Int J Antimicrob Agents, 1999 Aug, 12 Suppl 2, S79 - 93 Fusidic acid in bone and joint infections; Atkins B et al.; The prominence of staphylococci as the causative agent in bone and joint infections suggests that fusidic acid (FA) has a potentially important role in their treatment . FA has been studied in a broad range of orthopaedic infections, mostly in combination with other antimicrobials . For susceptible organisms, particularly Staphylococcus aureus, it has demonstrable efficacy in acute osteomyelitis, chronic osteomyelitis, specialised forms of osteomyelitis such as calcaneal and vertebral infection, septic arthritis, prosthetic and other device-related infections . A small number of studies have also examined the use of FA alone for the treatment of bone infections, with evidence of good efficacy, as well as the local application of FA in plaster-of-Paris (POP) beads, or incorporated into bone cement, again with promising results . Further studies are required to confirm the efficacy of FA in the treatment of orthopaedic infections caused by methicillin-resistant strains of S . aureus. Int J Antimicrob Agents, 1999 Aug, 12 Suppl 2, S35 - 44 Resistance to fusidic acid; Turnidge J et al.; Resistance to fusidic acid is determined by a number of mechanisms . The best described are alterations in elongation factor G, which appear in natural mutants that are harboured at low rates in normal populations of staphylococci (10(6) to 10(8)) . Altered drug permeability has also been described, and appears to be plasmid-borne . Binding by chloramphenicol acetyltransferase type I and efflux are other described mechanisms of resistance whose prevalence is unclear . A large number of studies have examined rates of fusidic acid resistance in staphylococci . Most show low levels of resistance . Studies where high levels of resistance have been seen are from areas of the hospital where cross infection is common . Rates of resistance have tended to be slightly higher in methicillin-resistant strains of Staphylococcus aureus . Studies on the evolution of resistance have shown no major trends to the emergence of resistance . In one case this is despite increasing use of both systemic and topical fusidic acid over more than 24 years . Selection for resistant variants during treatment was recognised early in vitro and in vivo . However, evidence suggests that it does not occur at high frequency in clinical practice . Nevertheless, accumulated experience is that fusidic acid in combination with other agents results in less resistance emergence. Bioorg Med Chem Lett, 1999 Oct 4, 9(19), 2893 - 6 2-Naphthylcarbapenems: broad spectrum antibiotics with enhanced potency against MRSA; Greenlee ML et al.; A regioisomeric set of 2-naphthylcarbapenems featuring cationic substituents was synthesized . Optimal placement of the cationic group was found to markedly improve activity against methicillin-resistant staphylococci while maintaining a good spectrum of gram-negative activity. Rev Clin Esp, 1999 Aug, 199(8), 503 - 10 {Bacteremias in a university hospital: study of etiologic agents and their sensitivity patterns}; Betriu C et al.; OBJECTIVE: To determine the bacterial etiology of bacteremic episodes recorded at our hospital during 1995 and their antimicrobial susceptibility patterns . METHODS: The microbiological records of all bacteremic episodes detected at our hospital from January to December 1995 were analysed . The susceptibility patterns of the 334 gram-positive aerobic isolates to 11 antimicrobials and of 236 gram-negative aerobic isolates to 16 antimicrobial agents were determined . The reference agar dilution method was used for these determinations . RESULTS: The incidence of bacteremia was 19.3/1,000 admissions . Gram-positive aerobic bacteria accounted for 56.6% of monomicrobial bacteremias; the microorganisms recovered most frequently were coagulase-negative staphylococci (22.4%), Escherichia coli (16.5%) and Staphylococcus aureus (14.2%); 75 polymicrobial episodes were recorded . Over half of bacteremic episodes occurred at medical services . Hematologic diseases and solid tumours were the most common underlying diseases . No resistance to glycopeptides was observed among the staphylococci studied . The incidence of resistance to vancomycin in enterococci was small (1.5%) . The aminoglycosides tested and some beta lactams showed good activity against the gram-negative bacilli studied . CONCLUSIONS: To carry out an epidemiologic surveillance of bacteremic episodes occurring at every hospital it is necessary to provide information on trends observed in the etiology of such infections, possible outbreaks, antimicrobial resistance, and uncommon pathogens. Am J Kidney Dis, 1999 Oct, 34(4), 678 - 87 Effects of L-carnitine on leukocyte function and viability in hemodialysis patients: A double-blind randomized trial; Thomas S et al.; Excess morbidity and mortality among long-term hemodialysis patients because of infectious complications is partly caused by an impairment of cellular immune defense . We hypothesized this impairment is related to an abnormal carnitine metabolism also present in these patients . In a double-blind, randomized, placebo-controlled trial, we investigated the effect of L-carnitine on phagocytic function and viability of blood leukocytes in 17 patients undergoing maintenance hemodialysis . After an observation period of 1 month, the patients received either 10 mg/kg of L-carnitine or placebo intravenously at the end of each hemodialysis session over a period of 4 months . Leukocyte oxidative metabolism was measured by means of luminol-enhanced chemiluminescence and superoxide generation after stimulation with Staphylococcus aureus or phorbol myristate acetate . Killing capacity and phagocytosis of radiolabeled staphylococci were determined . A lactate dehydrogenase (LDH) release test was applied to assess cell viability . We were unable to show an effect of L-carnitine on phagocytic function and viability in vivo . Several clinical parameters were observed during the trial . No statistically significant differences concerning dialysis-related morbidity, anemia, or reduction of blood urea nitrogen and creatinine levels were detected . Additionally, we tested the effect of L-carnitine on phagocytic function after in vitro incubation of blood leukocytes, which also showed no changes . LDH release was decreased, indicating an improved viability of these cells . The latter results were found after in vitro incubation of cells, but could not be confirmed in vivo . In summary, we could not show beneficial effects of L-carnitine administration in hemodialysis patients for the dosage and duration of treatment stated, either on phagocytic function and viability or on the clinical and biochemical parameters observed. Am J Infect Control, 1999 Oct, 27(5), 444 - 7 Risk of cross-patient infection with clinical use of a needleless injector device; Suria H et al.; BACKGROUND: Needleless injection devices use multiple-dose vials for the administration of local anesthetics to patients . There is a theoretic risk of iatrogenic infection associated with use of these devices . METHODS: This study used in vitro models to investigate the potential for transferring microbial pathogens among patients by using the Syrijet (Keystone Industries, Inc, Cherry Hill, NJ) . Staphylococcus aureus and coagulase-negative staphylococci were used to determine whether patient skin flora could contaminate the instrument internal canal by postejection reverse flow and whether the staphylococci could survive on the ejection surface, in the internal canal, or in the anesthetic vial . RESULTS: The ejection surface was contaminated by firing the device while it was in contact with a contaminated surface . Postejection reverse flow drew contaminants into the device, and increased with ejection volume . Reverse flow did not reach the multidose vial, and staphylococci did not grow in the commercial anesthetic solution typically administered with the device . Surface, but not internal, contamination could be removed by swabbing with disinfectant . CONCLUSION: Although autoclaving is the only way to ensure sterilization of this device, frequent cleaning of the ejection surface during clinical use minimizes the risk of cross-patient bacterial transfer. Biomaterials, 1999 Oct, 20(20), 1945 - 9 Presence and expression of collagen adhesin gene (cna) and slime production in Staphylococcus aureus strains from orthopaedic prosthesis infections; Montanaro L et al.; Prosthesis-associated infections still represent one of the most serious complications in the clinical use of biomaterials . The most frequent causes are Staphylococcus aureus and Staphylococcus epidermidis . Several studies have been devoted to identify adhesion mechanisms for these bacteria . Slime in particular has been extensively investigated . Recently, in Staphylococcus aureus species, considerable attention has been given to the host protein receptors that have been shown in in vitro assays to serve as substrates for bacterial adhesion . Collagen-rich tissues, as bone and cartilage, that are the preferential sites of staphylococcal infections, are also the tissues that harbour orthopaedic implants . These can be easily coated in vivo by collagen and thus become prone to adhesion of Staphylococci strains which carry the collagen adhesin gene (cna) . In this study the frequency of cna was determined within a collection of 35 Staphylococcus aureus strains from orthopaedic prosthesis infections by a PCR method . Also the collagen-binding ability and slime forming capacity was evaluated . 