Staphylococcus

Dtsch Med Wochenschr, 2000 May 19, 125(20), 613 - 8
{Rapid and reliable detection of multiresistent Staphylococcus aureus (MRSA) by multiplex PCR}; Domann E et al.; BACKGROUND AND OBJECTIVE: Staphylococci are widespread pathogens and are frequently associated with nosocomial infections . Many hospitals struggle with increasing amounts of methicillin-resistant Staphylococcus aureus (MRSA) which are "multiresistant" against all betalactam antibiotics . Often, applicable antibiotics for treatment are only glycopeptides like vancomycin and teicoplanin . In addition, MRSA infected patients require expensive intensive isolation measures and strict hygiene . To efficiently prevent dissemination of these pathogens rapid and reliable identification and a close collaboration between clinicians and microbiologists are required . The purpose of our study was to set up a rapid and reliable identification procedure for MRSA by the amplification of specific gene determinants by PCR in order to to efficiently support therapy and eradication of the pathogen . METHODS: 153 strains of staphylococci isolated from in-patients of the hospital of the Justus-Liebig University of Giessen were examined . The femB gene was used to differentiate between Staphylococcus aureus (S . aureus) and coagulase-negative staphylococci (CNS), a gene which allows the species-specific identification of methicillin-resistant (MRSA) and -susceptible S . aureus (MSSA) . Additionally, MRSA harbor the mecA gene encoding methicillin-resistance, which is absent in MSSA strains . RESULTS: Using a multiplex PCR with femB and mecA gene-specific oligonucleotides MRSA strains were unequivocally detected within 3 hours . The femB gene was detected in all 102 strains of S . aureus but in none of the 51 CNS . The mecA determinant was detected in 12 S . aureus . Among these, 11 strains were phenotypically methicillin-resistant and one strain was susceptible . The methicillin-resistance of this particular mecA-positive/methicillin-susceptible strain (cryptic MRSA) was inducible by cultivation on agar plates supplemented with flucloxacillin . CONCLUSIONS: The described method specifically detects S . aureus and identifies phenotypical and cryptic MRSA . These cryptic MRSA are of particular relevance since they are undetectable using common phenotypically based detection methods . It is conceivable that the methicillin resistance of these strains is induced under antibiotic therapy with flucloxacillin and that the mec-encoded feature of methicillin-resistance can be transferred to previously methicillin-susceptible strains . Using the reliable detection of these strains by PCR, failure of flucloxacillin therapy is avoidable.

J Antimicrob Chemother, 1999 Feb, 43(2), 253 - 9
The prevalence of aminoglycoside resistance and corresponding resistance genes in clinical isolates of staphylococci from 19 European hospitals; Schmitz FJ et al.; Aminoglycosides still play an important role in antistaphylococcal therapies, although emerging resistance amongst staphylococci is widespread . To further our understanding of the prevalence of aminoglycoside resistance in Europe, we tested 699 and 249 consecutive unrelated clinical isolates of Staphylococcus aureus and coagulase-negative staphylococci (CNS), respectively, from the SENTRY Antimicrobial Surveillance Program, for susceptibility to gentamicin, tobramycin, kanamycin and streptomycin, and examined the relationship between susceptibility to these antimicrobials and susceptibility to methicillin . Three hundred and sixty-three staphylococcal isolates demonstrated resistance to at least one of the aminoglycosides tested; all of these isolates were screened for the presence of aac(6')-Ie + aph(2"), ant(4')-Ia and aph(3')-IIIa, the genes encoding the most clinically relevant aminoglycoside-modifying enzymes . S . aureus isolates derived from hospital-acquired pneumonia tended to be more resistant to aminoglycosides and methicillin than isolates from blood or wound infections . In S . aureus, resistance to aminoglycosides was closely associated with methicillin resistance . Susceptibility of S . aureus to gentamicin has decreased by 9% from previous European studies to a current level of 77%, while susceptibility of CNS, currently at 67%, has increased by 21% . Geographical variation occurred, correlating with methicillin resistance, although intra-country variation was considerable . aac(6')-Ie + aph(2"), ant(4')-Ia and aph(3')-IIIa were found throughout Europe in 68%, 48% and 14% respectively of staphylococci resistant to at least one aminoglycoside . aph(3')-IIIa was considerably more common in methicillin-susceptible S . aureus and CNS isolates; the reverse was true for the other two resistance genes . The prevalence of ant(4')-Ia and aph(3')-IIIa genes in aminoglycoside-resistant staphylococci was significantly greater than that reported in previous European studies.

Clin Infect Dis, 2001 Mar 15, 32 Suppl 1, S33 - 8
Pharmacodynamics of moxifloxacin and levofloxacin against Staphylococcus aureus and Staphylococcus epidermidis in an in vitro pharmacodynamic model; Lister PD; An in vitro pharmacokinetic model was used to compare the pharmacodynamics of moxifloxacin and levofloxacin against 3 Staphylococcus aureus and 3 Staphylococcus epidermidis strains . Logarithmic-phase cultures were inoculated into the peripheral compartment of hollow-fiber cartridges and exposed to the peak serum concentrations achieved in humans with oral doses of moxifloxacin (400 mg) and levofloxacin (500 mg) . Drugs were added at 0 and 24 h, elimination kinetics were simulated, and changes in viable bacterial counts were evaluated over the course of 36 h . Moxifloxacin was bactericidal against all 6 staphylococci (times to 99.9% kill, 1-3 h) . Against most strains, bacterial killing continued through 36 h, with total kills exceeding 5.5 logs . Levofloxacin was bactericidal against 5 of the strains, with similar times to 99.9% kill . In contrast to moxifloxacin, however, resistant subpopulations emerged in 4 strains during therapy with levofloxacin, and this could have important implications for treatment of staphylococcal infections . These in vitro observations warrant the clinical evaluation of moxifloxacin in the treatment of staphylococcal infections.

J Vet Med B Infect Dis Vet Public Health, 2000 Nov, 47(9), 683 - 91
Evaluation of two commercial systems and a new identification scheme based on solid substrates for identifying coagulase-negative staphylococci from bovine mastitis; Thorberg BM et al.; Coagulase-negative staphylococci (CNS), mainly isolated from bovine mastitis (n = 89, representing 11 different species), were used to evaluate two commercial identification systems: ID 32 Staph and Staph-Zym . The level of agreement between the ID 32 Staph and Staph-Zym systems and conventional methods was 77 and 94%, respectively . An alternative method, based on solid biochemical substrates, is also presented . This can be used for identifying novobiocin-sensitive CNS strains from bovine mastitis.

Kyobu Geka, 2001 Mar, 54(3), 207 - 10
{Is open heart surgery clean: bacteriologic analysis of salvaged blood}; Ishida T et al.; In this prospective study, we evaluated contamination of surgical fields in open heart operations by salvaged blood culture used in autologous transfusions device (Cell Saver 5, Heamonetics Corp., Braintree, MA, USA) . And also, we prospectively investigated an efficacy of pre- and intra-operative prophylactic antibiotics administrations (cefazolin) . Thirty patients undergone open heart surgeries with median sternotomy enrolled in this study . The patients were divided into two groups, group A (n = 15); without prophylactic antibiotics administration, group B (n = 15); with pre- and intra-operative prophylactic antibiotics administrations . Blood samples were drawn through the right atrium after the discontinuation of CPB and from salvaged blood bags . Bacterial growth was detected in 80.0% of salvaged blood samples in group A, 86.7% in group B (p = 0.62) . Whereas no bacterial growth detection in blood samples though the right atrium . Quantitative estimates of contaminations showed 1.06 +/- 1.41, 0.90 +/- 1.24 cfu/ml, respectively (p = 0.22) . Although bacterial growth rate were not statistically significant difference between groups, detective rate of Staphylococci was remarkably decreased (p = 0.005) in group B . Pre- and intra-operative prophylactic antibiotics administrations were effective for Staphylococci, but not whole microorganisms . In conclusion, salvaged blood used in autologous transfusions was highly contaminated and it suggests that surgical fields were not clear . Prophylactic antibiotics administrations were effective especially for Staphylococci.

Science, 2001 Mar 9, 291(5510), 1962 - 5
A proteolytic transmembrane signaling pathway and resistance to beta-lactams in staphylococci; Zhang HZ et al.; beta-Lactamase and penicillin-binding protein 2a mediate staphylococcal resistance to beta-lactam antibiotics, which are otherwise highly clinically effective . Production of these inducible proteins is regulated by a signal-transducing integral membrane protein and a transcriptional repressor . The signal transducer is a fusion protein with penicillin-binding and zinc metalloprotease domains . The signal for protein expression is transmitted by site-specific proteolytic cleavage of both the transducer, which autoactivates, and the repressor, which is inactivated, unblocking gene transcription . Compounds that disrupt this regulatory pathway could restore the activity of beta-lactam antibiotics against drug-resistant strains of staphylococci.

J Immunol, 2001 Mar 15, 166(6), 4029 - 34
Bactericidal properties of group IIA and group V phospholipases A2; Gronroos JO et al.; Group V phospholipase A(2) (PLA(2)) is a recently characterized 14-kDa secretory PLA(2) of mammalian heart and macrophage-derived cells . Group IIA PLA(2), which is structurally close to group V PLA(2), has been shown to kill Gram-positive bacteria in vitro and to prevent symptoms of Gram-positive infection in vivo . We studied the antibacterial properties of fully active recombinant rat group IIA and V PLA(2)s . Both group IIA and V PLA(2)s were highly bactericidal against Gram-positive bacteria, including methicillin-resistant staphylococci and vancomycin-resistant enterococci . Only high concentrations of group IIA PLA(2) showed some bactericidal effect against the Gram-negative bacterium Escherichia coli . Our results confirm that group IIA PLA(2) is a potent antibacterial enzyme against Gram-positive bacteria . Moreover, we show here that group V PLA(2) is a novel antibacterial mammalian protein, but is less potent than group IIA PLA(2) . Both enzymes may be considered as future therapeutic agents against bacterial infections.

Vet Microbiol, 2001 Mar 20, 79(2), 155 - 69
Molecular epidemiology and genetic linkage of macrolide and aminoglycoside resistance in Staphylococcus intermedius of canine origin; Boerlin P et al.; A collection of 77 Staphylococcus intermedius isolates from dogs and cats in Switzerland was examined for resistance to erythromycin . Resistance profiles for 14 additional antibiotics were compared between erythromycin-resistant and susceptible isolates . A resistance prevalence of 27% for erythromycin was observed in the population under study . Complete correlation between resistance to erythromycin, and to spiramycin, streptomycin, and neomycin was observed . The erythromycin-resistant isolates all had a reduced susceptibility to clindamycin when compared to the erythromycin-susceptible isolates . Both constitutive and inducible resistance phenotypes were observed for clindamycin . Ribotyping showed that macrolide-aminoglycoside resistance was randomly distributed among unrelated strains . This suggests that this particular resistance profile is not related to a single bacterial clone but to the horizontal transfer of resistance gene clusters in S . intermedius populations . The erythromycin-resistant isolates were all carrying erm(B), but not erm(A), erm(C), or msr(A) . The erm(B) gene was physically linked to Tn5405-like elements known as resistance determinants for streptomycin, streptothricin, neomycin and kanamycin . Analysis of the region flanking erm(B) showed the presence of two different groups of erm(B)-Tn5405-like elements in the S . intermedius population examined and of elements found in Gram-positive species other than staphylococci . This strongly suggests that erm(B) or the whole erm(B)-Tn5405-like elements in S . intermedius originate from other bacterial species, possibly from enterococci.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Sep-Oct, (5), 11 - 5
{Microflora of patients with purulent septic diseases in the Moscow region}; Mironov AIu et al.; The microflora of clinical material (blood, wound discharge, abdominal exudate, pleural exudate, milk in mastitis, as well as feces in dysbiosis of the large intestine), obtained from patients with purulent septic diseases in the Moscow region was studied . The study revealed the change of microflora from surface biotopes to closed cavities of the body . Gram-positive cocci, primarily coagulase-negative staphylococci, mainly epidermal, were shown to play the leading etiological role in the development of purulent septic diseases . The development of bacteriemia was found to be caused by the penetration of staphylococci from local pyoinflammatory foci (appearing in purulent mastitis, wounds, peritonitis, pleural empyema and pleuritis), as well as by the translocation of staphylococci and Escherichia coli from the large intestine in dysbiosis.

Semin Respir Infect, 2000 Dec, 15(4), 308 - 13
Staphylococcal infections in the intensive care unit; McGahee W et al.; Staphylococcus aureus and coagulase-negative staphylococci are among the most common causes of nosocomial infections in the intensive care unit (ICU) . The clinical presentation of staphylococcal device-related infections, pneumonias, or surgical wound infections is not unique . However, treatment of these infections is increasingly problematic because of the resistance of clinical isolates to a widening number of antimicrobial agents.The confluence of critically ill patients and the need for multiple invasive procedures, as well as the use of broad-spectrum antimicrobial agents in the ICU, set the stage for the emergence of these multidrug-resistant staphylococci . In the past 10 years, there has been a progressive increase in the overall resistance of staphylococci to antimicrobial agents . Conventional infection control measures, such as handwashing and isolation precautions, to prevent the spread of staphylococcal infections in the ICU setting remain of critical importance . New approaches, including the prophylactic use of topical antistaphylococcal agents to eliminate nasal colonization in high-risk ICU patients and the development of antistaphylococcal vaccines, are currently being investigated.

J Antimicrob Chemother, 2001 Mar, 47(3), 297 - 304
Detection of mecA, mecR1 and mecI genes among clinical isolates of methicillin-resistant staphylococci by combined polymerase chain reactions; Petinaki E et al.; The distribution of the mec genes mecA, mecR1 and mecI that regulate the expression of methicillin resistance was investigated by PCR in 145 staphylococci of hospital origin . Determination of alterations and deletions in parts of the genes was achieved using 11 sets of primers in combined reactions . Methicillin-resistant Staphylococcus epidermidis strains appeared relatively stable, with 57.9% of isolates containing the whole regulatory region . Alterations within the mecA gene were detected more often in other coagulase-negative staphylococci, which also had a higher percentage with deletions of regulatory genes . Among methicillin-resistant S . aureus, a genetically heterogeneous population was identified, with several alterations and deletions of mec genes.

Kansenshogaku Zasshi, 2001 Jan, 75(1), 7 - 13
{Detection of mupirocin resistant staphylococci from patients treated with mupirocin}; Nakagawa S et al.; Susceptibility testing of mupirocin (MUP) was performed by an agar dilution method according to the National Committee for Clinical Laboratory Standard (NCCLS) to detect the MUP resistance . A total of 434 isolates of methicillin-resistant staphylococci were examined and all of 205 isolates of methicillin-resistant Staphylococcus aureus (MRSA) from 43 hospitals nationwide in 1993 were sensitive to MUP . However, MUP resistance emerged among 228 isolates {185 isolates (88 cases) of MRSA and 43 isolates (28 cases) of methicillin-resistant coagulase negative staphylococci (MR-CNS)} from nasal swabs of patients with MUP treatment between Sep 1996 and Feb 2000 in the Nagoya University Hospital . The high-level MUP resistance (MIC > or = 512 micrograms/mL) was isolated from two patients, one isolate of MRSA and four of S . hominis, respectively . Low-level MUP resistance (MIC 8-128 micrograms/mL) was isolated from three patients, 11 isolates of MRSA, one of S . chromogenes and five of S . epidermidis, respectively . The mupA which encodes the MUP resistant isoleucyl-tRNA synthetase (IRS) were investigated by PCR in these MUP resistant isolates . The mupA was detected only in high-level MUP resistant S . hominis, but not detected in high-level MUP resistant MRSA and low-level MUP resistant isolates . We also investigated the characteristics of the patients with MUP resistance . All of MUP resistant staphylococci were isolated after initiation of MUP treatment . Four patients with MUP resistant MRSA and low-level MUP resistant MR-CNS had MRSA infectious disease and MUP resistant strains were successfully eradicated with vancomycin treatment in two patients . MUP high-level resistant S . hominis, has emerged after MUP treatment for eradication of MRSA . Clinical guidelines for the prudent use of MUP should be generally adopted with careful monitoring of emergence of MUP resistance.

Drugs, 2001, 61(1), 1 - 7
Emergence of methicillin-resistant Staphylococcus aureus with intermediate glycopeptide resistance: clinical significance and treatment options; Rybak MJ et al.; Methicillin-resistant Staphylococcus aureus is a pathogen that is associated with serious infections that pose a significant risk of morbidity and mortality because of their multidrug resistant nature . Until recently, therapeutic options were limited to vancomycin, making the use of this drug widespread . Unfortunately, the continued application of this drug has led to the emergence of glycopeptide intermediate susceptible S . aureus (GISA) . By definition, these organisms demonstrated a vancomycin minimum inhibitory concentration (MIC) of >4 mg/L and <32 mg/L . However, although the mechanism of resistance is not fully elucidated at this time, GISA strains have demonstrated thickened or aggregated cell walls, an increase in penicillin binding proteins and greater autolytic activity . At present, the overall number of reported cases of GISA is relatively low . In most cases, thus far, prolonged courses of vancomycin were reported . A few cases reported monitoring serum vancomycin concentrations but because of limited information, no association with outcome can be made . Whether these GISA strains will become more widespread or evolve into fully glycopeptide resistant strains is unknown at this time . Although there are a number of new agents that possess activity against these pathogens, there is no consensus regarding specific recommendations for treatment . Strict infection control practices, routine screening for resistance and controlled use of antibacterial agents, especially vancomycin, are critical steps in preventing the further development of resistance among staphylococci.

CLAO J, 2001 Jan, 27(1), 30 - 4
Bacterial populations on 30-night extended wear silicone hydrogel lenses; Keay L et al.; PURPOSE: Ocular infection and inflammation during hydrogel lens extended wear is often associated with colonization of the lenses with bacteria . This study compares colonization of a high Dk silicone hydrogel contact lens (lotrafilcon A) worn on a 30-night extended wear basis to a low Dk HEMA-based lens (etafilcon A) worn on a 6-night extended wear schedule . METHODS: The group wearing the low Dk/t soft contact lens (n = 63) replaced their lenses weekly and the group wearing high Dk/t soft contact lenses replaced their lenses monthly (n = 64) . Lens allocation was assigned randomly at enrollment . Worn lenses, from one eye only, were collected aseptically and placed in sterile vials . Microbial growth on various media was enumerated and the number of colony forming units (cfu) per lens was calculated in categories of normal ocular microbiota (such as coagulase-negative staphylococci and Propionibacterium spp.) and known ocular pathogens (such as Staphylococcus aureus and gram-negative bacteria) . The proportion of samples colonized with these bacteria and the extent of colonization were compared between the two groups . The proportion of sterile lenses was calculated, and the types of bacteria on each lens group were compared . RESULTS: No differences between the low and high Dk/t Soft contact lens groups were observed in the proportion of lenses colonized by Propionibacterium spp . (48% vs 43%, P = 0.4) or coagulase-negative staphylococci (47% vs 54%, P = 0.2) . Similarly, no differences were found for lenses colonized by S . aureus (0% vs 2%, P = 0.1) or gram-negative bacteria (3% vs 2%, P = 0.8) . The types of bacteria isolated from the high and low Dk/t lenses were similar . There were no differences in the number of sterile samples (28% vs 27%, P = 0.8) from each group . CONCLUSIONS: These findings suggest that high Dk/t silicone hydrogel materials are colonized by similar numbers and types of microorganisms during extended wear compared to HEMA-based material . Most lenses were colonized by commensal bacteria during 30-night extended wear with high Dk/t lenses and during 6-night extended wear with low Dk/t lenses . The incidence of sterile samples was the same between the high and low Dk/t soft contact lens groups.

Antibiot Khimioter, 2000, 45(10), 15 - 8
{Microbiological evaluation of antibiotics for empirical therapy of community-acquired infections of the lower respiratory tract}; Bogdanov MB et al.; During first 3 days after patient hospitalization with pneumonia or chronic obstruction pulmonary disease (COPD) pathogens in sputum were studied according NCCLS standards (for 1999 year) . Among 93 pathogens isolated in pneumonia the most frequent were S . pneumoniae (41.9%), H . influenzae (21.5%) . Among 232 pathogens isolated in COPD the most frequent were S . pneumoniae (35.5%), H . influenzae (16.8%) . Other pathogens were staphylococci, moraxella, gram-negative bacteria . No penicillin-resistant S . pneumoniae, were isolated, the strains with moderate penicillin resistance were less than 3% in both groups . Among H . influenzae isolated from patients with pneumonia 25% were beta-lactamase producers, from COPD patients 21% strains produced beta-lactamase . Totally among all studied pathogens only 58% were sensitive to ampicillin in pneumonia groups and 48% in COPD groups, for azithromycin 70.7% and 71% respectively, for cefuroxime 84.5% and 85% respectively . Ampicillin efficacy for empirical treatment of community-acquired low respiratory tract infections was substantially less than that of modern antibiotics.

Cell Mol Life Sci, 1999 Nov 30, 56(9-10), 764 - 70
Genetic basis of methicillin resistance in Staphylococcus aureus; Berger-Bachi B; Methicillin resistance in staphylococci is due to the acquisition of the mecA gene encoding a new penicillin-binding protein (PBP2', PBP2a) that has a lower affinity to methicillin than the endogenous PBPs . PBP2' is involved in the assembly of the cell wall peptidoglycan in the presence of high concentrations of beta-lactams that otherwise inhibit the endogenous PBPs . The production of PBP2' is under dual control by its own mecR1-mecI- and the penicillinase blaR1-blaI-encoded regulatory elements . Resistance to high levels of methicillin depends, in addition to PBP2', on chromosomally encoded factors that are involved in the synthesis and degradation of the peptidoglycan . Any mutations that reduce peptidoglycan precursor formation or change the chemical composition of the muropeptide precursor result in lowered resistance.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Nov-Dec, (6), 13 - 5
{Occurrence of Staphylococcus aureus enterotoxigenic strains isolated from pregnant women with pathology}; Fluer FS et al.; 137 S . aureus strains, isolated from the larynx of pregnant women in cases of pathology, were studied for the formation of staphylococcal enterotoxins of types A and B (SEA and SEB) by the indirect hemagglutination test . The study revealed that SEA was produced by 35.0% and SEB, by 56.6% of the strains under study . The proportion of SEA and SEB producers among staphylococci isolated from mothers and children was, respectively, 18.4% and 20.0%, 89.41% and 67.5% . The number of enterotoxigenic staphylococci in the upper respiratory tract of newborn infants and mothers practically coincided with that in mothers . The occurrence of SEA- and SEB-producing enterotoxigenic strains in the medical personnel was 25.5% and 62.7% respectively.

New Microbiol, 2001 Jan, 24(1), 47 - 56
Antimicrobial use and susceptibility rates in isolates from intensive care unit and other nosocomial inpatient and outpatient areas; Lang A et al.; Our objective was to evaluate the relation between antimicrobial use and susceptibility in the intensive care unit (ICU) and non-ICU inpatient areas in the Bolzano regional hospital . For the isolates of S . aureus, coagulase negative staphylococci, Enterococcus sp., P . aeruginosa and E . coli we found a pattern of significant stepwise decrease in the frequency of antimicrobial susceptibility to penicilloic beta-lactam antibiotics and first generation cephalosporins; the highest senitivity rates occurred among isolates from outpatients, followed in decreasing order by rates among isolates from non-ICU inpatients and from ICU-patients; the rate of use of this group of antimicrobial agents was relatively high in the intensive care unit (13,1%) . For P . aeruginosa we observed significantly lower susceptibility-rates to second, third and fourth generation cephalosporins, carbapenems and monobactams for non-ICU inpatient areas than for outpatient or ICU areas; this paralleled with the low use of this group of agents in the ICU area (4,9%) . Also, for P . aeruginosa the prevalence of susceptibility to ciprofloxacin and norfloxacin in inpatient areas was lower than in the outpatient or ICU-areas; the rate of quinolone-use was relatively low in the ICU area (4,2%).

Br J Biomed Sci, 2000, 57(4), 317 - 22
Small-colony variants of Staphylococcus aureus; Looney WJ; Staphylococcus aureus remains a versatile and dangerous pathogen . Small-colony variants (SCVs) of S . aureus are a naturally occurring sub-population, first described nearly 100 years ago . These variants, of which there are different classes, grow slowly and have many atypical characteristics thought to be due to defective electron transport, and include minute colony forms . SCVs have been isolated from sites of infection, particularly persistent recurrent ones (e.g . in chronic osteomyelitis and cystic fibrosis), and also may arise following exposure to certain antibiotics . During infection the intraendothelial-cell milieu stimulates the formation of SCVs, which can better survive the assault of cell-mediated immunity . SCV phenotypes produce less tissue damage than normal staphylococci . Although microscopic morphology and Gram's staining of SCVs are normal, clinical microbiology laboratories may fail to detect them because of their very slow growth . The full extent of the role of S . aureus SCVs in clinical disease, and the most appropriate means of identifying such strains or testing to predict the clinical usefulness of therapeutic regimens, remains unknown . Failure to recover SCVs results in a major susceptibility reporting error, as the more resistant component of the infection will not have been reported . No controlled trials of therapy have been conducted, and, thus, optimal therapy has yet to be defined . However, SCVs are resistant to aminoglycoside antibiotics, and may be resistant to trimethoprim-sulphmethoxazole . The effectiveness of cell-wall-active antibiotics is reduced . SCVs are transmissible, and current infection control recommendations for normal S . aureus infections are appropriate.

Pol Merkuriusz Lek, 2000 Nov, 9(53), 746 - 50
{Predominance of multidrug resistant strains with reduced susceptibility to fusidic acid among methicillin-resistant Staphylococcus aureus strains (MRSA) isolated in the Gdánsk region}; Wisniewska K et al.; The aim of the present study was to follow the changes in the drug resistance among the methicillin-resistant Staphylococcus aureus strains (MRSA) isolated from clinical samples in various hospitals during 8 years, with particular consideration of Gdansk area . The study was carried out on 225 strains of MRSA from which 95 were isolated in the years 1990-1995 and 130 in the years 1997-1998 . The drug susceptibility was determined by the disc-diffusion method . The sensitivity to fusidic acid was determined by both disc-diffusion method and minimal inhibitory concentration (MIC) using agar dilutions . The results obtained show that in 1997-1998 in the hospitals of Gdansk area have been appeared MRSA strains which have not occurred before . These strains were intermediately sensitive or resistant to fusidic acid and simultaneously resistant to doxycycline, gentamicin, erythromycin, clindamycin, ciprofloxacin and rifampin . They represented 66.2% of all MRSA strains isolated in 1997-1998 and were present in majority of the hospitals monitored . Only in this group of staphylococci the strains additionally resistant to mupirocin (6.2%) occurred . Among the MRSA strains with reduced susceptibility to fusidic acid 64.4% were intermediately sensitive (MIC 8-16 mg/L) and 15.4% were resistant to this drug (MIC > 16) . In 1997-1998 the percentages of MRSA strains resistant to rifampin, clindamycin and ciprofloxacin increased significantly from 12.6% to 90.8%, from 42.1% to 92.3% and from 18.9% to 92.3% respectively . The percentage of the chloramphenicol resistant strains decreased from 14.7% to 0.8% . Like in 1990-1995, the MRSA strains resistant to vancomycin and teicoplanin were not found out in the same period of time.

Int J Med Microbiol, 2000 Dec, 290(7), 571 - 7
Staphylococcal surface display and its applications; Stahl S et al.; Novel surface proteins can be introduced onto the bacterial cell surface by recombinant means . Here, we describe the development of such display systems for two food-grade bacteria, Staphylococcus carnosus and Staphylococcus xylosus, and present how such engineered bacteria can be used in different applications . A study will be described in which such staphylococci were employed as vaccine delivery vehicles to elicit protective antibody responses to respiratory syncytial virus (RSV) . The use of surface-engineered staphylococci as novel microbial biocatalysts, as a new type of whole-cell diagnostic devices or for adsorption of metal ions with potential environmental or biosensor applications, will also be discussed.

Scand J Infect Dis, 2000, 32(6), 697 - 8
Peritonitis due to Staphylococcus sciuri in a patient on continuous ambulatory peritoneal dialysis; Wallet F et al.; Among the coagulase-negative staphylococci, Staphylococcus sciuri has rarely been described as the aetiology of continuous ambulatory peritoneal dialysis (CAPD) peritonitis . It has been reported in 1 case of endocarditis and has been isolated from peritoneal dialysis fluid in 2 patients . The case reported here describes CAPD peritonitis due to S . sciuri shortly after a previous episode due to S . aureus, showing the necessity to identify coagulase-negative staphylococci to find new species that cause CAPD peritonitis.

J Pharm Biomed Anal, 2001 Jan, 24(3), 429 - 36
Immunoreactivity of 80-kDa peptidoglycan and teichoic acid-like substance of slime producing S . epidermidis and specificity of their antibodies studied by an enzyme immunoassay; Kolonitsiou F et al.; S . epidermidis is considered an important cause of nosocomial bacteraernia in immunocompromized hosts as well as the commonest agent of sepsis in patients with prosthetic devices . Pathogenesis is attributed to adherence and growth on bioniaterials facilitated by production of extracellular slime . The major macromolecules of slime are: a 20-kDa acidic polysaccharide (20-kDa PS) comprising the 60% of carbohydrate-containing slime macromolecules, a peptidoglycan with average molecular size of 80-kDa (30% of slime dry weight) and cell wall teichoic acid-like substance . In this study, antibodies to these macromolecules as well as crude slime were raised in rabbits and their immunological reactivity and specificity were studied by an enzyme immunoassay . All isolated macromolecules induced the production of specific antibodies . 20-kDa PS was less immunogenic than 80-kDa peptidoglycan and teichoic acid-like substance . However, 20-kDa PS was the most potent inhibitor of the reaction of slime with its homologous antibodies revealing that this polysaccharide is the major antigenic determinant of slime . All three antibodies specifically recognize (p < 0.05) and react with slime-producing S . epidermidis in comparison to other staphylococci species . Obtained results indicate that the 20-kDa PS may be distributed in the surface of the slime exposing most of its antigenic determinants to the immune system, whereas those of 80-kDa peptidoglycan and teichoic acid-like substance seem to be less accessible.

Int Ophthalmol, 1999, 23(2), 117 - 20
The antibacterial effect of topical anesthetic proparacaine on conjunctival flora; Oguz H et al.; PURPOSE: To investigate the antibacterial effect of topical anesthetic proparacaine on conjunctival flora . METHODS: One hundred and forty-four eyes of 72 patients awaiting cataract surgery were included in the study . A commercially available solution of proparacaine, preserved with benzalkonium chloride 0.01%, was instilled in one eye of all subjects while the vehicle solution, including the same concentration of preservative in aqueous solution, was administered to the other eye . Conjunctival cultures were taken from all eyes before and 15 minutes after the instillation of proparacaine and the vehicle . RESULTS: Of the 144 eyes, 76 (52.8%) had positive-conjunctival cultures with the most commonly isolated organisms being coagulase-negative staphylococci in each group . Of the 76 culture-positive eyes, 40 (52.6%) received proparacaine and 36 (47.4%) the vehicle preparation . Fifteen minutes after the instillation of proparacaine and the vehicle eyedrops, four eyes (10%) and 12 eyes (33.3%) had culture-positive conjunctival smears, respectively . Proparacaine significantly reduced the number of culture-positive eyes (p = 0.0003), in contrast to the vehicle (p = 0.21) . CONCLUSION: A topical anesthetic, proparacaine, demonstrates antibacterial effects on the conjunctival flora.

Arch Microbiol, 2000 Dec, 174(6), 452 - 5
Inducible expression and cellular location of AgrB, a protein involved in the maturation of the staphylococcal quorum-sensing pheromone; Saenz HL et al.; AgrB has been suggested to be responsible for the posttranslational modification in staphylococci that leads to the production of the thiolactone-containing agr peptide pheromone . We demonstrate that AgrB is located in the cytoplasmic membrane . Vectors were constructed for the xylose-inducible overexpression of agrB, and of agrB and agrD together . A Staphylococcus epidermidis strain deleted for agr and containing these vectors was assayed for AgrB protein and pheromone production . The lack of adequate pheromone production suggests the involvement of additional factors in the production of the agr pheromone.

Med Clin North Am, 2001 Jan, 85(1), 1 - 17
Antistaphylococcal (MSSA, MRSA, MSSE, MRSE) antibiotics; Paradisi F et al.; S . aureus and coagulase-negative staphylococci such as S . epidermidis are important causes of infection of the bloodstream, cardiac valves, implanted devices, and skin, with repercussions on mortality and increased economic costs . Treatment of staphylococcal infections is made difficult by the increasing emergence of resistance to beta-lactams and other antimicrobials, including reduced susceptibility to glycopeptides . Penicillin must be used for infrequent penicillin-susceptible isolates, oxacillin and nafcillin are to be considered the major option for penicillin-resistant staphylococci, and glycopeptides are the drugs of choice for infections caused by methicillin-resistant strains . Co-trimoxazole, lincosamides, macrolides, tetracyclines, and fluoroquinolones are alternative agents, primarily in subjects allergic to beta-lactams . Newly introduced or experimental drugs, such as streptogramins (quinupristin-dalfopristin), oxazolidinones (linezolid), carbapenems (LY 333328), everninomicins (SCH 27899), and derivatives of tetracyclines (glycylcyclines), could be useful for therapy of infections caused by multiresistant staphylococci.

J AAPOS, 2001 Feb, 5(1), 60 - 1
Multiple recurrent hordeola associated with selective IgM deficiency; Kiratli HK et al.; An external hordeolum is an acute, suppurative inflammation of the glands of Zeis and sweat glands or hair follicles most commonly caused by staphylococci, usually in the setting of a chronic blepharitis.(1) We report a case of a boy with unilateral multiple recurrent hordeola in association with selective IgM deficiency.

FEMS Microbiol Lett, 2001 Feb 20, 195(2), 197 - 204
Directed immobilization of recombinant staphylococci on cotton fibers by functional display of a fungal cellulose-binding domain; Lehtio J et al.; The immobilization of recombinant staphylococci onto cellulose fibers through surface display of a fungal cellulose-binding domain (CBD) was investigated . Chimeric proteins containing the CBD from Trichoderma reesei cellulase Cel6A were found to be correctly targeted to the cell wall of Staphylococcus carnosus cells, since full-length proteins could be extracted and affinity-purified . Furthermore, surface accessibility of the CBD was verified using a monoclonal antibody and functionality in terms of cellulose-binding was demonstrated in two different assays in which recombinant staphylococci were found to efficiently bind to cotton fibers . The implications of this strategy of directed immobilization for the generation of whole-cell microbial tools for different applications will be discussed.

Anesthesiology, 2001 Feb, 94(2), 239 - 44
Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial; Kinirons B et al.; BACKGROUND: Chlorhexidine is better than povidone iodine for skin preparation before intravascular device insertion or blood culture collection, but it is not known whether chlorhexidine is superior in reducing colonization of continuous epidural catheters . METHODS: Children requiring an epidural catheter for postoperative analgesia longer than 24 h were randomly assigned to receive skin preparation with an alcoholic solution of 0.5% chlorhexidine or an aqueous solution of 10% povidone iodine before catheter insertion . Using surgical aseptic techniques, catheters were inserted into either the lumbar or the thoracic epidural space based on the preferences of the anesthesia team, on clinical indication, or both . Immediately before epidural catheter removal, their insertion site and hub were qualitatively cultures . After their removal, the catheter tips were quantitatively cultured . Catheters were classified as colonized when their tips yielded 1,000 or more colony-forming units/ml in cultures . RESULTS: Of 100 randomly assigned patients, 96 were evaluable . The clinical characteristics of the patients and the risk factors for infection were similar in the two groups . Catheters were kept in place for a median (range) duration of 50 (range, 21-100) h . Catheters inserted after skin preparation with chlorhexidine were one sixth as likely and less quickly to be colonized as catheters inserted after skin preparation with povidone iodine (1 of 52 catheters {0.9 per 100 catheter days} vs . 5 of 44 catheters {5.6 per 100 catheter days}; relative risk, 0.2 {95% confidence interval, 0.1-1.0}; P = 0.02) . Coagulase-negative staphylococci were the only colonizing microorganisms recovered, and the skin surrounding the catheter insertion site was the origin of all the colonizing microorganisms . CONCLUSIONS: Compared with aqueous povidone iodine, the use of alcoholic chlorhexidine for cutaneous antisepsis before epidural catheter insertion reduces the risk of catheter colonization in children.

Diagn Microbiol Infect Dis, 2001 Jan, 39(1), 61 - 4
Analysis on distribution of insertion sequence IS431 in clinical isolates of staphylococci; Kobayashi N et al.; Distribution of insertion sequence IS431 in clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus was investigated . Except for methicillin susceptible-S . aureus (MSSA), IS431 was detected in all isolates of the three staphylococcal species . In MSSA, only 20% of isolates with distinct coagulase types and genetic types possessed IS431 . In a few MSSA isolates, an IS431 variant with internal deletion was found.

Clin Microbiol Infect, 2000 Mar, 6(3), 121 - 4
Fibronectin concentrations in catheter sepsis; Nemet B et al.; OBJECTIVES: To investigate the role of fibronectin in the pathogenesis of biomaterial-related infections and the influence of catheter sepsis on the concentration of plasma fibronectin during various stages of bacteremia . METHODS: Plasma fibronectin concentrations were determined by the simple radial immunodiffusion method . Four groups of subjects were used: one group comprised patients with catheter sepsis, the second patients with local inflammation of the catheter insertion site caused by slime-positive, coagulase-negative staphylococci, the third patients with slime-negative, coagulase-negative staphylococci isolated from the catheter, and the fourth demonstrably healthy persons . RESULTS: In patients with catheter sepsis, fibronectin concentrations were found after the disappearance of catheter sepsis and 3--5 days after the removal of the catheter . A statistically significant decrease in fibronectin concentration was detected in the plasma of patients with catheter sepsis compared with other groups of patients and control subjects . CONCLUSIONS: The above results indicate a pathogenic role for fibronectin in biomaterial-related infections.

