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In vitro activities of three semisynthetic amide derivatives of teicoplanin, MDL 62208, MDL 62211, and MDL 62873.

MDL 62208, MDL 62211, and MDL 62873 are three semisynthetic amide derivatives of teicoplanin (MDL 62208 is an amide of teicoplanin aglycone, MDL 62211 is an amide of the teicoplanin A2 complex, and MDL 62873 is the corresponding derivative of peak A2-2 of the complex). The three semisynthetic glycopeptides were evaluated for in vitro antibacterial activity in comparison with the parent drug (teicoplanin) and vancomycin. A variety of gram-positive bacteria of clinical origin, whose species were carefully determined and that included 428 staphylococci (207 methicillin susceptible and 221 methicillin resistant), 41 streptococci, 82 enterococci, 43 strains of Listeria monocytogenes, 10 JK coryneform bacteria, and 67 anaerobes belonging to the genera Clostridium, Propionibacterium, Peptostreptococcus, and Eubacterium, were tested. The only resistances to MDL 62208, MDL 62211, and MDL 62873 were encountered with vancomycin- and teicoplanin-resistant enterococci. All of the other test strains, including some teicoplanin-resistant coagulase-negative staphylococci of the species Staphylococcus haemolyticus and Staphylococcus epidermidis, were highly susceptible to the three teicoplanin amides. Only minor differences in activity were observed among MDL 62208, MDL 62211, and MDL 62873, whereas the three experimental compounds were usually found to be more potent than teicoplanin or vancomycin (especially against staphylococci, with differences mostly ranging from 2- to 16-fold). The MBC-to-MIC ratios varied depending on the organisms, with the highest ratios usually observed for enterococci and listeriae. Overall, the MBC-to-MIC ratios yielded by the teicoplanin analogs were slightly greater than those yielded by teicoplanin or vancomycin.

Actinomycetales↗

Identification, clinical distribution, and susceptibility to methicillin and 18 additional antibiotics of clinical Staphylococcus isolates: nationwide investigation in Italy.

A multicentric study of clinical Staphylococcus isolates was performed by seven operative units working in different areas of Italy. Over a 6-month period, a total of 3,226 staphylococci, isolated from in- and outpatients, were identified and tested for antimicrobial susceptibility by a protocol agreed upon by all units. On the basis of their bacteriolytic-activity patterns and other conventional tests, the isolates were identified by lyogroups , which closely correlate with human Staphylococcus species. Lyogroup I (Staphylococcus aureus) and lyogroup III (Staphylococcus capitis) were the most and the least frequently isolated staphylococci, respectively. Significant differences depending on strain origin from in- or outpatients were only observed with lyogroup IV (i.e., novobiocin- resistant staphylococci), whose isolation from outpatients was three times greater than from inpatients. Lyogroup I was predominant among isolates from most clinical sources. Lyogroup IV predominated in strains isolated from the urinary tract; lyogroup V (Staphylococcus epidermidis) predominated in strains from blood, cerebrospinal fluid, and indwelling artificial devices; and lyogroup VI ( Staphylococcus hominis, Staphylococcus haemolyticus, and Staphylococcus warneri ) predominated in strains from bile and the male genital tract. The incidence of methicillin resistance within the different lyogroups varied from unit to unit, suggesting epidemiological differences among different hospitals and different geographical areas. On the whole, methicillin resistance was more frequent in coagulase-negative staphylococci than in S. aureus and ranged from 19% for lyogroups I and III to 30% for lyogroup II (Staphylococcus simulans). Laboratory testing with 18 additional antibiotics suggested the occurrence of some specific differences in susceptibility among the different lyogroups . The rate of organisms resistant to the various antibiotics was greater among methicillin-resistant than among methicillin -susceptible staphylococci; particularly marked differences occurred with cephalosporins, rifampin, gentamicin, and tobramycin. The results suggested an increasing spread in Italy, during the last few years, of staphylococcal resistance to methicillin and to many other antibiotics. Some questions about the actual reliability of laboratory tests for the determination of staphylococcal susceptibility to methicillin and other beta-lactam antibiotics were raised by parallel test performances in which both unsupplemented and 5% NaCl-supplemented Mueller-Hinton agars were used. The presence of NaCl heightened, on the whole, the number of resistant strains detected; however, a few isolates resistant in the unsupplemented medium and susceptible in the salt-supplemented medium were also encountered. This was true not only for methicillin but also for all other beta-lactam antibiotics tested except cefamandole. With cefamandole, the presence of 5% NaCl reduced the number of resistant strains detected.