29% of the strains were cna-positive and also able to bind collagen in vitro . 83% of the strains were slime forming . The results indicate that in the examined bacterial population slime-positive strains predominate over the cna-positive strains, with a striking association of the two adhesion mechanisms in cna-positive strains. J Antimicrob Chemother, 1999 Sep, 44(3), 351 - 8 Phenotypic detection of nosocomial mecA-positive coagulase-negative staphylococci from neonates; De Giusti M et al.; Over a 3-year period, we screened antimicrobial resistance genotype (mecA-positive or -negative) in clinically significant coagulase-negative staphylococci isolated from patients residing in our neonatal intensive care unit . For the 152 study strains, the accuracy of standard methods (agar dilution MIC, disc diffusion and agar screen tests) in detecting oxacillin resistance during 48 h of incubation was evaluated . Using mecA gene PCR and Southern blot hybridization as the gold standard, the differential in MICs of additional antibiotics selected for their relevant clinical use in our setting was also compared with mecA status of the isolates . The frequency of mecA was 48.6% among study strains . When applying the previous (1998) and most current (1999) NCCLS interpretive criteria, the specificities of oxacillin agar dilution MICs in detecting the 78 mecA-negative isolates were 100 and 89.7%, respectively, at 24 h, and 100 and 80.7%, respectively, at 48 h . In this respect, the sensitivities of oxacillin agar dilution MICs in detecting the 74 mecA-positive strains were 75.6 and 97.2%, respectively, at 24 h, and 86.4 and 100%, respectively, at 48 h . When applying the previous and most current NCCLS zone size interpretive criteria, oxacillin zone diameters were in false-susceptible error for 13.5 and 8.1%, respectively, of the 74 mecA-positive strains tested at 24 h, and for 6.7 and 2.7%, respectively, at 48 h . Accordingly, when the 78 mecA-negative strains were considered, oxacillin zone diameters were in false-resistant error for 2.5 and 8.9%, respectively, at 24 h, and for 8.9 and 15.3%, respectively, at 48 h . The oxacillin salt agar screen assay accurately identified all mecA-negative strains at both 24 and 48 h . However, 26 (35.1%) and 7 (9.4%) of the mecA-positive strains were misinterpreted as susceptible by the agar screen test at 24 and 48 h, respectively . Using the presence of mecA as the reference standard for interpreting oxacillin susceptibility results, strains lacking mecA were more likely to be susceptible to ampicillin, ceftazidime, gentamicin, netilmicin and rifampicin than were mecA-positive strains . Vancomycin was the only antibiotic tested for which all strains, regardless of mecA status, remained susceptible. J Antimicrob Chemother, 1999 Sep, 44(3), 343 - 9 The effects of NorA inhibition on the activities of levofloxacin, ciprofloxacin and norfloxacin against two genetically related strains of Staphylococcus aureus in an in-vitro infection model; Aeschlimann JR et al.; NorA is a membrane-associated multidrug efflux protein that can decrease susceptibility to fluoroquinolones in Staphylococcus aureus . We have previously determined that NorA inhibition can increase fluoroquinolone killing activity and post-antibiotic effect . In the current investigation, we studied the killing activity and development of resistance for levofloxacin, ciprofloxacin and norfloxacin with or without the H+/K+ ATPase inhibitor omeprazole, in a wild-type strain of S . aureus (SA-1199) and its NorA hyperproducing mutant (SA-1199-3) in an in-vitro pharmacodynamic model with infected fibrin-platelet matrices . Each drug was administered every 12-24 h for 72 h and human pharmacokinetics were simulated . Levofloxacin was the most potent fluoroquinolone against both strains and its activity was not significantly affected by combination with omeprazole . The addition of omeprazole to ciprofloxacin significantly lowered colony counts at all time-points against both strains and decreased the time to 99.9% kill from 72.2 h to 33.8 h against SA-1199 . The addition of omeprazole minimally increased norfloxacin activity against both strains . Omeprazole decreased the frequency of ciprofloxacin resistance nearly 100-fold at the 24 h time-point, but the frequency of resistance was not significantly different for any of the fluoroquinolone regimens after this time-point . No resistance was detected during levofloxacin regimens . The hydrophobic fluoroquinolones such as levofloxacin appear to circumvent NorA efflux, which may contribute to their better activity and decreased resistance rates against staphylococci . More durable and potent NorA inhibitor compounds are needed that can improve killing activity and prevent resistance. J Antimicrob Chemother, 1999 Sep, 44 Suppl A, 31 - 6 Costs of treating infections caused by methicillin-resistant staphylococci and vancomycin-resistant enterococci; Carbon C; Infection with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus faecium (VREF) increases the risk of mortality and results in prolonged hospitalization and high utilization of costly treatment modalities . Measures to prevent the spread of MRSA (and possibly VREF) include patient isolation and decontamination, hygiene measures, ward closure, and screening of patients and staff for carriage . In seriously ill patients, the increased use of vancomycin for the treatment of MRSA can lead to the emergence of VREF colonization/infection . Quinupristin/dalfopristin is effective in the treatment of MRSA infections, including nosocomial pneumonia, skin and soft tissue infection, and septicaemia . In the treatment of nosocomial pneumonia, clinical success rates were equivalent between quinupristin/dalfopristin and vancomycin . In the context of a hospital policy which emphasizes effective hygiene measures and the prudent use of antibacterials, quinupristin/dalfopristin is an effective antimicrobial that can help to control the high costs associated with multiresistant MRSA and VREF infections. J Antimicrob Chemother, 1999 Sep, 44 Suppl A, 11 - 8 Current and future management of infections due to methicillin-resistant staphylococci infections: the role of quinupristin/dalfopristin; Pechere JC; The rise in the number of multidrug-resistant gram-positive bacteria that has occurred in recent years has resulted in the development of infections that are difficult to treat, and also in severely restricted treatment options . In particular, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) has increased, with strains shown to cause up to 21% of skin infections and 59.6% of nosocomial pneumonia . Recently, strains of S . aureus with reduced susceptibility to vancomycin (glycopeptide-intermediate S . aureus or GISA) are causing great concern, particularly as vancomycin has been the agent of choice in the treatment of infection caused by MRSA . GISA has been identified in Japan, the USA and Europe . New agents that have anti-MRSA activity are now being investigated . These include the novel streptogramin, quinupristin/dalfopristin . This report examines the activity of quinupristin/dalfopristin against strains of S . aureus and coagulase-negative staphylococci, including multidrug-resistant MRSA and GISA. J Antimicrob Chemother, 1999 Sep, 44 Suppl A, 1 - 9 Antibiotic resistance in gram-positive bacteria: epidemiological aspects; Witte W; The emergence and spread of antibiotic resistance in gram-positive bacterial pathogens has become an increasing problem . There has been a dramatic increase in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci and enterococci . This is mainly due to the clonal dissemination of certain epidemic multiply-resistant strains, for example, those of MRSA and S . pneumoniae, as well as to the spread of resistance genes as exemplified by those causing glycopeptide resistance in enterococci. Neth J Med, 1999 Sep, 55(3), 155 - 9 An unusual presentation of sepsis caused by coagulase-negative staphylococci; Nieboer P et al.; We describe a 25-year-old male presenting with fever during the non-neutropenic phase of chemotherapy . The presentation was that of a viral infection . The cause of the fever turned out to be a bacteremia with coagulase-negative staphylococci (CONS) originating from a totally implanted venous access port (VAP) . We briefly discuss the different types of VAP-related infections and treatment modalities. Neth J Med, 1999 Sep, 55(3), 92 - 9 Prevention of vascular catheter-related infections; Darouiche RO; Infection is the most common serious complication of intravascular catheters . Most cases of catheter-related infection are caused by staphylococci that originate either from the skin of the patient and migrate along the external surface of the catheter or from a contaminated catheter hub and migrate along the internal surface of the catheter . Major risk factors predisposing to catheter-related infection include prolonged duration of catheter placement, frequent manipulation of the catheter, use of thrombogenic catheter material, location of the catheter, and