Staphylococcus

J Hosp Infect, 2003 Nov, 55(3), 184 - 9
Staphylococcal species in the oral cavity from patients in a regional burns unit; Smith AJ et al.; The aim of this study was to perform a quantitative and qualitative analysis of oral carriage of staphylococci in a range of oral specimens from patients admitted to a regional burns unit . The study recruited 28 patients and reasons for admittance were: burns (46%), skin grafting (39%), lacerations (7%), scalding (4%) and necrotizing fasciitis (4%) . No patient had smoke inhalation injuries or trauma to the oro-pharynx . There were five patients from whom methicillin-sensitive S . aureus (MRSA) could be detected in oral specimens . For three patients only the wound and oral specimens were positive for MRSA . In one patient only the oral specimens were positive for MRSA . There were five patients from whom methicillin-sensitive S . aureus (MRSA) could be detected in the oral specimens . In one patient only the oral specimens were positive for MSSA . Staphylococci could be recovered from the dental plaque, denture and toothbrush specimens with a mean count of 1.1 x 10(4)cfu/mL (range 20-5.3 x 10(4)), 5.4 x 10(3) (range 40-2.1 x 10(4)) and 264 cfu/mL (range 20-500), respectively . Both MSSA and MRSA could be recovered from these specimen types . In one patient only the toothbrush was positive for MRSA and all other oral specimens were negative . This study suggests that staphylococci are not infrequent colonizers of the oral cavity, and that this site may serve as a potential reservoir for transmission to other body sites.

Cell, 2003 Oct 17, 115(2), 217 - 28
A "dock, lock, and latch" structural model for a staphylococcal adhesin binding to fibrinogen; Ponnuraj K et al.; Gram-positive pathogens such as staphylococci contain multiple cell wall-anchored proteins that serve as an interface between the microbe and its environment . Some of these proteins act as adhesins and mediate bacterial attachment to host tissues . SdrG is a cell wall-anchored adhesin from Staphylococcus epidermidis that binds to the Bbeta chain of human fibrinogen (Fg) and is necessary and sufficient for bacterial attachment to Fg-coated biomaterials . Here, we present the crystal structures of the ligand binding region of SdrG as an apoprotein and in complex with a synthetic peptide analogous to its binding site in Fg . Analysis of the crystal structures, along with mutational studies of both the protein and of the peptide, reveals that SdrG binds to its ligand with a dynamic "dock, lock, and latch" mechanism . We propose that this mechanism represents a general mode of ligand binding for structurally related cell wall-anchored proteins of gram-positive bacteria.

Vet Res, 2003 Sep-Oct, 34(5), 689 - 716
Mastitis of dairy small ruminants; Bergonier D et al.; Staphylococci are the main aetiological agents of small ruminants intramammary infections (IMI), the more frequent isolates being S . aureus in clinical cases and coagulase negative species in subclinical IMI . The clinical IMI, whose annual incidence is usually lower than 5%, mainly occur at the beginning of machine milking and during the first third of lactation . These features constitute small ruminant peculiarities compared to dairy cattle . Small ruminant mastitis is generally a chronic and contagious infection: the primary sources are mammary and cutaneous carriages, and spreading mainly occurs during milking . Somatic cell counts (SCC) represent a valuable tool for prevalence assessment and screening, but predictive values are better in ewes than in goats . Prevention is most often based on milking machine management, sanitation and annual control, and milking technique optimisation . Elimination mainly relies on culling animals exhibiting clinical, chronic and recurrent IMI, and on drying-off intramammary antibiotherapy; this treatment allows a good efficacy and may be used selectively by targeting infected udders only . Heritability values for lactation mean SCC scores are between 0.11 and 0.15 . Effective inclusion of ewe's mastitis resistance in the breeding goal has recently been implemented in France following experimental and large scale estimations of genetic parameters for SCC scores.

J Korean Med Sci, 2003 Oct, 18(5), 631 - 6
Multiplex PCR for the detection of genes encoding aminoglycoside modifying enzymes and methicillin resistance among Staphylococcus species; Choi SM et al.; We developed multiplex polymerase chain reaction (PCR) to detect aac(6 ')/aph(2 "), aph(3 ')-IIIa, and ant(4 ')-Ia, the genes encoding the most clinically relevant amino-glycoside modifying enzymes (AME), and simultaneously, the methicillin resistant gene, mecA, in Staphylococcus species . Clinical isolates of 45 S . aureus and 47 coagulase negative staphylococci (CNS) from tertiary university hospitals were tested by conventional susceptibility testing, using the agar dilution method and by multiplex PCR . Of a total of 92 isolates, 61 isolates were found to be methicillin-resistant . Of these, 54 isolates (89%) were found to be harboring mecA . Seventy-five percent of the 92 isolates demonstrated resistance to at least one of the aminoglycosides tested . Moreover, resistance to aminoglycosides was closely associated with methicillin-resistance (p<0.05) . The most prevalent AME gene was aac(6 ')/aph(2 ") which was found in 65% of the isolates, and ant(4 ')-Ia and aph(3 ')-IIIa were present in 41% and 9% of the isolates, respectively . The concordance between methicillin-resistance and the presence of mecA gene was 98% in S . aureus and 81% in CNS . The concordance between gentamicin resistance and the presence of aac(6 ')/aph(2 ") gene was 100% in S . aureus and 85% in CNS . The multiplex PCR method that we developed appears to be both a more rapid and reliable than conventional method.

J Clin Microbiol, 2003 Oct, 41(10), 4740 - 4
Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci; Fiebelkorn KR et al.; Resistance to macrolides in staphylococci may be due to active efflux (encoded by msrA) or ribosomal target modification (macrolide-lincosamide-streptogramin B {MLSB} resistance; usually encoded by ermA or ermC) . MLSB resistance is either constitutive or inducible following exposure to a macrolide . Induction tests utilize closely approximated erythromycin and clindamycin disks; the flattening of the clindamycin zone adjacent to the erythromycin disk indicates inducible MLSB resistance . The present study reassessed the reliability of placing erythromycin and clindamycin disks in adjacent positions (26 to 28 mm apart) in a standard disk dispenser, compared to distances of 15 or 20 mm . A group of 130 clinical isolates of Staphylococcus aureus and 100 isolates of erythromycin-resistant coagulase-negative staphylococci (CNS) were examined by disk approximation; all CNS isolates and a subset of S . aureus isolates were examined by PCR for ermA, ermC, and msrA . Of 114 erythromycin-resistant S . aureus isolates, 39 demonstrated constitutive resistance to clindamycin, while 33 showed inducible resistance by disk approximation at all three distances . Only one isolate failed to clearly demonstrate induction at 26 mm . Of 82 erythromycin-resistant CNS isolates that contained ermA or ermC, 57 demonstrated constitutive clindamycin resistance, and 25 demonstrated inducible resistance, at 20 and 26 mm . None of the 42 S . aureus isolates or 18 CNS isolates containing only msrA and none of the erythromycin-susceptible isolates yielded positive disk approximation tests . Simple placement of erythromycin and clindamycin disks at a distance achieved with a standard disk dispenser allowed detection of 97% of S . aureus strains and 100% of CNS strains with inducible MLSB resistance in this study.

J Clin Microbiol, 2003 Oct, 41(10), 4660 - 5
Decreased vancomycin susceptibility of coagulase-negative staphylococci in a neonatal intensive care unit: evidence of spread of Staphylococcus warneri; Center KJ et al.; Coagulase-negative staphylococci (CoNS) are important pathogens in premature neonates; decreasing glycopeptide susceptibility has been observed among these isolates . The epidemiology of colonization with CoNS, the organisms' vancomycin susceptibilities, and genetic relatedness were studied over 6 months in a tertiary-care neonatal unit . A total of 321 isolates of CoNS were isolated . Seventy-five percent of the infants were colonized at admission, and virtually all were colonized thereafter . Common species were Staphylococcus epidermidis (69%), S . warneri (12%), S . haemolyticus (9.7%), and S . hominis (5.6%) . A total of 3.9% of CoNS isolates had decreased vancomycin susceptibility (DVS) (MICs > 2.0 microg/ml); isolate recovery was associated with a stay in a neonatal intensive care unit for >28 days (P = 0.039), vancomycin exposure (P = 0.021), and S . warneri colonization (P < 0.0001) . Nine of 12 (75%) CoNS with DVS were S . warneri, had enhanceable high-level resistance in vitro, were indistinguishable or closely related by pulsed-field gel electrophoresis, and were different from 29 vancomycin-susceptible S . warneri isolates . Epidemiological analysis suggested unsuspected nosocomial spread . Species determination in certain settings may aid in the understanding of emerging nosocomial problems.

Transplant Proc, 2003 Sep, 35(6), 2361 - 2
The effect of cyclosporine and tacrolimus on indigenous bacterial flora in human skin grafts; Moscicka M et al.; Allogeneic skin transplants require intensive immunosuppressive therapy . Treatment protocols used for parenchymal organ grafts are not satisfactory to prevent skin graft rejection . Another factor responsible for the destruction of allogeneic skin transplants is bacterial inflammation . Temporary ischemia and the allogeneic reaction in transplanted skin cause increased permeability of the epidermis and the dermal capillaries, making skin grafts vulnerable to bacterial penetration . Moreover, immunosuppressive therapy compromises the host immune response . The present study assessed the effects of immunosuppression by cyclosporine (CsA) or tacrolimus (Tac) on the indigenous bacterial flora of transplanted human skin . We found that a 6-day course of treatment with CsA or Tac was followed by an increased prevalence of bacterial isolates, mostly evidenced by a change in the spectrum of graft bacterial flora from Staphylococcus aureus and coagulase-negative staphylococci toward more pathogenic strains such as Escherichia coli, Enterococcus faecium, micrococcus, and pseudomonas . The mouse skin adjacent to the graft remained sterile, precluding the possibility of graft contamination with mouse flora.

Transplant Proc, 2003 Sep, 35(6), 2304 - 6
Resistance of gram-positive pathogens to antibiotics is a therapeutic challenge after liver transplantation: clinical experience in one center with linezolid; Odakowska-Jedynak U et al.; BACKGROUND: Orthotopic liver transplantation has become an established therapeutic option for a large variety of fulminant and chronic liver diseases . Postoperative infections are the major cause of morbidity and the leading cause of mortality . The microbes responsible for these severe infections are predominantly gram-positive . METHODS: This article reviews results of linezolid therapy based on the clinical characteristics, microbial features, and outcomes of severe bacterial infections due to known or suspected resistant gram-positive species in selected liver allograft recipients . RESULTS: Among the 7 patients who received linezolid, methacillin-resistant Staphylococcus aureus . was isolated from 3, no pathogen from 2 patients, and serious pulmonary infection in 2 patients, 1 of whom had to be reintubated due to of respiratory failure . Cholangitis observed in 5 of 7 patients was caused by enterococci and staphylococci with septicemia in 1 subject . All patients demonstrated clinical improvement; microbiological eradication was observed in 4 patients . The majority of reported adverse events were mild or moderate in intensity . No potential drug interactions were observed between linezolid and concomitant medication . CONCLUSIONS: In the present study, linezolid proved to be effective and well tolerated . In summary, linezolid may represent an effective and safe antimicrobial agent for the treatment of infections due to susceptible and resistant gram-postive bacteria after solid organ transplantation.

Syst Appl Microbiol, 2003 Sep, 26(3), 423 - 33
Combining denaturing gradient gel electrophoresis of 16S rDNA V3 region and 16S-23S rDNA spacer region polymorphism analyses for the identification of staphylococci from Italian fermented sausages; Blaiotta G et al.; Separation of amplified V3 region from 16S rDNA by denaturing gradient gel electrophoresis (PCR-DGGE) and 16S-23S rDNA intergenic spacer region polymorphism (ISR-PCR) analyses were tested as tool for differentiation of staphylococcal strains commonly isolated from fermented sausages . Variable V3 regions of 25 staphylococcal reference strains and 96 wild strains of species belonging to the genera Staphylococcus, Micrococcus and Kocuria were analyzed . PCR-DGGE profiles obtained were species-specific for S . sciuri, S . haemolyticus, S . hominis, S . auricularis, S . condimenti, S . kloosi, S . vitulus, S . succinus, S . pasteuri, S . capitis and S . (Macrococcus) caseolyticus . Moreover, 7 groups could be distinguished gathering the remaining species as result of the separation of the V3 rDNA amplicons in DGGE . Furthermore, the combination of the results obtained by PCR-DGGE and ISR-PCR analyses allowed a clear differentiation of all the staphylococcal species analysed, with exception of the pairs S . equorum-S . cohnii and S . carnosus-S . schleiferi . The suitability of both molecular techniques and of the combination their results for the identification of staphylococci was validated analysing partial nucleotide sequence of the 16S rDNA of a representative number of wild strains.

Probl Tuberk Bolezn Legk, 2003, (8), 40 - 3
{Specific changes in the phagocytic activity of leukocytes in children after BCG vaccination}; Sanakoeva LP; In 185 children vaccinated with BCG, the phagocytic activity of leukocytes (PAL) was studied in different postimmunization periods . The modified procedure for examining PAL that reveals and assays specific phagocytic changes irrespective of the level of PAL was used . A suspended matter mixture of BCG mycobacteria (a specific object) and white saprophytic staphylococci (a non-specific object) was used as the objects of phagocytosis . A specific increase in PAL in the first 1.5 years after vaccination and the specific changes of phagocytosis during a vaccination process were first established . There was a close relationship of the specific changes of phagocytosis to the size of an infiltrate at the site of vaccination injection . The strain of antituberculosis immunity may be more objectively assessed by the phagocytic test than by the size of a skin scar and by the Mantoux test with 2TE PPD-L . The phagocytic test is recommended for individual monitoring of a antituberculosis vaccination process in children.

Ophthalmology, 2003 Oct, 110(10), 1946 - 51
Antibiotic resistance patterns of ocular bacterial flora: a prospective study of patients undergoing anterior segment surgery; Ta CN et al.; PURPOSE: To determine the antibiotic susceptibility patterns of conjunctival bacterial flora isolated preoperatively from patients undergoing anterior segment surgery . DESIGN: Prospective observational study . PARTICIPANTS: One hundred fifty-six eyes from 139 patients scheduled for anterior segment surgery were enrolled over a 6-month period from August 2001 to February 2002 . METHODS: Conjunctival cultures were obtained on the day of surgery before povidone-iodine or antibiotic application . MAIN OUTCOME MEASURES: Bacterial isolates were identified and tested for antibiotic susceptibility using the Kirby-Bauer disc-diffusion technique . RESULTS: Among the 156 eyes studied, 36 were from patients who had undergone either bilateral surgery or more than one surgery in the same eye . Only the first eyes of the 120 patients that underwent initial ocular surgery were included in our analysis . Of these 120 eyes, 21 (18%) showed no bacterial growth . Of the 143 bacterial strains isolated from the remaining 99 eyes, 112 (78%) were coagulase-negative staphylococci (CNS) . Among the CNS, greater than 90% were susceptible to cefotaxime, levofloxacin, imipenem, meropenem, vancomycin, and each of the aminoglycosides except neomycin . Between 70% and 90% of the CNS were susceptible to cefazolin, neomycin, ciprofloxacin, ofloxacin, norfloxacin, and chloramphenicol . Less than 70% of the isolated CNS were sensitive to the penicillin analogues, ceftazidime, erythromycin, and tetracycline . CONCLUSIONS: Preoperative conjunctival isolates of CNS seem to be most sensitive to vancomycin, the aminoglycosides (except neomycin), and levofloxacin.

Pediatr Infect Dis J, 2003 Sep, 22(9 Suppl), S158 - 63
Linezolid versus vancomycin in the treatment of known or suspected resistant gram-positive infections in neonates; Deville JG et al.; BACKGROUND: Gram-positive infections caused by susceptible and resistant strains of Staphylococcus aureus, coagulase-negative staphylococci and enterococci are increasing problems in neonates . Linezolid, a new oxazolidinone, is active against these pathogens and has recently been approved by the Food and Drug Administration for treating Gram-positive infections in pediatric patients . OBJECTIVE: To compare the clinical efficacy and safety of intravenous and oral linezolid with vancomycin (10 to 15 mg/kg every 6 to 24 h) in neonates (age 0 to 90 days) . METHODS: Hospitalized infants with known or suspected hospital-acquired pneumonia, complicated skin or skin structure infections, bacteremia or other infections (e.g . pyelonephritis, abdominal abscess) were eligible . Test-of-cure clinical response was evaluated at follow-up . RESULTS: Sixty-three neonates, randomized 2:1 to linezolid (n = 43) or vancomycin (n = 20) were included in the intent-to-treat group . Clinical cure rates at follow-up in the intent-to-treat group were higher, but not significantly different, for linezolid vs . vancomycin (78% vs . 61%; P = 0.196) . Corresponding cure rates in clinically evaluable patients were 84% vs . 77% (P = 0.553) for linezolid and vancomycin, respectively . Pathogen eradication rates were as follows in the linezolid and vancomycin groups, respectively: S . aureus (67% vs . 60%; P = 0.850); coagulase-negative staphylococci (88% vs . 100%; P = 0.379); and enterococci (71% vs . 0%; P = 0.168) . Results for hematology and chemistry assays were similar between treatment groups . Fewer linezolid-treated neonates had drug-related adverse events than vancomycin-treated neonates (12% vs . 32%; P = 0.058) . CONCLUSIONS: Linezolid is well-tolerated and as effective as vancomycin in the treatment of resistant Gram-positive infections in neonates.

J Antimicrob Chemother, 2003 Nov, 52(5), 820 - 5 Epub 2003 Sep 30.
Bacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis; Drinkovic D et al.; OBJECTIVE: To analyse the bacteriological outcome of combination versus single-agent antimicrobial treatment in staphylococcal endocarditis . PATIENTS AND METHODS: Retrospective review of 152 episodes: 91 cases of native valve endocarditis (NVE), 74 due to Staphylococcus aureus and 17 due to coagulase-negative staphylococci (CoNS); and 61 cases of prosthetic valve endocarditis (PVE), 29 due to S . aureus and 32 due to CoNS . RESULTS: Valves from patients with S . aureus NVE treated with any kind of combination antibiotic treatment were no more likely to be culture-negative than those treated with a single agent {19 (45%) of 42 versus 13 (41%) of 32; P = 0.69} . This finding remained unchanged when cases of CoNS NVE were added to the S . aureus group . In PVE, after adjusting for duration of treatment, valves from patients receiving any kind of combination treatment were 5.9 times (95% confidence interval 1.3-27.5) more likely to be culture-negative than those receiving monotherapy (P = 0.024) . Patients treated for >14 days were more likely to be culture-negative than those treated for <or=14 days {49 (83%) of 59 versus 29 (31%) of 93; P < 0.001} . CONCLUSIONS: In staphylococcal NVE, combination treatment is not superior to monotherapy in sterilizing infected valves, but in PVE combination treatment confers an advantage.

J Clin Pathol, 2003 Oct, 56(10), 782 - 5
Fast, simultaneous, and sensitive detection of staphylococci; Stuhlmeier R et al.; AIMS: Bacterial infections are common and are involved in many forms of disease, ranging from arthritis to food poisoning . Of much concern are nosocomial infections, especially the increasing resistance of bacteria to methicillin . A prerequisite for the successful treatment of bacterial infections is a specific and sensitive method of detecting microorganisms . METHODS: Some methods to detect bacteria are time consuming, whereas others are faster but lack specificity and/or sensitivity . This article describes an optimised polymerase chain reaction (PCR) method that enables the simultaneous detection of different bacteria . A prerequisite for sensitive PCR is a method to isolate and recover extremely small amounts of bacterial DNA . This study used a new method to isolate DNA and compared the results to an established method . RESULTS: The method could detect fewer than 10 Staphylococcus aureus, methicillin resistant S aureus, Staphylococcus epidermitis, and other bacteria and it took less than two hours to perform . CONCLUSION: The rapid DNA isolation method used in conjunction with the optimised PCR makes it possible to confirm the presence or absence of extremely small numbers of bacteria . Using real time PCR would shorten the procedure even further . This method might therefore contribute to more timely and specific interventions.

APMIS, 2003 Sep, 111(9), 905 - 14
Evaluation of different disk diffusion/media combinations for detection of methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci; Skov R et al.; In order to find a disk diffusion method with both high sensitivity and specificity for determination of methicillin resistance primarily for S . aureus but also for coagulase-negative staphylococci we screened several methodological variants using a material of 66 S . aureus comprising of 11 methicillin-susceptible, 18 borderline-resistant, and 37 methicillin-resistant strains . Only four of the combinations studied performed with both high sensitivity and specificity . Two of these, the Columbia agar +4.5% NaCl and Mueller Hinton agar +2% NaCl combined with a 5 microg oxacillin disk, confluent inoculum and 24 h incubation at 35 degrees C were further evaluated using 105 MRSA and 91 mecA-negative S . aureus and 193 clinical isolates of coagulase-negative staphylococci . The Columbia agar +4.5% NaCl performed excellently for both S . aureus and coagulase-negative staphylococci . For Columbia agar +4.5% NaCl using a 5 microg oxacillin disk we suggest an interpretive zone diameter of R < or =15 mm and S > or =16 mm for S . aureus and R < or =24 mm and S >or =26 mm for coagulase-negative staphylococci . The Mueller Hinton agar +2% NaCl performed well for coagulase-negative staphylococci but for S . aureus at least three (3%) very major errors were found, making this method less attractive.

Curr Opin Crit Care, 2003 Oct, 9(5), 403 - 12
Antimicrobial resistance among gram-positive organisms in the intensive care unit; Clark NM et al.; PURPOSE OF REVIEW: The epidemiology of gram-positive pathogens in the intensive care unit are reviewed, recent trends in antimicrobial resistance among these organisms are discussed, and the significance of these data with respect to treatment are considered . RECENT FINDINGS: Results of surveillance studies published in 2001 and 2002 have demonstrated that gram-positive organisms such as Staphylococcus aureus, coagulase-negative staphylococci, and enterococci are among the most common bacteria infecting patients in intensive care units . Furthermore, these organisms are becoming increasingly resistant to available antimicrobial agents, and 2002 has ushered in worrisome developments such as the appearance of vancomycin-resistant S . aureus . Community-acquired methicillin-resistant S . aureus and the rise in incidence of vancomycin-resistant enterococci are other problems of great concern . Novel antibiotics such as quinupristin/dalfopristin and linezolid have activity against these agents, but resistance may develop to these agents as well . Studies have shown that infections caused by antibiotic-resistant organisms may be associated with increased morbidity, mortality, and costs . Exposure to antibiotics is a major risk factor for producing antibiotic resistance in patients, and methods to limit the spread of these organisms include restriction of antibiotic use, infection control, surveillance programs, and isolation procedures . SUMMARY: An awareness of the prevalence and patterns of resistance among gram-positive nosocomial pathogens is vital for the appropriate treatment of hospitalized patients . In addition, efforts must be made to minimize the selection and spread of these organisms.

Antimicrob Agents Chemother, 2003 Oct, 47(10), 3046 - 52
Novel plasmid-borne gene qacJ mediates resistance to quaternary ammonium compounds in equine Staphylococcus aureus, Staphylococcus simulans, and Staphylococcus intermedius; Bjorland J et al.; We identified a novel plasmid-borne gene (designated qacJ) encoding resistance to quaternary ammonium compounds (QACs) in three staphylococcal species associated with chronic infections in four horses . qacJ was located on a 2,650-bp plasmid (designated pNVH01), a new member of the pC194 family of rolling-circle replication plasmids . The 107-amino-acid protein, QacJ, showed similarities to known proteins of the small multidrug resistance family: Smr/QacC (72.5%), QacG (82.6%), and QacH (73.4%) . The benzalkonium chloride MIC for a qacJ-containing recombinant was higher than those for otherwise isogenic recombinants expressing Smr, QacG, or QacH . Molecular epidemiological analyses by pulsed-field gel electrophoresis suggested both the clonal spread of a qacJ-harboring Staphylococcus aureus strain and the horizontal transfer of pNVH01 within and between different equine staphylococcal species . The presence of pNVH01 of identical nucleotide sequence in different staphylococcal species suggests that recent transfer has occurred . In three of the horses, a skin preparation containing cetyltrimethylammonium bromide had been used extensively for several years; this might explain the selection of staphylococci harboring the novel QAC resistance gene.

Support Care Cancer, 2003 Dec, 11(12), 790 - 4 Epub 2003 Sep 20.
Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies; Harter C et al.; BACKGROUND: In contrast to the high risk of haemorrhage associated with the implantation of a central venous catheter (CVC) via the internal jugular or subclavian access, the use of a peripherally inserted catheter (PICC) offers the advantage of a lower risk of bleeding complications . However, the rate of phlebitis is higher with the PICC and its use has been declining . We have studied the benefits and adverse events of a new type of PICC and a common type . METHODS: From October 1999 to October 2001, 70 PICCs (Olimpicc, Vygon, Germany, n=40; and LIFECATH-PICC(PUR)5FR Vygon, Germany, n=30) were inserted into 66 patients with haematological malignancies and used for high-dose chemotherapy, total parenteral nutrition and autologous blood stem cell transplantation . While removing the catheter, central and peripheral blood cultures were taken . The catheter tip was investigated by the semi-quantitative roll-out method of Maki . RESULTS: Sixty-five PICCs were removed after a median of 8.9 days . In five cases a catheter-associated significant colonisation with coagulase-negative staphylococci occurred . In two instances catheter-related bacteraemia was found . CONCLUSION: In our study this catheter system was inserted in 94% of patients without problems and showed a low incidence of phlebitis (5/65) . Because of the high rate of catheter malfunction reported during and after our study, the Olimpicc catheter is no longer available . The PICC system, and the LIFECATH-PICC(PUR)5FR in particular, offers a safe and effective alternative for central venous access to the internal jugular vein.

J Food Prot, 2003 Sep, 66(9), 1693 - 6
Enterotoxin production by Staphylococcus aureus isolated from mastitic cows; Cenci-Goga BT et al.; Staphylococcus aureus is an important cause of mastitis in cows . The ability of S . aureus strains to produce one or more enterotoxins in milk and dairy products is linked to staphylococcal food poisoning . To determine whether staphylococci causing bovine mastitis could cause human foodborne intoxication, the production of staphylococcal enterotoxins A through D (SEA, SEB, SEC, and SED) by 160 S . aureus isolates was evaluated with the use of a reverse passive latex agglutination enterotoxin kit . All S . aureus strains were isolated over a 9-month period from 2,343 routine submissions of a composite quarter collection of individual mastitic cows at 18 dairy farms in the San Joaquin Valley in California . Prior to enterotoxin detection, isolates were grown by a method that enhances the in vitro synthesis of enterotoxin . Twenty-two of 160 S . aureus isolates produced enterotoxin . Seven produced SEC, 12 produced SED, and 3 produced both SEC and SED . None of the isolates produced SEA or SEB.

J Microbiol Methods, 2003 Oct, 55(1), 279 - 86
Development of specific PCR primers for a rapid and accurate identification of Staphylococcus xylosus, a species used in food fermentation; Morot-Bizot S et al.; Twenty-seven Staphylococcus strains isolated from food and food environments were assigned to Staphylococcus xylosus by API-Staph system . But only seven isolates had similar patterns to this species when compared to the pulse-field gel electrophoresis patterns of 12 S . xylosus strains . To perform a rapid identification of the S . xylosus species, a random amplified polymorphic DNA product of 539-bp shared by all of the S . xylosus strains was used to design a pair of primers . These primers were species-specific for S . xylosus when tested by PCR on 21 staphylococci species . This specific PCR assay confirms the identification of the seven isolates identified by PFGE to S . xylosus . In conclusion, we developed specific PCR primers for a rapid and accurate identification of the S . xylosus species.

Ann Hematol, 2003 Oct, 82 Suppl 2, S105 - 17 Epub 2003 Sep 09.
Antimicrobial therapy of unexplained fever in neutropenic patients--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG-German Cancer Society); Link H et al.; Cytostatic chemotherapy of hematological malignancies is often complicated by neutropenia, which increases the risk of infections, especially if the neutrophil count is below 500/microl . Frequently, fever is the first, and in most patients the only, sign of an infection . Unexplained fever is defined as follows: temperature of >/=38.3 degrees C or >/=38.0 degrees C for at least 1 h, or measured twice within 12 h, if the neutrophil count is <500/microl or <1000/microl with predicted decline to 500/microl . Different risk categories can be identified according to the duration of neutropenia: low risk </=5 days, intermediate risk 6-9 days, high risk >/=10 days . An empirical mono- or duotherapy with antipseudomonal and antistreptococcal agents should be initiated immediately . In the low risk patient group, oral therapy with cipro-, levo-, or ofloxacin combined with amoxicillin/clavulanic acid is permissible . For standard and high risk patients, monotherapy can be carried out with either ceftazidime, cefepime, piperacillin with tazobactam or a carbapenem . In duotherapy, a single dose of an aminoglycoside is combined with acylaminopenicillin or a cephalosporin of the third or fourth generation . The addition of glycopeptides in empirical therapy should only be considered in the presence of severe mucositis, or if a catheter-associated infection is suspected . If fever persists after 72-96 h of first-line therapy with antibiotics, the regimen should be modified (with the exception of e.g . coagulase-negative staphylococci infections, because these infections take longer to respond) . Intermediate risk patients should additionally receive an aminoglycoside after monotherapy (penicillin or a cephalosporin) . If a carbapenem was administered for monotherapy, this can be followed by a quinolone and/or a glycopeptide . In the high risk group, the same modifications should be made as in the intermediate risk group but with additional systemic antifungal treatment . In the presence of unexplained fever, fluconazole can be administered at first, but if this fails, amphotericin B (conventional or liposomal), itraconazole, voriconazole or caspofungin should be started . After defervescence to <38 degrees C, treatment should be continued for 7 days if the neutrophil count is <1000/microl, and for 2 days if the neutrophil count is >1000/microl.

Ann Hematol, 2003 Oct, 82 Suppl 2, S149 - 57 Epub 2003 Sep 09.
Central venous catheter (CVC)-related infections in neutropenic patients--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO); Fatkenheuer G et al.; Catheter-related infections cause considerable morbidity in hospitalised patients . The incidence does not seem to be higher in neutropenic patients than in non- neutropenic patients . Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the most frequently cultured pathogens, followed by Candida species . In contrast, Gram-negative bacteria play only a minor role in catheter-related infections . Positive blood cultures are the cornerstone in the diagnosis of catheter-related infections, while local signs of infection are only rarely present . However, a definite diagnosis generally requires the removal of the catheter and its microbiological examination . The role plate method with semiquantitative cultures (Maki) has been established as standard in most laboratories . Other standard procedures use quantitative techniques (Sherertz, Brun-Buisson) and are more sensitive . For therapy of catheter-related infections, antibiotics are administered according to the susceptibility of the cultured organism . Routine administration of gylcopepticed antibiotics is not indicated . Removal of the catheter has to be considered in any case of suspected catheter-related infection and is obligatory in Staphylococcus aureus and Candida infections . Tunnel or pocket infection of long-term catheters is always an indication for removal . In the future, the rate of catheter-related infections in neutropenic patients may be reduced by the use of catheters coated with antimicrobial agents.

Int J Antimicrob Agents, 2003 Sep, 22(3), 228 - 36
Msr(A) and related macrolide/streptogramin resistance determinants: incomplete transporters?
Reynolds E, Ross JI, Cove JH.
The gene msr(A) confers inducible resistance to 14-membered-ring macrolides and type B streptogramins (MS(B) resistance) in staphylococci . The encoded hydrophilic protein (Msr(A)) is 488 amino acids and contains two ATP-binding motifs characteristic of the ABC transporters . The classical organisation of ABC transporters requires interaction between the two cytoplasmically located ATP-binding domains with two hydrophobic domains positioned in the membrane . Msr(A) appears to mediate drug efflux and yet contains no hydrophobic membrane spanning domains . In addition, Msr(A) functions in previously sensitive heterologous hosts such as Staphylococcus aureus in the absence of other plasmid encoded products . Current research on Msr(A) and related determinants in Gram-positive cocci and in antibiotic producing organisms is reviewed . Alternative hypotheses for the mechanism of action of Msr(A) (i.e . active transport vs . ribosomal protection) are discussed . Evidence indicating Msr(A) may have a role in virulence in addition to conferring antibiotic resistance is also considered.

Int J Syst Evol Microbiol, 2003 Sep, 53(Pt 5), 1647 - 54
Macrococcus brunensis sp . nov., Macrococcus hajekii sp . nov . and Macrococcus lamae sp . nov., from the skin of llamas; Mannerova S et al.; Eight strains of Gram-positive, catalase- and oxidase-positive cocci were isolated from the skin of llamas (Lama glama L.) and characterized using a polyphasic approach . These strains were assigned to the genus Macrococcus on the basis of their phenotypic properties (resistance to bacitracin and sensitivity to furazolidone) and DNA base content (40-42 mol% G+C) . Phylogenetic analysis based on 16S rDNA confirmed that the strains are members of the genus MACROCOCCUS: They differed from all hitherto described macrococcal species in their production of phosphatase and reduction of nitrate (most strains) and the inability to produce acid from glycerol or to grow in 7.5 % NaCl . Ribotyping (EcoRI), macrorestriction analysis (XbaI) and fatty acid methyl ester analysis divided the strains from llamas into three stable clusters . Moreover, ribotyping differentiated the strains analysed not only from previously described macrococcal species but also from oxidase-positive staphylococci . DNA-DNA hybridization confirmed that the three clusters represent separate genomic groups (similarity values<54 %) . All the results showed that the strains represent three novel species, for which the names Macrococcus hajekii sp . nov . (type strain CCM 4809(T)=LMG 21711(T)), Macrococcus brunensis sp . nov . (type strain CCM 4811(T)=LMG 21712(T)) and Macrococcus lamae sp . nov . (type strain CCM 4815(T)=LMG 21713(T)) are proposed.

FEMS Immunol Med Microbiol, 2003 Sep 22, 38(2), 153 - 8
Strict infection control measures do not prevent clonal spread of coagulase negative staphylococci colonizing central venous catheters in neutropenic hemato-oncologic patients; van Pelt C et al.; Coagulase negative staphylococci (CoNS) are a main cause of catheter related infections (CRI) . Earlier studies (1994-1996) revealed a high incidence of CRI (6 per 1000 catheter days) among neutropenic hemato-oncologic patients in the Erasmus MC Hematology Department (Rotterdam, The Netherlands) . This was mainly explained by expansion of two methicillin resistant Staphylococcus epidermidis (MRSE) clones (Nouwen et al., J . Clin . Microbiol . 36 (1998) 2696-2702) . In a new, 16-bed unit in the same institution, we investigated the effect of strict clinical isolation measures on the incidence of CRI . During two 6-month screening periods (period I: April 1998-December 1998 and period II: April 1999-October 1999) all patients receiving a central venous catheter were prospectively monitored for the development of CRI . During period I every visitor of the cubicles had to wear hair caps, masks, gowns and gloves . During period II these procedures were abolished, but hands were cleansed using alcohol and masks were worn during both periods in case of coughing and sneezing . All CoNS strains isolated from blood cultures were genetically classifies by pulsed field gel electrophoresis (PFGE) . The incidence of CRI during period I was 13.0 per 1000 catheter days, in comparison to 9.6 in period II (P=0.84) . During this latter period, 19 CRI were diagnosed, 14 catheter related bacteremia episodes (CRB) and five local infections . Seventy-two percent (n=9) of CRB were due to a CoNS . The mean catheter survival until appearance of a CRI increased from 43 days during period I to 78 days in period II (P=0.39) . The mean catheter survival until infection related removal was increased from 43 days to 133 days (P=0.12) . During period I less experienced intervention radiologists introduced the catheters, which may have limited the efficacy of the strict hygiene measures . Thus, abolishing strict isolation precautions had no negative effect on the incidence of CRI . After genotyping of 38 MRSE strains isolated from blood and central venous catheter cultures of 12 patients in period II, eight PFGE types were found . Three types were found in more than one patient, but based on epidemiological data patient-to-patient spread could not be proven . No genotypic identity between patient and personnel CoNS isolates was shown and the two major clonal types that were present between 1994 and 1996 were not encountered . However, from December 1998 onwards new MRSE clones could be identified (types E and J) . In conclusion, despite a constant rate of CRI and implementation of optimal patient care, clonal spread of MRSE strains was not prevented by strict hygiene measures.

J Clin Oncol, 2003 Sep 15, 21(18), 3520 - 5
Catheter design influences recurrence of catheter-related bloodstream infection in children with cancer; Flynn PM et al.; PURPOSE: Multiple studies have demonstrated that catheter-related bloodstream infections (CRBI) can be successfully treated without catheter removal (in situ therapy), but there is insufficient information available to determine if catheter design can influence the eradication of bacteremia or recurrence . PATIENTS AND METHODS: Bacteremic episodes in patients at St Jude Children's Research Hospital between January 1996 and May 2001 were identified and patient records were reviewed . RESULTS: A total of 172 unique episodes of CRBI were identified . In situ therapy resulted in successful eradication of bacteremia in 87% of the episodes . Bacteremia recurred in 10% of the episodes . Although catheter design (Hickman and Broviac versus totally implantable central venous catheter) did not influence short-term eradication of bacteremia, totally implantable central venous catheters were significantly associated with recurrence of bacteremia (odds ratio, 10; 95% confidence interval, 3.1 to 33.3) . In a multivariable analysis, this association between catheter design and recurrence remained statistically significant after adjustment for other factors that influenced recurrence in this study (isolation of coagulase-negative staphylococci and inadequate duration of initial antibiotic therapy) . CONCLUSION: This study demonstrates that patients with CRBI with a totally implantable central venous catheter in place are more likely to develop recurrent bacteremia . Management strategies to prevent recurrence in this setting should be explored.

Diagn Microbiol Infect Dis, 2003 Sep, 47(1), 303 - 11
Detection of antimicrobial resistance by small rural hospital microbiology laboratories: comparison of survey responses with current NCCLS laboratory standards; Stevenson KB et al.; Microbiology laboratory personnel from 77 rural hospitals in Idaho, Nevada, Utah, and eastern Washington were surveyed in July 2000 regarding their routine practices for detecting antimicrobial resistance . Their self-reported responses were compared to recommended laboratory practices . Most hospitals reported performing onsite bacterial identification and susceptibility testing . Many reported detecting targeted antimicrobial resistant organisms . While only 5/61 hospitals (8%) described using screening tests capable of detecting all 8 targeted types of resistance, most (57/61, 93%) were capable of accurately screening for at least 6 types . Conversely, most hospitals (58/61, 95%) reported confirmatory testing capable of identifying only 3 or fewer resistance types with high-level penicillin resistance among pneumococci, methicillin and vancomycin resistance among staphylococci and enterococci, and extended spectrum beta-lactamase production by Gram-negative bacilli presenting the greatest difficulties . Furthermore, only 50% of hospitals compiled annual antibiogram reports to help physicians choose initial therapy for suspected infectious illnesses . This survey suggests that the antimicrobial susceptibility testing in many rural hospitals may be unreliable.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Jul-Aug, (4), 51 - 5
{Characterization of relationships between pro- and eukaryotic cells under the conditions of intracellular symbiosis of Staphylococcus aureus in the mucosa cells of the respiratory and digestive systems organs in terms of ecology and morphology}; Stadnikov AA et al.; The ecological and morphological analysis of reorganization processes in the cell and tissue structures of the mucous membranes of the respiratory and digestive systems in rats under the conditions of their prolonged symbiotic interactions with staphylococci (in the body of rats as a whole, as well as on the model of organotypic cultures in diffusion chambers in vivo) was carried out with the use of light and electron microscopy, radioautography and morphometry . The morphological equivalents of phenotypic reactions in the cell elements of the mucous membranes of the respiratory and digestive systems (epitheliocytes, leimyocytes, endotheliocytes, macrophages and fibroblasts) under the conditions of staphylococcus persistence were revealed . Adaptive and reactive shifts in eukaryotic cells were manifested by an increased volume of nuclei and greater proportion of euchromatin and a decreased DNA-synthetic and proliferative activity . Microorganisms located inside the cells underwent ultrastructural reorganization.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Jul-Aug, (4), 47 - 51
{Properties of Staphylococcus aureus in case of the unfavorable course of burn infection}; Brudastov IuA et al.; Clinical and microbiological study of wound discharge from 35 patients demonstrated a relationship between biological properties of S . aureus, the causative agent of burn infection, and the course of the infected burn trauma . The prognostic importance of the antioxidant properties of these staphylococci was established: in cases of the unfavorable course of the burn process they showed essentially greater resistance to peroxinitrite and higher superoxide dismutase activity in comparison with the cultures isolated from patients with uncomplicated wound infection.

Clin Orthop, 2003 Sep, (414), 89 - 94
PCR rapidly detects methicillin-resistant staphylococci periprosthetic infection; Tarkin IS et al.; Optimal treatment of methicillin-resistant staphylococcal periprosthetic infections is predicated on rapid and reliable detection of these organisms . Culture has served as the gold standard for identification of these organisms despite shortcomings with sensitivity and processing time . The objective of the current study was to investigate a polymerase chain reaction assay aimed at rapid genomic detection of methicillin-resistance in staphylococci (mecA gene) . The feasibility of the molecular approach first was validated using a septic arthritis model consisting of 73 synovial fluid samples inoculated with methicillin-resistant staphylococci and four negative controls . MecA polymerase chain reaction then was done on 35 clinical samples from 18 patients obtained at the time of revision arthroplasty . Results of the polymerase chain reaction were compared with culture . MecA polymerase chain reaction successfully predicted the presence of methicillin-resistant staphylococci in the septic arthritis model . In the clinical samples studied, the polymerase chain reaction results were concordant with culture results in 34 of the 35 samples tested . The one discordant result represented a false-positive culture result . The molecular assay was processed in less than 5 hours compared with 2 to 3 days for culture . Detection of methicillin-resistant staphylococci involved in periprosthetic infections by the polymerase chain reaction is a rapid and reliable approach.