Anti-Bacterial Agents↗

Recognition of Staphylococcus saprophyticus in urine cultures by screening colonies for production of phosphatase.

Phenolphthalein diphosphate was incorporated into a primary blood agar medium for use in performing quantitative urine cultures. Phosphatase-negative staphylococci, such as Staphylococcus saprophyticus, were differentiated from phosphatase-positive species, such as Staphylococcus epidermidis, by spot testing colonies on filter paper saturated with 1 N NaOH. Phosphatase-positive colonies turned pink within seconds, and phosphatase-negative colonies showed no color. None of 55 S. saprophyticus isolates showed production of phosphatase on this medium. Of 193 consecutive coagulase-negative staphylococci isolated from the urine of 190 adolescent female patients, 84% were phosphatase positive, non-S. saprophyticus species; 16% were phosphatase-negative and indicated S. saprophyticus (22), Staphylococcus haemolyticus (4), Staphylococcus simulans (2), Staphylococcus warneri (1), and Staphylococcus hominis (1). Phosphatase activity was variable in the other flora encountered in the urine cultures. Mixtures of phosphatase-positive and -negative organisms did not cause false-positive reactions.

Adolescent↗

Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection.

Consecutive record review over a 63-month period revealed 229 Staphylococcus lugdunensis isolates, or 10.1% of the staphylococcal species that were not Staphylococcus aureus or Staphylococcus epidermidis. A total of 155 S. lugdunensis specimens were isolated from sites over the entire bodies of the 143 patients studied. The most common clinical diagnoses were skin and skin structure infections (55.4%) and blood and vascular catheter infections (17.4%). For 40% of the reviewed specimens, S. lugdunensis was the sole agent isolated, and for 60% of specimens, S. lugdunensis was isolated as part of mixed flora. In only 15.4% of clinically reviewed specimens was S. lugdunensis clearly a culture contaminant or colonizing organism. The pattern of human infection identified in this study emphasizes the predominance of skin and soft tissue S. lugdunensis infections over deep serious infections such as endocarditis, peritonitis, infected hip prosthesis, and osteomyelitis and vascular-associated infections. S. lugdunensis should be included along with S. epidermidis, Staphylococcus haemolyticus, and Staphylococcus saprophyticus as a coagulase-negative species of Staphylococcus pathogenic for humans.

Adolescent↗

Pathogenicity and virulence of coagulase negative staphylococci in relation to adherence, hydrophobicity, and toxin production in vitro.

AIMS: To study the pathogenicity and virulence characteristics of Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus sapro-phyticus. METHODS: BALB/c mice were challenged intraperitoneally with graded doses of three strains belonging to each species. LD50s were measured for each strain. Haemolysin (alpha- and delta-) and enzyme (DNAase, lipase, and esterase) production in vitro were measured qualitatively and quantitatively. Adhesion to plastic was measured and related to cell surface hydrophobicity among the strains. RESULTS: S saprophyticus proved the most virulent (LD50 = 2.7-2.9 x 10(7) cfu/g body weight) while S epidermidis was the least virulent (LD50 = 6-8 x 10(7) cfu/g body weight). An enlarged spleen was the most common macroscopic pathological feature. Kidney, liver, and more rarely peritoneal abscesses were also seen in the infected animals. No direct correlation was found between adherence in vitro, cell surface hydrophobicity, or toxin/enzyme biosynthesis and virulence in mice. CONCLUSION: The results show that coagulase negative staphylococci are pathogenic in BALB/c mice. It is clear that these bacteria can cause invasive disease. However, the in vitro characteristics of coagulase negative staphylococci are not related to the pathogenicity of the organisms in mice.

Animals↗

[Drug susceptibility of staphylococci isolated from clinical specimens].

Eighty-eight strains of staphylococci were isolated from a variety of specimens collected from patients at our university hospital from June to August 1982. These strains were identified as Staphylococcus aureus (86%), Staphylococcus epidermidis (6.8%), Staphylococcus haemolyticus (2.3%), Staphylococcus capitis (2.3%), and Staphylococcus simulans (1.1%). One strain could not be identified with certainty as a currently recognized species. A majority (70%) of the S. aureus strains was resistant to two or more of the following drugs; penicillin G, kanamycin, doxycycline, erythromycin, and chloramphenicol. As for susceptibility to beta-lactam antibiotics, most of the strains that were resistant to penicillin G were also resistant to aminobenzyl penicillin and cephalexin. Whereas none of the strains was resistant to methicillin, cloxacillin, dicloxacillin, nor cefmetazole, and only a few strains were resistant to cefoperazone or cefazolin or both. Over 50% of the S. aureus strains were found to be resistant to each of four aminoglycosides (Kanamycin, gentamicin, tobramycin, and sagamicin), while only 5% of the strains were resistant to amikacin. Multiple resistance to the above four aminoglycosides was observed among more than 40% of the S. aureus strains, and also observed among three of six strains of S. epidermidis.

