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[Nature and antibiotic resistance of bacteria encountered in an intensive care unit. Computerized study based on 422 antibiograms].

A computer analysis of 422 sheets of data from antibiograms performed on 146 patients in a resuscitation unit of multipurpose type, was performed. The study comprises the investigation of the nature of the isolated bacteria and the resistance of the organisms to antibiotics alone or in combinations. The results obtained show on the one hand, that there is a development over time of resistance to antibiotics and a change in the nature of the bacteria, and on the other, that a precise knowledge of the bacteriological data concerning a given department enables the intiation of treatment before having the antibiogram results with an increased chance of efficacy. The importance of such a study is controversial.

Anti-Bacterial Agents

Typing methods for Proteus rettgeri: comparison of biotype, antibiograms, serotype, and bacteriocin production.

Two hunderd five strains of Proteus rettgeri from epidemic and nonepidemic sources were differentiated by a new biotyping scheme, agglutination in O antisera, antimicrobial resistance patterns, and a new scheme based on bacteriocin production. The P. rettgeri were divided into 10 groups by their fermentation of lactose, sucrose, D-mannitol, and salicin. These groups were then subdivided into 19 biotypes by other biochemical reactions. Bacteriocin production was tested by the cross-streak method. Thirty-four bacteriocin-sensitive indicator strains were evaluated, and 16 were selected for the final scheme and used to type the 205 P. rettgeri, which were divided into 15 bacteriocin types. Serologically, 43% of the P. rettgeri were O42, 13% were untypable, 4% were O15, and 3% each were O33, O64, and O84 in addition to 31 remaining serotypes. Strains of P. rettgeri from known outbreaks contained fewer biotypes, O groups, and bacteriocin types and were more resistant to antimicrobial agents than endemic strains. Strains with common patterns with all four marker systems were frequently associated with outbreaks. A strong correlation between multiple antibiotic resistance and bacteriocin production was shown.

Anti-Bacterial Agents

Antibiograms of pathogenic bacteria isolated from laboratory animals.

Study of antibiotic sensitivity patterns of 178 bacterial isolants from laboratory animals revealed that these bacteria in general were sensitive to many commonly used antibiotics; however, there were notable exceptions. This report presents current antibiotic sensitivity patterns of most gram-negative and gram-positive bacterial pathogens common to laboratory animals.

Ampicillin

[Value of the antibiogram for the treatment of urogenital Ureaplasma infections].

We have currently established the spectrum of sensitivity of the isolated strains to various antibiotics before prescribing the appropriate treatment. A microtechnic has been used. The most active antibiotics are: minocyclin, pristinamycin, erythromycin, chloramphenicol, oxytetracyclin, kanamycin, tobramycin, streptomycin, in this order.

Anti-Bacterial Agents

[Experiences with the uripret-system in pediatric practice (author's transl)].

The present study reports on the application of the Uripret-System for identification and susceptibility testing of microbial agents causing urinary tract infections carried out in a pediatric outpatient clinic. The findings were compared with those determined with the conventional methods in an institute of medical microbiology. For the detected mono- and mixed-cultures, in 85% of the cases a concurrent result of both methods was found. Only in one case a different microbial agent genus was determined with Uripret from that found in the institute. The quota of concurrence of the antibiograms for the mono-cultures was highest at 100% for gentamicin and lowest at 85.07% for tetracycline. With the mixed-cultures the concurrence ranged between 81.25% for tetracycline and 96.88% for sulphamethoxazole-trimethoprim. With proteus in mono- and mixed-culture the antibiograms showed concurrence to a lesser degree compared to the other microbial agent geni. The application of the Uripret-System in pediatric practice can be recommended on the basis of the present results.

Bacteria

Pseudomonas sternotomy wound infection and sternal osteomyelitis. Complications after open heart surgery.

Pseudomonas aeruginosa sternotomy wound infections occurred in five patients who underwent open heart surgery. The initial isolate in each case was from a mediastinal chest tube routinely cultured on removal. Soft-tissue infection developed in two patients, and sternal osteomyelitis developed in three patients. Pseudomonas-typing studies showed a correlation between five isolates from chest-tube suction pumps used postoperatively and the wound isolates. Analysis of antibiograms of Pseudomonas wound isolates from the cardiac surgery ward from 1975 to 1977 showed eight of 15 with the same antibiogram as the sternotomy pathogens, compared with two of 13 isolates from other wards.