Clin Microbiol Infect, 2000 Nov, 6(11), 608 - 12
In vitro activity of quinupristin/dalfopristin in comparison with five antibiotics against worldwide clinical isolates of staphylococci; Auckenthaler R et al.; OBJECTIVE: To evaluate the in vitro activity of quinupristin/dalfopristin (Q/D), a streptogramin combination, in comparison with five antibiotics against worldwide clinical isolates of staphylococci . METHODS: A multicenter in vitro study was performed using the E test during a period of 3 months (April to June) in 1997 on fresh, clinically significant, non repetitive strains of staphylococci from patients hospitalized in 23 different hospitals in 18 countries tested . RESULTS: A total of 2132 staphylococcal isolates including methicillin resistant (MR), methicillin susceptible (MS) S . aureus (1003 MS, 462 MR), S . epidermidis (169 MS, 251 MR), S . haemolyticus (28 MS, 46 MR), S . hominis (28 MS, 16 MR), and coagulase negative staphylococci (86 MS, 43 MR) were analyzed . Q/D was highly active against all species tested . MIC90 (mg/L) ranged from 0.5 to 2 depending on the species . Strains had MIC < or = 1 mg/L in 97.6% . For S . aureus, S . epidermidis, S . hominis and other coagulase-negative staphylococci no differences in MIC90 were observed for MS or MR . One dilution difference was observed for S . haemolyticus, which overall was the less susceptible species . Erythromycin resistance was observed among 57- 87% of MR-strains and was lower among MS-strains (18-56%) . Erythromycin resistance had no or little influence on MIC of Q/D . In comparison to vancomycin, Q/D was two to four times more active . CONCLUSIONS: The streptogramin combination Q/D showed an excellent in vitro activity against all staphylococcal species tested regardless of the resistance pattern to other drug classes, particularly resistance to methicillin . Q/D was two to four times more active than vancomycin and MIC values varied from 0.5-2 according to the species . The synergy of Q/D was well conserved in macrolide-resistant strains.

Clin Microbiol Infect, 2000 Oct, 6(10), 549 - 56
In vitro activity of evernimicin and selected antibiotics against methicillin-resistant staphylococci: a 24-country study; Goering R et al.; OBJECTIVE: To collect and analyze data on susceptibility of methicillin-resistant staphylococci to evernimicin and other antimicrobial agents . METHODS: Recent clinical isolates of methicillin-resistant staphylococci from 33 laboratories in North America, Europe and South Africa were investigated . RESULTS: Of the antimicrobial agents tested, evernimicin had the lowest MIC90s for methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci (0.75 and 1.0 mg/L, respectively) . Resistance to ciprofloxacin and erythromycin was widespread, with higher levels of resistance in North America than in other regions . CONCLUSIONS: Susceptibility surveys help to determine the antimicrobial activity of new agents . Ciprofloxacin- and erythromycin-resistant staphylococci were prevalent throughout all regions.

FEMS Microbiol Lett, 2001 Jan 15, 194(2), 163 - 9
Catecholamine inotropes as growth factors for Staphylococcus epidermidis and other coagulase-negative staphylococci; Neal CP et al.; Drugs commonly used in intensive care settings were assayed for their ability to affect the growth of Staphylococcus epidermidis in a minimal salts medium containing 30% serum . Of 28 compounds tested, the inotropic catecholamines adrenaline, dobutamine, dopamine, isoprenaline and noradrenaline significantly stimulated bacterial growth . These drugs, but not structurally similar compounds lacking a dihydroxybenzoyl moiety (such as tyramine, phenylephrine and salbutamol), were able to remove iron from iron-saturated transferrin and to supply transferrin-bound 55Fe to S . epidermidis cells . Similar results were observed with a range of coagulase-negative staphylococci associated with line infections, but not with Staphylococcus aureus (including MRSA).

Ann Epidemiol, 2001 Feb, 11(2), 118 - 26
The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991-1998 . Application of Medicare claims data; Baine WB et al.; PURPOSE: To describe the epidemiology of hospitalization of elderly Americans for septicemia or bacteremia . METHODS: Medicare claims data for discharges from 1991 through 1998 were used to study 75,920 hospitalizations with the principal diagnosis of septicemia or bacteremia in patients aged 65 years or older . RESULTS: "Unspecified septicemia" was the commonest principal diagnosis, followed by septicemia due to Escherichia coli or staphylococci . From 1991 through 1997, annual discharges for "unspecified septicemia" increased 108%, and those for pneumococcal septicemia increased 310% . Decreases in reported septicemia were seen after increases in the proportion of beneficiaries in Medicare health maintenance organizations . Discharge rates for septicemia principal diagnoses increased steeply with age . Age-specific discharge rates were usually highest for black men and lowest for white women . Exceptions included septicemia due to E . coli, with white men at low risk, and pneumococcal septicemia, without significant differences between races or sexes . The case-fatality rate in hospital ranged from 4.2% with "bacteremia" and 6.9% with E . coli septicemia to 22.2% with "septicemia due to gram-negative organism, unspecified," and 26.8% with "unspecified septicemia." Staphylococcal septicemia, septicemia due to pseudomonas, and septicemia due to anaerobes were the costliest common principal diagnoses in terms of the mean duration of hospital stay . CONCLUSIONS: Unexplained sharp increases were reported in hospitalization for septicemia or bacteremia in elderly Americans . Marked variation by race and sex were evident in discharge rates with these principal diagnoses . Prognosis and average cost of treatment also differed substantially among common rubrics . Further investigation of individual diagnoses should concentrate on explaining secular trends, exploring the basis for variation by race and sex, and elucidating risk factors for poor clinical outcomes.

J Clin Microbiol, 2001 Feb, 39(2), 544 - 50
A Shared noncapsular antigen is responsible for false-positive reactions by Staphylococcus epidermidis in commercial agglutination tests for Staphylococcus aureus; Blake JE et al.; Many of the commercial slide agglutination tests for Staphylococcus aureus incorporate antibodies against cell surface antigens associated with methicillin resistance, including capsular polysaccharides and an uncharacterized antigen, serotype 18 . These tests are more sensitive than the first-generation agglutination procedures that detected only bound coagulase and protein A, but they suffer from false-positive reactions with some coagulase-negative staphylococci . The aim of this study was to elucidate the mechanism for false-positive agglutination by S . epidermidis in these tests . A group of methicillin-resistant S . aureus (MRSA) isolates, including a serotype 18 strain, that were not detectable in the first-generation tests were found to be of capsular polysaccharide type 8 . All of these isolates were deficient in bound coagulase and/or protein A, and they possessed a heat-stable, proteinaceous antigen that was absent from a prototype capsule type 8 strain . Enzyme-linked immunosorbent assay and agarose gel immunodiffusion experiments demonstrated that this proteinaceous antigen was also present on both methicillin-sensitive and methicillin-resistant S . epidermidis clinical isolates . S . epidermidis strains that gave false-positive agglutination test results had a considerably higher level of this antigen than strains that gave the correct negative result . These findings reveal the importance of the careful selection of MRSA strains for raising anti-capsular type 8 antibodies for use in agglutination tests . Strains devoid of the antigen shared with S . epidermidis should be used to eliminate potential cross-reactions with this coagulase-negative coccus.

Eur J Vasc Endovasc Surg, 2000 Mar, 19(3), 283 - 7
Intraoperative contamination of synthetic vascular grafts . Effect of glove change before graft implantation . A prospective randomised study; Zdanowski Z et al.; OBJECTIVES: to investigate the incidence of intraoperative graft contamination, bacterial species and the influence of change of surgeon's gloves on contamination . DESIGN: a prospective randomised study . MATERIALS AND METHODS: forty patients had implantation of synthetic vascular grafts . All patients received intraoperative cloxacillin (2.0 g) or clindamycin (0.6 g) intravenously . The procedures were randomised to two groups: Group 1 - surgeons changed the gloves before the first contact with the vascular prosthesis and Group 2 - operation without glove change . The growth of all bacterial species from graft segments and from the gloves was recorded . The susceptibility to antibiotics was tested . RESULTS: the number of contaminated grafts was similar in the two groups . Growth of bacteria was recorded from 92.5% (37/40) of the graft segments and 33% (51/156) of glove imprints . Of the cultured species, 75% and 47%, respectively, were identified as coagulase-negative staphylococci (CNS) . Twenty-eight per cent of CNS were resistant to cloxacillin, 15% to clindamycin, and 10% to cloxacillin and clindamycin . In all, 25% of the CNS strains were resistant to the prophylactic antibiotic used . In 50% of cases, the antibiogram of the CNS strain recovered from gloves agreed with that of the strain harvested from the graft . CONCLUSIONS: a high incidence of graft contamination was found which was not reduced by changing gloves . However, changing gloves did seem to reduce the number of bacterial species .

J Agric Food Chem, 1998 Jan 19, 46(1), 228 - 234
Evaluation of Solid-Phase Microextraction for Analysis of Volatile Metabolites Produced by Staphylococci; Vergnais L et al.; The evaluation of solid-phase microextraction (SPME) for analysis of flavor compounds produced by bacteria has been studied . First, it was necessary to determine the optimal conditions to extract the different volatile compounds in dilute aqueous solutions . For this, the effects of salt, headspace, and liquid samplings and two coating phases {poly(dimethylsiloxane) (PDMS) and poly(acrylate) (PA)} were tested . The addition of salt enhanced SPME absorption of all the compounds . Ethyl ester was better extracted in liquid sampling with PDMS phase, whereas all of the other compounds were better extracted in headspace sampling at 80 degrees C with PA phase . The SPME technique was applied to the analysis of bacterial metabolites . It has been shown that Staphylococcus xylosus (16) and Staphylococcus carnosus (833) were able to produce esters and to catabolize leucine and that S . carnosus (833) limited the oxidation of free fatty acids.

J Chemother, 2000 Dec, 12(6), 459 - 62
Evolution of antibiotic resistance in gram-positive pathogens; Marchese A et al.; Staphylococcus aureus is a common cause of soft tissue infection, e.g . impetigo, cellulitis, or wound infection, and causes osteomyelitis, arthritis, bacteremia with metastatic infection, and scalded skin and toxic shock syndromes . Coagulase-negative staphylococci have become increasingly important causes of nosocomial bacteremia associated with invasive monitoring, intravascular catheters and prosthetic heart valves or joints . Most staphylococci produce b-lactamase and are resistant to penicillin . An increasing proportion of S . aureus have intrinsic resistance to methicillin (MRSA) and present major problems in hospitals for the control of cross infection . The glycopeptides, teicoplanin and vancomycin, are the antibiotics of first choice for treatment of these infections . After the first report describing a Japanese clinical isolate of vancomycin-resistant S . aureus (VRSA), several papers have documented the emergence of these microorganisms . Since the development and spreading of this phenomenon which is perceived as a fearsome threat to the already difficult therapy of nosocomial infections due to the prevalence of heterogeneous vancomycin resistance, we found the incidence of MRSA exceeds 35% in our hospital . Out of 179 methicillin-resistant S . aureus isolated during 1997-1998, two strains (1.1%) gave subclones with vancomycin MICs of 8 mg/L . PFGE showed identical restriction patterns for both isolates, suggesting transfer of a single clone between two different patients.

Support Care Cancer, 2001 Jan, 9(1), 8 - 10
New antibiotics for infections caused by resistant organisms; McKinnon PS et al.; A continued increase in the expression of resistance among bacterial pathogens has prompted the development of a variety of new compounds directed against resistant strains of bacteria . Recently, the most dramatic increase in resistance has been among gram-positive organisms, and the predominant areas of development have been within a few classes of agents . Expanded spectrum fluoroquinolones offer advantages against many resistant gram-positive organisms, including S . pneumoniae and S . aureus . Newly developed classes of antimicrobials offer some unique activity against resistant staphylococci and enterococci . The first classes approved for use in the US are the streptogramins, specifically quinupristin/dalfopristin (Synercid), and the oxazolidinone linezolid (Zyvox) . Other new classes of agents, including the ketolides, everninomycins, and newer glycopeptides, such as LY-333328, are in the early stages of development.

Microb Drug Resist, 2000 Fall, 6(3), 199 - 211
Patterns of multidrug resistance among methicillin-resistant hospital isolates of coagulase-positive and coagulase-negative staphylococci collected in the international multicenter study RESIST in 1997 and 1998; Santos Sanches I et al.; The primary purpose of the multicenter international study "RESIST" was to obtain an update on the degree of multidrug resistance among methicillin-resistant staphylococci collected from a geographically diverse sample . A total of 3,307 staphylococcal isolates were recovered from single patients and primarily from clinical specimens that were collected at 20 collaborating regional health centers located in several countries in Europe, Asia, and Latin America during a 3- to 4-month period each in 1997 and 1998 . All strains were deposited at the Laboratory of Molecular Genetics at ITQB/UNL in Oeiras, Portugal, for quality control and for testing by microbiological and molecular typing techniques; the Laboratory of Microbiology at The Rockefeller University serving as organizational center . The majority of strains, 3,100, were methicillin-resistant, of which 1,749 were coagulase positive (methicillin-resistant Staphylococcus aureus, MRSA), and 1,351 were coagulase negative (methicillin-resistant coagulase negative staphylococci, MRCNS) . The overall frequency of drug resistance traits among the 1,749 MRSA strains was high (over 70% and up to and over 90% of the strains) to ciprofloxacin, erythromycin, clindamycin, gentamicin, and tetracycline, and was somewhat less frequent to sulfamethoxazole-trimethoprim (45%), chloramphenicol (30%), and rifampin (38%) . None of the 3,307 staphylococcal isolates showed reduced susceptibility to vancomycin except for a single methicillin-resistant coagulase-negative isolate . The great majority of staphylococci were also susceptible to the new antimicrobial Synercid . In contrast, resistance to teicoplanin was significant among methicillin-resistant strains of coagulase-negative staphylococci, particularly among Staphylococcus haemolyticus . MRSA isolates showed marked geographic variation in their patterns of multiresistance, most likely reflecting the properties of unique multiresistant MRSA clones dominant in the hospitals that provided the MRSA isolates from the various geographic areas . The multiresistance patterns of MRSA strains and strains of methicillin-resistant coagulase-negative staphylococci originating at the same country source also showed striking differences, suggesting that resistance to antimicrobial agents emerged under different antibiotic pressures in these bacterial species.

Am J Med, 2000 Dec 15, 109(9), 697 - 704
Molecular typing of coagulase-negative staphylococci from blood cultures does not correlate with clinical criteria for true bacteremia; Seo SK et al.; PURPOSE: Determining whether a blood culture that contains coagulase-negative staphylococci represents bacteremia or contamination is a clinical dilemma . We compared molecular-typing results of coagulase-negative staphylococcal blood culture isolates with clinical criteria for true bacteremia . SUBJECTS AND METHODS: Pulsed-field gel electrophoresis and arbitrary primed polymerase chain reaction (PCR) were used to determine whether patients with two or more blood cultures with coagulase-negative staphylococcal isolates had the same strain of organism in each culture (same strain bacteremia) . We evaluated three different clinical criteria for bacteremia: whether the patient received more than 4 days of antibiotics, whether there was an explicit note in the medical chart in which the physician diagnosed a true bacteremia, and the Centers for Disease Control surveillance criteria for primary bloodstream infection . Agreement between same-strain bacteremia and each definition was examined, based on the assumption that most true infections should be the result of a single strain . RESULTS: The study sample consisted of 42 patients and 106 isolates . Nineteen of the 42 bacteremias (45%) were the same strain . Classification of bacteremias as same-strain correlated poorly with all three clinical assessments (range of percent agreement, 50% to 57%; range of kappa statistic, 0.01 to 0.15) . There were both false-positive and false-negative errors . Patients with three or more positive blood cultures were more likely to have same-strain bacteremia than those with only two positive cultures {11 of 15 (73%) vs 8 of 27 (30%), P = 0.006} . Pulsed-field gel electrophoresis was more discriminating than arbitrary primed PCR (percent agreement, 83%; kappa, 0.67) . CONCLUSION: Molecular typing correlated poorly with clinical criteria for true bacteremia, suggesting either that true bacteremias are frequently the result of multiple strains or that the commonly used clinical criteria are not accurate for distinguishing contamination from true bacteremia . Vancomycin treatment of clinically defined coagulase-negative staphylococcal bacteremia may frequently be unnecessary.

Int J Antimicrob Agents, 2000 Nov, 16 Suppl 1, S3 - 10
Antibiotic resistance in staphylococci; Livermore DM; When penicillin was introduced in 1944 over 94% of Staphylococcus aureus isolates were susceptible; by 1950 half were resistant . By 1960 many hospitals had outbreaks of virulent multi-resistant S . aureus . These were overcome with penicillinase-stable penicillins, but victory was brief; methicillin-resistant S . aureus (MRSA) were recorded in the year of the drug's launch . MRSA owe their behaviour to an additional, penicillin-resistant peptidoglycan transpeptidase, PBP-2', encoded by mecA . Their spread is clonal, with transfer of mecA being extremely rare . MRSA accumulated and then declined in the 1960s and 1970s, but became re-established in the early 1980s . Some early MRSA strains were colonists rather than invaders and the proportion of MRSA among S . aureus bacteraemias in England remained under 3% until 1992 . However, this proportion rose to 34-37% by 1998-1999, reflecting the dissemination of two new epidemic strains, EMRSA 15 and 16 . These may be more virulent than earlier MRSA, or their success may reflect changing hospital practice . Until 1996, glycopeptides were universally active against S . aureus; then glycopeptide-intermediate S . aureus (GISA) were found in Japan, France, and the USA . This resistance is associated with increased wall synthesis . Coagulase-negative staphylococci (CNS) are less pathogenic than S . aureus but are important in line-associated bacteraemias and prosthetic device infections . They are even more often resistant than S . aureus, notably to teicoplanin . Few anti-staphylococcal agents were launched from 1970 to 1995, but the situation is now improving . Dalfopristin/quinupristin inhibits virtually all S . aureus, although its bactericidal activity is impaired against strains with constitutive MLSB-type resistance; other new agents are in advanced development . New agents give a renewed opportunity for control, but S . aureus is a resilient foe, able to regain its importance if drugs are used profligately or if hygiene is slackened.

Braz J Infect Dis, 2000 Dec, 4(6), 271 - 4
Nosocomial coagulase negative Staphylococci bacteremia: five year prospective data collection; Silva HL et al.; Coagulase-negative Staphylococcus (CoNS) species, as a group, constitute a major component of the normal microflora of the human skin and mucous membranes . Over the last 20 years, there has been an increase in the documentation of infections due to CoNS, especially with S . epidermidis species, the most common cause of nosocomial primary bloodstream infections . OBJECTIVE: To determine the frequency of CoNS isolates in blood cultures, to evaluate the meaning of this isolation (contaminant or pathogen), and to determine their epidemiologic and susceptibility patterns (oxacillin, ciprofloxacin, vancomycin, clindamycin and teicoplanin) . METHODS: All strains of CoNS isolated from blood cultures collected from adults and children during 1993 to 1998, were classified as contaminant or pathogenic according to NNISS criteria (1988) . Infections were classified as primary or secondary bacteremia, from clinical or surgical patients, and divided by sex and age . Susceptibility patterns were also studied in both groups . RESULTS: From 1993 to 1998, 1,702 positive blood cultures were recorded . CoNS were isolated from 546 samples (32%), with 306 (56%) classified as contaminant and 240 (44%) as true bacteremia . The presence of an intravenous catheter was an important risk factor . Endocarditis (47%) ans pneumonia (32%) were the most common sites leading to secondary bacteremia . CONCLUSION: The results confirm the increasing importance of true CoNS bacteremia and confirm their association with prosthetic valve endocarditis . We emphasize the need for care at the time of blood collection, as well as the need for care in the processing of the material, so that contamination can be reduced . This will allow a more precise description of the infections caused by coagulase-negative Staphylococcus.

Am J Kidney Dis, 2001 Jan, 37(1), 43 - 48
Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis: colonization with identical strains at exit site, nose, and hands; Amato D et al.; To evaluate the relationship of nasal or skin STAPHYLOCOCCUS: carrier status with identical strains and the development of staphylococcal peritonitis, 59 consecutive peritonitis episodes in patients using a twin-bag system for continuous ambulatory peritoneal dialysis from a single dialysis center were prospectively studied . Dialysate samples and exit-site, nose, and nail swabs from patients and their dialysis partners were obtained on the same day for culture . When bacteria belonging to the same species of the STAPHYLOCOCCUS: genus were isolated from dialysate and at least one extraperitoneal anatomic site, pulsed-field gel electrophoresis typing was performed . The bacterial strains isolated from catheter exit site, nose, or nails of each patient and his or her dialysis partner were classified as identical or different . Twenty-seven of the 59 peritonitis episodes (46%) were caused by staphylococci . Nineteen of these 27 patients carried the same STAPHYLOCOCCUS: species causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63%) carried an identical strain . Four of 5 dialysis partners carried the same STAPHYLOCOCCUS: species causing the peritonitis episode at nose or nails, but the strain was identical for only 3 dialysis partners (60%) . Four patients and 1 dialysis partner carried unrelated strains of the STAPHYLOCOCCUS: species causing the peritonitis episode . The most frequently colonized site with strains identical to that causing the peritonitis episode was the catheter exit site, followed by nose and nails . This finding may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations.

Transfusion, 2000 Dec, 40(12), 1508 - 13
Coagulase-negative staphylococcal contamination of whole blood and its components: the effects of WBC reduction; Holden F et al.; BACKGROUND: Most bacteria present in blood components are normal skin flora, particularly Staphylococcus epidermidis and other coagulase-negative staphylococci . Growth patterns of these bacteria and the effects of different methods of component preparation may depend on variations in behavior between different isolates of the same species . STUDY DESIGN AND METHODS: Whole-blood units were inoculated with 19 different coagulase-negative staphylococcus (CNS) isolates at 1 to 10 and 10 to 100 CFUs per mL . After overnight holding at 22 degrees C, the units were processed into components . The components were cultured before inoculation and during processing, including before and after WBC reduction . RESULTS: At low inoculum levels, CNS was detected in 15 (79%) of 19 whole-blood units and in 12 (63%) of 19 RBCs after separation; after filtration, bacteria were detected in 3 (16%) of 19 (p = 0.0069) . For platelet concentrates, 6 (32%) of 19 grew bacteria before filtration and 1 of 18 after filtration (difference not statistically significant) . Three (16%) of 19 plasmas were positive before and after freezing . At high inoculum levels, 16 (89%) of 18 whole-blood samples and RBCs were positive before filtration; 6 (33%) of 18 RBCs were positive after filtration (p = 0.0002); 8 (44%) of 18 platelets were positive before filtration; 3 (17%) of 18 were positive after filtration (difference not statistically significant), and 7 (37%) of 18 plasma samples were positive before and after freezing . CONCLUSION: The growth characteristics of CNS in blood components vary with differences either in the subtype of bacteria or in the donor blood . Filtration reduces but does not eradicate contamination of RBCs and platelets by CNS . Plasma may act as a reservoir for CNS infection.

J Antibiot (Tokyo), 2000 Oct, 53(10), 1038 - 44
Ziracin, a novel oligosaccharide antibiotic; Ganguly AK; Ziracin is produced by Micromonospora carbonacea and is highly active against Gram-positive bacteria . In particular it is highly active against methicillin resistant staphylococci and vancomycin resistant enterococci . Ziracin, C71H97NO38Cl2, contains two orthoester linkages, a nitro sugar, a methylene dioxy group, two aromatic ester residues and thirty five centres of assymmetries . In this paper a brief description of the structural elucidation of ziracin is presented along with the chemical modification of the antibiotic which has led to the identification of several potent antibacterials.

J Nephrol, 2000 Nov-Dec, 13(6), 433 - 6
Environmental air pollution in an intensive care unit for nephrology and dialysis; Buemi M et al.; The quality of indoor air depends on external pollutant concentrations and on internal sources, such as heating and air conditioning systems, building materials, ventilation, cleaning products, personnel and their activity . This study assessed environmental air pollution in an intensive care unit (ICU) for nephrology and dialysis . Air-dispersed particulate pollution was measured using a gravimetric method and spectroscopic photocorrelation . Microbiological pollution was evaluated by passive and active collection . Particulate concentrations exceeded recommended limits in some of the environments . There was a prevalence of small particulates, which are the most harmful type of all . An overall evaluation of bacterial pollution showed low levels of contamination in some of the rooms . In none of the environments we were able to detect pathogens such as Aspergillus fumigatus, methycillin-resistant Staphylococci or toxin-producing fungi.

J Bone Joint Surg Br, 2000 Nov, 82(8), 1156 - 61
Serological detection of Gram-positive bacterial infection around prostheses; Rafiq M et al.; Coagulase-negative staphylococci produce an exocellular glycolipid antigen which has potential as a serological marker of infection in bone . The value of this newly detected antigen was investigated by enzyme-linked immunosorbent assay (ELISA) in 15 patients with culture-proven infection of prostheses caused by Gram-positive bacteria . The antigen was purified by gel-permeation chromatography from the culture supernatants of coagulase-negative staphylococci grown in a chemically defined medium . There were significant differences (p < 0.0001) between the serum IgG and IgM levels in patients with infection due to Gram-positive staphylococci and those of a control group of 32 patients with no infection . The ELISA test, which has potential for the diagnosis of infection, may be valuable in distinguishing between staphylococcal infection around prostheses and aseptic loosening.

Ann Hematol, 2000 Nov, 79(11), 627 - 30
Patients with malignant lymphomas experience a higher rate of documented infections than patients with breast cancer after high-dose chemotherapy with autologous peripheral stem cell transplantation; Sezer O et al.; The influence of underlying disease on documented infections has rarely been addressed in patients treated with high-dose chemotherapy (HDCT) and subsequent autologous peripheral blood stem cell transplantation (PBSCT) . Because autografting has been used most frequently for malignant lymphomas and breast cancer, we analyzed in a retrospective study the data of 100 consecutive adult patients with either malignant lymphomas (group A, n = 50) or breast cancer (group B, n = 50) treated with HDCT at a single institution . The number of autografted CD34+ cells was not statistically different in either group . In this paper, we show for the first time that there is a significant difference in clinically or microbiologically documented infections in these groups of patients: documented infections occurred in 30% of malignant lymphoma patients but only in 4% of breast cancer patients (P=0.001) . Of all isolated microorganisms, 78% were gram-positive . Because most of the documented infections were due to staphylococci, further studies should prospectively evaluate preventive measures to reduce the high incidence of these infections . This is especially important for lymphoma patients, who can be regarded as a high-risk group concerning gram-positive bacteremia.

Semin Dial, 2000 Nov-Dec, 13(6), 389 - 92
Indications for vancomycin in dialysis patients; Golper TA et al.; Resistance to vancomycin has emerged among Staphylococcus aureus, coagulase-negative staphylococci (CNS), and enterococci, and this emergence has particular prevalence in dialysis units . It has therefore become imperative that physicians use vancomycin judiciously . General recommendations regarding the appropriate use of vancomycin have been developed . Although in theory implementation of these guidelines should not be difficult, the medical community may be unable or unwilling to make the necessary adjustments in practice . The onslaught of cost constraints and bureaucratic encumbrance has occurred simultaneously with the increase in vancomycin resistance among pathogens commonly isolated among the dialysis population . When a patient responds to empiric antibiotic therapy and susceptibility data indicate that an antibiotic other than vancomycin would be appropriate, the clinician far too often does not make the change to this alternative . Previously there was no biological imperative to change the antibiotic . That complacency has infected an entire generation of physicians, and especially nephrologists . Furthermore, there is an active movement against change, driven by concerns such as malpractice accusations and frank errors in the interpretation of medical facts.

J Chemother, 2000 Oct, 12(5), 412 - 5
Long-term intramuscular teicoplanin treatment of chronic osteomyelitis due to oxacillin-resistant Staphylococcus aureus in outpatients; Testore GP et al.; Oxacillin-resistant staphylococci are the most serious pathogens in chronic osteomyelitis and only glycopeptides have been shown to be efficacious against them . We assessed the safety and efficacy of a regimen of teicoplanin 400 mg/day i.m . as long-term treatment in outpatients with osteomyelitis . A total of 76 patients received teicoplanin . Twenty-five patients had chronic prosthetic osteomyelitis (20 hip) and 51 patients had osteomyelitis caused by osteo-synthesis devices . Oxacillin-resistant Staphylococcus aureus was isolated in pure culture in 55 patients (72%) . A total of 21 patients had polymicrobial infection with a total of 48 isolated strains . All patients were treated with teicoplanin 400 mg i.m . once-a-day alone or with other drugs for a minimum of 4 months . Only one patient had side effects requiring discontinuation of treatment . The teicoplanin dose was reduced to 200 mg/day i.m . in 2 patients to decrease creatinine clearance values . Seventy out of 76 patients were cured.

Ther Drug Monit, 2000 Dec, 22(6), 661 - 7
Pharmacokinetics of vancomycin administered as prophylaxis before cardiac surgery; Kitzes-Cohen R et al.; Vancomycin concentrations in serum, tissues, and sternum, administered as prophylaxis to patients during coronary artery bypass surgery, were measured . Vancomycin (15 mg/kg) was administered to 15 patients 1 hour before skin incision . Blood, tissue, and sternum samples were collected before, during, and after bypass . The concentration in serum at the end of infusion was 55.1 +/- 22.8 microg/mL, the mean elimination half-life was 9 +/- 4 hours, the areas under the concentration-time curve (AUC) from 0 to 12 hours and from 0 to infinity were 90.6 +/- 25.1 and 289.7 +/- 86.5 microg/h per mL, respectively, the mean residence time (MRT) was 11.9 +/- 5.0 hours, the mean volume of distribution was 51.1 +/- 12.2 L, and the total clearance was 78.3 +/- 32.6 mL/min . Vancomycin concentrations in serum, tissues, and sternum during the operation were greater than the MIC90 for most staphylococci and ranged from 16 to 55 microg/mL in serum and from 4 to 39 microg/g in sternum and tissues.

Ann Acad Med Singapore, 2000 Sep, 29(5), 673 - 7
Case report of Staphylococcus lugdunensis native valve endocarditis and review of the literature; Teong HH et al.; INTRODUCTION: Coagulase-negative staphylococci, commonly Staphylococcus epidermidis, cause 5% of native valve endocarditis . We describe a case due to Staphylococcus lugdunensis, a coagulase-negative staphylococcus identified in 1988, as a first report in Southeast Asia . It was previously misidentified as S . aureus because it is sometimes slide coagulase positive, but always tube coagulase negative, resulting in its delayed recognition as a pathogen . We also reviewed 36 other cases reported in the English literature from 1988 to 1999 . CLINICAL PICTURE: Our patient was admitted 3 times over 4 months for unresolved weight loss and fever before the coagulase-negative staphylococcus bacteraemia was eventually considered significant . TREATMENT AND OUTCOME: He was treated with 4 weeks of high-dose intravenous penicillin and 2 weeks of gentamicin and did not require urgent valve replacement . CONCLUSION: A positive blood culture of coagulase-negative staphylococcus is not always a contaminant . S . lugdunensis can cause aggressive native valve endocarditis resulting in high mortality, especially without surgical intervention.

Antimicrob Agents Chemother, 2001 Jan, 45(1), 335 - 8
Genomic rearrangement of the mec regulator region mediated by insertion of IS431 in methicillin-resistant staphylococci; Kobayashi N et al.; Genomic diversification of the mec regulator region mediated by IS431 was investigated for clinical isolates of methicillin-resistant staphylococci . A single rearranged form of the mecR1 gene due to IS431 insertion was detected in the three staphylococcal species, while another type of mecR1 truncation with IS431 and an IS431 located downstream of mecI were found only in Staphylococcus haemolyticus . Genetic differentiation of IS431 and staphylococcal isolates suggested transmission of mecDNA with IS431-mediated rearrangement among different staphylococcal species.

Int J Antimicrob Agents, 2000 Dec, 16(4), 527 - 30
Clinical and microbiologic efficacy and safety profile of linezolid, a new oxazolidinone antibiotic; Corti G et al.; Gram-positive cocci are important causes of infection both in the community and in the hospital, with repercussions on mortality and increased economic costs . Treatment of these infections is made difficult by the increasing emergence of multi-resistant organisms, primarily among Gram-positive cocci, such as vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, and penicillin-resistant pneumococci . Linezolid, a member of the new class of synthetic antimicrobials named oxazolidinones, has several favourable characteristics including high activity against multiresistant Gram-positive cocci . In a number of clinical trials, linezolid showed good clinical and microbiologic efficacy in the therapy of infections caused by these organisms . It can be considered a valid option for treating both community- and hospital-acquired infections due to multiresistant Gram-positive cocci.

Int J Antimicrob Agents, 2000 Dec, 16(4), 473 - 8
Antibiotic resistance in Gram-positive cocci; Jeljaszewicz J et al.; Gram-positive cocci still predominate as a cause of nosocomial- and community-acquired infections . These organisms frequently reveal a high natural, intrinsic resistance to antimicrobials . Additionally, these bacteria are able to acquire resistance to frequently used drugs rapidly through selective pressure of the environment and via the genetic evolution of bacteria . The wide application of antimicrobials in medical and veterinary practice, usage of antibiotics in agriculture and common usage of antiseptics and disinfectants result in selective pressure . The use of antibiotics directly selects resistant variants to different antibiotics or disinfectants . The same genetic element (e.g . qac or smr) conferring resistance to some disinfectants are often present on the same plasmid conferring resistance to antibiotics . Selection of resistant variants occurs most frequently in the hospital environment . Staphylococcus aureus and enterococci are the most commonly isolated bacteria causing nosocomial infections . Among those giving therapeutic problems are methicillin-resistant staphylococci and vancomycin-resistant enterococci . Resistance to high levels of aminoglycosides or penicillins among hospital enterococcal strains can completely abolish synergism of the drugs . In these cases glycopeptides will be the drugs of choice in the treatment of serious infections . Recently S . aureus strains with decreased susceptibility to vancomycin has appeared . A mechanism for this elevated resistance, although intensively investigated, still remains unknown.

J Obstet Gynecol Neonatal Nurs, 2000 Nov-Dec, 29(6), 584 - 9
Effect of less frequent bathing of preterm infants on skin flora and pathogen colonization; Franck LS et al.; OBJECTIVE: To determine if less frequent bathing alters colony count or type of organism in skin flora of preterm infants . DESIGN: Descriptive, repeated measures study . SETTING: A regional neonatal intensive-care unit . PARTICIPANTS: Forty-five preterm infants, 31 weeks mean gestational age (SD +/- 1.6 weeks) and 17 days mean postnatal age (SD +/- 3.7 days) . INTERVENTIONS: Before the study, all infants received a bath every other day . On Day 1 of the study, a routine sponge bath was given, then no further bathing was performed for 4 days . MAIN OUTCOME MEASURE: Serial axillary skin cultures to identify the number of colony forming units (CFU) and type of organism were obtained within 30 minutes of the bath on Day 1 and at the same time on Days 2, 3, and 4 . RESULTS: Normal skin flora CFU count, predominantly coagulase-negative staphylococci, increased within 48 hours after bathing compared to values 30 minutes after bathing . There were no differences in normal skin flora CFU on Days 2, 3, and 4 . Pathogens were identified in 12 infants for at least one time point during the study . Significantly fewer pathogens were found in the cultures over time, despite longer interval since bathing, and no infant developed symptoms of infection during the study period . CONCLUSION: Findings from this study suggest that the frequency of bathing of preterm infants can be reduced without increasing the risk of infection.

Int J Hyg Environ Health, 2000 Oct, 203(2), 165 - 7
Influence of sequential cultivation on virulence of Legionella pneumophila and Staphylococcus aureus; Nagl M et al.; Virulence of Legionella pneumophila strain Monza 3 and Staphylococcus aureus strain Smith diffuse was investigated after sequential cultures on nutrient media . L . pneumophila lost its ability to multiply within Acanthamoeba polyphaga after 50 passages on Legionella selective agar, while S . aureus maintained its pathogenicity in the mouse peritonitis model after 100 sequential cultures on tryptic soy agar . These results demonstrate high preservation of virulence in staphylococci in contrast to legionellae . Differentiation of virulent and avirulent phenotypes of legionellae by the protozoal model may be helpful for detecting sources of infection in water hygiene.

Diagn Microbiol Infect Dis, 2000 Nov, 38(3), 131 - 40
Four year prospective evaluation of nosocomial bacteremia: epidemiology, microbiology, and patient outcome; Lark RL et al.; A prospective study of all patients with clinically significant nosocomial bacteremia at one institution from 1994 to 1997 was performed to: (1) describe the epidemiology and microbiology of nosocomial bacteremias; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality . Four hundred four episodes of bacteremia occurred in 322 patients; the crude in-hospital mortality was 31% . Coagulase-negative staphylococci, Staphylococcus aureus, and enterococci were the leading pathogens, and intravascular catheters were the most frequently identified source . The highest mortality occurred in patients with candidemia (67%) . Independent predictors of mortality included evidence of shock at the time of infection, acquisition of bacteremia in an intensive care unit, a "Do Not Attempt Resuscitation" order, and the presence of certain comorbid conditions (e.g., malignancy, HIV infection) . Because many of these infections may be preventable, education of health care providers and strict adherence to established infection control practices are critical.

