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PubMed2002

Furuncular myiasis: a simple and rapid method for extraction of intact Dermatobia hominis larvae.

We report a case of furuncular myiasis complicated by Staphylococcus aureus infection and beta-hemolytic streptococcal cellulitis. The Dermatobia hominis larva that caused this lesion could not be extracted using standard methods, including suffocation and application of lateral pressure, and surgery was contraindicated because of cellulitis. The botfly maggot was completely and rapidly extracted with an inexpensive, disposable, commercial venom extractor.

Adult↗

PubMedDate not supplied

[Comparative characterization of the microflora of the upper respiratory tract mucous membranes in bronchial asthma and allergic persistent rhinitis].

A total of 250 patients with diagnosed bronchial asthma (BA) were examined by microbiological methods. Among them--188 children and 62 adults. In 87 patients the microflora of nasal mucosa was studied, in 40--of pharynx only and in 123 patients--both the nasal and the pharynx. For comparative analysis earlier data obtained in 69 patients with persistent allergic rhinitis (PAR) were used. The cultures isolated from the nasal mucosa of BA patients were shown to number 18 genera and 42 species, while among those isolated from pharynx mucosa 20 genera and 40 species. Monocultures were isolated from the nasal mucosa only in 23% of the examined patients and from the pharynx mucosa--only in 1.42%. Associations with different numbers of components were isolated from nasal and pharynx mucosa (2 to 6, 2 to 8 respectively). Staphylococcus aureus was regarded as the main species of nasal biocenosis in BA and PAR, as well as pharynx biocenosis in BA. Besides, in BA other Staphylococcus species (schleiferi, caprae, capitis, hominis, etc.), reversely related to the main species, could be isolated from both mucous membranes. Similarities and differences in microflora of biocenoses in both nosological forms, confirming links between PAR and BA, are considered.

Adult↗

PubMed1999

The genomic diversity of coagulase-negative staphylococci associated with nosocomial infections.

A total of 117 isolates of coagulase-negative staphylococci (CNS) were collected from patients in three medical centres. They were genotyped by pulsed-field gel electrophoresis (PFGE) following digestion with restriction enzymes SmaI and SstII. The isolates included Staphylococcus epidermidis, S. simulans, S. hominis, S. lugdunensis, S. capitis, S. saprophyticus, S. caprae and S. sciuri. They were collected at random from 82 patients and were associated with infected central venous lines, continuous ambulatory peritoneal dialysis (CAPD) catheters, endocarditis, osteomyelitis of prosthetic hips and internally fixed fractures. The genetic heterogeneity of the strains was demonstrated by PFGE profiles and two dendrograms. Though the strains were segregated into species, there was no clustering of the strains by type of infection, associated medical unit or geographical location of the patient. Numerous genotypes were identified, suggesting that no specific strains of CNS are associated with prosthetic related infection.

Analysis of Variance↗

PubMed1990

Anastomotic femoral pseudoaneurysm: an investigation of occult infection as an etiologic factor.

Occult infection was investigated as an etiologic factor in the formation of femoral anastomotic pseudoaneurysms associated with prosthetic vascular grafts. Forty-five femoral pseudoaneurysms with no clinical evidence of infection 10 to 173 months after prosthetic graft placement were consecutively studied. The explanted Dacron or explanted polytetrafluoroethylene graft material was cultured in trypticase soy broth and ultrasonically oscillated to remove adherent bacteria. All patients were treated by excision of the pseudoaneurysm and surrounding perigraft capsule and in situ replacement with an interposition prosthetic graft. Thirty-two bacterial isolates were recovered from 27 (60%) of the specimens, with coagulase negative staphylococci (Staphylococcus epidermidis S. warneri, S. hominis, S. capitis) accounting for 24 of the recovered species. No infection of the replacement graft developed in any patient and no recurrent pseudoaneurysms were observed. Bacterial colonization may occur at implantation or during subsequent procedures when the prosthetic graft is exposed. This chronic infection can be diagnosed by means of sensitive culture techniques that dislodge adherent bacteria from the graft surface. On grounds of the observations reported in this study, there appears to be suggestive evidence that an occult infectious process may be one of the factors that play a role in the development of some femoral anastomotic pseudoaneurysms.

Aged↗

PubMed2003

Coagulase-negative staphylococci: comparison of phenotypic and genotypic oxacillin susceptibility tests and evaluation of the agar screening test by using different concentrations of oxacillin.