Aminoglycosides↗

[Study of the virulence of coagulase-negative staphylococci in experimental infections].

The pathogenicity and virulence of 3 strains of Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus saprophyticus, respectively were studied in BALB/c mice by intraperitoneal (ip) challenge using 4 bacterial suspensions of different colony forming units (CFU) of each strain. Strains were isolated from wound, blood, and urine of inpatients. On the base of the lethality rates, S. saprophyticus proved to be the most virulent (LD50 = 2.7-2.9 x 10(7) CFU/g body wt), while the S. epidermidis species was the least virulent (LD50 = 6-8 x 10(7) CFU/g body wt). The lethality rate of male mice was higher than that of the female ones at the same challenge bacterium concentration. Mice of higher body weight were generally more sensitive to a quality of bacteria calculated to 1 g of mice than the lighter mice. The 245 mice surviving the challenge were dissected at the 10th day of infection. Splenomegaly was found to be the most frequent macroscopic pathological alteration. There appeared kidney abscesses, liver abscesses, and rarely peritoneal abscess. The frequency of pathological findings were directly proportional to the amount of bacteria injected. The results indicate that clinical strains of coagulase-negative staphylococci (CNS) examined were pathogenic and virulent for BALB/c mice they are invasive after ip injection and can cause macroscopic pathological changes in parenchymal organs. Thus, ip CNS challenge in mice may be a model to imitate and study infections caused by CNS in human.

Animals↗

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↗

Identification of coagulase-negative staphylococci and typing of Staphylococcus epidermidis by a 4 h micromethod.

A new 4 h micromethod (Minibact-S) for identification of coagulase-negative staphylococci (CNS) important in human medicine, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus haemolyticus and Staphylococcus saprophyticus, has been investigated. The reproducibility for species identification was 100% and the reproducibility for the single reactions was 95%. When compared to a modified Kloos & Schleifer conventional identification method, discrepant identification was obtained with the Minibact-S in only 8 of 382 clinical and reference strains. The system has been used for typing and biotyping of 201 S. epidermidis strains, and gave a subdivision in 69 different types; 4 related types accounted for 91 (45%) of the isolates, whereas 44 types were represented by only 1 isolate. The discriminatory index was 0.82. In a comparison with other typing methods performed on 81 isolates from 15 patients Minibact-S gave about the same number of types as antibiograms, but in 20% of the patients extra types were obtained with Minibact-S alone compared to antibiogram alone and vice versa. The Minibact-S is of some value in the routine clinical microbiology laboratory as a first screening method for identification of coagulase-negative staphylococci and typing of S. epidermidis in combination with the antibiogram.

Coagulase↗

Characterization of coagulase-negative staphylococci causing nosocomial infections in preterm infants.

The species spectrum, antibiotic susceptibility, and genomic profile of coagulase-negative staphylococci (CNS) isolated from infected preterm infants were compared with those obtained in CNS from nursery personnel. Staphylococcus epidermidis was the predominant species in the 66 investigated preterm infants (171 isolates), accounting for 64% of all isolates. A high proportion of Staphylococcus haemolyticus (32%) could be detected. In contrast to the results in patients, the spectrum in nursery personnel was broad and included more species of CNS. All isolates of CNS from preterm infants demonstrated a low rate of susceptibility to the beta-lactam antibiotics (2% sensitivity to penicillin and 6% sensitivity to oxacillin). Sensitivity to gentamicin (9%) was also rare. An unexpected observation was susceptibility to teicoplanin in only 70% of all CNS isolated from patients due to the high proportion of Staphylococcus haemolyticus. Analysis of the genomic profile of 33 isolates of Staphylococcus haemolyticus by pulsed-field gel electrophoresis revealed a relationship between the strains. An outbreak of one particular strain of Staphylococcus haemolyticus in the neonatal intensive care unit investigated can therefore not be excluded.

Coagulase↗

Antimicrobial-resistance and enterotoxin-encoding genes among staphylococci isolated from expressed human breast milk.