Bone Marrow Transplant, 2000 Nov, 26(10), 1103 - 6
No effect of nadroparin prophylaxis in the prevention of central venous catheter (CVC)-associated thrombosis in bone marrow transplant recipients; Lagro SW et al.; Complications of CVCs in 382 consecutive patients receiving a stem cell transplantation (SCT) were analysed . Early complications were pneumothorax (3.6%), haematothorax (0.5%), dislocation (3%) and dysfunction (3.6%) . Eighty-seven-associated infections (22%) were observed, leading to removal of the CVC in 26 patients . More bacteraemias were associated with double- or triple-lumen CVCs, 19% vs 5% in single lumen CVCs (P < 0.0001) . Coagulase-negative staphylococci were the predominant microorganisms in 72% . A special point of investigation was CVC-associated thrombosis and the prophylactic value of nadroparin . Two consecutive regimens with nadroparin were used and compared; 7 days 2850 IE nadroparin and 10 days 5700 IE nadroparin . The incidence of CVC-associated thrombosis was 6.9% in 382 patients with 390 catheters . The incidence was 8% in patients receiving one of the prophylactic nadroparin regimens compared to 6% in a comparable control group without prophylaxis . A short course of nadroparin was unable to prevent thrombotic complications after discontinuation.

Am J Vet Res, 2000 Nov, 61(11), 1451 - 5
Methicillin-resistant coagulase-negative staphylococci isolated from healthy horses in Japan; Yasuda R et al.; OBJECTIVE: To determine patterns of methicillin-resistant staphylococci isolated from apparently healthy horses . SAMPLE POPULATION: 44 horses from 8 riding clubs in Japan . PROCEDURE: Methicill in-resistant staphylococci were isolated from the skin or nares, using a selective medium containing a beta-(symboric) lactam antibiotic, ceftizoxime . Clonality of isolates was determined by use of pulsed-field gel electrophoresis . Detection of mecA, mecl, and mecR1 genes was accomplished by use of polymerase chain reactions . RESULT: Of the 44 horses, 13 (29.5%) yielded 15 isolates of methicillin-resistant staphylococci . The 15 isolates were identified as 6 species (Staphylococcus epidermidis, S lentus, S saprophyticus, S xylosus, S sciuri, and S haemolyticus) . However, methicillin-resistant S aureus was seldom isolated . Each isolate contained the mecA gene and had a high resistance to beta-lactam antibiotics . Some isolates also were resistant to other antibiotics such as erythromycin and kanamycin . CONCLUSIONS AND CLINICAL RELEVANCE: Methicillin-resistant coagulase-negative staphylococci that were highly resistant to various antibiotics were isolated from apparently healthy horses in Japan . These organisms must be considered a potential threat to horses and veterinarians who care for them.

Med Dosw Mikrobiol, 2000, 52(2), 103 - 10
{Susceptibility of staphylococci to natural and synthetic iron chelators}; Lisiecki P et al.; A total of 237 strains of staphylococci belonging to 27 species were tested for susceptibility to natural and synthetic iron-chelators . Coagulase-negative staphylococci were much more susceptible than coagulase-positive ones: 82 out of 148 coagulase-negative strains were susceptible to desferrioxamine B, rhodotorulic acid and ovotransferrin and 7 out of 89 coagulase-positive strains . A correlation between the susceptibility to iron-chelators species affiliation and the origin of strain was not found.

Pharm World Sci, 2000 Aug, 22(4), 127 - 9
Pharmacokinetics of intraventricularly administered teicoplanin in Staphylococci ventriculitis; Beenen LF et al.; Following craniotomy for a medulloblastoma in the posterior cranial fossa, a 6-year old girl developed a ventriculitis with coagulase negative staphylococci associated with the use of a ventriculostomy . Treatment with intravenous (i.v.) and intraventricular (ivt) vancomycin resulted in negative cultures of the cerebrospinal fluid, but had to be stopped because of a severe allergic skin reaction . Teicoplanin was administered i.v . (240 mg once daily) and ivt (10 mg once daily), resulting in high teicoplanin CSF levels that were used to model the pharmacokinetics of ivt teicoplanin in this patient . No signs of recurrent infection or adverse events occurred . It is concluded that a pharmacokinetic model can be derived from this case that can be used as prior to guide teicoplanin intraventricular therapy in other patients.

J Antimicrob Chemother, 2000 Dec, 46(6), 941 - 9
Patterns of phenotypic resistance to the macrolide-lincosamide-ketolide-streptogramin group of antibiotics in staphylococci; Hamilton-Miller JM et al.; Phenotypes of resistance to the macrolide-lincosamide-ketolide-streptogramin (MLKS) group of antibiotics have been determined in 540 clinical isolates of staphylococci (210 Staphylococcus aureus and 330 coagulase-negative species) . Results of disc diffusion tests using erythromycin A, oleandomycin, rokitamycin, clindamycin, telithromycin, quinupristin and dalfopristin delineated four main groups corresponding to those defined classically using erythromycin and clindamycin only, but with sub-divisions . Resistance to erythromycin was more common in coagulase-negative strains (56%) than in S . aureus (16%); telithromycin, clindamycin, quinupristin-dalfopristin and rokitamycin were active against >97% of S . aureus strains and >88% of the coagulase-negative strains . The commonest resistance phenotype was 'inducible MLS(B)' (12% in S . aureus, 31% in coagulase-negative strains); this group could be divided in terms of the different inducing abilities of erythromycin and oleandomycin . 'Constitutive MLS(B)' and 'MS' phenotypes were more often found in coagulase-negative strains (11 and 13%, respectively) than in S . aureus (2 and 1%) . Novel phenotypes were found during the isolation of constitutively resistant mutants from inducible strains, and of resistant mutants from 'MS' strains . This extended phenotyping scheme has revealed further complexities and evolutionary possibilities in patterns of resistance to this group of antibiotics.

Curr Treat Options Cardiovasc Med, 1999 Oct, 1(3), 283 - 290
Infective Endocarditis; Segreti J et al.; Infective endocarditis remains a serious and potentially fatal disease . Even with appropriate therapy, mortality rates remain at about 10% to 20% . Common errors in treatment include starting antibiotics before obtaining at least three blood cultures, failing to use bactericidal drugs, stopping therapy too early, and delaying heart surgery when it is indicated . The epidemiology of endocarditis will continue to evolve, and we will see more cases that are hospital acquired, more cases associated with the presence of cardiac support devices, and cases associated with line-related bacteremia . Therefore, organisms associated with endocarditis will also likely evolve . We will see more cases due to multiresistant organisms (eg, vancomycin-resistant enterococci, glycopeptide-resistant staphylococci, and multidrug-resistant gram-negative rods) as well as yeast and fungi.

Curr Infect Dis Rep, 2000 Apr, 2(2), 147 - 153
Diagnosis and Management of Infectious Thyroiditis; Shah SS et al.; A broad range of disorders can cause inflammation of the thyroid gland . True thyroid infections are rare and can result from a variety of microorganisms, of which bacteria are the most common . Other rarer pathogens include fungi, parasites, and viruses . Gram-positive bacteria, especially staphylococci, predominate as causative agents in adults and children . In immunocompromised patients, opportunistic pathogens have been isolated . Most infections in adults occur as a result of hematogenous or lymphatic seeding of the thyroid gland . In children, congenital anomalies can lead to thyroid infection and require surgical correction to prevent recurrence . Fine-needle aspiration of the thyroid is usually required to identify the infecting agent, and prolonged antimicrobial therapy with or without surgical drainage is the cornerstone of management . This review outlines the pathogenesis, microbiology, diagnosis, and management of infectious thyroiditis in adults and children and compares this disorder with other, more common causes of thyroid inflammation.

J Vet Med B Infect Dis Vet Public Health, 2000 Oct, 47(8), 591 - 7
Phenotypic characteristics of Staphylococcus aureus isolated from bovine mastitis in Israeli dairy herds; Younis A et al.; A study of the characterization of the phenotypic patterns of Staphylococcus aureus strains isolated from bovine subclinical mastitis in Israeli dairy herds and their correlation with the severity of the disease was undertaken . A total of 400 chronically S . aureus-infected Israeli-Holstein cows, from 15 dairy herds were included in this study . Based on the results of the biochemical reactions, of the anti-biogram and phage typing, one major type of S . aureus was determined in each herd, its prevalence being between 54 and 100% of the total isolates from that same herd . The majority of the isolates were found to be non-haemolytic (62.7%) . The most common phage type was 3/A,3/C,55,71, which was predominant in five herds . In two herds none of the isolates (24) were typable by this set of phages . All isolates were susceptible to methicillin, erythromycin, cephalotin, norfloxacin, trimethoprin-sulphamethoxazole and novobiocin . Most isolates were resistant to penicillin (96.6%) and 52% to oxytetracyclin . Differences in protein patterns between 50 and 36 kDa were found by one-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis . No correlation between any combination of the phenotypic characteristics was found when correlation was done with milk yield and somatic cell count, corresponding to the 6 months before sampling . Otherwise, a positive correlation was found between type of haemolysis and the N-acetyl-beta-glucosaminidase (NAGase) values . In milk from quarters infected with the-non-haemolytic strains, the level of NAGase was significantly lower (P < 0.05) than that from quarters infected with the haemolytic strains (69.7 and 105.9, respectively) . However, the level of NAGase activity in the milk of the quarters infected with the non-haemolytic strains was significantly higher (P < 0.05) when compared to the milk of quarters infected with coagulase-negative staphylococci (43.5).

J Vet Med A Physiol Pathol Clin Med, 2000 Oct, 47(8), 463 - 8
Effect of teat dipping with a germicide barrier teat dip in late gestation on intramammary infection and clinical mastitis during the first 5 days post-partum in primiparous cows; Edinger D et al.; The effect of teat dipping with a barrier teat dip prior to parturition on intramammary infection (IMI) and clinical mastitis during the first 5 days post-partum was investigated in a split udder trial in 149 Holstein-Frisian heifers . Their left front and right hind quarters were dipped three times weekly (i.e . Monday, Wednesday and Friday) with a barrier teat dip containing 0.1% polyvidon iodine from day 260 of gestation until parturition . The opposite quarters (right front and left hind quarter) served as untreated control . Bacteria were isolated from 52.2% of quarter milk samples collected immediately after parturition prior to first machine milking . Staphylococcus aureus and coagulase-negative staphylococci (CNS) were predominantly found in the samples (29.2 and 35.6% of the positive samples, respectively) . At parturition 6.7% of the heifers showed signs of clinical mastitis and another 27.5% developed signs of clinical mastitis during the first five days of lactation . No significant differences were found between treated and control quarters regarding IMI and incidence of clinical mastitis . Teat dipping prior to parturition in primigravid dairy heifers did not improve udder health in this trial.

Int J Oral Maxillofac Surg, 2000 Oct, 29(5), 344 - 50
The microflora associated with extra-oral endosseous craniofacial implants: a cross-sectional study; Abu-Serriah MM et al.; Infection of soft tissues surrounding extra-oral craniofacial endosseous implants is a common clinical problem . The aim of this study was to analyse the microflora associated with such implants, in both health and disease . Eighteen patients with a total of 49 implants were studied . Each patient was seen on two occasions for both a clinical examination and for collection of microbiological samples, using swabs and paper points, from the peri-abutment soft tissues . Specimens were cultured on blood agar and on agars selective for staphylococci and yeasts . Isolates were identified and selective antibiotic susceptibility testing undertaken . No single organism emerged as a predominant cause of peri-abutment skin infection but Staphylococcus aureus, Gram-negative bacilli and yeasts were all present as potential pathogens in this context . Culture and sensitivity results should therefore guide the treatment of these infections.

Lett Appl Microbiol, 2000 Oct, 31(4), 303 - 6
Characterization of micrococcaceae isolated from salt used for Spanish dry-cured ham; Cordero MR et al.; The microbial flora of salt used in the production of Spanish dry-cured ham was studied . The results indicated that Micrococcaceae constituted the predominant flora . Identification of the 369 isolates belonging to the family Micrococcaceae revealed that 60% belonged to genus Staphylococcus, 25% to Micrococcus, 6% to Kocuria, 5.4% to Dermacoccus and 0.5% to Stomatococcus . The species most often isolated was Staph . xylosus (28.9%), followed by M . lylae (21.4%), Staph . equorum (18.55%) and D . nishinomiyaensis (5.4%) . The results indicate that the salt during salting process of dry-cured hams offers an ecosystem suitable for the survival of the staphylococci and micrococci.

FEMS Immunol Med Microbiol, 2000 Nov, 29(3), 195 - 202
Lipid S, a novel Staphylococcus epidermidis exocellular antigen with potential for the serodiagnosis of infections; Lambert PA et al.; We describe the characterisation of a novel glycerophosphoglycolipid (termed lipid S) produced by Staphylococcus epidermidis grown in a chemically defined medium . Lipid S is a short chain length form of the cellular lipoteichoic acid (LTA) . It shares common antigenic determinants with LTA, but its chain length of six glycerophosphate units contrasts with 40-42 units in LTA . Lipid S is exocellular and can be recovered from liquid growth medium whereas LTA is associated with the cell wall and membrane . Healthy individuals have low serum levels of IgG against lipid S, but significantly higher titres have been detected in serum from patients with central venous catheter-related sepsis due to coagulase-negative staphylococci and infection of orthopaedic prostheses . An indirect enzyme-linked immunosorbent assay test based on lipid S allows the rapid diagnosis of Gram-positive infection and may have clinical applications in the management of patients with sepsis.

J Dermatol Sci, 2000 Nov, 24(2), 142 - 5
The production of superantigenic exotoxins by coagulase-negative staphylococci isolated from human skin lesions; Akiyama H et al.; We examined the production of superantigenic exotoxins in 136 coagulase-negative staphylococci isolated from various skin lesions in humans using a reversed passive latex agglutination test (Denka Seiken) . As a control we examined the same in 50 Staphylococcus aureus strains isolated from non-infective skin ulcers in humans . Of the 136 strains of coagulase negative-staphylococci, 9 (6.6%) produced one or more identifiable exotoxins . In contrast, 21 (42%) out of the 50 S . aureus strains produced one or more identifiable exotoxins (P<0.01).

J Antimicrob Chemother, 2000 Nov, 46(5), 785 - 8
Molecular analysis of the translational attenuator of a constitutively expressed erm(A) gene from Staphylococcus intermedius; Werckenthin C et al.; During the course of a study on macrolide, lincosamide and streptogramin B resistance among staphylococci from animal sources, a Staphylococcus intermedius isolate was found to carry a constitutively expressed erm(A) gene on the 70 kb plasmid pSES29 . The molecular basis of constitutive erm(A) expression was investigated by cloning and sequence analysis of the erm(A)-associated translational attenuator . Two point mutations in this regulatory region were detected . These mutations cause constitutive erm(A) gene expression by destabilization of mRNA secondary structures required for the inducible type of erm(A) gene expression.

J Antimicrob Chemother, 2000 Nov, 46(5), 725 - 32
Comparative pharmacodynamics of moxifloxacin and levofloxacin in an in vitro dynamic model: prediction of the equivalent AUC/MIC breakpoints and equiefficient doses; Firsov AA et al.; To demonstrate the impact of the different pharmacokinetics of moxifloxacin and levofloxacin on their antimicrobial effects (AMEs), killing and regrowth kinetics of two clinical isolates of Staphylococcus aureus and one each of Escherichia coli and Klebsiella pneumoniae were studied . With each organism, a series of monoexponential pharmacokinetic profiles of single doses of moxifloxacin (T:1/2 = 12.1 h) and levofloxacin (T:(1/2) = 6.8 h) were simulated . The respective eight-fold ranges of the ratios of area under the concentration-time curve (AUC) to the MIC were 58-475 and 114-934 . Species- and strain-independent linear relationships observed between the intensity of AME (I:(E)) and log AUC/MIC were not superimposed for moxifloxacin and levofloxacin (r(2) = 0.99 in both cases) . The predicted AUC/MIC ratios for moxifloxacin and levofloxacin that might be equivalent to Schentag's AUC/MIC breakpoint for ciprofloxacin (125) were estimated at 80 and 130, respectively . The respective equivalent MIC breakpoints were 0.41 mg/L (for a 400 mg dose of moxifloxacin) and 0.35 mg/L (for a 500 mg dose of levofloxacin) . Based on the I:(E)-log AUC/MIC relationships, equiefficient 24 h doses (D:(24)s) of moxifloxacin and levofloxacin were calculated for hypothetical strains of S . aureus, E . coli and K . pneumoniae with MICs equal to the respective MIC50s (weighted geometric means of reported values) . To provide an 'acceptable' I:(E) = 200 (log cfu/mL)*h, the D:(24)s of moxifloxacin for all three organisms were much lower (150, 30 and 60 mg, respectively) than the clinically proposed 400 mg dose . Although the usual dose of levofloxacin (500 mg) would be in excess for E . coli and K . pneumoniae (D:(24) = 36 and 220 mg, respectively), it might be insufficient for S . aureus (the estimated D:(24) = 850 mg) . Moreover, to provide the same effect as a 400 mg D:(24) of moxifloxacin against staphylococci, levofloxacin would have to be given in a 5000 mg D:(24), which is 10-fold higher than its clinically accepted dose . The described method of generalization of data obtained with specific organisms to other representatives of the same species might be useful to predict the AMEs of new quinolones.

J Clin Microbiol, 2000 Nov, 38(11), 4262 - 3
Frequency of isolation of Staphylococcus lugdunensis among staphylococcal isolates causing endocarditis: a 20-year experience; Patel R et al.; Eighty-nine staphylococcal isolates recovered from patients with bacterial endocarditis at the Mayo Clinic from 1980 to 1999 were studied to determine the prevalence of Staphylococcus lugdunensis among clinical isolates of staphylococci causing endocarditis . Four isolates, all from patients with native mitral valve endocarditis, were identified as S . lugdunensis.

J Bacteriol, 2000 Nov, 182(22), 6517 - 22
Exfoliatin-producing strains define a fourth agr specificity group in Staphylococcus aureus; Jarraud S et al.; The staphylococcal virulon is activated by the density-sensing agr system, which is autoinduced by a short peptide (autoinducing peptide {AIP}) processed from a propeptide encoded by agrD . A central segment of the agr locus, consisting of the C-terminal two-thirds of AgrB (the putative processing enzyme), AgrD, and the N-terminal half of AgrC (the receptor), shows striking interstrain variation . This finding has led to the division of Staphylococcus aureus isolates into three different agr specificity groups and to the division of non-aureus staphylococci into a number of others . The AIPs cross-inhibit the agr responses between groups . We have previously shown that most menstrual toxic shock strains belong to agr specificity group III but that no strong clinical identity has been associated with strains of the other two groups . In the present report, we demonstrate a fourth agr specificity group among S . aureus strains and show that most exfoliatin-producing strains belong to this group . A striking common feature of group IV strains is activation of the agr response early in exponential phase, at least 2 h earlier than in strains of the other groups . This finding raises the question of the biological significance of the agr autoinduction threshold.

Rev Med Chil, 2000 Jul, 128(7), 708 - 20
{Infective endocarditis: short and long-term results in 261 cases managed by a multidisciplinary approach}; Braun S et al.; BACKGROUND: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE) . AIM: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Catolica de Chile Hospital . PATIENTS AND METHODS: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed . These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE . RESULTS: Sixty nine percent of patients were men and the mean age was 49 +/- 16 years . Seventy five percent had a definite diagnosis of IE (Duke) . S . viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains . Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis . Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE . Fifty one percent developed heart failure and 34% had embolic events . S . aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%) . Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications . The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups . The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves . Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years . CONCLUSION: A multidisciplinary approach may be very helpful to improve the prognosis of IE.

J Hosp Infect, 2000 Oct, 46(2), 130 - 4
Is hospital-acquired intravascular catheter-related sepsis associated with outbreak strains of coagulase-negative staphylococci?
Worthington T, Lambert PA, Elliott TS.
Macrorestriction fragment profile analysis by pulsed field gel electrophoresis was used to type strains of coagulase-negative staphylococci (CNS) isolated from 30 patients with catheter-related sepsis at the University Hospital Birmingham NHS Trust, UK . Twenty-three infections were hospital-acquired . A total of 56 CNS were isolated from the patients and identified by API as Staphylococcus epidermidis (54), Staphylococcus lugdunensis (1) and Staphylococcus hominis (1) . The micro-organisms were further characterized by antibiograms and restriction digestion using SmaI . Analysis of the macrorestriction fragment profiles demonstrated that the isolates from 24 patients were distinct, whereas a common genotype of S . epidermidis was isolated from the blood cultures of six patients, all of whom had acquired this infection in hospital . Three of these patients were located in a haematology ward, two on an intensive care unit and one on a dialysis unit . The data from this current study suggests that specific strains of S . epidermidis may be an important cause of nosocomial catheter-related sepsis resulting from cross-infection, and that this association would not be detected by conventional typing methods including biotyping and antibiograms .

J Anim Sci, 2000 Oct, 78(10), 2508 - 14
Effects of intramammary infection and parity on calf weaning weight and milk quality in beef cows; Paape MJ et al.; The objectives of this study were to determine 1) the effect of intramammary infection on calf weaning weight, milk somatic cell count, and milk composition, and 2) the effect of parity on percentages of infected cows, infected quarters, and blind quarters . The number of infected quarters, milk somatic cell counts, milk components, and intramammary infection were studied at weaning in 164 beef cows . The percentage of infected cows ranged from 61.9% at first parity to 66.7% at fifth to ninth parities . Cows with three or four infected quarters had higher (P < .01) milk somatic cell counts than cows with zero, one, or two infected quarters . Among bacterial isolates, Staphylococcus aureus-infected quarters had the highest (P < .01) milk somatic cell count . Percentages of butterfat and lactose were lower (P < .01) in milk from infected quarters than from uninfected quarters . Infections by S . aureus and coagulase-negative staphylococci were the most common and accounted for 67 to 78% of the infections . Percentages of infected quarters and infections caused by S . aureus increased with parity (P < .01) . Intramammary infections did not affect (P > .10) calf weaning weight . In conclusion, intramammary infection had no effect on calf weaning weight but increased milk somatic cell count and decreased the percentage of protein, lactose, solids-not-fat, and butterfat . The number of infected and blind mammary quarters increased with parity.

Berl Munch Tierarztl Wochenschr, 2000 Sep, 113(9), 321 - 5
Small colony variants of Staphylococci: a link to persistent infections; von Eiff C et al.; In prospective studies, Staphylococcus aureus small-colony variants (SCVs) have been linked to persistent and recurrent infections . SCVs are a naturally occurring subpopulation often defective in electron transport which may be identified in the microbiological laboratory as nonpigmented, nonhemolytic, slow-growing pinpoint colonies after incubation on rabbit blood agar . In addition, the often relatively unstable SCVs demonstrate a number of other characteristics that are atypical for S . aureus including reduced alpha-toxin production and delayed coagulase activity . A site-directed hemB mutant with a stable SCV phenotype provided strong evidence for the link between these electron transport defective strains and persistent infections . The hemB mutant was phagocytized by cultured endothelial cells, but did not lyse these cells, because the mutant produced very little alpha-toxin . Thus, SCVs can hide within the host cell, then revert to the highly virulent rapidly growing form and lyse the host cell, once the host immune response has abated and antibiotic therapy is completed . The intracellular position shields SCVs from host defenses and decreases exposure to antibiotics . This review discusses what is known of the biology of SCVs and describes the recovery and significance of Staphylococcus SCVs in clinical specimen.

Arthritis Rheum, 2000 Oct, 43(10), 2276 - 82
Role of macrophages in Staphylococcus aureus-induced arthritis and sepsis; Verdrengh M et al.; OBJECTIVE: A model of hematogenously induced Staphylococcus aureus arthritis was used to analyze the role of macrophages in this highly destructive condition . In this model, the majority of cells in the cartilage-synovial junction that participate in the destructive process are macrophages . METHODS: To assess the role of monocytes/macrophages in staphylococcal arthritis, mice were inoculated with S aureus or given phosphate buffered saline as control . Mice were rendered monocytopenic by administration of etoposide, a drug that selectively depletes the monocyte/macrophage population . RESULTS: Throughout the course of infection, the etoposide-treated mice exhibited a significantly less severe arthritis than the control animals . These data were confirmed by histopathologic analysis of the joints . The down-regulation of development of arthritis was accompanied by decreased serum levels of the proinflammatory cytokines tumor necrosis factor alpha and interleukin-6 . In contrast, infection-triggered mortality was increased in the etoposide-treated mice as compared with the control animals . Notably, the monocytopenic mice exhibited elevated bacterial burden in the blood and kidneys on days 3 and 7 after inoculation with staphylococci . CONCLUSION: This study indicates a dual role of mononuclear phagocytes in the pathogenesis of S aureus-induced infection . On the one hand, absence of macrophages leads to a favorable outcome concerning the severity of arthritic lesions, but on the other hand, the clearance of bacteria by monocytes/macrophages is decreased, resulting in poor survival.

Infect Immun, 2000 Nov, 68(11), 6162 - 7
Role of neutrophil leukocytes in cutaneous infection caused by Staphylococcus aureus; Molne L et al.; Despite the high prevalence of cutaneous infections, little is known about the role of host immune responsiveness during Staphylococcus aureus dermatitis . We have recently described a murine model of infectious dermatitis induced by superantigen-producing S . aureus . To assess the role of neutrophils in staphylococcal dermatitis, mice were given granulocyte-depleting monoclonal antibody prior to and on several occasions following intracutaneous inoculation with staphylococci . The granulocyte-depleted mice that had been intradermally inoculated with S . aureus developed crusted ulcerations which tended not to heal, whereas animals injected with control monoclonal antibody displayed only minor and transient skin lesions . The finding of severe ulcerations in neutropenic mice correlated with a significantly higher burden of bacteria in the blood and skin during the early phase of the infection . Importantly, while mice with an intact granulocyte population showed only limited skin infection, bacteremia occurred in the great majority of the neutrophil-depleted animals . As a consequence, the latter individuals exhibited significantly increased levels of the proinflammatory cytokine interleukin-6 and specific antibodies to staphylococcal cell wall components and toxic shock syndrome toxin-1 in the serum . Our data point to a crucial protective role of granulocytes in S . aureus dermatitis.

Ann Intern Med, 2000 Oct 17, 133(8), 604 - 8
Diagnosis and management of infections involving implantable electrophysiologic cardiac devices; Chua JD et al.; BACKGROUND: Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined . OBJECTIVE: To describe the clinical presentation, treatment, and outcome of patients with such infections . DESIGN: Retrospective case series . SETTING: The Cleveland Clinic Foundation, Cleveland, Ohio . PATIENTS: 123 patients with infections involving implantable cardiac electrophysiologic devices . MEASUREMENTS: Demographic characteristics, clinical manifestations, time to diagnosis, management, and outcome . RESULTS: 87 patients with permanent pacemakers and 36 patients with implantable cardioverter defibrillators had infections . The most common signs and symptoms were pocket erythema and local pain . The most common pathogens were coagulase-negative staphylococci (68%) and Staphylococcus aureus (23%) . In 117 patients (95%), all equipment was extracted and antibiotic therapy lasted a median of 28 days . Operative mortality was zero . Follow-up showed crude mortality and relapse rates of 8% and 3%, respectively . CONCLUSION: For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.

J Biomed Mater Res, 2000 Dec 15, 52(4), 754 - 61
Prophylaxis of implant-related staphylococcal infections using tobramycin-containing bone cement; Nijhof MW et al.; In a rabbit model, premixed tobramycin-containing bone cement was studied for its efficacy to prevent infections with two frequently encountered staphylococcal species in arthroplasty surgery . After intramedullary inoculation with staphylococci, either standard or premixed tobramycin-containing Simplex-P bone cement was injected in the right femur of 120 rabbits . Development of infection was examined by culture of femoral bone after 7 or 28 days . Loss of body weight and elevated erythrocyte sedimentation rate in the control rabbits inoculated with Staphylococcus aureus were seen in the first postoperative week, returning to normal in 28 days . Inoculation with Staphylococcus epidermidis resulted only in a low-grade infection . All rabbits receiving premixed tobramycin-containing bone cement were free of signs of infection, and all their cultures were negative . Culture yield from Staphylococcus aureus controls increased with time and inoculum dose . Staphylococcus epidermidis controls needed higher inoculum doses to establish an infection, while culture yield decreased in time . These differences in mode of prosthesis-related infection are explained by differences in virulence factors .

Oncol Rep, 2000 Nov-Dec, 7(6), 1239 - 42
A preoperative protocol for the prevention of infection in children with tunnelled right atrial catheters; Dawson S et al.; The use of central venous lines has come to be widely accepted by children with cancer and their families . However, attendant infection is a cause of considerable morbidity . Coagulase-negative staphylococci, the predominant aerobic species on the skin, are now the commonest cause of catheter-related bacteremia . We introduced a protocol to reduce the colonization of the skin at the catheter insertion site . Antiseptic skin scrubs, with 4% chlorhexidine gluconate, were performed on the neck and anterior chest the night before and again on the morning of the surgical procedure . A single dose of cephalothin (or vancomycin for penicillin-allergic patients) was administered IV immediately before the operation . Compared to the 12 month period prior to initiation of this protocol, the rate of infections (occurring within 30 days of catheter placement) in the 3.5 year period of intervention dropped from 8 to 4.9 per 1,000 catheter days . The proportion of infections that were staphylococcal was reduced from 93 to 63% and the proportion of non-ports removed within 30 days of placement fell from 45 to 0% . Despite these changes, the major contribution to improved infection control appeared to be the use of an increased proportion of ports (a rise from <10 to almost 60%).

Klin Lab Diagn, 2000 Aug, (8), 17 - 8
{Detection of Staphylococcus aureus and Staphylococcus epidermis species specific antigens and antibodies to alpha-toxin in the blood of patients with pneumonia}; Chernukha MIu et al.; Test systems for indirect hemagglutination (IHA) test for detection of S . aureus and S . epidermidis teichoic acids and S . aureus alpha-toxin in patients' sera have been developed on the basis of immunoglobulins isolated from monospecific sera . Test system for IHA test for detection of antitoxin in donor and patients' sera has been created on the basis of highly purified alpha-toxin . Thirty donor sera and 61 sera from patients with pneumonia were analyzed . Low antibody levels in the patients may be due to the fact that the sera were collected during the first days of disease . Group of patients with high content of staphylococcal antigens and antitoxin in the blood was particularly interesting . These patients developed severe pneumonia, among whose etiological agents were S . aureus and S . epidermidis . Diagnostic analysis of patients' sera by IHA test for detection of staphylococcal antigens was more effective, accurate, and rapid in comparison with the bacteriological method; moreover, it confirmed the significance of staphylococci in the pathogenesis of pneumonia.

Rev Med Suisse Romande, 2000 Aug, 120(8), 641 - 50
{Means of bacterial resistance}; Moreillon P; Fifty years ago, the introduction of penicillin, followed by many other antibacterial agents, represented an often underestimated medical revolution . Indeed, until that time, bacterial infections were the prime cause of mortality, especially in children and elderly patients . The discovery of numerous new substances and their development on an industrial scale confronted us with the illusion that bacterial infections were all but vanquished . However, the widespread and sometimes uncontrolled usage of these agents has led to the selection of bacteria resistant to practically all available antibiotics . Bacteria utilize three main resistance strategies: (i) decrease in drug accumulation, (ii) modification of target, and (iii) modification of the antibiotic . Bacteria can decrease drug accumulation either by becoming impermeable to antibiotics, or by actively excreting the drug accumulated in the cell . As an alternative, they can modify the structure of the antibiotic's molecular target--usually an essential metabolic enzyme of the bacteria--and thus escape the drug's toxic effect . Lastly, they can produce enzymes capable of modifying and directly inactivating the antibiotics . In addition, bacteria have evolved extremely efficient genetic transfer systems capable of exchanging and accumulating resistance genes . Some pathogens, such as methicillin-resistant Staphylococcus aureus and enterococci are now resistant to almost all available antibiotics . Vancomycin is the only non-experimental drug left to treat severe infections due to such organisms . However, vancomycin resistance has already appeared several years ago in enterococci, and was also recently described in staphylococci, in Japan, France and the United-States . Antibiotics are precious drugs which must be administered to patients who need them . On the other hand, the development of resistance must be kept under control by a better comprehension of its mechanisms and modes of transmission and by abiding by the fundamental rules of anti-infectious chemotherapy, i.e.: (i) choose the most efficient antibiotic according to clinical and local epidemiological data, (ii) target the bacteria according to the microbiological data at hand, and (iii) administer the antibiotic at an adequate dose which will leave the pathogen no chance to develop any resistance.

Res Vet Sci, 2000 Oct, 69(2), 181 - 4
Systemic and local immune response of cows to intramammary infection with Staphylococcus aureus; Leitner G et al.; The association between Staphylococcus aureus chronic mammary gland infection and the resulting immune response expressed by the production of specific IgG and IgA antibodies in blood and milk was studied in Israeli Holstein cows . Specific antibodies of the IgG class were detected in sera of 82.6 per cent of the cows chronically infected by S aureus, while in 17.4 per cent no such antibodies could be detected . Specific IgG antibodies to S aureus were neither detected in sera of cows free of mammary infection nor in those infected with different coagulase-negative staphylococci (CNS) such as S intermedius, S chromogenes or S haemolyticus . In milk, specific IgG antibodies to S aureus were detected only in cows with positive serology . The end point dilutions in the milk were 5 to 30 per cent of that of blood from the same cow . No significant difference in IgG titres was found in the same cow if the quarter was infected with S aureus or not . Specific antibodies to S aureus of the IgA class could not be detected in the sera of any of the cows included in this study . In milk, a specific IgA antibody was detected only in the samples from the S aureus infected quarters in which S aureus was isolated at the time of the experiment . In the same cow, quarters infected by S aureus were found to have a significantly higher IgA titre (P < 0.0001) than that of the non-infected ones .

J Antimicrob Chemother, 2000 Oct, 46(4), 527 - 34
Multiplex PCR assays for the detection of clinically relevant antibiotic resistance genes in staphylococci isolated from patients infected after cardiac surgery . The ESPRIT Trial; Martineau F et al.; Multiresistant staphylococci (82 Staphylococcus aureus and 114 coagulase-negative staphylococci) were characterized by testing with rapid multiplex polymerase chain reaction (PCR) assays for species identification and detection of associated antibiotic resistance genes . These 196 staphylococci were isolated from 149 adult patients who developed wound infection after elective coronary artery bypass grafts and/or valve surgery . The multiplex PCR assays allowed identification of the most common staphylococcal species with S . aureus- and Staphylococcus epidermidis-specific primers as well as the detection of the erythromycin resistance genes ermA, ermB, ermC and msrA, the aminoglycoside resistance gene aac(6')-aph(2"), the oxacillin resistance gene mecA and the penicillin resistance gene blaZ . There was a very good correlation between the genotypic analysis by PCR and the phenotype determined by standard methods of susceptibility testing and identification of staphylococcal species: 100% for erythromycin resistance, 98.0% for gentamicin resistance, 99.0% for oxacillin resistance, 100% for penicillin resistance and 100% for S . aureus and S . epidermidis species identification . This study suggests that the incidence and distribution of the tested clinically relevant antibiotic resistance genes in staphylococci associated with infections after cardiac surgery do not differ from those in strains from other infections . These multiplex PCR assays may be used as diagnostic tools to replace or complement standard methods of susceptibility testing and identification of staphylococci.

Clin Infect Dis, 2000 Sep, 31 Suppl 4, S139 - 43
Nosocomial bloodstream infections: organisms, risk factors, and implications; Karchmer AW; In the last 30 years, the frequency, etiology, and epidemiology of bloodstream infections (BSIs) have changed with the evolution of medical care, particularly among the increasing number of hospitalized patients who require intensive care . Although gram-negative bacilli were the predominant nosocomial pathogens in the 1970s, gram-positive cocci have emerged as a more frequent cause of nosocomial BSIs during the 1980s and 1990s . Many gram-positive cocci associated with nosocomial BSIs are now resistant to commonly used antibiotics . Currently, the 3 most common causes of nosocomial BSIs in the United States are coagulase-negative staphylococci, Staphylococcus aureus, and enterococci . The emergence of vancomycin-resistant staphylococcal infections is of particular concern . In addition, the incidence of methicillin-resistant S . aureus (MRSA) infections appears to be increasing; however, the effect of MRSA infection on mortality in hospitalized patients remains unclear . Therefore, newer, more effective antimicrobial therapies are needed to treat BSIs caused by gram-positive cocci are needed.

J Dairy Sci, 2000 Sep, 83(9), 1966 - 75
Location of Staphylococcus aureus within the experimentally infected bovine udder and the expression of capsular polysaccharide type 5 in situ; Hensen SM et al.; The objective of this study was to locate Staphylococcus aureus in the bovine udder and to investigate the expression of capsular polysaccharide type 5 (CP5) in situ in both the early and chronic stages of experimental intramammary S . aureus infections . Bovine udder tissue was obtained in early and chronic stages of intramammary infection; i.e., 24 to 96 h and 122 d after experimental intramammary infection with S . aureus Newbould 305 . The presence and location of S . aureus was investigated by Gram staining of tissue sections . The expression of CP5 by S . aureus in situ was investigated by immunochemical staining of tissue sections with specific antibodies against CP5 . Both in the early and chronic stages of infection, S . aureus was located within the lumen of alveoli or lactiferous ducts, in association with the epithelium, and within phagocytic cells . The staphylococci were mainly observed in clusters and often in the presence of polymorphonuclear neutrophils . Expression of CP5 by S . aureus was observed both in the early and chronic stages of infection . In general, CP5-positive S . aureus were located in alveoli and in association with the mammary epithelium . In the chronic infection, CP5-positive S . aureus were also located deep in the interstitial tissue . These results indicate that--both in early and chronic stages of experimental S . aureus mastitis--colonization of the mammary epithelia and invasion into the interstitial tissue occurs and that CP5 is expressed by S . aureus Newbould 305 in situ . The invasion of S . aureus in the interstitial tissue and the expression of CP5 probably help the bacteria to withstand the host defense mechanisms.