Braz J Infect Dis, 2003 Apr, 7(2), 142 - 8 Epub 2003 Nov 19.
Comparison between the jugular and subclavian vein as insertion site for central venous catheters: microbiological aspects and risk factors for colonization and infection; Sadoyama G et al.; Bacterial counts were made of catheter insertion site and of catheter tips to help determine risk factors associated with catheterization of the jugular and subclavian veins . Among the 116 patients included in this study, 69% had central venous catheters (CVC) in the subclavian vein . Seven or more days catheterization (p=0.001) and > or =3 invasive devices (p=0.01) were infection risk factors associated with catheterization of the jugular vein . More than half of the patients presented high colony counts at the insertion site (> or =200 CFU/20 cm2) and 27% of the catheter tips were contaminated . The risk factors associated with contaminated catheter tips were > or =14 days hospital stay (p=0.02), > or =7 days catheterization (p=0.01) and antibiotic therapy (p=0.04) . Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the most common microorganisms at the insertion site (78%) and in the catheter tip (94%) . Five patients presented sepsis (4.1%), four caused by Staphylococci and one by GNB . Twelve patients had the same microorganisms at the insertion site and catheter tip . We found a high prevalence of ORSA (62.5%) and ORCoNS (57.1%) in catheter tips . The high counts of staphylococci, including ORSA and ORCoNS, at the insertion site, and the significant association of this colonization with catheter tip contamination, indicate that the skin is an important reservoir of microorganisms associated with catheter-related bloodstream infection (CR-BSI) . Health professionals should be aware of this potential source of infection at the CVC insertion site.

Microb Drug Resist, 2003 Fall, 9(3), 273 - 82
Application of molecular typing methods to characterize nosocomial coagulase-negative staphylococci collected in a Greek hospital during a three-year period (1998-2000); Spiliopoulou I et al.; A total of 143 methicillin-resistant coagulase-negative staphylococci (MR-CNS) collected between 1998 and 2000 at the University Hospital of Patras, Greece, were characterized by antibiogram and genomic typing to define the clonal types endemic in this hospital and their evolution during the 3-year period . These isolates corresponded to 93 methicillin-resistant Staphylococcus epidermidis (MRSE) and 50 other MR-CNS, which were isolated from patients in different wards, exclusively from blood and catheter tips cultures . Pulsed-field gel electrophoresis (PFGE) of SmaI macrofragments and hybridization of ClaI digests with mecA and murE DNA probes were performed . The application of these methodologies demonstrated the existence, persistence and spread of MRSE, MR-Staphylococcus haemolyticus, and MR-Staphylococcus hominis clones in this hospital, whereas the SmaI/murE hybridization pattern was shown to be a valuable tool for the MRSE identification.

Pneumonol Alergol Pol, 2003, 71(1-2), 31 - 5
{Microorganisms isolated from clinical specimens of patients from the Department of Thoracic Surgery}; Czarniak E et al.; The clinical specimens received from patients hospitalized in Department of Thoracic Surgery between 1997 and 2001 were microbiologically examined . The main specimen for microbiological examination was pleural fluid (median 34%) . The frequency of specimens from bronchial tree increased significantly (from 4% to 26%) with concurrent decrease of sputum (from 29% to 6%) . Among isolated pathogens, Gram negative rods were the most frequent (median 48%) and Pseudomonas sp . was the main pathogen among them . Occurrence of staphylococci was median 22% and Staphylococcus aureus, with a little decrease in analyzed period, was still the main Gram positive pathogen . Simultaneously the occurrence of MRSA in the last three years dropped three times . The number of isolations of yeasts have risen from 5.8% to 10.3%.

J Clin Microbiol, 2003 Sep, 41(9), 4324 - 7
Evaluation of three rapid methods for the direct identification of Staphylococcus aureus from positive blood cultures; Chapin K et al.; Staphylococci represent the most commonly encountered blood culture isolates . Differentiating Staphylococcus aureus from coagulase-negative staphylococci (CoNS) is important in guiding empirical therapy, especially since the majority of CoNS are contaminants . This study evaluated three rapid methods for the direct identification of S . aureus from blood cultures . A total of 157 patient blood cultures with gram stains showing gram-positive cocci in clusters were included . The following assays were evaluated: API RAPIDEC staph (API) (bioMerieux, Durham, N.C.), the tube coagulase test (TCT) read at 4 h, and peptide nucleic acid (PNA) fluorescence in situ hybridization (FISH) (AdvanDx, Woburn, Mass.) . All assays yielded results of S . aureus or non-S . aureus . The direct rapid results were compared to results obtained with isolated colonies using the AccuProbe Staphylococcus aureus Culture Identification Test (Gen-Probe, San Diego, Calif.) . API, TCT, and PNA FISH exhibited sensitivities of 96, 84, and 99% and specificities of 99, 100, and 100%, respectively . Direct identification testing by any of these three assays yielded acceptable performance and timely results . This ability to accurately detect S . aureus in blood cultures gives the physician information with which to initiate or tailor antimicrobial therapy . Coupled with direct susceptibility testing of positive blood culture broths, the patient and institution may experience improved outcomes.

J Clin Microbiol, 2003 Sep, 41(9), 4259 - 63
Use of the VITEK 2 system for rapid identification of clinical isolates of Staphylococci from bloodstream infections; Spanu T et al.; Staphylococci are an increasing cause of bloodstream infections . Rapid reliable identification of these organisms is essential for accurate diagnosis and prompt effective treatment . We evaluated the ability of the VITEK 2 system (bioMerieux, Inc, Hazelwood, Mo.) to identify these organisms rapidly and accurately . A total of 405 clinically relevant nonduplicate staphylococcal isolates (Staphylococcus aureus, n = 130; coagulase-negative staphylococci, n = 275) collected from blood cultures were tested . VITEK 2 results were considered correct when they were identical to those furnished by the comparison method based on the ID 32 STAPH system (bioMerieux, Marcy l'Etoile, France) plus supplementary manual testing . When discrepancies occurred, isolate identity was verified by molecular typing . The VITEK 2 correctly identified 387 (95.6%) isolates at the species level: 379 (including all but one {99.2%} of 130 S . aureus isolates and 249 of 275 {90.5%} coagulase-negative isolates) were identified by the automated reading; for the other eight, supplemental tests suggested by the manufacturer had to be used . Only one strain (0.2%) was misidentified (Staphylococcus hominis as Staphylococcus epidermidis), and four (1%), all S . epidermidis, were not identified . For the remaining 13 strains (including 10 S . hominis), the VITEK 2 system was unable to discriminate among two species, and no supplemental tests were suggested for conclusive identification . Over 90% of results were obtained within 4 h . These results suggest that the VITEK 2 system can provide rapid, accurate, and reliable species-level identification of staphylococci responsible for bloodstream infections, although there is room for improvement in the identification of certain coagulase-negative species, especially S . hominis.

Appl Environ Microbiol, 2003 Sep, 69(9), 5328 - 35
Fluorescence-activated cell sorting of specific affibody-displaying staphylococci; Wernerus H et al.; Efficient enrichment of staphylococcal cells displaying specific heterologous affinity ligands on their cell surfaces was demonstrated by using fluorescence-activated cell sorting . Using bacterial surface display of peptide or protein libraries for the purpose of combinatorial protein engineering has previously been investigated by using gram-negative bacteria . Here, the potential for using a gram-positive bacterium was evaluated by employing the well-established surface expression system for Staphylococcus carnosus . Staphylococcus aureus protein A domains with binding specificity to immunoglobulin G or engineered specificity for the G protein of human respiratory syncytial virus were expressed as surface display on S . carnosus cells . The surface accessibility and retained binding specificity of expressed proteins were demonstrated in whole-cell enzyme and flow cytometry assays . Also, affibody-expressing target cells could be sorted essentially quantitatively from a moderate excess of background cells in a single step by using a high-stringency sorting mode . Furthermore, in a simulated library selection experiment, a more-than-25,000-fold enrichment of target cells could be achieved through only two rounds of cell sorting and regrowth . The results obtained indicate that staphylococcal surface display of affibody libraries combined with fluoresence-activated cell sorting might indeed constitute an attractive alternative to existing technology platforms for affinity-based selections.

J Vet Med Sci, 2003 Aug, 65(8), 899 - 906
Concentrations and specific antibodies to staphylococcal enterotoxin-C and toxic shock syndrome toxin-1 in bovine mammary gland secretions, and inflammatory response to the intramammary inoculation of these toxins; Kuroishi T et al.; To investigate the pathological role of staphylococcal enterotoxins (SEs) and toxic shock syndrome toxin-1 (TSST-1) in bovine mastitis, the production of SEs and TSST-1 was investigated in staphylococci isolated from 120 mammary gland secretions (MGS, 51 from no clinical sign-mammary glands and 69 from staphylococcal mastitic-mammary glands) collected from dairy farms where staphylococcal mastitis frequently occurred in Miyagi and Yamagata prefectures from 1997 to 1998 . Concentrations of these toxins and specific antibody titers in each MGS were also measured . Furthermore, SEC and TSST-1 were inoculated into lactating mammary glands and inflammatory responses were analyzed . A high percentage of staphylococci including Staphylococcus aureus and coagulase-negative staphylococci isolated from both no clinical sign- and mastitic-MGS produced both SEC and/or TSST-1 . The concentration of SEC increased with the severity of the mastitis, and was significantly higher (P<0.05) in acute mastitic-than in no clinical signs-MGS . Titers of specific antibodies to TSST-1 in MGS were significantly higher (P<0.05) than those to SEC, regardless of whether or not the cows were lactating or mastitic . Specific antibodies purified from MGS neutralized each toxin in vitro . A significant increase (P < 0.05) in somatic cell counts was induced by the intramammary inoculation of SEC but not TSST-1 . These findings indicated that SEC rather than TSST-1 plays an important role in the pathology of staphylococcal bovine mastitis . The inflammatory activity of TSST-1 was probably neutralized by specific antibodies in MGS.

Yonsei Med J, 2003 Aug 30, 44(4), 571 - 8
Korean nationwide surveillance of antimicrobial resistance in 2000 with special reference to vancomycin resistance in enterococci, and expanded-spectrum cephalosporin and imipenem resistance in gram-negative bacilli; Lee KW et al.; Antimicrobial resistance surveillance is necessary to determine the size of the problem and to guide empirical selection of antimicrobial agents for treating infected patients . The aim of this study was to analyze the results of susceptibility tests performed by hospitals participating in the Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) program . The rates of oxacillin-resistant staphylococci, penicillin-nonsusceptible pneumococci, and ampicillin-resistant E . faecium were over 70% . Ampicillin-resistant H . influenzae increased to 68% . Expanded-spectrum cephalosporin-resistant K . pneumoniae, fluoroquinolone-resistant E . coli, and imipenem-resistant P . aeruginosa remained at 16% through 27%, depending on the species . The proportions of vancomycin- resistant E . faecium and imipenem-resistant P . aeruginosa were 18 - 24% and 19-21%, respectively, indicating the seriousness of antimicrobial resistance . In conclusion, the increasing prevalence of resistant bacteria indicates that more concerted effort is required to conserve the usefulness of precious new antimicrobial agents.

Pathol Biol (Paris), 2003 Sep, 51(7), 400 - 4
{In vitro activity of the pristinamycin against the isolated staphylococci in the french hospitals in 1999-2000}; Leclercq R et al.; One thousand six hundred and fifty clinically significant, consecutive and non redundant strains of staphylococci, including 863 Staphylococcus aureus and 787 coagulase negative staphylococci (CNS), were isolated between October 1999 and March 2000 in 35 French hospital laboratories . Susceptibilities were determined in each center by a standard diffusion method according to the recommendations of CA-SFM . Strains with vancomycin zone size diameter <17 mm were sent to the central laboratory for MIC determination of vancomycin by agar dilution, as recommended by the CA-CSFM . Frequencies of resistance to oxacillin were 38.6% for S . aureus (MRSA), 54% for the CNS, all species and 62% for S . epidermidis, respectively . The antibiotics tested showed a good activity against strains of S . aureus susceptible to oxacillin, more than 95% of strains being susceptible except for erythromycin (82.6%) . Against MRSA, vancomycin and prisitinamycin had the highest rates of susceptible strains, greater than 93% for the later antibiotic . More than 92% of strains of CNS susceptible or resistant to oxacillin were sensitive to pristinamycin . Pristinamycin displayed a good activity whether the strains were constitutively or inducibly resistant to MLS(B) . It comes out from this in vitro study that the rate of resistance of staphylococci to pristinamycin remains weak and stable in France . Pristinamycin is a good alternative for oral treatment of staphylococcal infections.

Microb Pathog, 2003 Sep, 35(3), 119 - 24
Polarization of cytokine responses in B- and T-lymphocytes during Staphylococcus aureus infection; Gjertsson I et al.; The destructive course of Staphylococcus aureus arthritis is due to certain leukocytes and their products, mainly cytokines . The cellular source of cytokines mediating this inflammatory process has not been previously assessed on a protein level . Using a mouse model of hematogenously induced S . aureus infection the intracellular production of IFN-gamma, IL-4 and IL-10 in splenic B and T cells have been determined . This has enabled us to define distinct Th1 vs Th2 and Be1 vs Be2 populations of lymphocytes participating in S . aureus infection . Spleen cells were obtained before, and at different time intervals during the first week of infection and re-stimulated in vitro with staphylococcal peptidoglycan, formalin killed staphylococci and TSST-1 . The different antigens used for re-stimulation gave rise to different cytokine profiles in analysed T cells (identified as CD4+) and B cells (identified as CD19+) . TSST-1 acted as the most potent re-stimulator and we found that 40% of the CD4+ cells responded with IFN-gamma production, and unexpectedly almost 20% of the CD19+ cells . As to IL-4 and IL-10 production, the percentage of B cells expressing these cytokines was higher than the percentage T cells and the peak of their appearance appeared later than that of IFN-gamma . This finding indicates that Be1 cells are an important source of IFN-gamma early during the infection and that the production of the Th2 cytokines in B cells downregulates its production of IFN-gamma . In conclusion this study shows that both B and T cells contribute to the cytokine production during S . aureus infection in a complex pattern.

J Hosp Infect, 2003 Aug, 54(4), 272 - 8
Genotypic and phenotypic properties of coagulase-negative staphylococci causing dialysis catheter-related sepsis; Spare MK et al.; Sixty coagulase-negative staphylococcus (CNS) isolates were recovered from the blood cultures or peritoneal dialysate effluent of 43 patients on renal dialysis . The patients had either renal dialysis catheter-related sepsis (CRS) or continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis . Isolates were characterized by biotyping, and genotyped by pulsed-field gel electrophoresis (PFGE) . Phenotypic properties of the strains were also investigated . Several genotypes were identified with no one specific strain of CNS being associated with CRS . However, closely related strains were isolated from several patients within the units studied, suggesting horizontal transfer of micro-organisms . Genotypic macro-restriction profiles did not concur with phenotypic profiles or biotypes, confirming that genotyping is required for epidemiological studies . All staphylococcal strains were investigated for the production of phenotypic characteristics . Significant differences were predominantly seen in the production of lipase, esterase and elastase in strains isolated from the renal patients with CRS and CAPD-associated peritonitis, compared with a non-septic control group . These phenotypic characteristics may therefore have a role in the maintenance of CRS in renal patients.

Dtsch Tierarztl Wochenschr, 2003 Jul, 110(7), 295 - 8
Crowding and winter emergency feeding as predisposing factors for kerato-conjunctivitis in semi-domesticated reindeer in Norway; Aschfalk A et al.; Due to the hard environmental and climatic situation in late winter 1999, a herd of about 200 free-ranging, semi-domesticated reindeer was gathered in a paddock in northern Norway for emergency feeding . About the same number of reindeer was not corralled but supplementary fed on their winter pastures . The fodder was of relatively good quality but very dusty and fed in a very dry environment . Six weeks later, an outbreak of eye-infection was diagnosed in one third of the corralled reindeer; mild symptoms were observed in most of them, but 11 animals showed severe signs of disease . No signs of disease were found in the non-corralled animals . Ten reindeer died through emaciation, the eleventh was sacrificed . Histopathological diagnosis of two severely affected eyes revealed a severe purulent kerato-conjunctivitis with bacteria and plant particles embedded in purulent exudates on the cornea and conjunctiva . In one eye from the two most affected animals Actinomyces pyogenes, coagulase-negative Staphylococci and Escherichia coli and in the other one Staphylococcus aureus and Escherichia coli were found . The bacteria encountered in this study are not considered the primary cause of disease . They seem rather to be opportunistic infectious agents of eyes that have been irritated mechanically through exposure to dusty fodder in a dry environment . The stress through unfamiliar corralling of the reindeer, that followed an insufficient fodder supply, could be considered as an additional infection supporting factor . This case-report emphasises on the importance of different factors involved in favouring outbreaks of disease in reindeer, under intensified husbandry conditions . Even though crowding and emergency feeding may be, at certain circumstances, the only means of survival for reindeer, a negative impact of implied crowding diseases on their productivity, must be considered, as well.

Med Dosw Mikrobiol, 2003, 55(1), 1 - 10
{Therapeutic effect of some antibiotics on experimental staphylococcal infection and its correlation with in vitro activity of antibiotics in sub-inhibitory concentration against Staphylococcus aureus strains}; Kaczmarska L et al.; The aim of the study was to demonstrate of whether the therapeutic effects of antibiotics depend on their in vitro activity in sub-inhibitory concentrations against staphylococci . Cloxacillin, gentamicin and lincomycin were used in the study . Groups of S . aureus strains, containing 6 strains with similar MIC values each but different sensitivity to sub-inhibitory antibiotic concentrations (sub-MIC) were selected (a total of 36 trains): i . strains increasing their sensitivity to phagocytosis and bactericidal activity of rabbit leukocytes after incubation with an antibiotic in 0.1 MIC concentration, ii . strains with sensitivity to the above factors unaffected by incubation with an antibiotic in 0.5 MIC concentration . The doses of staphylococci causing death of 90-100% of Swiss albino mice 10 days after i.p . infection were determined . The injected doses (LD 90-100) and various doses of antibiotics were used to determine ED50 values as well as the survival rate of the mice with experimental staphylococcal infections after treatment with these antibiotics . It was demonstrated that effective doses (ED 50) of the antiboitics were significantly lower when the antibiotics were administered once to mice infected with strains S . aureus sensitive to sub-MIC concentrations of the investigated antibiotics than for mice infected with strains resistant to their sub-MIC concentrations . Similar correlations were observed in mice which were given the antibiotics several times (for 7 days): the percentage of the surviving mice was higher in the group infected with sub-MIC sensitive strains . The therapeutic effect of cloxacillin, gentamicin and lincomycin demonstrated a significant correlation with the S . aureus strains used to induce the infections and their sensitivity, or lack of sensitivity in vitro, to phagocytosis and bactericdal activity of leukocytes in the presence of antibiotics in sub-MIC concentrations.

J Dairy Sci, 2003 Jul, 86(7), 2382 - 9
Elevated milk soluble CD14 in bovine mammary glands challenged with Escherichia coli lipopolysaccharide; Lee JW et al.; The purpose of this study was to determine whether soluble CD14 (sCD14) in milk was affected by stage of lactation, milk somatic cell count (SCC), presence of bacteria, or lipopolysaccharide (LPS)-induced inflammation . Milk samples from 100 lactating cows (396 functional quarters) were assayed for sCD14 in milk to determine effects of stage of lactation, SCC, and intramammary infection . The concentration of sCD14 was highest in transitional milk (0 to 4 d postpartum) and in milk with high SCC (> 750,000 cells/ml) . Most of the infected quarters (> 80%) were infected by coagulase-negative staphylococci and yeast . No difference was found between noninfected and infected quarters . One quarter of six healthy lactating cows was challenged with 100 microg LPS in order to study the kinetics of sCD14 during an LPS-induced inflammation . Milk samples were collected at various intervals until 72 h after injection . Rectal temperature, milk tumor necrosis factor-alpha, and interleukin-8 increased immediately after challenge . The increase in sCD14 paralleled the increase in SCC, peaked at 12 h, and started to decline after 24 h . Serum leakage, as characterized by the level of bovine serum albumin in milk, peaked at 4 h and then gradually decreased . All parameters remained at basal levels in control quarters throughout the study . In vitro experiments indicated that neutrophils released sCD14 in response to LPS in a dose-dependent manner . The results indicate that the concentration of sCD14 was significantly increased in milk after LPS challenge . The increase was not likely due to serum leakage . Instead, infiltrated neutrophils might be the main source of increased sCD14 in milk during inflammation.

J Clin Microbiol, 2003 Aug, 41(8), 3942 - 4
Clinical impact of a PCR assay for identification of Staphylococcus aureus and determination of methicillin resistance directly from blood cultures; Hallin M et al.; We evaluated the clinical usefulness of a PCR assay that discriminates Staphylococcus aureus from coagulase-negative staphylococci and detects methicillin resistance on blood cultures by measuring the adaptation of antimicrobial therapy based on the PCR results . Only 7 of 28 patients (25%) benefited from a modification of antibiotic therapy based on the PCR results, since empirical therapy was appropriate in a majority of cases.

J Clin Microbiol, 2003 Aug, 41(8), 3890 - 2
Detection of methicillin-resistant Staphylococcus aureus (MRSA) in blood with the EVIGENE MRSA detection kit; Levi K et al.; A total of 200 blood cultures containing putative staphylococci were analyzed by a commercial gene probe hybridization assay (EVIGENE; Statens Serum Institut, Copenhagen, Denmark), and 18 were identified as methicillin-resistant Staphylococcus aureus (MRSA) positive . Of these, 17 were positive by PCR and 16 were positive by culture . Detailed analysis of the discrepant results showed that the EVIGENE kit allowed specific identification of MRSA in blood cultures without any of the drawbacks associated with PCR.

J Clin Microbiol, 2003 Aug, 41(8), 3609 - 14
Coagulase-negative staphylococci: comparison of phenotypic and genotypic oxacillin susceptibility tests and evaluation of the agar screening test by using different concentrations of oxacillin; Ferreira RB et al.; 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; bioMerieux 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.

J Clin Microbiol, 2003 Aug, 41(8), 3499 - 502
Evaluation of a novel medium for screening specimens from hospitalized patients to detect methicillin-resistant Staphylococcus aureus; Blanc DS et al.; A novel medium, Oxacillin Resistant Screening Agar (ORSA) medium, was evaluated for the screening of specimens for methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting . Screening swabs (swabs of the nose, throat, perineum, and infected sites) were inoculated onto the new ORSA medium and into an enrichment broth (Muller-Hinton broth supplemented with NaCl and oxacillin) . After 24 h of incubation, the enrichment broth was subcultured onto one ORSA plate and one lipovitellin Chapman salt agar plate . The sensitivities for the detection of MRSA were calculated for each medium alone and for the media in combination . A low sensitivity (74%) was obtained when ORSA medium was used alone as a primary culture, whereas the sensitivity was 88% when a single selective enrichment broth was used . Among the 414 blue colonies observed on ORSA plates, only 47% were found to be MRSA, 40% were coagulase-negative staphylococci, 7% were Enterococcus species, and 2% were methicillin-sensitive S . aureus . The optimal incubation time for the ORSA plates was evaluated . On primary culture, 38% of the blue MRSA colonies were visible only after 48 h of incubation (no blue colonies were not seen after 24 h of incubation), whereas 94% of the colonies were already visible at 24 h when ORSA plates were used for subcultures . In conclusion, the advantage of the novel ORSA medium is the ease of recognition of mannitol-fermenting bacteria, but further identification tests are needed to confirm the identification of S . aureus . An enrichment broth is still needed to ensure a good sensitivity for the recovery of MRSA, and an incubation time of 48 h is required for primary culture on ORSA medium.

Biomaterials, 2003 Aug, 24(18), 3013 - 9
Staphylococcus epidermidis-fibronectin binding and its inhibition by heparin; Arciola CR et al.; Staphylococcus epidermidis is able to adhere onto biomaterials and to cause implant infections . Recently, host matrix proteins, which in vivo cover the implants, have been indicated as substrates for adhesion by specific bacterial adhesins . Here, the binding of S . epidermidis to fibronectin, a main protein of the extracellular matrix, and the effect of heparin on this interaction were studied by dynamic force spectroscopy (DFS) . Novelties are that S . epidermidis strains analysed by DFS were clinical isolates from prosthesis-associated infections, genotyped and phenotyped for their adhesion properties to fibronectin and examined as living cells . Thus, fibronectin-binding staphylococci adhered to the fibronectin-coated substratum and formed a continuous layer assuring their contact with the fibronectin-coated cantilever tip during the approach-retraction cycles of the DFS measurements . Results show that only a single molecular binding site of fibronectin is involved in the interaction with S . epidermidis, that it takes place at the domain near the C-terminus and that it is specifically inhibited by heparin.

Mol Microbiol, 2003 Aug, 49(4), 919 - 27
Biphasic intracellular expression of Staphylococcus aureus virulence factors and evidence for Agr-mediated diffusion sensing; Shompole S et al.; Staphylococcus aureus invades a variety of mammalian cells and escapes from the endosome to multiply in the cytoplasm . We had previously hypothesized that the molecular events leading to escape of S . aureus from the endosome involved the Agr virulence factor regulatory system . In this report we demonstrate that temporal changes in intracellular activation of the Agr regulon correlates with expression of membrane active toxins . Also, the initial expression of Agr by even small numbers of staphylococci resulted in the permeabilization of the endosomal membrane and the eventual escape of bacteria into the cytoplasm by 3 h post invasion . After Agr downregulation, a second peak of expression coincided with increased permeability of the host cell membrane . In contrast to the parental strain, an Agr-mutant was unable to escape into the cytoplasm and was observed in intact endosomes as late as 5 h post invasion . These data provide evidence that staphylococcal virulence factor production during invasion of host cells is mediated by an Agr-dependent process that is most accurately described in the context of diffusion sensing.

Lik Sprava, 2003 Apr-Jun, (3-4), 90 - 2
{Species affiliation of staphylococci isolated in purulent infections.}; Nuruzova ZA et al.; The microflora was studied of the clinical material taken from those patients presenting with different pyo-septic diseases . It has been ascertained that a key role in the etiology of the above diseases must be referred to gramme-positive micro-organisms--to coagulase-negative staphylococci among their number . Of these, S . haemolyticus and S . epidermidis were found with high frequency.

Lik Sprava, 2003 Apr-Jun, (3-4), 72 - 4
{Treatment of patients with acute pneumonia}; Toropchin VI et al.; Efficiency was studied of treatment of acute pneumonia (AP) in 148 patients with a focal croupous form . In the grave course of AP, antibacterial therapy with benzilpenicillin combined with sulphanilamide agents biseptol and nitrofuran was tried, the correcting therapy having been instituted on obtaining findings from assays of the sputum for sensitivity of the microflora to antibiotics . In those cases with Friendlander's bacilli recoverable, methicillin, oxacillin, macrolids, cephalosporins and some other agents were antibiotics of choice . Administered in the atypical course that was related more frequently to mycoplasms or chlamidia, was erythromycin phosphate i.v., lincomycin . In Staphylococcus-associated pneumonia, there have been used antibiotics resistant to penicillinases and endowed with an inhibitory activity toward staphylococci--oxacillin, methicillin, cephalosporins, chlorophenicols or chlorophphyllipt i.v . combined with an antistaphylacoccal plasma, antistaphylococcal gammaglobulin or hyperimmune plasma . The following drugs were prescribed to ensure bronchial patency and liquefaction of the sputum--euphyllin, mucalthin, bromhexin, lasolvan that are known to stimulate production of sulfoctant . The therapeutic complex comprized fibs, aloe, apilac, prodigiosan, solcoseryl, methyluracil known to stimulate bodily reactivity and resolution of inflammatory infiltration, nicotinic acid, heparin that have been shown to improve micorcirculation, tocopherol, unithiol known to regulate lipid oxidation . The data secured suggest to us a sufficient efficacy of the above-outlined therapy of AP.

Zh Mikrobiol Epidemiol Immunobiol, 2003 May-Jun, (3), 99 - 109
{Molecular epidemiology of infections caused by methicillin-resistant staphylococci}; Shaginian IA et al.; The review deals with the periodicity of the spread of methicillin-resistant S . aureus (MRSA) strains during the last 40 years, the mechanism of their resistance to methicillin and other beta-lactamic antibiotics, the genetic control of methicillin resistance, the genome organization of mec DNA and its possible cause, as well as the organization of epidemiological surveillance on MSRA in hospitals . The problem of changes in the epidemiology of staphylococcal infections due to the appearance of MRSA in the absence of contacts with carriers, treatment with antibiotics or stay in a hospital is discussed . The concern of public health authorities in connection with the emergence of MRSA strains, moderately resistant or resistant to vancomycin, is also discussed . The most promising programs of the MRSA study, as well as the optimum programs introduced in economically developed counties for the control of hospital infections caused by MRSA, are considered.

Circulation, 2003 Aug 12, 108(6), 767 - 71 Epub 2003 Jul 28.
Prophylactic efficacy of topical temporin A and RNAIII-inhibiting peptide in a subcutaneous rat Pouch model of graft infection attributable to staphylococci with intermediate resistance to glycopeptides; Cirioni O et al.; BACKGROUND: Bacteria that adhere to implanted medical devices play an important role in industry and in modern medicine . Staphylococci are among the most common pathogens that cause biomaterial infections . Vascular prosthetic graft infection is one of the most feared complications that the vascular surgeon treats, frequently resulting in prolonged hospitalization, organ failure, amputation, and death . A rat model was used to investigate the topical efficacies of temporin A and the quorum-sensing inhibitor RNAIII-inhibiting protein (RIP) as prophylactic agents of vascular prosthetic graft infections caused by Staphylococcus aureus and Staphylococcus epidermidis with intermediate resistance to glycopeptides . METHODS AND RESULTS: Graft infections were established in the back subcutaneous tissue of adult male Wistar rats by implantation of Dacron prostheses 1 cm2 followed by topical inoculation with 2x10(7) colony-forming units of bacterial strains . The study included, for each staphylococcal strain, a control group (no graft contamination), a contaminated group that did not receive antibiotic prophylaxis, and 6 contaminated groups that received grafts soaked with temporin A, RIP, rifampin, temporin A plus RIP, RIP plus rifampin, or temporin A plus RIP . The infection was evaluated by quantitative agar culture . When tested alone, temporin A and RIP showed comparable efficacies, and their efficacies were significantly higher than that of rifampin against both strains . All combinations showed efficacies significantly higher than that of each single compound . The combinations of temporin A and RIP exerted the strongest antistaphylococcal efficacies, eliminating infection by 100% . CONCLUSIONS: The results of the present study make these molecules potentially useful for antimicrobial chemoprophylaxis in vascular surgery.

Aviakosm Ekolog Med, 2003, 37(3), 28 - 31
{Effects of high-pressure argon-containing gaseous compositions on operators' rhinopharynx and external ear microflora and its reactivity to antibiotics}; Solov'eva ZO et al.; Earlier investigations revealed an important microbiological feature of the human in hyperbaric environment--linear progressive unbalance in the opportunistic and commensal ratio within the main biotopes . Change in the gaseous environment may influence the activity of infectious agents . Purpose of our investigation was to study effects of argon-containing gaseous compositions on the rhinopharynx and external ear microflora in operators, and its reactivity to antibiotics . Attempted was quantification of the operators' aerobic microflora exposed for 6, 7 and 18 days to argon-containing gaseous compositions (normoxic and hypoxic) under an elevated pressure (0.15-0.5 MPa) . Evaluated was also susceptibility of the human microflora to antibiotics of the basic chemical classes under these conditions . The argon-containing gaseous compositions in the above pressure range did not have any specific effects on the ratio of aerobic gram-negative bacilli and staphylococci; neither they created selective advantages to any of the groups of microorganisms under study . It was found additionally that long-duration exposure in the argon-containing gaseous environment (6, 7 and 18 days) gave rise to cultures with the signs of hospitalism (e.g., high index of multiple drug resistance) . Potentiality of infection development in dwelling modules with argon-containing gaseous environment and proliferation of polyresistant strains point to the necessity to design a respective preventive system.

Environ Microbiol, 2003 Aug, 5(8), 711 - 6
Impact of antibiotics on conjugational resistance gene transfer in Staphylococcus aureus in sewage; Ohlsen K et al.; The growing rate of microbial pathogens becoming resistant to standard antibiotics is an important threat to public health . In order to assess the role of antibiotics in the environment on the spread of resistance factors, the impact of subinhibitory concentrations of antibiotics in sewage on gene transfer was investigated using conjugative gentamicin resistance (aacA-aphD) plasmids of Staphylococcus aureus . Furthermore, the concentration of antibiotics in hospital sewage was measured by high-performance liquid chromatography (HPLC)-electrospray tandem mass spectrometry . Several antibiotics were found to be present in sewage, e.g . ciprofloxacin up to 0.051 mgl(-1) and erythromycin up to 0.027 mgl(-1) . Resistance plasmid transfer occurred both on solidified (dewatered) sewage and in liquid sewage in a bioreactor with a frequency of 1.1x10(-5)-5.0x10(-8) . However, low-level concentrations of antibiotics measured in sewage are below concentrations that can increase plasmid transfer frequencies of gentamicin resistance plasmids of staphylococci.

Transfusion, 2003 Aug, 43(8), 1047 - 52
Estimation of bacterial risk in extending the shelf life of PLT concentrates from 5 to 7 days; Lee CK et al.; BACKGROUND: The use of bacterial culture to prevent bacterial contamination of blood components has renewed interest for extending the shelf life of PLT concentrates to 7 days after collection . STUDY DESIGN AND METHODS: This study was therefore conducted to determine the residual risk of bacterial contamination in PLT concentrates at the end of 5 and 7 days after collection in a center where all PLT concentrates are routinely screened by taking samples on Day 2 for culture . PLT units with no growth after 48 hours were sampled a second time on Day 5 or Day 7 after collection, followed by inoculation into aerobic culture bottles . The inoculated bottles were then monitored for up to 7 days at 35 degrees C in an automatic monitoring and detection system . RESULTS: During a 16-month study period, a total of 6020 PLT concentrates were tested 5 days (Group A, n=3010) and 7 days (Group B, n=3010) after collection . Four units in each group (0.133%) were found to be contaminated . In 6 units, bacteria were seen on direct Gram stain . In addition, 5 of the associated RBC units grew the same organisms on culture . The organisms include three coagulase-negative staphylococci and five Propionibacterium acnes . The positive rate of routine short-term bacterial culture was 0.035 percent during the same study period . CONCLUSION: Despite routine short-term bacterial culture, a significant risk of bacterial contamination remains at 5 and 7 days after collection . For now, the shelf life of PLT concentrates should remain 5 days.

Curr Infect Dis Rep, 2003 Aug, 5(4), 293 - 299
Infective Endocarditis in Patients with Kidney Failure: Chronic Dialysis and Kidney Transplant; Ireland JH et al.; Physicians who treat patients with infective endocarditis (IE) are encountering a growing number of dialysis and kidney transplant patients . Both groups have 30 to 100 times higher risk of IE, with 1-year mortalities of 40% to 60% . The predominant organisms causing IE are gram positive, with 60% to 80% of cases due to Staphylococcus aureus, and another 10% to 20% of cases due to coagulase-negative staphylococci . Renal transplant patients may develop fungal IE, but this risk is primarily in the first 3 months after transplant . In addition to blood cultures, transesophageal echocardiogram is the most useful diagnostic examination for IE in these patients . Initial antibiotic therapy, pending final culture and antibiotic susceptibility results, should provide coverage against the most common organisms and allow for the potential of either methicillin or vancomycin-resistant species . Removal of infected hemodialysis access devices and at least 4 to 6 weeks of intravenous antibiotics are recommended . Antibiotic prophylaxis against IE has been recommended for all dialysis and renal transplant patients, but this strategy is controversial and unproven.

Br J Biomed Sci, 2003, 60(2), 71 - 4
Screening for methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci: an evaluation of three selective media and Mastalex-MRSA latex agglutination; Bowers KM et al.; Laboratory confirmation of MRSA is important for the implementation of infection control; conventional screening culture methods take up to five days for confirmation . The purpose of this study is to ascertain the efficiency of three selective media for growth of methicillin-resistant Staphylococcus aureus (MRSA) before and after enrichment in salt broth, and to evaluate the Mastalex-MRSA latex agglutination kit for detection of methicillin resistance . Screening swabs were collected from 63 patients, yielding 125 S . aureus isolates and 40 coagulase-negative staphylococcus (CNS) isolates . Selective media used were mannitol salt agar (MSA), Baird-Parker agar with ciprofloxacin (BPC) and bromocresol purple (BCPA) . Polymerase chain reaction (PCR) for mecA gene detection was used as the reference standard for evaluation of the Mastalex-MRSA assay, which was also evaluated on colonies of S . aureus from the selective media . No significant difference was found in efficiency of MRSA isolation among the selective media . Pre-enrichment in the salt broth did not enhance isolation of MRSA . Methicillin-sensitive S . aureus and CNS were significantly inhibited in all selective media (P<0.05) . Only BPC significantly selected out methicillin-resistant CNS (P<0.01) . Mastalex-MRSA was 97% specific and sensitive for the detection of MRSA . It was 65% sensitive and 100% specific in detecting methicillin resistance in CNS . In conclusion, all selective media performed equally well (MRSA isolation rate of approximately 80%) . Mastalex-MRSA provided rapid and reliable detection of MRSA from selective media, reducing the time required for confirmation of this organism.

Nahrung, 2003 Jun, 47(3), 166 - 70
Differentiation of toxigenic Staphylococcus aureus in staphylococcal isolates from prepared and frozen foods by combined arbitrarily primed polymerase chain reaction and DNA probe; Cordoba MG et al.; In prepared and frozen flamenquin and hake fish fingers Staphylococcus aureus as sanitary hazards have been detected . In the present work, a combined method that includes an arbitrarily primed PCR (AP-PCR) and a mixed DNA probe hybridisation designed for the enterotoxigenic genes sea, seb, sec, and sed will be assayed to differentiate enterotoxigenic S . aureus from other staphylococcal species isolated during the processing of prepared and frozen foods . From the protocols tested for the AP-PCR, the highest number of amplification bands showing the best resolution was achieved at 30 degrees C annealing and 35 degrees C extension temperatures . Several staphylococci identified by a biochemical test as S . aureus showed in the AP-PCR analysis different banding patterns to the references S . aureus . The isolates, were investigated by slot blot hybridisation for genes encoding A, B, C, and D staphylococcal enterotoxins to determine their enterotoxigenic potential . Several isolates characterised by the AP-PCR analysis as S . aureus hybridised with the DNA probe mixture . The combined AP-PCR and DNA probe hybridisation assayed was able to differentiate toxigenic S . aureus from other staphylococcal species from prepared and frozen foods . This method could be considered as microbial quality assurance in these products.

J Antimicrob Chemother, 2003 Aug, 52(2), 258 - 63 Epub 2003 Jul 15.
Fitness of antibiotic resistant Staphylococcus epidermidis assessed by competition on the skin of human volunteers; Gustafsson I et al.; BACKGROUND: Antibiotic resistance typically confers a biological fitness cost on bacteria that can be manifested as a decreased growth rate in culture media and experimental animals . However, there are limited experimental data on the relative fitness of resistant and susceptible bacteria during growth in their natural environment . OBJECTIVE: We have developed a human competition model to investigate the relative fitness of antibiotic-resistant and -susceptible bacteria . MATERIALS AND METHODS: A non-epidemic Staphylococcus epidermidis strain was isolated from skin, and a rifampicin-resistant (RifR) clone was selected . The RifR marker was used to distinguish the inoculated strains from the resident population of coagulase-negative staphylococci . The RifR strains were further selected for resistance to ciprofloxacin (CipR) and fusidic acid (FusR) . A 1:1 mix of susceptible and resistant bacteria was applied on the forearms of 12 volunteers . Competition was monitored by sampling bacteria from skin and determining their relative numbers . RESULTS: Resistance to ciprofloxacin due to parC mutations did not decrease the growth rate in vitro, and the CipR/CipS ratio was close to 1 during day 1 and 3 in the in vivo competition experiments . In contrast, fusidic acid resistance due to fusA mutations resulted in a decrease in the growth rate in vitro and a considerable loss of fitness in the competition . The FusR/FusS ratio diminished from 1.3 to 0.023 in 3 days . CONCLUSIONS: These data show that human volunteers can be used as a simple and relevant model to study the biological cost of resistance.

East Afr Med J, 2000 Jul, 77(7), 386 - 90
Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi; Mwang'ombe NJ et al.; OBJECTIVE: To study infections complicating ventriculoperitoneal (VP) shunt surgery in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi . DESIGN: A retrospective survey . SETTING: Kenyatta National Hospital, Nairobi between January 1982 and December 1991 . SUBJECTS: Three hundred and forty five patients who underwent V-P shunt placement for non-tumour hydrocephalus . RESULTS: Three hundred and forty five patients underwent V-P shunt placement for non-tumour hydrocephalus . There were 107 infection episodes involving 85 patients . The ages of these patients ranged from three months to 12 years . Most of the patients had congenital hydrocephalus . The infection rate was high (24.6%) although comparable to infection rates reported for clean surgery in the hospital . Fever, septic wounds and features of shunt malfunction were the main presenting features . Bacteriological studies confirmed Staphylococcus aureus and coagulase negative staphylococci as the two most commonly isolated micro-organisms . CONCLUSION: This study emphasises need to reduce infection rate in ventriculoperitoneal shunt surgery at the Kenyatta National Hospital . Definitive surgical treatment for hydrocephalus was in most cases delayed and this problem was also observed during revision of infected shunts . Late presentation was often due to ignorance and the fact that many patients went for traditional forms of treatment first before going to hospital.

