampicillin; 24 of 28 strains (85.7%) were sensitive to ciprofloxacin; all 7 strains tested were sensitive to nitrofurantoin and all 20 strains tested were sensitive to cotrimoxazole; 14/20 (70%) and 16/17 (94.1%) were sensitive to cephalexin and cefuroxime respectively. This study shows that asymptomatic bacteriuria does occur in pregnant women, albeit at a very low rate in an urban setting like Cheras. Urine microscopy is not specific and only serves as a guide to bacteriuria. The commonest causative organisms are those from the gastrointestinal tract and vagina. The antibiogram showed that cefuroxime and cephalexin are likely to be effective in treating bacteriuria: ampicillin must be reserved for Gram-negative organisms. For Gram-positive organisms, of which Group B Streptococcus is important, ampicillin is still effective in vitro. Nitrofurantion and cotrimoxazole have excellent activity in vitro and should be considered for therapy. 17.2% of the urine culture yielded mixed growth: likely to indicate that contamination of urine specimens still happens despite the strict instructions given to patients about the collection of a midstream urine specimen. Proper collection, appropriate transport, and the early processing of urine specimens remain essential.

Adolescent↗

[Enterococcus faecalis: a multicenter study on antibiotic resistance].

676 E. faecalis strains were listed over a period of 2 years from the Charles Nicolle hospital of Tunis (167 strains), the Habib Bourguiba hospital of Sfax (350 strains) and the National Centre of Bone marrow Transplantation of Tunis (159 strains). Antibiotic sensibility study was realized by the method of the antibiogram, E-test method and the search of penicillinase by cefinase. E. faecalis resulted essentially from services of onco-haematology (24%), external consultations (23%), surgery (18%) and medicine (15%). These strains were isolated especially from urines (54%), coprocultures (15%), bloodcultures (11%) and from pus (9%). Resistance acquired with these strains is raised for erythromycin, tetracyclin and chloramphenicol (81% to 86%), followed by high level resistance to gentamicine (37%). 0.1% of E. faecalis strains have a low level resistance to amoxicillin without production of penicillinase. No resistance to vancomycin was observed.

Amoxicillin↗

A methicillin-resistant Staphylococcus aureus outbreak in a new University hospital due to a strain transferred with an infected patient from another city six months previously.

Kocaeli University Medical School was established in 1995. The first methicillin resistant Staphylococcus aureus isolate was detected two years later in a patient transferred from a different city. Six months after this, we detected a small MRSA outbreak in the intensive care unit involving four patients, two of whom had bacteremia, and a staff nasal carrier. All isolates, including the first, appeared to be a single outbreak strain, demonstrated by pulsed field gel electrophoresis profiles which different by at most two bands, identical randomly amplified polymorphic DNA profiles, and identical coagulase gene types by PCR. Antibiogram were identical except that one isolate was additionally resistant to cotrimoxazole. These results show that MRSA isolates can spread between hospitals with infected or colonized patients and can apparently persist in the hospital for six months without causing infection. Screening of asymptomatic patients on wards affected by MRSA or transferred from other hospitals may be helpful in controlling these infections.

Aged↗

Peritonitis caused by Chryseobacterium meningosepticum in a patient undergoing continuous ambulatory peritoneal dialysis.

Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in adults. A 54-year-old woman who underwent continuous ambulatory peritoneal dialysis for 8 years developed peritonitis due to C. meningosepticum. Although she received intravenous antibiotics with good in vitro activity against the organism, the fever and signs of peritonitis persisted. The Tenckhoff catheter was finally removed on the 25th day of hospitalization and the fever subsided. Four isolates of C. meningosepticum recovered from 4 ascites samples drawn on the third, 13th, 18th, and 23rd hospitalization days had identical antibiograms and random amplified DNA polymorphism patterns generated by an arbitrarily primed polymerase chain reaction. Early removal of Tenckhoff catheter and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to C. meningosepticum.

Catheters, Indwelling↗

Methicillin-resistant Staphylococcus aureus in England and Wales.

Methicillin-resistant Staphylococcus aureus (MRSA) were detected soon after the introduction of methicillin in 1960, and reports of their isolation increased up to 1971. Changes in antibiotic usage were associated with a fall and then, in the early 1980s, a further rise in the number of reports. This article reviews the various surveys that have been conducted to establish the frequency, distribution and strain varieties of MRSA. The first strain to be recognised as epidemic (ie, affecting more than one hospital), was defined by phage typing and antibiogram, confirmed with molecular typing, and designated EMRSA-1. It was first detected in 1981 and became progressively more widespread until it began to decline in 1987. Only three health regions reported this strain in the first quarter of 1991. EMRSA-2 has remained restricted to the South East and South West Thames regions. EMRSA-3 appeared in the South East Thames region in 1987 and has since spread, being reported from eight health regions in the first quarter of 1991. At least 11 other strains of MRSA affecting more than one hospital have been detected and ten endemic strains (restricted to single hospitals) have been identified. Imported strains of MRSA, often introduced following the repatriation of road traffic accident victims, may include strains with epidemic potential and local spread has followed importation in at least two incidents. Continued surveillance of epidemic MRSA strains and the search for simple and widely applicable markers, such as unusual antibiotic resistance patterns or biochemical features, are needed for the prompt application of control measures.

Aged↗