J Biotechnol, 2000 Sep 29, 83(1-2), 37 - 44
Vaccine potential of poly-1-6 beta-D-N-succinylglucosamine, an immunoprotective surface polysaccharide of Staphylococcus aureus and Staphylococcus epidermidis; Mckenney D et al.; Staphylococcus aureus and S . epidermidis are among the most common causes of nosocomial infection, and S . aureus is also of major concern to human health due to its occurrence in community-acquired infections . These staphylococcal species are also major pathogens for domesticated animals . We have previously identified poly-N-succinyl beta-1-6 glucosamine (PNSG) as the chemical form of the S . epidermidis capsular polysaccharide/adhesin (PS/A) which mediates adherence of coagulase-negative staphylococci (CoNS) to biomaterials, serves as the capsule for strains of CoNS that express PS/A, and is a target for protective antibodies . We have recently found that PNSG is made by S . aureus as well, where it is an environmentally regulated, in vivo-expressed surface polysaccharide and similarly serves as a target for protective immunity . Only a minority of fresh human clinical isolates of S . aureus elaborate PNSG in vitro but most could be induced to do so under specific in vitro growth conditions . However, by immunofluorescence microscopy, S . aureus cells in infected human sputa and lung elaborated PNSG . The ica genes, previously shown to encode proteins in CoNS that synthesize PNSG, were found by PCR in all S . aureus strains examined, and immunogenic and protective PNSG could be isolated from S . aureus . Active and passive immunization of mice with PNSG protected them against metastatic kidney infections after intravenous inoculation with eight phenotypically PNSG-negative S . aureus . Isolates recovered from kidneys expressed PNSG, but expression was lost with in vitro culture . Strong antibody responses to PNSG were elicited in S . aureus infected mice, and a PNSG-capsule was observed by electron microscopy on isolates directly plated from infected kidneys . PNSG represents a previously unidentified surface polysaccharide of S . aureus that is elaborated during human and animal infection and is a prominent target for protective antibodies.

Acta Ophthalmol (Copenh), 1988 Jun, 66(3), 355 - 7
Chronic bacterial endophthalmitis in pseudophakia; Pedersen OO; The present report describes a case of bacterial endophthalmitis which was suppressed with topical and systemic corticosteroids for 3 1/2 months in the belief that the uveitis was a sterile reaction . Subsequent pars plana vitrectomy and microbiological work-up disclosed an infection with coagulase-negative staphylococci . The patient was treated with intraocular and systemic antibiotics, and the inflammation settled rapidly . It is concluded that infectious endophthalmitis should be suspected after intraocular surgery when the intraocular inflammation is unexpectedly exaggerated . A diagnosis of sterile uveitis should be made only after careful evaluation which includes a proper microbiological work-up.

Otolaryngol Head Neck Surg, 1982 Nov-Dec, 90(6), 837 - 43
The role of coagulase-negative staphylococci in chronic otitis media with effusion; Bernstein JM et al.; Twenty-eight middle ear effusions from 27 patients with chronic otitis media with effusion were studied for the presence of bacteria . The most common isolates were coagulase-negative staphylococci . However, biochemical and antibiotic sensitivity patterns demonstrated that these organisms represented a heterogenous group . At least three subtypes of coagulase-negative staphylococci were identified from the middle ear effusions, and in only one instance was the isolate from the ear canal identical with that of the middle ear effusion . The data presented suggest that coagulase-negative staphylococci from the middle ear effusions may not be contaminants; however, it cannot be determined from this study whether these organisms play a role as pathogens or as the result of indolent colonization.

Antimicrob Agents Chemother, 2000 Oct, 44(10), 2855 - 7
Excretion of beta-lactam antibiotics in sweat--a neglected mechanism for development of antibiotic resistance?
Hoiby N, Pers C, Johansen HK, Hansen H.
The concentrations of beta-lactam antibiotics after standard doses were measured in blood and apocrine (axilla) and eccrine (forearm) sweat from six adult healthy persons . All persons had ceftazidime (axilla, 28.4 microg/ml; forearm, 11 microg/ml) and ceftriaxone (axilla, 8.9 microg/ml; forearm, 2.5 microg/ml) in sweat, and one person had cefuroxime in sweat (axilla, 7.8 microg/ml) (all data are mean peaks) . Three persons had benzylpenicillin (axilla, 2.6 to 0.1 microg/ml) and one had phenoxymethylpenicillin (axilla, 0.4 microg/ml) in sweat . Excretion of beta-lactam antibiotics in the sweat may explain why staphylococci so rapidly become resistant to these drugs.

Microb Drug Resist, 2000 Summer, 6(2), 133 - 41
Epidemiological study of staphylococcal colonization and cross-infection in two West African Hospitals; Aires De Sousa M et al.; Surveillance in two medium-size (250-300 beds) hospitals located in the most populated islands of Cape Verde was undertaken in July 1997 in order to obtain data concerning nasal carriage of staphylococci . Nasal swabs (172) taken from inpatients and health care workers (HCW) from different internment services yielded 68 Staphylococcus aureus and 105 coagulase-negative staphylococcal (CNS) isolates, demonstrating extensive colonization of both inpatients and HCW by S . aureus (carriage rate 41%) and CNS (carriage rate 65%) . The most frequent CNS species were S . epidermidis and S . haemolyticus . Three species--S . aureus, S . epidermidis, and S . sciuri-were recovered from wound swabs . The antibiotic susceptibility profiles of S . aureus and CNS differed sharply: all 68 S . aureus were resistant to penicillin but were fully susceptible to oxacillin as well as the other antimicrobial agents tested-gentamicin; erythromycin, except for three strains; ciprofloxacin; sulfamethoxazole-trimethoprim, except for two strains; vancomycin; and amoxicillin/clavulanate . In contrast, most (91/105) of CNS were resistant to both penicillin and oxacillin, and a variable but substantial proportion of CNS isolates also carried multiresistant traits to gentamicin, erythromycin, sulfamethoxazole-trimethoprim, and amoxicillin/clavulanate . The analysis by PFGE of the methicillin-susceptible S . aureus (MSSA) and the methicillin-resistant S . epidermidis (MRSE) strains provided evidence for extensive cross-infection and cross-colonization from HCW to patients.

Oncology (Huntingt), 2000 Aug, 14(8 Suppl 6), 9 - 16
Changing patterns of infections and antimicrobial susceptibilities; Maschmeyer G et al.; Nosocomial bloodstream infections across the United States and in Europe are increasingly attributable to gram-positive species--a trend that represents a reversal of the gram-negative predominance of the previous decades . Data from Memorial Sloan-Kettering Cancer Center and elsewhere show that patients with hematologic malignancies or patients who are immunocompromised because of anticancer treatments are experiencing this shift in microbial spectrum . Most common among gram-positive species are coagulase-negative Staphylococci . Antimicrobial resistance continues to increase, which makes treatment more difficult for infections caused by some species, especially vancomycin-resistant enterococcal species . The underlying causes of changes in microbial spectrum and drug-resistance patterns are incompletely understood, but it is clear that antibiotic exposure exerts a significant selective pressure on pathogens, resulting in partial or complete resistance . New drugs or drug combinations will be necessary to treat drug-resistant infections in cancer patients.

Antibiot Khimioter, 2000, 45(8), 25 - 30
{Evaluation of tolerance and efficacy of pefloxacin in the treatment and prevention of severe infections in children with mucoviscidosis and aplastic anemia}; Postnikov SS et al.; Pefloxacin (Abaktal) efficacy and safety were investigated at 21 children (7-16 years old) randomized in 2 groups: children with mucoviscidosis and children with aplastic anemia . The drug was used at the dose 15-20 mg/kg per day bid for 14-28 days . Pefloxacin was used in combination with ceftazidime and amikacin . Combined therapy demonstrated good clinical efficacy . Bacteriological efficacy was not uniform: staphylococci were not isolated from sputum since the 7th day of treatment, but pseudomonads were cultured even on the 14th day of the treatment (the sensitivity to pefloxacin remained) . The only but frequent side-effect was arthropathy . The background and some peculiarities of arthropathy development were analyzed . This phenomenon is called quinolone-induced synovitis . The risk group for quinolone-induced synovitis was estimated--children elder than 10 years with allergic anamnesis . Good clinical efficacy and tolerability of pefloxacin at the children with mucoviscidosis or aplastic anemia is a reason and base to cancel the limits to its use in pediatrics.

Am J Respir Crit Care Med, 2000 Sep, 162(3 Pt 1), 1027 - 30
Evaluation of outcome of intravenous catheter-related infections in critically ill patients; Rello J et al.; Fifty-seven patients developed an episode of catheter-related infection (CRI) in the bloodstream during their stay in the intensive care unit (cases) and were prospectively observed to establish the attributable mortality, increase in length of stay, and excess costs . Costs were estimated by multiplying the number of excess days of stay by the reimbursement provided . The outcomes for these cases were compared with those for matched control subjects without CRI . Eight cases were excluded as no control was found . Of the 49 cases, 31 were coagulase-negative staphylococci (CNS) . The level of severity was similar for both groups (APACHE II 15.5 +/- 7 . 2 versus 15.2 +/- 7.3) . There were no significant differences (p > 0 . 20) in the mortality observed in the hospital for the cases (22.4%, 95% confidence interval {CI} 0.3% to 34.9%) and the control subjects (34.7%, 95% CI 21.2% to 40.1%) . Among the survivors, the hospital stay was increased by 19.6 d (95% CI -1.1; 40.4) . This represents an added cost of 3,124 Euros per episode of CRI among the survivors . In conclusion, our cohort study failed to show a difference in attributable mortality due to CRI in intensive care unit patients . Nevertheless, these infections lead to an increase in hospital stay of approximately 20 d . Each episode of CRI represents an additional cost of more than 3,000 Euros.

Blood, 2000 Sep 15, 96(6), 2149 - 56
Protein A is the von Willebrand factor binding protein on Staphylococcus aureus; Hartleib J et al.; Endovascular infection is a highly critical complication of invasive Staphylococcus aureus disease . For colonization, staphylococci must first adhere to adhesive endovascular foci . Von Willebrand factor (vWF) is a large, multimeric glycoprotein mediating platelet adhesion at sites of endothelial damage . Earlier it was demonstrated that vWF binds to and promotes the surface adhesion of S . aureus, prompting this effort to identify the vWF adhesin . In Western ligand assays of S . aureus lysates, staphylococcal protein A (SPA) was recognized by purified vWF . Surface plasmon resonance demonstrated the binding of soluble vWF to immobilized recombinant protein A with a K(d) of 1.49 x 10(-8) mol/L . Using flow cytometry, the binding of fluorescein isothiocyanate-labeled vWF to S . aureus was found to be saturable and inhibitable by unlabeled vWF, antiprotein-A antibodies, or IgG . Isogenic Deltaspa::Tc(r) mutants were constructed by the insertion of a tetracycline resistance cassette into spa using allelic replacement, and it exhibited decreased binding of soluble vWF and decreased adhesion to vWF-adsorbed surfaces . The interaction was restored on complementation of the mutants with spa-containing plasmid pSPA7235 . In conclusion, protein A confers interaction of S . aureus with soluble and immobilized vWF in a newly discovered function characterizing protein A as a novel member of the staphylococcal surface protein adhesin superfamily and suggesting its potential role in the pathogenesis of endovascular staphylococcal disease.

Am J Vet Res, 2000 Sep, 61(9), 1128 - 32
Characterization of erythromycin-resistant methylase genes from multiple antibiotic resistant Staphylococcus spp isolated from milk samples of lactating cows; Khan SA et al.; OBJECTIVE: To isolate and characterize erythromycin-resistant methylase genes in multiple-antibiotic resistant staphylococci isolated from milk samples . ANIMALS: 300 lactating cows . PROCEDURE: 23 erythromycin-resistant staphylococci were isolated from milk samples of 300 lactating cows . The prevalence of erythromycin-resistant methylase (erm) genes, ermC and ermA genes, and the multicomponent macrolide efflux pump in staphylococci msrA genes were identified and characterized by use of multiplex polymerase chain reaction (PCR), Southern hybridization, restricted fragment length polymorphism (RFLP) analysis, and dot-blot hybridization . RESULTS: Biochemical characterization indicated that 3 of 23 (13%) isolates were coagulase-positive Staphylococcus aureus, and the rest were coagulase-negative . Multiplex PCR resulted in amplification of a 520-base pair (bp) region of the ermC gene from the cell lysates of a strain of S simulans M-21 and S sciuri M-28 . The ermC gene in both isolates was found on a 3-kilobase plasmid . The ermA gene was found on the chromosome of 21 isolates, and 6 RFLP patterns were observed . None of the isolates harbored the msrA gene . CONCLUSIONS: Erythromycin-resistant Staphylococcus spp isolated from milk samples of lactating cows may serve as reservoirs of erm genes homologous to those described in human isolates . However, the chromosomal insert patterns and prevalence of these genes, the sizes of plasmids harboring the genes, and the number of inserts of the genes (copy number) may differ from that of human isolates.

Lett Appl Microbiol, 2000 Aug, 31(2), 134 - 8
Rapid detection of Staphylococcus aureus using bioluminescent enzyme immunoassay; Fukuda S et al.; A bioluminescent enzyme immunoassay (BLEIA) method for detecting protein A-bearing Staphylococcus aureus was developed using biotinylated firefly luciferase . The BLEIA was able to detect protein A at one pg ml-1 and 103 cfu ml-1 level of Staph . aureus . The BLEIA showed significant signals with overnight cultures of all 24 Staph . aureus strains, and the BLEIA did not show any significant signals with overnight cultures of all 44 strains of coagulase-negative staphylococci and the other genus bacteria . After 5 h cultivation beginning at approximately 50 cfu ml-1, the BLEIA was able to detect all 35 Staph . aureus strains isolated from healthy humans.

J Clin Microbiol, 2000 Sep, 38(9), 3407 - 12
Rapid extraction from and direct identification in clinical samples of methicillin-resistant staphylococci using the PCR; Jaffe RI et al.; Methicillin-resistant staphylococci (MRS) are one of the most common causes of nosocomial infections and bacteremia . Standard bacterial identification and susceptibility testing frequently require as long as 72 h to report results, and there may be difficulty in rapidly and accurately identifying methicillin resistance . The use of the PCR is a rapid and simple process for the amplification of target DNA sequences, which can be used to identify and test bacteria for antimicrobial resistance . However, many sample preparation methods are unsuitable for PCR utilization in the clinical laboratory because they either are not cost-effective, take too long to perform, or do not provide a satisfactory DNA template for PCR . Our goal was to provide same-day results to facilitate rapid diagnosis and therapy . In this report, we describe a rapid method for extraction of bacterial DNA directly from blood culture bottles that gave quality DNA for PCR in as little as 20 min . We compared this extraction method to the standard QIAGEN method for turnaround time (TAT), cost, purity, and use of template in PCR . Specific identification of MRS was determined using intragenic primer sets for bacterial and Staphylococcus 16S rRNA and mecA gene sequences . The PCR primer sets were validated with 416 isolates of staphylococci, including methicillin-resistant Staphylococcus aureus (n = 106), methicillin-sensitive S . aureus (n = 134), and coagulase-negative Staphylococcus (n = 176) . The total supply cost of our extraction method and PCR was $2.15 per sample with a result TAT of less than 4 h . The methods described herein represent a rapid and accurate DNA extraction and PCR-based identification system, which makes the system an ideal candidate for use under austere field conditions and one that may have utility in the clinical laboratory.

Rev Soc Bras Med Trop, 2000 May-Jun, 33(3), 281 - 301
{Problems with gram-positive bacteria: resistance in staphylococci, enterococci, and pneumococci to antimicrobial drugs}; Tavares W; The resistance in staphylococci, enterococci, and pneumococci is reviewed . The author also recalls the first cases, and presents an overview of the distribution of cases in the world, the genetic and molecular mechanisms of resistance, the importance in Brazil and therapeutic alternatives . The factors that contribute to the dissemination of these problem bacteria and the measures for their control are emphasized.

Curr Opin Cardiol, 2000 Mar, 15(2), 82 - 5
The surgical management of bacterial valvular endocarditis; Ferguson E et al.; Bacterial endocarditis is an important cause of cardiac valvular problems . The diagnosis of bacterial endocarditis can be difficult, and, often, an aggressive clinical evaluation including serial blood cultures is necessary . The pathophysiology of endocarditis is changing with the rise of intravenous drug use; staphylococci are an increasingly common cause . Endocarditis often warrants surgical intervention . Operations for bacterial endocarditis range from valve repair to valve replacement to homograft replacement . The operations are technically challenging, but new methods of myocardial protection have markedly improved the surgical outcomes . Valve excision is an option for intravenous drug users with tricuspid valve endocarditis . Surgical management of endocarditis is a technically challenging but rewarding procedure that should be offered to appropriate patients.

Eur J Clin Microbiol Infect Dis, 2000 Jun, 19(6), 403 - 17
Glycopeptide resistance in coagulase-negative staphylococci; Biavasco F et al.; Coagulase-negative staphylococci (CNS) were the first organisms in which acquired glycopeptide resistance was recognized . Ever since the early reports, it has been apparent that resistance to teicoplanin is more common than that to vancomycin and that resistance occurs mostly in species such as Staphylococcus haemolyticus and Staphylococcus epidermidis . The minimum inhibitory concentrations (MICs) of teicoplanin for CNS usually fall over a wide range, and, especially in some methicillin-resistant isolates of the two above-mentioned species, they can reach and even exceed the resistance breakpoint, whereas vancomycin MICs tend to remain more stable over a narrower range within the limits of susceptibility . CNS strains intermediately susceptible and even resistant not only to teicoplanin but also to vancomycin have, however, been isolated, most frequently from patients subjected to prolonged glycopeptide treatment . Laboratory detection of glycopeptide-resistant CNS may be problematic, mainly because susceptibility tests, particularly those for teicoplanin, are influenced by various technical factors, and agar diffusion tests may yield false susceptibility data . In studies with experimental glycopeptides, some molecules have exhibited improved in vitro activity compared with teicoplanin and vancomycin, but these encouraging microbiological findings have not usually been followed by in vivo trials . Stepwise and single-step exposure to teicoplanin and vancomycin has allowed stable clones for which glycopeptide MICs are increased to be obtained from susceptible CNS strains, particularly strains of Staphylococcus haemolyticus and Staphylococcus epidermidis . In these studies, resistance to teicoplanin was generally easier to obtain than resistance to vancomycin, and the levels of teicoplanin resistance were higher . Population studies have demonstrated the usually heterogeneous nature of glycopeptide resistance in CNS . Although glycopeptide-resistant CNS have been shown to differ in several features from their glycopeptide-susceptible counterparts, the exact mechanism of staphylococcal glycopeptide resistance remains unknown.

Int J Syst Evol Microbiol, 2000 Jul, 50 Pt 4, 1521 - 7
Staphylococcus fleurettii sp . nov., isolated from goat's milk cheeses; Vernozy-Rozand C et al.; A new coagulase-negative and novobiocin-resistant species of the genus Staphylococcus, Staphylococcus fleurettii, isolated from raw-milk cheeses, is described . This species is differentiated from the other novobiocin-resistant staphylococci on the basis of ribotype and intergenic transcribed spacer patterns, DNA-DNA reassociation reactions, cell wall composition and phenotypic characteristics . S . fleurettii could be distinguished by its oxidase activity, by its ability to produce acid aerobically from D-trehalose, D-mannose, D-turanose and maltose and by its inability to produce acid from D-cellobiose . The type strain of S . fleurettii is CIP 106114T (= DSM 13212T).

Transplantation, 2000 Jul 27, 70(2), 302 - 5
Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease; Sigurdsson L et al.; BACKGROUND: Bacteremia occurs frequently after intestinal transplantation (ITx) in children . During our initial experience with this procedure, we noted that bacteremic episodes tended to occur simultaneously with the presence of rejection and/or gastrointestinal (GI) posttransplant lymphoproliferative disease (PTLD) . AIM: To document the association of bacteremia with rejection and GI PTLD in pediatric ITx recipients . METHODS: Retrospective analysis of all medical records from 62 children who underwent ITx between July 1990 and January 1998 at Children's Hospital of Pittsburgh . A bacteremic episode was defined as two positive blood cultures from different sites at the same time or from the same site at different times . Rejection and PTLD were defined using previously published criteria . RESULTS: A total of 39/62 ITx recipients had 133 blood stream infections (2.1 episodes/patient) including 121 episodes of bacteremia and 12 of fungemia . Enteric organisms were the most frequently recovered pathogens (Gram negative rods, n=76; enterococci, n=36) . Enteric organisms were recovered as a single organism (n=57), with another enteric bacteria (n=23), or with coagulase negative staphylococci (CONS) (n=24) . CONS were recovered as a single organism on 21 occasions . An obvious source of bacteremia was not found for 115/121 episodes . Endoscopy was performed for 107 of the 115 bacteremia episodes; an abnormal histology was identified in 74 revealing rejection (n=36), GI PTLD (n=21), or both (n=17) . When endoscopy showed GI pathology, enteric organisms alone or in combination with CONS were recovered on 63/107 occasions, although CONS were recovered alone only 11 times . CONCLUSIONS: Bacteremia accompanies GI rejection and intestinal PTLD in ITx recipients . Endoscopy should be performed to inspect the allograft when bacteremia occurs without an obvious source in these patients . This is especially true for patients with bacteremia due to enteric organisms.

Rev Latinoam Microbiol, 1999 Apr-Jun, 41(2), 67 - 72
Evaluation of the antimicrobial susceptibilities of coagulase-negative staphylococci by E-test; Barelli C et al.; Coagulase-negative staphylococci (CoNS) have recently emerged as important nosocomial pathogens . In this study, the susceptibility of 53 isolates of CoNS (42 S . epidermidis, 6 S . haemolyticus, 3 S . caprae, 1 S . lugdunensis and 1 S . chromogenes) obtained over a 1 year period at a Brazilian Hospital were tested for vancomycin, teicoplanin, cephalothin, penicillin, oxacillin, and chloramphenicol . The minimal inhibitory concentration (MICs) were determined by the E-test using saturated swabs or the flooding method . No isolates showed resistance to vancomycin, 3 (5.7%) were resistant to teicoplanin, 5 (9.4%) to cephalotin, most of them, (47, 88.6%) were resistant to penicillin, 19 (35.8%) to oxacillin and 27 (50.9%) to chloramphenicol . The study shows that the increased resistance of CoNS can cause serious infections of difficult treatment . The E-test proved to be a convenient and reliable method for MIC determination of CoNS isolates and the qualitative and quantitative results obtained by flooding were much more reproducible than the results obtained using swabs.

Acta Vet Scand, 1999, 40(4), 315 - 21
Identification of coagulase-positive staphylococci isolated from bovine milk; Capurro A et al.; A total of 414 coagulase-positive staphylococcal strains obtained at the mastitis laboratory, National Veterinary Institute, Uppsala, Sweden, were studied . One hundred and seventy seven strains were used for a frequency study . Ninety-seven per cent were identified as Staphylococcus aureus, 2% as Staphylococcus intermedius and 1% as Staphylococcus hyicus . Two hundred and thirty seven strains with atypical hemolysis reactions on bovine blood agar were randomly selected, with the aim to increase the number of S . intermedius and S . hyicus strains available for testing . Eight different characteristics, including physiological, enzymatical and biochemical properties, were used to identify the coagulase-positive Staphylococcus species . The results of this study suggest that the following tests should be included for correct identification of the 3 different species of coagulase-positive staphylococci: P agar supplemented with acriflavin, beta-galactosidase and hemolytic reaction on chocolate agar . These 3 tests are simple and quick to perform and enable accurate for easy differentiation of the 3 coagulase-positive Staphylococcus species.

Bone Marrow Transplant, 2000 Jul, 26(2), 211 - 4
Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies; Celebi H et al.; The risk and outcome of infection in febrile neutropenic patients is mainly determined by the duration of neutropenia, the underlying disease or the treatment . This study was undertaken to compare infections and the outcome after conventional chemotherapy (CCT), allogeneic PBSC transplantation (alloPBSCT) or autologous PBSC transplantation (autoPBSCT), during the period of neutropenia, in a single center . A total of 145 patients (50 in CCT group, 50 in alloPBSCT and 45 in autoPBSCT) were evaluated . In the alloPBSCT group, 86% of the patients (43/50), in the autoPBSCT group 93% of the patients (42/45) and in the CCT group 92% (46/50) of the patients had at least one febrile episode during their neutropenic period (P > 0.05) . Microbiologically and/or clinically documented infection rates were 50% (25/50), 42% (19/45) and 48% (24/50) respectively . Gram-positive pathogens, mostly coagulase-negative staphylococci were the most frequent cause of bacteremias in all groups . The frequency of CNS infections was significantly higher in the alloPBSCT and autoPBSCT groups compared to the CCT group (P < 0 . 008 and P < 0.04, respectively) . Catheter infections were frequent in the PBSCT groups and pulmonary infections were more frequent in the CCT group (P < 0.05) . The CCT group needed longer antibiotic usage compared to the alloPBSCT group (P < 0.006) . The duration of neutropenia and the type of treatment given, does not affect the rate of febrile episodes, but affects the type of infections in febrile neutropenic patients.

J Clin Microbiol, 2000 Aug, 38(8), 2819 - 23
Nationwide German multicenter study on prevalence of antibiotic resistance in staphylococcal bloodstream isolates and comparative in vitro activities of quinupristin-dalfopristin; von Eiff C et al.; Antibiotic-resistant gram-positive bacteria have become an increasing problem in the last two decades . In order to evaluate the prevalence of antibiotic resistance in staphylococcal bloodstream isolates in Germany, 2,042 staphylococci collected in 21 tertiary-care hospitals were investigated during a 3-year period (March 1996 to March 1999) . Altogether, 1,448 S . aureus isolates and 594 coagulase-negative staphylococci (CoNS) that comprised 13 different species were included . Furthermore, the antistaphylococcal activities of quinupristin-dalfopristin were compared with those of eight other compounds by the broth microdilution method . The rates of oxacillin resistance in Staphylococcus aureus, S . epidermidis, S . haemolyticus, and other CoNS were 13.5, 69, 90, and 34%, respectively . In oxacillin-resistant strains high rates of resistance (up to 100%) to erythromycin, clindamycin, ciprofloxacin, and gentamicin were also observed . However, no strain appeared to be resistant to vancomycin or quinupristin-dalfopristin . The streptogramin combination exhibited excellent in vitro activity against all staphylococcal species tested, regardless of the patterns of resistance to other drug classes . In terms of MICs at which 90% of the isolates are inhibited, quinupristin-dalfopristin was 2 times more active against S . aureus isolates, 4 to 16 times more active against S . haemolyticus, and 8 to 32 times more active against S . epidermidis than vancomycin or teicoplanin.

Acta Paediatr Taiwan, 2000 May-Jun, 41(3), 123 - 8
Nosocomial infection in a neonatal intensive care unit--from a viewpoint of national health insurance; Lin IJ et al.; In order to survey both the epidemiology of nosocomial infection in our neonatal intensive care unit (NICU) and the changing face of nosocomial infection after the introduction of National Health Insurance (NHI) in Taiwan, we retrospectively reviewed the nosocomial infections which occurred in our NICU from March 1, 1991, to February 28, 1999 . We also compared the nosocomial infections from the viewpoint of NHI . The mean rate of nosocomial infections in our NICU during these 8 years was 13.6%, and it had significantly increased after the NHI plan was implemented (from 7.9% to 19.0%) . The most common type of nosocomial infection was blood stream infection (53.8%, 120 of 223 infections) . Coagulase-negative Staphylococci and fungi were the two most common pathogens of nosocomial blood stream infection in our NICU, accounting for 28.1% and 24.2% of the infections, respectively . The survival rate of very low birth weight (VLBW) infants increased from 76.3% to 78.4% after the implementation of NHI . However, the nosocomial infection rate of the VLBW infants had markedly increased from 22.6% to 41.9% . The total number of hospitalization days of the patients with nosocomial infection was significantly greater than that of those without nosocomial infections (p < 0.05), and the patients with the lower birth weights had longer hospital stays . The risk factors for nosocomial infection including invasive procedures, multiple and empirical antibiotics, and extremely low birth weight premature infants, remained the same, but the prevalence of nosocomial infection in the neonatal intensive care unit has changed markedly since the NHI plan began . Further investigation to determine strategies for preventing nosocomial infection in very low birth weight infants is warranted.

Acta Paediatr, 2000 Jun, 89(6), 690 - 3
Clinical and laboratory impact of coagulase-negative staphylococci bacteremia in preterm infants; Maayan-Metzger A et al.; A retrospective evaluation of the clinical and laboratory impact of coagulase-negative staphylococci (CONS) bacteremia in preterm infants was carried out . The study population included all preterm infants (n = 31) in whom two or more blood cultures were positive for CONS within a period of 4 d, with negative blood cultures 1 wk before and 1 wk after the CONS bacteremia . Clinical manifestations and the results of laboratory tests 7 d before and after the positive blood cultures, and on the first day of sepsis, were recorded and compared . During CONS bacteremia, the infants demonstrated apnoea and bradycardia (88%) and a need for oxygen (59%) and ventilatory support (69%) . Significant laboratory findings were leukopenia below 5,000 cells/mm3 (12%), leukocytosis above 30,000 cells/mm3 (39%), and thrombocytopenia below 150,000/mm3 (25%) . These clinical and laboratory manifestations differed significantly during the bacteremia infection compared with the week before and after . CONCLUSION: CONS bacteremia is a clinically significant infection in preterm infants, causing episodes of apnoea and bradycardia, and a need for ventilatory support.

Clin Infect Dis, 2000 Jul, 31(1), 24 - 30 Epub 2000 Jul 26.
Polyclonal Staphylococcal endocarditis caused by genetic variability; Van Eldere J et al.; Cultures of blood obtained from a patient with Staphylococcus epidermidis prosthetic valve endocarditis yielded 15 strains of S . epidermidis . Genome macrorestriction and amplified fragment-length polymorphism analyses of these strains showed that they belonged to 4 different, very closely related clones, suggesting that they were the result of genetic variability of an infecting strain during the infectious episode . In vivo experiments in a rat model for foreign body infections using 1 of the S . epidermidis strains from the patient showed genetic variability similar to that of the infecting strain . In the rat model, we also detected the simultaneous presence of different clones that were identical to those isolated from our patient, thus confirming the possibility of genetic variability . It is important to note that the 4 clones isolated from our patient presented with 2 different antibiograms . Therefore, in cases of foreign device-related infections due to coagulase-negative staphylococci, the possibility of polyclonal infection has to be taken into account, particularly as regards differences in antibiotic susceptibility.

Clin Infect Dis, 2000 Jul, 31(1), 16 - 23 Epub 2000 Jul 14.
Assessment of the relationship between antimicrobial usage and susceptibility: differences between the hospital and specific patient-care areas; White RL et al.; Current evidence suggests that controlling antibiotic resistance requires the monitoring of both susceptibility trends and antimicrobial usage within specific patient-care areas of the hospital . To assess the differences between antimicrobial usage-versus-susceptibility relationships found in the hospital and those relationships found in specific patient-care areas, susceptibility and antimicrobial usage data collected over a 5-year period (1992-1996) at the Medical University of South Carolina were analyzed . For each area, the relationship between drug use and susceptibility was analyzed for 8 gram-negative organisms with respect to 19 different agents and for 3 staphylococci with respect to 10 agents with use of simple linear regression . The relationships found in the hospital had a poorer overall agreement with the relationships found in the intensive care units (ICUs; <20%) than they did with the relationships found in the non-ICUs ( approximately 65%) . Surveillance should include both susceptibility and drug usage patterns in individual areas within an institution.

Klin Khir, 1993, (1), 21 - 3
{The skin microflora of the upper extremities as the source of suppurative diseases of the hand and fingers}; Salaida IM et al.; The parallel bacteriologic studies of microflora of skin of the upper extremities and pus in purulent diseases of the hands and digits in workers of the combine plant was carried out . It was established that besides Staphylococcus aureus, the haemolytic forms of coagulase-negative species, in particular S . hyicus, S . epidermidis, S . haemolyticus, S . warneri, were the agents of purulent-inflammatory processes both in monocultures and in associations . Incidence of isolation of staphylococci and density of bacterial populations depend on the use of oils and emulsions in the manufacturing process.

J Infect, 2000 May, 40(3), 262 - 6
A novel serological test for the diagnosis of central venous catheter-associated sepsis; Elliott TS et al.; OBJECTIVES: To determine the sensitivity and specificity of a novel antibody test for the diagnosis of intravascular catheter-related infections due to coagulase-negative staphylococci . METHODS: Sixty-seven patients diagnosed as having central venous catheter (CVC)-associated sepsis based on strict clinical criteria, including positive blood cultures, were compared to 67 patients with a CVC in situ who exhibited no evidence of sepsis . An ELISA serological test based on a novel short-chain lipoteichoic acid antigen isolated from coagulase-negative staphylococci (CNS) was used to determine the patient's serological response (IgG and IgM) to CVC sepsis caused by CNS . The specificity and sensitivity of the test was determined . RESULTS: There was a significant increase in the antibody levels (IgG and IgM) to the short-chain lipoteichoic acid in patients with CVC-associated staphylococcal sepsis as compared to the control patients . CONCLUSIONS: This new serological method may offer a useful diagnostic test for intravascular catheter infections caused by staphylococci.

Antibiot Khimioter, 2000, 45(6), 25 - 8
{The results and characteristics of the mupirocin (Bactroban) sanative treatment of intranasal Staphylococcus carriers in a large hospital}; Lykova EA et al.; The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains . The study included 37 medical workers from different and mainly problem units of the large general hospital . The tolerability of the ointment was good . After the Bactroban use no complications of the patients were recorded . The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent . The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases . A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated . No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted . The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent . A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.

Eur J Immunol, 2000 Jun, 30(6), 1606 - 13
Role of selectins in experimental Staphylococcus aureus-induced arthritis; Verdrengh M et al.; The selectin family of adhesion molecules mediates the initial attachment of leukocytes to venular endothelial cells at sites of tissue injury and inflammation . To assess the role of selectin family in Staphylococcus aureus-triggered septic arthritis, we used several approaches . First, treatment with fucoidin, a carbohydrate molecule capable of binding to and blocking selectin functions, was used . In addition, we used P-selectin gene-targeted mice as well as mice pretreated with monoclonal antibody blocking L-selectin function . The P-selectin-deficient and fucoidin-treated animals initially exhibited a less severe septic arthritis both clinically and histopathologically . In the later stages of the disease no significant differences with respect to arthritis were evident . Pretreatment with L-selectin blocking antibody did not influence the severity of arthritis . High numbers of staphylococci were recovered from the kidneys of selectin-deficient mice, indicating a less efficient clearance of bacteria . Our results demonstrate a dual role for selectins in S . aureus-induced arthritis: on the one hand, blockade of these selectins leads to less severe arthritic lesions in the initial stage of the disease; on the other, delayed recruitment of phagocytes decreases the clearance of bacteria.

Eur J Clin Microbiol Infect Dis, 2000 May, 19(5), 385 - 7
Distribution of macrolide-resistance genes in Staphylococcus aureus blood-culture isolates from fifteen German university hospitals . M.A.R.S . Study Group . Multicentre Study on Antibiotic Resistance in Staphylococci; Schmitz FJ et al.; The purpose of the study was to analyze the distribution of the macrolide-resistance genes in 134 erythromycin-resistant Staphylococcus aureus blood-culture isolates collected at 15 German university hospitals . The most prevalent resistance gene was ermC (68/134; 50.7%), followed by ermA (52/134; 38.8%), ereB (10/134; 7.5%), and mrsA/msrB (4/134; 6%) . The least common genes were ermB (3/134; 2.2%) and ereA (1/134; 0.7%) . Overall, resistance to erythromycin was predominantly due to the presence of two erm genes, although with different distributions, depending on the methicillin-resistance pattern.

Lett Appl Microbiol, 2000 Jul, 31(1), 42 - 5
Antimicrobial susceptibility of staphylococci isolated from otitis externa in dogs; Lilenbaum W et al.; Samples were obtained from 65 unmedicated adult dogs, processed for isolation of Staphylococcus species and tested for susceptibility to penicillin G, gentamicin, oxacillin, tetracycline, trimethoprim-sulphamethoxazole, streptomycin, ampicillin and rifampin . Forty-four isolates were obtained, which represents 67.7% of samples . Coagulase-negative species were most commonly found, and the most frequently isolated staphylococcus species were Staph . epidermidis and Staph . aureus . Other species, such as Staph . simulans, Staph . haemolyticus, Staph . saprophyticus and Staph . intermedius were also isolated . Resistance to antibiotics was frequently observed, with 90.9% of the isolates showing resistance to at least one drug . The most active antimicrobial agents against staphylococci isolated from otitis externa of dogs were rifampin and oxacillin . Multidrug resistance was a common finding, and one strain of Staph . haemolyticus species, was resistant to all tested antimicrobial agents . Resistance to three or more different drugs was a common finding, observed in 16 strains (36.4%) of both coagulase-positive and coagulase-negative staphylococci . This study highlights the emergence of cases of otitis externa determined by coagulase-negative staphylococcus strains and once more emphasizes the need for bacterial culture with species identification and susceptibility testing of swab specimens from the ear canal in order to choose appropriate antimicrobial agents.

Ann Thorac Surg, 2000 May, 69(5), 1388 - 92
Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997; Gordon SM et al.; BACKGROUND: We reviewed all cases of early onset prosthetic valve endocarditis (EO-PVE) occurring less than 12 months after valve operation among 7,043 patients undergoing heart valve replacements or repairs at The Cleveland Clinic between 1992 and 1997 . METHODS: Cases were defined by the Duke criteria and identified through prospective surveillance . RESULTS: Seventy-seven cases of EO-PVE were identified (1 per 100 procedures), and during the study period the incidence of EO-PVE decreased from 1.5% (1992 to 1994) to 0.7% (1995 to 1997) (p < 0.01) . The incidence of EO-PVE for rings (0.2%; 4 of 1,992) was significantly lower than for mechanical (1.6%; 28 of 1,731) and bioprosthetic valves (1.1%; 41 of 3,320) (p < 0.001) . The incidence of EO-PVE was also significantly lower for mitral valve versus aortic valve surgeries (0.6% versus 1.4%, p < 0.001) . The most common pathogens causing EO-PVE were coagulase-negative staphylococci (52%), fungi (13%), Staphylococcus aureus (10%), and enterococci (8%) . Patients undergoing combined surgical and medical treatment of EO-PVE had a significantly higher 30-day, 2-year, and 3-year survival than medically treated patients, although patients judged to be too ill to survive surgery accounted for two-thirds of the patients treated medically . CONCLUSIONS: There is a 1% incidence rate of EO-PVE among patients undergoing valve operations at our institution, usually caused by coagulase-negative staphylococci, and combined surgical and medical treatment is associated with improved survival compared with medical treatment alone.