Microbes Infect, 2003 Jul, 5(9), 775 - 80
The role of Staphylococcus aureus sortase A and sortase B in murine arthritis; Jonsson IM et al.; Gram-positive pathogenic bacteria display proteins on their surface that play important roles during infection . In Staphylococcus aureus, these surface proteins are anchored to the cell wall by two sortase enzymes, SrtA and SrtB, that recognize specific surface protein sorting signals . The role of sortase enzymes in bacterial virulence was examined using a murine septic arthritis model . Intravenous inoculation with any of the Delta(srtA), Delta(srtB) or Delta(srtAB) mutants resulted in significantly increased survival and significantly lower weight loss compared with the parental strain . Mice inoculated with the Delta(srtA) mutant did not express severe arthritis, while arthritis in mice inoculated with the Delta(srtB) mutant was not different from that seen in mice that were infected with the wild-type parent strain . Furthermore, persistence of staphylococci in kidneys and joints following intravenous inoculation of mice was more pronounced for wild-type and Delta(srtB) mutant strains than for Delta(srtA) or Delta(srtAB) variants . Together these results indicate that sortase B (srtB) plays a contributing role during the pathogenesis of staphylococcal infections, whereas sortase A (srtA) is an essential virulence factor for the establishment of septic arthritis.

Echocardiography, 2003 Apr, 20(3), 289 - 90
Role of transesophageal echocardiography in detecting implantable cardioverter defibrillator lead infection; Wasson S et al.; Implantable cardioverter defibrillator (ICD) lead infection is a rare condition with reported incidence of 0.2% to 16% . It usually presents with persistent bacteremia or fever of unknown origin and requires high clinical suspicion for diagnosis . Whenever ICD lead infection is suspected, transesophageal echocardiography is the diagnostic technique of choice for detection and characterization of the lesions . Lead infections are extremely difficult to manage conservatively and surgical removal of the entire defibrillator system is recommended along with antimicrobial therapy . We describe a case of recurrent staphylococci bacteremia due to an ICD lead infection in a patient with arrhythmogenic right ventricular dysplasia.

Eur J Clin Microbiol Infect Dis, 2003 Aug, 22(8), 489 - 91 Epub 2003 Jul 04.
Staphylococcus lugdunensis endocarditis--the hidden peril of coagulase-negative staphylococcus in blood cultures; Seenivasan MH et al.; Reported here is a successfully treated case of native mitral valve endocarditis caused by Staphylococcus lugdunensis and a review of 47 similar cases reported in the English literature . In the literature review, perineal skin flora appeared to be the source of the organism in patients with endocarditis . Staphylococcus lugdunensis is generally susceptible in vitro to beta-lactam agents . If speciation is not performed, these bacteria might be mistaken for Staphylococcus epidermidis, a relatively avirulent bacterium that is a common contaminant of cultures . Prompt speciation can lead to earlier recognition of endocarditis and possibly enable earlier surgical intervention with improved outcome for this high-mortality infection . Multiple positive blood cultures yielding coagulase-negative staphylococci should be identified to the species level; endocarditis or another intravascular source of infection should be sought.

Infez Med, 1997, 5(4), 214 - 29
{Antimicrobial prophylaxis in clean surgery}; de Lalla F; Antibiotic prophylaxis in clean surgery is generally not required except for prosthetic cardiac, vascular and orthopedic surgery . In these cases, the cephalosporins mostly active against staphylococci such as cefazolin, cefuroxime and cefamandole or antistaphylococcal penicillins, such as oxacillin, associated or not with aminoglycosides, are recommended . The progressive increase of methicillin-resistant staphylococci has led to use for the above mentioned surgeries also glycopeptides, especially in those wards where methicillin resistance is particularly high . Nevertheless, not enough many prospective-controlled studies have been carried on to evaluate whether glycopeptides reduce the risk of post-surgical infections, more than other conventional antibiotic regimens . Further, the possible risk of selecting glycopeptide-resistant enterococci suggests that prophylactic use of glycopeptides should be limited and a minimal number of doses should be administered, favouring whenever possible, the ultra short term prophylaxis (single dose).

Ann Hematol, 2003 Aug, 82(8), 526 - 8 Epub 2003 Jul 03.
Henoch-Schönlein IgA glomerulonephritis complicating myeloma kidneys: case report; Arrizabalaga P et al.; Myeloma kidney is the principal pathological substrate of rapidly progressive renal failure in multiple myeloma . We report the unusual case of a 72-year-old male diagnosed with kappa Bence Jones myeloma with renal failure which needed dialysis . After treatment with vincristine, doxorubicin (Adriamycin), dexamethasone (VAD), and plasmapheresis, the renal function was recovered until serum creatinine level was <2 mg/dl . Six months later, the pathological counterpart of rapidly progressive renal failure was crescentic IgA proliferative glomerulonephritis as a manifestation of Henoch-Schonlein syndrome associated with sepsis caused by coagulase-negative staphylococci . This case suggests that mesangial IgA deposition should be considered within the spectrum of consequent glomerular lesion-associated chemotherapy occurring in multiple myeloma.

Mikrobiyol Bul, 2002 Jul-Oct, 36(3-4), 253 - 7
{Comparison of methods used to detect methicillin resistance in staphylococci}; Kuzucu C et al.; In this study, the methicillin resistance of 112 Staphylococcus aureus and 93 coagulase negative Staphylococcus (CNS) strains, which were initially found methicillin resistant by routine disk diffusion method in our laboratory, have been searched by microdilution and oxacillin agar screen test and the results were compared with the results obtained by disk diffusion method . The presence of mecA gene was investigated by polymerase chain reaction in case of discordant results . All S . aureus strains (100%) and 69.9% (65/93) of CNS strains were found resistant to methicillin by three of the methods . Of CNS isolates, 28 strains which were found methicillin resistant by disk diffusion method, were found methicillin susceptible by oxacillin agar screen method, and 27 of these were detected as mecA positive . Our results indicated that, the three methods tested were reliable for the detection of methicillin resistance in S . aureus strains, but oxacillin agar screen revealed to be unsatisfactory for the detection of methicillin resistance in CNS.

Pediatr Int, 2003 Jun, 45(3), 301 - 6
Efficacy and safety of arbekacin for staphylococcal infection in the NICU; Suzuki K; BACKGROUND: This is a retrospective study on the efficacy and safety of arbekacin (ABK), an aminoglycoside antibiotic, for acquired staphylococcal infection in the neonatal intensive care nursery . PATIENTS AND METHODS: Subjects were 29 infants treated with ABK in a tertiary care neonatal center . They were 23-39 (median 28) weeks' gestation, 530-3334 (median 930) grams at birth, and 3-157 (median 17) days of age . Diagnosis of staphylococcal infection was made by clinical signs and laboratory findings . Sensitivity of the isolated organisms to ABK was tested by the microliquid dilution method . Serum ABK level was monitored to achieve the therapeutic range during the treatment . Effectiveness was defined by improving clinical signs and laboratory findings within 3 days . Effectiveness was studied in relation to type of infection and other antibiotics administered . Auditory brainstem response and serum creatinine changes were studied for ototoxicity and nephrotoxicity assessment, respectively . RESULTS: Twenty-seven (93.1%) cases of infection were attributed to methicillin-resistant Staphylococcus aureus (MRSA) and two (6.9%) were attributed to coagulase-negative staphylococci (CNS) . The rate of in vitro sensitivity to ABK was 85.2% for MRSA and 100.0% for CNS . The overall clinical effeciveness rate was 79.3% (23/29) with no difference associated with types of infection . Combination of ABK with sulbactam/ampicillin showed greater effectiveness (100.0%) than with other antibiotics (64.3%) (P < 0.05) . There was no abnormal auditory brainstem response or serum creatinine change associated with ABK treatment . CONCLUSION: ABK is an effective and safe antibiotic for the treatment of acquired staphylococcal infection in the neonatal intensive care nursery.

Pediatr Infect Dis J, 2003 Jun, 22(6), 572 - 3
Primary osteomyelitis and suppurative arthritis caused by coagulase-negative staphylococci in a preterm neonate; Eggink BH et al.; Coagulase-negative staphylococci are a major cause of nosocomial infections in neonatal intensive care unit patients . These infections are usually related to the presence of intravascular devices . An 1175-g preterm neonate developed primary osteomyelitis and septic arthritis by coagulase-negative staphylococci in the absence of any indwelling central catheters.

Prescrire Int, 2003 Jun, 12(65), 108 - 9
Acute otitis media in adults: many unknowns.
{Antimicrobial activity of fosfomycin against beta-lactamase-producing methicillin-sensitive Staphylococcus aureus and methicillin-sensitive coagulase-negative staphylococci}
Hara T, Araake M, Tsuruoka T, Watabe H.

Pharmaceutical Research Center, Meiji Seika Kaisha, Ltd., 760 Morooka-cho, Kohoku-ku, Yokohama, Kanagawa, 222-8567, JapanAntimicrobial activity of fosfomycin (FOM), cefazolin (CEZ), cefmetazole (CMZ), cefotiam (CTM) and piperacillin (PIPC) against clinical isolates of methicillin-sensitive Staphylococcus aureus (MSSA) (beta-lactamase-producing or non-producing) and methicillin-sensitive coagulase-negative Staphylococci (MSCNS) (beta-lactamase-producing or non-producing) were determined to make clear the differences in antimicrobial activity of FOM and beta-lactam antibiotics . The antimicrobial activity of PIPC against beta-lactamase-producing strains of MSSA was lower than that against non-producing ones, judging from the distribution patterns of susceptibility of the strains to PIPC . There were no differences in the antimicrobial activity of FOM, CEZ and CMZ for the producing and non-producing strains . The activity of FOM against MSCNS was comparable to that against MSSA, although those of CEZ, CMZ, CTM and PIPC were decreased . FOM, CEZ, CMZ and CTM showed bactericidal activity against TH4278 (MIC {microgram/ml}: FOM, 1; CEZ, 0.5; CMZ, 1; CTM, 0.5; PIPC, 1) of beta-lactamase-producing MSSA at 1 microgram/ml for 6 h, but PIPC did not at the same condition . FOM and CMZ at MIC suppressed regrowth of the strain, but CEZ, CTM and PIPC did not . In conclusion, FOM, which is not affected by beta-lactamase, demonstrated strong bactericidal activity at low concentration against the beta-lactam-resistant strains due to beta-lactamase production.

Arch Pathol Lab Med, 2003 Jul, 127(7), 845 - 9
Development and validation of a molecular beacon probe-based real-time polymerase chain reaction assay for rapid detection of methicillin resistance in Staphylococcus aureus; Elsayed S et al.; CONTEXT: A rapid, real-time, duplex, fluorescent molecular beacon probe-based polymerase chain reaction (PCR) assay was recently developed for the detection of methicillin-resistant Staphylococcus aureus . OBJECTIVE: To describe the development and validation of this unique assay . DESIGN: Prospective laboratory analysis . SETTING: Urban health region/centralized diagnostic microbiology laboratory . BACTERIAL STRAINS: One hundred eighty-one previously characterized clinical and American Type Culture Collection isolates, including 50 strains each of methicillin-resistant and methicillin-sensitive S aureus, plus 50 strains of coagulase-negative staphylococci and 31 nonstaphylococcal isolates to ensure assay specificity . INTERVENTION: Assays were performed on purified genomic DNA extracted from growing bacterial colonies . Two sets of oligonucleotide primers were used to specifically amplify the mecA and nuc genes, followed by detection of amplicons using fluorophore-labeled molecular beacon probes . Assays were performed on the Mx4000 Multiplex Quantitative PCR System (Stratagene Inc, La Jolla, Calif) . MAIN OUTCOME MEASURES: (1) Assay sensitivity and specificity, and (2) analytical sensitivity . RESULTS: The assay demonstrated 100% sensitivity and 100% specificity, and accurately characterized isolates as methicillin-resistant S aureus, methicillin-sensitive S aureus, or methicillin-resistant coagulase-negative staphylococci, with test results available in 2.5 hours . The analytical sensitivity of the assay was determined to be between 6 and 60 genomic equivalents . CONCLUSIONS: This assay is rapid, accurate, easy to perform, and is compatible with other real-time PCR instruments, making it a suitable alternative to conventional PCR methodologies.

Chemotherapy, 2003 Jun, 49(3), 105 - 20
The art of fusion: from penams and cephems to penems; Dalhoff A et al.; This synopsis of published literature summarises the key chemical and bacteriological characteristics of penicillins, i.e . penams, cephalosporins, i.e . cephems, and their hybrid structure, i.e . the penems . Consequently, the antibacterial spectrum of a typical penem, e.g . faropenem, encompasses gram-positive as well as gram-negative species . Dependent from the substituents at position 1 of the five-membered saturated ring fused to the beta-lactam ring oxa-, carba-, or thiopenems can be differentiated . A major determinant of their antibacterial activity and CNS-excitatory potential, however, is the C-2 side chain . The excitatory potential correlates with the basicity of the C-2 side chain as does their antibacterial activity against gram-negative species and non-fermenters like P . aeruginosa . Lipophilicity is a determinant for good in vitro activity against gram-positive bacteria . Several investigational penems exhibit interesting antibacterial spectra, encompassing methicillin resistant staphylococci, enterococci and even P . aeruginosa due to their improved binding affinity to both wild-type and modified low-affinity penicillin binding proteins . The development of these agents may offer therapeutic alternatives for the management of infections .

Diagn Microbiol Infect Dis, 2003 Jun, 46(2), 139 - 45
Detection of mutations in quinolone resistance-determining regions in levofloxacin- and methicillin-resistant Staphylococcus aureus: effects of the mutations on fluoroquinolone MICs; Horii T et al.; The minimum inhibitory concentrations (MICs) of 18 antibiotics were determined for 66 clinical isolates of staphylococci . Genotypes, mutations in the quinolone resistance-determining regions (QRDRs), and effect of efflux were determined in the 18 levofloxacin-resistant isolates, for which the MICs of levofloxacin were high (> or =8 microg/ml) . The increased levofloxacin resistance mainly resulted from some combinations of mutations in the QRDRs, although NorA-mediated efflux may play a minor role in resistance . A combination of mutations in GrlA (Ser80Phe), GrlB (Pro451Ser), and GyrA (Ser84Leu) was found in 4 methicillin-resistant Staphylococcus aureus (MRSA) isolates that were unrelated genotypically . The mutations in grlA QRDR varied in the isolates classified as being in an identical pulsed-field gel electrophoresis (PFGE) group, although the grlB, gyrA, and gyrB QRDRs were the same . These results suggest that the patterns of amino acid mutations in the QRDRs can provide distinct epidemiologic information from PFGE genotypes in fluoroquinolone-resistant MRSA . A combination of at least three mutations in GrlA, GrlB, and/or GyrA is required to increase the MICs of fluoroquinolones, although all of the levofloxacin-resistant MRSA retained the MICs of sitafloxacin in the range of 1 to 2 microg/ml.

J Dairy Res, 2003 May, 70(2), 157 - 64
Dynamics of experimentally induced Staphylococcus epidermidis mastitis in East Friesian milk ewes; Winter P et al.; The responses of five lactating East Friesian milk ewes to experimental mammary infection with Staphylococcus epidermidis and of five control ewes were examined over a period of 10 weeks . Infection caused an influx of neutrophils into milk, the numbers of which started to rise 4 h post infection and peaked 24 h after infection . The initial response was accompanied by mild fever and mild leucopaenia in blood (8 h after infection) . No other signs of systemic infection were observed . Milk appeared normal at all times, although the milk yield of infected ewes tended to decline . Staphylococci were absent in milk from four ewes at 2 d and at 3 d after infection, but re-emerged intermittently in four of five ewes at subsequent samplings . Cytokines in milk were measured by ELISA . IL-8 was elevated in infected glands at 2 h and peaked at 8 h . In the four ewes intermittently shedding bacteria, IL-8 remained elevated until the final sampling at 10 weeks . IL-1beta was transiently elevated at 1 d and 2 d and showed a pronounced peak in one sheep . Milk samples from this ewe were bacteriologically negative, somatic cell count (SCC) was within the normal range and the concentrations of IL-1beta, as well as IL-8, were similiar to the control group (n=5) from 1 week after infection until the final sampling . Histological examination revealed leucocytic infiltrates in the four glands remaining infected at the end of the experiment, and a high level of CD5+ lymphocytes in three ewes . The results suggest that the relationship between the initial neutrophil influx and the proinflammatory cytokines may be responsible for determining the course of infection . Subclinical mastitis due to coagulase-negative staphylococci leads to minor changes in milk yield and milk constituents.

Folia Microbiol (Praha), 2003, 48(2), 249 - 52
Effect of vaccination therapy for acne, using a staphylococci antigenic complex in combination with clindamycin; Jautova J et al.; A group of 46 patients with acne vulgaris were prescribed clindamycin in combination with a vaccination therapy using a staphylococci antigenic complex (Polystafana; Sevapharma, Czechia) . Acne papulopustulosa was diagnosed in 36 patients and acne indurata in 10 patients . The clinical effect of clindamycin and Polystafana was determined on the basis of the regression of the inflammatory manifestation of acne: regression by 0-30% was considered unsuccessful, by 30-80% satisfactory, and above 80% excellent; the immunomodulation effect of the treatment was evaluated in parallel . The clinical effect was excellent in 21 patients with acne papulopustulosa and in 6 with acne indurata; it was accompanied by pronounced immunomodulation effect as both cellular and humoral immunity was also tended to return to normal values . A satisfactory clinical effect was observed in 15 patients with acne papulopustulosa, whose cellular immunity component was also stimulated . Only 4 patients with acne indurata failed to respond successfully . These were the patients who showed a pronounced deficit of the cellular immunity component persisting even after the treatment . The administration of clindamycin in combination with Polystafana vaccination can be recommended as an effective means for the treatment of acne vulgaris.

J Clin Microbiol, 2003 Jun, 41(6), 2444 - 7
Infection of a ventriculoatrial shunt with phenotypically variable Staphylococcus epidermidis masquerading as polymicrobial bacteremia due to various coagulase-negative Staphylococci and Kocuria varians; Ben-Ami R et al.; The diagnosis of bloodstream infection with coagulase-negative staphylococci is frequently based on the isolation of the same organism from more than one blood culture . Phenotypic variation is a common characteristic of pathogenic strains of Staphylococcus epidermidis which may affect species identification by the microbiology laboratory . We describe a patient with a new onset of nephritis and gram-positive bacteremia . Gram-positive cocci grew in multiple blood cultures and were identified by the Vitek 2 system as Kocuria varians, Staphylococcus hyicus, and S . epidermidis . Bacterial isolates grew on blood agar and Congo red agar plates as two distinct morphotypes and exhibited phenotypic variation . Neither morphotype could be identified by the API-Staph assay . Cellular fatty acid analysis identified one of the morphotypes as S . epidermidis but could not identify the other morphotype . All isolates were found to be identical by pulsed-field gel electrophoresis, and both colonial morphotypes were identified as S . epidermidis by 16S ribosomal gene sequencing . Phenotypic variation of S . epidermidis may affect identification to the species level by phenotype-based identification systems . Caution should be exercised when differentiating between true infection and contamination based on strain identification.

J Clin Microbiol, 2003 Jun, 41(6), 2391 - 4
Controlled clinical comparison of BacT/ALERT standard aerobic medium with BACTEC standard aerobic medium for culturing blood; Mirrett S et al.; Standard aerobic media are widely used for culturing blood with the BacT/ALERT (BioMerieux, Inc., Durham, N.C.) (BM) and BACTEC 9240 (BD Diagnostic Systems, Sparks, Md.) (BD) automated continuously monitoring instrument systems . Although similarly composed of soybean-casein digest broths, the formulations of the standard aerobic media available for these instruments differ from each other in supplements and in sodium polyanetholesulfonate concentration . Therefore, we compared the standard aerobic media available for these systems at two university hospitals . Blood samples from adult patients with suspected bloodstream infection were inoculated at the bedside into nonvented BM and BD standard aerobic blood culture bottles and incubated in their respective instruments . The laboratories received 6,743 pairs of bottles that were each filled with 8 to 12 ml of blood . A total of 523 isolates representing true infections were recovered from 257 patients; of these isolates, 348 were recovered from both the BD and the BM bottles, 108 were recovered from the BM bottles only, and 67 were recovered from the BD bottles only (P < 0.005) . More staphylococci (P < 0.05), especially coagulase-negative staphylococci (P < 0.05), and yeasts (P < 0.01) were recovered from BM bottles than from BD bottles . Of 291 unimicrobial episodes of bloodstream infection, 220 were detected with both bottles, 41 were detected with the BM bottles only, and 30 were detected with the BD bottles only (difference not significant) . Among 335 cultures that were positive in both bottles within the first 72 h of incubation, the median times to detection were 14 h for BM bottles and 13 h for BD bottles . Rates for false-positive results were 0.5% for BM bottles and 0.1% for BD bottles . One BM bottle and seven BD bottles yielded false-negative results . We conclude that the BM medium provides improved recovery of microorganisms, especially staphylococci and yeasts, compared with that provided by the BD medium.

Acta Pharmacol Sin, 2003 Jun, 24(6), 519 - 26
Horizontal gene transfer-emerging multidrug resistance in hospital bacteria; Dzidic S et al.; The frequency and spectrum of antibiotic resistant infections have increased worldwide during the past few decades . This increase has been attributed to a combination of microbial characteristics, the selective pressure of antimicrobial use, and social and technical changes that enhance the transmission of resistant organisms . The resistance is acquired by mutational change or by the acquisition of resistance-encoding genetic material which is transferred from another bacteria . The spread of antibiotic resistance genes may be causally related to the overuse of antibiotics in human health care and in animal feeds, increased use of invasive devices and procedures, a greater number of susceptible hosts, and lapses in infection control practices leading to increased transmission of resistant organisms . The resistance gene sequences are integrated by recombination into several classes of naturally occurring gene expression cassettes and disseminated within the microbial population by horizontal gene transfer mechanisms: transformation, conjugation or transduction . In the hospital, widespread use of antimicrobials in the intensive care units (ICU) and for immunocompromised patients has resulted in the selection of multidrug-resistant organisms . Methicillin-resistant Staphylococci, vancomycin resistant Enterococci and extended-spectrum beta-lactamase (ESBL) producing Gram negative bacilli are identified as major problem in nosocomial infections . Recent surveillance studies have demonstrated trend towards more seriously ill patients suffering from multidrug-resistant nosocomial infections . Emergence of multiresistant bacteria and spread of resistance genes should enforce the application of strict prevention strategies, including changes in antibiotic treatment regimens, hygiene measures, infection prevention and control of horizontal nosocomial transmission of organisms.

Eye Contact Lens, 2003 Jan, 29(1 Suppl), S63 - 6; discussion S83-4, S192-4
The causes of and cures for contact lens-induced peripheral ulcer; Wu P et al.; PURPOSE: Contact lens-induced peripheral ulceration (CLPU) is a relatively common adverse response associated with wearing hydrogel lenses, especially on an extended wear schedule . Bacteriologic examination of lenses at the time of an event has demonstrated an association with Staphylococci spp . We sought to investigate the causes of CLPU in a rabbit model of contact lens wear . METHODS: Rabbits wore contact lenses for a period of 24 hr in the presence or absence of bacteria or in presence or absence of epithelial scratches made in the periphery of the cornea before lens wear . Bacteria tested were a strain of Staphylococcus aureus or a strain of Staphylococcus epidermidis isolated from human CLPUs . Rabbits were also challenged with S . aureus in the presence of an epithelial defect and in the absence of a contact lens . Corneas were monitored by slitlamp, histology, and microbial culture after 24 hr . RESULTS: No CLPU-like lesions were detected under the following conditions: corneal scratch plus lens wear with no bacteria; corneal scratch plus S . epidermidis colonized lenses; corneal scratch without lens wear and with S . aureus applied to eyes; no scratch plus S . aureus colonized lenses; and corneal scratch plus contact lenses colonized by dead S . aureus . CLPU-like lesions were found only when the corneas were scratched and contact lenses colonized by viable S . aureus were applied to the eye . The histology of the lesions demonstrated a frank epithelial break with underlying stromal infiltration . Only low numbers of bacteria could be cultivated from the corneas with CLPU-like lesions . The CLPU-like lesions shared many similarities with CLPU in humans . CONCLUSION: CLPU-like lesions were only produced by S . aureus and not S . epidermidis in the presence of an epithelial abrasion and contact lens . Thus, we hypothesize that to reduce the incidence of CLPU, contact lenses designed to reduce corneal interaction and repel microbial colonization should be produced.

Binocul Vis Strabismus Q, 2003 Spring-Summer, 18(2), 75 - 9
Quantification of incidental needle and suture contamination during strabismus surgery; Carothers TS et al.; PURPOSE: To quantify the level of bacterial contamination of needles and sutures immediately after use in strabismus surgery . METHODS: Strabismus surgery was performed on 56 eyes from 31 pediatric strabismus surgical cases . Preoperative site preparation included instillation of 5% povidone-iodine in the conjunctival fornices in all cases . A total of 124 needles and 127 sutures were cultured immediately after final scleral passage . RESULTS: Seventeen of the 31 cases (54.8%) produced at least one positive specimen . Nineteen per cent of the needles and 25.2% of the sutures were culture positive . The bulk of positive specimens (96.7% of needles, 91.3% of sutures) produced 3 or less colony forming units, corresponding to 7 or less total viable organisms per needle or sutures in accordance with the dilution scheme . Coagulase-negative staphylococci overwhelmingly predominated . CONCLUSIONS: Needles and sutures used in strabismus surgery can become contaminated during surgery despite preoperative povidone-iodine preparation . The number of viable bacterial contaminants is usually below the level known to consistently produce experimental endophthalmitis . However, a few needles and sutures carried a high contaminant load, suggesting the possibility that contaminated needles and sutures could potentially cause postoperative intraocular infection.

Wien Med Wochenschr, 2003, 153(7-8), 153 - 5
{Antimicrobial combination therapy}; Weiss G; Anti-microbial combination therapy is a very frequently used therapeutic approach although clinical data from prospective randomized trials thus fulfilling the criteria of evidence based medicine are very rare . Rationales for the use of combination therapy are thus empirical treatment of polymicrobial infections, infections in critical ill or in immuno-compromised patients, prevention of the emerge of antibiotic resistances, utilization of a potential synergism of antibiotics directed against a certain bacterial strain, or simply despair . Prospective studies have demonstrated a superiority of combination therapy over single drug regimen in enterococcal endocarditis, and infections with gram negative rods including pseudomonas sp., but in the latter condition only if the patient is severely immuno-compromised . There is clinical indication that combination therapy may be beneficial in infections with staphylococci sp., however, well designed studies supporting this experience are largely absent . Nonetheless, antimicrobial combination therapy also harbors some risks for patients which can be referred to potential antagonism between antibiotics, accumulation of side effects, or stimulation of resistance pathways in bacteria by one drug leading to destabilization of the other one . Thus, the insightful use of combination therapy is warranted and well designed, prospective studies are urgently needed to evaluate the true benefit of combination therapy for the treatment of different infections and specific micro-organisms.

Am J Otolaryngol, 2003 May-Jun, 24(3), 163 - 8
The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis; Aral M et al.; PURPOSE: To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis . Patients and Methods: The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis . During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria . Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses . RESULTS: Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42 . For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci . Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included . It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2% . All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials . Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5% . CONCLUSIONS: This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Antimicrob Agents Chemother, 2003 Jun, 47(6), 1824 - 31
Worldwide assessment of linezolid's clinical safety and tolerability: comparator-controlled phase III studies; Rubinstein E et al.; Linezolid, an oxazolidinone antibiotic, has 100% oral bioavailability and favorable activities against gram-positive pathogens including multidrug-resistant staphylococci, enterococci, and pneumococci . Safety assessments were conducted for 2,046 linezolid-treated patients and 2,001 comparator drug-treated patients from seven controlled clinical trials comparing the activities of linezolid and comparator drugs against nosocomial and community-acquired pneumonia, skin and skin structure infections, and methicillin-resistant staphylococcal infections . Drug-related adverse events were primarily transient . The most frequent (> or = 2%) adverse events caused by linezolid and the comparator drugs were diarrhea (4.3 and 3.2%, respectively; P = 0.074), nausea (3.4 and 2.3%, respectively; P = 0.036), and headache (2.2 and 1.3%, respectively; P = 0.047) . Treatment discontinuations due to drug-related events (2.4 and 1.9%, respectively), serious adverse events (11.4 and 10.6%, respectively), and deaths (4.8 and 4.9%, respectively) were similar . No clinically significant drug-related hematologic events were reported, and laboratory safety data were comparable . In the first 6 months of postmarketing surveillance, hematologic abnormalities were reported in 0.1% of linezolid-treated patients, but no irreversible blood dyscrasias were documented . The risk for transient, reversible hematologic effects from treatment with linezolid should be considered together with the clinical benefits associated with its use.

J Bacteriol, 2003 Jun, 185(11), 3446 - 52
Quantitation of mecA transcription in oxacillin-resistant Staphylococcus aureus clinical isolates; Rosato AE et al.; The transcription of mecA, the gene required for oxacillin resistance in staphylococci, was quantified in a collection of 65 geographically and genetically diverse clinical and 8 defined laboratory Staphylococcus aureus isolates . mecA transcription was measured by real-time reverse transcription-PCR, confirmed by Northern blot analysis, and correlated with the presence and DNA sequence of the two mecA repressors, mecI and blaI . Isolates were first examined that contained mecI and/or blaI with wild-type sequence . BlaI provided significantly more repression of mecA transcription than did MecI, unrelated to blaI genetic location . Both together repressed mecA better than either one alone . In clinical isolates containing only wild-type mecI, mecA transcription repression was 10- to 25-fold less effective than that seen in previously studied constructs derived from strain N315 . There was a difference in the mecI ribosomal binding site (RBS) between the clinical isolates (GGAA) and N315 (GGAG) . The GGAA RBS was associated with 5.5- to 7.3-fold less mecA repression than GGAG in isogenic constructs . The values generated for wild-type repressors were compared to those in 26 isolates containing mecI mutations . mecA transcription appeared to be repressed only by BlaI in isolates with mecI nonsense and frameshift mutations . In contrast, mecI repression seemed to be partially or fully retained in many of the isolates with mecI and one isolate with blaI missense mutations, providing structure-function correlates with the site and type of mutation . We conclude that mecA repressor activity is highly variable in clinical S . aureus isolates due to mecI mutations, RBS polymorphisms, and unidentified genomic adaptations.

Infez Med, 1999, 7(4), 245 - 252
{Microbiological survey in an Intensive Care Unit}; Cuniato V et al.; An epidemiological survey on 417 sample from ICU patients, was carried out from January '97 to December 98 to verify the epidemiology of bacteria responsible for nosocomial infections and to monitor the susceptibility patterns to antimicrobial drugs during this period . Microbiological cultures were positive in 47.7% of the samples . P . aeruginosa was the most frequent pathogen, followed by Staphylococcus aureus, Candida spp, coagulase-negative staphylococci, E.coli, with a clear prevalence of Gram-negative over Gram-positive isolates . The evaluation of the antibiotic susceptibility profile of this bacterial pathogens suggests the importance of a costant epidemiological surveillance in ICU.

Syst Appl Microbiol, 2003 Mar, 26(1), 38 - 46
Three new antibiotic producing species of the genus Amycolatopsis, Amycolatopsis balhimycina sp . nov., A . tolypomycina sp . nov., A . vancoresmycina sp . nov., and description of Amycolatopsis keratiniphila subsp . keratiniphila subsp . nov . and A . keratiniphila subsp . nogabecina subsp . nov; Wink JM et al.; Screening of Indian soils for strains producing antibiotics active against methicillin resistant staphylococci resulted in the isolation of the actinomycetes FH 1894T, ST 101170T, and FH 1893T, producing novel glycopeptide antibiotics and a polyenic compound, respectively . Studies of the cellular fatty acids and the absence of mycolic acids as well as the 16S rRNA gene sequence analysis of the producers indicated their membership to the genus Amycolatopsis . Comparison of genomic and metabolic properties of these strains with known species of this genus indicated that they represent new species for which the names Amycolatopsis balhimycina (type strain FH 1894T, DSM 44591T) and Amycolatopsis vancoresmycina (type strain ST 101170T, DSM 44592T) are proposed . The producer of the antibiotic Tolypomycin, strain IFO 14664T, representing the invalid species "Amycolatopsis tolypophorus", was also included in this investigation . As this strain was found to represent a valid species of the genus Amycolatopsis the name Amycolatopsis tolypomycina is proposed for this species, with the type strain IFO 14664T (DSM 44544T) . The producer of the antibiotic Nogabecin, strain FH 1893T, was found to be closely related to the type strain of A . keratiniphila DSM 44409T which justifies the description of two subspecies of this species, A . keratiniphila subsp . keratiniphila DSM 44409T and A . keratiniphila subsp . nogabecina DSM 44586T.

Vaccine, 2003 Jun 2, 21(19-20), 2661 - 6
Protective immune response against methicillin resistant Staphylococcus aureus in a murine model using a DNA vaccine approach; Senna JP et al.; Methicillin resistant Staphylococcus aureus (MRSA) are a major pathogen responsible for serious hospital infections worldwide . These bacteria are resistant to all beta-lactam antibiotics due to the production of an additional penicillin binding protein, the PBP2a, encoded by the mecA gene, which shows low affinity for this class of antibiotics . In this study, we cloned an internal region from the transpeptidase domain from the PBP2a into a mammalian expression vector, to be used as DNA vaccine in a Murine model . After three sets of DNA vaccination, the immune response represented by antibodies against a fragment of PBP2a was evaluated by enzyme linked immunosorbent assay (ELISA), showing a significant antibody response . The antibacterial effect of the DNA vaccine was evaluated by intraperitoneal immunization and challenge with a sublethal dose of MRSA for 7 days in mice . After the challenge, the number of bacteria from kidneys from immunized and non-immunized mice were determined . Kidneys from immunized mice had 1000 times less on bacteria than the positive controls (non-immunized mice) . The response specificity indicates no effects against the normal PBPs from staphylococci and no effects against Gram positive rods from normal intestinal flora . Our results indicate that the immunization against the PBP2a from MRSA using a DNA vaccine approach could be used as a new strategy to efficiently fight these multiresistant bacteria.

Surg Infect (Larchmt), 2003 Spring, 4(1), 57 - 70
Effect of linezolid versus vancomycin on length of hospital stay in patients with complicated skin and soft tissue infections caused by known or suspected methicillin-resistant staphylococci: results from a randomized clinical trial; Li JZ et al.; BACKGROUND: Complicated skin and soft tissue infections are common surgical indications usually requiring patients to be hospitalized, and are often caused by gram-positive bacteria, including methicillin-resistant staphylococci such as MRSA . Vancomycin has been the standard treatment for methicillin-resistant staphylococcal infections in many countries, but its intravenous-only formulation for systemic infections often confines patients to the hospital for the treatment . Linezolid, a novel oxazolidinone antibiotic available in intravenous and 100% bioavailable oral forms, was shown in a randomized trial to be as efficacious as vancomycin for suspected or proven methicillin-resistant staphylococcal infections . To determine if oral linezolid can reduce length of hospital stay (LOS) when compared to vancomycin, we compared the LOS for the 230 complicated skin and soft tissue infection patients enrolled in this trial . MATERIALS AND METHODS: Patients received up to four weeks of linezolid (intravenous followed by optional oral) or vancomycin (intravenous only), followed by up to four weeks of observation . Unadjusted LOS was estimated using Kaplan-Meier survival functions, whereas the log-logistic survival analysis model was used to estimate the multivariate-adjusted LOS controlling for patient demographics and selected baseline clinical variables . Analysis was done on the intent-to-treat (n = 230) sample as well as on two subsamples of the clinically evaluable (n = 144) and surgical site infection (n = 114) patients . RESULTS: The unadjusted Kaplan-Meier median LOS was five days shorter for the linezolid group than the vancomycin group in the intent-to-treat sample (9 vs . 14 days, p = 0.052) . It was eight days shorter (8 vs . 16 days, p = 0.0025) in the clinically evaluable sample, but the difference in the surgical site infection sample was not significant (10 vs . 14 days; p = 0.29) . The linezolid group's unadjusted mean LOS was 1.7, 5.3 and 0.8 days shorter in the intentto-treat, clinically evaluable, and surgical site infection samples, respectively . After adjusting for age, gender, race, geographic region, bacteremia, type of inpatient location, and number of concurrent medical conditions using the log-logistic model, between-treatment differences in the multivariate-adjusted median LOS decreased to 3, 6, and 3 days, whereas the differences in mean LOS increased to 3.1, 6.5 and 2.5 days for the intent-to-treat, clinically evaluable, and surgical site infection samples (p < 0.01, < 0.01, and < 0.10), respectively . When the between-treatment differences in LOS were expressed as odds ratio of hospital discharges, multivariate-adjustment increased the odds ratios in favor of linezolid for all the three samples . CONCLUSION: Results from this randomized trial show that linezolid can significantly reduce LOS for patients with complicated skin and soft tissue infections from suspected or confirmed methicillin-resistant staphylococci.

Vet Microbiol, 2003 Jun 24, 94(1), 71 - 7
Effect of freezing goat milk samples on recovery of intramammary bacterial pathogens; Sanchez A et al.; With the aim of evaluating the effect of freezing goat milk samples on recovery of intramammary pathogens, 1200 milk samples from udder halves with subclinical intramammary infection were studied . Samples (20 ml) were frozen at -20 and at -80 degrees C . Thawing was carried out at room temperature at 7, 14, 21, 28, 58, 118, 178, 236 and 730 days after collection and bacteriological analyses were carried out to determine the number of colony forming units/ml (CFU/ml) . Mixed model statistical analysis showed that bacterial group, temperature of storage, interaction of bacterial group and temperature of storage and the interaction of bacterial group, time and temperature of storage were statistically significant effects . For coagulase negative staphylococci (CNS), least squares means of log CFU/ml recovered at -20 and -80 degrees C were not different . Nevertheless, for Gram negative bacilli (GNB) a significant decrease was detected in samples frozen at -20 vs . -80 degrees C . At both temperatures and at different times of storage, significant increases were detected between log CFU/ml of CNS and values on day zero . At -20 degrees C, a significant decrease in GNB recovery was detected between freezing days zero and 730 . This difference was not detected when goat milk samples infected by GNB were frozen at -80 degrees C . The results show that frozen milk samples can be useful in goat subclinical mastitis control programs.

J Microbiol Immunol Infect, 2003 Mar, 36(1), 51 - 5
Coagulase-negative staphylococcal bacteremia in critically ill children: risk factors and antimicrobial susceptibility; Huang SY et al.; Coagulase-negative staphylococci (CoNS) are the most common microorganisms isolated from blood cultures in childern, and determining whether there is true bacteremia or merely contamination is a clinical dilemma . A total of 67 episodes of CoNS-positive blood cultures in pediatric and neonatal intensive care units were evaluated during a 3-year period in order to find the possible risk factors involved and the antimicrobial susceptibility of CoNS isolates . In this study, 37 episodes were judged to be infections as opposed to 30 that were not . In comparison with individuals without infection, patients with true infection of CoNS stayed longer in the hospital (32 +/- 32.9 vs 10.7 +/- 9.3 days, p = 0.001), had more surgical procedures (32.4% vs 6.7%, p = 0.014), received more antibiotic treatments in the recent 2 weeks (37.8% vs 0%, p < 0.001), underwent more central venous catheter insertions (86.4% vs 10%, p < 0.001), received more parenteral nutrition (37.8% vs 3.3%, p = 0.001), had higher C-reactive protein profiles (4.8 +/- 5.4 vs 0.6 +/- 0.9 mg/dL, p < 0.001), and had higher neutrophil proportion (58.1% vs 44.3%, p = 0.001) . However, there were no significant differences in corticosteroid therapy, hemoglobin level, total leukocyte count, and platelet count . All strains of the infection group were resistant to cefazolin, cefotaxime, penicillin, and erythromycin . Nonetheless, all isolates were susceptible to vancomycin . The percentage of multiple-resistant CoNS in the infection group was 96.9% . Empirical therapy with vancomycin for CoNS bacteremia in critically ill children is therefore recommended.

Biotechnol Bioeng, 2003 Jul 5, 83(1), 65 - 74
Fluid shear contributions to bacteria cell detachment initiated by a monoclonal antibody; Mascari L et al.; Receptor-mediated adhesion of bacteria to biological surfaces is a significant step leading to infection . Due to an increase in bacterial antibiotic resistance, novel methods to block and disrupt these specific interactions have gained considerable interest as possible therapeutic strategies . Recently, several monoclonal antibodies specific for the Staphylococcus aureus collagen receptor demonstrated specialized ability to displace attached cells from collagen in static assays . In this study, we experimentally examine the monoclonal antibody detachment functionality under physiological shear conditions to evaluate the role of this parameter in the detachment process . The detachment of staphylococci from collagen was quantified in real-time using a parallel plate flow chamber, phase contrast video-microscopy and digital image processing . The results demonstrate a unimodal dependence of detachment on fluid wall shear rate . The observed decrease in effective detachment rate with increasing force at the highest shear levels evaluated is counterintuitive and has not been previously demonstrated . Several possible mechanisms of this result are discussed .

Eur J Epidemiol, 2003, 18(2), 139 - 45
Distribution of mecA among methicillin-resistant clinical staphylococcal strains isolated at hospitals in Naples, Italy; Galdiero E et al.; Two hundred and twenty strains of Staphylococcus isolated in Naples, Italy, were surveyed for the distribution of the mecA, the structural gene for penicillin-binding protein 2a, which is the genetic determinant for methicillin-resistance in staphylococci . Screening by a cloned mecA, revealed that of 220 strains, 43 were methicillin-resistant (19.5%) and 177 were methicillin-susceptible (80.5%) . Among the 43 resistant strains 23 (53.5%) carried mecA in their genome and 20 (46.5%) did not carry mecA, in spite of their resistance to methicillin . Every group was submitted to the AP-PCR profiling . A quantitative analysis of the patterns divided strains into four different clusters for methicillin-resistant mecA-negative and two different clusters for methicillin-resistant mecA-positive with primer 1, while no clusters were noted with primer 7 . We conclude that these clinical isolates from our area, were not found to belong to a single clone, although the predominance of four methicillin-resistant mecA-negative genotypes were noted.