use of occlusive transparent plastic dressings . A number of measures have been reported in prospective, randomized clinical trials to protect against vascular catheter-related infection . This paper summarizes the clinical efficacy of various preventive measures, such as placement and maintenance of vascular catheters by a skilled infusion therapy team, institution of maximal sterile barriers, use of silver-impregnated subcutaneous cuff, antimicrobial coating of catheters with either antibiotics or antiseptics, use of an antiseptic catheter hub, application of topical disinfectants, and flushing catheters with the combination of antimicrobial and antithrombotic agents. Antimicrob Agents Chemother, 1999 Oct, 43(10), 2395 - 9 Plasmid-mediated resistance to thrombin-induced platelet microbicidal protein in staphylococci: role of the qacA locus; Kupferwasser LI et al.; Thrombin-induced platelet microbicidal protein 1 (tPMP-1) is a small, cationic peptide released from rabbit platelets following thrombin stimulation . In vitro resistance to this peptide among strains of Staphylococcus aureus correlates with the survival advantage of such strains at sites of endothelial damage in humans as well as in experimental endovascular infections . The mechanisms involved in the phenotypic resistance of S . aureus to tPMP-1 are not fully delineated . The plasmid-encoded staphylococcal gene qacA mediates multidrug resistance to multiple organic cations via a proton motive force-dependent efflux pump . We studied whether the qacA gene might also confer resistance to cationic tPMP-1 . Staphylococcal plasmids encoding qacA were found to confer resistance to tPMP-1 in an otherwise susceptible parental strain . Deletions which removed the region containing the qacA gene in the S . aureus multiresistance plasmid pSK1 abolished tPMP-1 resistance . Resistance to tPMP-1 in the qacA-bearing strains was inoculum independent but peptide concentration dependent, with the level of resistance decreasing at higher peptide concentrations for a given inoculum . There was no apparent cross-resistance in qacA-bearing strains to other endogenous cationic antimicrobial peptides which are structurally distinct from tPMP-1, including human neutrophil defensin 1, protamine, or the staphylococcal lantibiotics pep5 and nisin . These data demonstrate that the staphylococcal multidrug resistance gene qacA also mediates in vitro resistance to cationic tPMP-1. Perit Dial Int, 1999 Jul-Aug, 19(4), 334 - 42 Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients; Posthuma N et al.; OBJECTIVE: To investigate peritoneal defense during icodextrin use in continuous cyclic peritoneal dialysis (CCPD) . DESIGN: In an open, prospective, 2-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime dwell . SETTING: University hospital and teaching hospital . PATIENTS: Both established and patients new to CCPD were included . A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry . Patients aged under 18 years, those who had peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded . Thirty-eight patients (19 Glu, 19 Ico) started the study . The median follow-up was 16 and 17 months for Glu and Ico respectively (range 0.5-25 months and 5-25 months, respectively) . OUTCOME MEASURES: Peritoneal defense characteristics and peritoneal dialysis-related infections were recorded every 3 months . RESULTS: Total peritoneal white cell count tended to decrease over time in both groups . After 1 year, absolute numbers and percentages of effluent peritoneal macrophages (PMphis) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years . Percentage of mesothelial cells increased overtime in Ico patients . The phagocytic capacity of PMphis decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci (p = 0.05) and a significant difference for Escherichia coli (p < 0.05) phagocytosis in favor of Ico patients . PMphi oxidative metabolism remained stable over time without a difference between the groups . PMphi cytokine production and effluent opsonic capacity also remained stable over time . Finally, 16 peritonitis episodes in Glu and 14 in Ico patients occurred . Glucose patients had 37 and Ico patients 32 exit-site infections during the study . CONCLUSION: CCPD patients using Ico did equally as well as Glu-treated patients with respect to clinical infections and most peritoneal defense characteristics . However, in a few peritoneal defense tests, Ico-treated patients did better. J Int Med Res, 1999 May-Jun, 27(3), 143 - 7 Efficacy of Shiunko for the treatment of atopic dermatitis; Higaki S et al.; Shiunko is a typical Kampo drug made from herbal extracts and used to treat a range of conditions including atopic dermatitis . Shiunko, white petrolatum and 3.5% salt water were applied to the skin of atopic dermatitis patients, and their clinical effectiveness, and the changes in bacterial species and cell numbers on the skin were studied . Staphylococcus aureus was the main species seen but several other coagulase-negative staphylococci were also identified on some patients . Shiunko was clinically effective in four of seven patients (57%) compared with no patients for petrolatum and one of seven (14%) for salt water . Bacterial counts were reduced with Shiunko in four of seven patients compared with one of seven patients (14%) for both petrolatum and salt water . The results suggest that Shiunko may have antibacterial effects on staphylococci, and may be an effective treatment for atopic dermatitis and other skin infections caused mainly by Staphylococcus species. J Clin Microbiol, 1999 Oct, 37(10), 3353 - 6 Case of Staphylococcus schleiferi endocarditis and a simple scheme to identify clumping factor-positive staphylococci; Leung MJ et al.; Staphylococcus schleiferi is a coagulase-negative staphylococcus infrequently reported as a human pathogen . We report a case of prosthetic valve endocarditis attributed to this organism, contrast it to another Staphylococcus species that gives similar clumping factor results (S . lugdunensis), and propose a simple, effective identification scheme for identification of clumping factor-positive staphylococci. Aust N Z J Ophthalmol, 1999 Jun-Aug, 27(3-4), 234 - 6 Comparison of potential pathogenic traits of staphylococci that may contribute to corneal ulceration and inflammation; Wu PZ et al.; Staphylococcus epidermidis and Staphylococcus aureus are two of the commonest bacteria isolated from corneal ulcers . The aim of the current investigation was to determine the frequency of potentially pathogenic traits in the two staphylococcal species . Strains of both species, some isolated from eyes during active corneal inflammation, were screened for their ability to degrade a variety of proteins and hyaluronic acid and the production of cytotoxins . S . aureus produced more tissue-destructive enzymes than the S . epidermidis . S . aureus strains more commonly synthesized the cytotoxin, alpha-toxin . The production of elastase was more common among S . aureus strains isolated from ulcerative events . The production of alpha-toxin was inversely correlated with isolation from keratitis . This study has demonstrated that S . aureus is better equipped with a range of potentially damaging enzymes and toxins than S . epidermidis and that S . aureus elastase may be involved in the production of corneal ulcers. Mikrobiol Z, 1999 May-Jun, 61(3), 23 - 9 {The etiological spectrum and immunosuppressive properties of the causative agents of pyoderma}; Gaidash IS et al.; The etiological spectrum and some immunoaggressive properties of microorganisms, that cause pyoderma in newborns which were isolated from patients have been studied . It was established that staphylococci (mostly coagulase-positive S . aureus, S . hyicus, S . intermedius) played the leading role in etiology of pyoderma, mostly in association with coagulase-negative staphylococci and (or) other conditionally pathogenic bacteria . Staphylococci occupying significant place in the skin diseases etiology are multiresistant to antibiotics and have valuable anti-lysozyme and anticomplement activities. J Med Microbiol, 1999 Sep, 48(9), 819 - 23 Enterotoxin production by coagulase-negative staphylococci in restaurant workers from Kuwait City may be a potential cause of food poisoning; Udo EE et al.; Staphylococcus aureus and coagulase-negative staphylococci (CNS) were isolated from the hands of food handlers in 50 restaurants in Kuwait City and studied for the production of staphylococcal enterotoxins, toxic shock syndrome toxin-1, slime and resistance to antimicrobial agents . One or a combination of staphylococcal enterotoxins A, B or C were produced by 6% of the isolates, with the majority producing enterotoxin B . Toxic shock syndrome toxin-1 was detected in c . 