Resistance traits and the presence of enterotoxin-encoding genes were investigated in staphylococcus isolates obtained from expressed human breast milk. A total of 54 staphylococcal isolates identified as Staphylococcus epidermidis (53.6 %), Staphylococcus warneri (20.4 %), Staphylococcus haemolyticus (13 %) and Staphylococcus aureus (13 %) were investigated. By using a disc-diffusion method, higher rates of resistance, including intermediate resistance, were observed for penicillin (87 %) and erythromycin (59.3 %). All strains were susceptible to clindamycin and vancomycin. Minimal inhibitory concentration (MIC) was determined by a macrodilution method for four clinically relevant antimicrobial drugs. High rates of resistance or intermediate resistance were observed for erythromycin, gentamicin and oxacillin. Additionally, three isolates showed reduced susceptibility to vancomycin (MIC, 8 microg ml(-1)). Genetic determinants of resistance were detected by using PCR and the results showed good correlation with the macrodilution tests. Moreover, in four staphylococcus isolates, the presence of enterotoxin-encoding genes (seg, seh and sea) was identified. The results demonstrated that expressed human breast milk can be a reservoir of multiresistant staphylococci that may also harbour important virulent determinants.

Anti-Bacterial Agents↗

Susceptibility of gram positive cocci to teicoplanin. Three year survey (1984-1986) at Perugia University.

From 1984 to 1986, 1038 Gram positive cocci (865 Staphylococci and 173 Enterococci) have been tested for sensitivity to teicoplanin by the agar diffusion method: only one strain (Staphylococcus haemolyticus) resulted to have no zone of inhibition around the teicoplanin disk. All Staphylococcus haemolyticus strains showed higher MIC: 2.79 mcg/ml after 24h of incubation and 20.50 mcg/ml after 48h. The reduced teicoplanin sensitivity of Staphylococcus haemolyticus was not detected by the agar diffusion test.

Anti-Bacterial Agents↗

[Examination of antibiotic sensitivity/resistancy relations of strains of staphylococcus aureus haemolyticus originating from osteomyelitic patients (author's transl)].

On the basis of bacteriology results of osteomyelitic patients of the recent 10 year period the authors examined the changes of antibiotic sensitivity/resistancy relations of strains of coagulase positive Staphylococcus aureus haemolyticus. Examination of 385 strains of Staphylococci showed that Staphylococci originating from osteomyelitic patients are more sensitive, respectively in a lesser degree resistant to antibiotics than those of miscellaneous origin. Concerning 8, in everyday practice most commonly used antibiotics, by means of regression trend line analysis, it has been stated that in the period of 1966-1975 years Staphylococci originating from osteomyelitic patients show a decreasing resistancy to antibiotics examined. The authors are of the opinion that in osteomyelitic patients the no satisfactory results and the high number of recurrent inflammations are not attributable to resistant strains of Staphylococci, but are due to many other biologic factors.

Chloramphenicol↗

[Antimicrobial susceptibility of coagulase negative staphylococci isolated from urine].

This study was conducted to investigate the antimicrobial susceptibilities of the strains of coagulase negative Staphylococci (CNS) isolates from urine at Juntendo University Hospital in Tokyo from 1989 to 1994. The susceptibility testing were performed according to the broth dilution method standerdized by the Japan Society of Chemotherapy. The following bacteria were tested; Staphylococcus epidermidis (59 strains), Staphylococcus haemolyticus (42 strains), Staphylococcus saprophyticus (30 strains). The antimicrobial agents tested wre as follows; Oxacillin, Cefazolin, Imipenem, Flomoxef, Gentanicin, Tobramycin, Arbekacin, Clindamycin, Tetracycline, Minicycline, Vancomycin, Sulfamethoxaxole-Trimethoprim and, Ofloxacin. 1. 100% of S. caprae, 62% of S. haemolyticus and 42% of S. epidermidis were resistant to Oxacillin. All strains of S. saprophyticus were sensitive to Oxacillin. 2. S. saprophyticus showed the highest sensitivities to all anti-microbial agents. 3. All strains of S. caprae were resistant to Tobramycin and Clindamycine. 4. Vancomycin and Arbecacin has strong antimicrobial activities to all CNS. S. saprophyticus, which is the pathogen of acute urinary tract infections, showed high sensitivities to many antimicrobial agents. On the other hand, S. haemolyticus and S. caprae, which are the predominate microorganisms of bacteriuria of inpatients, showed high resistance rates to antimicrobial agents.