This study evaluated the oxacillin susceptibilities of 152 coagulase-negative staphylococcal (CoNS) strains of 12 species by disk diffusion; agar dilution; E-test; the slide latex agglutination test (Slidex MRSA Detection test; bioMérieux S/A, Paris, France); the agar screening test with 1, 2, 4, or 6 microg of oxacillin per ml and incubation for 24 or 48 h; and detection of the mecA gene by PCR. The results revealed that the agar screening test with 4 micro g of oxacillin per ml and incubation for 48 h was superior to any single phenotype-based susceptibility assay, presenting a sensitivity and a specificity of 100% each. For the different methods evaluated, the sensitivities and specificities were as follows: for disk diffusion, 94.2 and 91.8%, respectively; for the agar dilution test 100 and 73.5%, respectively; for E-test, 100 and 71.4%, respectively; and for the slide latex agglutination test, 97.1 and 98%, respectively. A good correlation was observed between oxacillin susceptibility testing results and PCR results for Staphylococcus epidermidis, S. haemolyticus, S. hominis subsp. hominis, and all mecA-positive strains. However, at least 60% of the mecA-negative isolates of the species S. saprophyticus, S. cohnii subsp. urealyticum, S. lugdunensis, and S. sciuri were erroneously classified as oxacillin resistant by the agar dilution test. Conversely, the slide latex agglutination test presented a high sensitivity (97.1%) and a high specificity (98%) for all CoNS species. Our results demonstrated the accuracy of the agar screening test with 4 micro g of oxacillin per ml and incubation for 48 h and the slide latex agglutination test for the appropriate detection of the oxacillin susceptibilities of CoNS isolates. Both assays are technically simple and can be easier to perform in routine laboratories than PCR.

Agar↗

PubMed1999

Antimicrobial susceptibility of coagulase-negative staphylococci and characterization of isolates with reduced susceptibility to glycopeptides.

The antimicrobial susceptibility of 239 coagulase-negative staphylococci (CNS) isolates consecutively collected from blood culture in patients admitted in a 600-bed teaching hospital was evaluated. The isolates were identified to the species level by conventional methods and the MicroScan Positive Combo Panel type 6 system, and their susceptibility to vancomycin, teicoplanin, and oxacillin were tested by agar dilution, disk diffusion, and MicroScan-WalkAway system. The species distribution was as follows: Staphylococcus epidermidis 120 (50.2%), S. hominis 29 (12.1%), S. haemolyticus 24 (10.0%), S. cohnii 14 (5.9%), and isolates from other CNS species 52 (21.8%). The percentage of resistance to oxacillin was 74.5% by agar dilution. The highest percentages of oxacillin resistance were found among S. haemolyticus (95.8%) and S. epidermidis (80.8%). Teicoplanin resistance (MIC > or = 32 micrograms/mL) was detected in five S. haemolyticus isolates, whereas intermediate resistance (MIC = 16 micrograms/mL) was detected in nine strains. These isolates with reduced susceptibility to teicoplanin were resistant to oxacillin, but remained susceptible to vancomycin (MIC < or = 4 micrograms/mL). Two isolates, one S. haemolyticus and one S. epidermidis, showed a vancomycin MIC of 8 micrograms/mL, and both MicroScan and disk diffusion methods classified these isolates as susceptible. Our results showed that glycopeptide resistance is emerging among CNS isolates in our institution and the disk diffusion method may not detect isolates with decreased susceptibility to these antimicrobial agents.

Adult↗

PubMed1986

Microbiologic studies of coagulase-negative staphylococci isolated from patients with nosocomial bacteraemias.

We studied 50 strains of coagulase-negative staphylococci (CNS) isolated from 50 patients with hospital-acquired bacteraemia, identified by prospective surveillance at the University of Virginia Hospital between March 1981 and September 1982. Using the Staph-Ident System for speciation, we found that 37 strains (74%) were Staphylococcus epidermidis, 7 (14%) Staph. hominis, 3 (6%) Staph. haemolyticus and 3 (6%) Staph. warneri. 33 (66%) of the strains produced slime and a higher proportion of the Staph. epidermidis group (75%) than the non-epidermidis group (46%), did so. Minimal inhibitory concentrations (MIC) were determined by a microdilution technique with 20 different antibiotics. There was no difference in geometric mean MICs between slime producers and non-slime producers within either the epidermidis or non-epidermidis group. The most potent antibiotics against Staph. epidermidis (MIC90 mg l-1) were rifampin (0.05), netilmicin (0.05), amikacin (2.9), thienamycin (0.75), teichomycin (0.85), vancomycin (1.0) and nafcillin (0.39). On the other hand strains were resistant to tobramycin (15), moxalactam (50), fosfomycin (greater than 64), and clindamycin (greater than 64). Overall, eight (16%) of the CNS strains were resistant to methicillin, three of which were Staph. haemolyticus. The non-epidermidis strains were more resistant than the Staph. epidermidis strains to most beta-lactam antibiotics. Differences in antibiograms indicate that speciation of CNS may prove useful for clinical and epidemiologic purposes.