Presse Med, 2003 Mar 15, 32(10), 450 - 6
{Complications due to peripheral venous catheterization . Prospective study}; Barbut F et al.; OBJECTIVE: Peripheral venous catheter (PVC)-associated complications were prospectively evaluated in a 2 month-study performed in 3 different wards . METHODS: For each inserted PVC, the following complications were observed daily by an external investigator: tenderness, erythema, swelling or induration, palpable cord and purulence . PVC that were removed were systematically sent to the Microbiology department and analysed according to the semi-quantitative method described by Brun-Buisson et al . RESULTS: A total of 525 PVC (corresponding to 1,036 catheterisation-days) were included . Main clinical complications were erythema (22.1%), tenderness (21.9%), swelling or induration (20.9%), palpable cord (2.7%) and purulence (0.2%) . Phlebitis, defined by 2 or more of the following signs: tenderness, erythema, swelling or induration and palpable cord, was observed in 22% . Catheter colonization (> or = 103 CFU/ml) occurred in 13% . Bacteria isolated from colonized catheters were coagulase-negative staphylococci (88.1%), Staphylococcus aureus (7.1%) and Candida sp . (4.8%) . Multivariate risk factor analysis showed that age > or = 55 y . (OR = 3.16, p = 0.003), insertion on articulation site (OR = 2.94, p = 0.01) or in jugular vein (OR = 8.18, p = 0.01) and > 72 hour-catheterisation (OR = 4.74, p = 0.0003) were significantly associated with PVC colonization . Risk factors for phlebitis were skin lesions (OR = 1.88, p < 0.016), active infection unrelated to PVC (OR = 2.8, p = 0.001), "poor quality" peripheral vein (OR = 2.46, p < 0.02) and > 72 hour-catherisation (OR = 2.38, p = 0.009) . CONCLUSION: Complications associated with peripheral venous catheters are frequent but remain benign . They could probably be reduced by a systematic change every 72-96 hours as recommended by different guidelines.

Peptides, 2003 Mar, 24(3), 329 - 38
Control of antimicrobial peptide synthesis by the agr quorum sensing system in Staphylococcus epidermidis: activity of the lantibiotic epidermin is regulated at the level of precursor peptide processing; Kies S et al.; The accessory gene regulator (agr) quorum sensing system in staphylococci is responsible for the regulation of surface proteins and exoproteins, including many virulence factors in the pathogenic species Staphylococcus aureus and S . epidermidis . Strain S . epidermidis Tu3298 produces the lantibiotic epidermin . An isogenic agr deletion mutant of this strain showed a strong reduction of epidermin production . Detailed analysis of the impact of agr on epidermin biosynthesis revealed that agr does not interfere with the transcription of epidermin biosynthetic genes, but controls the extracellular processing of the N-terminal leader peptide by the EpiP protease.

Enferm Infecc Microbiol Clin, 2003 May, 21(5), 232 - 6
{Orthopedic implant infection: prognostic factors and influence of long-term antibiotic treatment on evolution . Prospective study, 1992-1999}; Gomez J et al.; INTRODUCTION: Orthopedic implant infections are significant because of their morbidity, a tendency to serious relapses and an elevated health cost . OBJECTIVES: To study prognostic factors and the influence of long-term antibiotic treatment on the evolution of orthopedic implant infections . METHODS: This prospective study was performed in 110 patients with orthopedic implant infections . Clinical, analytical, and microbiological studies, as well as gammagraphy with Tc, Ga and labeled leukocytes, were performed in all patients . Controls were carried out at 7, 15 and 30 days after starting treatment, every 3 months thereafter until the end of treatment, and every 6 months thereafter up to one year after stopping treatment . Initial antibiotic treatment was prescribed according to the epidemiological characteristic of the type of infection and was modified according to the microorganism isolated . Duration of treatment was established by patient and implant characteristics, severity of infection and evolution of the process, and it was adjusted to criteria of cure, failure and relapse.RESULTS: Among the 110 cases, 63 were women and 37 men, with a mean age of 59.6 years (range 18-79 years) . Implants included 72 joint prostheses (42 knee, 29 hip and 1 shoulder) and 38 bone implants . Microbiological documentation was obtained in 60%; among these, 60.6% were gram-positive cocci, with a predominance of staphylococci, 33.3% were gram-negative bacilli and 6.1% were anaerobic microorganims . Prognostic factors significantly associated with failure or relapse included previous joint surgery, previous hospital stay longer than 15 days, diabetes, microbiological isolation and treatment with cefuroxim plus rifampicin . Mean treatment duration was 9.8 months (range 2-17 months) . Antibiotic treatment consisted of the following: 61 cases received fluorquinolones or cotrimoxazole plus rifampicin, 29 received cefuroxime-axetil plus rifampicin and the remaining 20 received monotherapy . Among 110 cases, 91 cured (83%) . Treatment failures or relapses were observed in 19 (17%) patients; 26.7% of the latter were related to the implants . Tolerance to long-term antibiotic treatment was good.Conclusion . Long-term antibiotic treatment lasting a mean of 9.8 months had a positive influence on the evolution of orthopedic implant infections.

J Arthroplasty, 2003 Apr, 18(3), 342 - 6
Regional and systemic prophylaxis with teicoplanin in total knee arthroplasty: a tissue penetration study; Lazzarini L et al.; Five patients undergoing total knee arthroplasty (TKA) received 800 mg intravenous teicoplanin systemically 2.5 hours before surgery and 15 patients received 200 mg teicoplanin into a foot vein in the leg to be treated . Samples of bone, synovia, subcutaneous tissue, and skin were collected at 20, 40, and 60 minutes after tourniquet inflation and at the end of surgery . None of the study subjects experienced adverse effects, adverse events, or infections during the postoperative and follow-up period . Mean teicoplanin concentration in the collected tissue ranged from 1.52 to 5.81 mg/L after regional prophylaxis and from 0.9 to 2.94 mg/L after systemic prophylaxis . Bone and soft tissue penetration of teicoplanin after regional prophylaxis with 200 mg is at least comparable with that achieved after systemic prophylaxis with 800 mg . Regional prophylaxis in TKA appears to be safe and valuable . Higher dosages of teicoplanin seem to be needed to ensure coverage against coagulase negative staphylococci .

J Antimicrob Chemother, 2003 Jun, 51(6), 1397 - 401 Epub 2003 Apr 25.
Molecular analysis of the plasmid-borne aacA/aphD resistance gene region of coagulase-negative staphylococci from chickens; Lange CC et al.; OBJECTIVES: The aim of this study was to analyse selected coagulase-negative staphylococci from chickens for the genetic basis of plasmid-borne resistance to gentamicin, tobramycin and kanamycin, and also for the presence of Tn4001-like elements . METHODS: Three staphylococcal strains, two Staphylococcus warneri, and one Staphylococcus sciuri, were included in this study . The gene aacA/aphD coding for a bifunctional enzyme that mediates resistance to gentamicin, tobramycin and kanamycin was detected by hybridization with a specific probe . Plasmid location of this gene was also confirmed by hybridization and conjugation . The resistance gene and its adjacent regions were cloned and sequenced . RESULTS: Three different types of Tn4001-like elements in which the IS256 elements were largely truncated and replaced by IS257 elements were identified on large conjugative and non-conjugative plasmids of 33-43 kb in the staphylococcal strains from chickens . Seven different types of IS257-analogous insertion sequences were identified . CONCLUSIONS: Resistance to gentamicin, tobramycin and kanamycin in three staphylococcal strains from chickens was mediated by plasmid-borne aacA/aphD genes located on structurally modified Tn4001-like elements . In one of the three plasmids studied, the arrangement of the elements in the aacA/aphD resistance gene area closely resembled that on plasmids pSH6, pSK41 and pUW3626 from Staphylococcus aureus of human origin.

J Antibiot (Tokyo), 2003 Feb, 56(2), 123 - 8
YM-266183 and YM-266184, novel thiopeptide antibiotics produced by Bacillus cereus isolated from a marine sponge . I . Taxonomy, fermentation, isolation, physico-chemical properties and biological properties; Nagai K et al.; Novel antibiotics, YM-266183 (1) and YM-266184 (2), were found in the culture broth of Bacillus cereus QN03323 which was isolated from the marine sponge Halichondria japonica . The structures of both antibiotics were determined by several spectroscopic experiments as new thiopeptide compounds . They exhibited potent antibacterial activities against staphylococci and enterococci including multiple drug resistant strains, whereas they were inactive against Gram-negative bacteria.

Prof Nurse, 2003 Apr, 18(8), 441 - 4
Reducing the risks of device-related infection caused by staphylococci; Kiernan M; Many patients require the administration of therapy via intravenous lines, which increases their risk of acquiring an infection in hospital . It it vital for nurses to be aware of such risks and to minimise them by taking precautions when inserting and removing i.v . devices, as well as in removing or changing dressings . Nurses should also be able to recognise signs of infection should this occur.

Clin Infect Dis, 2003 May 1, 36(9), 1103 - 10 Epub 2003 Apr 14.
Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States; Wisplinghoff H et al.; A total of 2340 patients with underlying malignancy were identified among 22,631 episodes of nosocomial bloodstream infections (BSIs) in a prospectively collected database for 49 hospitals in the United States (Surveillance and Control of Pathogens of Epidemiologic Importance {SCOPE} Project) . Data were obtained for the period of March 1995 through February 2001 . Gram-positive organisms accounted for 62% of all BSIs in 1995 and for 76% in 2000 (P<.001), and gram-negative organisms accounted for 22% and 14% of all BSIs for these years, respectively . Neutropenia was observed in 30% of patients, so neutropenic and nonneutropenic patients were compared . In both, the predominant pathogens were coagulase-negative staphylococci (32% of isolates recovered from neutropenic patients and 30% of isolates recovered from nonneutropenic patients) . The source of BSI was not determined for 57% of patients . The crude mortality rate was 36% for neutropenic patients and 31% for nonneutropenic patients.

World J Surg, 2003 May, 27(5), 529 - 33 Epub 2003 Apr 28.
Surveillance of surgical site infections: decade of experience at a Colombian tertiary care center; Arias CA et al.; A protocol for surveillance of surgical site infections (SSIs) was established in a tertiary care center in 1991 in Bogota, Colombia and followed for 10 years . Wounds were classified according to the Centers for Disease Control guidelines . The National Nosocomial Infection Surveillance and Study of the Efficacy of Nosocomial Infection Control scores for risk factors were included from June 1999 . A total of 33027 surgical procedures were followed by the surveillance team . The overall infection rate was 2.6% . Most surgical procedures (70.6%) were classified as clean; 25.3%, 3.8%, and 0.26% were classified as clean/contaminated, contaminated, and dirty, respectively . Infection rates according to wound classification were 1.28%, 3.9%, 15.4%, and 38.4% for clean, clean/contaminated, contaminated, and dirty procedures, respectively . Escherichia coli and coagulase-negative staphylococci were the most frequently isolated microorganisms from SSI: 23.9% and 22.8% of isolates, respectively . A program of surveillance of SSIs has been successfully implemented in a country with limited resources and has maintained the infection rate within international standards.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Jul-Aug, (4 Suppl), 36 - 43
{Virulence and persistence of staphylococci: phenotypic manifestations and genetic control}; Deriabin DG et al.; On the basis of the analysis of the results obtained in the studies carried out by the authors and the data of literature the alternating character of the expression of virulence factors (e.g., exotoxins and cytolysin) and persistence (in particular, immunoresistance factors) has been described, thus making it possible to characterize the above manifestations of the phenotype of staphylococci as two independent aspects of their pathogenicity . The data of literature on the genetic mechanism of the control of staphylococcal pathogenicity allow to make suggestions on the role of "global" genetic regulators in switching the biosynthesis of the microbial cell over from virulence factors to persistence factors.

Antimicrob Agents Chemother, 2003 May, 47(5), 1589 - 97
Lysostaphin cream eradicates Staphylococcus aureus nasal colonization in a cotton rat model; Kokai-Kun JF et al.; The anterior nares are a primary ecologic niche for Staphylococcus aureus, and nasal colonization by this opportunistic pathogen increases the risk of development of S . aureus infection . Clearance of S . aureus nasal colonization greatly reduces this risk . Mupirocin ointment is the current standard of care for clearance of S . aureus nasal colonization, but resistance to this antibiotic is emerging . Lysostaphin is a glycylglycine endopeptidase which specifically cleaves the cross-linking pentaglycine bridges in the cell walls of staphylococci . Lysostaphin is extremely staphylocidal (MIC at which 90% of isolates are inhibited, 0.001 to 0.064 micro g/ml) and rapidly lyses both actively growing and quiescent S . aureus . This study demonstrates that a single application of 0.5% lysostaphin (actual dose, approximately 150 micro g of lysostaphin), formulated in a petrolatum-based cream, dramatically reduces S . aureus nasal colonization in 100% of animals tested and eradicates S . aureus nasal colonization in 93% of animals in a cotton rat model . A single dose of lysostaphin cream is more effective than a single dose of mupirocin ointment in eradicating S . aureus nasal colonization in this animal model . The lantibiotic peptide nisin, which has potent in vitro antistaphylococcal activity, was ineffective in reducing staphylococcal nasal carriage in this model . Nasal colonization was not reduced after three treatments with 5% nisin ( approximately 1,500 micro g/dose) in any of the treated animals . Lysostaphin formulated in cream may prove to be a superior alternative to mupirocin ointment for clearance of S . aureus nasal colonization.

J Am Soc Nephrol, 2003 May, 14(5), 1296 - 306
Effects of conventional and new peritoneal dialysis fluids on leukocyte recruitment in the rat peritoneal membrane; Mortier S et al.; Peritonitis remains an important cause of morbidity and technique failure in peritoneal dialysis (PD) . Conventional peritoneal dialysate fluids (PDF) inhibit peritoneal leukocyte function in vitro and may thus adversely affect the immune response to peritonitis . New PDF have been designed with neutral pH, low glucose degradation product (GDP) contents, and bicarbonate as buffer . The present intravital microscopy study examined the effects of conventional and new PDF on leukocyte behavior in the peritoneal microcirculation of Wistar rats . The visceral peritoneum was superfused by a control solution (EBSS), a conventional (CAPD), or a new bicarbonate-buffered PDF with neutral pH and low GDP content (CAPD BicaVera) . In addition, spent conventional and new PDF were tested . The number of rolling, adhering, and extravasated leukocytes and leukocyte rolling velocity were assessed at different time intervals after exposure to lipopolysaccharide (LPS) or cell-free supernatants of coagulase-negative staphylococci (CNS-CFS) . Exposure to LPS or CNS-CFS dissolved in EBSS dramatically increased the number of rolling, adhering and extravasated leukocytes and decreased leukocyte rolling velocity . Superfusion by CAPD abolished the LPS- or CNS-CFS-induced leukocyte recruitment, whereas CAPD BicaVera had significantly fewer depressant effect . Spent PDF affected the leukocyte response in a similar way as fresh PDF . High lactate concentrations, GDP, and hypertonicity appeared to be mainly responsible for the inhibition of leukocyte recruitment . In conclusion, conventional PDF abolish in vivo leukocyte recruitment in response to potent inflammatory stimuli . Bicarbonate-buffered pH-neutral PDF with low GDP contents have fewer depressant effects and may therefore contribute to a better preservation of peritoneal host defense.

Trends Microbiol, 2003 Apr, 11(4), 145 - 8
Solving staphylococcal resistance to beta-lactams; Chambers HF; Class resistance to beta-lactam antibiotics in Gram-positive bacteria is mediated by structural changes in transpeptidase penicillin-binding proteins . These structural changes render a complex series of interactions between antibiotic and protein that are energetically unfavorable, such that the active site is inactivated not at all or too slowly to prevent cell-wall synthesis and bacterial growth . Determination of the crystal structure of the low-affinity penicillin-binding protein PBP2a, which mediates beta-lactam antibiotic resistance in staphylococci, has identified the molecular structures and interactions that are responsible for resistance . This information could be useful for designing beta-lactams to overcome these structural impediments, as well as resistance.

Int J Food Microbiol, 2003 Jun 15, 83(2), 185 - 94
Validation of EN ISO standard methods 6888 Part 1 and Part 2: 1999--enumeration of coagulase-positive staphylococci in foods; De Buyser ML et al.; The methods of European and International Organisations for Standardization for the enumeration of coagulase-positive staphylococci (CPS, Staphylococcus aureus and other species) described in EN ISO 6888 Part 1 and Part 2: 1999 were validated by order of the European Commission (Standards, Measurement and Testing Fourth Framework Programme Project SMT4-CT96-2098) . EN ISO 6888-1 prescribes the use of Baird-Parker (BP) agar whereas EN ISO 6888-2 prescribes the use of Rabbit Plasma Fibrinogen Agar (RPFA) . The objective was to determine the precision of each method in terms of repeatability (r) and reproducibility (R) using three different food types inoculated with various levels of S . aureus and a typical background flora . The results are intended for publication in the associated standards . Cheese, meat and dried egg powder were examined by 24 laboratories from 16 countries in Europe . Each participant received eight test materials per food type: blind duplicates at four inoculum levels (0, 10(3), 10(4) to 10(5), 10(5) to 10(6) cfu/g) . In addition, two reference materials (RM) (capsules containing milk powder inoculated with S . aureus) were included in the study . All test materials were subjected to stringent homogeneity and stability testing before being used in the collaborative trial . Two statistical methods were used to calculate the precision parameters . Draft EN ISO 16140: 2000 method appeared more appropriate to the case of microbiological data than ISO 5725-2: 1994 method and was retained to calculate the precision data.Concerning EN ISO 6888-1, overall values for repeatability (r) when used with food test materials was r=log(10) 0.28 (expressed as an absolute difference between log(10)-transformed test results) . For the reference materials, r=log(10) 0.19 . Overall values for reproducibility (R) when used with food test materials were R=log(10) 0.43 . For the reference materials, R=log(10) 0.39.Concerning EN ISO 6888-2, overall values for repeatability (r) when used with food test materials were r=log(10) 0.22 . For the reference materials, r=log(10) 0.17 . Overall values for reproducibility (R) when used with food test materials were R=log(10) 0.33 . For the reference materials, R=log(10) 0.31.These results were presented to the ISO technical committee and to the Comite Europeen de Normalisation (CEN) . Both committees agreed to incorporate the precision data obtained with food materials as two amendments to EN ISO 6888-1 and -2, and to give an equal status to each part of the standard.

Microb Drug Resist, 2003 Spring, 9(1), 1 - 6
Study of developed resistance due to antibiotic treatment of coagulase-negative Staphylococci; Tegnell A et al.; Coagulase-negative Staphylococci (CoNS) are a major cause of postoperative infections . These infections are often associated with foreign material implants and/or a compromised immune system in the patient . Multiresistant strains are increasingly common in the hospital environment and there is concern that the infections will become difficult or impossible to treat . This report is based on a study of 75 patients, with postoperative infections caused by CoNS after thoracic surgery . All patients were treated with surgical revision and antibiotic therapy . One or more bacterial cultures were made in each case, and the resistance pattern of the CoNS found was determined . The goal of the study was to evaluate possible relationships between antibiotic therapy and the appearance of resistance to antibiotics in CoNS found . To describe this relationship, three models were constructed and analyzed by multiple logistic regression . The results indicate an increased resistance to beta-lactam antibiotics and clindamycin after the use of cephalosporins . Also, the use of vancomycin or vancomycin in combination with rifampicin or fusidic acid increases the risk for development of resistance to beta-lactam antibiotics, ciprofloxacin, fusidic acid, clindamycin, netilmycin, and rifampicin . The hypothesis that a combination of antibiotics will curtail the development of resistance was not supported in this study.

Arch Med Res, 2003 Mar-Apr, 34(2), 130 - 6
Occurrence of resistance to antibiotics, metals, and plasmids in clinical strains of Staphylococcus spp; Ug A et al.; BACKGROUND: Presence of staphylococci resistant to antibiotics is of concern, as is the possible spread of resistance determinants among Staphylococcus species . During the past several years, a series of staphylococcal isolates that demonstrated reduced susceptibility to vancomycin or other glycopeptides has been reported . However, there are no useful data on species sensitivity of coagulase-negative staphylococci to heavy metals . METHODS: A total of 22 Staphylococcus spp . isolates recovered from clinical sources was studied for antibiotic and heavy metal resistance patterns and plasmid profiles . Isolated strains were biochemically identified by conventional tests followed by use of API Staph system . Isolates were tested for antimicrobial susceptibility by standard methods . Resistance patterns to nickel chloride (NiCl(2)), zinc sulfate (ZnSO(4)), lead acetate Pb(CH(3)COO)(2), cobalt chloride (CoCl(2)), copper sulfate (CuSO(4)), potassium chromate (K(2)Cr(2)O(7)), silver nitrate (AgNO(3)), and mercuric chloride (HgCl(2)) were surveyed by agar-dilution method . Plasmid DNA was prepared according to a previously described modification of alkaline lysis procedure . RESULTS: In this study, isolated strains included eight (36.4%) Staphylococcus xylosus, five (22.7%) Staphylococcus aureus, four (18.2%) nonidentifiable Staphylococcus spp., one (4.5%) Staphylococcus capitis, one (4.5%) Staphylococcus lentus, one (4.5%) Staphylococcus epidermidis, one (4.5%) Staphylococcus sciuri, and one (4.5%) Staphylococcus chromogenes . All strains showed widest resistance profile to both antibiotics and metals . Methicillin resistance of Staphylococcus aureus (MRSA) was 40% . Resistance to oxacillin was 53% in coagulase-negative staphylococci (CNS) strains . No isolate was resistant to vancomycin . All isolates were resistant to K(2)Cr(2)O(7) and Pb(CH(3)COO)(2); on the other hand, all isolates were sensitive to AgNO(3) . Highest incidence of metal-antibiotic multiple resistance existed between K(2)Cr(2)O(7), Pb(CH(3)COO)(2), and penicillin-G . Plasmid content and profile studies showed that isolates carried plasmids ranging from 2.224 to 20.650 kb in size . CONCLUSIONS: Fifty percent of studied strains harbored plasmids and association between occurence of plasmids and resistance to antibiotics and heavy metals was observed.

Infez Med, 2001 Jun, 9(2), 90 - 7
{Correlation between methicillin-resistance and resistance to fluoroquinolones in Staphylococcus aureus and Staphylococcus epidermidis}; Cafiso V et al.; Fluoroquinolones resistance in Staphylococci is associated to point mutations in grlA (80,84 and 116) grlB, gyrA (84,88) and gyrB genes . Almost all MRSA strains are ciprofloxacin and levofloxacin resistant while, in a lesser degree, MRCoN staphylococci show to be resistant to levofloxacin . This observation made possible to predict a different correlation between methicillin-resistance and the resistance to FQs in this two different species . In this study, we compare genomic analysis of S . aureus and S . epidermidis with the resistance to FQs . Our results show that strains of MRSA are distributed in 4 different PFGE-types while 12 MRSE strains are distributed in 9 . MRSA resistant to FQs showed a unique PFGE pattern; on the contrary of FQs susceptible MRSA and MSSA . Furthermore mecA and gyrA genes are located in the same SmaI fragment in MRSA and in different in MRSE . MSSE and MRSE show more ClaI/mecA polymorphisms than MRSA . All this data confirm the clonal origin of MRSA and show that FQs resistance is linked to the presence of mec locus and both clonally spread . On the contrary in MRSE FQs-resistance is independent from MR and arise with the normal frequence of antibiotic induction.

Infez Med, 2001 Jun, 9(2), 82 - 9
{Epidemiology of methicillin-resistance among Staphylococci strains isolated in risk units and effects of the vancomycin on the expression of methicillin-resistance}; Roveta S et al.; Four hundred Staphylococci strains, isolated from different in intensive care unit hospitalized patients, were analyzed . 53% of all strains were resistant to methicillin . Against methicillin-resistant S . aureus (MRSA), teicoplanin and vancomycin (100% of susceptibility), rifampin (76.3%) and co-trimoxazole (73%) emerged as the most potent drugs tested; the 15% of the strains were susceptible to ciprofloxacin, erythromycin, clindamycin and gentamicin . Only one MRSA strain (0.8%) resulted hetero-resistant to vancomycin . Among 100 strains exposed to serial concentration of vancomycin (0.25-32 mg/L for 30 days), 57 were selected with intermediate-level of resistance to the glycopeptides; the MRSA strains have shown to acquire resistance in vitro more easily than methicillin-susceptible . These results indicate that in the clones of Staphylococci circulating in our region, the evolution of glycopeptides-resistance is not a rapid process and the loss of effectiveness of these antibiotics cannot be predicted to short term . In particular, the restriction profile analysis of chromosomal DNA from MRSA strains, selected in vitro with intermediate -level of vancomycin resistance, demonstrated that at the moment in the hospital departments studied, the diffusion of a clone able to acquire resistance more easily than others is not present.

J Antimicrob Chemother, 2003 May, 51(5), 1301 - 5 Epub 2003 Apr 14.
Evaluation of fusidic acid in therapy of experimental Staphylococcus aureus meningitis; Ostergaard C et al.; OBJECTIVES: Combination therapy that includes fusidic acid, an antimicrobial agent highly active against staphylococci, has been recommended in the treatment of patients with Staphylococcus aureus meningitis . The aim of this study was to evaluate the pharmacokinetic, CSF bactericidal and anti-inflammatory properties of fusidic acid . METHODS: The pharmacokinetics, treatment efficacy and parameters of the meningeal inflammatory response were studied in rabbits, using an experimental meningitis model against S . aureus (MICs of fusidic acid and methicillin were 0.125 and 1 mg/L, respectively) . RESULTS: Fusidic acid entered the CSF, with peak values within 0.5-1 h of the intravenous bolus injection/infusion and with a percentage penetration (AUCCSF/AUCserum) into uninfected and purulent CSF of 1.9% +/- 0.7 and 4.5% +/- 0.7, respectively . Rabbits treated with antibiotics {fusidic acid 80 mg/kg/6 h (n = 6), methicillin 80 mg/kg/3 h (n = 7) and the two combined (n = 6)} had significantly higher bacterial kill rates than untreated controls (n = 6, P < 0.05) . Combination therapy was less effective, with significantly less killing after 6 h of treatment than methicillin alone (P < 0.05) . CSF white blood cells and CSF levels of interleukin-8 (IL-8), glucose, lactate and protein were altered during staphylococcal meningitis, but with no significant difference between antibiotic-treated and untreated rabbits . CONCLUSIONS: Antagonism between methicillin and fusidic acid was observed in staphylococcal meningitis.

J Antimicrob Chemother, 2003 May, 51(5), 1191 - 202 Epub 2003 Apr 14.
Comparative evaluation of the VITEK 2 Advanced Expert System (AES) in five UK hospitals; Barry J et al.; OBJECTIVES: We carried out an evaluation of VITEK 2 in five UK laboratories, comparing results with 'gold standard' agar-dilution MIC data, assessing its ability to recognize resistant phenotypes and comparing results with those generated by routine antimicrobial susceptibility testing methods . METHODS: Laboratories tested a collection of 82 strains selected on the basis of their challenging and characterized resistance mechanisms . RESULTS: In comparison with the reference MIC method, VITEK 2 gave an essential agreement of 304/315 (enterococci), 1619/1674 (staphylococci) and 2937/3074 (Gram-negative bacilli): overall 96.0% agreement . Corresponding category (SIR) agreements with VITEK 2 were 247/252, 1496/1561 and 2478/2626 (overall 95.1%) . Using five routine methodologies, category agreements ranged from 58/63 to 45/45; 222/232 to 174/174, and 333/372 to 250/259 for the three organism groups with an overall agreement of 95.0% . In contrast to VITEK 2 Advanced Expert System (AES), routine microbiology laboratories did not attempt to detect resistance mechanisms for every antibiotic studied . VITEK 2 AES detected all 19 resistance mechanisms in enterococci: where applicable, routine methods detected 14, 10 and 10 . Of 30 resistance mechanisms in staphylococci, VITEK 2 AES detected 25 compared with 23, 20, 17 and 18 detected by routine methods . Finally, of 44 resistance mechanisms in Gram-negative bacilli, VITEK 2 AES detected 30 compared with 30, 23, 15 and 10 detected by routine methods . CONCLUSIONS: VITEK 2 performed susceptibility tests accurately and the AES detected and interpreted resistance mechanisms appropriately . Heavy inocula in a liquid medium possibly favour better expression of certain resistance determinants . Although certain routine microbiology methods performed adequately, VITEK 2 AES offers a rapid, standardized method suited to laboratories lacking experience of resistance mechanisms and/or those not testing an appropriate number, or range, of antibiotics to detect resistance phenotypes.

Int J Dermatol, 2003 Apr, 42(4), 260 - 4
Pityriasis amiantacea: a clinical and etiopathologic study of 85 patients; Abdel-Hamid IA et al.; BACKGROUND: Studies on pityriasis amiantacea (PA) in the literature are limited and mostly retrospective . We prospectively analyzed the clinical and etiopathologic factors in a large series of PA diagnosed at our department within a defined period (2000-01) . METHODS: All PA patients who attended our department were evaluated clinically and underwent bacteriologic, mycologic, and histopathologic examinations . Forty healthy control persons were similarly subjected to bacteriologic and mycologic investigations of their scalp hairs . RESULTS: A total of 85 PA patients were collected and studied . Pathological diagnosis of scalp psoriasis was confirmed in 35.3% of cases . Eczematous features suggesting a diagnosis of seborrheic and atopic dermatitis were detected in 34.2% . Diagnosis of tinea capitis, diagnosed by potassium hydroxide preparation, fungal culture, and periodic-acid Schiff staining, was detected in 12.9% of the PA patients . Staphylococcus isolates were detected in 96.5% of the PA patients compared with 15% in healthy persons as the control (P > 0.00001) . CONCLUSIONS: Pityriasis amiantacea represents a particular reaction pattern of the scalp to various inflammatory scalp diseases . The most frequent skin diseases associated with PA are psoriasis and seborrheic dermatitis . It is important to keep the diagnosis of tinea capitis in mind when evaluating PA patients . Staphylococci on the scalp could participate in the pathogenesis of PA.

Epidemiol Prev, 2003 Jan-Feb, 27(1), 18 - 25
{Hospitalization for pneumonia in adults . Lazio, 1997-1999}; Giorgi Rossi PG et al.; The aim of this study is to define the burden of pneumonia requiring hospitalization among adults in Lazio region from 1997 to 1999 and to describe the characteristic of community acquired (CAP), suspected nosocomial (NP) and in AIDS pneumonia . The data source is the hospital discharge register . 30517 incident episodes of pneumonia hospitalization occurred in the three years period, 20497 CAP, 9760 NP and 964 in AIDS of which 704 supposed to be acquired in hospital; the mean age is 65, 69 and 38 years respectively . Standardized hospitalization rates for CAP do not show a clear geographical pattern, while for NPs and in AIDS they are higher in the city of Rome than in the rest of the region . There are peaks of incidence during the winter for CAPs and NPs but not for AIDS . Only 20% of pneumonias have etiological diagnosis . The proportional analysis of aetiological agents shows: pneumococcus, pseudomonas, staphylococci and influenza; the most frequent comorbidities are: circulatory diseases, chronic obstructive pulmonary disease (COPD), malignancies and diabetes . 3.9% of individuals in the study with CAP or NP had more than one episode of pneumonia during the study period, for those with pneumonia in AIDS this percentage was 14.8 . In-hospital lethality is 9.4%, 29.3% and 11.2% for CAP, NP and in AIDS, respectively . Data from the hospital discharge registers can be used to give a cheap and rapid glimpse to the epidemiology of pathologies frequently requiring hospitalisation neglected from more analytical surveillance systems or registries.

J Korean Med Sci, 2003 Apr, 18(2), 158 - 62
Growth and siderophore production of staphylococci in human peritoneal dialysate; Chung JH et al.; Although activity of iron uptake system (IUS) was thought to play an important role in staphylococcal growth in human peritoneal dialysate (HPD) solution, siderophore production, one of the well-known IUS, was not yet detected directly in HPD solution . Therefore, we tried to detect siderophore production directly in HPD solution by using a newly developed chrome azurol S (CAS) agar diffusion assay and to investigate the effect of IUS activity on bacterial growth in HPD solution . According to the susceptibility test for streptonigrin and the productivity of siderophore in the iron-deficient (ID) medium, Staphylococcus aureus ATCC 6538 strain and Staphylococcus epidermidis clinical isolate had higher IUS activity and grew better than S . aureus ATCC 25923 strain in the ID medium . These bacteria did not grow and produce siderophore in the unused chronic ambulatory peritoneal dialysis solution . However, these bacteria grew and produced siderophore in the HPD solution . Moreover, S . aureus ATCC 25923 strain with lower activity of IUS grew poorly and produced smaller amount of siderophore in HPD compared to S . aureus ATCC 6538 strain and S . epidermidis clinical isolate with higher activity of IUS like in the ID medium . To the best of our knowledge, this is the first report that siderophore production is directly detected in the HPD by CAS agar diffusion assay . These results indicated that activity of IUS plays an important role in bacterial growth in the HPD solution and pathogenesis of continuous ambulatory peritoneal dialysis peritonitis.

Carbohydr Res, 2003 Apr 22, 338(9), 903 - 22
Isolation, structural characterization, and immunological evaluation of a high-molecular-weight exopolysaccharide from Staphylococcus aureus; Joyce JG et al.; Colonization of implanted medical devices by coagulase-negative staphylococci such as Staphylococcus epidermidis is mediated by the bacterial polysaccharide intercellular adhesin (PIA), a polymer of beta-(1-->6)-linked glucosamine substituted with N-acetyl and O-succinyl constituents . The icaADBC locus containing the biosynthetic genes for production of PIA has been identified in both S . epidermidis and S . aureus . Whereas it is clear that PIA is a constituent that contributes to the virulence of S . epidermidis, it is less clear what role PIA plays in infection with S . aureus . Recently, identification of a novel polysaccharide antigen from S . aureus termed poly N-succinyl beta-(1-->6)-glucosamine (PNSG) has been reported . This polymer was composed of the same glycan backbone as PIA but was reported to contain a high proportion of N-succinylation rather than acetylation . We have isolated a glucosamine-containing exopolysaccharide from the constitutive over-producing MN8m strain of S . aureus in order to prepare polysaccharide-protein conjugate vaccines . In this report we demonstrate that MN8m produced a high-molecular-weight (>300,000 Da) polymer of beta-(1-->6)-linked glucosamine containing 45-60% N-acetyl, and a small amount of O-succinyl (approx 10% mole ratio to monosaccharide units) . By detailed NMR analyses of polysaccharide preparations, we show that the previous identification of N-succinyl was an analytical artifact . The exopolysaccharide we have isolated is active in in vitro hemagglutination assays and is immunogenic in mice when coupled to a protein carrier . We therefore conclude that S . aureus strain MN8m produces a polymer that is chemically and biologically closely related to the PIA produced by S . epidermidis.

Vet Clin North Am Food Anim Pract, 2003 Mar, 19(1), 171 - 85, vii
Management and treatment of staphylococcal mastitis; Sears PM et al.; This article deals with two kinds of staphylococci that cause mastitis: Staphylococcus aureus and coagulase-negative staphylococci . The source of infection, the ease of laboratory identification, and the practices used to manage clinical and subclinical mastitis for these two staphylococcal categories makes this a convenient separation.

Russ J Immunol, 2002 Oct, 7(3), 251 - 8
Effect of cytokines on the level of free radicals in the blood of patients with systemic and local staphylococcus infection; Mikhalchik EV et al.; An increased extracellular production of free radicals with bactericidal activity does not improve the efficacy of intracellular digestion of Staphylococci . The amount of intracellular oxygen reactive species generated by the neutrophils from patients with an infectious condition has been found considerably decreased as compared to healthy donors . On the other hand, the excess of secretion of free radicals into the extracellular space leads inevitably to the adaptive increase of antioxidant enzymes and, as a result, to an increase in the total antioxidant capacity of the blood plasma . Indeed, patients with septicemia at its highest peak (at the moment of hospitalization) showed a significant increase (more than twice) in the parameters of catalase and superoxide dismutase activity; the antioxidant capacity of the plasma was elevated as well . The patients of the other two groups in our study (with a localized infection) did not show any statistically significant rise in these parameters . On the second day after the initiation of an intensive treatment the activity of the enzymes and the total antioxidant capacity of the plasma dropped sharply below the normal level . Therefore, the staphylococcus infection, especially its generalized from, is characterized by an increased extracellular secretion of radicals together with a decreased generation of intracellular radicals . On one hand this leads to the failure of the intracellular killing, on the other--to the inflammatory free radical-mediated damage of the host cells and tissues . Cytokines, such as interleukins and interferons, can regulate the free radical-mediated processes during the staphylococcus infections . The effect of the two recombinant cytokines (IL-1 beta, IFN-gamma) on the character of free radical production and intracellular killing of Staphylococci by neutrophils isolated from the blood of patients and healthy donors has been studied . The analysis of the effect of cytokines on the radical production by phagocytes revealed a redistribution of the extracellular and intracellular fractions of free radicals rather than a general increase of the oxygen active metabolite production . As expected, the increment in the number of intracellular radicals improved significantly the process of phagocytosis.

Wien Klin Wochenschr, 2003 Feb 28, 115(3-4), 99 - 103
{Surveillance of nosocomial infections in intensive care units . Current data and interpretations}; Gastmeier P et al.; The German nosocomial infections surveillance system KISS was established in 1996 using a surveillance protocol based on the National Nosocomial Infections Surveillance (NNIS) System . Meanwhile data from a total of 274 intensive care units (ICU) are available, among them 134 interdisciplinary, 71 surgical, 55 medical, 9 neurosurgical and 5 paediatric ICUs . The data comprise about 6,966 surveillance months with more than 500,000 intensive care patients and more than 1.8 million patient days . A total of 6,888 cases of pneumonia and 2,357 cases of central venous catheter (CVC) associated primary bloodstream infections (BSI) were recorded . Ventilator associated pneumonia rates and CVC associated primary BSI rates are presented, stratified according to the type of the ICU and affiliation to a university, a teaching hospital or another type of hospital . The most frequent pathogens associated with ventilator associated pneumonia were S . aureus (24.1%), followed by P . aeruginosa (16.8%) and Klebsiella spp . (12.1%) . In the case of CVC associated primary BSI coagulase negative staphylococci dominated (30.9%) followed by S . aureus (15.4%) and Enterococci spp . (11.6%) . A remarkable increase of Methicillin Resistant Staphylococcus aureus (MRSA) infections was observed during the period from 1997 to 2002 . 19.2% of S . aureus associated pneumonia cases and 25.5% of S . aureus associated primary BSI were due to MRSA . KISS data are useful benchmarks for internal quality management, however a careful interpretation is necessary to stimulate infection control efforts.

J Infect Chemother, 2003 Mar, 9(1), 30 - 4
Survey of methicillin-resistant coagulase-negative staphylococci isolated from the fingers of nursing students; Kitao T; To clarify the state of methicillin-resistant coagulase-negative staphylococci (MRCNS) contamination in the hospital environment, we compared MRCNS isolated from the fingers of 40 nursing students who had not yet experienced clinical practice and 40 who had just completed clinical practice in the hospital . Fourteen MRCNS strains were detected in 13 students (32.5%) after clinical practice; Staphylococcus epidermidis in 9 students, Staphylococcus haemolyticus in 3, and Staphylococcus saprophyticus in 2 . Drug sensitivity tests were performed, and the minimum inhibitory concentration (MIC) of penicillin-G (PCG) was more than 2 microg/ml in all strains, and that of ampicillin (ABPC) was more than 16 microg/ml in many strains . Only a few strains showed high MIC values for the other drugs tested . However, some Staphylococcus haemolyticus strains showed high MIC values for cefazolin (CEZ), arbekacin (ABK), gentamicin (GM), ofloxacin (OFLX), or imipenem (IPM) . In all strains, the mecA gene was detected by polymerase chain reaction (PCR), and penicillin binding protein 2' (PBP2') was detected by the latex agglutination method . Methicillin-resistant Staphylococcus epidermidis (MRSE) isolated from the fingers of nursing students was compared with that isolated from blood culture specimens by arbitrarily primed (AP)-PCR analysis . The patterns obtained were different, a finding which excluded the presence of cross-infection . The present results show that basic preventive measures for cross-infection should be considered in the future, using such genetic analysis methods, so that MRCNS may not cause hospital infection.

Curr Opin Investig Drugs, 2003 Feb, 4(2), 149 - 55
Have the oxazolidinones lived up to their billing? Future perspectives for this antibacterial class; Nilius AM; Linezolid was the first antibacterial oxazolidinone to be approved for clinical use . Oxazolidinones meet a growing medical need to treat multidrug-resistant, methicillin-resistant staphylococci, vancomycin-resistant enterococci, and penicillin-non-susceptible pneumococci in hospitalized patients . They also offer a treatment option for patients who are intolerant of vancomycin and other antibacterial agents, or who have infections that are refractory or resistant to other therapies . Two main concerns, however, have arisen as linezolid use has increased . The first is the incidence of myelosuppression, in particular thrombocytopenia, which appears to be greater than that seen during clinical trials . Secondly, linezolid-resistant Staphylococcus aureus and enterococci have emerged during linezolid treatment, which can be transmitted from patient-to-patient . This review will discuss the mechanism of action, the mechanism of resistance, and the antibacterial spectrum and potency of the oxazolidinones . In addition, the efficacy and safety of linezolid derived from clinical experience will be presented.