7% of the isolates; 47% produced slime . In all, 21% of the isolates were resistant to tetracycline and 11.2% were resistant to propamidine isethionate and mercuric chloride . There was no correlation between slime and toxin production or between slime production and antibiotic resistance . The detection of enterotoxigenic CNS on food handlers suggests that such strains may contribute to food poisoning if food is contaminated by them and held in conditions that allow their growth and elaboration of the enterotoxins . It is recommended that enterotoxigenic CNS should not be ignored when investigating suspected cases of staphylococcal food poisoning. Sangre (Barc), 1999 Jun, 44(3), 176 - 81 {Infectious and non-infectious complications of tunneled central catheters in hematologic patients}; Albo Lopez C et al.; PURPOSE: Long-term therapy of haematology patients has been facilitated by permanent indwelling central venous catheters . We performed a retrospective study to compare the problems occurring with a externalized catheter (Hickman) versus a totally implanted port catheter . PATIENTS AND METHODS: A total of 171 catheters were placed to 139 haematological patients, 77 patients with Hickman catheters and 94 with totally implanted port catheters . We review our experience in order to identify factors associated with complications . RESULTS: Pneumothorax occurred in one of 171 of the percutaneously placed devices . Other early complications were hematoma 13, and catheter migration out of the vascular tree 8 . Late complications included malposition (5.8%), thrombosis (2.9%), septic thrombosis (1.7%) and most notably infection (38.5%) . 62 of 77 patients with Hickman catheters developed catheter-related infection (hazard rate infection 7.1/1000 days) compared with 53 of 94 patients with implanted port catheters (hazard rate infection 1.5/1000 days, p < 0.001) . Most of infections that occurred were caused by gram-positive organisms but the gram-negative organisms infections resulted in a significantly higher rate of treatment failure and recurrence . A total of 72 catheters were removed of the central line: 36 for infection . CONCLUSION: We found a significantly increased incidence of catheter-related infection in patients with Hickman catheters . We also observed that the use of intravenous antibiotic prophylaxis prior to catheter insertion did not appear to be beneficial and thrombocytopenia at this moment was a factor in the development of hematoma . The infections due to coagulase-positive staphylococci can be treated successfully without removal of the catheters . However in catheter-related bacteremia due gram-negative organisms there is a chance that the bacteremia will recur if the catheter is not removed. Ophthalmologe, 1999 Jul, 96(7), 465 - 7 {Difficulties of fungus detection in corneal culture medium}; Jendral G et al.; It is not always possible to prevent the growth of microorganisms in organ culture for cornea preservation, despite many prophylactic measures . It is especially difficult to prove the presence of fungi in the cultural medium . MATERIALS AND METHODS: A culture medium was examined for sterility after 8 days' storage of cornea in organ culture . To prove the presence of fungi a culture of Sabouraud 2% glucose-agar was prepared and its growth examined by light microscopy . RESULTS: After 8 days of preservation we noticed a color change in the cultural medium and suspected contamination with fungi . Coagulase-negative Staphylococci could be cultivated from the conjunctival smear obtained before preparation of the cornea only . Routine screening of microbiological contamination did not show any results . We were able to identify an Aspergillus species only after preparing a special culture . The conjunctival smear as well as the cultural medium of the other eye of the same donor showed no contamination . CONCLUSIONS: In spite of the fact that microbiological contamination can be seen macroscopically, it is difficult to prove the presence of a specific microorganism and even more so when dealing with fungus . Especially in these cases the incubation of the cornea in media might have an advantage because contamination can be suspected by just looking at the medium . By excluding these preparations from transplantation we can possibly prevent infections, even when routine examinations show negative results. Antimicrob Agents Chemother, 1999 Sep, 43(9), 2295 - 8 Activities of clinafloxacin, alone and in combination with other compounds, against 45 gram-positive and -negative organisms for which clinafloxacin MICs are high; Clark CL et al.; Time-kill studies indicated that clinafloxacin showed synergy after 24 h with ceftazidime, amikacin, and imipenem against 12, 8, and 10 of 33 gram-negative rods, respectively; with vancomycin, teicoplanin, cefotaxime, and amikacin against 3, 3, 1, and 1 of 9 staphylococci and enterococci, respectively; and with vancomycin, penicillin, and cefotaxime against 0, 2, and 2 of 3 pneumococci, respectively . The MICs of clinafloxacin alone for most strains were >/=1 microg/ml. Zentralbl Bakteriol, 1999 Jul, 289(3), 365 - 70 False-positive beta-lactamase results with Staphylococcus lugdunensis in the Vitek AutoMicrobic system; Zbinden R et al.; The Vitek AutoMicrobic system in combination with the Gram-positive susceptibility card detects beta-lactamase in staphylococci by utilizing penicillin as the substrate coupled with oxacillin as an inducer . The beta-lactamase activity of 21 clinical isolates and two reference strains of Staphylococcus lugdunensis was determined with this automated system and compared with a liquid nitrocefin assay after induction with oxacillin . Eight (38%) clinical isolates and the reference strain ATCC 49576 of S . lugdunensis showed production of beta-lactamase in both tests . Thirteen (62%) clinical isolates and the type strain ATCC 43809 were nitrocefin-negative . The Vitek AutoMicrobic system reported false-positive beta-lactamase results for 9 of those 13 isolates and for the type strain of S . lugdunensis . Results for disk diffusion (ampicillin) were concordant with the nitrocefin assay . With one exception, the MICs for penicillin of the nitrocefin-negative strains were in the equivocal range of 0.06-0.12 mg/l according to NCCLS . However, none of the nitrocefin-negative and Vitek-positive strains revealed any of the known staphylococcal genes for beta-lactamase as investigated by Southern hybridization, supporting the fact that false-positive beta-lactamase results may occur in the Vitek AutoMicrobic system . We conclude from our data that it may be justified to include S . lugdunensis in the quality control of Vitek cards containing beta-lactamase tests. J Food Prot, 1997 Jan, 60(1), 43 - 7 Effectiveness of sanitation with quaternary ammonium compound or chlorine on stainless steel and other domestic food-preparation surfaces; Frank JF et al.; The relative ability of various materials used for domestic and/or food-service sinks and countertops to be sanitized was determined . Both smooth (unused) and abraded surfaces were tested by exposure to 200 mg of quaternary ammonium compound per liter or 200 mg of sodium hypochlorite per liter . Surface materials tested included mechanically polished (type 304, #4 finish) and electropolished stainless steel, polycarbonate, and mineral resin . Surfaces were prepared for testing by allowing attachment of a Staphylococcus aureus culture for 4 h to achieve an initial attached population of 10(4) to 10(5) CFU/cm2 . The test procedure involved immersion of the surface in sanitizer solution followed by wiping with a sanitizer-saturated cloth . Residual staphylococci were detected by overlaying agar directly on the treated surface . Results indicated that the stainless steels and the smooth polycarbonate, which had 0.5 log CFU/cm2 or fewer of residual staphylococci, were more readily sanitized by quaternary ammonium compound than were either the mineral resin surfaces, which had nearly 2.0 log CFU/cm2 of residual staphylococci, or the abraded polycarbonate which had nearly 1.0 log CFU/cm2 of residual staphylococci . Chlorine was most effective on the mechanically polished stainless steel, the unabraded electropolished stainless steel, and the polycarbonate surfaces, reducing cell populations to less than 1.0 log CFU/cm2 . Chlorine was less effective on abraded electropolished stainless steel and mineral resin surfaces, where populations remained greater than 1.0 log CFU/cm2 . Sanitation with quaternary ammonium compound or chlorine reduced S . aureus populations more than 1,000-fold on all surfaces except unabraded mineral resin. Microbios, 1999, 98(391), 149 - 57 Catabolism of the methyl derivatives of adenosine and cytidine in staphylococci; Krasuski A et al.; Products of 1-methyladenosine, 2'-O-methyladenosine, 2'-O-methylcytidine, and 5-methylcytidine catabolism by resting cells of Staphylococcus aureus and Staphylococcus intermedius were chromatographically separated . The methyl group in 1-methyladenosine protected the adenosine derivative from deamination by S . intermedius but it did not protect N-glycosidic bond from cleavage by S . intermedius and S . aureus . The methyl group in 2'-O-methyladenosine and 2'-O-methylcytidine protected the N-glycosidic bond from cleavage by S . aureus and S . intermedius but it did not protect the adenosine and cytidine derivatives from deamination by S . intermedius . 