Anti-Bacterial Agents↗

PubMed1993

Posthysterectomy wound infection. A review.

We reviewed the microorganisms isolated from gynecologic surgery wounds showing signs of infection, from January to December 1990. A total of 88 samples of abdominal wall exudates from as many patients who had undergone abdominal hysterectomy were studied. In 54 women (61.3%), cultures were positive and, in 26 specimens (48.1%), mixed aerobic-anaerobic flora were isolated. In 28 cases (51.9%), a single microorganism was isolated, the most frequent being Staphylococcus aureus, followed by Mycoplasma hominis and Escherichia coli. Mycoplasma hominis was unexpectedly frequent, appearing in five women with wall abscess and fever.

Bacteria↗

PubMed1981

Distribution of the different Staphylococcus species according to their meat or dairy origin.

152 Micrococcaceae strains, originating from meat or dairy products, already classified by the "Single Linkage" technique according to their biochemical profiles, into 13 taxa of food origin, are identified using the G + C content and biochemical tests, to the species of Staphylococcus described by Kloos and Schleifer. -The strains originating from near meat or dairy products are mainly S. aureus coagulase negative and S. xylosus biotype 2, the strains from raw milk include more varied species and correspond to S. epidermidis, S. hominis, S. aureus coagulase positive: the Staphylococcus found in different cheeses are principally S. xylosus biotype 1. - The API 20 Staph biochemical gallery enables the identification, in the Staphylococcus taxa (Schleifer) of most of the Staphylococcus strains isolated from meat or dairy products.

Dairy Products↗

PubMed2000

Cloning and nucleotide sequence of the DNA gyrase (gyrA) gene from Mycoplasma hominis and characterization of quinolone-resistant mutants selected in vitro with trovafloxacin.

We report the cloning and characterization of the gyrA gene of the Mycoplasma hominis DNA gyrase, which was previously shown to be associated with quinolone resistance in this organism. The 2,733-bp gyrA gene encodes a protein of 911 amino acids with a calculated molecular mass of 102.5 kDa. As expected, M. hominis GyrA exhibits higher homology with the GyrA subunits of the gram-positive bacteria Clostridium acetobutylicum, Bacillus subtilis, Streptococcus pneumoniae, and Staphylococcus aureus than with its Escherichia coli counterpart. Knowing the entire sequence of the gyrA gene of M. hominis could be very useful for confirming the role of the GyrA subunit in fluoroquinolone resistance. Twenty-nine mutants of M. hominis were selected stepwise for resistance to trovafloxacin, a new potent fluoroquinolone, and their gyrA, gyrB, parC, and parE quinolone resistance-determining regions were characterized. Three rounds of selection yielded 3 first-step, 12 second-step, and 14 third-step mutants. The first-step mutants harbored a single substitution, Glu460-->Lys (E. coli coordinates), in ParE. GyrA changes, Ser83-->Leu, Glu87-->Lys, and Ala119-->Glu or Val, were found only in the second round of selection. At the third step, additional substitutions, at ParC Ser80, Ser81, and Glu84 and ParE Leu440, associated with high-level resistance to fluoroquinolones, appeared. Thus, high-level resistance to trovafloxacin required three steps and was associated with alterations in both fluoroquinolone targets. According to these genetic data, in M. hominis, as in Staphylococcus aureus and Streptococcus pneumoniae, topoisomerase IV seems to be the primary target of trovafloxacin.

Amino Acid Sequence↗

PubMedDate not supplied

[Microbial associations in Trichomonas urethritis].

The results on isolation of associated microflora from 190 patients suffering from Trichomonas urethritis are given. Microorganisms belonged to the species: Mycoplasma hominis. Ureaplasma urealyticum. Streptococcus pyogenes. Escherichia coli. Klebsiella pneumoniae. Proteus mirabilis. Moraxella lacunata. Acinetobacter Calcoaceticus and Candida. Staphylococcus cultures which were isolated from 100% patients belonged to 8 species: Staphylococcus aureus, S. intermedius, S. haemolyticus, S. epidermidis, S. capitis, S. hominis, S. warneri, S. saprophyticus. Most of Staphylococcus cultures had pathogenic features. Structure of Trichomonas vaginalis and interaction between them and associated microflora were studied by electron microscopy.

Animals↗

PubMed1977

Temporal study of the staphylococci and micrococci of normal infant skin.