Anti-Bacterial Agents↗

Inactivation of lincosaminide antibiotics in Staphylococcus. Identification of lincosaminide O-nucleotidyltransferases and comparison of the corresponding resistance genes.

Resistance to lincomycin by inactivation has been detected in numerous clinical isolates of Staphylococcus; in crude extracts of Staphylococcus haemolyticus BM4610 and Staphylococcus aureus BM4611, inactivation of lincomycin and clindamycin requires the presence of a nucleoside 5'-triphosphate (ATP, GTP, CTP, or UTP) as nucleotidyl donor and Mg2+ as cofactor. The biochemical mechanism of lincosaminide inactivation was elucidated by determination of the structure of inactivated lincomycin and clindamycin by physicochemical techniques, including UV absorption spectrophotometry, 31P and 1H nuclear magnetic resonance, and periodate oxidation. In the two strains, inactivation of lincomycin gave rise to lincomycin 3-(5'-adenylate), whereas clindamycin was inactivated through its conversion to clindamycin 4-(5'-adenylate). The gene linA' encoding the 3-lincomycin, 4-clindamycin O-nucleotidyltransferase in S. aureus BM4611 has been sequenced and displays 93% homology with the gene linA encoding the 3-lincomycin, 4-clindamycin O-nucleotidyltransferase found in S. haemolyticus BM4610. The two enzymes are 161 amino acids long and differ by 14 amino acid substitutions.

Amino Acid Sequence↗

[Post-marketing surveillance of antibacterial activities of cefozopran against various clinical isolates--I. Gram-positive bacteria].

As a post-marketing surveillance, the in vitro antibacterial activities of cefozopran (CZOP), an agent of cephems, against various clinical isolates were yearly evaluated and compared with those of other cephems, oxacephems, penicillins, and carbapenems. Changes in the bacterial sensitivity for CZOP were also evaluated with the resistance ratio calculated with breakpoint MIC. Sixteen species (1,913 strains) of Gram-positive bacteria were isolated from the clinical materials annually collected from 1996 to 2000, and consisted of methicillin-susceptible Staphylococcus aureus (MSSA; n = 178), methicillin-resistant S. aureus (MRSA; n = 199), methicillin-susceptible Staphylococcus epidermidis (MSSE; n = 98), methicillin-resistant S. epidermidis (MRSE; n = 164), Staphylococcus haemolyticus (n = 72), Staphylococcus saprophyticus (n = 28), Enterococcus faecalis (n = 206), Enterococcus faecium (n = 91), Enterococcus avium (n = 72), Streptococcus pyogenes (n = 133), Streptococcus agalactiae (n = 138), penicillin-susceptible Streptococcus pneumoniae (PSSP; n = 133), penicillin-intermediate resistant S. pneumoniae (PISP; n = 100), penicillin-resistant S. pneumoniae (PRSP; n = 29), Streptococcus milleri group (n = 135) and Peptostreptococcus spp. (n = 137). CZOP possessed comparable antibacterial activities against MSSA and MSSE to other cephems, and was also effective on MRSE but not on MRSA. An antibacterial activity of CZOP against S. saprophyticus was comparable to or higher than other cephems. CZOP, however, did not indicate an antibacterial activity against S. haemolyticus, just like other cephems. An antibacterial activity of CZOP against E. faecalis was comparable to cefpirome (CPR) and higher than other cephems. No antibacterial activity of CZOP against E. faecium and E. avium was observed, just like other drugs. An antibacterial activity of CZOP against S. pyogenes was as potent as that of cefotiam (CTM), cefepime (CFPM) and CPR, and that against S. agalactiae was also preferable. CZOP and other cephems also had a preferable antibacterial activity against S. milleri group that was most sensitive to benzylpenicillin. An antibacterial activity of CZOP against Peptostreptococcus spp. was preferable but weaker than that of cefazolin, CTM and cefmetazole. The resistance ratio estimated with breakpoint MIC of CZOP was 96.5% in MRSA, 93.1% in PRSP, 60.0% in PISP, 40.3% in S. haemolyticus, 22.3% in E. faecalis, and 15.9% in MRSE. Those resistance ratios were similar to those for CFPM, but E. faecalis showed 90.8% resistance for CFPM. The difference in the resistance ratio of E. faecalis demonstrated that CZOP successfully maintained its antibacterial activity against this species. In conclusion, no remarkable annual change in the antibacterial activities of CZOP against the Gram-positive bacteria was observed. The sensitivities of PISP and PRSP to CZOP, however, was suggested to be decreasing.

Cephalosporins↗