5-Methylcytidine was converted by the common route in which 5-methylcytidine was first deaminated to ribothymidine which was cleaved to yield thymine . S . intermedius deaminated the purine and pyrimidine ribonucleosides adenosine, 2'-O-methyladenosine, cytidine, and 5-methylcytidine . Pyrimidine ribonucleosides (cytidine, 5-methyl-cytidine) were deaminated only slowly and purine ribonucleosides (adenosine, 2'-O-methyladenosine) not at all by S . aureus. J Hosp Infect, 1999 Sep, 43(1), 33 - 7 Rapid detection of methicillin-resistant staphylococci by multiplex PCR; Kearns AM et al.; A multiplex PCR was developed to detect the coagulase gene (coa; pathognomic of Staphylococcus aureus) and the mecA gene (characteristically encoding for methicillin resistance in staphylococci) in a single, rapid test . Suitable primers for the gene targets and an internal, amplification control were incorporated into a multiplex PCR assay, which was then optimized on a capillary air thermal cycler to improve the turnaround time of the test to approximately 1.5 hours . The assay was evaluated with 111 fresh clinical isolates of staphylococci . The multiplex PCR correctly distinguished between isolates of S . aureus, which were sensitive to methicillin (MSSA) and those resistant to it (MRSA) . It also correctly differentiated between similar isolates of coagulase negative staphylococci (MSSE and MRSE respectively) . It was concluded that this multiplex PCR was a rapid and reliable method for the detection of methicillin-resistant staphylococci . Khirurgiia (Mosk), 1999, (7), 46 - 8 {Prognosis of postinjection abscesses course with use of mathematical model}; Kurlaev PP et al.; Virulent and persistent characteristics of staphylococci isolated from 100 patients with various types of course of the abscessed forms of postinjection suppuration were defined . Comparative analysis of 11 biological characteristics of the microorganisms was carried out . An important role of the complex of properties of Staphylococcus aureus was established, including lysozyme, proteolytic, fibrinolytic activities, ability for inactivation of immunoglobulins through their Fc-receptors' binding to protein A, antilysozyme, "antiinterferon", anticomplement activities in determination of protracted character of festering and inframmatory process initiated by them . The model for prognosis of the course of postinjection abscesses was developed with the help of discriminant analysis, being based on the analysis of the informative properties of the pathogen. Infect Immun, 1999 Sep, 67(9), 4673 - 8 Fibronectin binding protein and host cell tyrosine kinase are required for internalization of Staphylococcus aureus by epithelial cells; Dziewanowska K et al.; Staphylococcus aureus expresses several surface proteins that promote adherence to host cell extracellular matrix proteins, including fibronectin (Fn) . Since this organism has recently been shown to be internalized by nonprofessional phagocytes, a process that typically requires high-affinity binding to host cell receptors, we investigated the role of its Fn binding proteins (FnBPs) and other surface proteins in internalization by the bovine mammary gland epithelial cell line (MAC-T) . Efficient internalization of S . aureus 8325-4 required expression of FnBPs; an isogenic mutant (DU5883), not expressing FnBPs, was reduced by more than 95% in its ability to invade MAC-T cells . Moreover, D3, a synthetic peptide derived from the ligand binding domain of FnBP, inhibited the internalization of the 8325-4 strain in a dose-dependent fashion and the efficiency of staphylococcal internalization was partially correlated with Fn binding ability . Interestingly, Fn also inhibited the internalization and adherence of S . aureus 8325-4 in a dose-dependent manner . In contrast to internalization, adherence of DU5883 to MAC-T was reduced by only approximately 40%, suggesting that surface binding proteins, other than FnBPs, can mediate bacterial adherence to cells . Adherence via these proteins, however, does not necessarily result in internalization of the staphylococci . An inhibitor of protein tyrosine kinase, genistein, reduced MAC-T internalization of S . aureus by 95%, indicating a requirement for a host signal transduction system in this process . Taken together, these results indicate that S . aureus invades nonprofessional phagocytes by a mechanism requiring interaction between FnBP and the host cell, leading to signal transduction and subsequent rearrangement of the host cell cytoskeleton. South Med J, 1999 Aug, 92(8), 812 - 4 Destructive native valve endocarditis caused by Staphylococcus lugdunensis; Burgert SJ et al.; Coagulase-negative staphylococci are uncommon causes of native valve endocarditis, and the clinical course after valvular infection with these organisms is variable . In clinical practice, species identification is frequently not done, and possible differences in the pathogenicity of various species may be unrecognized . We report a case of Staphylococcus lugdunensis native valve endocarditis associated with valve leaflet perforation and cerebral embolization . This recently described species appears to be more virulent when infecting native cardiac valves than other species of coagulase-negative staphylococci . We review S lugdunensis native valve endocarditis. Heart . 1999 Sep;82(3):e1. Staphylococcus capitis endocarditis: two cases and review of the literature; Sandoe JA et al.; Coagulase negative staphylococci are the principal cause of prosthetic valve endocarditis but are a rare cause of native valve infections . However, the incidence of native valve endocarditis is increasing . Staphylococcus capitis is a coagulase negative staphylococcus with the capacity to cause endocarditis on native heart valves . Two cases of native valve endocarditis caused by S capitis are presented; both in patients with aortic valve disease . The patients were cured with prolonged intravenous vancomycin and rifampicin and did not need surgery during the acute phase of the illness . Five of the six previously described cases of endocarditis caused by this organism occurred on native valves and responded to medical treatment alone. J Clin Pathol, 1999 Mar, 52(3), 231 - 3 Cross contamination of blood cultures associated with a multiple use venting device; Holliman RE et al.; AIM: To investigate cross contamination of blood cultures associated with multiple use venting devices, which are widely used in clinical microbiology laboratories to reduce labour costs . METHODS: Systematic analysis of 13,880 blood culture results in a large teaching hospital where multiple use venting devices were employed . RESULTS: Nine series of potential cross contamination were identified in a 12 month period . Four series involved coagulase negative staphylococci and were unlikely to represent true cross contamination . Five series involved blood cultures which had significant bacterial growth at the time of venting . CONCLUSIONS: Multiple use venting devices can be associated with cross contamination of blood cultures . This may result from contamination of the internal lumen of the venting device which is not exposed to the biocide . Medical microbiologists should consider the possibility of cross contamination associated with venting procedures when interpreting blood culture results . Further development of multiple use venting devices is required to reduce the risk of cross contamination of cultures. J Clin Microbiol, 1999 Sep, 37(9), 2781 - 8 Outbreak of mupirocin-resistant staphylococci in a hospital in Warsaw, Poland, due to plasmid transmission and clonal spread of several strains; Leski TA et al.; An outbreak of mupirocin-resistant (MuR) staphylococci was investigated in two wards of a large hospital in Warsaw, Poland . Fifty-three MuR isolates of Staphylococcus aureus, S . epidermidis, S . haemolyticus, S . xylosus, and S . capitis were identified over a 17-month survey which was carried out after introduction of the drug for the treatment of skin infections . The isolates were collected from patients with infections, environmental samples, and carriers; they constituted 19.5% of all staphylococcal isolates identified in the two wards during that time . Almost all the MuR isolates were also resistant to methicillin (methicillin-resistant S . aureus and methicillin-resistant coagulase-negative staphylococci) . Seven of the outbreak isolates expressed a low-level-resistance phenotype (MuL), whereas the remaining majority of isolates were found to be highly resistant to mupirocin (MuH) . The mupA gene, responsible for the MuH phenotype, has been assigned to three different polymorphic loci among the strains in the collection analyzed . The predominant polymorph, polymorph I (characterized by a mupA-containing EcoRI DNA fragment of about 16 kb), was located on a specific plasmid which was widely distributed among the entire staphylococcal population . All MuR S . aureus isolates were found to represent a single epidemic strain, which was clonally disseminated in both wards . The S . epidermidis population was much more diverse; however, at least four clusters of closely related isolates were identified, which suggested that some strains of this species were also clonally spread in the hospital environment . Six isolates of S . epidermidis were demonstrated to express the MuL and MuH resistance mechanisms simultaneously, and this is the first identification of such dual MuR phenotype-bearing strains . The outbreak was attributed to a high level and inappropriate use of mupirocin, and as a result the dermatological formulation of the drug has been removed from the hospital formulary. Arch Ophthalmol, 1999 Aug, 117(8), 1023 - 7 Vancomycin concentration in the vitreous after intravenous and intravitreal administration for postoperative endophthalmitis; Ferencz