Staphylococcus and Micrococcus populations were collected from the healthy skin of 10 infant subjects. Infants were sampled from 1 day to 32 weeks of age. Species were characterized by approximately 30 different morphological, physiological, and biochemical characters. Staphylococci were the predominant inhabitants of normal skin, whereas micrococci were found only occasionally in this environment. Staphylococcus epidermidid, S. haemolyticus, and S. hominis were the predominant and persistent staphylococci. These species constituted a high percentage of the total aerobic bacterial flora of infant skin. Micrococcus luteus and M. kristinae were the prevalent micrococci found on infant skin. Only limited correlation between Staphyloccus and Micrococcus populations and infant age or body area sampled was indicated by this study.

Age Factors↗

PubMed2000

[Characteristics of coagulase-negative staphylococci isolated from hemocultures].

The authors investigated 352 strains of coagulase-negative staphylococci isolated from hemo-cultures of patients with assumed bacteraemia who were hospitalized in standard hospital departments and intensive care units. The strains were identified using STAPHYtest 16 and 14 different species and subspecies of coagulase-negative staphylococci were found. Most frequent were strains of Staphylococcus epidermidis (53%), strains of S. hominis subsp. hominis (22%) and S. haemolyticus (13%). In the strains the production of slime and delta-haemolysin was investigated. The formation of these two important factors of virulence was recorded in 95% strains (incl. major slime production in 13.4%), and 50% strains resp. The resistance to 13 antibiotics was also assessed. A total of 91% strains were resistant to penicillin, 63% to oxacillin and amoxicillin with clavulanic acid, 67% to gentamicin and 66% to erythromycin. In the group 15 strains of a recently described subspecies S. hominis subsp. novobiosepticus was identified. These isolates displayed most frequently resistance: they were resistant in 100% to five antibiotics (penicillin, oxacillin, erythromycin, clindamycin and amoxicillin with clavulanic acid) and with a single exception to another three antibiotics (chloramphenicol, gentamicin and ciprofloxacin). In these strains most frequently slime as well as delta-haemolysin was found. The authors assume, consistent with previous work, that it is important to focus attention on the incidence of strains of S. hominis subsp. novobiosepticus which very probably play an important role as agents in hospital infections. The authors describe also detection of one strain of S. cohnii subsp. urealyticum which was resistant to 10 of 13 antibiotics. The authors are convinced that also classical phenotypic analysis can contribute in an effective manner to the solution of the problem of infections caused by coagulase-negative staphylococci.

Bacteremia↗

PubMed2000

Correlation of oxacillin MIC with mecA gene carriage in coagulase-negative staphylococci.

The National Committee for Clinical Laboratory Standards has recently changed the oxacillin breakpoint from >/=4 mg/liter to >/=0. 5 mg/liter to detect methicillin-resistant coagulase-negative staphylococci (CoNS) because the previous breakpoint lacked sensitivity. To determine the correlation between the new oxacillin breakpoint and the presence of the mecA gene, 493 CoNS of 11 species were tested. The presence of the mecA gene was determined by PCR, and oxacillin susceptibility was determined by the agar dilution method with Mueller-Hinton agar containing 2% NaCl and oxacillin (0. 125 to 4.0 mg/liter). The new breakpoint correctly classified all CoNS strains with mecA as methicillin resistant and strains of Staphylococcus epidermidis, S. haemolyticus, and S. hominis without mecA as methicillin susceptible. The breakpoint of >/=0.5 mg/liter was not specific for S. cohnii, S. lugdunensis, S. saprophyticus, S. warneri, and S. xylosus, in that it categorized 70 of 74 strains of these species without mecA (94.6%) as methicillin resistant. The results of this study indicate that the new oxacillin breakpoint accurately identifies strains of CoNS with mecA but is not specific for strains of certain species of CoNS without mecA.

Coagulase↗

PubMed1988

Composition and density of microflora in the subungual space of the hand.

There were significant quantitative differences in the composition and density of microflora in different areas of the hands of 26 adult volunteers. The subungual spaces had an average log10 CFU of 5.39, compared with a range from 2.55 to 3.53 for other hand sites. In quantitative cultures from five subungual spaces in 26 subjects, coagulase-negative staphylococci were the dominant organisms, with Staphylococcus epidermidis, S. haemolyticus and S. hominis being the most frequently isolated species. Other bacteria recovered from subungual spaces included gram-negative bacilli in 42.3% of subjects, with Pseudomonas species composing 31.3% of this group, and coryneforms in 42.3% of subjects, with multiply resistant JK group coryneforms making up 12.5%. Yeasts were isolated from 69.0% of subjects sampled, with 51.3% of the yeasts identified as Candida parapsilosis. The subungual coagulase-negative staphylococci were susceptible to most antibiotics, with resistance to penicillin, ampicillin, and erythromycin detected in 23 to 38% of isolates.