Infection, 2000 May-Jun, 28(3), 149 - 52
Comparison of topical 0.3% ofloxacin to fortified tobramycin-cefazolin in the therapy of bacterial keratitis; Khokhar S et al.; BACKGROUND: In this study we compared topical ofloxacin with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proved bacterial keratitis . METHODS: 30 eyes of culture-proved bacterial corneal ulcers of moderate severity were included in a prospective randomized, controlled, double-masked study for comparison . The cases were randomly allocated to treatment with 0.3% ofloxacin solution (Group I) and combination of fortified antibiotics (1.5% tobramycin and 5% cefazolin solutions--Group II as control) along with supportive cycloplegic, vitamins and antiglaucoma therapy . Time for healing of ulcer and subjective symptoms were main outcome measures . Student's t-test was used to compare the results . RESULTS: Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated . Resolution of the ulcer was achieved in 93% and 87% in the treated and the control group, respectively . The mean duration of symptomatic relief was 7.8 +/- 1.54 days in the treated group and 8.33 +/- 1.44 days in the control group; for epithelial healing it was 15.0 +/- 3.86 days in the treated group and 15.46 +/- 3.86 days in the control group . Post resolution the best corrected visual acuity of 20/200 or better was achieved in all but one eye each in both groups . CONCLUSIONS: Both ofloxacin 0.3% and combined fortified tobramycin 1.5% and cefazolin 5% topical drops were comparable for treating cases of bacterial corneal ulcer of moderate severity . However, considering the easy availability and cost effectiveness of ofloxacin, a monotherapy with ofloxacin may be preferred over the combined, fortified tobramycin and cefazolin therapy.

J Clin Microbiol, 2000 Jul, 38(7), 2516 - 9
A 5' nuclease PCR (TaqMan) high-throughput assay for detection of the mecA gene in staphylococci; Killgore GE et al.; In an effort to find a rapid, efficient, and reliable method of screening large numbers of bacterial isolates for specific antimicrobial resistance genes, we compared conventional PCR results to the results generated using the TaqMan 5' nuclease PCR kit in conjunction with an ABI Prism 7700 Sequence Detector for detecting the mecA gene in various species of staphylococci . DNA was extracted using two techniques . The first used a high-salt extraction method suitable for conventional PCR but resulted in a 7.2% rate of PCR inhibition with the TaqMan technique . PCR inhibition could be overcome by diluting samples 1:5 prior to testing . The second method used the Qiagen QIAamp Tissue Kit; no instances of PCR inhibition were encountered with this method . A total of 197 (96%) of the 206 samples with no inhibition showed agreement between the two methods . Eight of the nine disagreements were likely the result of low-level DNA cross contamination caused by frequent specimen handling . Target DNA in all eight of these samples was first detected in the initial tests only after >30 PCR cycles, and all were negative upon repeat testing even after 40 PCR cycles using freshly extracted DNA . Among those positive samples in agreement, target DNA was invariably detected before 30 PCR cycles . The TaqMan assay eliminated the need to load, run, stain, and read agarose gels and provided the advantage of instant detection of PCR product by laser-activated fluorescence . Thus, final results were obtained 2 h after PCR was initiated, as opposed to a requirement of 2 days to examine 96 samples by agarose gel electrophoresis.

Res Vet Sci, 2000 Jun, 68(3), 279 - 83
Adherence by Staphylococcus intermedius to canine keratinocytes in atopic dermatitis; Mcewan NA; The adherence of Staphylococcus intermedius to canine keratinocytes in normal dogs was compared to that in dogs suffering from atopic dermatitis, primary seborrhoea and bacterial pyoderma . Statistically significant greater adherence by S . intermedius to keratinocytes occurred in atopic dogs and dogs suffering from pyoderma when compared with the normal group (P < 0.01) and dogs suffering from primary seborrhoea (P < 0.05) . This is similar to the results of a study of human atopic dermatitis by Cole and Silverberg (1986) who demonstrated increased adherence by S . aureus to keratinocytes from atopic dermatitis patients when compared with adherence to keratinocytes in a variety of non-atopic dermatoses . This increased adherence by pathogenic staphylococci to keratinocytes may in part explain the high incidence of staphylococcal pyoderma seen in both canine and human patients suffering from atopic dermatitis .

Zh Mikrobiol Epidemiol Immunobiol, 2000 Jan-Feb, (1), 17 - 21
{The frequency of staphylococcal colonization of the intestines in children with the manifestations of dysbacteriosis}; Nikolaeva IV et al.; In 2100 children of different age groups the microbiocenosis of the large intestine was studied . The study revealed that the colonization of the mucous membrane of the large intestine with staphylococci developed in 30% of children with intestinal dysbacteriosis . Young children were mainly affected (91%) . The prevailing species among isolated staphylococci was S . aureus (86%), capable of persistence in the intestine (30.9%) . In children non typing S . aureus strains mainly circulated (70%), and among phage-typing strains isolates of phage group III prevailed (70.2%) . The colonization of the intestine with coagulase-negative staphylococci was possible (14%) . Microecological intestinal disturbances in children of different age groups were characterized by different degrees of changes in normal microflora with the prevalence of opportunistic microorganisms in the microbial picture.

Cesk Slov Oftalmol, 2000 Apr, 56(2), 132 - 5
{Clinical experience with the preparation Uniflox Unimed Pharma in ophthalmology}; Cernak A et al.; The authors investigated in a group of 186 adults and 46 children the effect of antibiotic drops UNIFLOX UNIMED PHARMA . The drops contain the effective substance ofloxacine and were used in different inflammations of the eye and adnexa as well as before and after surgery of the eye . Of 110 patients where before surgery from the conjunctival sac pathogenic microorganisms were cultivated, after 7 days following administration of the drops in 105 patients the finding was negative . The marked effect on staphylococci was remarkable . During the postoperative period, in particular after operations of the cornea, a positive prophylactic effect was found and the authors did not observe any effect on healing of the surgical wounds or epithelization of the cornea . The drug had a high antimicrobial effect also in children where it was administered in suppurative dacrocystitis of neonates, acute inflammations of the conjunctiva or bacterial superficial keratitis . All patients tolerated the drug very well, no side-effects were observed.

Med Arh, 2000, 54(1), 13 - 6
Occurrence of surgical pathogens and their antimicrobial susceptibility patterns; Dobardzic R et al.; OBJECTIVE: To assess the occurrence frequency of bacterial pathogens at the Surgical Wards, Casualty and Outpatient Department (OP) of major Kuwaiti hospital and to compare their antimicrobial susceptibility patterns . METHODS: The Automicrobic System (bioMerieux-Vitek) with respective ready-to-use cards were used for identification of isolates and their susceptibility testing . Vitek DataTrac software automatically tabulated the occurrence rate of pathogens or their antimicrobial susceptibility percentage--for defined periods of time and specified patient locations . RESULTS: The most common organisms for surgical inpatient isolates were E . coli, S . aureus, K . pneumoniae and P . aeruginosa; but for blood culture and sputum, by far, the most common were coagulase-negative staphylococci and K . pneumoniae, respectively . E . coli from wounds were less susceptible (for 12-26%) to ampicillin, co-amoxiclave, cephalothin and cefuroxime than surgical inpatient, OP or casualty E . coli isolates . Cephalothin and piperacillin susceptibility rates of K . pneumoniae of surgical in- and outpatients were twice higher than that of respective E . coli isolates . CONCLUSION: The occurrence frequency of bacterial pathogens were dependent on the surgical services . Overall, antimicrobial susceptibility rates were high for different surgical subcategories, especially for casualty and inpatients . The lowest susceptibility rate showed the wound isolates versus beta-lactams, except third generation cephalosporins.

Microb Drug Resist, 2000 Spring, 6(1), 29 - 36
Comparison of genes involved in penicillin resistance in staphylococci of bovine origin; Yazdankhah SP et al.; Ten penicillin-resistant and -susceptible staphylococci, isolated from bovine mastitis milk, were studied for the presence of genes that are, or may be, involved in resistance against penicillin . The repressor (blaI), antirepressor (blaR1), and structural (blaZ) genes of the beta-lactamase-operon were found to be closely linked in all penicillin-resistant strains . The beta-lactamase gene cluster was more commonly located on chromosomal rather than plasmid DNA in the strains studied . The transposase (p480) gene, which has been identified in the Staphylococcus aureus beta-lactamase transposon Tn552, was found in only one single penicillin-resistant S . aureus strain . The other penicillin-resistant S . aureus isolates contained IS1181 in close location with the beta-lactamase gene cluster . In only one S . haemolyticus isolate was the beta-lactamase gene cluster found in close association with IS257 . Penicillin-resistant S . aureus strains, which were additionally resistant to tetracycline, contained IS257 in close association with the tetracycline resistance gene (tetK) . Sequence analysis of blaI, blaR1, and blaZ in two penicillin-resistant S . aureus strains revealed 94-96% sequence homology with bla in staphylococci of human origin . The results indicate a predominance of class I bla transposons rather than Tn3 family class II transposons in the isolates used in this study.

Med Dosw Mikrobiol, 1999, 51(1-2), 17 - 23
{Sensitivity to vancomycin and teicoplanin of coagulase-negative staphylococci isolated from clinical specimens}; Mlynarczyk G et al.; The frequency of resistance and elevated resistance to teicoplanin and vancomycin among 689 strains of coagulase-negative staphylococci isolated in one year from clinical specimens was determined . Using ATB.STAPH test, a resistance was shown mainly among strains of S . epidermidis and S . haemolyticus . The elevated resistance to teicoplanin was much more frequently observed than to vancomycin . About 27% of isolated strains of S . haemolyticus and 6.8% of S . epidermidis were classified as resistant . Among other species only single strains were recognised as resistant: one strain of S . xylosus, one of S . cohni and one of S . intermedius . 94.7% of S . epidermidis and 100% of S . haemolyticus strains classified as resistant to teicoplanin in ATB showed MIC values 14 mg/l . Moreover it was shown that 26.3% of these strains of S . epidermidis and 33.3% of S . haemolyticus had MBC of teicoplanin values equal to or higher than 32 mg/l.

Braz Dent J, 1999, 10(1), 39 - 45
Staphylococci from dental personnel; Pereira ML et al.; Thirty dental students and five professors were cultured in nares, throat, and hands for the presence of staphylococci . Twenty-four students and two professors were colonized with staphylococci that were classified as S . aureus . Twelve students and one professor were colonized with staphylococci that produced enterotoxin . Care needs to be taken to avoid contaminating patients during dental examination, particularly during any type of surgery.

J Hosp Infect, 2000 Jun, 45(2), 145 - 54
Predominant staphylococci in the intensive care unit of a paediatric hospital; Szewczyk EM et al.; Coagulase-negative staphylococci cause a significant number of infections, especially in immunocompromised patients, including premature neonates . Nosocomial strains present in the environment create a special risk.We studied staphylococci isolated from the intensive care unit of a paediatric teaching hospital over the period of six months in 1997 . Biotyping and species identification were performed; resistance to methicillin and other beta-lactam antibiotics and patterns of resistance to antimicrobial agents were determined.Staphylococcus cohnii was the predominant species of 147 isolates of staphylococci recovered from the ward environment . Strains were resistant to several antibiotics and 97% were resistant to methicillin . In isolates from infants (72) methicillin-resistant strains of Staphylococcus epidermidis were predominant . Susceptibility to beta-lactams (penicillin, amoxycillin, amoxycillin-clavulanic acid and cephalosporins: cephalothin, cefuroxime and cefotaxime) showed differences between the two species . Some S . cohnii were susceptible to penicillin and amoxycillin despite methicillin-resistance . S . epidermidis were relatively susceptible to amoxycillin-clavulanic acid and cephalosporins . All strains investigated were susceptible to vancomycin, but nearly 30% demonstrated high-level resistance to mupirocin . The search for strains of the same origin showed clones belonging to S . epidermidis, S . hominis and S . saprophyticus but not S . cohnii.A large number of multiresistant, phenotypically different S . cohnii strains surviving in the ward environment may provide a reservoir of antimicrobial resistance genes .

Polim Med, 1999, 29(3-4), 21 - 39
Investigation of antistaphylococcal activity of collagen dressing containing bacitracin; Lewandowski R et al.; In the present paper the anti-bacterial effect of bacitracin released from the collagen-based dressing and penetrating to the Staphylococcus aureus-colonised polyurethane sponge was assessed . The bacteria-colonised sponge, regarded as the "in vitro model of an infected wound", was used as a modification of the previously utilised by us analogous experimental systems . In addition, kinetics of the penetration of bacitracin from the collagen dressing to the sponge was estimated . The results indicate that in spite of the fact that the amount of bacitracin in the polyurethane sponge exceeded the minimal bactericidal concentration (MBC), not all bacteria from the S . aureus species colonising the sponge could be killed . Moreover, it appeared that in order to efficiently eradicate the sponge-adherent staphylococci the concentration of bacitracin 50-fold higher than the MBC value must be used.

Int J Antimicrob Agents, 2000 Jun, 15(1), 25 - 30
Comparison of vancomycin pharmacodynamics (1 g every 12 or 24 h) against methicillin-resistant staphylococci; Lacy MK et al.; This study compared the duration of serum bactericidal activity for vancomycin, 1 g every 12 or 24 h at steady state, against methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (MR-CNS) . All four test isolates were susceptible to vancomycin with minimal inhibitory concentration (MIC) values of either 2 or 4 mg/l . Serum bactericidal titres (SBTs) were run in duplicate and serum bactericidal activity (SBA) was defined as the time points at which all subject SBTs were greater than or equal to 1:2 . For the every 12-h regimen, SBA was 10-12 h . With the every 24-h regimen, the duration of SBA was 10-16 h for MRSA and 8-10 h for MR-CNS . The pharmacodynamic data suggest that for those with good renal function a Q12h dosing interval is most appropriate for MR-CNS or staphylococcal isolates with MICs of 4.

Int J Antimicrob Agents, 2000 Jun, 15(1), 19 - 24
Rapid detection of methicillin resistance in staphylococci using a slide latex agglutination kit; Udo EE et al.; The slide latex agglutination test, MRSA-Screen, was compared with the mecA polymerase chain reaction (PCR) and traditional susceptibility test methods for the detection of methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci . The MRSA-Screen test detected the same number of methicillin-resistant S . aureus as the mecA PCR and the traditional susceptibility tests . It correctly identified all 21 methicillin-susceptible S . aureus as being sensitive . It also produced the same result as the mecA PCR in identifying a methicillin-resistant S . aureus among six isolates classified as borderline resistant by traditional susceptibility tests . The MRSA-Screen test and mecA PCR detected methicillin resistance in 10 and 15 of 17 methicillin-resistant coagulase-negative staphylococci, respectively . From these results, it is concluded that the MRSA-Screen is a very accurate, reliable and rapid method of detecting methicillin resistance in S . aureus and is suitable for use in clinical microbiology laboratories . Further study of its use in detecting methicillin resistance in coagulase-negative staphylococci is required.

J Invest Dermatol, 2000 Jun, 114(6), 1120 - 5
An experimental model of cutaneous infection induced by superantigen-producing Staphylococcus aureus; Molne L et al.; Skin infections caused by Staphylococcus aureus, such as erysipelas, are commonly occurring, painful, and costly for society . Despite the high prevalence of this condition, little is known about the host immune responsiveness and bacterial virulence factors during S . aureus dermatitis . We present here a mouse model of infectious dermatitis in which S . aureus is inoculated by an intracutaneous injection to the shaved back of NMRI mice . Visible skin inflammation, characterized by redness and swelling, was noted 48 h after inoculation of staphylococci in mice that received 2 x 108 colony-forming units of S . aureus . Microscopic evaluation revealed a dermal and subcutaneous infiltrate rich in macrophages and neutrophilic granulocytes already within 6 h after inoculation . A sparse influx of T lymphocytes was noted somewhat later . Bacterial cultures from skin revealed high numbers of staphylococci early after inoculation, with a successive decline during 2 wk follow-up . Total white blood cell count as well as the number of polymorphonuclear leukocytes peaked 2 d after bacterial inoculation . Also, serum interleukin-6 levels peaked within 2 d, with a 10-fold increase compared to non-infected control mice, indicating a systemic reaction to skin infection . The role of toxic shock syndrome toxin 1 in the pathogenesis of the dermatitis was assessed using isogenic S . aureus strains . Even though the gross inflammatory skin reaction was similar for mice infected with either of the strains, it was apparent that bacteria secreting toxic shock syndrome toxin 1 preferentially triggered influx of T lymphocytes to the skin . In addition, mice inoculated with staphylococci producing toxic shock syndrome toxin 1 showed a weight decrease during the experiment whereas mice inoculated with the isogenic strain showed a weight increase . This model of staphylococcal dermatitis will enable future in-depth studies regarding the host-bacterium relationship.

J Dairy Res, 2000 May, 67(2), 155 - 69
Mammary infection with Staphylococcus aureus in cows: progress from inoculation to chronic infection and its detection; Shoshani E et al.; The progress of Staphylococcus aureus infection from inoculation to the early chronic stage was examined in 12 Israeli-Holstein cows (four primiparous and eight multiparous) for up to 48 d after inoculation . Before inoculation, the primiparous cows were free from any infection and the multiparous cows were infected by coagulase-negative staphylococci . Two quarters in each cow were inoculated intracisternally following milking with 2000 cfu of a local prevailing Staph . aureus strain, VL-8407 . Infection was established in 21 out of 24 quarters . The control quarters remained free from infection during the study, with no significant change in function . No statistically significant differences were found between primiparous and multiparous cows in the responses examined . Somatic cell count (SCC) increased within 24 h of inoculation and remained high for the duration of the study . In the infected quarters mean ln (SCC) increased within 24 h from 9.9 +/- 0.5 before inoculation to 13.0 +/- 0.2 after inoculation; most of the cells were neutrophils . N-acetyl-beta-glucosaminidase activity, expressed as ln (nnmol/min per l), was increased from 0.9 +/- 0.6 to 2.4 +/- 0.2 by inoculation, and was highly correlated with SCC . The Staph . aureus count fluctuated with no particular relationship with SCC . The phagocytic activity of neutrophils was significantly lower in the inoculated than in the control quarters and this difference increased with time after inoculation . CD8+ T lymphocytes were the main subpopulation of lymphocytes found in inoculated quarters . After inoculation, maximum but not minimum electrical conductivity (EC) recorded during milking increased significantly . The rises in maximum EC varied significantly among cows . The rises in SCC were associated with a persistent increase in EC in only one of the eight cows examined . No clinical signs were observed, and milk yield and composition were not affected during the study period . The results suggest that some strains of Staph . aureus may induce a relatively mild response in mammary glands of cows in mid lactation, and that the concomitant development of such chronic Staph . aureus infections in two quarters may not be detected by changes in the EC of composite milk and in the yield of the cow.

Am J Infect Control, 2000 Jun, 28(3), 269 - 72
Nasal colonization by methicillin-resistant coagulase-negative staphylococcus in community skilled nursing facility patients; Lee YL et al.; BACKGROUND: Methicillin-resistant coagulase-negative staphylococci (MRCNS) are increasing nosocomial pathogens in acute care hospital patients . However, there is little information on the epidemiology of MRCNS in skilled nursing facilities (SNFs) . We report a pilot survey of the prevalence of MRCNS colonization in SNF patients . METHODS: Anterior nasal swabs were plated on oxacillin salt screening agar for selection of MRCNS . Suspected MRCNS were confirmed by coagulase and catalase tests and standard disc-diffusion antimicrobial susceptibility tests . RESULTS: The overall prevalence of MRCNS was 40% for in-house continuing SNF patients, 49% for newly admitted patients, and 60% for SNF nursing personnel . The prevalence was 13% in a "control" group of nonmedical personnel . Forty-six percent of MRCNS were resistant to ciprofloxacin . The frequency of colonization with MRCNS increased over time . After an average 17 months of facility stay, 32% of noncarriers acquired MRCNS . High frequency of colonization was associated with greater disability . CONCLUSION: Colonization with MRCNS is common among SNF patients, who can serve as a reservoir for transfer of such strains to acute care hospitals . Careful infection control practice, including judicious use of antibiotics with frequent handwashing, will remain critical policies for limiting spread of such strains.

Epidemiol Mikrobiol Imunol, 2000 Apr, 49(2), 51 - 8
{Characteristics of coagulase-negative staphylococci isolated from hemocultures}; Drozenova J et al.; The authors investigated 352 strains of coagulase-negative staphylococci isolated from hemo-cultures of patients with assumed bacteraemia who were hospitalized in standard hospital departments and intensive care units . The strains were identified using STAPHYtest 16 and 14 different species and subspecies of coagulase-negative staphylococci were found . Most frequent were strains of Staphylococcus epidermidis (53%), strains of S . hominis subsp . hominis (22%) and S . haemolyticus (13%) . In the strains the production of slime and delta-haemolysin was investigated . The formation of these two important factors of virulence was recorded in 95% strains (incl . major slime production in 13.4%), and 50% strains resp . The resistance to 13 antibiotics was also assessed . A total of 91% strains were resistant to penicillin, 63% to oxacillin and amoxicillin with clavulanic acid, 67% to gentamicin and 66% to erythromycin . In the group 15 strains of a recently described subspecies S . hominis subsp . novobiosepticus was identified . These isolates displayed most frequently resistance: they were resistant in 100% to five antibiotics (penicillin, oxacillin, erythromycin, clindamycin and amoxicillin with clavulanic acid) and with a single exception to another three antibiotics (chloramphenicol, gentamicin and ciprofloxacin) . In these strains most frequently slime as well as delta-haemolysin was found . The authors assume, consistent with previous work, that it is important to focus attention on the incidence of strains of S . hominis subsp . novobiosepticus which very probably play an important role as agents in hospital infections . The authors describe also detection of one strain of S . cohnii subsp . urealyticum which was resistant to 10 of 13 antibiotics . The authors are convinced that also classical phenotypic analysis can contribute in an effective manner to the solution of the problem of infections caused by coagulase-negative staphylococci.

J Clin Microbiol, 2000 Jun, 38(6), 2378 - 80
New chromogenic identification and detection of Staphylococcus aureus and methicillin-resistant S . aureus; Merlino J et al.; This paper describes a new chromogenic plate medium, CHROMagar Staph aureus (CHROMagar, Paris, France), for the identification of Staphylococcus aureus on the basis of colony pigmentation . The abilities of CHROMagar Staph aureus, thermostable nuclease (DNase), and mannitol salt agar (MSA) to identify S . aureus isolates (n = 114) and discriminate between S . aureus and coagulase-negative staphylococci (CoNS; n = 22) were compared . CHROMagar Staph aureus proved to be more sensitive and specific than DNase and MSA, allowing a reliable, simple, and rapid method for the identification of S . aureus isolates . All CoNS encountered in this study with the exception of S . chromogenes could be easily differentiated from S . aureus on this medium . The supplementation with 4 microgram of oxacillin or methicillin per ml allowed simple identification of methicillin resistance in hospital-acquired S . aureus strains which show multiple-drug resistance profiles . Community-acquired methicillin-resistant S . aureus strains showing non-multi-drug resistance profiles require further evaluation on this new chromogenic medium . Methicillin or oxacillin resistance of all S . aureus isolates was confirmed by the detection of penicillin-binding protein 2a, encoded by the mecA gene, using the latex slide agglutination MRSA-Screen test (PBP 2' Test, DR900M; Oxoid).

J Clin Microbiol, 2000 Jun, 38(6), 2051 - 4
Rapid detection of mecA-positive and mecA-negative coagulase-negative staphylococci by an anti-penicillin binding protein 2a slide latex agglutination test; Hussain Z et al.; A rapid slide latex agglutination (LA) test, MRSA-Screen (Denka Seiken Co., Niigata, Japan), which detects PBP 2a, was tested for its ability to differentiate between mecA-positive and -negative coagulase-negative staphylococci . A total of 463 isolates from 13 species were included in the study . The mecA gene was detected by PCR, and the oxacillin MIC was determined by the agar dilution method according to the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS) . The LA test was performed with oxacillin-induced isolates . The true-positive and true-negative results were defined on the basis of the presence or the absence of the mecA gene . By PCR, 251 isolates were mecA positive and 212 were mecA negative . The sensitivities, specificities, and positive and negative predictive values for the LA test compared to the NCCLS breakpoint for oxacillin resistance (>/=0.5 mg/liter) were as follows: for the LA test, 100, 99.5, 99.6, and 100%, respectively; for the NCCLS breakpoint, 100, 60.8, 75.1, and 100%, respectively . One hundred twenty-five mecA-positive isolates were also tested by the LA test without induction of PBP 2a; only 72 (57.6%) gave a positive result and required 3 to 15 min for reaction . With induction, all 251 isolates were positive within 3 min . The LA test was reliable in classifying mecA-negative isolates, but it classified isolates for which the oxacillin MIC was >/=0.5 mg/liter as oxacillin susceptible . For the reliable detection of oxacillin resistance by the MRSA-Screen in coagulase-negative staphylococci, induction of the mecA gene appears to be necessary.

Vet Microbiol, 2000 Jun 12, 74(4), 353 - 64
Antimicrobial susceptibility and presence of resistance genes in staphylococci from poultry; Aarestrup FM et al.; The species distribution, susceptibility to 19 antimicrobial agents and presence of selected genes encoding resistance to macrolides, streptogramins and tetracyclines were examined among 118 staphylococcal isolates from infections of poultry in Denmark . Isolates were identified using a combination of conventional biochemical testing and 16S rDNA sequencing . The most common species were Staphylococcus aureus (83), Staphylococcus hyicus (11), Staphylococcus xylosus (9) and Staphylococcus cohnii (6) . The isolates were susceptible to most antimicrobials tested . A high frequency of S . aureus (30%) was resistant to ciprofloxacin . Only six (7%) S . aureus isolates and one Staphylococcus saprophyticus were penicillin resistant . Resistance to sulphamethoxazole was observed among 16 (19%) of S . aureus isolates and two coagulase negative staphylococci (CNS) . Twenty (24%) of the S . aureus isolates were resistant to erythromycin and 19 of these isolates contained the ermA gene, whereas the remaining isolate contained the ermC gene . Eleven (48%) of the novobiocin resistant CNS were resistant to erythromycin and all these isolates contained the ermA gene . Two isolates identified as S . xylosus, were found to be resistant to streptogramins and both contained the vatB- and the vgaB-genes . Thirty-nine (47%) of the S . aureus isolates, three of nine S . hyicus and eight of the 23 novobiocin resistant CNS were tetracycline resistant and all contained the tet(K) gene . A single S . aureus isolate also contained the tet(M) gene . The present study showed a frequent occurrence of resistance to fluoroquinolones, tetracycline and macrolides among staphylococci isolated from broilers in Denmark, whereas the occurrence of resistance to other antimicrobial agents remains low . Similar genes, encoding resistance to erythromycin, tetracycline and streptogramins to those previously observed, were detected.

Int J Clin Pract, 2000 Apr, 54(3), 147 - 50
Management of septicaemic infants during long-term parenteral nutrition; Page S et al.; Young infants, particularly following gastrointestinal surgery, are at high risk of septicaemia during parenteral nutrition . Febrile illness in the absence of focal infection inevitably raises suspicion of central venous catheter sepsis and poses the following dilemma: remove the catheter (which may then prove uninfected) and lose venous access, or leave the catheter and risk clinical deterioration? We examined retrospectively the isolates from blood culture during febrile episodes in 13 children who received long-term (> 2 months) parenteral nutrition via a central venous catheter, and assessed the effectiveness of through-catheter antibiotic treatment during 76 episodes of blood culture positive sepsis . Coagulase-negative Staphylococci accounted for only 16% of positive isolates, with yeasts accounting for 5%, and Gram-negative organisms accounting for 46%, suggesting that infection was often associated with bacterial translocation from the gastrointestinal tract . Treatment with the central venous catheter left in situ was successful in resolving infection in 53 (70%) of septic episodes . These findings indicate that, in this specific group of patients, through-catheter antibiotic treatment is often effective in treating septicaemia . When long-term venous access is essential, this approach should be tried before recourse to central venous catheter removal.

Infect Dis Clin North Am, 2000 Jun, 14(2), 463 - 74
Antibiotics for gram-positive bacterial infections . Vancomycin, teicoplanin, quinupristin/dalfopristin, and linezolid; Lundstrom TS et al.; Vancomycin is a safe, effective antibiotic for a variety of serious gram-positive infections . Because of emerging resistance in enterococci and staphylococci and the emerging threat of spread of vancomycin-resistant genes to other gram-positive organisms, judicious use of vancomycin should be promoted . Quinupristin/dalfopristin, a streptogramin antibiotic, and linezolid, an oxazolidinone, show promise against some strains of gram-positive bacteria that are resistant to vancomycin.

Instr Course Lect, 2000, 49, 605 - 14
Emerging multiresistant strains: recommended precautions in the emergency room and surgical setting; Garvin KL et al.; The current success in treatment of surgical site infections may be jeopardized by the continued emergence of antibiotic resistance in bacteria common to these infections . The effectiveness of vancomycin against methicillin-resistant staphylococci may decrease as more cases of VISA emerge . No currently available antimicrobial is consistently effective against certain strains of VRE and the potential emergence of VRSA . Orthopaedic surgeons soon may be in the undesirable position of having to eradicate organisms resistant to all available antibiotics . Several new antibiotics show promising activity and may be useful against these multidrug-resistant bacteria . However, as the history of bacterial resistance has taught us, it likely only will be a matter of time until these organisms adapt mechanisms of resistance to these new drugs . The key then lies, as it always has, in preventive measures . Surgeons, and all physicians, must adhere to the precautionary guidelines recently set forth by the CDC and HICPAC . Chief among these guidelines is the elimination of inappropriate antibiotic usage, especially inappropriate vancomycin use.

Ophthalmologe, 2000 Apr, 97(4), 257 - 63
{Endophthalmitis after cataract surgery: predisposing factors, infectious agents and therapy}; Zell K et al.; BACKGROUND: Infectious exogenous endophthalmitis is a serious complication after cataract surgery . Despite modern pharmacological and surgical methods, its treatment is still difficult . PATIENTS AND METHODS: In a retrospective study the records of all patients treated for endophthalmitis following cataract extraction at the Department of Ophthalmology of the University Hospital in Hamburg between January 1989 and December 1997 were assessed . RESULTS: Of 36 patients treated for endophthalmitis, 29 (80.6%) had been referred . In 14 (38.9%) of these 29 patients endophthalmitis had occurred after outpatient cataract surgery . Seven patients (19.4%) had been treated as inpatients at the University Eye Hospital Eppendorf . Vitrectomy was performed in 80.6% of the cases . An infectious agent was isolated from 50% of diagnostic probes . The most common organism isolated were coagulase-negative staphylococci (4 cases) . Predisposing factors for the development of endophthalmitis were diabetes (27.8%), intraoperative loss of vitreous (19.4%), application of systemic steroids (13.9%) and wound dehiscence (11.1%) . Of 27 patients (75%) followed up, 16 (59.3%) had a final visual acuity of 20/400 or better (mean 20/40) . An enucleation had to be performed in 4 patients (13.8%) . CONCLUSION: In this study, approximately 60% of patients with endophthalmitis following cataract extraction had their globes preserved and a good visual outcome after appropriate surgical interventions.

Antimicrob Agents Chemother, 2000 Jun, 44(6), 1720 - 4
Activities of taurolidine in vitro and in experimental enterococcal endocarditis; Torres-Viera C et al.; In vitro, the antimicrobial agent taurolidine inhibited virtually all of the bacteria tested, including vancomycin-resistant enterococci, oxacillin-resistant staphylococci, and Stenotrophomonas maltophilia, at concentrations between 250 and 2,000 microg/ml . Taurolidine was not effective in experimental endocarditis . While it appears unlikely that this antimicrobial would be useful for systemic therapy, its bactericidal activity and the resistance rates found (<10(-9)) are favorable indicators for its possible development for topical use.

Br J Dermatol, 2000 May, 142(5), 885 - 92
The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ; Till AE et al.; The cutaneous microbiology and antibody status to Propionibacterium acnes of patients with persistent (males, n = 32; females, n = 33) and late-onset (females, n = 25) acne were compared with individuals with adolescent acne (males, n = 22; females, n = 18) and normal control volunteers (persistent acne: males, n = 26; females, n = 30; late-onset: females, n = 20) . Males had significantly higher grades of acne compared with females (P < 0.05) . The microflora consisted in the main of propionibacteria, staphylococci and Malassezia; other bacteria represented less than 0.01% of the total microflora . At all sites for all samples there were significantly more propionibacteria than staphylococci or Malassezia (P < 0.05) . There were significantly higher (P < 0.05) numbers of microorganisms in follicular casts from patients compared with their control volunteers for female facial skin and male back skin . Twenty-six papules and 48 normal follicles were analysed . A bimodal distribution of microbial colonization was noted, with about 90% of normal follicles and about 10% of acne follicles having no detectable viable microorganisms . Anti-P . acnes IgG antibody titres were measured using a secondary fluorescein isothiocyanate antibody technique, and no significant differences in titre were found between any groups of patients (P > 0.05) . Correlation analysis showed no association between the population densities of P . acnes and anti-P . acnes IgG titres . There were no differences in the microbiology of skin of adolescent acne patients, persistent acne patients or late-onset acne patients which could account for these various forms of acne.

Perit Dial Int, 2000 Mar-Apr, 20(2), 215 - 9
Outcome following staphylococcal peritonitis; Peacock SJ et al.; OBJECTIVE: Staphylococcus spp predominate as the causative pathogen of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis.This study evaluated the difference in morbidity and mortality between peritonitis caused by S . aureus and coagulase-negative staphylococci (CoNS) . DESIGN: Prospective observational study . SETTING: A single regional dialysis unit in a teaching hospital . PATIENTS: Thirty-seven patients had S . aureus peritonitis and 65 patients had CoNS peritonitis between July 1990 and November 1995 . MAIN OUTCOME MEASURES: Using the first recorded episode of peritonitis, survival analysis was performed for time to (1) death, (2) removal of peritoneal dialysis catheter, and (3) change to hemodialysis . Abdominal complications were recorded for the first and subsequent episodes . RESULTS: No difference in time to death was demonstrated for the two groups (p = 0.79), although two deaths that occurred during therapy for peritonitis were attributable to S . aureus infection . In addition, 5 patients developed serious abdominal complications related to an episode of S . aureus peritonitis . Patients with S . aureus peritonitis had a shorter time to both peritoneal dialysis catheter removal (p = 0.004) and change to hemodialysis (p = 0.014) . The change in mode of dialysis was independent of catheter loss . CONCLUSION: This study highlights the serious nature of S . aureus peritonitis and confirms the need for effective preventive measures against infection by this pathogen.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Mar-Apr, (2), 118 - 21
{The role of staphylococci in the occurrence, development and chronicity of lactation mastitis}; Deriabin DG et al.; The investigation results obtained by the authors and the data of literature on the role of the biological properties of staphylococci in the pathogenesis, development and chronization of acute suppurative lactation mastitis are generalized . The concept of lactation mastitis as a monoetiological disease caused solely by bacteria of the genus Staphylococcus is substantiated . The importance of the individual properties of staphylococci at different stages of the pathogenesis of lactation mastitis, as well as their role in ensuring the resistance of the infective agent to the protective mechanisms of the body and in the chronization of the suppurative process, is considered . The data on the use of a number of biological properties of staphylococci as markers for the prognostication of the course of lactation mastitis are presented and their prognosticating effect at different tactics of surgical treatment is evaluated.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Mar-Apr, (2), 89 - 92
{The characteristics of local immunity in Chlamydia-associated chronic inflammatory diseases of the organs of the lesser pelvis in women}; Medvedev BI et al.; Local immune reactions in 107 women with Chlamydia-associated chronic endometritis and salpingo-oophoritis were studied on endometrial biopsy specimens . Of these women, group 1 consisted 45 patients with Chlamydia-associated chronic endometritis and salpingo-oophoritis and group 2 consisted of 62 such patients having, in addition, bacterial vaginosis and candidiasis . Among associated bacteria, epidermal staphylococci, Escherichia coli and their combinations prevailed . Pathomorphologically, in the biopsy specimens taken from the patients of group 1 a decrease in the activity of mononuclear phagocytes, secondary SIgA deficiency with the level of IgA-producing plasmocytes relatively unchanged, the moderate intensity of the synthesis of IgG and a shift in the ratio of T-helpers/T-suppressors towards the latter were observed . In the biopsy specimens of the uterine mucosa obtained from group 2 a decrease in the phagocytic activity of neutrophil granulocytes and macrophages, the pronounced suppression of IgA production by IgA plasmocytes with a sharp decrease in the amount of SIgA and an essential increase in the number of IgG-producing cells were noted . Disturbances of local immunity, observed in the presence of associated Chlamydia infection, gives grounds for the inclusion of immunomodulating preparations into the complex of therapeutic measures.

Mayo Clin Proc, 2000 May, 75(5), 511 - 2
Prosthetic joint infection due to Staphylococcus lugdunensis; Sampathkumar P et al.; Staphylococcus lugdunensis, a coagulase-negative staphylococcus, is being increasingly recognized as the cause of serious infections . We report 2 cases of total knee arthroplasty infection caused by S lugdunensis . S lugdunensis frequently produces a clumping factor that can result in a positive slide (short) coagulase test result . If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism may be misidentified as Staphylococcus aureus . S lugdunensis is more virulent than other coagulase-negative staphylococci and in many clinical situations behaves like S aureus, further increasing the confusion . However, S lugdunensis differs from S aureus in that it is susceptible to most antibiotics . This fact may alert the microbiology laboratory or the clinician that the isolate is likely not S aureus and prompt further testing of a specific isolate . Accurate identification of S lugdunensis isolates facilitates studies to define the epidemiology and pathogenesis of prosthetic joint infection due to S lugdunensis and delineates optimal medical and surgical therapies.