JR et al.; OBJECTIVES: To measure the concentrations of vancomycin in the vitreous of patients with postoperative endophthalmitis after administration of 1 g of vancomycin hydrochloride intravenously and injection of 1 mg of vancomycin hydrochloride into the vitreous, and to determine whether these concentrations are adequate for treatment of gram-positive infections . METHODS: Patients with acute postoperative endophthalmitis were treated with intravenous administration of 1 g of vancomycin hydrochloride followed by vitrectomy and collection of vitreous samples 1 to 5 hours later . Intravitreal vancomycin and ceftazidime were given . Vitreous samples were cultured and their vancomycin concentrations assayed . Minimal inhibitory concentrations of vancomycin for the isolated vitreal pathogens, and serum and vitreous cidal activity were determined . RESULTS: Eighteen patients with acute postoperative endophthalmitis were studied . Fourteen vitreous samples were available after intravenous vancomycin administration, and 4 vitreous samples were available after intravitreal vancomycin administration . After intravenous injection, vitreous vancomycin concentrations ranged from 0.4 to 4.5 microg/mL . Minimal inhibitory concentrations in these samples, obtained from 10 bacterial isolates, were below the therapeutic levels for most causative organisms, including staphylococci . Vitreous cidal activity values were negative at a dilution of 1:2 in 9 of 10 patients examined . After a 1-mg intravitreal injection, vancomycin concentrations in vitreous samples obtained by a second tap from 4 patients 44 to 72 hours later were 182, 138, 58, and 25 microg/mL . In 2 patients in whom measurements were obtained, vitreous cidal activity values were 1:512 and 1:32 . CONCLUSION: Vitreous vancomycin concentrations for the treatment of gram-positive endophthalmitis were nontherapeutic after intravenous administration but therapeutic after intravitreal administration. CLAO J, 1999 Jul, 25(3), 167 - 75 Incidence of contamination of preserved saline solutions during normal use; Sweeney DF et al.; PURPOSE: To ascertain the incidence of microbial contamination of preserved contact lens saline solutions with normal patient use . METHODS: Eight different brands of preserved saline were dispensed to 40 patients attending optometric practices in the Sydney area . After specific periods of time (7 to 28 days), the samples were collected and the solution bottle nozzles and contents underwent microbial analysis . RESULTS: The overall contamination rate was approximately 26% for contents only and 55% for nozzles of preserved saline solutions . This rate remained constant for all periods of use . Coagulase-negative Staphylococci were most frequently isolated . No Acanthamoebae were isolated . Saline preserved with ethylene-diamine-tetraacetic acid (EDTA) in conjunction with sorbic acid showed the highest percentage of sterility . CONCLUSIONS: The results of this study show that preserved saline became contaminated with gram-positive bacteria . This is in contrast to our previously published paper using unpreserved saline, where contamination was predominantly with gram-negative bacteria . The overall contamination rates with preserved saline were lower than for unpreserved saline. Int J Food Microbiol, 1999 Jun 1, 48(3), 211 - 9 Identification and characterization of quaternary ammonium compound resistant staphylococci from the food industry; Heir E et al.; The distribution of known genes conferring resistance to quaternary ammonium compounds (QACs) among different species of staphylococci isolated from the food industry was investigated . Twenty-four isolates hosting one of the genes qacA/qacB, smr, qacG or qacH, were subjected to species identification . Species determination was performed by biochemical analyses (API STAPH), comparative 16S rDNA sequence analysis and tDNA intergenic spacer length polymorphism analysis . Good correlation was obtained between the different methods . The isolates belonged to six different species of coagulase-negative Staphylococcus . The most commonly found species were Staphylococcus epidermidis and Staphylococcus saprophyticus . The results also indicated the possible spread of specific isolates of staphylococci which may reflect the dominance of certain strains in environments were QACs are used on a regular basis . The isolates were further characterized by the resistance phenotype to antimicrobial agents including antibiotics and disinfectants . Resistance to ampicillin, penicillin G and dyes was prevalent in strains harbouring the qacA or qacB genes, features also common among clinical staphylococci containing qacA/qacB . One QAC resistant strain harbouring the smr gene showed resistance to ampicillin, penicillin, tetracycline, erythromycin and trimethoprim . No enterotoxin production was detected among the QAC resistant strains. FEMS Immunol Med Microbiol, 1999 Aug 1, 25(1-2), 51 - 8 Toxigenic bacteria and sudden infant death syndrome (SIDS): nasopharyngeal flora during the first year of life; Blackwell CC et al.; Many developmental and environmental risk factors for sudden infant death syndrome (SIDS) are similar to those for susceptibility to respiratory tract infection, and toxigenic bacteria have been implicated in some SIDS cases . We assessed nasopharyngeal flora of healthy infants in relation to risk factors to determine which species best lit the mathematical model proposed for the common bacterial toxin hypothesis and if these findings complemented results obtained from SIDS cases which occurred during the period of the survey . Longitudinal studies were carried out between April 1993 and March 1996 on 253 healthy infants and their mothers . 150 from a multiply deprived area, 103 from an affluent area . Concurrent SIDS infants (37) were screened for nasopharyngeal flora . Among healthy infants < or = 3 months of age, the predominant isolate was Staphylococcus aureus 57% compared with 86% for SIDS infants in that age range (P< 0.02) . There were significant associations between isolation of different species from both mother and baby but no association between isolation of any species with: area of residence: parental smoking habits; breast or bottle feeding; symptoms of viral infection: seasonality . We conclude that S . aureus fits the mathematical model for SIDS . Both staphylococci and/or their toxins were identified in a significant proportion of SIDS cases . Isolation of staphylococci from healthy infants was associated with the 2-4-month age range, a risk factor consistently found in all epidemiological studies of SIDS . This might reflect the developmental stage in which 80-90% of infants express the Lewis(a) antigen which we have shown to be one of the receptors for S . aureus. FEMS Immunol Med Microbiol, 1999 Aug 1, 25(1-2), 11 - 7 The common bacterial toxins hypothesis of sudden infant death syndrome; Morris JA; The background to the common bacterial toxin hypothesis of sudden infant death syndrome is presented . The idea is that some cases of sudden infant death syndrome are due to the lethal effects of nasopharyngeal bacterial toxins which can act synergistically to trigger the events leading to death . The concept is consistent with the age distribution of sudden infant death syndrome, the winter excess of cases and the role of prone sleeping and passive exposure to cigarette smoke . A number of laboratory-based investigations are described . There is an increased isolation of staphylococci and Gram-negative bacilli from sudden infant death syndrome infants compared with age- and season-matched healthy infants . Bacteria from sudden infant death syndrome infants interact synergistically to cause sudden death in gnotobiotic weanling rats . Bacterial toxins implicated in sudden infant death syndrome interact synergistically to cause death in chick embryos . Nicotine in very low doses potentiates the lethal effect of toxin combinations in chick embryos . Staphylococcal toxins and endotoxins have been demonstrated in sudden infant death syndrome tissues, antibodies to endotoxins are low in sudden infant death syndrome cases and the prone sleeping position leads to pooling of secretions in the upper airways, increasing the risk of bacterial growth and toxin production . If the hypothesis is correct, then there is the possibility of a further reduction in the incidence of sudden infant death syndrome based on immunisation against the toxins involved. Infect Control Hosp Epidemiol, 1999 Jul, 20(7), 494 - 8 Long-term central venous catheter infection in HIV-infected and cancer patients: a multicenter cohort study; Astagneau P et al.; OBJECTIVES: To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients . DESIGN: Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period . SETTING: Services of infectious diseases and oncology of 12 university hospitals in Paris, France . PARTICIPANTS: In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation . RESULTS: Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients . Most were associated with bacteremia, most commonly coagulase-negative staphylococci . The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001) . The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection . The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population . CONCLUSIONS: Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC. Ann Fr Anesth Reanim, 1999 May, 18(5), 558 - 66 {Nosocomial meningitis in the adult}; Pottecher T et al.; Cerebrospinal fluid (CSF) has anti-infectious defense abilities similar to those of the serum of a neutropenic patient . A septic inoculation as in case of nosocomial meningitis (NM), results rapidly in microbial proliferation with major alterations to the blood brain barrier, cerebral oedema and loss of autoregulation of the cerebral blood flow . Arterial hypotension during NM may induce focal or global cerebral ischaemia . The incidence of NM is increasing, staphylococci and Gram negative bacilli being the most frequent pathological agents . Clinical symptoms are not specific in this postoperative and post-traumatic context . In this context, the analysis of pleocytosis and the increased protein content of CSF is disturbing . Numerous clinical conditions may cause NM . Among them, NM from spinal puncture is an important issue for anaesthetists, while combined epidural and spinal anaesthesia carry the highest risks . Cutaneous contamination plays a major role . Half of the post-operative infections after neurosurgery are due to NM, and CSF leakage, iterative operations and surgery in contaminated conditions are the main risk factors . Antibioprophylaxis for postoperative NM is validated for clean and clean-contaminated surgery . Some consider that only procedures of more than two hours require this prophylaxis . Prophylaxis is targeted on staphylococci . Other preventive measures (drainage of less than 24 h, head shaving and prevention of CSF leakage) are of major importance . Antibiotherapy should be guided by the same considerations as for community acquired meningitis, associated with specific issues in the surgical context (presence of foreign material and CSF blockage). FEMS Microbiol Lett, 1999 Jul 15, 176(2), 463 - 9 Disorganization of cell division of methicillin-resistant Staphylococcus aureus by a component of tea (Camellia sinensis): a study by electron microscopy; Hamilton-Miller JM et al.; A component of aqueous extracts of green tea (Camellia sinensis), known to reverse methicillin-resistance in staphylococci, causes extensive morphological changes in methicillin-resistant but not in methicillin-sensitive Staphylococcus aureus . Clumps of partly divided cocci, consisting of up to 14 individuals, with thickened internal but normal external cell walls were seen by electron microscopy in cultures of methicillin-resistant S . aureus grown in the presence of the active principle . The morphological changes observed were consistent with selective inhibition of penicillin-binding proteins. Int J Food Microbiol, 1999 May 1, 48(2), 81 - 5 Use of pulse field gel electrophoresis for the epidemiological characterisation of coagulase positive Staphylococcus isolated from meat workers and beef carcasses; Vanderlinde PB et al.; Coagulase positive staphylococci isolated at an Australian abattoir, from beef carcasses, hands, and environmental samples, were typed by the DNA macrorestriction patterns obtained following PFGE of SmaI digests . The predominant PFGE pattern of isolates collected before evisceration was different from the dominant pattern of isolates collected after evisceration . PFGE patterns for isolates from workers' hands and from concordant carcasses were indistinguishable . PFGE types among isolates collected from non-evisceration abattoir personnel and clerical staff were distinct from patterns among isolates collected from the slaughter floor personnel . Twenty-nine (85%) of the 34 isolates collected from carcasses after evisceration exhibited PFGE patterns that were 93% homologous . During evisceration the carcasses were handled extensively and it is proposed that the hands of workers at this abattoir are the primary source of staphylococcal contamination of carcasses on the slaughter floor . This paper highlights the usefulness of PFGE as an epidemiological tool for determining the source of staphylococcal contamination in the food industry. Pathol Biol (Paris), 1999 May, 47(5), 497 - 500 {Evaluation of Hemofast MRSA for identification of Staphylococcus aureus and detection of methicillin-resistance staphylococci, directly in blood culture broths}; Langlet S et al.; The newly developed Hemofast MRSA system for Staphylococcus aureus identification and methicillin-resistant staphylococci (MRS) detection in blood culture broths was evaluated in 106 Bactec broths containing grapelike clusters of Gram-positive cocci . All 26 S . aureus positive broths were correctly identified by Hemofast MRSA within two hours, and 81% were identified within one hour . Sensitivity and specificity were both 100% . Accuracy of MRS detection was 100%, i.e., no discrepancies versus the agar diffusion method were found . When the 28 broths containing coagulase negative staphylococci (CNS) were tested using an inoculum ten fold larger than for S . aureus testing, a number of discrepancy were recorded . For 49 other broths containing CNS, accuracy was 98.5% when the test was interpreted based on the growth rate of the strain, according to the manufacturer's instructions . One broth containing S . epidermidis strain susceptible yielded a false result with Hemofast MRSA, indicating that it probably contained a contaminant . The other discrepancies occurred with specimens containing mixed populations with CNS or a Micrococcus strain . Most (85%) results were available within 4 hrs 30 min, irrespective of the S . aureus or CNS strains . Avoiding the isolation step on agar, Hemofast MRSA saves 24 to 48 hours, thus allowing earlier antistaphylococcal treatment. Pathol Biol (Paris), 1999 May, 47(5), 409 - 13 {Infection after total hip replacement by Staphylococcus caprae . Case report and review of the literature}; Blanc V et al.; We report a case of Staphylococcus caprae bone and joint infection, that illustrate difficulties to diagnose coagulase-negative staphylococci (CNS) orthopedic surgery infections, specially following implantation of prostheses . Four of 5 strains successivelly isolated from deep and/or peri-operative specimens during late infection after total hip replacement (THR) have been identified, using commercial systems and conventionnal tests, as S . caprae . Identity of biochemical profile, antibiotype and pulsotype of the 4 isolates confirmed the pathogenicity of this animal CNS, rarely described as a human pathogen . Analysis of the 24 S . caprae human cases previously described evidence a relation ship between this bacteria and bone and joint infections, with implantation of prosthetic material as supplementary risk factor . S . caprae, whose major identification criteria are resumed, may have previously been misidentified as some similar CNS; this bacteria is probably part of our normal flora but may be recognized as an opportunistic pathogen, responsible for both nosocomial and community acquired infections. Jpn J Ophthalmol, 1999 May-Jun, 43(3), 162 - 5 Microbiologic analysis of aqueous humor in phacoemulsification; Oguz H et al.; PURPOSE: This study was designed as a microbiologic survey of the fluids aspirated from the anterior chamber at the end of cataract extraction performed by phacoemulsification, and to correlate the contamination rate of the anterior chamber to the surgical technique used . METHODS: One hundred and one consecutive patients (126 eyes) who underwent cataract extraction by phacoemulsification and posterior chamber intraocular lens implantation were included in the study . Microscopical examination, culture, and determination of the number of colonies were carried out on the bacteria and fungi in the anterior chamber fluids aspirated at the end of surgery, before final suture placement . RESULTS: Anterior chamber fluids yielded positive cultures in nine specimens (8.14%), six of which were identified as coagulase-negative staphylococci . Quantification disclosed colony counts ranging between 2-10 and 10-40 per mL . CONCLUSIONS: Preliminary results in a small population show that the contamination of the aqueous humor is significantly less frequent if the cataract extraction is performed by phacoemulsification. J Leukoc Biol, 1999 Jul, 66(1), 158 - 64 Induction of CC chemokines in human peripheral blood mononuclear cells by staphylococcal exotoxins and its prevention by pentoxifylline; Krakauer T; We investigated the inflammatory processes that might be associated with the arthrogenic activity of Staphylococcus aureus, the principal causative agent of bacterial arthritis . Human peripheral blood mononuclear cells (PBMC) were stimulated with the staphylococcal toxic shock syndrome toxin-1 (TSST-1) or enterotoxin B (SEB) and the production of chemokines was examined . Both TSST-1 and SEB induced high levels (ng/mL) of MIP-1alpha, MIP-1beta, and MCP-1 . The induction of these chemokines occurred mostly by direct stimulation of PBMC with staphylococcal exotoxins (SE), without requiring the intervention of IL-1 and TNF-alpha . The production of SE-induced chemokines was blocked partially by anti-DR and anti-CD2 antibodies . Cell separation revealed monocytes as the cell source of these chemokines . However, addition of purified T cells amplified the levels of chemokine produced, suggesting that cognate interaction of SE bound on antigen-presenting cells with