Am J Infect Control, 2003 Apr, 31(2), 93 - 6
Environmental surface cleanliness and the potential for contamination during handwashing; Griffith CJ et al.; Effective handwashing (including drying) is important in infection control . The ability of the various stages of handwashing to decrease skin-surface microbial counts has been documented . However, an important element, environmental surface cleanliness, and the potential for contamination of hands during the process has not been well studied or quantified . An examination of the adenosine triphosphate (a measure of residual organic soil), bacterial, and staphylococcal load on ward handwash station surfaces, which could be touched during handwashing, is reported . Hand contact surfaces tested consisted of approximately 620 each of: faucet handles, soap dispenser activator mechanisms, and folded paper-towel dispenser exits . Failure rates in excess of benchmark clean values were higher with adenosine triphosphate assays than microbial counts . This could indicate the presence of a higher level of general organic debris (eg, skin cells) as opposed to microbial contamination or could reflect greater assay sensitivity . Faucet handles were more likely to be contaminated and be in excess of benchmark values than paper-towel dispenser exits . However, the latter are likely to be the final surface touched during the handwashing process and overall nearly 20% were above microbiologic benchmark values . Many of the organisms isolated were staphylococci and the results are discussed within the context of microbial cross-contamination and potential pathogen spread.

Bioorg Med Chem Lett, 2003 Apr 7, 13(7), 1265 - 8
Conformational restriction of methionyl tRNA synthetase inhibitors leading to analogues with potent inhibition and excellent gram-positive antibacterial activity; Jarvest RL et al.; Conformationally restricted analogues of the central linker unit of bacterial methionyl tRNA synthetase (MRS) inhibitors have been prepared . The (1S,2R)-cyclopentylmethyl moiety was identified as the preferred cyclic linker, with significant diastereo- and enantioselectivity of activity . Combination of this linker with an optimal substituted aryl right-hand side has resulted in a compound with exceptionally good antibacterial activity against staphylococci and enterococci, including antibiotic resistant strains.

Int J Syst Evol Microbiol, 2003 Jan, 53(Pt 1), 87 - 92
Phylogenetic study of Staphylococcus and Macrococcus species based on partial hsp60 gene sequences; Kwok AY et al.; A 600 bp partial hsp60 gene sequence has been described previously as a novel genetic marker for species identification and phylogenetic studies within the genus Staphylococcus . In the present study, the 600 bp partial hsp60 gene sequences of 40 validly described Staphylococcus species and subspecies and four Macrococcus species were PCR-amplified and sequenced . Phylogenetic analysis revealed excellent concordance between the unrooted dendrograms based on partial hsp60 and 16S rRNA gene sequences . The genus Macrococcus is clearly separated from the genus Staphylococcus, but is closely related to the 'sciuri group', the only staphylococci that are cytochrome c oxidase-positive . The remaining Staphylococcus species clustered into five broad-based subdivisions, which corresponded to the 'aureus group', the 'epidermidis group', the 'haemolyticus group', the 'saprophyticus group' and the 'intermedius group' . These results agreed remarkably well with the current taxonomy of this diverse family, which is based on classical phenotypic and biochemical testing . Furthermore, pairwise sequence comparisons indicated that the hsp60 gene is more divergent and more discriminatory than the 16S rRNA gene for species differentiation among strains of the genera Staphylococcus and Macrococcus . It is concluded that the hsp60 gene may be an efficient alternative target for taxonomic and phylogenetic studies on members of these genera.

Antimicrob Agents Chemother, 2003 Apr, 47(4), 1443 - 6
Antibiotic resistance in bacteria isolated from subgingival plaque in a norwegian population with refractory marginal periodontitis; Handal T et al.; The prevalence of beta-lactamase-producing bacteria in subgingival plaque from patients with refractory periodontitis in Norway was assessed by the chromogenic nitrocefin method . beta-Lactamase activity was detected in 68% of the patients . Enzyme-producing strains belonged predominantly to the genus Prevotella; others were staphylococci, enteric gram-negative rods, and Bacillus spp.

Drug Resist Updat, 2003 Feb, 6(1), 41 - 52
Insights on antibiotic resistance of Staphylococcus aureus from its whole genome: genomic island SCC; Ito T et al.; Staphylococci are ubiquitous colonizers of the skin and mucous membranes and Staphylococcus aureus is the most pathogenic species . The spread of antibiotic resistance among S . aureus strains is a major concern in the treatment of staphylococcal infections . Acquisition of resistance may involve mutation of a bacterial gene on the chromosome or transfer of a resistance gene from other organisms by some form of genetic exchange (conjugation, transduction, or transformation) . Completion of whole genome sequences of three methicillin-resistant S . aureus (MRSA) strains has provided us a bird's-eye view of the distribution of the mobile genetic elements in the bacterial chromosome that encode antibiotic resistance as well as pathogenicity in S . aureus.

Surg Neurol, 2003 Jan, 59(1), 28 - 33; discussion 33
Title comparison of primary and secondary spinal epidural abscesses: a retrospective analysis of 29 cases; Khan SH et al.; BACKGROUND: Spinal epidural abscesses (SEA) are uncommon . In certain regions their incidence is rising . Vague initial presentation may result in delayed diagnosis . Familiarity with SEA is imperative because if not treated expeditiously, they can have devastating neurologic sequelae . METHODS: A retrospective analysis using analysis of variance (ANOVA) was performed on patients diagnosed with SEA between 1980 through 2000 . The patients were assigned to one of the two defined groups: primary (PSEA) consisted of SEA alone; secondary (SSEA) included SEAs with vertebral osteomyelitis . Both groups were compared for factors including survival, age, diagnostic accuracy, etiology, hospitalization, management, and outcome . RESULTS: Twenty-nine cases were identified . Four (23.7%) were PSEAs and 25 (86.2%) were SSEAs . Mean age (52.7 vs . 53.2 years) and mean duration of hospitalization (39.2 vs . 38.6 days) were comparable in both groups (p = 0.9) . The admitting diagnosis was correct in 75% of PSEA and 20% of SSEA cases (p = 0.1) . Staphylococcus aureus was present in 75% and 68%, respectively . In SSEA cases, 24% (n = 6) of the infections were consequent to spinal surgery . PSEA did not show a predilection for any level . Most (56%) cases of SSEA occurred at the lumbar levels . The entire PSEA group and 58.3% of the SSEA group underwent surgery (p = 0.06), 75% versus 40.9% had a good outcome for PSEA and SSEA, respectively . CONCLUSIONS: PSEAs are very rare . Both groups have similar characteristics . Staphylococci remain the predominant etiologic agent . PSEAs are treated by surgery; SSEAs are managed surgically or conservatively.

FEMS Immunol Med Microbiol, 2003 Mar 20, 35(2), 99 - 106
Staphylococcus aureus strains isolated from bovine mastitis: virulence, antibody production and protection from challenge in a mouse model; Leitner G et al.; Septic arthritis in mice was used as a model to evaluate the virulence of Staphylococcus aureus and coagulase-negative staphylococci (CNS) isolated from cases of bovine mastitis . In addition, the model was used to evaluate the cross protection elicited by heterologous antibodies . Mice were intramuscularly inoculated with serial bacterial doses of different strains of S . aureus or CNS, for virulence determination; they were monitored for arthritis, gangrene or death up to 20 days . Antibody response, cross reactivity and resistance to challenge were tested by subcutaneous inoculation with a low dose of one of the S . aureus or CNS strains followed by challenge with two S . aureus strains . S . aureus alpha-hemolysin isolate was the most virulent, followed by alpha+beta-hemolysin and beta-hemolysin isolates . The least virulent isolates were the non-hemolytic S . aureus strains but even they were more virulent than the CNS strains tested . Antibodies against three different S . aureus antigens were detected by the ELISA in all mice that were inoculated with the S . aureus strains but not in any of those with the CNS strains . Immunoblot test against various S . aureus strains as antigens showed high cross-reactivity among the S . aureus strains but only a slight similarity, restricted to the bands above 36 kDa, with the CNS sera . Low-dose inoculation of alpha or alpha+beta strains before challenge with homologous and heterologous strains protected the mice, whereas the two beta strains provided only partial protection . The inoculations of non-hemolytic S . aureus or the CNS strains did not elicit any protection . Our findings demonstrate that pre-exposure of mice to a low dose of certain S . aureus strains could provide protection and that the antibodies produced could have an important protective role.

J Clin Microbiol, 2003 Mar, 41(3), 1219 - 24
Five-test simple scheme for species-level identification of clinically significant coagulase-negative staphylococci; De Paulis AN et al.; A working scheme developed in our laboratory for identification (by species group and species) of coagulase-negative staphylococci (CNS) was evaluated with 201 consecutive isolates and then validated by using the reference method of Kloos and Schleifer (W . E . Kloos and K . H . Schleifer, J . Clin . Microbiol . 1:82-88, 1975) . This five-test simple scheme (referred to here as the simple scheme) combines the novobiocin susceptibility test with tests for urease, pyrrolidonyl arylamidase, ornithine decarboxylase, and aerobic acid from mannose . The addition of one or two tests within a particular species group could then positively identify the isolate . Two commercial systems, Staph-Zym (Rosco) and API-Staph (bioMerieux), along with results obtained by using Rosco diagnostic tablets (nongrowth tests), were also compared with the reference method . One isolate could not be identified even by the reference method . Of the remaining 200 strains, 191 (95.5%) strains were correctly identified with Staph-Zym and 171 strains (85.5%) were correctly identified with API-Staph . The most frequent clinical CNS species isolated were Staphylococcus epidermidis (50.5%), S . haemolyticus (18.5%), S . saprophyticus subsp . saprophyticus (16.0%), S . lugdunensis (6.0%), and S . warneri (2.5%) . The simple scheme validated with the reference method has demonstrated an excellent correlation in the identification of the three most frequent species isolated: S . epidermidis, S . haemolyticus, and S . saprophyticus subsp . saprophyticus . With the simple scheme, identification of CNS was possible within 24 h after the enzymatic tests were used, whereas up to 72 h is necessary for the growth tests . This methodology would be very useful in any clinical microbiology laboratory for the presumptive identification of CNS species groups and species.

J Antimicrob Chemother, 2003 Mar, 51(3), 619 - 23
Prevalence and mechanisms of low- and high-level mupirocin resistance in staphylococci isolated from a Korean hospital; Yun HJ et al.; Mupirocin has been used against Gram-positive pathogenic bacteria, and is a specific inhibitor of bacterial isoleucyl-tRNA synthetase . In this work, we have determined the prevalence of mupirocin resistance among staphylococci isolated from a Korean hospital, and have investigated the characteristics of the resistance . In Staphylococcus aureus, the prevalence of high-level mupirocin resistance was 5% (16 of 319), whereas low-level mupirocin resistance was not detected . In coagulase-negative staphylococci (CoNS) the rates of high- and low-level mupirocin resistance were 16.7% (34 of 204) and 10.3% (21 of 204), respectively . The high-level resistant strains contained the ileS-2 gene, which encodes a novel staphylococcal isoleucyl-tRNA synthetase . In contrast, all of the low-level mupirocin-resistant CoNS contained the mutation V588F, which is located near the conserved motif KMSKS, within the chromosomal staphylococcal isoleucyl-tRNA synthetase gene (ileS) . In conclusion, this work describes the recent, but rapid, emergence of two different types of mupirocin-resistant staphylococci in Korea, and the sequence and mutant characterization of the isoleucyl-tRNA synthetase of CoNS.

Epidemiol Infect, 2003 Feb, 130(1), 79 - 86
Febrile gastroenteritis after eating on-farm manufactured fresh cheese--an outbreak of listeriosis?
Carrique-Mas JJ, Hokeberg I, Andersson Y, Arneborn M, Tham W, Danielsson-Tham ML, Osterman B, Leffler M, Steen M, Eriksson E, Hedin G, Giesecke J.
An outbreak of febrile gastroenteritis affected consumers of on-farm manufactured dairy products from a summer farm in Sweden . Symptoms included diarrhoea, fever, stomach cramps and vomiting in 88, 60, 54 and 21% of cases identified . The median incubation period was 31 h . A cohort study with 33 consumers showed an attack rate of 52% and an association between the total amount of product eaten and illness (P=0.07) . Twenty-seven of 32 (84%) stool samples cultured for Listeria monocytogenes tested positive, although there was no association between clinical disease and the isolation of L . monocytogenes . In addition, gene sequences for VTEC and ETEC were detected in 6 and 1 subjects, respectively . Bacteriological analysis of cheese samples revealed heavy contamination with L . monocytogenes and coagulase positive staphylococci in all of them and gene markers for VTEC in one of them . Molecular profiles for L . monocytogenes isolated from dairy products, stool samples and an abscess from 1 patient who developed septic arthritis were identical . Results of both microbiological and epidemiological analyses point to L . monocytogenes as the most likely cause of this outbreak . The finding of markers for VTEC in some humans and cheese samples means that a mixed aetiology at least in some cases cannot be conclusively ruled out.

Epidemiol Infect, 2003 Feb, 130(1), 33 - 40
An extensive outbreak of staphylococcal food poisoning due to low-fat milk in Japan: estimation of enterotoxin A in the incriminated milk and powdered skim milk; Asao T et al.; An extensive outbreak of staphylococcal food poisoning occurred in Kansai district in Japan . As many as 13,420 cases frequently ingested dairy products manufactured by a factory in Osaka City . The main ingredient of these dairy products was powdered skim milk manufactured by a factory in Hokkaido . Staphylococcal enterotoxin A (SEA) (< or = 0.38 ng/ml) was detected in low-fat milk and approx . 3.7 ng/g in powdered skim milk . The total intake of SEA per capita was estimated mostly at approx . 20-100 ng . The assumed attack rate was considerably lower than those reported in previous outbreaks . SEA exposed at least twice to pasteurization at 130 degrees C for 4 or 2 s retained both immunological and biological activities, although it had been partially inactivated . The present outbreak was unusual in that the thermal processes had destroyed staphylococci in milk but SEA had retained enough activity to cause intoxication.

Antimicrob Agents Chemother, 2003 Mar, 47(3), 1148 - 50
Antipneumococcal and antistaphylococcal activities of ranbezolid (RBX 7644), a new oxazolidinone, compared to those of other agents; Hoellman DB et al.; For 260 pneumococcal and 266 staphylococcal strains, ranbezolid MICs ranged from < or =0.06 to 4 micro g/ml . The MICs for pneumococci were similar irrespective of the strains' beta-lactam, macrolide, or quinolone susceptibilities, and ranbezolid MICs for coagulase-negative staphylococci were lower than those for Staphylococcus aureus . Ranbezolid was bacteriostatic against pneumococci . Ranbezolid MICs were similar to or lower than those of linezolid . Vancomycin and quinupristin-dalfopristin were also very active.

Hua Xi Yi Ke Da Xue Xue Bao, 2001 Jun, 32(2), 167 - 71
{The HVR genotypes and their relationship with the resistance of methicillin-resistant staphylococci}; Liao F et al.; 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.

Arch Dis Child Fetal Neonatal Ed, 2003 Mar, 88(2), F89 - 93
A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units; Isaacs D; Australasian Study Group For Neonatal Infections; OBJECTIVE: To study late onset systemic infections with coagulase negative staphylococci . METHODS: Prospective longitudinal study of coagulase negative staphylococcal infection in 18 Australasian neonatal nurseries . RESULTS: From 1991 to 2000 inclusive, there were 1281 cases of coagulase negative staphylococcal (CoNS) sepsis, comprising 57.1% of all late onset infections . The male/female ratio was 1.27:1 (p < 0.05) . The incidence of CoNS sepsis was 3.46 episodes per 1000 live births . Most infected babies (71%) were 24-29 weeks gestation at birth (mode 26 weeks) . The first positive culture was day 7-14 in 49% of babies (mode 10 days) . Five cases of meningitis were reported, an incidence of 0.4% of all CoNS infections . Twenty nine babies (2.3%) had concurrent necrotising enterocolitis and CoNS septicaemia . Four babies (0.3%) died from CoNS infection, but CoNS infection possibly contributed to the death of an additional 20 babies (1.6%) . The mortality directly attributable to CoNS infection was significantly lower than that from late onset infections with Staphylococcus aureus (13.1%; relative risk (RR) = 36.1 (95% confidence interval (CI) 13.0 to 100.2) or with Gram negative bacilli (14.2%; RR = 45.5 (95% CI 16.8 to 123.3)) . CONCLUSIONS: CoNS are currently responsible for most late onset neonatal infections . Most infected babies are < 30 weeks gestation at birth, and usually present between 7 and 14 days of age . CoNS infections may be associated with necrotising enterocolitis, although causality is unproven . Neonatal CoNS infections are relatively benign: meningitis is rare and mortality low compared with infection from other organisms . Over-vigorous attempts to reduce the incidence of CoNS infections using prophylactic antibiotics are not advisable.

Surg Infect (Larchmt), 2000, 1(1), 39 - 47
Overview of resistant gram-positive pathogens in the surgical patient; Rapp RP; Staphylococci and enterococci are the most common pathogens in surgical-site and bloodstream infections . The emergence of drug resistance among these gram-positive bacteria thus poses a substantial threat to patients with surgical infections . Resistance to methicillin/oxacillin is frequently observed in Staphylococcus aureus isolates and is often accompanied by multidrug resistance . Vancomycin is usually the treatment of choice for infections caused by methicillin-resistant S . aureus (MRSA), so the recent appearance of S . aureus isolated with intermediate sensitivity to vancomycin is cause for concern . Vancomycin resistance has already appeared in most species of enterococci . Infections caused by vancomycin-resistant enterococci (VRE) are associated with increased mortality compared to infections caused by vancomycin-sensitive isolates . Measures for preventing vancomycin resistance include reducing the use of vancomycin and other agents that appear to be associated with VRE, including third-generation cephalosporins and anti-anaerobic drugs . Third-generation cephalosporins have also been implicated in the increased prevalence of MRSA infections . Prudent use of existing antibiotics is an essential strategy for combating the rising tide of drug-resistant gram-positive pathogens.

Proc Natl Acad Sci U S A, 2003 Mar 4, 100(5), 2795 - 800 Epub 2003 Feb 18.
Detection of secreted peptides by using hypothesis-driven multistage mass spectrometry; Kalkum M et al.; A method is presented for the rapid detection and characterization of trace amounts of peptides secreted from microorganisms, including pheromones, virulence factors, and quorum-sensing peptides . The procedure, based on targeted multistage MS, uses a novel matrix-assisted laser desorptionionization-ion trap mass spectrometer to overcome limitations of current MS methods (limited dynamic range, signal suppression effects, and chemical noise) that impair observation of low abundance peptides from complex biological matrixes . Here, secreted peptides that are hypothesized to be present in the supernatant, but that may not be sufficiently abundant to be observed in single-stage mass spectra, are subjected to multistage MS . Highly specific fragmentation signatures enable unambiguous identification of the peptides of interest and differentiation of the signals from the background . As examples, we demonstrate the rapid (<1 min) determination of the mating type of cells in colonies of Saccharomyces cerevisiae and the elucidation of autoinducing peptides (AIPs) from supernatants of pathogenic Staphylococci . We confirm the primary structures of the agrD encoded cyclic AIPs of Staphylococcus aureus for groups I, II, and IV and provide direct evidence that the native group-III AIP is a heptapeptide (INCDFLL) . We also show that the homologous peptide from Staphylococcus intermedius is a nonapeptide (RIPTSTGFF) with a lactone ring formed through condensation of the serine side chain with the C terminus of the peptide . This is the first demonstration of cyclization in a staphylococcal AIP that occurs via lactone formation . These examples demonstrate the analytical power of the present procedure for characterizing secreted peptides and its potential utility for identifying microorganisms.

J Biol Chem, 2003 May 16, 278(20), 18419 - 25 Epub 2003 Feb 18.
Resistance to beta-lactam antibiotics and its mediation by the sensor domain of the transmembrane BlaR signaling pathway in Staphylococcus aureus; Golemi-Kotra D et al.; Staphylococci, a leading cause of infections worldwide, have devised two mechanisms for resistance to beta-lactam antibiotics . One is production of beta-lactamases, hydrolytic resistance enzymes, and the other is the expression of penicillin-binding protein 2a (PBP 2a), which is not susceptible to inhibition by beta-lactam antibiotics . The beta-lactam sensor-transducer (BlaR), an integral membrane protein, binds beta-lactam antibiotics on the cell surface and transduces the information to the cytoplasm, where gene expression is derepressed for both beta-lactamase and penicillin-binding protein 2a . The gene for the sensor domain of the sensor-transducer protein (BlaR(S)) of Staphylococcus aureus was cloned, and the protein was purified to homogeneity . It is shown that beta-lactam antibiotics covalently modify the BlaR(S) protein . The protein was shown to contain the unusual carboxylated lysine that activates the active site serine residue for acylation by the beta-lactam antibiotics . The details of the kinetics of interactions of the BlaR(S) protein with a series of beta-lactam antibiotics were investigated . The protein undergoes acylation by beta-lactam antibiotics with microscopic rate constants (k(2)) of 1-26 s(-1), yet the deacylation process was essentially irreversible within one cell cycle . The protein undergoes a significant conformational change on binding with beta-lactam antibiotics, a process that commences at the preacylation complex and reaches its full effect after protein acylation has been accomplished . These conformational changes are likely to be central to the signal transduction events when the organism is exposed to the beta-lactam antibiotic.

J Hosp Infect, 2003 Feb, 53(2), 136 - 9
Bacterial contamination of surgical gloves by water droplets spilt after scrubbing; Heal JS et al.; Wound infection and deep sepsis can have disastrous consequences, particularly in orthopaedic surgery . Strict protocols, ultra-clean air, prophylactic antibiotics, and impervious gowns and drapes, have all been shown to diminish wound infection . However it remains a common and significant problem . The water droplets spilt from the surgeons hands after meticulous scrubbing with povidone iodine were cultured . The permeability of the surgical glove packaging to Gram-positive bacteria was also investigated . The water droplets from the surgeon's arms contained environmental and potentially pathogenic bacteria including a micrococcus, a coliform and coagulase-negative staphylococci . The paper packaging for the range of sterile surgical gloves tested was discovered to be permeable to Gram-positive bacteria . In conclusion accidental water droplet contamination of surgical gloves is a potential source of infection . Alternative recommendations are made .

J Chemother, 2002 Dec, 14(6), 574 - 8
Effect of aminoglycosides (sub-MICs) on adherence of coagulase-negative Staphylococci to intraocular lens surface; Chisari G et al.; The authors evaluated the in vitro effects of subinhibitory concentrations (sub-MICs) of aminoglycosides (gentamicin, netilmicin and tobramycin) on the adherence of coagulase-negative staphylococcus to intraocular lens (PMMA, acrylic and heparin) surface . The five strains of coagulase-negative Staphylococcus epidermidis used (S . epidermidis IMe7, IMe11, IMe27, IMe29 and IMe31) were tested for their ability to produce slime . The minimum inhibitory concentrations (MIC) indicated high susceptibility in vitro to the antibiotics and homogeneous values . The adhesion tests without antibiotics (K1, K2 and K3) for every time considered (30 min, 60 min and 180 min) and for all examined strains showed more constant adhesive activity on the surface of acrylic intraocular lens (IOLs) than on the surface of heparin IOLs . The aminoglycosides tested were able to reduce adhesivity by coagulase-negative S . epidermidis slime to the IOL surfaces, even at sub-MICs . The documentation obtained by scanning electron microscope shows the growth of a strain of S . epidermidis IMe11 after 180 minutes of contact which remains adherent to the surface of the acrylic IOLs.

Indian J Pathol Microbiol, 2000 Jan, 43(1), 41 - 5
Study of coagulase negative staphylococci isolated from blood and CSF cultures; Seetha KS et al.; Coagulase negative Staphylococci (CONS) which were considered as laboratory contaminants and normal flora of skin in man, have emerged as opportunistic pathogens . The infection with CONS has been reported since 1950 with increasing frequency and has been implicated as the causative agents of certain categories of patients viz, neonates with sepsis, cardiac patients with prosthetic valves, immunocompromided patients which include end-renal stage disease, and renal transplantation, burns and cancer patient . These are causing problems to clinicians because of their drug resistance . 180 strains of CONS isolated from blood and CSF during the period of 2 years (Jan 1997-Dec 1998) were studied . Not only they were resistant to Penicillin (P), Ampicillin, (Amp), Oxacillin (Ox), but also developing resistance to Vancomycin (Van) which pose a therapeutic problem . So this study was undertaken and this area needs further exploration.

New Microbiol, 2003 Jan, 26(1), 39 - 45
Methicillin resistance in staphylococci isolated from subclinical mastitis in sheep; Corrente M et al.; One hundred ovine milk samples were subjected to bacteriological analysis to detect staphylococci . Twenty-four staphylococcal strains isolated were characterised for methicillin resistance with disk diffusion test (DDT) after incubation at 24 and 48 h, oxacillin agar screen test, Minimal Inhibitory Concentration (MIC), nitrocefin test for beta-lactamase production and PCR for the mecA gene . Nine staphylococcal strains resulted resistant in DDT; some differences in the halo diameter at double incubation period were noted; eight of these strains were resistant in MIC test; just one strain was positive to oxacillin agar screen test . All strains were mecA negative by PCR and positive by nitrocefin test . On the basis of these results methicillin-resistant strains can be classified as beta-lactamase hyperproducers.

Diagn Microbiol Infect Dis, 2003 Jan, 45(1), 13 - 22
Isolation of methicillin-resistant coagulase-negative staphylococci from patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and comparison of different molecular techniques for discriminating isolates of Staphylococcus epidermidis; de Mattos EM et al.; Coagulase-negative staphylococci (CNS) have emerged as an important pathogen in nosocomial infections . About 80%-90% of CNS isolates associated with hospital infections are methicillin-resistant coagulase-negative staphylococci (MRCNS) . The aims of this study were to screen for MRCNS isolates in the flora of a small population of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and to evaluate the discriminatory power of different molecular methods: pulsed-field gel electrophoresis (PFGE), mecA location, ClaI/mecA polymorphism and arbitrarily primed polymerase chain reaction (AP-PCR) for characterizing isolates of methicillin-resistant Staphylococcus epidermidis (MRSE) . Seventy-nine CNS isolates were recovered from the 11 CAPD patients studied . Using a methicillin screening agar and a DNA specific mecA probe we verified that 30 of the 79 (38%) CNS isolates were resistant to methicillin (MRCNS) . Twenty-two of the 30 MRCNS (73%) were MRSE, 7 (23%) methicillin-resistant S . haemolyticus (MRSH(ae)) and 1 (3%) methicillin-resistant S . hominis (MRSH(om)) . All patients analyzed carried MRCNS in their flora, in one or more sites . Since CAPD patients have high risk for developing peritonitis, the colonization of these patients with MRCNS might represent an additional problem, due to the therapeutic restrictions imposed by these multiresistant isolates . A wide genetic diversity was verified when the PFGE of the MRSE isolates was analyzed . The 22 MRSE isolates displayed a total of 15 PFGE different patterns (11 PFGE types and 4 subtypes) . The location of mecA in the SmaI-fragmented genome DNA did not bring any additional advantage for epidemiologic characterization of the isolates . The ClaI/mecA polymorphism was able to correctly discriminate 12 from the 15 PFGE patterns . In addition, the DNA of 20 MRSE isolates were used for AP-PCR typing . These isolates belonged to 14 PFGE patterns (11 types and 3 subtypes) and displayed 15 genotypes (for the association of PFGE, mecA location and ClaI/mecA polymorphism) . A total of 17 different amplification patterns was verified using the primer 1 . Only for 2 genotypes, strains having identical genetic backgrounds were further discriminated by AP-PCR (2 of 15 genotypes (87%) for AP-PCR and 1 of 15 genotypes for PFGE; (93%) . Concluding, our results indicated that the AP-PCR can be an alternative and useful tool for monitoring and genotyping MRSE colonization and also to molecular characterizing MRSE outbreaks in hospitals.

J Antimicrob Chemother, 2003 Feb, 51(2), 419 - 21
Detection of methicillin resistance in coagulase-negative staphylococci and in staphylococci directly from simulated blood cultures using the EVIGENE MRSA Detection Kit; Poulsen AB et al.; The EVIGENE MRSA Detection Kit was evaluated on coagulase-negative staphylococci (CoNS) from agar plates and on staphylococci directly from positive spiked blood cultures . For the CoNS study, a total of 242 isolates were tested, and of these 237 gave valid test results . For the 237 valid tests, all gave correct mecA classification . For the blood culture procedure, a collection of 51 mecA-positive Staphylococcus aureus, 21 mecA-negative S . aureus, 31 mecA-positive CoNS and 28 mecA-negative CoNS were used for the simulated blood cultures . For the S . aureus strains, all gave valid test results and correct mecA classification . One of the MRSA isolates gave a very faint nuc signal, and another four isolates gave results close to the cut-off of the kit; however, these were still clearly positive when read by the naked eye . For the CoNS isolates, 51 of the 59 strains gave valid results . All of these 51 strains gave correct mecA status . Thus the EVIGENE MRSA Detection Kit can provide fast and accurate determination of methicillin resistance in CoNS . This preliminary study of the blood culture procedure indicates that it is possible to achieve determination of methicillin resistance in staphylococci 8 h after positivity of the blood culture, making same-day detection of methicillin resistance possible.

Arch Pathol Lab Med, 2003 Jan, 127(1), e19 - 21
Favorable outcome after infusion of coagulase-negative staphylococci-contaminated peripheral blood hematopoietic cells for autologous transplantation; Nifong TP et al.; Bacterial contamination of peripheral blood hematopoietic cells collected for autologous bone marrow transplantation occurs sporadically . Although transfusion of contaminated hematopoietic cells without adverse clinical sequelae has been reported, detailed guidelines for transfusing cells with contamination are not available . We report a case of autologous hematopoietic cell transplantation that necessitated using multiple aliquots of peripheral blood hematopoietic cells known to be contaminated with coagulase-negative Staphylococcus bacteria . Prophylactic intravenous antibiotic therapy was given with the infusion of contaminated hematopoietic cells . The patient had positive results on a blood culture, but engraftment was successful, and serious adverse effects did not occur . With appropriate microbial identification and prophylactic antibiotic therapy, contaminated hematopoietic products can be safely infused when necessary with a good clinical outcome.

Mikrobiol Z, 2002 Sep-Oct, 64(5), 59 - 62
{Species composition and antibiotic sensitivity of staphylococci isolated from patients with furunculosis}; Kutsyk RV et al.; Biological properties and sensitivity to modern antibacterial drugs 54 strains of staphylococci isolated under furunculosis have been studied with the aim to optimize this disease treatment . Staphylococcus aureus was revealed with frequency 35.2 +/- 6.50%, S . epidermidis (31.5 +/- 6.32%), S . warneri (16.7 +/- 5.08%), S . hominis (7.4 +/- 3.56%), S . haemolyticus and S . saprophyticus (3.7 +/- 2.57%) as well as S . lentus (1.9 +/- 1.86%) were identified among coagulase-negative staphylococci . Methycillin-resistant staphylococci were isolated from 25.92% of patients with furunculosis . High level of resistance of furunculosis agents to erythromycin, clarythromycine, cephtriaxon, pephloxacyne, tetracycline, doxycycline, levomycetine and phosphomycine has been registered . Basing on the study of isolates antibioticograms, cephasoline is recommended as the selected drug under furunculosis, and tobramycin as the reserve antibiotic . Autovaccine was also made for the patients treatment.

Crit Care Med, 2003 Jan, 31(1), 52 - 9
Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection; Ranucci M et al.; OBJECTIVE: To evaluate a new antimicrobial treatment for central venous catheters in comparison with a traditional treatment, by assessing the catheter colonization and catheter-related bloodstream infection rates in two groups of patients . DESIGN: Multiple-center, prospective randomized study . SETTING: The medical and surgical departments of ten institutions . PATIENTS: Patients requiring a central venous catheter for medical or surgical pathologies between June 2000 and November 2001 . INTERVENTIONS: Patients in the control group received a conventional benzalkonium-treated double-lumen central venous catheter, while patients in the oligon group received an oligon-treated (polyurethane combined with silver, carbon, and platinum) catheter with the same characteristics . Data collection included demographics, preexisting clinical conditions, main pathology, catheter insertion, and management data . Catheter colonization was defined as the growth of > or = 15 colony-forming units in culture of catheter segments by the roll-plate method, or > or = 1000 colony-forming units for the sonication method, and catheter-related bloodstream infection was defined as isolation of the same organism from the colonized catheter and from the peripheral blood of a patient with clinical signs of bloodstream infection . MEASUREMENTS AND MAIN RESULTS: Data were obtained from 545 catheters . Of these, 132 catheters (24.2%) were positive for colonization . Patients in the oligon group demonstrated a lower risk for catheter colonization in the overall population (relative risk, 0.63; 95% confidence interval, 0.46-0.86; p = .003) and in the surgical subgroup (relative risk, 0.5; 95% confidence interval, 0.33-0.76;p = .001) . Significant differences between groups were detected for coagulase-negative staphylococci and Gram-negative bacilli colonization rates . Twenty-one patients (3.8%) were positive for catheter-related bloodstream infection, without significant differences between control and oligon groups . CONCLUSIONS: Oligon treatment is effective in limiting the catheter colonization rate . Due to the limited amount of events, this study lacked the power to detect significant differences in terms of catheter-related bloodstream infection rate.

Pediatr Infect Dis J, 2003 Jan, 22(1), 17 - 21
Persistent bacteremia and outcome in late onset infection among infants in a neonatal intensive care unit; Chapman RL et al.; BACKGROUND: Persistent bacteremia despite antibiotic therapy has been correlated with adverse outcomes, including focal suppurative complications and death . Coagulase-negative staphylococci (CONS) are the most common cause of nosocomial infection in infants requiring neonatal intensive care and might yield more substantial pathology if infection were persistent . METHODS: To compare the severity and features of persistent infection by CONS with those of other bacteria, we reviewed infants admitted to our neonatal intensive care unit from 1990 through 2001 who developed bacteremia at >5 days of age with recovery of the same bacterial species from blood for >24 h after initiation of antibiotic therapy to which the organism was susceptible . Cases were excluded if a focal complication was already present with the initial positive culture or if the medical record was unavailable . Outcomes of interest included focal suppurative complications, death attributable to infection and duration of hospitalization among survivors . RESULTS: We identified 62 infants with sustained infection, caused by CONS in 30 and by other organisms in 32 {10 Gram-negative, 22 Gram-positive (16 Staphylococcus aureus)} . Infants with persistent CONS had significantly lower birth weight and gestational age, but no difference was found for multiple other clinical and demographic risk factors . Indwelling vascular catheters were present at diagnosis in 85% of the infants (CONS 26 of 30, non-CONS 27 of 32) . Responses of bacteremia to catheter removal vs . in situ treatment did not differ between the groups . No differences were observed for death from all causes (27 vs . 34%), death attributable to infection (6 vs . 12%) or duration of hospitalization among survivors {median (interquartile range): 102 (73 to 167) 107.5 (89 to 130) days} . Focal suppurative complications were significantly more frequent in infants persistently infected with non-CONS (28 vs . 3%; P = 0.01) . Duration of persistence correlated with focal complication in non-CONS infants (r = 0.988; P < 0.001) . CONCLUSIONS: Although persistent infection with CONS occurs in significantly smaller and less mature infants than with non-CONS, death is no more frequent and focal complications are significantly less frequent . Infants with persistent infection should undergo aggressive evaluation for focal complications, with the yield expected to be higher in those with non-CONS.

J Burn Care Rehabil, 2003 Jan-Feb, 24(1), 37 - 41
Comparison of silver sulfadiazine 1%, mupirocin 2%, and fusidic acid 2% for topical antibacterial effect in methicillin-resistant staphylococci-infected, full-skin thickness rat burn wounds; Acikel C et al.; Silver sulfadiazine 1%, mupirocin 2%, and fusidic acid 2% were compared to assess the antibacterial effect of a once-daily application on experimental rat 15% full-skin thickness burn wounds seeded 24 hours earlier with a 10 standard strain of methicillin-resistant staphylococci . The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined at postburn day 7, beside the cultures of blood and lung biopsies . All tested topical agents were equally effective against methicillin-resistant in reducing local burn wound bacterial count and preventing systemic infection.

Semin Dial, 2003 Jan-Feb, 16(1), 30 - 7
Infection with antimicrobial-resistant microorganisms in dialysis patients; Berns JS; The prevalence of antimicrobial-resistant microorganisms in various health care settings, including outpatient dialysis facilities, has increased dramatically in the last decade . Antimicrobial use and patient-to-patient transmission of resistant strains are the two main factors that have contributed to this rapid increase . Methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci are commonly isolated as a cause of hemodialysis (HD) catheter-related bacteremia and peritoneal dialysis (PD)-related catheter infection and peritonitis . The widespread use of vancomycin in dialysis patients is of concern because of an increase in the prevalence of vancomycin-resistant enterococci (VRE) in dialysis patients . Staphylococci with reduced sensitivity to vancomycin have also appeared in dialysis patients . A more recent problem is the appearance of S . aureus isolates with a high degree of resistance to the topical antimicrobial agent mupirocin . This has been seen in PD patients who have received prophylactic application of mupirocin at the peritoneal catheter exit site . Appropriate antimicrobial use will help protect the efficacy of currently used antibiotics, such as vancomycin . Published guidelines for use of vancomycin should be followed . New antimicrobials such as linezolid and quinupristin/dalfopristin have activity against VRE and MRSA, but resistance to these agents has already occurred . Preventing transmission of antimicrobial-resistant microorganisms in health care settings, including outpatient dialysis facilities, is important in limiting the spread of these resistant organisms.

Br J Dermatol, 2003 Jan, 148(1), 46 - 50
Effects of staphylococci on cytokine production from human keratinocytes; Sasaki T et al.; BACKGROUND: Staphylococcus skin infection is characterized by the infiltration of numerous neutrophils within the epidermis; however, the precise mechanism of epidermal infiltration of neutrophils during skin infection with staphylococci is not well understood and the factors regulating the neutrophil recruitment are yet to be determined . OBJECTIVES: We investigated the effects of staphylococci on cytokine production from keratinocytes, specifically to elucidate the mechanisms of neutrophil infiltration within the epidermis in cutaneous microbial infection . METHODS: Cytokine production from human keratinocytes was examined after stimulation with heat-killed Staphylococcus aureus, S . epidermidis and S . intermedius . RESULTS: Interleukin (IL)-6 and IL-8 were detected in the culture supernatants by enzyme-linked immunosorbent assay but IL-1beta, monocyte chemotactic protein-1 and tumour necrosis factor-alpha were not . IL-6 and IL-8 mRNAs were also confirmed by reverse transcription-polymerase chain reaction in the keratinocytes stimulated with killed staphylococci for 1, 3, 6, 10 and 24 h . CONCLUSIONS: These results could explain the epidermal infiltration of neutrophils in cutaneous infection with staphylococci, suggesting that the analysis of cytokines might add valuable information for the pathogenesis of cutaneous infection with Staphylococcus species.

Zhongguo Zhong Yao Za Zhi, 2000 Dec, 25(12), 742 - 5
{Investigation on antibacterial activity of Forsythia suspense Vahl in vitro with Mueller-Hinton agar}; Li ZX et al.; OBJECTIVE: To evaluate the antibacterial activity of Forsythia suspensa in vitro with different media . METHOD: MIC determination of Forsythia suspensa against Staphylococci was performed by the agar dilution method . RESULT: MIC90 of decoction of Forsythia suspensa against Staphylococcus epidermidis in M-H agar was 1:640, but in nutrient agar 1:40, the antibacterial activity with M-H agar being 16 fold higher than nutrient agar . CONCLUSION: The M-H agar should be recommended to replace nutrient agar as medium in the antibacterial experiment of Traditional Chinese medicine, and it is better to use multipoint inoculating device in the sensitivity test.

Rev Mal Respir, 2002 Dec, 19(6), 760 - 6
{Acute pulmonary infections in elderly patients in institutions}; Durand-Gasselin B et al.; The high incidence of lower lung infections in elderly subjects in institutions is responsible for an increase in mortality both as the result of the infection itself and of the deterioration of pre-existing conditions . The multiple pathology of these elderly patients living in institutions necessitates particularly detailed diagnosis and management . While the pneumococcus remains the predominant organism the percentage of infections with staphylococci and Gram negative bacteria is higher than among younger subjects . The initial severity should be assessed by clinical and pathological criteria in the same way as the response to treatment . Transfer to hospital is often necessary . Among preventative measures anti-influenzal and anti-pneumococcal vaccines are recommended and reimbursed at 100%.

Vet Microbiol, 2003 Apr 2, 92(3), 245 - 52
Prepartum teat apex colonization with Staphylococcus chromogenes in dairy heifers is associated with low somatic cell count in early lactation; De Vliegher S et al.; A high number of dairy heifers freshen with udder health problems . The prevalence of teat apex colonization (TAC) with Staphylococcus chromogenes, one of the most widespread coagulase-negative staphylococci (CNS) in milk samples from freshly calved dairy heifers, was measured cross-sectionally in non-lactating heifers on eight commercial dairy farms in Belgium . The influence of age on this prevalence, and the association between teat apex colonization with S . chromogenes prepartum and quarter milk somatic cell count (SCC) in early lactation were studied . In total, 492 teat apices were sampled from 123 heifers . The age of the heifers varied from 8 to 34 months . Overall, 20% of the heifers had at least one teat apex colonized with S . chromogenes . Of all teats sampled, 10% were colonized with S . chromogenes . The chance of having at least one teat apex colonized with S . chromogenes increased with age of the heifer . The presence of prepartum teat apex colonization with S . chromogenes was not associated with intramammary infection (IMI) early postpartum with the same bacterium . On the contrary, teat apex colonization with S . chromogenes prepartum appeared to protect quarters in the first few days of lactation from having somatic cell count >or=200000cells/ml milk, commonly accepted as the threshold for intramammary infection.