Cardiac Surgical Procedures

[Treatment of severe urinary infection in the elderly. Clinical and bacteriological study of 130 cases (author's transl)].

Strict criteria were applied in the choice of the 130 patients with severe urinary infections included in the study: men or women over 65 years of age presenting with clinical signs and symptoms, a bacterial count greater than or equal to 10(6)/mm3, one type of germ found on urine culture. The results of an antibiogram showed the frequency with which each germ was involved and their sensitivity to antibiotics, more particularly gentamicin, minocyclin, sulphamethoxazole-trimethoprime, oxolinic acid. Based on sensitivity and tolerance criteria, the choice of antibiotic was : oxolinic acid orally ; gentamicin parenterally, after evaluation of renal function. These results can assist the physician, when confronted with cases of severe urinary infection, and before the results of the antibiogram are available, in choosing effective therapy adapted to each case.

Aged

Meningitis due to two serotypes of Escherichia coli. An infant who recovered.

A newborn infant with hyaline membrane disease and aspiration pneumonia developed purulent meningitis on day 19, three days after discontinuation of ampicillin sodium and gentamicin sulfate therapy. Therapy with gentamicin, both systemically and intrathecally, for two weeks was ineffective. During this time each of four specimens of cerebrospinal fluid contained two serotypes of Escherichia coli, namely, O83:H4 and O75:H5. The antibiograms of the two strains were identical, both being susceptible to gentamicin and ampicillin. Treatment with ampicillin resulted in prompt disappearance of the infecting microorganisms and recovery from the infection. One of the strains (O75:H5) produced an antigen cross-reacting with the capsular antigen of Haemophilus influenzae type B; the other did not. The patient developed O antibodies in substantial titers against E coli O83 but not against E coli O75.

Ampicillin

Correlation of minimum inhibitory concentration and beta-lactamase activity.

The beta-lactamase activity of 510 recently isolated Enterobacteriaceae was investigated with a quantitative photometric test. Beta-lactamase could be detected in 55 percent of the Enterobacteriaceae. At the same time minimal inhibition concentration (MIC) of beta-lactam antibiotics was determined. There was no correlation between MIC values and lactamase activity. For correct antibacterial therapy the clinician requires information on the lactamase activity of isolated bacteria in addition to the antibiogram. The qualitative test is useful for screening.

Amidohydrolases

Exacerbations of chronic bronchitis: exogenous or endogenous infection?

Six male patients with chronic bronchitis, who were known previously to have excreted Streptococcus pneumoniae and/or Haemophilus influenzae, both at the times of exacerbations and during remission, were studied for 43 to 52 months. Sputum was examined fortnightly and at the time of exacerbations. Strains of Strep. pneumoniae were serotyped and those of Haemophilus species were typed by antibiograms along with other supporting methods. Sera collected before or at the time of an exacerbation and seven and 30 days afterwards were examined by complement fixation tests against respiratory viruses and Mycoplasma pneumoniae. In 18 out of 25 exacerbations there was evidence of a new type of Strep. pneumoniae and/or Haemophilus spp. or of a current virus infection, suggesting exogenous infection in the majority of these cases. There was a possible reason for failure to detect a new pathogen in three of the seven cases in which none was found. In five further exacerbations adequate investigation was not possible.

Aged

Detection of Serratia outbreaks in hospital.

Infections due to Serratia marcescens were studied in 23 different hospitals. A retrospective study was done in 4 hospitals; all isolates were compared by serological typing, antibiograms, bacteriocin production, and bacteriocin sensitivity. 2 of the hospitals were having cross-infection problems due to antibiotic-resistant strains, but the other 2 had little or no cross-infection. Outbreaks were studied in 19 other hospitals. 9 of these outbreaks were classified as "common source" since contaminated "sterile solutions" were incriminated as the cause in each. One hospital had a "pseudo-outbreak," in which Serratia from E.D.T.A. blood-collecting tubes contaminated blood-cultures as they were collected. All 10 of these strains from common-source outbreaks were generally sensitive to antibiotics. Outbreaks in 9 other hospitals resulted from cross-infection and were caused by strains which were very resistant to antibiotics. Guidelines for detecting outbreaks are given and control measures are suggested.

Alabama