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 mor