Adolescent↗

PubMed1995

Outpatient treatment of endocarditis in a clinic-based program in Argentina.

The major cost in the treatment of infective endocarditis (IE) is the length of hospitalization required for the administration of intravenous antibiotics. This can be reduced by substituting shorter regimens and by the introduction of outpatient parenteral antibiotic therapy (OPAT). Careful selection of patients is vital for the success of OPAT in IE. The patients should be hemodynamically stable and without clinical complications. The delivery of OPAT for IE followed a clinical and home-based program involving an endocarditis team whose members included an infectious diseases physician, a microbiologist, a cardiologist and a nurse trained in intravenous techniques. Among the antimicrobial agents used in OPAT of IE, single-agent ceftriaxone for four weeks followed by a short course of amoxicillin or ceftriaxone in combination with an aminoglycoside for two weeks (short course) are effective modes of treatment for streptococcal endocarditis, the most common cause of IE. This treatment is also effective for carefully selected patients with other types of endocarditis, such as those due to the HACEK group (Haemophilus aphrophilus/paraphrophilis, Actinobacillus actinomycetem comitans, Caradiobacterium hominis, Eikenella corrodens and Kingella kingae). Staphylococcus aureus, enterococci and late prosthetic valve endocarditis associated with a streptococcus may also be treated on an outpatient basis after stabilization (approximately 2 weeks). As a result of their need for prolonged treatment periods, these patients are also very good candidates for OPAT. In conclusion, new regimens utilizing ceftriaxone once daily and short-term therapy on a clinical or home basis offer the potential benefits of cheaper safer and more convenient treatment for patients with IE.

Ambulatory Care Facilities↗

PubMed1981

Premature labor. II. Bacterial sources of phospholipase.

Human term labor is thought to be initiated by amniotic and chorionic phospholipase A2, an enzyme that liberates arachidonic acid esters from the phospholipids of these membranes, leading to the synthesis of prostaglandins by the placental membranes. The striking association of premature labor with intrauterine infection or contamination, urinary tract infection, and early neonatal sepsis led us to study the microorganisms present in these infections for phospholipase A2 activity. Activity was found in Bacteroides fragilis, Peptostreptococcus, Fusobacterium necrophorum, Streptococcus viridans, Streptococcus fecalis, Streptococcus A and B, Escherichia coli, Klebsiella, Staphylococcus epidermidis, Pneumococcus, Lactobacillus, and Mycoplasma hominis. Bacteroides fragilis, Peptostreptococcus, Fusobacterium, and S viridans had the highest activities. The specific activities of phospholipase A2 from these organisms were several times higher than that of the membrane phospholipase A2 of the amnion and chorion. We postulate that premature labor may be initiated by microorganisms with phospholipase A2 activity from endocervical and/or intrauterine contamination or infection, producing deacylation of arachidonic acid from amniotic phospholipids with increased concentrations of free arachidonic acid and increased prostaglandin synthesis, which triggers labor.

Animals↗

PubMed1996

Serious bacterial infections after endoscopic procedures.

Transient bacteremia during and after endoscopic procedures is a well- documented phenomenon, but complicated bacteremia such as endocarditis in patients at risk is considered to be extremely rare. The recommendations for prophylaxis before endoscopy in patients with valvular heart disease were recently released. We discuss 16 cases of complicated bacteremia that developed after endoscopy (eight cases previously published in the literature and eight cases we encountered). The endoscopic procedures were gastroscopy (five cases), sclerotherapy (six cases), sigmoidoscopy (three cases), and esophageal dilation (two cases). Fourteen patients had underlying disease: valvular heart disease (six patients), cirrhosis of the liver (five patients, one of whom also had a prosthetic knee), valvular heart disease and cirrhosis of the liver (two patients), and gastric carcinoma (one patient). The organisms involved were Streptococcus viridans (six cases), streptococcus group D (three cases), Streptococcus pneumoniae (two cases), Streptococcus microaerophilicus (two cases), Staphylococcus aureus (two cases), and Cardiobacterium hominis (one case). The patients presented with the following infections: endocarditis (12 patients), spontaneous bacterial peritonitis (two patients), septic arthritis (one patient), and brain abscess (one patient). The outcome was good in 15 patients; one patient died. Patients with valvular heart disease, cirrhosis of the liver, ascites, malignancies, or prosthetic joints who undergo endoscopic procedures should be considered for antibiotic prophylaxis.

Adult↗