Rinsho Byori, 2000 Jan, Suppl 111, 84 - 93
{Gene examination methods (detection and genotyping of resistant genes)--MRSA}; Mitsuda T; Molecular diagnosis of MRSA infection including methods of detecting drag-resistant gene and genotyping is described . In Japan, MRSA is the major pathogen for nosocomial infections . For symptomatic patients with MRSA infection, rapid detection of mecA and spa gene by PCR is quite critical to their prognosis . In cases of carry-over contamination of PCR products and mixed infection with coagulase-negative Staphylococci, take precautions are needed while working with this examination . Analysis by restriction length polymorphisms using pulsed-field gel electrophoresis (PFGE-RFLPs) for MRSA nosocomial infection is also described.

Med Dosw Mikrobiol, 1999, 51(3-4), 199 - 205
{Genetic transfer of methycilline resistance in Staphylococus epidermidis and Staphylococcus aureus strains in mixed cultures}; Mlynarczyk A et al.; In mixed cultures of staphylococci a transfer of the resistance to methicillin and penicillinase plasmids as well as tetracycline and chloramphenicol plasmids was investigated . It was shown that the resistance to methicillin was transferred in mixed cultures from one strain of S . aureus to another and from S . epidermidis to S . aureus . In both cases transfer of methicillin resistance required, the presence of penicillinase plasmid in recipient or donor strain . In the case of other markers transmission was independent . Moreover it was shown that the transfer of resistance genes in mixed cultures was mediated by bacteriophage of the serologic group A.

Med Dosw Mikrobiol, 1999, 51(3-4), 187 - 98
{Susceptibility to selected chemotherapeutics of Staphylococcus aureus strains resistant to methycyline isolated from clinical materials in the years 1991-1992 and 1997}; Kochman M et al.; The susceptibility to selected chemotherapeutic agents was determined in 100 strains of Staphylococcus aureus methicillin-resistant (MRSA) isolated from clinical materials in 1991-1992 (50 strains) and in 1997 (50 strains) . Two methods were used for the determination: disc method and antibiotic dilution in agar . The minimal inhibitory concentration (MIC) was determined for vancomycin, teicoplanin, furazolidone, nitrofurantoin, ofloxacin, gentamicin, netilmicin and trimethoprim . The concentrations of the chemotherapeutics in the substrate ranged from 0.125 to 512 mg/l . The obtained results served for drawing of the following conclusions: all studied MRSA strains isolated in 1991-1992 and in 1997 were sensitive to glycopeptide antibiotics: vancomycin and teicoplanin, to nitrofurans: nitrofurantoin and furazolidone, and to fusidic acid . MRSA strains isolated in 1991-1992 were sensitive to ofloxacin, but in 1997 about 80% of the strains were resistant to that antibiotic, and this resistance was noted in S . aureus strains with homogeneous resistance to methicillin . Increasing frequency of resistance to mupirocin was found, in 1991-1992 4% of the strains were resistant, and in 1997 the resistance of MRSA to that antibiotic was found in 12% . No changes occurred in the sensitivity of staphylococci to trimethoprim/sulfamethoxazole (cotrimoxazole) . About 94% of strains in 1991-1992 and 1997 were sensitive to that drug . The sensitivity to cotrimoxazole is connected with one of its components (trimethoprim), with 94% of MRSA strains sensitive to it.

Eur J Vasc Endovasc Surg, 2000 Apr, 19(4), 437 - 9
Gradual Hunterian ligation for infected prosthetic bypass; Egun A et al.; OBJECTIVE: To review gradual snare occlusion for the management of complex or recurrent graft infection . PATIENTS AND METHODS: Medical records of patients treated with gradual snare occlusion following graft infection were reviewed for indication for operation, type of bypass and graft material used . In addition, infecting organism, grade of infection (Szilagyi) and outcome were recorded . RESULTS: Four femoropopliteal, two extra-anatomic (axillofemoral) and aortobifemoral bypasses were included in this study . All had chronic infection (Szilagyi grade III) with onset of 4 to 24 months and two of which were recurrent . The causative organisms were coagulase-negative staphylococci, Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus in three patients, with no organism isolated in the remaining cases . There was no loss of limb following gradual snare occlusion but there was only one death due to aortic stump rupture 2 weeks later . CONCLUSION: Gradual snare occlusion is an alternative for the management of chronic or recurrent graft infection .

Ann Thorac Surg, 2000 Apr, 69(4), 1110 - 5
Spread of coagulase-negative staphylococci during cardiac operations in a modern operating room; Bitkover CY et al.; BACKGROUND: Coagulase-negative staphylococci cause 33% to 62.5% of wound infections after cardiac operations . The aim of this study was to investigate the sources of coagulase-negative staphylococci in the sternal wound . METHODS: Twenty operations performed in zonal ventilated operating rooms were investigated prospectively . Cultures were taken from all persons present in the room, the sternal wound, and the air . Isolates macroscopically judged to be coagulase-negative staphylococci were metabolically classified, and similar isolates were investigated by pulsed-field gel electrophoresis . RESULTS: Bacterial counts in the operating room air were very low . Wound contamination was found in 13 of 20 operations . Six wound isolates could be traced, three to the patients' sternal skin, one to the patient's groin, one to the surgeon's nose, and one to the surgeon's arm and forehead and the assistant's nose . Three operating field air cultures could be traced to the scrubbed theatre staff . The single case of superficial sternal wound infection was caused by Staphylococcus aureus, which was not isolated from the wound at operation . CONCLUSIONS: In an ultraclean environment, bacteria in the sternal wound originated from the patients' own skin and from the surgical team.

Ann Thorac Surg, 2000 Apr, 69(4), 1104 - 9
Coagulase-negative staphylococci and sternal infections after cardiac operation; Tegnell A et al.; BACKGROUND: Coagulase negative staphylococci (CoNS) have been recognized as important pathogens in nosocomial infections, especially in connection with implanted foreign materials . In cardiac operation they are among the most common pathogens isolated from infected sternal wounds . The definition of the infection is very important . In this study we focus on deep postoperative chest infections . METHODS: By studying 33 infected patients retrospectively and comparing them to 33 matched uninfected controls, we studied the characteristics and costs of the infections . RESULTS: Typical for these infections is the late and insidious onset, and that the infections initially give only minor symptoms such as pain, redness, and serous secretion . We found the following risk factors for infection: number of preoperative days in a hospital, the total length of the operation, and if the patient had undergone an early reoperation due to causes other than infection . This kind of infection more than doubled the hospital costs for the patients affected . CONCLUSIONS: Coagulase negative staphylococci are the most important pathogens in deep postoperative infections in this material . They cause infections that are difficult to recognize since they give only discrete symptoms and start well after the patients leave the hospital . The risk factors for patients with CoNS infections are mostly associated with a long exposure to the hospital environment . The treatment is often difficult and costly because of multiresistant bacteria and frequent need for repeated surgical revisions.

Indian J Med Sci, 1999 Jan, 53(1), 10 - 3
Predominant phage types of coagulase positive staphylococci in hospital infections; Arora U et al.; 360 strains of Staphylococcus aureus isolated from various clinical specimens were subjected to bacteriophage typing . 247(68.6%) strains were typable . Among the typable strains 75(20.83%) belonged to phage group I, 45(12.5%) belonged to phage group III, 6(1.67%) belonged to phage group II and 14(3.89%) strains belonged to miscellaneous group . By far, the largest was the mixed group having 107(29.72%) strains . 113 strains (31.4%) were untypable . All the strains were tested for antibiotic sensitivity test . 287 (79.7%) were multiple drug resistant strains.

Indian J Med Sci, 1999 Mar, 53(3), 111 - 9
Streptogramins: a new class of antibiotics; Khosla R et al.; Streptogramin antibiotics represent a unique class of antibacterials in the each member of the class consists of at least 2 structurally unrelated molecules: group a streptogramins (macrolactones) and group B streptogramins (cyclic hexadepsipeptides) . Both group A and group B streptogramins inhibit protein synthesis at the ribosomal level, and they act synergistically against many isolates their combination generating bactericidal activities and reducing the possibility of emergencies of resistant strains . The mechanisms of acquired resistance to group B streptogramins remain unaffected by target modifications and active efflux . The pharmacokinetic parameters of group A and group B streptogramins in blood are quite similar . In addition, both the A and B group penetrate and accumulate in macrophages and in the bacterial gegetations of experimental endocarditis . Until recently, the complex and irregular composition of naturally occurring pristinamycin and virginiamycin, as well as the unavailability of soluble forms, have limited the clinical development of streptogramins . The synthesis of water soluble derivatives of pristinamycin IA and IIB has now allowed the development of injectable streptogramins with fixed compositions . This unique class of antibacterials will have a significant clinical impact in a world of increasing multidrug resistance affecting the Gram-positive cocci, especially staphylococci and pneumococci . The absence of cross-resistance to macrolides in many of these isolates and the rapid antibacterial killing against these species bright future for this class of antibiotics.

Indian J Med Res, 2000 Jan, 111, 6 - 10
Slime production as a virulence factor in Staphylococcus epidermidis isolated from bacterial keratitis; Nayak N et al.; A total of 126 coagulase negative staphylococci (CONS) isolated from corneal scrapings of patients of bacterial keratitis and 50 isolates from healthy eyes (controls) were tested for slime production . Eighty eight (69.84%) of 126 isolates from patients and 11 (22%) of 50 isolates from controls were slime producing (P < 0.001) . Of these 88 isolates, 42 were Staphylococcus epidermidis biotype II, 30 were S . epidermidis biotype I, 8 were S . epidermidis biotype III and the rest belonged to CONS other than S . epidermidis . Amongst the corneal ulcer isolates, multidrug resistance (resistance to 3 or more antibiotics) was observed in 82.9 per cent (73/88) slime producing organisms as against only 18.4 per cent (7/38) nonslime producing organisms (P < 0.001) . Similarly, of the total 99 slime positive and 77 slime negative isolates, 79 (79.8%) and 22 (28.6%) respectively were multidrug resistant (P < 0.001) . Although, slime production is known to be one of the major virulence factors of CONS in extraocular systemic staphylococcal infections, the present study detected slime in isolates from ocular infections . It was found that S . epidermidis I and II were the common biotypes associated with bacterial keratitis and, slime production and multidrug resistance were the two important virulence factors . These observations have clinical and therapeutic significance.

Med Hypotheses, 2000 Jan, 54(1), 91 - 4
Highly pleomorphic staphylococci as a cause of cancer; Wainwright M; An extensive historical literature exists suggesting that bacteria and other non-virus microorganisms cause cancer . Much of this literature stresses the likely involvement of highly pleomorphic bacteria in carcinogenesis . Pleomorphic bacteria exhibit a variety of morphological types, some of which are identical to other bacteria . In particular, bacteria that can express more than one morphology, including that normally associated with common species of Staphylococcus, have frequently been isolated from cancers . Not surprisingly, this has led to considerable confusion and ridicule . The literature linking highly pleomorphic bacteria with carcinogenesis is presented here in an attempt to add weight to the view that bacteria, notably those expressing the morphology of common species of staphylococci, cause cancer.

J Clin Microbiol, 2000 May, 38(5), 1740 - 6
Molecular epidemiology of Staphylococcus epidermidis in a neonatal intensive care unit over a three-year period; Villari P et al.; Coagulase-negative staphylococci, especially Staphylococcus epidermidis, are increasingly important nosocomial pathogens, particularly in critically ill neonates . A 3-year prospective surveillance of nosocomial infections in a neonatal intensive care unit (NICU) was performed by traditional epidemiologic methods as well as molecular typing of microorganisms . The aims of the study were (i) to quantify the impact of S . epidermidis on NICU-acquired infections, (ii) to establish if these infections are caused by endemic clones or by incidentally occurring bacterial strains of this ubiquitous species, (iii) to evaluate the use of different methods for the epidemiologic typing of the isolates, and (iv) to characterize the occurrence and the spread of staphylococci with decreased glycopeptide susceptibility . Results confirmed that S . epidermidis is one of the leading causes of NICU-acquired infections and that the reduced glycopeptide susceptibility, if investigated by appropriate detection methods such as population analysis, is more common than is currently realized . Typing of isolates, which can be performed effectively through molecular techniques such as pulsed-field gel electrophoresis but not through antibiograms, showed that many of these infections are due to clonal dissemination and, thus, are potentially preventable by strict adherence to recommended infection control practices and the implementation of programs aimed toward the reduction of the unnecessary use of antibiotics . These strategies are also likely to have a significant impact on the frequency of the reduced susceptibility of staphylococci to glycopeptides, since this phenomenon appears to be determined either by more resistant clones transmitted from patient to patient or, to a lesser extent, by strains that become more resistant as a result of antibiotic pressure.

Trends Microbiol, 2000 May, 8(5), 231 - 7
The staphylococcal transferrin receptor: a glycolytic enzyme with novel functions; Modun B et al.; To obtain iron from the host for growth, staphylococci have evolved sophisticated iron-scavenging systems including siderophores and a cell surface receptor for transferrin, the mammalian iron-transporting glycoprotein . The staphylococcal transferrin receptor has been identified as a member of a newly emerging family of multifunctional, cell-surface-associated glyceraldehyde-3-phosphate dehydrogenases, which not only retain their glycolytic enzyme activities but also bind diverse human serum proteins and possess NAD-ribosylating activity . These multiple functions suggest a potential contribution to virulence far beyond iron acquisition.

Vaccine, 2000 Jun 1, 18(24), 2743 - 52
Partial protection to respiratory syncytial virus (RSV) elicited in mice by intranasal immunization using live staphylococci with surface-displayed RSV-peptides; Cano F et al.; A live bacterial vaccine-delivery system based on the food-grade bacterium Staphylococcus carnosus was used for delivery of peptides from the G glycoprotein of human respiratory syncytial virus, subtype A (RSV-A) . Three peptides, corresponding to the G protein amino acids, 144-159 (denoted G5), 190-203 (G9) and 171-188 (G4 S), the latter with four cysteine residues substituted for serines, were expressed by recombinant means as surface-exposed on three different bacteria, and their surface accessibility on the bacteria was verified by fluorescence-activated cell sorting (FACS) . Intranasal immunization of mice with the live recombinant staphylococci elicited significant anti-peptide as well as anti-virus serum IgG responses of balanced IgG1/IgG2a isotype profiles, and upon viral challenge with 10(5) tissue culture infectious doses(50) (TCID(50)), lung protection was demonstrated for approximately half of the mice in the G9 and G4 S immunization groups . To our knowledge, this is the first study in which protective immunity to a viral pathogen has been evoked using food-grade bacteria as vaccine-delivery vehicles.

Antimicrob Agents Chemother, 2000 May, 44(5), 1394 - 6
Vancomycin and oxacillin synergy for methicillin-resistant staphylococci; Domaracki BE et al.; An increase in oxacillin activity was observed against methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) in the presence of a sub-MIC of vancomycin . Vancomycin and oxacillin were synergistic against 14 of 21 strains of MRCNS and MRSA . A pattern of enhanced killing was also supported by time-kill studies . These results suggest that combinations of sub-MICs of vancomycin and oxacillin may have therapeutic benefits against methicillin-resistant staphylococci.

Pediatr Dent, 2000 Mar-Apr, 22(2), 96 - 100
Odontogenic bacteremia following tooth cleaning procedures in children; Lucas V et al.; PURPOSE: This study was designed to investigate the prevalence and intensity of odontogenic bacteremia from tooth cleaning procedures in children and adolescents . METHODS: One hundred and fifty five children receiving dental treatment under general anesthesia at The Great Ormond Street Hospital for Children and Guy's Hospital were recruited . Each child was randomly allocated to one of three tooth cleaning groups . These were (1) toothbrushing, (2) professional cleaning with a rubber cup and (3) scaling . RESULTS: There was no significant difference in the prevalence of positive blood cultures or intensity of bacteremia between the three groups . The bacterial species isolated were similar to those reported by other workers . These were S . mitis, S . sanguis and Coagulase--negative staphylococci, all of which are implicated in the pathogenesis of Bacterial Endocarditis . CONCLUSIONS: Patients at risk are as likely to develop odontogenic bacteremia from toothbrushing at home as from professional scaling and polishing of the teeth at dental surgery.

Antibiot Khimioter, 2000, 45(3), 35 - 8
{A trial of the use of mupirocin in the nasal carriage of Staphylococcus aureus in medical personnel}; Dmitrieva NV et al.; Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus . The role of S . aureus nasal carriage in development of wound infections due to autoinfection is confirmed . Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci . The S . aureus persistence in hospital personnel results in distribution of the microorganisms in the environment . Therefore, detection of S . aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S . aureus infection in hospitals . Clinical efficacy of nasal ointment of mupirocin in the treatment of S . aureus carriers among the intensive care personnel of the N . N.Blokhin Cancer Research Center was evaluated . S . aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons . All the isolates were susceptible to oxacillin . 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S . aureus was stated in 100 per cent of the cases . The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months . It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S . aureus nasal carriage.

Cent Eur J Public Health, 2000 Feb, 8(1), 18 - 20
Production of slime by staphylococcal isolates from blood cultures; Votava M et al.; The aim was to examine the ability of staphylococci isolated from blood cultures to produce slime and to compare the slime production of strains considered clinically significant and of strains considered mere contaminants . The ability to produce slime was examined in 359 staphylococcal isolates from blood cultures by the congo red agar method . The clinical significance of an isolate was estimated according to the frequency of its occurrence in a series of blood cultures . Only strains isolated at least twice from the series of two or more blood cultures were considered significant . The slime production was detected in 18 of 32 strains (56.2%) of Staphylococcus aureus, in 61 of 231 strains (26.4%) of S . epidermidis and in 14 of 101 strains (14.6%) of the remaining seven species . Out of 80 strains considered significant, 33 strains (41.2%) produced slime, out of 132 strains considered contaminants, 24 strains (18.2%) were slime producers . The significance of the remaining isolates was non-evaluable . We conclude that the staphylococcal isolates from blood cultures considered clinically significant produced slime more often than the isolates considered mere contaminants.

Int J Antimicrob Agents, 2000 Feb, 13(4), 273 - 9
Detection of genes encoding aminoglycoside-modifying enzymes in staphylococci by polymerase chain reaction and dot blot hybridization; Udo EE et al.; Dot blot hybridization and the polymerase chain reaction (PCR) were used to study aminoglycoside-modifying enzymes in aminoglycoside-resistant staphylococci isolated in hospitals in Kuwait . DNA encoding the acetyltransferase (AAC) (6')-phosphotransferase (APH) (2"), nucleotidyltransferase (ANT) (4') and APH (3') enzymes were detected in Staphylococcus aureus and coagulase negative staphylococci . ANT (4') was the most common enzyme detected . The majority of isolates contained genes for all three modifying enzymes, AAC (6')-APH (2"), ANT (4') and APH (3'); only few isolates carried genes for a single modifying enzyme . Genes encoding the AAC (6')-APH (2") were detected in all except two gentamicin-resistant isolates . In these isolates the genes for the AAC (6')-APH (2") enzyme could not be detected by PCR and dot blot hybridization . Whereas antibiotic resistance testing could be used to predict the presence of the AAC (6')-APH (2") enzyme it was not useful in predicting the presence of the ANT (4') or APH (3') enzymes in gentamicin-resistant isolates . Results obtained with dot blot hybridization were comparable to those obtained with PCR . However, PCR was fast and results were obtained within the same day . Therefore PCR would be preferred for the detection and confirmation of the presence of aminoglycoside-modifying enzymes in clinical microbiology laboratories.

Int J Antimicrob Agents, 2000 Feb, 13(4), 257 - 71
Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in the USA, Canada and Latin America . SENTRY Participants Group; Diekema DJ et al.; From January through June of 1998, 4579 bloodstream infections (BSI) due to bacterial pathogens were reported from SENTRY hospitals in Canada, the USA and Latin America . Staphylococcus aureus, Escherichia coli, and coagulase-negative staphylococcus (CoNS) were the most common pathogens, together accounting for 55.2% of all BSI during this time period . Compared with the 5794 BSI reported from SENTRY from January through June of 1997, no major change was seen in the frequencies of occurrence of the most common bacterial causes of BSI . Between 1997 and 1998, the major change in antimicrobial resistance was an increase in oxacillin-resistance in both S . aureus and CoNS in all regions . These data demonstrate widespread antimicrobial resistance in Canada, Latin America and the USA, with a notable increase in oxacillin-resistance among staphylococci . Ongoing surveillance remains essential, and will enhance efforts to limit the scope of this worldwide problem.

Burns, 2000 Jun, 26(4), 359 - 66
Staphylococcal septicaemia in burns; Gang RK et al.; This study analyses staphylococcal septicaemia in a series of 1516 burn patients who were admitted to the burn unit of the Al-Babtain Centre for Burns and Plastic Surgery, Ibn Sina Hospital, Kuwait over a period of 6.5 years (1 June 1992-31 December 1998) . One hundred and nine patients (7.2%) developed clinically and microbiologically proven septicaemia, of which 80 (73.4%) showed one or the other type of Staphylococcus in their blood . Fifty (62.5%) of them were males and 30 (37.5%) females, with a mean age of 26 years and the mean total body surface area of burns (TBSA) of 45% (range 1-93%) . Preschool age children comprised 27.5% of the patients . Flame was the dominant (80%) cause of burn . Of the 80 patients who had 91 episodes of septicaemia, 52 (65%) had MRSA, 8 (10%) MSSA, 11 (13.8%) MRSE and 5 (6.2%) MSSE and 4 (5%) others had mixed organisms . Only the patients with MRSA had multiple episodes . Eight patients (10%) showed septicaemic episodes within only 48 h of admission; however, the majority of the patients (77.5%) had a septicaemic attack within 2 weeks postburn . Of the 52 MRSA septicaemic cases, 39 (75%) survived and 13 (25%) died . Four patients with septicaemia due to mixed infections died . A total of 19 patients were intubated, 14 due to inhalation injury and 5 because of septicaemia; all in the former group died . Glycopeptide therapy (vancomycin/teicoplanin) was instituted immediately following the detection of staphylococci in the blood . No significant difference was noted in relation to mortality amongst the septicaemic patients, whether or not on prophylactic antibiotic . Fifty-six (70%) of the 80 patients had 139 sessions of skin grafting and survived . Of the 52 MRSA patients, 40 had 101 sessions of skin grafting and 33 of them survived . The apparent low mortality was probably due to early detection of the organism, appropriate antibiotic therapy, care for nutrition and early wound cover . This study indicates a high incidence of staphylococcal septicaemia (especially due to MRSA) in the burn unit . A surface wound is the likely source of entry to the blood stream in these immunocompromised patients . The organism could be detected in blood as early as 48 h postburn and in as little TBSA burn as 1% in this MRSA endemic unit . Inhalation injury with major burns and added staphylococcal septicaemia invariably proved to be fatal.

Pediatr Infect Dis J, 2000 Mar, 19(3), 200 - 6
Impact of an antibiotic restriction policy on hospital expenditures and bacterial susceptibilities: a lesson from a pediatric institution in a developing country; Saez-Llorens X et al.; BACKGROUND: In an era of growing concern about bacterial resistance and hospital costs, limiting the use of broad spectrum antibiotics is important . OBJECTIVES: To evaluate the effects of an antibiotic restriction policy on expenditures, antimicrobial resistance rates and clinical outcomes of hospitalized children . DESIGN: Starting in January, 1997, a prior consultation with an infectious disease specialist for using restricted antibiotics was required in all hospital areas . A retrospective assessment of study objectives obtained 2 years before (1995, 1996) and 2 years after (1997, 1998) initiation of the restriction policy was performed . SETTING: The present study was conducted in a 500-bed university hospital serving children nationwide of a developing country, Panama . RESULTS: Total expenditures for antimicrobial agents decreased by 50%, from $699,543 (US dollars) during 1995 and 1996 to $347,261 during 1997 and 1998 . Susceptibility rates of many nosocomial isolates (especially staphylococci and Gram-negative enteric bacilli) usually improved for restricted antibiotics with >35% reduction in utilization (notably for gentamicin, third generation cephalosporins, piperacillin and vancomycin) . Major improvements in bacterial susceptibilities were observed in the nursery, a place harboring microorganisms exhibiting the higher initial resistance rates of the hospital . No differences in days of hospital stay and mortality rates of all patients and of children with nosocomial infections were detected during the study period . CONCLUSIONS: Requirement for prior approval of selected antimicrobial drugs in a pediatric institution decreases hospital expenditures and improves susceptibilities to antibiotics without compromising patient outcomes or length of hospital stays.

J Clin Microbiol, 2000 Apr, 38(4), 1359 - 63
Heterogeneous antimicrobial resistance patterns in polyclonal populations of coagulase-negative staphylococci isolated from catheters; Garcia de Viedma D et al.; Most cases of nosocomial bacteremia are catheter related, and coagulase-negative staphylococci (CoNS) are the microorganisms most frequently associated with these infections . Subtle morphological differences are frequently found among CoNS colonies cultured from infected catheters . The aim of this study was to analyze the significance of the morphological heterogeneity observed in these CoNS populations . With this purpose in mind, the clonal composition of the CoNS populations obtained from a selection of nine catheters was analyzed by two different molecular techniques, arbitrarily primed-PCR and DNA macrorestriction analysis by pulsed-field gel electrophoresis . Twenty CoNS morphotypes were included for analysis, and four single colonies representative of each morphotype were selected . Morphological differences between colonies were found to correlate in all cases with differences at the molecular level . Unique fingerprints were also obtained for some isolates which were indistinguishable from other representatives of the same morphotypes . Differences in the molecular patterns among the isolates were associated in most of the cases with differences in the antimicrobial susceptibility patterns . The frequent isolation of polyclonal CoNS populations from catheters, with heterogeneous antimicrobial susceptibility patterns, has relevant epidemiologic and therapeutic implications in the context of catheter-related infections.

Eur J Clin Microbiol Infect Dis, 2000 Feb, 19(2), 118 - 20
Spondylodiscitis associated with bacteraemia due to coagulase-negative staphylococci; Bucher E et al.; Three cases are reported of spondylodiscitis caused by coagulase-negative staphylococci in patients without osteosynthetic material . All three patients had bacteraemia associated with an infected intravascular device left in place . On the basis of this observation, it is concluded that such devices should be removed promptly in cases of prolonged or relapsing bacteraemia . Furthermore, spondylodiscitis should be suspected in patients with back pain after bacteraemia caused by coagulase-negative staphylococci.

Int J Food Sci Nutr, 2000 Jan, 51(1), 19 - 24
Antibiotic resistance of coagulase-negative staphylococci isolated from artisanal Naples-type salami; Mauriello G et al.; In the present paper 42 isolates from Italian salami were specified as Staphylococcus xylosus (30), Staph . capitis (1), Staph . saprophyticus (1), Staph . hominis (1), Staph . simulans (1), Staph . cohnii (1) and as Staph . spp . (7) . These strains were coagulase-negative and were examined for resistance/sensitivity against 25 antibiotics including beta-lactams (7), macrolides (3), amynoglicosides (5), glycopeptides, lincosamides (4) and novobiocin, fusidic acid, chloramphenicol, rifampicin, tetracycline, minocycline . More than 64% of the strains were resistant to lincomycin, penicillin G, amoxicillin, fusidic acid and novobiocin . All the strains were multiresistant and displayed at least three resistances . Over 75% had a multiple antibiotic resistance (MAR) index between 0.2 and 0.5.

Infect Control Hosp Epidemiol, 2000 Mar, 21(3), 213 - 7
Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital: a role for species and strain identification; Kim SD et al.; OBJECTIVES: To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI) . SETTING: 400-bed community hospital . DESIGN: Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC) . Retrospective review of medical records of 37 patients with multiple cultures positive for CNS . RESULTS: During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had > or =2 positive cultures . Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions . Species identification and strain clonality of CNS isolates from patients with > or =2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the > or =2 positive cultures, suggesting that CNS from these patients probably were contaminants . Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and > or =2 positive blood cultures . CONCLUSIONS: Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with > or =2 positive blood cultures.

J Bacteriol, 2000 Apr, 182(8), 2170 - 8
Replication of staphylococcal multiresistance plasmids; Firth N et al.; Based on structural and functional properties, three groups of large staphylococcal multiresistance plasmids have been recognized, viz., the pSK1 family, pSK41-like conjugative plasmids, and beta-lactamase-heavy-metal resistance plasmids . Here we describe an analysis of the replication functions of a representative of each of these plasmid groups . The replication initiation genes from the Staphylococcus aureus plasmids pSK1, pSK41, and pI9789::Tn552 were found to be related to each other and to the Staphylococcus xylosus plasmid pSX267 and are also related to rep genes of several plasmids from other gram-positive genera . Nucleotide sequence similarity between pSK1 and pI9789::Tn552 extended beyond their rep genes, encompassing upstream divergently transcribed genes, orf245 and orf256, respectively . Our analyses revealed that genes encoding proteins related to the deduced orf245 product are variously represented, in several types of organization, on plasmids possessing six seemingly evolutionarily distinct types of replication initiation genes and including both theta-mode and rolling-circle replicons . Construction of minireplicons and subsequent functional analysis demonstrated that orf245 is required for the segregational stability of the pSK1 replicon . In contrast, no gene equivalent to orf245 is evident on the conjugative plasmid pSK41, and a minireplicon encoding only the pSK41 rep gene was found to exhibit a segregational stability approaching that of the parent plasmid . Significantly, the results described establish that many of the large multiresistance plasmids that have been identified in clinical staphylococci, which were formerly presumed to be unrelated, actually utilize an evolutionarily related theta-mode replication system.

Pharmacoeconomics, 1999 Dec, 16(6), 627 - 47
Diagnosis and management of osteomyelitis . Decision analytic and pharmacoeconomic considerations; Tavakoli M et al.; Osteomyelitis, or bone infection, is becoming more common, largely because of increases in the use of implanted prosthetic devices in the management of arthritis or fractures . The clinical management of osteomyelitis requires accurate microbiological diagnosis that will identify appropriate antibacterials to which the pathogenic organisms are sensitive . Therapy will largely depend on the type of bacteria, the route by which the bacteria reach the bone, the presence of any orthopaedic devices and the patient's ability to mount an immune response . Consequently, therapy often requires a combination of medical and surgical management . The aim of this review is primarily to assess the impact of different drug regimens on the total cost and to clarify the implications of various treatment options for patients with osteomyelitis . Thus, the review examines the link between the main categories of osteomyelitis and common pathogens, and provides additional comments on the aetiology and epidemiology of the condition . At present, there is a real shortage of high quality evidence to guide the decision-maker through the range of available options . One way to deal with the complexity and uncertainty surrounding the management of osteomyelitis is to develop treatment protocols leading to decision trees which will in turn systematically analyse the options available for treating patients with osteomyelitis . Consequently, we have developed a number of decision trees to show the range of options available and have applied these to the relatively simple problem of route of administration of antibacterials . However, even here the available data allow only relatively crude estimations of the costs and consequences of alternative regimens . Thus, the aim has been to provide structures that may help to set priorities for research based on the expected value of new information . In the absence of evidence, there are broadly 2 alternatives . One is based on selection of the least expensive regimen in the absence of evidence to prove that more expensive options are more effective; patients with multiply resistant staphylococci, for which no effective oral regimen is available, should be treated with intravenous therapy . This is consistent with the UK legal system, which is founded on the so-called Bolam test . The alternative is providing the maximum available treatment; in the US, it is more likely that a doctor will be held negligent for not providing the maximum available treatment, and most standard texts recommend routine use of intravenous therapy for osteomyelitis.

Antimicrob Agents Chemother, 2000 Apr, 44(4), 1093 - 6
Control of staphylococcal adhesion to polymethylmethacrylate and enhancement of susceptibility to antibiotics by poloxamer 407; Veyries ML et al.; We studied the antiadhesive effect of Poloxamer 407 (P407), together with modifications in the antimicrobial susceptibility of residual adherent staphylococci . Bacterial adherence was markedly inhibited (77% to more than 99.9%) whether polymethylmethacrylate was exposed to P407 before or during the adherence assay . Furthermore, residual adherent staphylococci appeared to be more susceptible to antibiotic activity, suggesting that combination of P407 with antibiotics could be a promising approach to the prevention of infection of foreign material.

Antimicrob Agents Chemother, 2000 Apr, 44(4), 1062 - 6
In vitro activities of daptomycin, vancomycin, linezolid, and quinupristin-dalfopristin against Staphylococci and Enterococci, including vancomycin- intermediate and -resistant strains; Rybak MJ et al.; The in vitro activity of daptomycin was compared with those of vancomycin, linezolid, and quinupristin-dalfopristin against a variety (n = 203) of gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and S . epidermidis (MRSA and MRSE, respectively), vancomycin-resistant enterococci (VRE), and vancomycin-intermediate S . aureus (VISA) . Overall, daptomycin was more active against all organisms tested, except Enterococcus faecium and VISA, against which its activity was similar to that of quinupristin-dalfopristin . In time-kill studies with MRSA, MRSE, VRE, and VISA, daptomycin demonstrated greater bactericidal activity than all other drugs tested, killing > or =3 log CFU/ml by 8 h . Daptomycin may be a potential alternative drug therapy for multidrug-resistant gram-positive organisms and warrants further investigation.

Arch Immunol Ther Exp (Warsz), 2000, 48(1), 21 - 6
Preventing staphylococcal disease by disarming the immune responses to infection; Tarkowski A; Use of experimental models of staphylococcal infections clarified several bacterial virulence factors as well as many hematopoetic cell types and their products that are involved in the pathogenesis of infection . For many decades it has been believed that antibody mediated response to staphylococci and their products was the major, if not the only one, hallmark of immune reactivity during infection . Recent studies have documented that T cell mediated responses to superantigens produced by staphylococci are not only prominent but also decisive with respect to sequels . Also the nonantigen specific immune responsiveness to staphylococcal infection is reviewed including roles of neutrophils, complement system and nitric oxide . The knowledge gained regarding staphylococcal virulence factors and the host immune responses has prompted researchers to develop new strategies how to interact in vivo witl the infectious process . Some of these approaches are commented in this review regarding e.g . vaccination procedures in order to prevent severe infections as well as therapeutic procedures to minimize organ damage during an ongoing infectious process.

Pediatr Allergy Immunol, 1999 Nov, 10(4), 241 - 8
Infants colonized with enterotoxin-producing staphylococci at 3 months display a decreased frequency of interferon-gamma-producing CD45RO lymphocytes upon stimulation with staphylococcal enterotoxin A at birth but not at 6 months of age; Schauer U et al.; The aim of the study was to elucidate the relationship between the cytokine response to staphylococcal enterotoxin A (SEA) at birth and subsequent staphylococcal colonization in the first months of life . In a cohort of 45 newborns, cord blood lymphocytes were stimulated with SEA (10 ng/ml) in vitro, re-stimulated with PMA (phorbol myristate acetate) and ionomycin at day 3 and assessed for CD45RO expression and cytokine generation by flow cytometry . The infants were classified into three groups according to nasal staphylococcal colonization and enterotoxin generation at 3 months: There were 16 infants with either no colonization or non-enterotoxin-producing staphylococci, 16 infants with enterotoxins B, C, D and E, and 13 infants colonized with SEA-producing staphylococci . At birth, the group without subsequent colonization displayed a significantly higher frequency of CD45RO-positive interferon-gamma-producing cells (1.7%; range 0.0-9.3%) in comparison to the SEA-positive group (0.1%; range 0.0-0.4%) and also to the group positive for other enterotoxins (0.50%; range 0.0-2.5%) . Comparable but less pronounced results were found for interleukin-5 but not for interleukins 2 and 4 . At 6 months, no differences in cytokine generation were detected between the three groups . The results provide evidence that a non-specific immunologic immaturity at birth is a risk factor for early bacterial colonization . Furthermore, it is remarkable that this immaturity is similar to that seen in infants destined to be atopic with respect to disequilibrium of interferon-gamma to interleukin-4 generation . Thus the link between early staphylococcal colonization and subsequent atopy requires further investigation.

J Pharm Pharmacol, 2000 Feb, 52(2), 227 - 33
Do biocides select for antibiotic resistance?
Russell AD.
Some similarities exist between bacterial resistance to antibiotics and to biocides, and gram-negative bacteria that have developed resistance to cationic biocides may also be insusceptible to some antibiotics . Outer membrane changes are believed to be responsible for this non-specific increase in resistance . Efflux, another important resistance mechanism, is associated with the qacA/B gene system in staphylococci that confers low-level resistance to cationic agents including chlorhexidine salts and quaternary ammonium compounds . It has been proposed that the introduction into clinical practice of chlorhexidine and quaternary ammonium compounds has resulted in the selection of staphylococci containing qacA genes on multiresistance plasmids . A linkage between low-level resistance to triclosan and to antibiotics has recently been claimed to occur in Escherichia coli, with the bisphenol selecting for chromosomally-mediated antibiotic resistance . A key issue in many studies has been the use of biocides at concentrations significantly below those used clinically . It remains to be determined how an increase to low-level resistance to cationic biocides can be held responsible for the selection of antibiotic-resistant bacteria.