Clin Infect Dis, 2003 Jan 15, 36(2), 159 - 68 Epub 2003 Jan 03.
Linezolid for the treatment of multidrug-resistant, gram-positive infections: experience from a compassionate-use program; Birmingham MC et al.; Linezolid was provided for treatment of multidrug-resistant, gram-positive infections through a compassionate-use program . Patients (n=796) received 600 mg of linezolid intravenously or orally every 12 h (828 treatment courses) . Bacteremia was present in 46% of infections, endocarditis was present in 10.6%, and line-related infections were present in 31.1% . Other infections included intraabdominal infections (15.1%), complicated skin and skin-structure infections (13.3%), and osteomyelitis (10.7%) . Causative pathogens included vancomycin-resistant enterococci (66.3%) and methicillin-resistant staphylococci (22.1%) . Clinical intent-to-treat (ITT) outcomes in the evaluable population were as follows: cure, 73.3%; failure, 6.8%; and indeterminate, 19.9% . Microbiological ITT outcomes in evaluable patients were as follows: cure, 82.4%; failure, 14.1%; and indeterminate, 3.5% . At the test of cure assessment, the clinical cure and microbiological success rates were 91.5% and 85.8%, respectively . The most common adverse events possibly related to linezolid use were gastrointestinal disturbances (9.8% of cases), thrombocytopenia (7.4% of cases), decreased hemoglobin/hematocrit levels (4.1% of cases), and cutaneous reactions (4.0% of cases) . Linezolid provided high rates of clinical cure and microbiological success in this complicated patient population, with very good overall tolerance.

Afr J Med Med Sci, 2002 Jun, 31(2), 127 - 30
Neonatal septicaemia in Ilorin: bacterial pathogens and antibiotic sensitivity pattern; Mokuolu AO et al.; All cases of septicemia among neonates admitted to the neonatal intensive care unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria between Jan 1995 and Dec 1996 were studied . Our aims were (1) to assess the incidence and microbial epidemiology of neonatal sepsis, (2) to generate baseline data and necessary research question for a proposed study on predictors of neonatal sepsis in our centre . Microbiology records of patients with confirmed septicemia was reviewed . Each of these babies had a single venous blood sample from a peripheral vein taken under aseptic conditions and before commencement of antibiotics . The needed data were entered into a proforma . Of the 198 neonates screened for sepsis, there were 61 (30.8%) positive blood cultures . Twenty-nine (48%) of these were inborn . The total number of live births in the hospital during the study period was 4118, thus giving a hospital-based incidence of neonatal sepsis of 7.04/1000 for in-born patients . The male:female ratio was 1.2:1 . Overall Staphylococcus aureus was the commonest pathogen, accounting for 18 (29.5%) of the total isolates . Other pathogens were as follows; coagulase negative Saphylococcus albus 15 (24.6%), Klebsiella spp 10 (16.4%) and unclassified Coliforms 9 (14.8%) . The predominant organisms in the first 48 hours were Gram negative bacilli; accounting for (70%) of the 10 isolates . Between 3 and 7 days of life the Gram positive cocci accounted for 12 (60%) of the 20 isolates while the Gram negative bacilli represented 40% . After 7 days, the predominant organism was Staphylococcus aureus (38.8%) while coagulase-negative Staphylococci were isolated in 7 of 31 isolates (22.6%) . The sensitivity pattern showed that 94% of the organisms were sensitive to azythromicin, 77.8% to streptomycin, 73.3% to gentamicin and 69.2% to ampicillin-sulbactam . For the cephalosporins the isolates showed a sensitivity rate of 69% to ceftriaxone, 66.7% to ceftazidime and 58.3% to cefuroxime . As a group the Gram positive organisms had 100% sensitivity to Azythromcin, 85% to ampicillin-sulbactam, 63% to ceftazidime and 62.5% to gentamicin . In the Gram negative group, the best overall sensitivity was to ceftriaxone (86.4%) . Gentamicin had 85.7% while sensitivity to ceftazidime was 60% . The distribution of the organisms causing early and late onset sepsis were different . For early onset sepsis, the Gram negative bacilli as a group were the commonest organisms while Staphylococcus aureus was the commonest cause of late onset sepsis . There was a lower incidence of sepsis compared to reports from other parts of the country . This, in addition to differences in antibiotic sensitivity pattern call for more multi-centre studies on predictors of neonatal sepsis . The antibiotic sensitivity profiles suggest that the initial empirical choice of ampicillin-sulbactam and gentamicin appears to be the most rational for our environment.

J Clin Microbiol, 2003 Jan, 41(1), 118 - 23
Bloodstream infection in neutropenic cancer patients related to short-term nontunnelled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed-field gel electrophoresis; Seifert H et al.; To determine the rate of catheter-related bloodstream infection (CRBSI) among cases of primary bloodstream infection (BSI) in febrile neutropenic cancer patients with short-term nontunnelled catheters, quantitative paired blood cultures (Isolator) from the central venous catheter (CVC) and peripheral vein were obtained between November 1999 and January 2001 . Bactec blood culture bottles were obtained to determine the differential time to positivity (DTP) . CRBSI was defined as a quantitative blood culture ratio of >5:1 (CVC versus peripheral) with proven identity of isolates from positive peripheral and CVC blood cultures as confirmed by pulsed-field gel electrophoresis . Forty-nine episodes of primary BSI were detected among 235 cancer patients with febrile neutropenia . Of these, 18 episodes (37%) were CRBSI and 31 (63%) were BSI with an unknown portal of entry . Coagulase-negative staphylococci were present in nine cases of CRBSI (50%) . The identity of isolates from peripheral and CVC blood cultures was confirmed in all cases . Earlier positivity (>2 h) of CVC-drawn versus peripheral blood cultures was observed in 18 of 22 CRBSI-associated blood cultures (sensitivity, 82%; specificity, 88%; positive predictive value, 75%; negative predictive value, 92%) . In summary, CRBSI accounted for 37% of cases of primary BSI in this population of neutropenic cancer patients . DTP compares favourably with quantitative blood cultures for the diagnosis of CRBSI and may be particularly useful for patients in whom catheter salvage is highly desirable.

Am J Rhinol, 2002 Nov-Dec, 16(6), 319 - 21
Bacterial colonization of nasal steroid inhalers in chronic rhinosinusitis; Bhattacharyya N et al.; BACKGROUND: The aim of this study was to determine if nasal steroid inhalers harbor bacteria . METHODS: Nasal steroid inhalers were randomly selected from an adult patient population with chronic rhinosinusitis . Swab cultures of the tip of the nasal inhaler were obtained and submitted for microbiological analysis . Contemporaneous control cultures were obtained from freshly opened nasal steroid inhalers . Comparisons were conducted between bacterial recovery rates and types of organisms recovered from the patient and control groups . RESULTS: Among 31 nasal inhalers in use, 14 inhalers (45%) were found to harbor bacteria . The most common organisms were coagulase negative Staphylococci (11 inhalers) followed by oral flora (2 inhalers) and bacillus species (1 inhaler) . None of the 10 control cultures were found to harbor bacteria . Nasal steroid inhalers in use were more likely to have bacterial colonization than new inhalers (p = 0.008, chi-square) . CONCLUSIONS: Nasal steroid inhalers may harbor pathogenic bacteria . Therefore, they may serve as a vehicle for subsequent reinfection.

Zh Mikrobiol Epidemiol Immunobiol, 2002 Nov-Dec, (6), 65 - 8
{Enzyme immunoassay system for detection of staphylococcal enterotoxin, type C}; Fluer FS et al.; An enzyme immunoassay (EIA) system for detection of staphylococcal enterotoxin, type C, has been developed . The sensitivity of the system is 1 ng/ml . The optimum EIA parameters have been worked out . The absence of false positive results with heterologous toxins confirms the specificity of the assay system . The possibility of the detection of staphylococcal enterotoxin, type C, in staphylococci isolated from different sources has been shown.

Pancreas, 2003 Jan, 26(1), 18 - 22
The early increase in intestinal permeability and systemic endotoxin exposure in patients with severe acute pancreatitis is not associated with systemic bacterial translocation: molecular investigation of microbial DNA in the blood; Ammori BJ et al.; INTRODUCTION: Sepsis is the main cause of late mortality in patients with severe acute pancreatitis and is largely attributed to secondary infection of pancreatic necrosis with gram-negative enteric organisms . This is commonly preceded by a significant increase in intestinal colonization with such microbes and with early increases in intestinal permeability, thus suggesting a mechanism of bacterial translocation . Whilst cultures of blood specimens from these patients often remain sterile, it is conceivable that bacteria might translocate in small volumes with detrimental effects but elude detection by standard microbial culture techniques . AIMS: To investigate the incidence and frequency with which bacterial DNA may exist in the systemic circulation of patients with acute pancreatitis and to relate that to disease severity, changes in intestinal permeability, and systemic endotoxin exposure . METHODOLOGY: Blood samples were obtained at admission and on days 3 and 7 from 26 patients with acute pancreatitis (seven with severe cases) and from 10 healthy controls for DNA extraction and standard microbial cultures . Polymerase chain reaction techniques were used to amplify a gene region (16S ribosomal RNA) found in all bacteria . Levels of serum endotoxin and antibodies to endotoxin core (EndoCAb) were measured at admission, and intestinal permeability to the macromolecule polyethylene glycol 3350 was determined within 72 hours of the onset of symptoms . RESULTS: Blood cultures yielded and enterococci for one patient with a severe attack and coagulase-negative staphylococci for another patient with a mild attack . No bacterial DNA was found in any of the samples . Endotoxemia was detected in 20 patients (five with severe cases), and levels of serum IgM EndoCAb were depleted in patients with severe attacks but remained relatively unchanged during mild attacks (p = 0.033) . Intestinal permeability was significantly increased in patients with severe attacks of acute pancreatitis but remained unchanged during mild attacks (p < 0.05) . CONCLUSIONS: Whilst severe attacks of acute pancreatitis are associated with early derangement in gut barrier function and systemic endotoxin translocation, there is no molecular evidence for associated bacterial "translocation."

Presse Med, 2002 Nov 30, 31(38), 1807 - 9
{Concentrations preventing resistance mutations against fluoroquinolones}; Dubreuil L; AS A PRECAUTION: The new fluoroquinolones are clearly active on both Gram negative and Gram positive bacteria and on intracellular and strictly anaerobic bacteria, with excellent pharmacological properties . Nevertheless, there is a risk of resistant mutants appearing due to selective pressure, that would rapidly delete their activity . CONCENTRATIONS AVOIDING MUTATIONS: Among the definitions envisaged for the concept of a concentration that would prevent mutations or "mutation preventing concentration" (MPC), the most frequently retained is the concentration at which no mutant appears in the presence of a high inoculum . VALUES OF CONCENTRATIONS PREVENTING MUTATIONS: These have been established for Gram negative bacilli, for staphylococci methicillinsusceptible and for pneumococci . The MPC values are not correlated with those of the minimum inhibitory concentration (MIC), they are related to the bactericidal potential of fluoroquinolones . IN PRACTICE: Despite their limits, the MPC are of major interest for the prevention of mutants, which are always dangerous, since their underlying resistance mechanism is eventually unknown.

Infect Immun, 2003 Jan, 71(1), 140 - 6
Fibronectin bound to the surface of Staphylococcus aureus induces association of very late antigen 5 and intracellular signaling factors with macrophage cytoskeleton; Shinji H et al.; Staphylococcus aureus Cowan I and a clinically isolated coagulase-negative Staphylococcus strain, S . saprophyticus 10312, were found to have two fibronectin binding proteins, FnBPA and FnBPB . While both staphylococci bound to serum fibronectin to a similar extent, fibronectin binding significantly increased the phagocytic activity of macrophages against S . aureus (by ca . 150%) but not against S . saprophyticus . This enhancing effect of fibronectin was inhibited by an RGD sequence-containing peptide and also by anti-very late antigen 5 antibody . This suggests that the effect is mediated by very late antigen 5 expressed on macrophages . In macrophages ingesting fibronectin-bound Cowan I, alpha(5) and beta(1) chains were associated with the cytoskeleton . Cytosolic signaling factors such as paxillin, c-Src, and c-Csk were also associated with the cytoskeleton . On the contrary, beta(3) integrin transiently disappeared from the cytoskeleton when macrophages ingested the fibronectin-treated S . aureus Cowan I . Furthermore, the Src kinase family tyrosine kinase Lyn dissociated from the cytoskeleton . These cellular components did not respond in a fibronectin-dependent manner when macrophages phagocytosed S . saprophyticus . This means that only fibronectin-treated S . aureus Cowan I induces the accumulation of very late antigen 5, which in turn induces the association of paxillin and tyrosine kinases . It is thought that the phagocytic activity of macrophages against fibronectin-treated S . aureus was increased by signaling via the activation of very late antigen 5.

J Antimicrob Chemother, 2003 Jan, 51(1), 113 - 22
Antibacterial effect of beta-thujaplicin on staphylococci isolated from atopic dermatitis: relationship between changes in the number of viable bacterial cells and clinical improvement in an eczematous lesion of atopic dermatitis; Arima Y et al.; Beta-thujaplicin (hinokitiol) is a tropolone-related compound purified from the wood of Chamaecyparis obtusa, SIEB: et Zucc . and Thuja plicata D . Don . All Staphylococcus aureus isolates were inhibited by beta-thujaplicin with MICs of 1.56-3.13 mg/L . However, a paradoxical zone phenomenon occurred, with each isolate producing regrowth at higher beta-thujaplicin concentrations . Other antimicrobial agents showed a wide range of MICs . The combination of beta-thujaplicin and zinc oxide inhibited the paradoxical zone phenomenon, and enhanced killing activity against clinically isolated staphylococci . Large numbers of viable bacterial cells, especially S . aureus cells, were detected in the skin surface of atopic dermatitis, in comparison with those in healthy volunteers . The number of cells increased as the severity of the skin condition worsened . Topical application of beta-thujaplicin resulted in a reduction in the number of bacterial cells on the skin surface, and an improvement in skin condition after treatment . The results of this study suggest that the degree of reduction in the number of viable bacterial cells in an eczematous lesion of atopic dermatitis is related to the degree of improvement in skin condition.

J Antimicrob Chemother, 2003 Jan, 51(1), 59 - 68
Multicentre surveillance of antimicrobial resistance in enterococci and staphylococci from Colombian hospitals, 2001-2002; Arias CA et al.; Invasive isolates of staphylococci and enterococci were collected from 15 tertiary care centres in five Colombian cities from 2001 to 2002 . A total of 597 isolates were available for analysis . Identification was confirmed by both automated methods and multiplex PCR assays in a central laboratory . Staphylococcus aureus and coagulase-negative staphylococci (CoNS) corresponded to 49.6% and 29.6% of isolates, respectively, and 20.8% were identified as enterococci . MICs of ampicillin, ciprofloxacin, chloramphenicol, erythromycin, gentamicin, linezolid, oxacillin, rifampicin, teicoplanin, tetracycline, trimethoprim/sulfamethoxazole (SXT) and vancomycin were determined using an agar dilution method as appropriate . Screening for vancomycin-resistant S . aureus was also carried out on brain-heart infusion agar plates supplemented with vancomycin . The presence of mecA and van genes was investigated in methicillin-resistant staphylococci and glycopeptide-resistant enterococci (GRE), respectively . All staphylococci were susceptible to vancomycin, teicoplanin and linezolid . No VISA isolates were found . In S . aureus and CoNS, the lowest rates of resistance were found for SXT (7.4%) and chloramphenicol (10.7%), respectively . Resistance to oxacillin in S . aureus and CoNS was 52% and 73%, respectively . The mecA gene was detected in 97.5% of methicillin-resistant S . aureus isolates . In enterococci, resistance to glycopeptides was 9.7%: vanA (58.3%) and vanB (41.7%) genes were found . Pulsed-field gel electrophoresis indicated that the GRE isolates were closely related . Rates of resistance to ampicillin, ciprofloxacin, chloramphenicol, rifampicin and high levels of gentamicin and streptomycin were 9.7%, 27.4%, 8.9%, 43%, 17% and 28.2%, respectively . All enterococci were susceptible to linezolid.

Pathol Biol (Paris), 2002 Nov, 50(9), 552 - 9
{Bacteremia caused by coagulase-negative staphylococci: incidence, frequency of teicoplanin resistance and molecular epidemiology}; Bertrand X et al.; All the patients hospitalised at Besancon Hospital between October 2000 and December 2000 were included in a prospective study in order to determine the incidence of bloodstream infections caused by coagulase-negative staphylococci (CNS), the prevalence of decreased susceptibility to glycopeptides and the molecular epidemiology of these pathogens . CNS isolates from bloodstream infections were collected and characterised by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed field gel electrophoresis . Forty-five episodes of CNS bacteremia occurred in 43 patients . The crude incidence of infected patients was 0,51 per 1,000 days of hospitalisation . These 45 bacteremia represented 23.3% of the total number of bacteraemia . Forty three of 45 bacteremia were studied, 36 were positive with a single PFGE pattern, 5 bacteraemias with 2 PFGE patterns, and 2 bacteraemias with 3 PFGE patterns . We identified 52 distinct PFGE patterns and 42 major PFGE patterns (35 were isolated in a single patient, 5 in 2 patients and 2 in 3 patients) . The dendrogram generated showed deep but limited branching, each large branch corresponding to a species . Of these CNS isolates, 28.8% and 25.0% showed decreased susceptibility to teicoplanin, with the reference method and E-test respectively . The 16 strains belonging to multiple PFGE patterns were not more resistant to teicoplanin . Clonal dissemination did not seem to play a major role in the spread of glycopeptides resistance among CNS.

J Vet Med B Infect Dis Vet Public Health, 2002 Nov, 49(9), 419 - 23
Identification and antimicrobial susceptibility of coagulase positive staphylococci isolated from healthy dogs and dogs suffering from otitis externa; Tejedor Junco MT et al.; A total of 67 strains of coagulase positive staphylococci isolated from healthy dogs and dogs suffering from otitis externa were studied . Twenty-two isolates were from healthy dogs (five from hound dogs and 17 from companion dogs) and 45 from dogs suffering otitis externa (14 from hound dogs and 31 from companion dogs) . Presumptive identification was attempted using the following tests: production of acetoin, anaerobic utilization of mannitol, acid production from mannitol, presence of beta-galactosidase, and growth on P agar supplemented with different concentrations of acriflavine . Susceptibility of staphylococci to 16 antibiotics was determined . Most effective antibiotics were imipenem, amoxycillin/clavulanic acid, ciprofloxacin, tobramycin, gentamicin and marbofloxacin . Penicillin, ampicillin and polymyxin B showed the lowest activity . There were no significant differences in antimicrobial susceptibility among isolates from healthy dogs and dogs suffering from otitis externa.

Crit Care Med, 2002 Dec, 30(12), 2632 - 5
Inflammation at the insertion site is not predictive of catheter-related bloodstream infection with short-term, noncuffed central venous catheters; Safdar N et al.; BACKGROUND: Noncuffed, percutaneously inserted central venous catheters (CVCs) are widely used and cause at least 250,000 bloodstream infections (BSIs) in U.S . hospitals each year . We report a prospective study to determine whether inflammation at the insertion site is predictive of CVC-related BSI . METHODS: Percutaneously inserted, noncuffed CVCs inserted into the subclavian, internal jugular, or femoral vein in two randomized trials during 1998-2000 were prospectively studied; most patients were in an intensive care unit . The condition of the insertion site was evaluated daily by research nurses, quantifying pain (0, 1), erythema (0-2), swelling (0, 1), and purulence (0, 1); the lowest possible overall inflammation score was 0 and the highest was 5 . CVC-related BSI was confirmed in each case by demonstrating concordance between isolates from the catheter segment and from blood cultures by restriction-fragment DNA subtyping . RESULTS: Among 1,263 CVCs prospectively studied, 333 (26.3%) were colonized at removal; of these, 35 catheters (2.7%) caused BSIs (5.9 per 1000 CVC days) . BSIs were caused by coagulase-negative staphylococci (n = 27), enterococci (n = 4), enteric Gram-negative bacilli (n = 3), or (n = 1) . Most insertion sites showed little or no inflammation at the time of removal . There were no significant differences among mean scores for each inflammatory variable examined or overall score among colonized CVCs (0.1 +/- 0.1), catheters causing CVC-related BSI (0.2 +/- 0.4), and noncolonized CVCs (0.1 +/- 0.1) . The sensitivity of local inflammation for diagnosis of CVC-related BSI was dismal (0-3%) . CONCLUSION: Local inflammation is uncommon with infected CVCs, probably because most catheter-associated infections are currently caused by coagulase-negative staphylococci, a pathogen that incites little local or systemic inflammation . Whereas overt inflammation of the insertion site should raise suspicion of CVC-related BSI caused by or Gram-negative bacilli, especially if the patient has fever or other signs of sepsis, in general, site appearance cannot be relied on to identify catheter colonization or CVC-related BSI.

Symp Ser Soc Appl Microbiol, 2002, (31), 158S - 162S
Susceptibility of antibiotic-resistant cocci to biocides; Fraise AP; Biocide resistance has hitherto been a poorly studied subject, possibly due to the belief that such resistance was rare and clinically insignificant . Various recent findings, however, have underlined the importance of biocide resistance as a clinically relevant phenomenon . Outbreaks of biocide-resistant organisms in hospitals have been described and the genetic mechanism for resistance to quaternary ammonium compounds (QACs) in Staphylococcus aureus has now been elucidated . Mycobacteria resistant to commonly used endoscope disinfectants are now commonly reported and have caused numerous adverse clinical events . Cross-resistance between triclosan and antituberculous drugs has been demonstrated in other strains of mycobacteria . This is related to a common mechanism of action . The work presented here describes studies into the biocide resistance of antibiotic-resistant cocci and attempts to create biocide-resistant strains in vitro . Strains of staphylococci (including methicillin-resistant Staph . aureus (MRSA)) and enterococci (including vancomycin-resistant enterococci (VRE)) had their susceptibility to biocides assayed using broth macro dilution methods and resistant strains were selected by serial subculture on biocide-containing media . Mutants were created with relative ease; for instance, triclosan minimal bactericidal concentrations (MBCs) increased from 0.002 to 3.12 mg l(-1) . Some strains of MRSA which have intermediate resistance to glycopeptides were demonstrated to have decreased susceptibility to some biocides . Biocide resistance amongst enterococci was demonstrated although there was no clear correlation between biocide and antibiotic resistance . The exact mechanisms of resistance in these strains are still being studied but it is clear that biocide resistance is an important clinical phenomenon.

Medicina (B Aires), 2002, 62 Suppl 2, 52 - 5
{Pharmacokinetic characteristics and antimicrobial spectrum of teicoplanin}; Paganini H et al.; Teicoplanin is a glycopeptide antibiotic with similar spectrum to vancomycin . Its long half-life permits administration in a single daily dose . The adverse effects of teicoplanin are less frequent than those of vancomycin . Rash and local intolerance are the most frequent . Staphylococcus aureus, coagulase-negative staphylococci and Enterococcus sp . are susceptible to teicoplanin . Clinical data have shown teicoplanin to be less nephrotoxic than vancomycin when combined with amino glycosides . Teicoplanin, alone or in combination with additional antibacterial drugs, has proven to be effective in the treatment of several Gram-positive infections, such as sepsis, bone and joint infections, endocarditis and skin and soft tissue infections . Clinical efficacy was obtained in more than 90% of the patients treated . Similar data have been reported in adults, children and elderly patients . Due to its easy administration and dosage, teicoplanin is a treatment of choice for outpatient parenteral therapies.

Medicina (B Aires), 2002, 62 Suppl 2, 48 - 51
{Role of teicoplanin in the ambulatory treatment of infections in children due to gram-positive microorganisms}; Debbag R et al.; Infections caused by Gram-positive bacteria remain a major cause of morbidity and mortality . Teicoplanin is a glycopeptide antibiotic with similar spectrum to vancomycin . Easy administration and dosage encourage its use in children, particularly due to its long half-life which allows single daily dose regimens . We evaluated the efficacy of teicoplanin in severe infections in children due to Gram-positive organisms . We retrospectively analyzed 171 children with proven or suspected Gram-positive infection treated with teicoplanin between January 1996 and December 2000 . Of them, 166 cases were valuable for clinical assessment . Staphylococcus aureus (72) and coagulase-negative staphylococci (38) were the most frequent pathogens isolated . Osteoarthritis (35) and catheter-related infections (31) were the predominant clinical foci . The cure and improvement rates were 88% (150 patients) and 5% (9 patients) respectively . There were 7 (4%) cases of therapeutic failure . Mean treatment duration was 10 +/- 34.3 days (range: 1-205) . Adverse events were registered in 11 patients (6%, 15 adverse events) . In this study population, teicoplanin was safe and effective in the ambulatory treatment of severe Gram-positive infections in children.

Medicina (B Aires), 2002, 62 Suppl 2, 40 - 7
{Teicoplanin in the treatment of bone and joint infections due to methicillin resistant staphylococci . Experience in adult patients}; Pensotti C et al.; We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA) . We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS) . Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT) . The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs . 46%, p = 0.001; 100 vs . 33%, p = 0.0049 and 76 vs . 50%, p = 0.09) . All SA were cured . The overall efficacy of T was higher in IAA with implant removal vs . surgical debridement (100 vs . 54%, p = 0.045) . In all cases, T was similarly effective when administered three times a week vs . daily administration, when associated to AS . The savings derived from OPAT were 897 days/bed and USS 179,400 . Adverse effects were few and light (8 episodes, 9%) . The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections . The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods.

Medicina (B Aires), 2002, 62 Suppl 2, 36 - 9
{Teicoplanin in the prophylaxis of surgical infections and bacterial endocarditis}; Nacinovich F et al.; Antibiotic prophylaxis has become a standard of care in all surgical categories, since its impact in reducing the incidence of post-operative infections has now been well established . Antibiotic prophylaxis should target expected pathogens . Glycopeptide-based regimens have been considered a choice for surgical procedures, since Gram-positive bacteria are the pathogens most commonly isolated from wound infections . In orthopedics, cardiac, vascular and other clean surgical procedures, staphylococci (S . aureus and coagulase-negative staphylococci) are responsible for 70-90% of post-surgical infections . The isolation of methicillin-resistant strains has also risen to alarmingly high rates . This article focuses on the results of clinical trials on the efficacy of teicoplanin as prophylaxis in clean surgical procedures.

Medicina (B Aires), 2002, 62 Suppl 2, 30 - 5
{Methicillin resistant Staphylococcus}; Marin M; The pathogenic potential of Staphylococcus aureus is well known as well as its role both in nosocomial and community-acquired infections . When penicillin was introduced by mid '40s, S . aureus was almost 94% susceptible to this drug . Widespread resistance to penicillin developed in the '50s, followed by resistance to semi synthetic penicillins in the '60s and '70s . Since then, strains of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci have spread worldwide . The prevalence of methicillin-resistant S . aureus varies geographically . In our country it reaches nearly 50% . Methicillin resistance in Staphylococci develops due to an additional penicillin binding protein, PBP2a, which is encoded by gene mecA, the responsible of methicillin resistance . Methicillin resistance in Staphylococcus aureus and in coagulase-negative staphylococci represents a serious problem both for the microbiologist and the physician . A special feature of methicillin resistance is its heterogeneous nature with different levels of resistance . Most clinical isolates show a heterogeneous pattern under routine growth conditions . The high prevalence of methicillin-resistant staphylococci compromises the use of semi synthetic penicillins for empiric treatments in many institutions, thus increasing the use of vancomycin . Until 1996, glycopeptides were almost universally active against S . aureus but it was then that the first glycopeptide-intermediate S . aureus (GISA) was described and isolated in Japan, followed by France and USA . The exact mechanism involved has not been elucidated yet, although vancomycin resistance is associated with increased wall synthesis.

Medicina (B Aires), 2002, 62 Suppl 2, 25 - 9
{New therapeutic strategies with teicoplanin}; Carbone E et al.; Teicoplanin is a glycopeptide antibiotic with similar spectrum to vancomycin . However, unlike this drug, teicoplanin can be administered by i.v . or i.m . route once daily thanks to its long half-life (88 to 182 hours) . This pharmacokinetic characteristic is particularly interesting in infections that require extended antimicrobial therapy, where new therapeutic strategies may be considered . Long-term treatment with teicoplanin proved effective in the treatment of bone and joint infections due to methicillin-resistant staphylococci . Teicoplanin administered three times a week yields comparable clinical efficacy than daily administration with considerably improved cost-effectiveness . This aspect merits special attention, particularly when evaluating prolonged outpatient antibiotic therapy regimens . For synergic effects it is possible to associate teicoplanin with other antibiotics . Chronic suppressive antibiotic therapy with teicoplanin may be an alternative in carefully selected patients, particularly those carrying prosthetic devices.

Medicina (B Aires), 2002, 62 Suppl 2, 5 - 24
{Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci}; Stamboulian D et al.; Bone and joint infections are a group of complicated diseases with high morbidity . Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients . The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci . They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue . The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities . A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.

Int J Pharm, 2003 Jan 2, 250(1), 181 - 90
Enhanced intestinal absorption of vancomycin with Labrasol and D-alpha-tocopheryl PEG 1000 succinate in rats; Prasad YV et al.; Vancomycin hydrochloride (VCM) is a glycopeptide antibiotic used for the treatment of infections caused by methicillin-resistant staphylococci . It is water soluble, having a high molecular weight, and poorly absorbed from the gastrointestinal tract . Mixtures of VCM with Labrasol and D-alpha-tocopheryl polyethylene glycol 1000 succinate (TPGS) were prepared to improve oral absorption of VCM . Administration of VCM solution to rat ileum at a dose of 20 mg/kg did not result in detectable plasma VCM concentration . Formulation containing 50% of Labrasol resulted in a Cmax value of 5.86+/-0.97 microg/ml and an AUC(0-6h) value of 16.06+/-1.78 microgh/ml . Addition of TPGS to VCM solution at 12.5% concentration also increased the plasma VCM concentration with a Cmax value of 4.98+/-0.45 microg/ml . But the AUC(0-6 h) (9.87+/-1.90 microgh/ml) was significantly lower than that obtained with Labrasol . The addition of 5.0 and 25.0% TPGS to solutions of VCM containing 50% of Labrasol did not result in any significant increase either in Cmax or AUC(0-6 h) of VCM . Whereas the addition of 12.5% of TPGS has resulted in an increase in Cmax and AUC(0-6 h) by 2.2 and 2.4 times, respectively, suggesting that this concentration of 50% Labrasol and 12.5% TPGS (1:0.25) was optimum for improving intestinal absorption of VCM . A dose dependent decrease in the Cmax and AUC(0-6 h) values was observed when the dose of absorption enhancers was decreased by 50% with formulation containing Labrasol and TPGS in 1:0.25 ratio . The results of the study indicate that formulations containing Labrasol and TPGS improve intestinal absorption of hydrophilic macromolecular drug, VCM.

FEMS Microbiol Lett, 2002 Dec 17, 217(2), 125 - 32
Current status of pathogenetic mechanisms in staphylococcal arthritis; Tarkowski A et al.; Interactions between staphylococci and the joint tissues of the host lead typically to rapidly progressing and highly destructive processes . Staphylococci possess a vast arsenal of components and products that contribute to the pathogenesis of joint infection . Occasionally these compounds have overlapping activities and act either in concert or alone . Host responsiveness to staphylococcal infection displays an even more complex pattern . Most of the cells and molecules that participate in the innate immune system protect the host against bacteria . However, the staphylococci have developed systems that counteract endogenous protective mechanisms . Interestingly, certain cells and molecules of the acquired immune system potentiate the severity of infection by triggering exaggerated responses to the staphylococcal danger signals . This review deals with the intricate host-bacterium interactions that occur during experimental septic arthritis, and outlines potential preventive and treatment modalities .

Ophthalmologe, 2002 Dec, 99(12), 922 - 6
{Endophthalmitis following cataract surgery}; Hesse Y et al.; BACKGROUND: Infectious endophthalmitis is a serious complication following cataract surgery, since it often induces a substantial reduction of visual acuity . PATIENTS AND METHODS: We retrospectively evaluated the clinical data of 53 patients with endophthalmitis following cataract surgery who were treated at the department of ophthalmology of the University Hospital in Ulm between 1995 and May 2001.Of these patients, 50 had been referred.Clinical presentation, infecting organism, treatment and visual outcome were analysed with a followup ranging from 2 weeks up to 42 months (median: 6 months) . RESULTS: In 52 patients endophthalmitis was preceeded by cataract extraction and IOL implantation, in one case by secondary IOL implantation.Confirmed microbiologic growth was demonstrated from intraocular specimens in 26 out of 41 operated eyes (63%), the most frequent causative organisms were coagulase-negative Staphylococci (50%) . All isolated bacteria were sensitive to a combination of the antibiotics vancomycin and amikacin or vancomycin and ceftazidime . 13 patients were treated with intravenous antibiotic therapy alone . In 46% of patients, who were initially treated with intraocular antibiotic injections alone, required further therapeutic intervention for recurrent infection . Only 7.7% of the patients who initially underwent intraocular antibiotic injections combined with IOL removal or pars plana vitrectomy with or without IOL removal, required further surgical intervention . Initial visual acuity was hand movements (median) only but improved during follow-up to 0.2 (median) . CONCLUSIONS: In this series all tested bacteria were susceptible to the combination of vancomycin with either amikacin or ceftazidime . Aggressive initial treatment including IOL removal may be associated with a lower frequency of recurrent disease.

Hosp Med, 2002 Nov, 63(11), 653 - 6
The pathogenesis of atopic eczema; Friedmann PS; Atopic eczema is associated with a genetic predisposition to dysregulation of the immune system . T lymphocytes differentiate towards the Th2 type with promotion of immunoglobulin E antibodies . Allergic responses to environmental allergens develop and microbes, including staphylococci and pityrosporum yeasts, may contribute to the inflammatory process.

J Hosp Infect, 2002 Dec, 52(4), 273 - 80
Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study; Donnell SC et al.; We performed a prospective, observational, cohort study on 208 surgical neonates and infants between 1992 and 1997 . Surveillance cultures of the oropharynx and rectum were obtained at the start of parenteral nutrition and thereafter twice weekly . Blood cultures were taken on clinical indication only . Microbial translocation was diagnosed when the micro-organisms in the blood were not distinguishable from those carried in the oropharynx and/or rectum . Liver function was monitored weekly and when septicaemia was suspected . The incidence of septicaemia was 15% . The predominant micro-organisms (86%) were the low-level pathogens, coagulase-negative staphylococci and enterococci . Potential pathogens, including aerobic Gram-negative bacilli, were responsible for the remainder . Microbial translocation was responsible for 84% of septicaemic episodes in 76% of patients . The potential pathogens caused septicaemia significantly later than coagulase-negative staphylococci, at a time when liver function was significantly more impaired . In neonates and infants receiving parenteral nutrition, septicaemia is mainly a gut-derived phenomenon and requires novel strategies for prevention .

Vet Rec, 2002 Nov 16, 151(20), 600 - 5
Antimicrobial resistance in staphylococci from canine pyoderma: a prospective study of first-time and recurrent cases in Sweden; Holm BR et al.; In a prospective study involving eight veterinary clinics during 1995 and 1996, samples from first-time and recurrent cases of canine pyoderma were collected by a needle technique . Three hundred and ninety-four staphylococci were isolated and their susceptibility to various antimicrobial drugs was assessed by a microdilution technique . Resistance to macrolides, lincosamides, fusidic add, tetracycline and streptomycin was significantly more common in isolates from the recurrent cases than from the first-time cases; 20 per cent of the isolates from the first-time cases were resistant to three or more of the antimicrobials tested, compared with 45 per cent of those from the recurrent cases . Coresistance between macrolide-lincosamides, tetracyclines and streptomycin was common . No resistance to penicillinase-stable beta-lactams was observed . A comparison with earlier studies indicated that there had been a marked increase in resistance during the previous five years.

J Antimicrob Chemother, 2002 Dec, 50(6), 933 - 8
In vitro activity of quinupristin/dalfopristin, linezolid, telithromycin and comparator antimicrobial agents against 13 species of coagulase-negative staphylococci; John MA et al.; 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.

Clin Exp Immunol, 2002 Dec, 130(3), 409 - 14
Interleukin-10 ameliorates the outcome of Staphylococcus aureus arthritis by promoting bacterial clearance; Gjertsson I et al.; Staphyllococcus aureus-induced infections often result in high mortality and permanent joint destruction, despite treatment with antibiotics . IL-10 is typically regarded as an anti-inflammatory cytokine because it promotes a T helper cell type 2 response, and subsequently down-regulates cell mediated immune functions . To investigate the role of IL-10 in S . aureus-induced arthritis and sepsis, Balb/c mice, intact or defective with respect to IL-10 gene were intravenously inoculated with bacteria . IL-10-/- mice develop a more frequent and destructive arthritis compared to their congeneic controls . The mechanisms regulating such outcome may be due not only to the anti-inflammatory properties of IL-10 but also, directly or indirectly, to antibacterial features of this molecule . Indeed, inoculation of staphylococci to IL-10-/- mice resulted in higher bacterial load in blood and kidneys compared to congeneic controls . Altogether our data indicate that IL-10 is essential for efficient elimination of bacteria and thereby for protection against septic arthritis.

J Int Med Res, 2002 Sep-Oct, 30(5), 525 - 8
Demonstration of in vitro antagonism between fusidic acid and quinolones; Ertek M et al.; Fusidic acid is an antibiotic active against staphylococci and other bacterial pathogens . It is used in the treatment of staphylococcal infections usually in combination with other antibacterial agents . Reports of the clinical effects of antimicrobial combinations containing fusidic acid have been somewhat inconsistent . The aim of this study was to investigate the in vitro antagonism of fusidic acid and quinolones . Twenty-six staphylococci strains isolated from various clinical samples were tested . After detecting the diameter of the zone of inhibition around fusidic acid, levofloxacin, ciprofloxacin, ofloxacin and moxifloxacin for each strain, in vitro antagonism between fusidic acid and each quinolone was investigated using disk approximation . In all 26 strains, quinolones and fusidic acid were antagonist in vitro . The reason for this antagonistic effect and its clinical implications are not known . However, care should be exercised in prescribing quinolones and fusidic acid in combination.

Lik Sprava, 2002 Jul-Sep, (5-6), 27 - 31
{Efficacy of diagnostic plates with batumin in identification and indication of staphylococci}; Smirnov VV et al.; In investigations designed to study sensitivity of 763 clinical strains of microorganisms that belonged to different taxonomic groups with respect to batumin, a new antibiotic recovered from bacteria of the genus Pseudomonas, all members of the genus Staphylococcus displayed high sensitivity to batumin irrespective of their sensitivity or resistance to other antibiotics . High selectivity of batumin in respect to representatives of the genus Staphylococcus has been used to create a novel diagnostic preparation diastaph--a batch of paper disks with batumin (5 mkg) spread on them . Results of the trial given to the preparation diastaph suggest to us a high specificity of this identification option for staphylococci of different species in mono- and mixed cultures, a possibility of our using them simultaneously with or instead of the Hew-Leuffson medium, and an expediency of employment of batumin disks for a prompt preindication of staphylococci in a clinical setting while studying a material notable for a high probability that there are bacterial associations involving staphylococci.

Pediatr Infect Dis J, 2002 Nov, 21(11), 1000 - 4
Efficacy of subcutaneous tunneling for prevention of bacterial colonization of femoral central venous catheters in critically ill children; Nahum E et al.; BACKGROUND: Blood stream infections are a common and serious complication of central venous catheters (CVCs) . To decrease catheter colonization, some authors advocate tunneling the catheter in the subcutaneous tissue during insertion . This technique has proved effective in adults, but there are no data on its safety and efficacy in critically ill children . Our objective was to evaluate the efficacy and safety of subcutaneous tunneling of short term, noncuffed CVCs for the prevention of CVC-related infections in critically ill children . METHODS: A prospective randomized controlled trial was performed at a tertiary children's medical center in Israel and included children ages 0 to 18 years admitted to the pediatric intensive care unit or the pediatric cardiac intensive care unit from September 2000 to April 2001 who required placement of a femoral central venous catheter for >48 h . The children were randomized for tunneled or nontunneled insertion . The main outcome measures were bacterial colonization of proximal and distal catheter segments tested by semiquantitative technique and infectious or noninfectious complications of the CVC . RESULTS: Of 98 eligible children, 49 received tunneled catheters and 49 received nontunneled catheters . Patients' age ranged from 1 month to 16.5 years (mean, 3.07 +/- 2.48 years) . There were no significant differences between the groups in age, sex, disease severity {Pediatric Risk of Mortality III (PRISM) score}, duration of catheterization and underlying diseases . Bacterial colonization was found in 11 (22.4%) catheters in the nontunneled group compared with 3 (6.1%) in the tunneled group (P = 0.004) . Proximal segment colonization occurred in 7 (14.2%) nontunneled catheters and 2 (4.8%) tunneled catheters (P = 0.07), and distal segment colonization occurred in 3 (6.1%) and 9(18.3%) tunneled and nontunneled catheters, respectively (P = 0.053) . The main pathogens were coagulase-negative staphylococci, Pseudomonas spp . and Klebsiella spp . There was no statistically significant difference between the groups in the rate of bloodstream infection (2 in the tunneled group, 3 in the nontunneled) . Except for 1 case of subcutaneous hematoma, which resolved, there were no immediate or late complications of the tunneling procedure . CONCLUSION: Subcutaneous tunneling of CVCs in the femoral site is a safe procedure and decreases significantly the rate of CVC colonization in critically ill children.

Crit Care Med, 2002 Nov, 30(11), 2462 - 7
Population-based assessment of intensive care unit-acquired bloodstream infections in adults: Incidence, risk factors, and associated mortality rate; Laupland KB et al.; OBJECTIVE: Nosocomial bloodstream infections have been extensively investigated, but relatively few studies have specifically evaluated the epidemiology of intensive care unit-acquired bloodstream infections . The study objective was to define the incidence, risk factors, microbiology, and clinical outcomes of intensive care unit-acquired bloodstream infections . DESIGN: Population-based prospective cohort . SETTING: Multidisciplinary intensive care units . PATIENTS: All Calgary Health Region (population 930,000) adult patients admitted to multidisciplinary intensive care units (>/=48 hrs) from May 1, 1999, to April 30, 2000 . INTERVENTIONS: Blood sample analysis . MEASUREMENTS AND RESULTS: There were 1,158 admission episodes in 1,017 patients; 37% involved females, and mean +/- sd age and Acute Physiology and Chronic Health Evaluation II scores were 59.6 +/- 18.7 yrs and 23.4 +/- 7.7, respectively . Fifty-one patients developed intensive care unit-acquired bloodstream infections (first positive blood culture >/=48 hrs after intensive care unit admission) for an incidence of 4.4% and an incidence density of 5.2 per 1000 intensive care unit days . Younger age (adjusted odds ratio, 0.98; 95% confidence interval, 0.96-1.00, p =.01), longer intensive care unit length of stay (adjusted odds ratio, 4.74; 95% CI, 3.26-6.90, p <.001), and lower hematocrit (adjusted odds ratio, 0.95; 95% confidence interval, 0.90-1.00, p =.04) were significant independent predictors of intensive care unit-acquired bloodstream infections, and these infections were associated with an increased intensive care unit length of stay of 2.86 days (95% confidence interval, 2.29-3.57, p <.001) . Staphylococcus aureus (27%), coagulase-negative staphylococci (14%), and Enterococcus faecium (12%) were most commonly isolated . Four (8%) bloodstream infections involved antibiotic-resistant organisms, and ten (20%) were polymicrobial . In multivariate analysis, intensive care unit-acquired bloodstream infection was associated with an increased intensive care unit mortality rate (adjusted odds ratio, 2.03; 95% confidence interval, 1.03-4.00, p = 0.04) but not overall hospital mortality rate . CONCLUSIONS: One patient in 20 admitted to Calgary Health Region intensive care units acquires bloodstream infection and suffers longer intensive care unit stay and increased mortality rates . In our region, multiple antibiotic-resistant organisms are uncommon causes of bloodstream infections, suggesting that it may be safe to use narrower spectrum empirical treatment regimens than current guidelines recommend.

Nippon Rinsho, 2002 Nov, 60(11), 2187 - 93
{Bloodstream infection}; Touyama M et al.; Bloodstream infection is the most serious disease and the third mortality rate among nosocomial infections . Recently, catheter-related bloodstream infection(CRBSI) is the major cause of the bloodstream infection, related to serious complication, leading to increase in morbidity and mortality . Coagulase-negative staphylococci, Staphylococcus aureus, enterococci and Candida spp . are most commonly causes of CRBSI . A variety of methods such as aseptic insertion techniques and appropriate catheter care have proved effective, which are also preferable to prevent CRBSI . If CRBSI occurs, empirical antimicrobial therapy should be immediately started after appropriate cultures of blood and catheter sample are performed.

Biol Chem, 2002 Jul-Aug, 383(7-8), 1075 - 86
Extracellular proteases of Staphylococcus spp; Dubin G; Bacterial proteases secreted into an infected host may exhibit a wide range of pathogenic potentials . Staphylococci, in particular Staphylococcus aureus, are known to produce several extracellular proteases, including serine-, cysteine- and metalloenzymes . Their insensitivity to most human plasma protease inhibitors and, even more, the ability to inactivate some of these make the proteases potentially harmful . Indeed, several recent studies have shown that staphylococcal proteases are able to interact with the host defense mechanisms and tissue components as well as to modify other pathogen-derived virulence factors . A tight, cell density-dependent control of proteolytic activity expression, similar to that of the well-defined virulence determinants, further suggests the role of staphylococcal proteases in the infection process . Consistently, alterations in coordinated expression of extracellular proteins markedly diminished the virulence . However, despite these data and the fact that a strain deficient in sspABC operon coding for serine (sspA) and cysteine (sspB) proteases was highly attenuated in virulence in the animal infection model, it was impossible to unambiguously demonstrate the importance of any particular protease as a virulence factor . Therefore, it can be assumed that the orchestrated expression and interaction of a variety of extracellular and cell surface proteins rather than any particular one is responsible for the staphylococcal pathogenicity and that the proteases apparently play an important role in this complex process . Such redundant mechanism is very well suited for promoting the survival of staphylococci under diverse environmental conditions encountered in the infected host.

Microbiol Immunol, 2002, 46(9), 629 - 32
Identification of Staphylococcus xylosus isolated from C57BL/6J-Nos2(tm1Lau) mice with dermatitis; Won YS et al.; Coagulase negative staphylococci (CNS) are significant pathogens, particularly in medical device related infections and in immunocompromised patients . Five CNS strains were isolated from 5 NOS2 knockout mice with dermatitis . Histologically, granulomatous dermatitis was found in the skin around the ear with epidermal ulceration . Dermal lesions included pustules, necrosis, and accumulations of neutrophils and macrophages . Isolates of the bacterial strains were identified to be Staphylococcus xylosus by the API STAPH kit and 16S-23S intergenic transcribed spacer-PCR . These results demonstrate the potential of this organism to be an opportunistic pathogen in immunocompromised mice.

Acta Anaesthesiol Sin, 2002 Sep, 40(3), 149 - 51
Red Man's syndrome following administration of vancomycin in a patient under spinal anesthesia--a case report; Hui YL et al.; Prophylactic antibiotics are frequently administered during anesthesia to reduce the incidence of infection . The most common organisms revealed in wound infections are staphylococci . Vancomycin is the antibiotic of choice for resistant staphylococcal infections and bacterial endocarditis in patient allergic to penicillin . We had a case of tibial osteomyelitis, while undergoing removal of implants under spinal anesthesia developed hypotensions, bradycardia, consciousness change and skin erythematous macular rash after 0.1% vancomycin slow infusion for 10 min . After appropriate management, the patient recovered well and was discharged on the following day . Our report is intended to alert our colleagues that vancomycin can cause hypotension secondary to histamine release, direct myocardial depression and direct peripheral vasodilation . Even cardiac arrest had been reported in the literatures.

Clin Microbiol Infect, 2002 Sep, 8(9), 545 - 50
Clinical management of catheter-related infections; Fatkenheuer G et al.; Central venous catheters represent a major source of nosocomial bloodstream infections, which cause considerable excess morbidity . It is currently unknown to what extent these infections contribute to mortality . Most catheter-related infections (CRIs) are caused by Gram-positive organisms (mainly coagulase-negative staphylococci) . Definite diagnosis of CRI necessitates removal of the catheter in most cases . However, the recently described technique of differential time to positivity may allow diagnosis of CRI with the catheter left in place . Removal of the catheter has been standard clinical practice for the management of CRI in the past and is still recommended in many cases . In specific situations, such as infections of implanted catheters with coagulase-negative staphylococci, a trial of catheter salvage may be justified . In catheter-related bloodstream infection Staphylococcus aureus and Candida spp., the catheter should be removed immediately, due to the high risk of metastatic infection and increased mortality . A clinical work-up for the detection of additional foci (including transesophageal echocardiography in S . aureus infections) is advisable in these cases . All CRIs should be treated with antibiotics to which the causative agent has been shown to be susceptible . In addition to systemic antimicrobial therapy, antibiotic lock therapy may be applied, especially in patients with implanted long-term catheters if catheter salvage is attempted.

J Vet Med Sci, 2002 Oct, 64(10), 873 - 8
Effects of bovine lactoferrin by the intramammary infusion in cows with staphylococcal mastitis during the early non-lactating period; Kai K et al.; To evaluate the clinical effects of bovine lactoferrin on staphylococcal mastitis in Holstein cows during the early non-lactating period, 41 mammary quarters were selected randomly from 36 cows on 3 dairy farms . Twelve quarters were infused intramammarily with bovine lactoferrin . Twenty-nine quarters were infused with antibiotic as a control . In the bovine lactoferrin-infused group, 91.7% of mastitic quarters were cured at 7 days after calving, compared with 48.3% in the control group . Furthermore, the changes in mammary secretion induced by the infusion of bovine lactoferrin were investigated . Mean numbers of staphylococci in mammary gland secretions were significantly decreased in both 5 bovine lactoferrin-infused quarters and 5 antibiotic-infused control quarters (p<0.05) . Unlike in the control quarters, the mean total cell concentration in the mammary gland secretions increased in bovine lactoferrin-infused quarters . Similar results were obtained in 6 healthy quarters which were infused with bovine lactoferrin . In these quarters, the cell population contained mainly phagocytes such as polymorphonuclear leukocytes and cells positive for CD11b which is known as a complement receptor . The mean concentration of C3 in mammary gland secretions was significantly increased in 5 mastitic quarters infused with bovine lactoferrin (p<0.05), but showed no significant change in 5 mastitic control quarters . These results suggested that bovine lactoferrin treatment for staphylococcal mastitis in the early non-lactating period might increase the rate of cure through the induction of innate immunity in the host.

Rev Argent Microbiol, 2002 Jul-Sep, 34(3), 171 - 5
{Antimicrobial sensitivity of coagulase-positive staphylococcal strains isolated from bovine mastitis in the central dairy catchment area of Argentina }; Calvinho LF et al.; The activity of antimicrobial agents frequently used for treating bovine mastitis was determined against 101 coagulase-positive staphylococci isolated from bovine mammary secretion . The isolates were obtained from 39 dairy farms located in the central dairy area of Argentina . The disk diffusion method was used and the following antimicrobial agents were tested: penicillin, ampicillin, oxacillin, cephacetrile, penicillin + novobiocin, erythromycin, pirlimycin, novobiocin and neomycin . The highest levels of resistance were observed against penicillin and ampicillin (47.6%), while the lowest against erythromycin (2%), pirlimycin (4%) and neomycin (2.9%) . No resistant strains against oxacillin, cephacetrile and penicillin + novobiocin were detected.

Bull Acad Natl Med, 2002, 186(3), 649 - 58; discussion 659-60
{Prevention of bacterial endophthalmitis after cataract surgery in adults}; Delpech J; Technical progress in cataract surgery has led to the phacoemulsification of the eye lens by ultrasound followed by the intraocular lens implantation . In spite of rigorous preventive hygiene and sterilization measures taken before, during and after the operation, two clinical forms of endophthalmitis seriously threaten vision in the operated eye: externally induced endophthalmitis, specifically with pyocyanic bacillus, which often follows the irregular use of reuseable tubings and internally induced endophthalmitis due to the inevitable penetration during the intraocular operation of conjunctival micro-organisms especially staphylococci . A zero-risk level is non-existent and it would be unjust to hold the ophthalmologist responsible for it, when he has done everything possible to reduce the risk . The question of bacteriological examinations, the problem of antibioprophylaxis, and the danger of the reuseable tubings and of the ambulatory surgery, concerning at-risk patients, are discussed in this paper.

Clin Infect Dis, 2002 Nov 15, 35(10), 1212 - 8 Epub 2002 Oct 28.
Antimicrobial-resistant, Gram-positive bacteria among patients undergoing chronic hemodialysis; D'Agata EM; Numerous antimicrobial-resistant pathogens (ARPs) have emerged among patients who undergo chronic hemodialysis (CHD), including vancomycin-resistant enterococci, vancomycin-resistant coagulase-negative staphylococci, Staphylococcus aureus with reduced susceptibility to vancomycin, and linezolid-resistant S . aureus . In June 2002, the first isolate of vancomycin-resistant S . aureus (minimum inhibitory concentration of vancomycin, > or =32 microg/mL) was isolated in the United States from a patient who required CHD . Frequent administration of antibiotics and repeated exposure to settings conducive to cross-transmission contribute to a patient population at considerable risk of harboring ARPs . Dissemination of ARPs among patients who are undergoing CHD is facilitated by the requirement for regular hemodialysis in a closed setting in which health care workers provide concurrent care to multiple patients . Frequent hospitalizations in this patient population further contribute to acquisition of ARPs and to the spread of ARPs to other hospitalized patients . The epidemiology of antimicrobial-resistant, gram-positive pathogens in patients undergoing CHD is reviewed, and recommendations for limiting further dissemination are provided.

J Clin Pathol, 2002 Nov, 55(11), 824 - 8
DNA fingerprinting analysis of coagulase negative staphylococci implicated in catheter related bloodstream infections; Dobbins BM et al.; AIMS: The epidemiological assessment of cases of coagulase negative staphylococcal catheter related bloodstream infection . METHODS: Two hundred and thirty patients with suspected catheter related bloodstream infection were evaluated over a two year period . Central venous catheters were cultured both endoluminally and extraluminally . Peripheral blood, catheter hubs, skin entry, and skin control sites were also cultured . Pulsed field gel electrophoresis (PFGE) was used to DNA fingerprint coagulase negative staphylococci isolated from patients with presumptive catheter related bloodstream infection . RESULTS: Sixty cases of catheter related bloodstream infection were identified, 21 of which were attributed to coagulase negative staphylococci . Two hundred and ninety four separate isolates of coagulase negative staphylococci from the 21 cases of catheter related bloodstream infection were subjected to PFGE (mean of 14 for each case) . Catheter related bloodstream infection was only confirmed by PFGE analysis in 16 of the 21 cases because in the remaining five cases peripheral blood and central venous catheter coagulase negative staphylococci isolates were different . Skin entry, control skin, and central venous catheter hub isolates matched peripheral blood isolates in six, four, and seven cases, respectively . Coagulase negative staphylococci isolates could not be cultured from the patients' own skin in seven cases of catheter related bloodstream infection . Central venous catheter lumens were colonised in all cases of catheter related bloodstream infection compared with 44-81% of cases that had positive external surface catheter tip cultures, depending on the threshold used to define significant growth . CONCLUSIONS: Catheter related bloodstream infection as a result of coagulase negative staphylococci may be over stated in about a quarter of cases, unless a discriminatory technique is used to fingerprint isolates . No single, simplistic route of bacterial contamination of central venous catheters was identified, but endoluminal catheter colonisation is invariably present in cases of catheter related bloodstream infection.

Ultraschall Med, 2002 Oct, 23(5), 341 - 4
{Echocardiographic detection of tricuspid valve endocarditis and right atrial and ventricular masses in a patient with acute myeloid leukaemia}; Buchheidt D et al.; In a patient with acute leukaemia, tricuspid valve vegetations and both right atrial and ventricular masses formed within a few weeks were detected by echocardiography . In addition to endocarditis which is a very rare condition in patients with acute leukaemia, the diagnostic efforts including cardiac surgery resulted in the unusual finding of right-sided cardiac thrombi which had formed autochthonously . The most likely cause was thought to be a very severe systemic infection with staphylococci characterised by repeated episodes of bacteraemia during profound and prolonged neutropenia as well as a paraneoplastic coagulopathy . Surgery performed on the grounds of the echocardiography findings and differential-diagnostic considerations resulted in the relapse-free removal of the infectious focus . The maintenance therapy for leukaemia could thus be continued and led to a distinctly improved outcome . This case report confirms the great importance of sonography in the management of fever of unknown origin in immunocompromised patients.

J Vet Med Sci, 2002 Sep, 64(9), 821 - 7
Distribution of mecA-harboring staphylococci in healthy mares; Yasuda R et al.; The prevalence of staphylococci that harbor the mecA gene responsible for methicillin resistance was examined in healthy breeding mares . Staphylococci often cause diseases of horses such as metritis, keratitis, and abscess . Methicillin-resistant staphylococci would make antibiotic treatments ineffective, so it may be significant to know the distribution of mecA-harboring staphylococci in mares . Isolation of mecA-harboring staphylococci was achieved from nares and pasterns of 100 mares in Hokkaido, Japan . From 13% of the mares, mecA-harboring staphylococci, including 15 isolates of Staphylococcus sciuri and 3 of Staphylococcus lentus, were isolated . Isolates of S . sciuri were found to be genetically polyclonal by pulsed-field gel electrophoresis . These isolates produced no PCase and showed low or no resistance to beta-lactam and other classes of antibiotics . Distribution of staphylococcal species and levels of antibiotic resistance were found to be different between isolates from the present mares and those previously reported from riding-horses . Antibiotic pressure may lead to these differences . In addition, it appears that mecA-harboring S . sciuri may be native to horses.

Pediatr Infect Dis J, 2002 Oct, 21(10), 950 - 6
Safety and efficacy of quinupristin/dalfopristin for treatment of invasive Gram-positive infections in pediatric patients; Loeffler AM et al.; BACKGROUND: Antibiotic-resistant Gram-positive pathogens are an increasingly common cause of serious pediatric infections . Although quinupristin/dalfopristin demonstrates favorable activity against resistant Gram-positive pathogens (including many vancomycin-resistant and methicillin-resistant staphylococci), published experience in the pediatric patient population is limited . METHODS: We retrospectively analyzed data from the global quinupristin/dalfopristin Emergency-Use Program, which enrolled patients with serious Gram-positive infections who had no further therapy options because of resistance to, failure on or intolerance to standard antibiotic treatments . Our subset included safety and efficacy data from pediatric patients (age <18 years) . There were no restrictions on underlying diseases, severity of illness or prior/concomitant antimicrobial use . RESULTS: Between May 1995 and October 1999, 127 pediatric patients with 131 infections were enrolled . Microbiologic confirmation of etiology was available in 124 patients . All patients had 1 or more concomitant conditions, including malignancy and solid organ or bone marrow transplantation . The most frequent causative pathogens were vancomycin-resistant (80%), spp . (7%), methicillin-resistant (6%) and (4%) . All but 21 patients received intravenous quinupristin/dalfopristin 7.5 mg/kg every 8 h . The favorable clinical response rate of quinupristin/dalfopristin was 86 of 124 (69%); the favorable microbiologic response rate was 97 of 124 (78%) . Eleven patients (8%) had nonvenous adverse events classified as possibly or probably related to quinupristin/dalfopristin . CONCLUSIONS: Quinupristin/dalfopristin demonstrated favorable response rates and was reasonably well-tolerated in pediatric patients with serious Gram-positive infections unable to receive alternative therapy . In our opinion quinupristin/dalfopristin is a therapeutic option for the management of such infections.

East Afr Med J, 2002 Jan, 79(1), 45 - 8
Antimicrobial susceptibility of staphylococci species from cow foremilk originating from dairy farms around Gaborone, Botswana; Guta C et al.; OBJECTIVE: To determine the prevalence of antibiotic susceptibility of Staphylococcus species isolated from foremilk samples . SETTING: Milk was collected from five farms within a 70 km radius of Gaborone, Botswana . SUBJECTS: Two hundred and twenty five staphylococci isolates from foremilk samples . MAIN OUTCOME MEASURES: Antibiotic susceptibility tests to penicillin G, ampicillin, tetracycline, erythromycin, cephalothin, chloramphenicol, methicillin, gentamicin and vancomycin . RESULTS: The susceptibility patterns of the staphylococcal strains to the antibiotics were as follows: penicillin G (47.1%), ampicillin (58.7%), tetracycline (62.7%), erythromycin (72%), cephalothin (72.9%), chloramphenicol (79.1%), methicillin (86.2%), gentamicin (88.9%) and vancomycin (100%) . Lower susceptibility to chloramphenicol, methicillin and gentamicin was displayed by Staphylococcus epidermidis, S . haemolyticus and S . saprophyticus . Only 19 (8.5%) of the isolates were susceptible to all the antibiotics tested . The most common multiple resistance patterns encountered were penicillin-ampicillin (9.3%), penicillin-erythromycin-ampicillin (6.1%) and erythromycin-tetracycline-ampicillin (3.6%) . CONCLUSION: Most of the Staphylococcus isolates were resistant to one or more of the antimicrobial agents, with none being resistant to vancomycin . Inappropriate use of antibiotics is suspected to be a major contributory factor in the relatively high level of resistance to antimicrobial agents observed in this study . Therefore, milk can act as a very good source of antibiotic resistant Staphylococcus species posing a threat to consumers.

Transfusion, 2002 Jul, 42(7), 855 - 61
Experience with universal bacterial culturing to detect contamination of apheresis platelet units in a hospital transfusion service; AuBuchon JP et al.; BACKGROUND: Bacterial contamination of platelet units poses one of the greatest risks of morbidity and mortality to platelet transfusion recipients . A routine culture of all units (WBC-reduced apheresis platelet units) was instituted on Day 2 over a 2-year period to reduce this risk . STUDY DESIGN AND METHODS: A sterile connecting device was used to attach a small transfer pack on the morning of Day 2 after collection, and 10 mL of the unit were transferred to the small bag . After disconnection from the unit, about half of this volume was transferred to an aerobic culture bottle of an automated bacterial detection system . Units were maintained in available inventory until and unless a report was received of growth in the sample . When available, the unit or a retained aliquot was recultured if the initial sample was positive . Units were held up to 2 days beyond their 5-day outdate and used for transfusion if no other suitable units were available to meet the clinical need or were evaluated with in vitro testing on Day 8 . RESULTS: Of 2678 units cultured, 16 (0.6%) were positive on initial culture . Thirteen could be recultured, and all of these samples were negative . Shortly after the 2-year period of the study, two units (split from the same collection) were documented as growing coagulase-negative Staphylococci 12 hours after sampling . Units transfused on Day 6 or 7 (n = 40) yielded expected clinical responses, and CCI available on 21 cipients 10 to 60 minutes after transfusion demonstrated acceptable results (mean, 14,400 +/- 8800; median, 12,191; 90% > 7500) . More than 96 percent of units tested on Day 8 had pH greater than 6.2 and continued to demonstrate swirling . CONCLUSIONS: Routine culturing of apheresis platelet units is feasible, can be accomplished with a low rate of false positivity, and can detect contaminated units . The cost of such a protocol could be mitigated with extension of the storage period, and clinical experience with units held for 6 or 7 days was satisfactory.

Eur J Clin Microbiol Infect Dis, 2002 Sep, 21(9), 660 - 5 Epub 2002 Sep 07.
Characterisation of coagulase-negative staphylococci isolated from blood infections: incidence, susceptibility to glycopeptides, and molecular epidemiology; Boisson K et al.; The purpose of this study was to determine incidence of coagulase-negative staphylococci (CNS) bacteraemia and to characterise the epidemiology of isolates with reduced susceptibility to glycopeptides . CNS isolates from bloodstream infections were collected and characterised by determination of the species, analysis of antibiotic susceptibility, and restriction fragment length polymorphism using pulsed-field gel electrophoresis . The medical records of patients with positive cultures and the trends in glycopeptide use were reviewed to determine the effect of previous antibiotic treatment on the susceptibility profile of these organisms . The incidence of bacteraemia caused by CNS was 0.26 per 100 patients or 0.36 per 1,000 days of hospitalisation . According to genomic fingerprinting typing, 41 (67.2%) cases of bacteraemia were caused by a unique strain of CNS and 20 were caused by several strains . Nineteen of the 61 cases of bacteraemia studied were caused by an isolate with decreased susceptibility to teicoplanin . Genomic DNA analysis of the 90 CNS isolates recovered from the 61 cases of bacteraemia generated 50 unique profiles (1 isolate per major PFGE pattern) and 13 multiple profiles (several isolates per major PFGE pattern) . Neither decreased susceptibility of an isolate to teicoplanin nor hospital acquisition was associated with a multiple profile . There was a significant correlation between the incidence of bacteraemia caused by CNS with decreased susceptibility to teicoplanin and glycopeptide use at the unit level but not in individual patients . Cross-transmission did not play an important role in the dissemination of CNS with decreased susceptibility to teicoplanin, thus strains probably become resistant as a result of antibiotic pressure . Prudent use of glycopeptides is necessary to minimise the spread of resistance to these agents.

J Hosp Infect, 2002 Sep, 52(1), 37 - 42
A clone of coagulase-negative staphylococci among patients with post-cardiac surgery infections; Tegnell A et al.; Coagulase-negative staphylococci (CoNS) are important causes of hospital-acquired infections such as infections after cardiac surgery . Efforts to reduce these infections are hampered by the lack of knowledge concerning the epidemiology of CoNS in this setting . Forty strains of CoNS collected during the surgical revision of 27 patients operated on between 1997 and 2000 were analysed . Strains were also collected from the ambient air in the operating suite . Their pulsed-field gel electrophoresis (PFGE) characteristics and antibiotic resistance were analysed . Using PFGE 19 of 40 strains from 15 of 27 patients were shown to belong to one clone, and strains from this clone were also isolated from the ambient air . This clone had caused infections throughout the period . Antibiotic resistance did not correlate with PFGE patterns . Using PFGE one clone could be identified that caused 56% of the CoNS infections during this period . A strain from this clone was also found in the air of the operating suite suggesting the origin of the CoNS causing infections was the hospital environment.

Antibiot Khimioter, 2002, 47(5), 8 - 11
{Susceptibility to antimicrobial agents of bacteria isolated from pregnant, postpartum women, and newborns from zones with high irradiation risk}; Motavkina NS et al.; Susceptibility of 350 strains of staphylococci, isolated from pregnant women, puerperal and newborns and of 170 strains, isolated from obstetrical hospital environment at the region with high risk of radiation after accident was determined . The tested bacterial strains were the following: 56--Staphylococcus aureus, 152--S . epidermidis, 142--S . saprophyticus, isolated from women and newborns; strains isolated from hospital environment included 120 strains of S . saprophyticus and 50 strains E . coli . The tested antimicrobial factors were the following: 22 antibiotics, 2 bioantibiotics of the breast milk and blood (lysozyme, betalysin) not separated from the substrate and tested on test-cultures of M . luteus and B . subtilis, and 5 desinfectants . Analysis was performed by common disk-diffusion method and by contact method elaborated before . High resistance of staphylococci to many antibiotics, bioantibiotics and disinfectants was demonstrated . The resistance is considered to be due to high radiation background because it is much higher than resistance frequency of the similar strains isolated at the safe areas . The resistance to antimicrobial factors was higher among the opportunistic and saprophyte staphylococci along with appearance of pathogenic factors and activation of persistence properties.

Microb Drug Resist, 2002 Fall, 8(3), 171 - 7
Molecular analysis of constitutively expressed erm(C) genes selected in vitro by incubation in the presence of the noninducers quinupristin, telithromycin, or ABT-773; Schmitz FJ et al.; A Staphylococcus aureus strain that harbored a plasmid-borne inducibly expressed erm(C) gene was cultivated in the presence of the noninducers quinupristin, telithromycin, and ABT-773 . After overnight incubation, 78 mutants that displayed combined resistance to macrolides, lincosamides, streptogramin B antibiotics, and ketolides were analyzed for the genetic basis of this altered resistance phenotype . Because this resistance phenotype is indicative for constitutively expressed erm(C) genes, the erm(C) regulatory regions of all mutants were sequenced . All 78 mutants showed sequence alterations in the erm(C) translational attenuator . Seventeen different types of sequence deletions ranging from 5 bp to 121 bp and nine different types of tandem duplications of 13-100 bp, all causing constitutive erm(C) gene expression, were detected . These sequence deletions or tandem duplications either favored the formation of mRNA secondary structures in the erm(C) translational attenuator, which did not inhibit translation of the erm(C) transcripts, or completely prevented the formation of any mRNA secondary structures in the erm(C) translational attenuator . The mean frequencies of 10-6 to 10-8 by which constitutive mutants were obtained, strongly suggest that telithromycin and ABT-773 not be recommended for the treatment of staphylococci that exhibit the inducible MLSB phenotype.

Acta Derm Venereol, 2002, 82(4), 260 - 5
Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle; Mills O Jr et al.; Two-hundred-and-eight acne vulgaris patients were enrolled in a 24-week study to determine the bacterial resistance issues associated with the use of a topical 2% erythromycin gel . It consisted of a 12-week randomized, double-blind, parallel-group treatment phase comparing the active gel versus its vehicle followed by a 12-week single-blind regression phase with gel vehicle only . Bacteriological samples were taken from the face, back and nares for quantification by species and antibiotic resistance characteristics . Acne efficacy was assessed through week 12 . The prevalence of erythromycin-resistant coagulase-negative Staphylococci on the face was extremely high (87%) at baseline, increased to 98% by week 12 in the erythromycin-treated group and did not change during regression . The density of these resistant organisms also significantly increased with erythromycin treatment with no change during regression . Similar prevalence and density patterns were also observed on the untreated back and in the nares . Nearly all of the resistant isolates were highly resistant (minimal inhibitory concentrations > 128 microg/ml) . Resistance development was confined to the macrolide class of antibiotics . No anti-acne efficacy was observed.

Aust Endod J, 2002 Aug, 28(2), 61 - 3
Staphylococcus epidermidis and Staphylococcus xylosus in a secondary root canal infection with persistent symptoms: a case report; Siqueira JF Jr et al.; The aim of this case report is to highlight the importance of maintaining the aseptic chain during endodontic treatment . This paper describes a clinical situation in which persistent symptoms had developed after the first appointment to treat a vital pulp case . Microbiological analysis of the case indicated that symptoms were probably due to a secondary root canal infection by two species of coagulase-negative staphylococci--Staphylococcus epidermidis and Staphylococcus xylosus . Symptoms had persisted in spite of using various intracanal antimicrobial agents and systemic antibiotic therapy.

Pediatrics . 2002 Oct;110(4):e42.
Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists' practices; Rubin LG et al.; OBJECTIVE: To ascertain current diagnostic and treatment practices for suspected late-onset sepsis in infants in neonatal intensive care units (NICUs) and identify areas that may benefit from clinical practice guidelines . METHODS: During June 2000, we conducted a multicenter survey of neonatologists and infection control professionals regarding practices related to late-onset sepsis in NICUs at children's hospitals participating in the Pediatric Prevention Network . RESULTS: Personnel at 35 hospitals with NICUs completed surveys; 34 were infection control professionals, and 278 were neonatology clinicians, primarily attending neonatologists or neonatology fellows . At these facilities, coagulase-negative staphylococci (CoNS) were the most frequent blood culture isolate from infants with late-onset sepsis accounting for 54% of bloodstream infections . When late-onset sepsis was suspected, 83% of clinicians drew only 1 blood culture when no central venous catheter was present or when a central vascular was present with no blood return . Thirty-two percent obtained 1 or more C-reactive protein concentration determinations . Sixty percent of clinicians prescribed a vancomycin-containing regimen for a 900 g, 3-week-old infant with suspected late-onset sepsis . The presence of a central venous catheter or shock increased empiric vancomycin use . The presence of methicillin-resistant Staphylococcus aureus in the NICU did not increase vancomycin use, but a vancomycin restriction policy decreased empiric vancomycin use . Clinicians at an individual NICU tended to have similar empiric antibiotic-prescribing practices: in 29 (83%) of 35 centers > or =75% of respondents had similar practice with regard to prescribing a vancomycin-containing regimen for empiric therapy . Forty-seven percent to 85% completed a full course of antimicrobials when a single blood culture was obtained and grew CoNS, but a significantly lower percentage of respondents (22%-47%) completed a full course when 1 of 2 blood cultures obtained grew CoNS . Eleven percent of respondents removed an umbilical catheter at the time of suspected sepsis, but fewer than 5% removed a nonumbilical central venous catheter for suspected sepsis . Most (> or =61%) retained a nonumbilical catheter despite documentation of CoNS bacteremia . CONCLUSIONS: Neonatologists varied in management of suspected late-onset sepsis, particularly that caused by CoNS . Procedures to prevent CoNS-positive blood cultures and to differentiate CoNS contaminants from pathogens are needed . For safely decreasing vancomycin use in NICUs, clinical practice guidelines should be developed, implemented, and evaluated . The guidelines should include optimal skin antisepsis and catheter disinfection before obtaining blood for culture, obtaining 2 blood cultures and using adjunctive tests and information to help differentiate contaminants from pathogens, and restriction on empiric vancomycin use.

J Antimicrob Chemother, 2002 Oct, 50(4), 577 - 82
Enterococcal intravascular catheter-related bloodstream infection: management and outcome of 61 consecutive cases; Sandoe JA et al.; Enterococci are an increasingly important cause of intravascular catheter-related bloodstream infection (CRBSI), but the evidence base for treating such cases is limited . Successful antimicrobial treatment of CRBSI while leaving the central venous catheter (CVC) in situ has been reported for some bacteria, such as coagulase-negative staphylococci, but the effectiveness of this approach for treating enterococcal CRBSI is unknown . We aimed to determine the effectiveness of treatment options for enterococcal CRBSI and whether CVC removal is mandatory . Treatment and outcome was determined in a 3 year cohort of patients with enterococcal CRBSI from a university teaching hospital . All episodes of enterococcal bacteraemia during the study (n = 268) were examined to identify the cohort of 61 CRBSIs . Outcomes were determined for various antimicrobial regimens with or without CVC removal . Forty-eight episodes were managed with CVC removal and 13 were managed with the CVC in situ . Forty of 48 (83%) and five of 13 (38%) episodes were cured with the CVC removed or left in situ, respectively . All five episodes cured with the CVC in situ were treated with a cell wall-acting antimicrobial plus an aminoglycoside . This antimicrobial combination was significantly more effective than either ampicillin or vancomycin monotherapy (P < 0.05), or antimicrobials to which isolates were not susceptible (P < 0.01) when the CVC remained in situ . We conclude that enterococcal CRBSI can be treated successfully without CVC removal . The combination of a cell wall-acting antimicrobial with an aminoglycoside was the most effective regimen when the CVC remained in situ in this small group of patients . Although CVC removal was associated with a high cure rate, it did not guarantee treatment success.

J Obstet Gynaecol India, 1968 Feb, 18(1), 70 - 8
Puerperal and postabortal sepsis (a bacteriological study); Venugopal MS et al.; PIP: 117 cases of puerperal sepsis and 33 cases of postabortal sepsis at the King George Hospital in Visakhapatnam, India were included in a study of the incidence of various species of microorganisms . 50 patients in the third trimester and 50 cases in normal puerperium were included as controls . 190 microorganism strains were isolated from the infected samples . A single infection occurred in 76.1% and 48.5% of puerperal and postabortal sepsis, respectively . In the cases of puerperal sepsis 146 strains were isolated . The most common classes of strains were coliforms (75), coagulase negative staphylococci (30), and coagulase positive staphylococci (21) . In the cases of postabortal sepsis 44 strains were isolated . The most common strains were again coliforms (21), coagulase negative staphylococci (10), and coagulase positive staphylococci (7) . In the controls 83 cases yielded 90 strains: 76 yielded a single organism; 7, mixed flora . Major classes were coliforms (29), coagulase negative staphylococci (28), and diphtheroids (18) . The incidence of coliforms and coagulase positive staphylococci was significantly higher (p less than .01) in the septic group . Diphtheroids are associated with normal cervical secretions . The differences in the incidences of single and mixed infections in the puerperal and postabortal sepsis cases were significant (p less than .01) . The coliform most often isolated was Escherichia coli .

Biomaterials, 2002 Dec, 23(23), 4581 - 9
Venous shear stress enhances platelet mediated staphylococcal adhesion to artificial and damaged biological surfaces; Fallgren C et al.; We investigated the role of blood components in the adhesion of staphylococci to biological and artificial surfaces under well-defined flow conditions by using the Cone and Plate(let) Analyzer . An enzyme-linked immunosorbent assay-like binding assay with biotinylated bacteria determined the extent of bacterial adhesion to subendothelial extracellular matrix (ECM), polystyrene (PS) and adult bovine aortic endothelial (ABAE) cell monolayer . The presence of adsorbed plasma proteins on PS and ECM did not increase and in some cases reduced staphylococcal adhesion under flow conditions (200s(-1)) . However, their presence on ABAE cells increased bacterial adhesion but to a level still lower than the adhesion to PS and ECM . In contrast, adhered platelets significantly increased staphylococcal adhesion to both PS and ECM, but did not affect the adhesion to ABAE cells . Furthermore, bacterial adhesion to the platelets coated ECM and PS under flow conditions (200s(-1)) was increased by 1.4 to 2.6-fold compare to static conditions . The platelet-enhanced bacterial adhesion was markedly inhibited by blockade of the platelet GPIb receptor . In conclusion, staphylococcal extensive adhesion to ECM and PS surfaces is increased by venous flow and mediated by surface adhered activated platelets via a GPIb dependent mechanism . On the other hand, ABAE cells demonstrated limited bacterial adhesion that is mediated by adsorbed plasma proteins . Our results suggest that under physiological venous flow conditions the intact vessel wall is less prone for bacterial adhesion than damaged vessel wall.

Cytokine, 2002 Aug 21, 19(4), 206 - 12
Induction of cytokine production by different Staphylococcal strains; Megyeri K et al.; In light of the important role of cytokines in the pathogenesis of bacterial infections, we analyzed the cytokine production induced by different Staphylococcus aureus (S . aureus), S . epidermidis and S . saprophyticus strains in human mononuclear cells (MNCs) . MNCs secreted high amounts of interleukin-1beta (IL-1beta) and IL-6 proteins in responses to stimulation with all three species of Staphylococci . Interestingly, a large majority of the S . aureus strains induced significantly higher IL-12 and interferon (IFN) titers than did the S . epidermidis and S . saprophyticus strains . The RNase protection assay revealed high increases in IL-1alpha, IL-1 beta, IL-1 receptor antagonist, IL-6 and IL-12 p40 transcript levels in MNCs stimulated with Staphylococci . All of the tested Staphylococcal strains proved highly efficient in mediating the induction of these genes . Reverse transcriptase polymerase chain reaction (RT-PCR) analysis indicated considerable increases in IFNA transcript levels in MNCs stimulated with S . aureus strains, while only a very weak expression was stimulated by S . epidermidis and S . saprophyticus . These results confirm that heat-killed Staphylococci exert strong immunomodulatory effects, and suggest that the contribution of T-helper 1 (Th(1)) cells to the immune response may be much extensive in infections caused by S . aureus strains, due to their high IL-12p70 and IFN-alpha-inducing activities .

J S Afr Vet Assoc, 2002 Jun, 73(2), 62 - 5
Prevalence of coagulase-negative staphylococci in bovine mastitis in Zimbabwe; Kudinha T et al.; This study was carried out to determine the prevalence of coagulase-negative staphylococci in clinical and subclinical mastitis in commercial and small-scale farms in Zimbabwe . Thirty five quarter milk samples from clinical mastitis cases and 371 quarter milk samples from cows with subclinical mastitis were cultured for bacterial pathogens . The most frequent pathogens isolated in clinical mastitis were the enteric bacteria (31.4%), followed by coagulase negative staphylococci (22.9%) and then Staphylococcus aureus (17.1%), whereas in subclinical mastitis S . aureus (34.2%) and coagulase-negative staphylococci were (33.2%) the most common . Bacillus species were only isolated in milk samples from subclinical mastitis . Coagulase-negative staphylococci were observed in mixed infections with other bacteria in only 2.2 of the 406 milk samples from clinical and subclinical mastitis where they were isolated together with Bacillus species in 6 of the 9 mixed infection cases . About 95% of the milk samples from which 131 coagulase-negative staphylococci were isolated had correspondingly high somatic cell counts . The coagulase-negative staphylococci isolated most frequently were S . chromogenes (7.9%), S . epidermidis (7.4%) and S . hominis (5.9%) . They were all associated with high somatic cell counts . All the coagulase-negative staphylococci isolates were susceptible to cloxacillin and erythromycin, and more than 90% of the isolates were susceptible to neomycin, penicillin and streptomycin . The highest resistance was to tetracycline (17.6%), followed by lincomycin (13.7%) . About 8% of the isolates were resistant to both penicillin and streptomycin.

Acta Cardiol, 2002 Aug, 57(4), 309 - 11
Superior vena cava syndrome and infection of pacing leads in one patient; Ravyts M et al.; The superior vena cava (SVC) syndrome is an uncommon complication due to permanent transvenous pacemaker electrodes . Infection of the leads is a risk factor for its occurrence . After being treated for SVC syndrome, due to multiple pacemaker leads, with thrombolysis and coumarine therapy, our patient was diagnosed with repetitive positive blood cultures . Because of relapsing SVC syndrome all pacemaker material was surgically removed . Recovery was complete and the patient remained pacemaker-independent . Culture of the leads showed the same coagulase-negative staphylococci as in the blood cultures.The indications for pacemaker implantation should always be rigorously defined and complications thoroughly investigated and treated.

Blood Purif, 2002, 20(5), 477 - 80
Incidence of infectious morbidity and mortality in dialysis patients; Vanholder R et al.; Infections remain among the major causes of disease, hospitalization and death in uremic patients, especially in those treated by dialysis . Several pathophysiologic factors enhance this infectious risk: (1) breakdown of protective barriers; (2) affinity of bacteria for foreign materials; (3) bioincompatibility; (4) uremic toxin retention; (5) deficiency and resistance to vitamin D; (6) carriership of germs, and (7) malnutrition . Twenty to 30% of dialysis patients develop infection, and 20-30% of these die from their infection . Sepsis is significantly more frequent, and mortality secondary to sepsis is 50 times higher than in the normal population . Bacteremia (prevalence 1 episode/100 patient-months) is mainly caused by Gram-positive species, especially in vascular access-related infection and infection of unknown origin . Among these Gram-positive germs, staphylococci play a predominant role . The most frequent and most morbid viral infections are associated with hepatitis . Whereas the incidence of hepatitis B decreases, hepatitis C has become the major variant . The incidence of tuberculosis has increased up to 15 times, and in the Western world it mainly affects patients who immigrated from endemic areas . Fungal infections are also frequent, especially in the setting of peritoneal dialysis . In conclusion, infections remain a frequent and morbid problem in dialysis patients . Preventive measures should be applied more vigorously .