J Med Microbiol, 2000 Mar, 49(3), 217 - 25
Binding of von Willebrand factor by coagulase-negative staphylococci; Li DQ et al.; Coagulase-negative staphylococci (CNS) are the most common infectious micro-organisms isolated from prosthetic devices . To determine whether von Willebrand factor (vWF) acts as an adhesin in bacterial recognition, bacterial binding of recombinant vWF (rvWF) was studied . Eleven CNS strains, belonging to S . epidermidis, S . haemolyticus and S . hominis species, bound soluble rvWF, but to a lesser extent than S . aureus . S . epidermidis strain H2-W bound 125I-labelled rvWF in a dose-dependent manner . The binding could be inhibited by unlabelled rvWF and thrombospondin, but not by fibrinogen, vitronectin or the carbohydrates N-acetylgalactoseamine, D-galactose, D-glucose, and D-fucose . Pre-incubation of rvWF with type I collagen and Arg-Gly-Asp-Ser (RGDS) peptides did not inhibit binding, whereas pre-incubation of rvWF with heparin decreased binding significantly . The interaction between CNS and rvWF was sensitive to proteinase treatment of bacterial cells . CNS strains bound to immobilised rvWF an extent greater or equal to the positive control strain S . aureus Cowan I . rvWF binding structures from bacterial cell wall were detected by immunoblot . Cowan I strain had 140-, 90- and 38-kDa binding molecules . S . haemolyticus strain SM131 and S . epidermidis strain H2-W had two (120 and 60 kDa) and five (120, 90, 60, 52 and 38 kDa) binding molecules, respectively . Similar binding structures were formed when cell wall extracts from these strains were incubated with thrombospondin . These results indicate that specific ligand-receptor interaction between CNS and rvWF may contribute to bacterial adhesion and colonisation on biomaterial surfaces . Heparin-binding domains of rvWF might be the crucial regions for bacterial attachment . rvWF and thrombospondin may recognise similar molecules in staphylococcal cell wall extracts.

Eye, 1999 Dec, 13 ( Pt 6), 744 - 7
Comparison of topical 0.3% ofloxacin with fortified tobramycin plus cefazolin in the treatment of bacterial keratitis; Panda A et al.; PURPOSE: Ofloxacin is a broad spectrum fluoroquinolone antibiotic with good ocular penetration . We compared ofloxacin 3% solution with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proven bacterial keratitis . METHODS: Thirty eyes with culture-proven bacterial corneal ulcers were enrolled in a prospective randomised, controlled, double-masked study for comparison . The ofloxacin drop and saline were decanted into two identical-looking bottles to the tobramycin and cefazolin . The cases were randomly allocated into treatment with 0.3% ofloxacin solution or a combination of fortified antibiotics (1.5% tobramycin and 10% cefazolin solutions; control group) along with supportive cycloplegic, vitamins and anti-glaucoma therapy . Student's t-test was used to compare the results . RESULTS: Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated . Resolution of the ulcer was achieved in 93% and 87% of cases in the ofloxacin and control groups respectively . The mean time required for symptomatic relief was 7.8 +/- 1.54 days and for epithelial healing 15.0 +/- 3.86 days in ofloxacin group, compared with 8.33 +/- 1.54 days for symptomatic relief and 15.46 +/- 3.86 days for epithelial healing in the control group . Post-resolution best corrected visual acuity of 20/200 or better was achieved in all but one eye in both groups . CONCLUSIONS: Ofloxacin and combined fortified tobramycin and cefazolin topical drops were comparable for treating cases of bacterial corneal ulcer . However, considering its easy availability and cost-effectiveness, monotherapy with ofloxacin is preferred over the combined fortified tobramycin and cefazolin therapy.

Zentralbl Bakteriol, 2000 Jan, 289(8), 827 - 33
Phenotypes of staphylococcal resistance to macrolides, lincosamides and streptogramin B (MLS) in a Turkish university hospital; Tunckanat F et al.; Resistance to macrolides, lincosamides and streptogramin B (MLS) which is expressed either constitutively or inducibly, is mediated by erm genes (erm A, erm B, and erm C in staphylococci) . The transposon TN 554, harbouring the erm A gene also encodes spectinomycin resistance . In Turkey, data related to MLS resistance phenotypes of staphylococci are not available . In this study, we screened 500 consecutive clinical isolates of staphylococci isolated in Hacettepe University Hospital, for MLS and spectinomycin resistance by the standard disk diffusion method . All MLS-resistant isolates were further tested for spectinomycin susceptibility by the agar screening method . Of 500 staphylococcal isolates, 368 (73.6%) were susceptible and 132 (26.4%) were resistant to MLS antibiotics . Ninety-one (18.2%) of the resistant isolates exhibited a constitutive resistance pattern, whereas 40 were inducibly resistant . MS (resistance to macrolides and lincosamides only) resistance was detected in only one isolate (0.2%) . Of 40 inducibly resistant isolates, 21 were found to be resistant to spectinomycin by both the disk diffusion and agar screening tests, probably indicating a presence of the erm A gene . These results suggest that MLS resistance has been considerably high among clinical isolates of staphylococci in our hospital . On the whole, constitutive resistance was the pattern most frequently encountered . In contrast, MS resistance was very rare . Further epidemiological and molecular investigations are required for clarification of the data presented.

J Antimicrob Chemother, 2000 Mar, 45(3), 321 - 8
A retrospective analysis of pharmacokinetic/pharmacodynamic indices as indicators of the clinical efficacy of ciprofloxacin; Sanchez-Recio MM et al.; A retrospective analysis of the relationship between estimated pharmacokinetic/pharmacodynamic indices and the reported efficacy of ciprofloxacin has been carried out using different correlation models . f1.gif" BORDER="0">, T(ss) > MIC, f2.gif" BORDER="0"> and AUIC(ss) were calculated for each clinical case included in the study, from simulated plasma level curves corresponding to the dosage regimen administered . A univariate correlation analysis was performed considering efficacy (%) as the dependent variable and indices as the independent variables according to linear and non-linear pharmacokinetic-pharmacodynamic models (PK-PD models).The results prove that log-transformation of the independent variable improves the data fitting to linear model . The four estimated indices show a log-linear relationship with outcome, T(ss) > MIC and AUIC(ss) being the parameters best correlated with percentage efficacy . The E(max) model with intrinsic response is an additional correlation strategy for T(ss) > MIC, leading to estimated values of E(max) and E(0) of 100.34 +/- 25.09% and 24.40 +/- 11.7%, respectively . The wide range of bacteria responsible for the infections considered, including Gram-positive pathogens such as staphylococci, might explain the good correlation between T(ss) > MIC and percentage efficacy found for ciprofloxacin in this study.

Vet Microbiol, 2000 Feb, 71(3-4), 287 - 94
Improvement of the identification of staphylococci isolated from bovine mammary infections using molecular methods; Bes M et al.; Fifty-six Staphylococcus strains isolated from cases of bovine mammary infections were identified by using phenotypic and genotypic methods . Twenty-eight strains (50%) were identified at the species level according to their phenotypic characteristics, whereas the remaining 28 strains presented atypical or unreliable profiles . A combination of phenotypic and genotypic methods allowed the 56 strains studied to be classified . Internal transcribed spacer-polymerase chain reaction (ITS-PCR) based on the polymorphism of the 16S-23S rDNA spacer region appeared as a rapid and reliable method for the classification of bovine staphylococcal isolates at the species and subspecies levels.

J Microbiol Methods, 2000 Apr, 40(2), 193 - 8
Screening method for detecting staphylococci with reduced susceptibility to teicoplanin; Park YJ et al.; The incidence of infections caused by staphylococci with decreased susceptibility to teicoplanin (MIC>/=8 microg/ml) is increasing, but the disk diffusion test has difficulty detecting this low level of resistance . In addition, detection is complicated because of the heterogeneous phenotypes for teicoplanin . In this study, we evaluated an agar screening method to detect staphylococci with decreased susceptibility to teicoplanin or heterogeneous resistance . First, to investigate the inoculum density and teicoplanin concentration of screening agar, we used 10(5) and 10(6) CFU/ml and Mueller-Hinton agars supplemented with 6 and 8 microg of teicoplanin/ml to test 39 genetically distinct staphylococcal strains (15 strains with teicoplanin MICs>/=8 microg/ml and 24 strains with teicoplanin MICs</=4 microg/ml) . On the basis of the results obtained, a final inoculum of 10(6) CFU/spot and a teicoplanin concentration of 8 microg/ml were selected . By this screening method, all strains having teicoplanin MICs>/=8 microg/ml or showing heteroresistance could be detected . These findings indicate that the method can be used as a reliable screening method for detecting staphylococci with reduced susceptibility to teicoplanin.

Appl Environ Microbiol, 2000 Mar, 66(3), 1243 - 8
Staphylococcal surface display of metal-binding polyhistidyl peptides; Samuelson P et al.; Recombinant Staphylococcus xylosus and Staphylococcus carnosus strains were generated with surface-exposed chimeric proteins containing polyhistidyl peptides designed for binding to divalent metal ions . Surface accessibility of the chimeric surface proteins was demonstrated and the chimeric surface proteins were found to be functional in terms of metal binding, since the recombinant staphylococcal cells were shown to have gained Ni(2+)- and Cd(2+)-binding capacity, suggesting that such bacteria could find use in bioremediation of heavy metals . This is, to our knowledge, the first time that recombinant, surface-exposed metal-binding peptides have been expressed on gram-positive bacteria . Potential environmental or biosensor applications for such recombinant staphylococci as biosorbents are discussed.

J Clin Microbiol, 2000 Mar, 38(3), 1136 - 43
Molecular characterization of Staphylococcus sciuri strains isolated from humans; Couto I et al.; We previously characterized over 100 Staphylococcus sciuri isolates, mainly of animal origin, and found that they all carried a genetic element (S . sciuri mecA) closely related to the mecA gene of methicillin-resistant Staphylococcus aureus (MRSA) strains . We also found a few isolates that carried a second copy of the gene, identical to MRSA mecA . In this work, we analyzed a collection of 28 S . sciuri strains isolated from both healthy and hospitalized individuals . This was a relatively heterogeneous group, as inferred from the different sources, places, and dates of isolation and as confirmed by pulsed-field gel electrophoresis analysis . All strains carried the S . sciuri mecA copy, sustaining our previous proposal that this element belongs to the genetic background of S . sciuri . Moreover, 46% of the strains also carried the MRSA mecA copy . Only these strains showed significant levels of resistance to beta-lactams . Strikingly, the majority of the strains carrying the additional MRSA mecA copy were obtained from healthy individuals in an antibiotic-free environment . Most of the 28 strains were resistant to penicillin, intermediately resistant to clindamycin, and susceptible to tetracycline, erythromycin, and gentamicin . Resistance to these last three antibiotics was found in some strains only . The findings reported in this work confirmed the role of S . sciuri in the evolution of the mechanism of resistance to methicillin in staphylococci and suggested that this species (like the pathogenic staphylococci) may accumulate resistance markers for several classes of antibiotics.

Am Surg, 2000 Feb, 66(2), 112 - 6
Antibiotic-resistant organism infection; Postier RG; Bacteria possess a remarkable number of ways to become resistant to antibiotics . Antibiotic resistance has become a major problem in the treatment of Gram-positive infections . Resistance to methicillin and vancomycin in staphylococci and enterococci has resulted in organisms that are resistant to all known antibiotics . Although it is important to continue to search for newer and more effective antibiotics, it is imperative that we develop a surgical mindset of appropriate antibiotic stewardship . The use of single-dose prophylactic regimens, using narrow-spectrum agents when possible for therapeutic indications, limiting the duration of therapeutic agents appropriately, avoiding the use of vancomycin except when necessary, and adhering to strict infection control measures are all steps that will limit the spread and development of resistant organisms.

Infect Immun, 2000 Mar, 68(3), 1102 - 8
Cytotoxic activity of coagulase-negative staphylococci in bovine mastitis; Zhang S et al.; Secreted toxins play important roles in the pathogenesis of bacterial infections . In this study, we examined the presence of secreted cytotoxic factors of coagulase-negative staphylococci (CoNS) from bovine clinical and subclinical mastitis . A 34- to 36-kDa protein with cell-rounding cytotoxic activity was found in many CoNS strains, especially in Staphylococcus chromogenes strains . The protein caused cell detachment and cell rounding in several cell lines, including HEp-2, Int 407, CHO-K1, and Y-1 cells . Native protein recovered from nondenatured polyacrylamide gel electrophoresis showed both cytotoxic activity and casein hydrolysis activity . The purified protein had a pH optimal at 7.2 to 7.5 and a pI of 5.1 and was heat labile . The proteolytic activity could be inhibited by zinc and metal specific inhibitors such as 1, 10-phenanthroline and EDTA, indicating that it is a metalloprotease . Protein mass analysis and peptide sequencing indicated that the protein is a novel metalloprotease . Different bacterial strains expressed variable levels of 34- to 36-kDa protease, which may provide an indication of strain virulence.

J Perinatol, 1999 Jun, 19(4), 290 - 3
Comparison of DNA probe technology and automated continuous-monitoring blood culture systems in the detection of neonatal bacteremia; Hertz D et al.; OBJECTIVE: The present study assessed the ability of a rapid chemiluminescent DNA probe assay to detect bacterial growth in blood culture specimens before their detection by continuous-monitoring blood culture (CMBC) systems . STUDY DESIGN: Three newborn intensive care units, which are members of the National Institute of Child Health and Human Development Neonatal Research Network, participated in this study . Each center employs an automated CMBC system against which the DNA probe was compared . A total of 1700 blood cultures were analyzed . A 3-ml aliquot of culture medium was removed from each culture during early incubation, processed, and analyzed by the DNA probe . RESULTS: Of 1700 blood cultures, 130 (7.6%) were detected positive by a CMBC system . Coagulase-negative staphylococci (CNS) were present in 90 (69%) of the positive cultures, and 26 (29%) were detected by the DNA probe . Other organisms accounted for the remaining 40 positive cultures, and 31 (78%) of these were detected by the probe assay . Seventy-six percent of all positive cultures were detected by a CMBC system within 24 hours . Ninety-eight percent of all positive cultures were detected by a CMBC system within 48 hours . Of the two organisms that grew in a CMBC system beyond 48 hours, both were CNS and one of these was considered a contaminant . Therefore, 99% of clinically significant organisms were detected by a CMBC system within 48 hours . CONCLUSION: This DNA probe is not sufficiently sensitive to be clinically useful; however, automated CMBC systems are sufficiently sensitive to aid in clinical decision-making regarding the continuance or discontinuance of antibiotic therapy following 48 hours of culture incubation.

Hunan Yi Ke Da Xue Xue Bao, 1998, 23(2), 126 - 8, 132
{Drug resistance study and detection of methicillin-resistant staphylococci}; Shu M et al.; MRSA and MRSE were identified by detecting oxacillin resistance of 107 strains of staphylococci from clinical sources . The positive rates of MRSA were 45.2% and 16.9%, respectively among the whole number of staphylococci examined . Antibiotic-resistant strains were detected with disks by Kirby-Bauer method . All MRSA and MRSE strains were multi-resistant . Resistant rates of MRSA and MRSE were higher than MSSA and MSSE . The positive rates of beta lactamase producing in MRSA and MRSE were significantly higher than MSSA and MSSE (P< 0.05 and P< 0.01) respectively . These results indicated that MRSA and MRSE were the main pathogens in the clinical infection . MRSA and MRSE detection are important for the early diagnosis and treatment of patients with infective diseases.

Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi, 1999 Dec, 10(2), 97 - 102
{Evaluation of direct identification testing from positive blood culture bottles with MicroScan rapid identification panels}; Wada Y et al.; We evaluated the direct identification method from growth-positive blood culture bottles using MicroScan Rapid ID panels (DADE BEHRING) for the purpose of rapid identification . The inoculum for Rapid ID panels were prepared using an isolation method from blood culture bottles by VACUTAINER (BD) . McF 1.0 had a better result than McF 0.5 as the inoculum concentration for Rapid ID panels . Rapid ID panel identification results were effected by blood contamination for > or =0.3% of S . aureus and 0.9% of a strain of E . coli . Blood contamination from the bottle may cause an issue to the identification results . The accuracy of this direct identification testing was 72.0% (36 out of 50) for gram positives organisms and 88 . 9% (80 out of 90) for gram negatives organisms . Although some strains including S . pyogenes, coagulase-negative staphylococci and non-Fermentative Gram Negative Rods had not identified correctly, this method provides a preliminary result within 3 hours and provides a fast turn around time . In conclusion, this method was considered as an effective method for routine testing.

Antimicrob Agents Chemother, 2000 Mar, 44(3), 802 - 5
Comparative in vitro activities of ciprofloxacin, gemifloxacin, grepafloxacin, moxifloxacin, ofloxacin, sparfloxacin, trovafloxacin, and other antimicrobial agents against bloodstream isolates of gram-positive cocci; Hardy D et al.; The in vitro activity of gemifloxacin against 316 bloodstream isolates of staphylococci, pneumococci, and enterococci was compared with the activities of six fluoroquinolones and three other antimicrobial agents . Of the antimicrobial agents tested, gemifloxacin was the most potent against penicillin-intermediate and -resistant pneumococci, methicillin-susceptible and -resistant Staphylococcus epidermidis isolates, and coagulase-negative staphylococci.

Zentralbl Veterinarmed B, 1999 Dec, 46(10), 707 - 12
Coagulase-negative staphylococci and mammary gland infections in cows; Chaffer M et al.; Coagulase-negative staphylococci (CNS) are the most frequently isolated bacteria from bovine mammary gland milk samples . The objective of this study was to determine the type of inflammation evoked by CNS in the mammary gland of cows during their first lactation . Twenty-four Israeli-Holstein heifers in their first lactation were tested for bacteriological status, somatic cell count (SCC) and differential leucocyte count in milk 60-120 days postparturition and every 50-60 days after until drying off . Following the first testing, the 96 quarters of the 24 heifers were classified as follows: 69.8% as no bacterial growth (NBG), 27.1% infected with CNS and 3.1% infected with Staphylococcus aureus . During lactation, 84.5% quarters had no change in their classification, 6.2% were newly infected with other pathogens, 3.1% were classified as self-cured and in 6.2% sporadic bacteria were isolated . Among the CNS, S . intermedius, S . chromogenes and S . haemolyticus were the most frequently isolated . Milk from CNS-infected quarters had significantly higher SCC than milk from NBG quarters . An analysis of the leucocyte pattern in milk from CNS vs . NBG quarters revealed a significant increase in polymorphonuclears and a significant decrease in the percentage of total lymphocytes and lymphocytes bearing CD4+ or CD8+ . The high percentage of CNS-infected quarters that remained unchanged in their bacterial status during the first lactation, indicates that those CNS have the ability to elude the immune system and persist in the mammary gland for a long time . The persisting infection, resulting to some extent from an increase of SCC by some CNS strains, suggests that in the near future control steps will have to be taken into consideration, in order to enhance the improvement of milk quality.

Ann Surg, 2000 Feb, 231(2), 276 - 81
Bactericidal activity against coagulase-negative staphylococci is impaired in infants receiving long-term parenteral nutrition; Okada Y et al.; OBJECTIVE: To examine the role of total parenteral nutrition (TPN) in predisposing infants to infection caused by coagulase-negative staphylococci . SUMMARY BACKGROUND DATA: Total parenteral nutrition is an important means of providing essential nutrients to newborn infants . However, its use has been associated with complications, particularly infection caused by coagulase-negative staphylococci . Recent data suggest that TPN may modulate immune function; however, reports directly indicating impaired immunity against coagulase-negative staphylococci during TPN are limited . METHODS: Study 1 involved 31 infants younger than 4 months who had undergone surgery and were not receiving antibiotics; 20 were receiving TPN and 11 were receiving a normal enteral diet . An in vitro whole blood model was used to measure the host bactericidal activity against coagulase-negative staphylococci . Bacterial killing and phagocytosis were measured after a 45-minute challenge with viable coagulase-negative staphylococci . In study 2, whole blood killing and intracellular killing of coagulase-negative staphylococci were measured in five newborn infants (younger than 2 months) who were receiving long-term TPN (>10 days), five control infants receiving a normal enteral diet, and five healthy adults . RESULTS: In study 1, infants receiving a normal enteral diet showed a high capacity to ingest and kill coagulase-negative staphylococci . In contrast, the blood of infants receiving long-term TPN showed a reduction in coagulase-negative staphylococci phagocytosis and killing . There were significant negative linear correlations between the duration of TPN and killing of coagulase-negative staphylococci and phagocytosis of coagulase-negative staphylococci . In study 2, infants receiving long-term TPN had lower whole blood killing and intracellular killing than infants receiving a normal enteral diet and healthy adult volunteers . These data seem to indicate a neutrophil dysfunction mediated by TPN in infancy . CONCLUSIONS: Host defense mechanisms, including phagocytosis and killing of coagulase-negative staphylococci, are impaired during long-term TPN . The impaired bactericidal activity seems to be related to defective intracellular killing in neutrophils . These findings may explain the high rate of septicemia caused by coagulase-negative staphylococci in infants receiving TPN.

Br J Anaesth, 1999 Oct, 83(4), 657 - 8
Bacterial contamination of needles used for spinal and epidural anaesthesia; Raedler C et al.; We have investigated prospectively the incidence of bacterial contamination of 114 spinal and 20 epidural needles collected immediately after lumbar puncture of the subarachnoid or epidural space . Bacteriological examination revealed bacterial contamination of 24 (17.9%) of the needles, mainly coagulase-negative staphylococci (21; 15.7%) followed by yeasts (2; 1.5%), enterococcus (1; 0.8%), pneumococcus (1; 0.8%) and micrococcus (1; 0.8%) . Our results suggest that even during aseptic puncture for lumbar anaesthesia, there is a significant rate of needle contamination.

APMIS, 1999 Dec, 107(12), 1060 - 8
Low occurrence of antibiotic resistance in Escherichia coli and staphylococci isolated from blood cultures in two Norwegian hospitals in 1991-92 and 1995-96; Leegaard TM et al.; The aim of this study was to investigate the antibiotic resistance rates of major bacterial pathogens causing bloodstream infections in two very different types of hospital in Norway . We examined all Escherichia coli and staphylococci (330 isolates) causing bloodstream infections from one general county hospital and one specialist national cancer hospital during the periods 1991-92 and 1995-96 . Minimal inhibitory concentrations (MICs) were determined using the E-test . E . coli and staphylococci constituted 46.7% of all isolates from bloodstream infections in the two hospitals . Overall, E . coli isolates were resistant to amoxicillin (21%), trimethoprim (21%), doxycycline (20%) and trimethoprim-sulphamethoxazole (17%), while Staphylococcus aureus strains were resistant to benzylpenicillin (66%) . No methicillin-resistant S . aureus was detected . Coagulase-negative staphylococci were often multiresistant, but remained fully sensitive to vancomycin . For a few antibiotics, significantly more resistance was found in the specialist hospital . In our material we found no significant increase in resistance between 1991-92 and 1995-96 . In conclusion, antimicrobial resistance still remains low in important bacterial pathogens causing bloodstream infections in Norway.

J Clin Microbiol, 2000 Feb, 38(2), 752 - 4
Correlation of oxacillin MIC with mecA gene carriage in coagulase-negative staphylococci; Hussain Z et al.; The National Committee for Clinical Laboratory Standards has recently changed the oxacillin breakpoint from >/=4 mg/liter to >/=0 . 5 mg/liter to detect methicillin-resistant coagulase-negative staphylococci (CoNS) because the previous breakpoint lacked sensitivity . To determine the correlation between the new oxacillin breakpoint and the presence of the mecA gene, 493 CoNS of 11 species were tested . The presence of the mecA gene was determined by PCR, and oxacillin susceptibility was determined by the agar dilution method with Mueller-Hinton agar containing 2% NaCl and oxacillin (0 . 125 to 4.0 mg/liter) . The new breakpoint correctly classified all CoNS strains with mecA as methicillin resistant and strains of Staphylococcus epidermidis, S . haemolyticus, and S . hominis without mecA as methicillin susceptible . The breakpoint of >/=0.5 mg/liter was not specific for S . cohnii, S . lugdunensis, S . saprophyticus, S . warneri, and S . xylosus, in that it categorized 70 of 74 strains of these species without mecA (94.6%) as methicillin resistant . The results of this study indicate that the new oxacillin breakpoint accurately identifies strains of CoNS with mecA but is not specific for strains of certain species of CoNS without mecA.

J Clin Microbiol, 2000 Feb, 38(2), 724 - 6
Survival of enterococci and staphylococci on hospital fabrics and plastic; Neely AN et al.; The transfer of gram-positive bacteria, particularly multiresistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), among patients is a growing concern . One critical aspect of bacterial transfer is the ability of the microorganism to survive on various common hospital surfaces . The purpose of this study was to determine the survival of 22 gram-positive bacteria (vancomycin-sensitive and -resistant enterococci and methicillin-sensitive and -resistant staphylococci) on five common hospital materials: smooth 100% cotton (clothing), 100% cotton terry (towels), 60% cotton-40% polyester blend (scrub suits and lab coats), 100% polyester (privacy drapes), and 100% polypropylene plastic (splash aprons) . Swatches were inoculated with 10(4) to 10(5) CFU of a microorganism, assayed daily by placing the swatches in nutritive media, and examining for growth after 48 h . All isolates survived for at least 1 day, and some survived for more than 90 days on the various materials . Smaller inocula (10(2)) survived for shorter times but still generally for days . Antibiotic sensitivity had no consistent effect on survival . The long survival of these bacteria, including MRSA and VRE, on commonly used hospital fabrics, such as scrub suits, lab coats, and hospital privacy drapes, underscores the need for meticulous contact control procedures and careful disinfection to limit the spread of these bacteria.

Clin Podiatr Med Surg, 2000 Jan, 17(1), 159 - 64, viii
Vancomycin-resistant Enterococci infected puncture wound to the foot . A case report; Hayes DW Jr et al.; Vancomycin is often administered empirically to patients with osteomyelitis, septic arthritis, septic throbophlebitis, infected burns, and cellulitis of the lower extremities when methicillin-resistant staphylococci are suspected, or when a staphylococcus organism is suspected in a penicillin-allergic patient . Physicians must be aware of the guidelines established regarding the use of Vancomycin to avoid bacterial resistance . Physicians also must be aware of the procedures that have been developed to help contain nasocomial outbreaks of Vancomycin-resistant Enterococci.

Kidney Int, 2000 Feb, 57(2), 613 - 8
Clonal spread of staphylococci among patients with peritonitis associated with continuous ambulatory peritoneal dialysis; Monsen T et al.; BACKGROUND: Peritonitis is the most important complication of continuous ambulatory peritoneal dialysis (CAPD) . Coagulase-negative staphylococci (CNS) are the most common causes of peritonitis, only limited information is available regarding the distribution and epidemiology of different CNS species associated with CAPD peritonitis . METHODS: CNS isolated from dialysis effluent from CAPD patients with peritonitis was identified by species and further analyzed with pulsed-field gel electrophoresis (PFGE) . RESULTS: A total of 216 microorganisms (206 bacteria and 10 Candida species) were isolated from 196 consecutive culture-positive CAPD samples obtained from 75 patients . One hundred and twenty-one (56%) isolates represented staphylococci . The four most frequently isolated staphylococcal species were Staphylococcus epidermidis (70 isolates), Staphylococcus aureus (31 isolates), Staphylococcus hemolyticus (10 isolates), and Staphylococcus hominis (4 isolates) . PFGE analysis revealed the clonal spread among patients of three different clones of S . epidermidis and one clone of S . aureus among the investigated patients . Indistinguishable isolates of either S . epidermidis, S . hominis, or S . aureus were also isolated in repeated samples from several patients . CONCLUSION: PFGE is a useful method for the epidemiological evaluation of staphylococci-associated CAPD infections and should replace older and less accurate methods, such as antibiotic sensitivity patterns . We recommend that CNS isolates from patients with CAPD-associated peritonitis should be saved for future investigations and typing, which would aid in the management of this patient category.

Antimicrob Agents Chemother, 2000 Feb, 44(2), 231 - 8
Correlation between the resistance genotype determined by multiplex PCR assays and the antibiotic susceptibility patterns of Staphylococcus aureus and Staphylococcus epidermidis; Martineau F et al.; Clinical isolates of Staphylococcus aureus (a total of 206) and S . epidermidis (a total of 188) from various countries were tested with multiplex PCR assays to detect clinically relevant antibiotic resistance genes associated with staphylococci . The targeted genes are implicated in resistance to oxacillin (mecA), gentamicin inverted question markaac(6')-aph(2"), and erythromycin (ermA, ermB, ermC, and msrA) . We found a nearly perfect correlation between genotypic and phenotypic analysis for most of these 394 strains, showing the following correlations: 98% for oxacillin resistance, 100% for gentamicin resistance, and 98.5% for erythromycin resistance . The discrepant results were (i) eight strains found to be positive by PCR for mecA or ermC but susceptible to the corresponding antibiotic based on disk diffusion and (ii) six strains of S . aureus found to be negative by PCR for mecA or for the four erythromycin resistance genes targeted but resistant to the corresponding antibiotic . In order to demonstrate in vitro that the eight susceptible strains harboring the resistance gene may become resistant, we subcultured the susceptible strains on media with increasing gradients of the antibiotic . We were able to select cells demonstrating a resistant phenotype for all of these eight strains carrying the resistance gene based on disk diffusion and MIC determinations . The four oxacillin-resistant strains negative for mecA were PCR positive for blaZ and had the phenotype of beta-lactamase hyperproducers, which could explain their borderline oxacillin resistance phenotype . The erythromycin resistance for the two strains found to be negative by PCR is probably associated with a novel mechanism . This study reiterates the usefulness of DNA-based assays for the detection of antibiotic resistance genes associated with staphylococcal infections.

J Paediatr Child Health, 1999 Dec, 35(6), 578 - 81
Clinical significance of quantitative blood cultures in newborn infants; Sabui T et al.; AIM: To evaluate quantitative blood culture as a secondary test on a positive blood culture for the diagnosis of sepsis in newborn infants . METHOD: A 15-month prospective study of colony forming units (CFU) on positive blood cultures from newborn infants clinically suspected of having bacterial sepsis . Growth of bacteria in peripheral blood cultures was quantified using the isolater 1.5 microbial tube lysis direct plating culture system . Colony forming units were evaluated against a clinical assessment of infection . RESULTS: Of 137 positive blood cultures, 71 (51.8%) were taken from neonates with clinically defined infection and 66 (48.2%) were from non-infected infants . The clinical and biographical data in these two groups were similar . Coagulase negative staphylococci were the most commonly isolated organisms in each group (60.6% vs 93.9%) . Eight deaths from sepsis occurred in the clinically infected group . Eighty-five per cent of sepsis was late onset . Although a CFU count > or = 30/mL predicted sepsis (sensitivity 83%, specificity 60%, positive predictive value 69%, negative predictive value 76%), a CFU count < 30/mL did not rule out serious sepsis . The higher the CFU count the greater the likelihood of sepsis . CONCLUSION: Quantitative blood culture was not shown to be a sensitive secondary test on a positive blood culture to distinguish clinical sepsis from culture contamination . Although a positive threshold of > or = 30 CFU/mL proved to be optimal, improvement in test performance would be expected with a lower incidence of culture contamination.

J Basic Microbiol, 1999, 39(5-6), 373 - 6
Evaluation of the MicroScan system for identification of staphylococci; Saa AI et al.; Conventional biochemical tests were compared with reactions in a multiple test system, MicroScan Walkaway (Dade Diagnostic Inc . MicroScan Divison, West Sacramento, California) in conjugation with the Combo Pos ID Panels (Dade Diagnostic Inc . MicroScan Divison, West Sacramento, California), in order to evaluate the accuracy for the identification of 99 clinical isolates of Staphylococcus spp . and five reference strains . False-negative or positive reactions were detected from Voges-Proskauer, urease and mannose tests . A good correlation was found among the two identification systems for the fermentation of trehalose, lactose, raffinose, as well as for arginine dyhydrolase, esculin hydrolisis and nitrate reduction . From the results of the present study, it is concluded that the MicroScan Walkaway system is a reliable method for identification of staphylococci (94.23%), although 8.2% could be identified to the species level only after use of additional test.

J Food Prot, 2000 Dec, 63(12), 1697 - 701
Potential use of presumptive enterococci and staphylococci as indicators of sanitary condition in plants making hard Italian-type cheese; Ingham SC et al.; Raw milk, pasteurized milk, unripened cheese (1 day old), and partially ripened cheese (3 months) from 42 milk lots at a plant making hard Italian-type cheese were analyzed for presumptive enterococci using kanamycin esculin azide agar pour plates . Fully ripened (> or =10 months) cheeses, derived from other milk lots, were also tested . Numbers of presumptive staphylococci (Baird-Parker agar {B-P}) were determined in the partially and fully ripened cheeses . Presumptive enterococci were ubiquitous in raw milk, usually at levels of 2.1 to 3.0 log CFU/ml . Enterococci were detected in 11 (26%) of 42 pasteurized milk samples . Enterococci and staphylococci were detected in 39 (93%) and 6 (14%) of unripened cheeses and in 33 (80%) and 4 (10%) of partially ripened cheeses, respectively . Only eight and five samples of enterococci-positive unripened and partially ripened cheese, respectively, were made from pasteurized milk in which presumptive enterococci were detected . Of 42 samples of fully ripened cheese, 35 (83%) and 8 (19%), respectively, contained presumptive enterococci and staphylococci . Results suggest either that low numbers of presumptive enterococci survive pasteurization and cheese ripening or that contamination of cheese by enterococci occurs after pasteurization . Biochemical testing confirmed 63% of presumptive enterococci isolates . None of the 20 presumptive staphylococci isolates produced colonies typical of Staphylococcus aureus on B-P agar; the isolates were identified as 1 Staphylococcus epidermidis, 1 Staphylococcus xylosus, 2 Staphylococcus saprophyticus, 1 Staphylococcus warneri, 5 Kocuria spp., and 10 unidentified gram-positive, catalase-positive cocci . Three staphylococci isolates decreased in numbers by more than 3.0 log CFU/ml in 9.9 ml of skim milk heated 30 min in a 62.8 degrees C water bath . This finding suggests that most presumptive staphylococci detected may have been prepasteurization contaminants . Unless specificity of the kanamycin esculin azide and B-P media is improved, use of presumptive enterococci and staphylococci as indicators of postpasteurization sanitation in plants making hard Italian-type cheese cannot be recommended.

J Antimicrob Chemother, 2000 Jan, 45(1), 111 - 3
Comparison of PCR detection of mecA with methicillin and oxacillin disc susceptibility testing in coagulase-negative staphylococci; Graham JC et al.; The provisional BSAC method for the detection of methicillin sensitivity in coagulase-negative staphylococci (CNS) requires incubation of isolates for 48 h and raises the problem of timely reporting of susceptibility data . The forthcoming withdrawal of methicillin raises another difficulty . We evaluated 42 clinically significant CNS blood culture isolates by PCR, methicillin and oxacillin disc testing and by using methicillin Etests . Our results suggest that, although oxacillin disc susceptibility testing is a reasonable first line step, optimal and timely detection of resistance or susceptibility may require a combination of phenotypic and genotypic methods.

Am J Vet Res, 1999 Dec, 60(12), 1526 - 30
Methicillin resistance among staphylococci isolated from dogs; Gortel K et al.; OBJECTIVE: To determine whether methicillin-resistant staphylococci from dogs expressed the mecA gene and to determine what proportion of canine staphylococcal isolates positive for the mecA gene were resistant to oxacillin and other antibiotics . SAMPLE POPULATION: 25 methicillin-resistant (10 coagulase-positive and 15 coagulase-negative) and 15 methicillin-susceptible (8 coagulase-positive and 7 coagulase-negative) staphylococci isolated from dogs . PROCEDURE: All strains were tested for methicillin resistance by use of oxacillin agar screening and identified by use of standard techniques . Minimum inhibitory concentrations of 16 antibiotics were determined for all 40 isolates . A polymerase chain reaction method targeting a 533-basepair fragment of the mecA gene was used to detect mecA gene expression . RESULTS: 23 of the 25 methicillin-resistant isolates and none of the methicillin-susceptible isolates possessed the mecA gene . For 10 of 16 antibiotics, the proportion of mecA-positive isolates that were resistant or of intermediate susceptibility was significantly higher than the proportion of mecA-negative isolates that were resistant or of intermediate susceptibility . Only 1 methicillin-resistant coagulase-positive isolate was identified as Staphylococcus intermedius; the other 9 were identified as S . aureus . CONCLUSIONS AND CLINICAL RELEVANCE: Results confirm that staphylococci isolated from dogs may have methicillin resistance mediated by the mecA gene . Isolates positive for the mecA gene were more likely to be resistant to various antibiotics than were isolates negative for the mecA gene . Results suggest that in dogs, infections caused by staphylococci that have the mecA gene may be difficult to treat because of resistance to antibiotics.

Ann Thorac Surg, 1999 Dec, 68(6), 2123 - 8
Hydrogen peroxide for prevention of bacterial growth on polymer biomaterials; Alt E et al.; BACKGROUND: Despite widespread use of potent antibiotics, infections of artificial implants and catheters are of increasing concern . We tested whether local treatment with 3% hydrogen peroxide (H2O2), long known as an inexpensive wound disinfectant, could prevent or reduce bacterial growth on polymer biomaterials . METHODS: Two-centimeter-long pieces of polyurethane and silicone tubing were contaminated with a standardized solution of Staphylococcus epidermidis (10(5)/mL) and then rinsed and wiped with saline (0.9%) solution . Bacterial growth was assessed after incubation at 37 degrees C for 24 hours . Bacterial colonies were compared for the following treatments: wiping only with saline; wiping with 1.5%, 2%, or 3% H2O2; pretreating biomaterials with 3% H2O2 and subsequent contamination for 2 and 4 hours without treatment after contamination; and contamination of tubings 1 month after pretreatment with 3% H2O2 . The effect of 3% H2O2 was also assessed on contamination with Escherichia coli . RESULTS: Bacterial growth was reduced by more than 99% when the contaminated tubes were treated with 3% H2O2 compared with saline control (p < 0.001) . Lower concentrations of H2O2 were less effective . The length of the contamination period had no influence on the effectiveness of H2O2 when used on polyurethane but did with silicone tubings . Pretreatment with H2O2 1 month before contamination still reduced bacterial growth rate by 90% on polyurethane and by 75% on silicone tubings . Comparable effects on bacterial growth rate were observed for staphylococci (-90%, p < 0.001) and escherichiae (-90%, p < 0.001) . CONCLUSIONS: Local treatment with 3% H2O2 significantly reduced bacterial growth on polymer biomaterials even for 1 month after treatment . This finding might influence clinical strategies of prevention of foreign body infection.

J Burn Care Rehabil, 1999 Nov-Dec, 20(6), 471 - 7
The 1999 Lindberg award . 3% hydrogen peroxide for the gram-positive disinfection of fabrics; Neely AN et al.; Because of growing concern about the spread of antibiotic-resistant gram-positive bacteria in burn and trauma units, an inexpensive, safe, effective means of spot-disinfecting fabrics (such as privacy curtains) that remain in clinic or patient rooms as various patients use the rooms was sought . From comparisons of cost and safety data, 3% hydrogen peroxide was chosen to be tested for its efficacy in the control of these bacteria . Systematic laboratory testing used 30 antibiotic-resistant and sensitive staphylococci and enterococci and 4 common hospital fabrics: cotton (clothing), terry cloth (towels), cotton-polyester blend (scrub suits), and polyester (curtains) . Without disinfection, bacteria survived for many hours to several days . After a single spraying with 3% hydrogen peroxide, all bacteria on all fabrics were dead within 5 to 120 minutes . On-site testing targeted privacy curtains in patients' rooms . Curtain edges that tended to be grabbed when moving the curtain showed a mixture of gram-positive and gram-negative bacteria (median, 22 bacteria/24 cm2) . After these areas were sprayed with 3% hydrogen peroxide, no bacteria were found . It was concluded that spraying with 3% hydrogen peroxide is a safe, inexpensive, effective means of spot-disinfecting fabrics in patients' rooms; this simple procedure may limit the spread of potentially pathogenic antibiotic-resistant bacteria.

Clin Orthop, 1999 Dec, (369), 110 - 23
Emerging antibiotic-resistant bacteria . Their treatment in total joint arthroplasty; Garvin KL et al.; Successful treatment of an infected total joint arthroplasty can be achieved in approximately 90% of cases . This outcome may be jeopardized by the emergence of antibiotic resistance in bacteria common to these infections . Staphylococci are the most frequently isolated bacteria in total joint infections, and the prevalence of antibiotic resistance in these organisms among all nosocomial and community-acquired infections has been increasing . As many as 46.7% of Staphylococcus aureus strains and 85.7% of coagulase-negative staphylococci strains are methicillin-resistant . Enterococci also are commonly isolated from infected total joint arthroplasties . The prevalence of vancomycin-resistant enterococci among all enterococci strains is estimated at 23% . As the prevalence of these resistant bacteria continues to increase among all infections, it is anticipated that they will be encountered more regularly in total joint infections . Knowledge of the mechanisms of resistance of these bacteria and currently available and newly developed antimicrobials is key to preventing the expansion of antimicrobial resistance and ensuring the future successful treatment of total joint infections.

Rev Esp Cardiol, 1999 Nov, 52(11), 1022 - 4
{A right aorto-atrial fistula as a complication of early prosthetic endocarditis}; Ten Morro F et al.; Early infectious endocarditis occurs in 3% of prostheses in the first 12 months after valvular surgery and is more aggressive than late prosthetic endocarditis . Mortality remains high, especially in early cases, despite combined medical and surgical treatment . Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction, and is mainly caused by staphylococci . We present a case report of early prosthetic endocarditis in aortic prostheses complicated with severe aortic regurgitation and right atria-aortic root fistula with auriculoventricular and intraventricular disturbance in electrocardiogram.

Salud Publica Mex, 1999, 41 Suppl 1, S44 - 50
{Surveillance of surgical wound infections . 18-month experience in the Instituto Nacional de Cancerología}; Vilar-Compte D et al.; OBJECTIVE: To calculate the surgical site infection (SSI) rates with a surgical prospective surveillance program and postdischarge follow-up . MATERIAL AND METHODS: During a 18 months period (01/01/93 to 04/30/94), a surgical wound surveillance program followed on the surgeries practiced at the National Institute of Cancerology, a referral center situated in Mexico City . Rates per 100 surgeries were calculated for the surgical services and for each of the wound class strata . The SS's were classified according to the 1992 Center for Disease Control definitions for surgical infections . RESULTS: Three thousand, three hundred and severity-two surgeries were assessed; 313 were diagnosed as infected: 140 (44.7%) were superficial incisional, 137 (43.7%) were deep incisional and 36 (11.5%) were organ and space infections . The SSI rate for this period was 9.28%; for the clean, clean-contaminated, contaminated and dirty surgeries the rates were 7.35, 10.5, 17.3 and 21.5% respectively . The rates for each service were: gastroenterology, 14.13%; breast tumors, 11.08%; mixed tumors, 10.98%; gynecology, 9.06%; urology, 7.38%; head and neck, 7.13%, and thoracic surgery, 1.81% . On average SSI were detected at 11.6 +/- 6.23 days, eighty-five (27.16%) were diagnosed while the patient was in-hospital, the remaining 228 (72.84%) were detected after discharge . In 134 (42.8%) patients a culture was obtained . The bacteria most frequently found were: E . coli, 38 (22.5%); coagulase negative Staphylococci, 23 (13.6%); Pseudomonas sp., 22 (13%); S . aureus, 16 (9.4%); and Enterococcus, 13 (7.7%) . CONCLUSIONS: The prospective surveillance program with a follow-up for 30 days increased by 400% the chance to identify a SSI . The SSI rate for clean and clean-contaminated surgeries are above the rates reported in the literature.

Presse Med, 1999 Nov 27, 28 Suppl 3, 15 - 6
{Some aspects of virulence}; Joly-Guillou ML; GLYCOPEPTIDE INTERACTION AND THE STAPHYLOCOCCI WALL: Glycopeptides induce modifications in the cell wall of staphylococci . This modification has been observed in VISA strains and could involve bacterial adherence to materials . QUORUM SENSING: Bacterial virulence in Gram-negative germs is closely related to quorum sensing, a system regulated by bacterial inoculum . The use of strains deficient in different steps of quorum sensing in a experimental rat model has been useful in better understanding the pathophysiological effects linked to this system of virulence.

Antimicrob Agents Chemother, 2000 Jan, 44(1), 190 - 1
satG, conferring resistance to streptogramin A, is widely distributed in Enterococcus faecium strains but not in staphylococci; Haroche J et al.; A gene almost identical to satG was isolated from an Enterococcus faecium strain . This gene was transferred to a Staphylococcus aureus recipient strain where it conferred resistance to streptogramin A . satG was found to be widely distributed among E . faecium strains but not detected among staphylococci.

Adv Exp Med Biol, 1999, 455, 387 - 96
Antibiotic resistance in bacteria . A current and future problem; Liu HH; Bacterial pathogens have become increasingly resistant to commonly used antibiotics . In some cases, there are no remaining first-line options for therapy . Problem pathogens which may cause dermatologic and rheumatologic infections will be discussed, including vancomycin-resistant staphylococci and enterococci as well as the multiply-resistant Gram-negative bacilli . Risk factors for acquisition of these organisms and diagnostic studies available for their detection will be reviewed . The underlying mechanisms of resistance, geographic prevalence, potential for continued spread, and proposed strategies for prevention and control are examined . Finally, information on the newer topical and systemic antimicrobial agents, including investigational therapies, will be presented.

J Int Med Res, 1999 Jul-Aug, 27(4), 191 - 5
Distribution and antimicrobial susceptibility of coagulase-negative staphylococci from skin lesions; Higaki S et al.; The distribution and antimicrobial susceptibility of coagulase-negative staphylococci from skin lesions were investigated . Staphylococcus epidermidis was found on all areas of the body, whereas S . capitis, S . haemolyticus and S . hominis were mainly found on the face/head or arm/leg . The distribution of coagulase-negative staphylococci in skin lesions and at the same location on normal skin was similar . Staphylococcus lugdunensis was the most susceptible to the nine tested antimicrobials (benzylpenicillin, ampicillin, piperacillin, cefazolin, erythromycin, minocycline, gentamicin, vancomycin and ofloxacin) and S . epidermidis the least susceptible . S . haemolyticus also showed low susceptibility to all nine antimicrobials . Low susceptibility to penicillins may be explained by beta-lactamase production . The existence of coagulase-negative staphylococci, especially concerning their potential pathogenicity and multiple drug resistance, should not be neglected.

J Microbiol Immunol Infect, 1997 Nov, 30(4), 275 - 80
{Identification of Staphylococcus epidermidis by desferrioxamine susceptibility and trehalose fermentation tests}; Chiou JY et al.; The importance of coagulase-negative staphylococci, especially Staphylococcus epidermidis in clinical and nosocomial infection are recognized increasingly in recent years . A rapid and accurate identification of S . epidermidis is therefore important and necessary . A new test, susceptibility to desferrioxamine, coupled with trehalose fermentation has been recommended for the identification of this organism . However, the medium and method used are different from what has been recommended by the NCCLS . To investigate the feasibility of using the desferrioxamine susceptibility test in conjunction with the routinely used disc agar diffusion test, we employed 111 staphylococcal strains (including 51 S . epidermidis isolates, 15 S . hominis and 45 other coagulase-negative staphylococci) as test organisms, and followed the procedures recommended by the NCCLS in which Mueller-Hinton agar and standard inoculum were used . Results indicated that all strains of S . epidermidis and S . hominis were susceptible to 1 mg desferrioxamine (the diameter of the inhibition zone were 28-37 mm) . The minimum inhibitory concentrations of desferrioxamine to S . epidermidis and S . hominis isolates were determined to be 125 micrograms/ml . Further differentiation of S . hominis and S . epidermidis can be made by their ability to ferment trehalose, the former could while the latter could not . We conclude that the desferrioxamine susceptibility test of coagulase-negative staphylococci can be used in conjunction with the routine disc agar diffusion method . S . epidermidis can be identified rapidly and accurately by its susceptibility to 1 mg desferrioxamine and inability to ferment trehalose.

Lancet, 1999 Nov 27, 354(9193), 1875 - 6
Association between cerebral palsy and coagulase-negative staphylococci; Mittendorf R et al.; Coagulase-negative staphylococci were cultured from the space between the placental membranes at delivery in four of five neonates who were later diagnosed with cerebral palsy, and in 26 of 102 neonates who were not found to have the disorder (p=0.02).

Clin Infect Dis, 1999 Oct, 29(4), 932 - 4
Bloodstream infections caused by small-colony variants of coagulase-negative staphylococci following pacemaker implantation; von Eiff C et al.; Small-colony variants (SCVs) of Staphylococcus aureus cause persistent and relapsing infections . Relatively little is known regarding infections caused by SCVs of coagulase-negative staphylococci . We report two cases of pacemaker electrode infections due to SCVs of Staphylococcus epidermidis and Staphylococcus capitis . Sequence analysis of a portion of the 16S rRNA gene (16S rDNA) confirmed the identity of the staphylococcal species as S . capitis and S . epidermidis . Isolates from cultures of blood obtained over at least a 2-week interval were compared by pulsed-field gel electrophoresis and found to be clonal even though the colony morphology was very different . Analysis for auxotrophism revealed hemin dependencies for all isolated SCVs . The two cases have several clinical and laboratory characteristics (which are also seen with S . aureus SCV infections) and strongly suggest that SCVs of coagulase-negative staphylococci must be actively sought, because they grow very slowly and can be easily missed.

Clin Infect Dis, 1999 Oct, 29(4), 760 - 7
Bacteremia caused by staphylococci with inducible vancomycin heteroresistance; Wong SS et al.; The clinical significance of bacteremia due to vancomycin-heteroresistant staphylococci and a rapid laboratory screening method were examined; 203 strains of staphylococci isolated from patients with clinically significant bacteremia were screened by the disk-agar method with use of vancomycin-salt agar to demonstrate satellitism around an aztreonam disk as well as by conventional population screening . Eighteen isolates (three Staphylococcus aureus and 15 coagulase-negative staphylococci) were shown to be heteroresistant to vancomycin . A case-control clinical study showed that the interval between admission and bacteremia, admission to the intensive care unit, prior use of vancomycin and/or beta-lactams, and isolation of methicillin-resistant staphylococci were significantly more common among patients with bacteremia due to staphylococci with heteroresistance to vancomycin; these patients had an overall mortality of 44.4% . The use of vancomycin and admission to the intensive care unit were independently significant risk factors on multivariate analysis . Vancomycin heteroresistance is inducible by salt and beta-lactams . Indiscriminate sequential use of beta-lactams and glycopeptides may facilitate the emergence of glycopeptide resistance.

J Antimicrob Chemother, 1999 Oct, 44(4), 541 - 4
Resistance to methicillin in isolates of Staphylococcus aureus from blood and cerebrospinal fluid in Wales, 1993-1997; Morgan M et al.; Surveillance data for organisms isolated from blood cultures and cerebrospinal fluid (CSF) specimens has been gathered electronically in Wales since 1993 . Over this period the proportion of total reported organisms from blood cultures and CSF represented by methicillin-resistant staphylococci (MRSA) has risen steadily . This has corresponded to a rise in rates of methicillin resistance amongst Staphylococcus aureus isolated from blood cultures and CSF from 4 to 43% . In certain age/gender groups in 1997, more than 50% of isolates of S . aureus were resistant to methicillin, suggesting that a change in empirical treatment may be necessary for suspected staphylococcal sepsis.

Eur J Clin Microbiol Infect Dis, 1999 Oct, 18(10), 691 - 6
Presence of Staphylococcus aureus with reduced susceptibility to vancomycin in Germany; Bierbaum G et al.; A total of 457 Staphylococcus aureus strains from the culture collection of the National Reference Center for Staphylococci in Bonn, Germany, were screened for susceptibility to vancomycin because some Staphylococcus aureus strains are able to form subpopulations that show intermediate resistance to vancomycin . Two methicillin-resistant Staphylococcus aureus strains (isolated in 1993) exhibited intermediate resistance . One of these, Staphylococcus aureus 137-93, which displayed the genomic DNA fragment pattern of the northern German epidemic strain, appeared homogeneously resistant . Neither of these strains had been identified by routine susceptibility testing . The resistance of the German isolates was lower than that of the Japanese isolate Mu50 . To determine whether a similar mechanism confers vancomycin resistance in Staphylococcus aureus Mu50 and 137-93, the intracellular cell wall precursor concentration was measured and was not found to be comparably increased in Staphylococcus aureus 137-93 . In conclusion, strains showing intermediate resistance have been present in Germany for some time (at least since 1993), but the subpopulations with decreased sensitivity were overlooked during antibiotic susceptibility testing.

Eur J Clin Microbiol Infect Dis, 1999 Oct, 18(10), 683 - 90
Vancomycin resistance: status quo and quo vadis; Endtz HP et al.; The prevalence of vancomycin resistance is steadily rising among clinical isolates of Enterococcus spp., thereby limiting the treatment options for infections caused by vancomycin-resistant enterococci . The precise nature of the glycopeptide resistance genes has been elucidated, and many studies on gene reservoirs and strain-versus-resistance-gene epidemiology have been performed . The prevalence of vancomycin-resistant enterococci in various clinical and environmental settings in relation to nosocomial and veterinary applications of antimicrobial glycopeptides is discussed in detail in this review . Novel molecular tools for the identification of vancomycin-resistant enterococci genomes or the various resistance genes have been applied in order to expand current insight into the overall epidemiology of the resistance trait itself . The risk of the spread of vancomycin resistance to other bacterial species was recently underscored by the emergence of staphylococci showing clinical resistance to vancomycin . The topics mentioned above are elaborated on and discussed in light of the increasing medical concern on the future detection of microbial infections beyond chemotherapeutic cure.

Br J Dermatol, 1999 Sep, 141(3), 558 - 61
Micrococcus folliculitis in HIV-1 disease; Smith KJ et al.; Organisms with little pathogenic potential in immunocompetent hosts may produce disease in HIV-1 + patients . We describe three HIV-1 + patients in late disease who presented with pruritic papules with central ulceration over the face and arms . In all the patients the eruptions had been present for months, and the patients did not develop sepsis . Biopsy specimens in all the patients showed large Gram-positive cocci, forming tetrads . Colony morphology, catalase positivity and coagulase negativity, and resistance to nitrofurantoin were used to separate micrococci from staphylococci . Micrococcus species are usually considered normal inhabitants of the skin; however, in patients with HIV-1 disease, Micrococcus species can produce localized cutaneous infections.

J Hosp Infect, 1999 Nov, 43(3), 195 - 202
Rapid emergence of resistant coagulase-negative staphylococci on the skin after antibiotic prophylaxis; Terpstra S et al.; One approach for prosthetic vascular surgery is to continue antimicrobial prophylaxis while intravascular lines and catheters are in place . However this may give rise to antimicrobial resistance in the colonizing bacterial flora . We studied 37 patients undergoing vascular surgery, who received either co-amoxyclav for three days (group 1), ofloxacin plus metronidazole for three days (group 2) or for one day (group 3), respectively . Seventeen hospitalized patients not undergoing surgery or receiving antibiotics were studied as controls . In groups I and II there was a significant decline in susceptibility to cloxacillin (12.8% respectively 23.6%) and ofloxacin (0.5% and 85% respectively) in skin staphylococci . The results from group 3 were intermediate . Molecular typing showed that the patient's susceptible community-derived strains were replaced by genetically unrelated resistant strains, probably hospital derived . Long-term prophylaxis should be avoided as colonization occurs with resistant strains.

J Hosp Infect, 1999 Nov, 43(3), 187 - 93
The genomic diversity of coagulase-negative staphylococci associated with nosocomial infections; Lang S et al.; A total of 117 isolates of coagulase-negative staphylococci (CNS) were collected from patients in three medical centres . They were genotyped by pulsed-field gel electrophoresis (PFGE) following digestion with restriction enzymes SmaI and SstII . The isolates included Staphylococcus epidermidis, S . simulans, S . hominis, S . lugdunensis, S . capitis, S . saprophyticus, S . caprae and S . sciuri . They were collected at random from 82 patients and were associated with infected central venous lines, continuous ambulatory peritoneal dialysis (CAPD) catheters, endocarditis, osteomyelitis of prosthetic hips and internally fixed fractures . The genetic heterogeneity of the strains was demonstrated by PFGE profiles and two dendrograms . Though the strains were segregated into species, there was no clustering of the strains by type of infection, associated medical unit or geographical location of the patient . Numerous genotypes were identified, suggesting that no specific strains of CNS are associated with prosthetic related infection.

J Hosp Infect, 1999 Nov, 43(3), 179 - 85
Nosocomial infections in patients with HIV disease; Laing RB; Throughout the AIDS epidemic, nosocomial infection in the patient with HIV disease has presented a constant problem--not only for the hospitalized patient but also for the clinic attender . The nosocomial spread of multidrug-resistant tuberculosis has emphasized the need for effective control of infection measures in dealing with the immunodeficient . Increased recognition of nosocomial bacterial pneumonias has raised questions about the place, if any, of antimicrobial prophylaxis in preventing Gram-negative and Legionella infection . The use of long-term indwelling venous catheters for the administration of parenteral therapy is associated with an increased risk of nosocomial bloodstream infection--particularly from staphylococci and Pseudomonas spp . Evidence now exists for the nosocomial spread of opportunistic infections, including Cryptosporidium parvum, Mycobacterium avium complex and Pneumocystis carinii . The delay between exposure and diagnosis, the atypical presentation of infections such as tuberculosis and repeated hospital admissions of AIDS patients can combine to confuse the issue with the result that a nosocomial infection may be mis-classified as community-acquired . It seems likely that the burden of nosocomial infection in HIV disease is continually underestimated.

Int J Food Microbiol, 1999 Nov 1, 52(1-2), 47 - 56
Effect of nitrate and incubation conditions on the production of catalase and nitrate reductase by staphylococci; Talon R et al.; The objective of this work was to study the production of catalase and nitrate reductase by staphylococci in order to understand their role in lipid oxidation during sausage manufacturing . Catalase and nitrate reductase were measured in resting cells and supernatants of staphylococci grown in different conditions . All staphylococci (except S . warneri) synthetized nitrate reductase . In static condition, the synthesis was maximal during exponential growth phase, whereas in shaking condition, the synthesis was maximal at the beginning of stationary phase . The production of nitrate reductase was increased in presence of nitrate, this effect was particularly important for the two S . carnosus strains which exhibited the highest activity . For all staphylococci, the production of catalase was maximal at the end of the exponential growth phase . The lowest amount of catalase was produced by S . warneri and the highest by S . carnosus . Only S . xylosus 873 and S . saprophyticus 852 released high amounts of catalase in the supernatant growth . Staphylococci produced higher amounts of catalase in shaking conditions . Addition of nitrate in the growth media favoured the synthesis of catalase, with a pronounced effect for S . carnosus . Nitrate also favoured the release of catalase.

Chemotherapy, 1999 Nov-Dec, 45(6), 399 - 404
Gastrointestinal damage induced by cytostatic treatment does not affect the bioavailability of co-trimoxazole; Nyhlen A et al.; Twelve lymphoma patients received prophylaxis with co-trimoxazole during cytostatic treatment according to the MACOP-B regimen with cyclophosphamide, doxorubicin, vincristine, methotrexate, bleomycin, folinic acid and prednisone . Gastrointestinal mucosal damage from cytostatic treatment was estimated by WHO toxicity scores . No correlation was found between the degree of gastrointestinal damage and the presumed bioavailability of co-trimoxazole as estimated from serum levels of trimethoprim and sulphamethoxazole . The serum concentrations were above the minimum inhibitory concentration for Escherichia coli, Staphylococcus aureus and coagulase-negative staphylococci irrespective of the degree of toxicity . There is no apparent reason to change the dosing regimen of prophylactic co-trimoxazole when there is clinical evidence of damage to the gastrointestinal mucosa induced by chemotherapy.

Sao Paulo Med J, 1999 Jul 1, 117(4), 175 - 8
Identification and medical importance of coagulase-negative staphylococci species; Minto EC et al.; A total of 126 coagulase-negative staphylococci strains (CNS) were isolated from blood samples and from the intravenous catheters and cerebrospinal fluid of 103 patients admitted to the University Hospital of Ribeirao Preto . Staphylococcus epidermidis (68.2%), S . haemolyticus (11.1%) and S . hominis (3.2%) were the most frequent species . The last two CNS showed greater resistance to antimicrobial agents than S . epidermidis . CNS were the agents of infection in 10 . 7% of the patients and the agents of intravenous catheter colonization in 18.4% of the cases.

Infect Immun, 1999 Dec, 67(12), 6688 - 90
A lithium chloride-extracted, broad-spectrum-adhesive 42-kilodalton protein of Staphylococcus epidermidis is ornithine carbamoyltransferase; Hussain M et al.; To identify novel putative staphylococcal adhesins, lithium chloride extraction (an established method for selective surface molecule solubilization) was employed . N-terminal sequencing and functional assays identified a 42-kDa fibronectin-binding protein from Staphylococcus epidermidis as ornithine carbamoyltransferase (OCTase) . However, OCTase was not recognizable extracellularly, and this fact together with the fact that LiCl induced DNA release and a decrease in viability suggests that LiCl extraction may not be the method of choice for selective surface molecule extraction from staphylococci.

J Clin Microbiol, 1999 Dec, 37(12), 4192 - 3
Direct mecA detection from blood culture bottles by branched-DNA signal amplification; Zheng X et al.; A branched-DNA (bDNA) signal amplification method was used to detect the mecA gene directly from blood culture broth growing staphylococci . BACTEC blood culture bottles with positive growth indices and containing staphylococcus-like organisms as shown by Gram stain were tested for the presence of the mecA gene . Comparison of test results was done among 225 patients (one blood culture from each patient) . Compared with PCR, the sensitivity and specificity of the bDNA method are 100 and 99%, respectively . The bDNA test is carried out in a 96-well format and requires approximately 6 h to perform . Our preliminary results suggest that direct detection of the mecA gene by bDNA signal amplification is (i) sensitive enough to detect mecA directly from blood culture bottles without the requirement for subculture and (ii) as sensitive and specific as the PCR-based method.

J Clin Microbiol, 1999 Dec, 37(12), 4051 - 8
Methods for improved detection of oxacillin resistance in coagulase-negative staphylococci: results of a multicenter study; Tenover FC et al.; A multilaboratory study was undertaken to determine the accuracy of the current National Committee for Clinical Laboratory Standards (NCCLS) oxacillin breakpoints for broth microdilution and disk diffusion testing of coagulase-negative staphylococci (CoNS) by using a PCR assay for mecA as the reference method . Fifty well-characterized strains of CoNS were tested for oxacillin susceptibility by the NCCLS broth microdilution and disk diffusion procedures in 11 laboratories . In addition, organisms were inoculated onto a pair of commercially prepared oxacillin agar screen plates containing 6 microg of oxacillin per ml and 4% NaCl . The results of this study and of several other published reports suggest that, in order to reliably detect the presence of resistance mediated by mecA, the oxacillin MIC breakpoint for defining resistance in CoNS should be lowered from >/=4 to >/=0.5 microg/ml and the breakpoint for susceptibility should be lowered from </=2 to </=0.25 microg/ml . In addition, a single disk diffusion breakpoint of </=17 mm for resistance and >/=18 mm for susceptibility is suggested . Due to the poor sensitivity of the oxacillin agar screen plate for predicting resistance in this study, this test can no longer be recommended for use with CoNS . The proposed interpretive criteria for testing CoNS have been adopted by the NCCLS.

J Clin Oncol . 1999 Apr;17(4):1304.
Hickman catheter-related infections in neutropenic patients: insertion in the operating theater versus insertion in the radiology suite; Nouwen JL et al.; PURPOSE: To determine the influence of microbial air quality during Hickman catheter insertion in the operating theater versus insertion in the radiology suite on the incidence of catheter-related infections (CRIs) . PATIENTS AND METHODS: Hemato-oncologic patients with prolonged neutropenia on antimicrobial prophylaxis were entered onto the study . Catheters were inserted by experienced radiologists under sonographic and fluoroscopic guidance . RESULTS: Forty-eight Hickman catheters in 39 patients were inserted (23 in the operating theater, 25 in the radiology suite) . CRIs were seen in 16 catheters (33%; six per 1,000 catheter days; eight in each group) . Local infections were found in nine catheters (22%; six in the operating theater v three in the radiology suite; not significant {NS}), catheter-related bacteremia was found in 10 (29%; three in the operating theater v seven in the radiology suite; NS) . Coagulase-negative staphylococci (CoNS) caused all CRIs . Despite early vancomycin therapy, 11 (69%; four in the operating room group v seven in the radiology suite group; NS) of the catheters with CRIs had to be removed prematurely . At 90 days after insertion, catheter survival was 78% and 60% (NS) for the operating room and radiology suite, respectively . Multivariate analysis showed that neutropenia increased the CRI risk 20-fold (P =.004) and was strongly related to premature catheter removal owing to infection (relative risk = 11.9; P =.009) . Neutropenia on the day of insertion was also significantly correlated with CRI (P =.04) and premature catheter removal owing to infection (P =.03) . Serial cultures of blood, exit site, and catheter hub did not predict the development of CRI . CONCLUSION: The high incidence of Hickman CRI caused by CoNS was not associated with insertion location (operating theater v radiology suite) . Neutropenia, including neutropenia on the day of insertion, was a significant risk factor for CRI and infection-related catheter removal.

Ophthalmologe, 1999 Oct, 96(10), 663 - 7
{Preoperative infection prophylaxis with 1% polyvidon-iodine solution based on the example of conjunctival staphylococci}; Binder CA et al.; BACKGROUND: Most germs causing postoperative endophthalmitis derive from the conjunctival bacterial normal flora . Postoperative endophthalmitis is often induced by staphylococcal germs . The application of polyvidone-iodine solution to the conjunctiva is one possibility to reduce potential endophthalmitis-causing bacteria . The aim of this study was to evaluate the effectiveness of 1% polyvidone-iodine solution concerning the reduction of colonization with staphylococci in the course of intraocular surgery . This is to evaluate the effectiveness of 1% polyvidone-iodine solution concerning coagulase-negative and positive staphylococci . PATIENTS AND METHODS: Patients with intrabulbar surgery (300) had three conjunctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after antisepsis with polyvidone-iodine before opening the conjunctiva . At the end of surgery the third smear was taken . RESULTS: In 30.3% staphylococci were isolated from eyes before disinfection . Some patients (7.7%) were staphylococci-positive after disinfection; 5.3% of the patients showed staphylococcal growth at the end of surgery . To evaluate the effectiveness of polyvidone-iodine 1% solution we compared the first and the second smear (Mc Nemar) . We found a statistically significant reduction (P < 0.001) . At the end of surgery the conjunctival colonization with staphylococcal germs remained statistically significant reduced (P < 0.001) . The mean operation time was 37 +/- 24 min . CONCLUSIONS: We concluded that a significant reduction of a staphylococcal colonization can be achieved by preoperative application of polyvidone-iodine (1%) (P < 0.001) . Even at the end of surgery the effect of 1% polyvidone-iodine solution held.

Anesthesiology, 1999 Nov, 91(5), 1394 - 400
Growth of Staphylococcus aureus in Diprivan and Intralipid: implications on the pathogenesis of infections; Langevin PB et al.; BACKGROUND: The incidence and severity of infections are increased when Intralipid or Diprivan are administered to patients . Intralipid promotes infection, presumably by inhibiting the reticuloendothelial system, thereby suppressing the host's constitutive immunity, whereas Diprivan supposedly promotes infection by supporting bacterial growth and increasing the inoculating dose . This study considers whether bacterial replication alone in Intralipid and Diprivan adequately explains the increased risk of infection associated with these agents or whether other factors might also be involved . METHODS: Staphylococcus aureus was cultured in 10% Intralipid or Diprivan at clinically relevant conditions or in Intralipid containing 0.005% (w/v) sodium EDTA, a current additive, to measure growth . To determine whether Intralipid affected infection, New Zealand white rabbits were injected intravenously with S . aureus with or without Intralipid . Twenty-four hours later, bacteria in lung, liver, spleen, and kidney tissues were enumerated . RESULTS: S . aureus failed to grow in Diprivan or Intralipid containing 0.005% EDTA . Whereas S . aureus did replicate in plain Intralipid, growth was delayed until the bacteria conditioned the media . Once initiated, growth was slow at clinically relevant temperatures . The administration of Intralipid to rabbits significantly increased the recovery of staphylococci from the kidneys, P < 0.001, relative to the other tissues 24 h after an intravenous inoculation with S . aureus, compared with rabbits receiving S . aureus with no Intralipid . CONCLUSIONS: These results suggest that Diprivan, and possibly Intralipid, represent poor media for the growth of S . aureus and may promote infection through mechanisms other than increased inoculum size.

Clin Oral Implants Res, 1999 Oct, 10(5), 339 - 45
Microbial findings at failing implants; Leonhardt A et al.; The aim of this study was to evaluate qualitative differences in the subgingival microbiota at titanium implants, ad modum Branemark, demonstrating clinical and radiographic signs of loss of supporting tissues (peri-implantitis) as compared to implants surrounded by healthy tissues . A total of 37 patients demonstrating 1 or more implants with bone loss > or = 3 threads, bleeding on probing and/or suppuration and 51 patients with clinically healthy mucosa and no bone loss were recruited for the study . In each patient subgingival bacterial samples were obtained using paper-points, and subjected to microbiological analysis by culture . The two types of clinical conditions showed distinct bacterial profiles . For implants with peri-implantitis putative periodontal pathogens, such as Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens and Actinobacillus actinomycetemcomitans, were found in 60% of the cases and microorganisms primarily not associated with periodontitis, such as Staphylococcus spp., enterics and Candida spp., were found in 55% of the peri-imaplant lesions . In contrast, implants surrounded by healthy tissue demonstrated a microbiota associated with periodontal health . The results indicate that the microbiota of the healthy peri-implant sulci is similar to that from corresponding conditions around teeth . However, in peri-implant areas staphylococci, enterics and yeasts were found almost as frequently as periopathogens indicating differences as compared to the microbiota around periodontitis affected teeth . A microbiological diagnosis may therefore be of guidance for the choice of antimicrobial treatment in patients with peri-implant infection.

Klin Lab Diagn, 1999 Aug, (8), 35 - 7
{A nutrient medium for the isolation of staphylococci with persistence characteristics}; Bukharin OV et al.; A new selective medium with fusidine for isolation of persistent staphylococci is developed and tried . The medium can be used for detecting the agent (staphylococcus) in mixed microflora in infectious diseases, in screenings for resident Staphylococcus carriership, in bioindication of air contamination, for predicting the course and for monitoring rational therapy of pyoinflammatory diseases in humans and animals in medicine and veterinary.

Antimicrob Agents Chemother, 1999 Nov, 43(11), 2780 - 2
Distribution of insertion sequence-like element IS1272 and its position relative to methicillin resistance genes in clinically important Staphylococci; Kobayashi N et al.; The distribution of insertion sequence-like element IS1272 was analyzed for clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus . In each of the staphylococcal species, IS1272 was detected in both methicillin-resistant (MR) and methicillin-susceptible strains of different genetic types . In MR isolates, IS1272 was generally located downstream of the truncated mecR1 gene (DeltamecR1), with an identical junction sequence occurring between DeltamecR1 and IS1272, although insertion of an additional gene sequence in the junction sequence was detected in one S . epidermidis isolate . These findings suggest that the mec element with the rearranged form of mecR1 (DeltamecR1-IS1272) has been transmitted to multiple clones of staphylococci.

Proc Natl Acad Sci U S A, 1999 Oct 26, 96(22), 12424 - 9
Purification and characterization of sortase, the transpeptidase that cleaves surface proteins of Staphylococcus aureus at the LPXTG motif; Ton-That H et al.; Surface proteins of Staphylococcus aureus are linked to the bacterial cell wall by sortase, an enzyme that cleaves polypeptides at the threonine of the LPXTG motif . Surface proteins can be released from staphylococci by treatment with hydroxylamine, resulting in the formation of threonine hydroxamate . Staphylococcal extracts, as well as purified sortase, catalyze the hydroxylaminolysis of peptides bearing an LPXTG motif, a reaction that can be inhibited with sulfhydryl-modifying reagents . Replacement of the single conserved cysteine at position 184 of sortase with alanine abolishes enzyme activity . Thus, sortase appears to catalyze surface-protein anchoring by means of a transpeptidation reaction that captures cleaved polypeptides as thioester enzyme intermediates.

Eur J Clin Microbiol Infect Dis, 1999 Sep, 18(9), 643 - 7
Evaluation of the mecA femB duplex polymerase chain reaction for detection of methicillin-resistant Staphylococcus aureus; Jonas D et al.; This study systematically evaluated a recently described duplex polymerase chain reaction test for methicillin-resistant Staphylococcus aureus with 25 different German epidemic strains of methicillin-resistant Staphylococcus aureus and 66 staphylococci other than methicillin-resistant Staphylococcus aureus, including 17 different coagulase-negative staphylococcal species and subspecies, that were either oxacillin susceptible or oxacillin resistant . The results were compared with those of conventional cultural identification and susceptibility testing . Of the 91 isolates tested, all 25 confirmed strains of methicillin-resistant Staphylococcus aureus were identified correctly . None of the remaining strains of methicillin-susceptible Staphylococcus aureus was misidentified as methicillin-resistant Staphylococcus aureus . It was concluded that the duplex polymerase chain reaction appears to offer a time-saving and accurate method of detection of methicillin-resistant Staphylococcus aureus.

Microbiol Immunol, 1999, 43(7), 653 - 61
Apoptosis observed in BALB/3T3 cells having ingested Staphylococcus aureus; Murai M et al.; Staphylococcus aureus was previously shown to be internalized by murine fibroblast . We examined the intracellular events of S . aureus ingested by BALB/3T3 cells . After uptake of strains A191 and A151, isolates from atopic lesion, and a laboratory strain, Cowan I, for 1 hr, BALB/3T3 cells were incubated with 1.25 microg/ml lysostaphin . Laddering of the DNA in multiples of approximately 180 bp occurred within 4 hr following bacterial addition in BALB/3T3 cells infected with A191 and within 18 hr in BALB/3T3 cells infected with A151: histochemical staining by the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method revealed that the rate of the fragmentation of nucleic DNA in Cowan I-infected BALB/3T3 cells at 21 hr following bacterial addition was 0.52 +/- 0.25%, significantly higher than that in the control cells . Transmission electron micrographs of BALB/3T3 cells at 4 hr following A191 addition showed that the apoptotic features, including electron-dense nucleus and plasma membrane blebbing, occurred in some cells in which many staphylococci escaped the endosome and went on to cell division . At the same time, A151 organisms enclosed with endosome membrane were static in the intact BALB/3T3 cells . The significant increase of A191 was confirmed by counting intracellular live bacteria during 2- to 6-hr incubation . These results suggest that internalized S . aureus escapes the endosome, multiplies and induces apoptosis in the fibroblast cell.

Scand J Infect Dis, 1999, 31(4), 399 - 404
Antibiotic susceptibility of staphylococci isolated in blood cultures in relation to antibiotic consumption in hospital wards; Monsen T et al.; A total of 510 isolates of Micrococcaceae, 500 of staphylococci and 10 micrococci, detected in 485 (3.3%) of 14,860 consecutive blood cultures obtained from patients at a Swedish university hospital and 2 local hospitals were identified to species level and investigated for antibiotic susceptibility . The 5 most frequently isolated species were Staphylococcus epidermidis (54.8%), S . aureus (28.0%), S . hominis (3.4%), S . warneri (3.2%) and S . haemolyticus (2.8%) . All isolates of S . aureus were oxacillin sensitive . Great diversity in antibiotic resistance among coagulase negative staphylococci between hospitals and different ward units in the university hospital was observed . The frequency of antimicrobial resistance among S . epidermidis correlated with the antibiotic consumption at different ward units, in particular for ciprofloxacin (p < 0.001) and co-trimoxazole (p < 0.004) . The study emphasizes the importance of monitoring antibiotic consumption and resistance patterns of nosocomial staphylococci in order to avoid emergence and spread of multi-resistant bacteria within the hospital environment.

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