Chemotherapy, 2002 Sep, 48(4), 174 - 81
Presence of mec genes and overproduction of beta-lactamase in the expression of low-level methicillin resistance among staphylococci; Petinaki E et al.; Detection of methicillin-resistant staphylococci is critical for the management of infected patients in the hospital . A total of 55 nonreplicated clinical isolates of staphylococci (31 Staphylococcus aureus and 24 coagulase-negative staphylococci; CNS) collected during a one-year period and expressing low-level resistance to methicillin (oxacillin MIC of 2-4 mg/l for S . aureus and 0.5-4 mg/l for CNS) were studied . mec determinants and overproduction of beta-lactamase were investigated and pulsed-field gel electrophoresis (PFGE) was applied as a typing method . Twenty-four S . aureus isolates and 19 CNS carried the mecA gene . The presence of mecR1/mecI and blaR1/blaI genes correlated with the expression of low-level methicillin resistance in CNS . Four mecA-negative isolates (2 S . aureus and 2 CNS) overproduced beta-lactamase . PFGE revealed the presence of 2 major clonal types in mecA-positive S . aureus isolates, and 3 in CNS . Low-level methicillin resistance of staphylococci is correlated with the presence of the mecA gene and overproduction of beta-lactamase .

J Dairy Sci, 2002 Aug, 85(8), 1913 - 7
Antimicrobial susceptibility of coagulase-negative staphylococci isolated from bovine mastitis in Argentina; Gentilini E et al.; A total of 123 isolates of coagulase-negative staphylococci isolated from bovine clinical and subclinical mastitis in Argentina from March 1998 to March 2000 was investigated for in vitro susceptibility to several antimicrobial agents . Minimum inhibitory concentrations that inhibit 90% of the isolates tested (reported in micrograms per milliliter) were: 4.40, 0.38, 4.00, 0.75, 0.75, 3.60, and 2.00 for penicillin, oxacillin, cephalothin, gentamicin, erythromycin, clindamycin, and ampicillin-sulbactam, respectively . Resistance was detected in 34 (27.6%), 4 (3.2%), 7 (5.7%), and 6 (4.8%) isolates for penicillin, oxacillin, erythromycin, and pirlimycin, respectively . No resistance was detected for gentamicin, cephalothin, or ampicillin-sulbactam . Results indicated that coagulase-negative staphylococci isolates in Argentina exhibited the highest degree of resistance to penicillin of all antimicrobial agents tested.

Vet Immunol Immunopathol, 2002 Oct 8, 89(1-2), 57 - 65
Immunological responses of the lactating ovine udder following experimental challenge with Staphylococcus epidermidis; Winter P et al.; The responses of five lactating ewes to experimental mammary infection with Staphylococcus epidermidis were examined . Infection caused an intense but transient influx of neutrophils into milk, which peaked at 8 h and was accompanied by mild fever and mild leukopaenia in blood . No other signs of systemic infection were observed . Number of staphylococci in milk decreased logarithmically until 24 h, were absent from three ewes at 48 h and then increased in number or re-emerged in four of the five ewes at 72 or 144 h . At all times milk appeared grossly normal . Expression of the adhesion molecules CD11b and CD18 increased on neutrophils in milk at 24 h then tended to decline over subsequent days . The proportion of lymphocytes positive for CD4, CD8, WC1 and MHCII tended to decrease from 24 to 72 h then increased at 144 h . Cytokines in milk were measured by ELISA . IL-8 was elevated in infected glands at 2 h, peaked at 24 h and remained elevated until the final sampling at 144 h . IL-6 was transiently elevated at 4 and 8 h while IL-1beta remained elevated from 8 until 144 h . The results suggest that the intense early neutrophil infiltrate eliminated most but not all bacteria and a state of subclinical infection ensued . After 24 h , leukocyte numbers in milk declined while cytokines, especially IL-8 remained elevated, suggesting that sensitivity or responsiveness of gland to inflammatory signals decreased as infection progressed . This attenuation of the host defence response may have contributed to the failure of the gland to eliminate bacteria and may be an important feature of the development of chronic and subclinical mastitis.

Clin Infect Dis, 2002 Sep 15, 35(6), 671 - 7 Epub 2002 Aug 16.
Strains of Staphylococcus aureus obtained from drug-use networks are closely linked; Quagliarello B et al.; Drug users have a higher incidence of colonization with Staphylococcus aureus than does the general population, and, as a result, they are at increased risk of infection with their colonizing strain . The purpose of this study was to examine the role of drug-use risk networks in S . aureus transmission, the similarity of S . aureus isolates within these networks, and the possible role of inhalation drug use paraphernalia in the transmission of S . aureus . Strains of S . aureus are shared among colonized inhalation drug users within drug-use risk networks . It suggests that patterns of drug use and the geographic location where drug sharing occurs are major contributors to the transfer of staphylococci and, as a result, to the high prevalence of staphylococcal colonization and perhaps disease in this population.

J Clin Microbiol, 2002 Sep, 40(9), 3291 - 5
Rapid detection of methicillin resistance in coagulase-negative Staphylococci with the VITEK 2 system; Horstkotte MA et al.; The aim of the present study was to evaluate the accuracy of the new VITEK 2 system (bioMerieux, Marcy l' Etoile, France) for the detection of methicillin resistance in coagulase-negative staphylococci (CoNS) by using AST-P515 and AST-P523 test cards . Analyses of the VITEK 2 oxacillin MIC determination evaluated according to the actual breakpoint (>/=0.5 micro g/ml) of the National Committee for Clinical Laboratory Standards resulted in a high sensitivity of 99.2% but a moderate specificity of 80% . The newly included oxacillin resistance (OR) test of the VITEK 2 system displayed a high sensitivity and a high specificity of 97.5 and 98.7%, respectively . Concordance between the results of the mecA PCR and the VITEK 2 oxacillin MIC was observed for almost all Staphylococcus epidermidis strains, but the reduced specificity was attributable to higher oxacillin MICs for mecA-negative non-S . epidermidis strains, especially S . saprophyticus, S . lugdunensis, and S . cohnii . Evaluation of alternative oxacillin MIC breakpoints of 1, 2, or 4 micro g/ml resulted in improved degrees of specificity of 84, 90.7, and 97.3%, respectively . Only minor changes occurred in the corresponding sensitivity values, which were 98.4, 97.5, and 97.5%, respectively . Methicillin resistance in CoNS was detected after 7 and 8 h in 91.1 and 93.5% of the mecA-positive strains, respectively, by the VITEK 2 OR test and in 86.3 and 89.5% of the mecA-positive strains, respectively, by VITEK 2 oxacillin MIC determination . After 7 and 8 h the VITEK 2 OR test classified 59.2 and 78.9% of the mecA-negative strains, respectively, as susceptible to oxacillin, whereas comparable values were obtained 2 h later by VITEK 2 oxacillin MIC determination . The results of our study encourage the use of the VITEK 2 system, which proved to be a highly reliable and rapid phenotypic method for the detection of methicillin resistance in CoNS.

Arch Microbiol, 2002 Sep, 178(3), 165 - 71 Epub 2002 Jun 19.
Factors influencing methicillin resistance in staphylococci; Berger-Bachi B et al.; Methicillin resistance in staphylococci is due to an acquired penicillin-binding protein, PBP2' (PBP2a) . This additional PBP, encoded by mecA, confers an intrinsic resistance to all beta-lactams and their derivatives . Resistance levels in methicillin-resistant Staphylococcus aureus (MRSA) depend on efficient PBP2' production and are modulated by chromosomal factors . Depending on the genetic background of the strain that acquired mecA, resistance levels range from phenotypically susceptible to highly resistant . Characteristic for most MRSA is the heterogeneous expression of resistance, which is due to the segregation of a more highly resistant subpopulation upon challenge with methicillin . Maximal expression of resistance by PBP2' requires the efficient and correct synthesis of the peptidoglycan precursor . Genes involved in cell-wall precursor formation and turnover, regulation, transport, and signal transduction may determine the level of resistance that is expressed . At this stage, however, there is no information available on the functionality or efficacy of such factors in clinical isolates in relation to methicillin resistance levels.

Infect Control Hosp Epidemiol, 2002 Aug, 23(8), 447 - 51
Molecular characterization of methicillin-resistant coagulase-negative staphylococci from a neonatal intensive care unit; Bogado I et al.; OBJECTIVE: To evaluate clonal dissemination of methicillin-resistant coagulase-negative staphylococci (CNS) . SETTING: Neonatal intensive care unit of a 180-bed, university-affiliated general hospital . PATIENTS: Neonates admitted to the neonatal intensive care unit between March 1999 and October 2000, from whom CNS were isolated as a unique pathogen . Patients from other wards from whom epidemiologically unrelated staphylococci strains were obtained served as control-patients . METHODS: Conventional methods were used for phenotypic characterization of CNS . Methicillin resistance was determined by mecA polymerase chain reaction (PCR) amplification . Genotypic characterization was done by random amplification of DNA with degenerated primers (RAPD) and repetitive element sequence-based PCR (rep-PCR) . RESULTS: Forty methicillin-resistant CNS isolates obtained from neonates were characterized as Staphylococcus epidermidis (33), S . hominis (5), S . warneri (1), and S . auricularis (1) . Both RAPD and rep-PCR indicated the presence of 4 different clones among the 33 S . epidermidis isolates . In turn, the 4 randomly selected, epidemiologically unrelated methicillin-resistant CNS strains obtained from control-patients showed 3 new profiles by RAPD and 2 by rep-PCR, which differed from the corresponding patterns mentioned earlier . Persistence of S . hominis in a neonate could be assessed by both genotypic techniques . CONCLUSIONS: The molecular characterization of the methicillin-resistant CNS studied indicated dissemination of one particular methicillin-resistant CNS clone among the neonates in the ward studied . Although RAPD showed a superior power to discriminate among methicillin-resistant CNS isolates, both RAPD and rep-PCR detected intraspecific and interspecific genomic diversity.

Med Dosw Mikrobiol, 2002, 54(2), 97 - 101
{Antibiotic resistance of staphylococci isolated from outpatients}; Chylak J et al.; The aim of the study was to determine susceptibility of 587 strains of S . aureus and 85 strains of coagulase-negative staphylococci isolated from outpatients in Poznan to co-trimoxazole, amoxycillin/clavulanic acid, erythromycin, gentamycin, doxycycline, ampicillin, oxacillin, cephradine, clindamycin and neomycin . Also methicillin-resistant strains were determined as well as strains ability to produce beta-lactamases . Susceptibility testing and examination of methicillin-resistant strains were performed by the disc diffusion techniques according to recommendation of NCCLS . Methicillin-resistant strains were additionally examined to their sensitivity to vankomycin and teicoplanin . beta-lactamase production was detected using nitrocefin impregnated discs and iodometric method . Amoxacillin/clavulanic acid, gentamycin, co-trimoxazole, cephradin, oxacillin and clindamycin occurred to be very active against both, S . aureus and coagulase-negative staphylococci . 84.7% to 100% of examined strains were sensitive to these drugs . Doxycyclin, erythromycin and ampicillin were less effective . Nine strains (1.5%) of 587 strains of S . aureus as well as 7 strains (8.7%) of coagulase-negative staphylococci were methicillin-resistant . All of methicillin-resistant strains were sensitive to vancomycin and teicoplanin . More than 75% of S . aureus and close to 50% of coagulase-negative staphylococci were able to produce beta-lactamases.

Med Dosw Mikrobiol, 2002, 54(2), 109 - 18
{Ability of Staphylococcus cohnii strains to adhere to epithelial cells and solid surfaces in the hospital environment}; Waldon E et al.; Presented study describes abilities of staphylococci to adhere to exfoliated cheek and uroepithelial epithelium cells and to various surfaces such as plastics, glass and steel . The subject of the study were strains of Staphylococcus cohnii ssp . cohnii and Staphylococcus cohnii ssp . urealyticus isolated from Intensive Care Unit of Pediatric Hospital . Staphylococcus cohnii ssp.cohnii adhered in great number to epithelial cells . However, the adhesion differed by individual strains . We did not find relationship between slime production and adherence to epithelial cell . Most of investigated strains adhered closely to surfaces--especially of plastics and glass . This phenomenon was stronger in the presence of culture medium and phosphate buffer.

Med Dosw Mikrobiol, 2002, 54(2), 103 - 8
{The effect of culture conditions on expression of surface proteins from coagulase-negative staphylococci isolated from clinical material of newborns hospitalized in an intensive care unit}; Bartoszewicz-Potyrala M et al.; A surface adhesion is a fundamental stage, in a pathogenesis of inflammations caused by coagulase-negative staphylococci, at which surface proteins take part . The proteins that were found at S . saprophyticus and ascribed to take part in polystiren plates adhesion: SSP-1 and SSP-2 could be an example . In this work the effort to esteem surface protein expression of various kinds of coagulase-negative staphylococcus according to cultivation conditions has been made . The studies carried out with 31 staphylococcus strains being obtained from new-born children hospitalised in Neonatology Clinic helped to analyse the similarities among these proteins in the area of a given strain cultivated on different mediums . The examined strains belonged to five different species and it had been taken into consideration during the results esteem . On the grounds of electrophoretic surface proteins division the charts dysometric analysis was created showing interdependence between Rf for surface proteins and optical density . Afterwards an analysis for each strain was done taking into account a sort of medium on which the cultivation had been placed . S . haemolyticus strains analysis cultivated on three different mediums allows to isolate two protein groups showing similar expression of both low- and high-molecular proteins . For the majority of strains belonging to the same species one can observe a similar expression within low- and high-molecular surface proteins regardless of cultivation conditions . Recurrence of the electrophoretic pictures regardless of changes in cultivation conditions, creates the base for the recognised proteins identification and also for the proteins with unmarked activity isolation.

Intensive Care Med, 2002 Aug, 28(8), 1157 - 60 Epub 2002 Jun 20.
Clinical experience with quinupristin-dalfopristin as rescue treatment of critically ill patients infected with methicillin-resistant staphylococci; Sander A et al.; OBJECTIVES: To describe the efficacy and safety of quinupristin-dalfopristin (Q-D) as rescue therapy in critically ill patients with severe infections caused by methicillin-resistant staphylococci unresponsive to vancomycin treatment . DESIGN: Observational study in the context of the compassionate use programme for Q-D . METHODS: Twelve mechanically ventilated patients suffering from severe staphylococcal infections, pretreated unsuccessfully with vancomycin despite in vitro sensitivity, were included . Patients received, intravenously, Q-D 7.5 mg/kg body weight 3 times daily . The duration of Q-D therapy averaged 11.8 days (range: 1-26 days) . The outcome variables were clinical efficacy and bacteriological eradication . RESULTS: Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were isolated in three patients each, and both bacteria were isolated from six patients . Eradication of pathogen(s) was achieved in 7 of 12 patients (66%) . Five patients (42%) died due to severe co-morbidity . Adverse events related to Q-D were not observed and neither renal nor liver function was adversely affected . CONCLUSIONS: Quinupristin-dalfopristin appears to be an efficient and safe antimicrobial drug for the rescue treatment of staphylococcal infections in critically ill patients . It may be considered as a treatment option in cases of vancomycin treatment failure.

Antimicrob Agents Chemother, 2002 Sep, 46(9), 2797 - 803
Frequency of disinfectant resistance genes and genetic linkage with beta-lactamase transposon Tn552 among clinical staphylococci; Sidhu MS et al.; A total of 61 strains of Staphylococcus aureus and 177 coagulase-negative staphylococcal strains were isolated from the blood of patients with bloodstream infections and from the skin of both children under cancer treatment and human immunodeficiency virus-positive patients . The MIC analyses revealed that 118 isolates (50%) were resistant to quaternary ammonium compound-based disinfectant benzalkonium chloride (BC) . The frequencies of resistance to a range of antibiotics were significantly higher among BC-resistant staphylococci than among BC-sensitive staphylococci . Of 78 BC-resistant staphylococcal isolates, plasmid DNA from 65 (83%), 2 (3%), 43 (55%), and 15 (19%) isolates hybridized to qacA or -B (qacA/B), qacC, blaZ, and tetK probes, respectively . The qacA/B and blaZ probes hybridized to the same plasmid in 19 (24%) staphylococcal strains . The plasmids harboring both qacA/B and blaZ genes varied from approximately 20 to 40 kb . The Staphylococcus epidermidis Fol62 isolate, harboring multiresistance plasmid pMS62, contained qacA/B and blaZ together with tetK . Molecular and genetic studies indicated different structural arrangements of blaZ and qacA/B, including variable intergenic distances and transcriptional directions of the two genes on the same plasmid within the strains . The different organizations may be due to the presence of various genetic elements involved in cointegration, recombination, and rearrangements . These results indicate that qac resistance genes are common and that linkage between resistance to disinfectants and penicillin resistance occurs frequently in clinical isolates in Norway . Moreover, the higher frequency of antibiotic resistance among BC-resistant strains indicates that the presence of either resistance determinant selects for the other during antimicrobial therapy and disinfection in hospitals.

Am J Clin Dermatol, 2002, 3(7), 463 - 74
Dermatological care of the diabetic foot; Aye M et al.; Approximately 30% of patients with diabetes mellitus will have disease-related dermatological problems . Dry skin can be associated with autonomic neuropathy and may be fragile, promoting bacterial invasion . Any potentially infected 'diabetic foot' must be taken seriously, and non-painful deep sepsis suspected if there is evidence of sensory loss . Consideration should be given to eliminating nasal carriage of staphylococci if recurrent superficial sepsis occurs in the presence of poor diabetic control . Fungal infections, both of skin and nails, are common but usually not serious in the absence of immunosuppression . Treatment with topical antifungals may need to be combined with systemic therapy for successful eradication . Systemic antifungal therapy should be carefully considered as treatment needs to be prolonged and is potentially toxic, particularly in individuals with diabetes mellitus who often have co-morbidities . Varicose eczema should be treated by physical therapies intended to improve venous return and prevent peripheral edema and tissue injury . Allergic dermatitis is commonly associated with topical treatments and other sensitizers . Many reactions are not apparent from history, and patch testing for sensitivity is recommended . There are several diabetes mellitus-specific conditions that dermatologists must be aware of, including, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic dermopathy (spotted leg syndrome or shin spots), diabetic bullae (bullosis diabeticorum), and limited joint mobility and waxy skin syndrome . Ulceration, due to varying combinations of peripheral vascular disease and sensory neuropathy, is the province of the specialist team dealing with the diabetic foot and should ideally be referred to an appropriate multidisciplinary team.

Structure (Camb), 2002 Aug, 10(8), 1107 - 15
X-ray crystal structure of Staphylococcus aureus FemA; Benson TE et al.; The latter stages of peptidoglycan biosynthesis in Staphylococci involve the synthesis of a pentaglycine bridge on the epsilon amino group of the pentapeptide lysine side chain . Genetic and biochemical evidence suggest that sequential addition of these glycines is catalyzed by three homologous enzymes, FemX (FmhB), FemA, and FemB . The first protein structure from this family, Staphylococcus aureus FemA, has been solved at 2.1 A resolution by X-ray crystallography . The FemA structure reveals a unique organization of several known protein folds involved in peptide and tRNA binding . The surface of the protein also reveals an L-shaped channel suitable for a peptidoglycan substrate . Analysis of the structural features of this enzyme provides clues to the mechanism of action of S . aureus FemA.

J Am Chem Soc, 2002 Aug 21, 124(33), 9729 - 36
Mannopeptimycins, novel antibacterial glycopeptides from Streptomyces hygroscopicus, LL-AC98; He H et al.; A series of novel antibiotics with activity against methicillin-resistant staphylococci and vancomycin-resistant enterococci has been purified, and their structures have been characterized using spectroscopic analyses and chemical conversions . These antibiotics, designated mannopeptimycins alpha-epsilon (1-5), are glycosylated cyclic hexapeptides containing two stereoisomers of an unprecedented amino acid, alpha-amino-beta-{4'-(2'-iminoimidazolidinyl)}-beta-hydroxypropionic acid (Aiha), as a distinguishing feature . The cyclic peptide core of these antibiotics is attached to a mannosyl monosaccharide moiety in 2 and to mannosyl monosaccharide and disaccharide moieties in 1, 3, 4, and 5 . The presence and position of an isovaleryl group in the terminal mannose (Man-B) in 3-5 are critical for retaining antibacterial potency.

New Microbiol, 2002 Jul, 25(3), 367 - 73
Production and novel quantification of haemolysins produced by coagulase-negative staphylococci isolated from subclinical mastitis in sheep; Kanellos TS et al.; Coagulase-negative staphylococci producing cell-damaging toxins were isolated from the milk of sheep with subclinical mastitis . The haemolytic activity of Coagulase-negative staphylococcal strains was assessed on solid and liquid culture media . More than 61% and 76% of the tested strains on solid media produced evidence of alpha- and delta- haemolysins and more than 78% produced synergistic haemolysis . However almost all isolates producing haemolysin in liquid culture media produced only very few units of haemolysin compared to the positive control of five Coagulase-positive strains of staphylococci . It was concluded that solid media are better for classifying Coagulase-negative staphylococci as producers or not of haemolysins, and liquid media for measuring the size of this activity within the first few hours of intramammary infection.

J Commun Dis, 2001 Jun, 33(2), 121 - 5
A study of bacterial pathogens in acute pelvic inflammatory disease; Baveja G et al.; The study was carried out on two groups--the study group consisting of 50 women with acute pelvic inflammatory disease and the control group consisting of 20 women admitted for tubal ligation . Pouch of Douglas aspirates were collected under all aseptic precautions with 18 gauge medicut needle . The samples were transferred to thioglycollate broth . A direct Gram staining was done followed by plating on media for aerobic and anaerobic incubation . All cultures were sterile in the control group . There were both monomicrobial (56.7%) and polymicrobial (43.2%) isolates in the study group . The predominant aerobic isolates were coagulase negative Staphylococci, E . coli and Staphylococcus aureus . Amongst anaerobic isolates gram negative bacilli were the most common at 46.6% followed by gram positive cocci at 40%.

J Bacteriol, 2002 Sep, 184(17), 4709 - 14
Transposase-dependent formation of circular IS256 derivatives in Staphylococcus epidermidis and Staphylococcus aureus; Loessner I et al.; IS256 is a highly active insertion sequence (IS) element of multiresistant staphylococci and enterococci . Here we show that, in a Staphylococcus epidermidis clinical isolate, as well as in recombinant Staphylococcus aureus and Escherichia coli carrying a single IS256 insertion on a plasmid, IS256 excises as an extrachromosomal circular DNA molecule . First, circles were identified that contained a complete copy of IS256 . In this case, the sequence connecting the left and right ends of IS256 was derived from flanking DNA sequences of the parental genetic locus . Second, circle junctions were detected in which one end of IS256 was truncated . Nucleotide sequencing of circle junctions revealed that (i) either end of IS256 can attack the opposite terminus and (ii) the circle junctions vary significantly in size . Upon deletion of the IS256 open reading frame at the 3' end and site-directed mutageneses of the putative DDE motif, circular IS256 molecules were no longer detectable, which implicates the IS256-encoded transposase protein with the circularization of the element.

Pediatrics, 2002 Aug, 110(2 Pt 1), 285 - 91
Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network; Stoll BJ et al.; OBJECTIVE: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants . To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 6956 VLBW (401-1500 g) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period (1998-2000) . METHODS: The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth . Expanded infection surveillance was added in 1998 . RESULTS: Of 6215 infants who survived beyond 3 days, 1313 (21%) had 1 or more episodes of blood culture-proven late-onset sepsis . The vast majority of infections (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of infections . Rate of infection was inversely related to birth weight and gestational age . Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus, prolonged ventilation, prolonged intravascular access, bronchopulmonary dysplasia, and necrotizing enterocolitis . Infants who developed late-onset sepsis had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days) . They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%) . CONCLUSIONS: Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors . Strategies to reduce late-onset sepsis and its medical, social, and economic toll need to be addressed urgently.

J Antimicrob Chemother, 2002 Aug, 50(2), 277 - 80
Comparative in vitro activity of faropenem against staphylococci; von Eiff C et al.; The anti-staphylococcal activity of faropenem, a novel beta-lactam, was examined and compared with that of amoxicillin, cefuroxime, clindamycin and vancomycin using the agar dilution method . A total of 234 staphylococci, including a large number of clonally different methicillin-resistant strains and a representative number of Staphylococcus aureus small colony variants, were tested . While the activity of faropenem was independent of the staphylococcal phenotype, the novel penem was up to eight times more active against methicillin-susceptible strains compared with the other agents tested . In addition, faropenem was active against many methicillin-resistant strains of S . aureus and coagulase-negative staphylococci.

Plasmid, 2002 May, 47(3), 241 - 5
Expression of the S . aureus hysA gene in S . carnosus from a modified E . coli-staphylococcal shuttle vector; Williams RJ et al.; We have modified an E . coli-staphylococcal shuttle vector for use in the general cloning and expression of genes from pathogenic staphylococci in Staphylococcus carnosus . As S . carnosus is non-pathogenic, this expression system will facilitate the study of the roles of individual gene products in the disease process . To evaluate the use of this expression system, a DNA fragment containing the Staphylococcus aureus hyaluronate lyase (hysA) gene was cloned into the modified vector, pNW21, and introduced into S . carnosus . Hyaluronate lyase was both produced and secreted by S . carnosus . In addition, the secreted HysA protein was enzymatically active, as determined using a zymographic assay.

J Clin Microbiol, 2002 Aug, 40(8), 2786 - 90
Rapid detection of methicillin-resistant staphylococci from blood culture bottles by using a multiplex PCR assay; Louie L et al.; Rapid detection and accurate identification of methicillin-resistant staphylococci are critical for the effective management of infections caused by these organisms . We describe a multiplex PCR-based assay for the direct detection of methicillin-resistant staphylococci from blood culture bottles (BacT/Alert; Organon-Teknika, Durham, N.C.) . A simple lysis method followed by a multiplex PCR assay designed to detect the nuc, mecA, and bacterial 16S rRNA genes was performed . A total of 306 blood culture specimens were collected over a period of 10 months from June 1998 to April 1999, consisting of 236 blood cultures growing staphylococci (including 124 methicillin-resistant Staphylococcus spp.), 50 positive blood cultures which grew organisms other than staphylococci, and 20 blood cultures that were negative for bacterial and fungal pathogens after 5 days of incubation and terminal subculture . DNA extraction, PCR, and detection could be completed in 2.5 h . Of the positive blood cultures with staphylococci, the multiplex PCR assay had a sensitivity and specificity of 99.2% and 100%, respectively . Our results show that rapid, direct detection of methicillin-resistant staphylococci is possible, allowing clinicians to make prompt and effective decisions for the management of patients with staphylococcal bacteremia.

J Dairy Sci, 2002 Jun, 85(6), 1460 - 7
Mammary pathogens and their relationship to somatic cell count and milk yield losses in dairy ewes; Gonzalo C et al.; A total of 9592 samples of half udder milk were collected monthly throughout lactation for bacteriological and somatic cell count (SCC) study from 1322 Churra ewe lactations from seven separate flocks enrolled in the recording scheme of the National Association of Spanish Churra Breeders in the Castile-Le6n region of Spain . Statistical analyses were carried out from a mixed model with random factor half udder or ewe for repeated measures . Test of significance of fixed effects of this mixed model showed significant effects of organisms, flock, parity, lactation stage, and birth type on SCC . Special reference must be made to novobiocin-sensitive coagulase-negative staphylococci, which represented more than 50% of the isolates and which elicited SCC geometric means of around 106/ml . In addition, the analysis of 4352 monthly test-day records for milk yield, SCC, and bacteriology showed that the ewes that were uninfected and infected by minor pathogens had the lowest SCC and the highest milk yields, whereas those infected by major pathogens had high SCC and milk yield losses between 8.8 and 10.1% according to the uni- or bilateral character of the infection . Finally, ewes infected by novobiocin-sensitive coagulase-negative staphylococci elicited SCC values similar to those of infections by major pathogens and milk yield losses ranging between those caused by minor and major pathogens . As a result, emphasis should be put on prevention of subclinical mastitis, particularly mastitis caused by novobiocin-sensitive coagulase-negative staphylococci in dairy sheep herds to improve microbiological and hygienic milk quality and to minimize losses in milk yield.

J Hosp Infect, 2002 Jul, 51(3), 207 - 14
Bacteraemia caused by coagulase-negative staphylococci exhibiting decreased susceptibility to teicoplanin; Lallemand S et al.; The purpose of our study was to assess the prevalence of coagulase-negative staphylococci (CoNS) isolates with reduced susceptibility to glycopeptides among the isolates responsible for bloodstream infections and to describe the epidemiology of these isolates . CoNS isolates from bloodstream infections were collected and characterized by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed-field gel electrophoresis . The medical records of patients with positive cultures and trends in glycopeptide use were reviewed to determine the effect of previous antibiotic treatment on the susceptibility profile of these organisms . The crude incidence of CoNS bacteraemia was 0.51 per 1000 days of hospitalization . The 15 (28.8%) strains identified as having decreased susceptibility to teicoplanin by the reference method were all hospital-acquired and displayed 13 different DNA patterns . The relative risk of harbouring strains with decreased susceptibility to teicoplanin was 3.55 among patients previously treated with vancomycin (confidence interval 95%: 2.15-5.85) . The teicoplanin consumption in our institution was constant and represented about 27% of the glycopeptide consumption in daily defined doses . The implementation of programmes aiming to reduce the unnecessary use of glycopeptides should have a significant impact on the reduced-susceptibility rate because strains probably become resistant as a result of antibiotic pressure.

J Biotechnol, 2002 Jun 13, 96(1), 67 - 78
Engineering of staphylococcal surfaces for biotechnological applications; Wernerus H et al.; Novel surface proteins can be introduced onto bacterial cell surfaces by recombinant means . Here, we describe various applications of two such display systems for the food-grade bacteria Staphylococcus carnosus and Staphylococcus xylosus, respectively . The achievements in the use of such staphylococci as live bacterial vaccine delivery vehicles will be described . Co-display of proteins and peptides with adhesive properties to enable targeting of the bacteria, have significantly improved the vaccine delivery potential . Recently, protective immunity to respiratory syncytial virus (RSV) could be evoked in mice by intranasal immunization using such 'second generation' vaccine delivery systems . Furthermore, antibody fragments and other 'affinity proteins' with capacity to specifically bind a certain protein, e.g . Staphylococcus aureus protein A-based affibodies, have been surface-displayed on staphylococci as initial efforts to create whole-cell diagnostic devices . Surface display of metal-binding peptides, or protein domains into which metal binding properties has been engineered by combinatorial protein engineering, have been exploited to create staphylococcal bioadsorbents for potential environmental or biosensor applications . The use of these staphylococcal surface display systems as alternatives for display of large protein libraries and subsequent affinity selection of relevant binding proteins by fluorescence-activated cell sorting (FACS) will be discussed.

Chemotherapy, 2002 Jul, 48(3), 154 - 7
Central venous catheter infections in patients with acute leukemia; Karthaus M et al.; BACKGROUND: Central venous catheters (CVCs) have become an essential tool for an appropriate management of patients with acute leukemia . Infectious complications are a major concern in patients treated for acute leukemia . Although CVC-related infections are considered to be a major source of infections during neutropenia (<500/microl), data regarding the incidence of CVC-related infections are rare in acute leukemia . PATIENTS AND METHODS: We analyzed nontunneled CVCs in 58 patients with acute leukemia (22 men/36 women) in 119 chemotherapy cycles from April 1996 to January 1998 in a prospective trial . Proven CVC-related infection was defined as the isolation of the same organism from peripheral blood and CVC tip . CVC infection was suspected or possible when exit site inflammation and positive blood culture or organisms typical for CVC infection were observed . RESULTS: Mean neutropenia/cycle was 16.3 days (SD 8.0) . 178 CVCs with 2,576 CVC days (mean 14.5 days, SD 7.2 days) were used in 119 cycles . Fever occurred in 87 cycles (73%) . Blood stream infection was proven in 31 out of 87 febrile episodes (26.1%) with 40 isolates (8 gram-negative, 31 gram-positive, 1 Candida spp.) . Colonization of the CVC tip was observed in 24 CVC lines with 28 isolates (27 gram-positive, 1 gram-negative); however, proven CVC-related infections were observed in 5 episodes only, all with coagulase-negative staphylococci . In another 6 episodes, CVC-related infection was assumed (local inflammation and gram-positive blood culture) . Six further episodes had typical blood isolates (4 coagulase-negative staphylococci, 1 Candida spp.) and were considered possible CVC-related infections . In none of the remaining afebrile 32 cycles was a CVC infection observed or suspected . CONCLUSION: Gram-positive organisms contributed to the majority of CVC-related infections (16 out 17 CVC infections); however, the overall incidence of CVC infections in acute leukemia patients was 6.5/1,000 CVC days only (1.9 proven/2.3 suspected/2.3 possible/1,000 CVC days) .

Antimicrob Agents Chemother, 2002 Aug, 46(8), 2662 - 4
In vitro evaluation of AZD2563, a novel oxazolidinone, against 603 recent staphylococcal isolates; Anderegg TR et al.; AZD2563, a novel oxazolidinone, and a selection of comparator drugs that included linezolid, erythromycin, clindamycin, quinolones, and gentamicin were tested against 384 Staphylococcus aureus (176 oxacillin-resistant S . aureus {ORSA}) and 219 coagulase-negative staphylococci (CoNS; 162 oxacillin resistant) by reference microdilution (all strains) and agar dilution (30 strains) methods . The following results were noted for AZD2563 . (Note that, for comparison only, a breakpoint of < or =4 microg/ml {the breakpoint of linezolid} was used for this study, although a susceptibility breakpoint for AZD2563 has not been determined.) For S . aureus, the MIC at which 50% of the isolates tested are inhibited (MIC(50)) was 1 microg/ml, the MIC(90) was 2 microg/ml, and the percent susceptibility was 100% . For CoNS, the MIC(50) was 0.5 microg/ml, the MIC(90) was 1 microg/ml, and the percent susceptibility was 100% . ORSA and OR-CoNS strains were equally inhibited by AZD2563 and linezolid . AZD2563 demonstrated antistaphylococcal activity comparable to that of linezolid.

Infect Immun, 2002 Aug, 70(8), 4254 - 60
Induction of cell-mediated immunity to Staphylococcus aureus in the mouse mammary gland by local immunization with a live attenuated mutant; Gomez MI et al.; The efficacy of intramammary (Ima) immunization with a live attenuated (la) Staphylococcus aureus mutant to protect the mouse mammary gland from infection has previously been established . The present study was aimed at evaluating whether Ima immunization with la-S . aureus can induce cell-mediated immune responses to the pathogen within the mammary gland . Mice were immunized by Ima route with la-S . aureus, and regional lymph node mononuclear cells were obtained thereafter . A higher expression of the interleukin-2 receptor was found on B and T cells from immunized mice when they were compared with control mice . Immunization with la-S . aureus induced strong proliferative responses to S . aureus . Moreover, significantly increased levels of gamma interferon (IFN-gamma) were produced by CD4+ T cells when lymphocytes from immunized mice, but not from control mice, were cultured in the presence of staphylococcal antigens . Moreover, a significant increase in the percentage of IFN-gamma-producing CD4+ and CD8+ T cells was observed after S . aureus Ima challenge in immunized mice compared to challenged control mice . Our results demonstrated that Ima immunization with la-S . aureus induced primed lymphocyte populations capable of responding against staphylococcal antigens during in vitro stimulation, as well as during in vivo infection by S . aureus . CD4+ and CD8+ T cells appear to be the main lymphocyte subpopulations involved in this response . It is suggested that IFN-gamma production induced by Ima immunization may play a pivotal role in the eradication of intracellular staphylococci.

Clin Infect Dis, 2002 Aug 1, 35(3), E32 - 4 Epub 2002 Jun 27.
Staphylococcus lugdunensis infection sites: predominance of abscesses in the pelvic girdle region; Bellamy R et al.; We used a screening protocol to identify Staphylococcus lugdunensis in clinical specimens with pure or predominant growth of coagulase-negative staphylococci . S . lugdunensis was isolated from 17 patients in a 12-month period and was judged to be the cause of infection in 14 cases . In 13 cases, the patient had a soft-tissue abscess, and in 9 of these, the abscess was located in the pelvic girdle region, which suggests that this may be the natural habitat of S . lugdunensis.

J Allergy Clin Immunol, 2002 Jul, 110(1), 72 - 7
Maternal vaginal microflora during pregnancy and the risk of asthma hospitalization and use of antiasthma medication in early childhood; Benn CS et al.; BACKGROUND: Infants with wheezing and allergic diseases have a microflora that differs from that of healthy infants . The fetus acquires microorganisms during birth when exposed to the maternal vaginal microflora . It is therefore conceivable that the maternal vaginal microflora might influence the establishment of the infant flora and, as a consequence, the development of wheezing and allergic diseases . OBJECTIVE: We sought to study the associations between the composition of the maternal vaginal microflora and the development of wheezing and asthma in childhood . METHODS: We performed a population-based cohort study in Denmark . Vaginal samples for bacterial analysis were obtained during pregnancy . A total of 2927 women (80% of the invited women) completed the study and had 3003 live infants . Infant wheezing was assessed as one or more hospitalizations for asthma between 0 and 3 years of age . Asthma was assessed as use of 3 or more packages of antiasthma medication between 4 and 5 years of age . RESULTS: Maternal vaginal colonization with Ureaplasma urealyticum during pregnancy was associated with infant wheezing (odds ratio {OR}, 2.0; 95% CI, 1.2-3.6), but not with asthma, during the fifth year of life . Maternal colonization with staphylococci (OR, 2.2; 95% CI, 1.4-3.4) and use of antibiotics in pregnancy (OR, 1.7; 95% CI, 1.1-2.6) were associated with asthma during the fifth year of life . CONCLUSION: The composition of the maternal vaginal micro-flora might be associated with wheezing and asthma in the offspring up to 5 years of age.

Diagn Microbiol Infect Dis, 2002 Jul, 43(3), 175 - 82
"Staphylococcus pettenkoferi," a novel staphylococcal species isolated from clinical specimens; Trulzsch K et al.; In this report we describe a novel species of coagulase-negative novobiocin susceptible staphylococci obtained from an epidemiologically unrelated blood culture and a wound infection . These isolates significantly differed from all other validated Staphylococcus species based on phenotypic characteristics and 16S rRNA gene sequencing . Both isolates had identical 16S rRNA sequences and phylogenetic trees constructed from evolutionary distances showed that this species formed a distinct and deep subline that was most closely related to members of the Staphylococcus saprophyticus cluster group (S . kloosii, S . gallinarum, S . arlettae, S . saprophyticus, S . xylosus, S . equorum, S . succinus and S . cohnii) and Staphylococcus auricularis . Furthermore these strains could each be distinguished from all other staphylococci based on at least one phenotypic trait . Therefore we propose the designation of "Staphylococcus pettenkoferi" a novel species of coagulase-negative staphylococci.

Clin Microbiol Rev, 2002 Jul, 15(3), 430 - 8
Vancomycin resistance in staphylococci; Srinivasan A et al.; Vancomycin resistance has been reported in clinical isolates of both coagulase-negative staphylococci and Staphylococcus aureus . The emerging threat of widespread vancomycin resistance poses a serious public health concern given the fact that vancomycin has long been the preferred treatment of antibiotic-resistant gram-positive organisms . Though major efforts are now being focused on improving our understanding of vancomycin resistance, there is much that remains unknown at this time . This article reviews the major epidemiologic, microbiologic, and clinical characteristics of vancomycin resistance in both coagulase-negative staphylococci and S . aureus . The review begins with a discussion of issues common to both coagulase-negative staphylococci and S . aureus, such as definitions, laboratory detection of vancomycin resistance, and infection control issues related to vancomycin-resistant staphylococci . The rest of the article is then devoted to a discussion of issues unique to each organism, including epidemiology, risk factors for infection, mechanisms of resistance, and management options.

J Antimicrob Chemother, 2002 Jul, 50(1), 89 - 93
In vitro activity of a novel oxazolidinone, AZD2563, against randomly selected and multiresistant Gram-positive cocci; Johnson AP et al.; The in vitro activity of AZD2563, a novel oxazolidinone, was assessed against 595 Gram-positive cocci, comprising recent surveillance isolates and a collection of resistant (including multiresistant), epidemiologically diverse isolates . The MICs of AZD2563 for staphylococci, pneumococci and enterococci had narrow ranges, 0.25-2 mg/L, with modal MICs of 1 mg/L for staphylococci and pneumococci, and 1-2 mg/L for enterococci . AZD2563 was equally active against the surveillance isolates and those that had been selected for their multiresistance to other agents . The MICs of AZD2563 were either the same as those of linezolid or two-fold lower.

Eur J Anaesthesiol, 2002 Jun, 19(6), 455 - 8
Bacterial contamination of propofol: the effects of temperature and lidocaine; Aydin N et al.; BACKGROUND AND OBJECTIVE: The intravenous anaesthetic propofol may become contaminated once the ampoules have been opened . The effect of lidocaine and cooling was tested on the bacterial contamination of propofol . METHODS: The study was performed in two parts . In Part 1,1920 aliquots of propofol alone, and of a propofollidocaine mixture, were drawn into sterile syringes and stored at room temperature (24-26 degrees C) or in the refrigerator (12-14 degrees C) . In Part 2, 1200 aliquots from opened ampoules of propofol alone, or as a propofol-lidocaine mixture, were stored at room temperature or in the refrigerator . Samples were aerobically cultured at 0, 1, 2, 4, 8 and 12 h . RESULTS: In Part 1, diphtheroid bacillus was isolated from one aliquot (0.06%) . In Part 2, there was bacterial growth in both groups; the number of contaminated ampoules increased with time and it was 20-26% at 12 h . Diphtheroid bacilli and coagulase-negative staphylococci were the most frequent micro-organisms . CONCLUSIONS: When propofol is stored in opened ampoules, the bacterial contamination rate is high . Adding lidocaine, or storing opened ampoules at 12-14 degrees C, does not affect the contamination rate, except during the first few hours . It is advisable to draw propofol aseptically into a syringe in an amount that can be used during one procedure.

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