T cells also contributes to chemokine production . The activation and recruitment of leukocytes by these chemokines may contribute to the pathophysiology of septic arthritis caused by staphylococci in humans through tissue injury and the recruitment of T lymphocytes, perhaps also initiating autoimmune responses . Pentoxifylline, an anti-inflammatory agent, completely inhibited the production of these chemokines. Pediatr Hematol Oncol, 1999 Jul-Aug, 16(4), 299 - 309 Right atrial catheter-related complications in pediatric oncology patients: the situation in a developing country; Ertem M et al.; The complications of right atrial catheters (RACs) in pediatric oncology patients are unknown for centers in developing countries . This study examined the complications of RACs at Ankara University Medical School, Turkey . A total of 90 RACs were placed in 61 children for long-term chemotherapy with a total experience of 15,536 catheter days . The rate of catheter-related sepsis was 4.9 episodes per 1000 catheter days . Coagulase-negative staphylococci and Candida species were the most common organisms, accounting for 25.0 and 13.1% of all organisms, respectively . The most common reasons for the removal of the RACs were infection (42.4%) and dislodgement (32.2%) . The rates of complications were significantly higher in this study than in western studies . This increase could be explained by the differences in catheter care practices in the Turkish center . In conclusion, the use of RACs in a developing country necessitates an appraisal of the benefits and risks for each patient and improvement of catheter care procedures. Diagn Microbiol Infect Dis, 1999 Jul, 34(3), 185 - 91 Antimicrobial susceptibility of coagulase-negative staphylococci and characterization of isolates with reduced susceptibility to glycopeptides; Del' Alamo L et al.; The antimicrobial susceptibility of 239 coagulase-negative staphylococci (CNS) isolates consecutively collected from blood culture in patients admitted in a 600-bed teaching hospital was evaluated . The isolates were identified to the species level by conventional methods and the MicroScan Positive Combo Panel type 6 system, and their susceptibility to vancomycin, teicoplanin, and oxacillin were tested by agar dilution, disk diffusion, and MicroScan-WalkAway system . The species distribution was as follows: Staphylococcus epidermidis 120 (50.2%), S . hominis 29 (12.1%), S . haemolyticus 24 (10.0%), S . cohnii 14 (5.9%), and isolates from other CNS species 52 (21.8%) . The percentage of resistance to oxacillin was 74.5% by agar dilution . The highest percentages of oxacillin resistance were found among S . haemolyticus (95.8%) and S . epidermidis (80.8%) . Teicoplanin resistance (MIC > or = 32 micrograms/mL) was detected in five S . haemolyticus isolates, whereas intermediate resistance (MIC = 16 micrograms/mL) was detected in nine strains . These isolates with reduced susceptibility to teicoplanin were resistant to oxacillin, but remained susceptible to vancomycin (MIC < or = 4 micrograms/mL) . Two isolates, one S . haemolyticus and one S . epidermidis, showed a vancomycin MIC of 8 micrograms/mL, and both MicroScan and disk diffusion methods classified these isolates as susceptible . Our results showed that glycopeptide resistance is emerging among CNS isolates in our institution and the disk diffusion method may not detect isolates with decreased susceptibility to these antimicrobial agents. Biomaterials, 1999 Jul, 20(14), 1319 - 26 Cell surface characteristics of microbiological isolates from human percutaneous titanium implants in the head and neck; Holgers KM et al.; Percutaneous implants are commonly associated with several problems, and different failure modes have been described . Infections constitute one serious complication which may lead to the removal of the implant . In contrast to infections around polymer implants, infections around skin-penetrating titanium implants anchored in the temporal bone are often cured by local treatment . Coagulase-negative staphylococci are the most common etiological agents in infections related to polymers whereas Staphylococcus aureus is considered as the main pathogen in infections around metallic implants . Microbial adhesion is a prerequisite for an infection . In the present study, the cell surface of microbes isolated from the skin around skin-penetrating titanium implants, with and without signs of infection, was characterized with respect to expression of cell surface hydrophobicity and to binding of immobilized fibronectin, vitronectin and collagen type 1 which could mediate adhesion . Expression of protein binding was similar in strains isolated from the two groups . No strain expressed a hydrophobic cell surface as determined by two-phase separation, and we conclude that the microenvironment around a titanium implant promotes expression of a hydrophilic rather than a hydrophobic cell surface which in turn makes many infections around a titanium implant curable by local treatment. Ukr Biokhim Zh, 1998 Nov-Dec, 70(6), 92 - 7 {Inclusion of protein and nucleic acid precursors by staphylococci that are sensitive and resistant to antibiotics}; Kozyts'ka SM; We have convey comparative study of including intensity of marking protein predecessors and nucleic acids by initial strains of Staphylococcus aureus sensitive to antibiotics and strains, which contain plasmids of resistance to different antibiotics . Shown including intensity increase of adenine, uridine, thymidine and marked amino acids by strains which contain plasmids of resistance to different antibiotics to compare with unplasmids variant . On the base of receiving results we may affirm that in general we observe intensification of protein synthesis and separate staves nucleic acid synthesis by observing staunch strains. Rheumatology (Oxford), 1999 Jun, 38(6), 572 - 5 Oral carriage of staphylococci in patients with rheumatoid arthritis; Jackson MS et al.; OBJECTIVE: To determine the prevalence of oral staphylococcal carriage in patients with rheumatoid arthritis compared with healthy controls . METHODS: Fifty healthy adults, 25 healthy elderly volunteers and 25 patients with rheumatoid arthritis were studied . An oral rinse, tongue swab and nasal swab were collected for culture on blood agar and a range of selective agars . Isolates of staphylococci were identified and antibiotic sensitivity profiles determined by standard methods . RESULTS: Staphylococci were isolated from the mouths of 94% of the healthy adults, 24% of whom carried Staphylococcus aureus . All the healthy elderly carried oral staphylococci and 36% were colonized with S . aureus . Staphylococci were isolated from 96% of the rheumatoid arthritis patients and this group had the highest carriage rate of S . aureus (56%), significantly higher than the healthy adults (P < 0.05) . In all three groups, Staphylococcus epidermidis was isolated from the mouths of > 80% . No methicillin-resistant strains of S . aureus were isolated . CONCLUSION: Oral carriage of S . aureus appears to be common in patients with rheumatoid arthritis and studies of the mouth as a source of infection in septic arthritis would be merited. Antimicrob Agents Chemother, 1999 Jul, 43(7), 1747 - 53 Combinations of vancomycin and beta-lactams are synergistic against staphylococci with reduced susceptibilities to vancomycin; Climo MW et al.; Evidence of synergism between combinations of vancomycin and beta-lactam antibiotics against 59 isolates of methicillin-resistant staphylococci (Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus) for which vancomycin MICs ranged from 1 to 16 microg/ml were tested by broth microdilution checkerboard, disk diffusion, agar dilution, and time-kill antimicrobial susceptibility tests . The combination of vancomycin and oxacillin demonstrated synergy by all test methods against 30 of 59 isolates; no antagonism was seen . Synergy with vancomycin was also found by modified disk diffusion testing for ceftriaxone, ceftazidime, cefpodoxime, and amoxicillin-clavulanate but not for aztreonam . Evidence of synergy correlated directly with vancomycin MICs . The efficacy of vancomycin given alone and in combination with nafcillin was tested in the rabbit model of experimental endocarditis caused by three clinical isolates of glycopeptide-intermediate-susceptible S . aureus (GISA) (isolates HIP5827, HIP5836, and MU50) . Two of the GISA isolates (isolates MU50 and HIP5836) were extremely virulent in this model, with 27 of 42 (64%) animals dying during the 3-day trial . Therapy with either vancomycin or nafcillin given as a single agent was ineffective for animals infected with HIP5827 or MU50 . However, the combination of vancomycin and nafcillin resulted in a mean reduction of 4.52 log10 CFU/g of aortic valvular vegetations per g compared to the reduction for controls for animals infected with HIP5827 and a reduction of 4 . 15 log10 CFU/g for animals infected with MU50 . Renal abscesses caused by HIP5827 were sterilized significantly better with the combination of vancomycin and nafcillin than by either treatment alone . We conclude that the combination of vancomycin and beta-lactams with antistaphylococcal activity is an effective regimen for the treatment of infections with clinical strains of staphylococci which demonstrate reduced susceptibility to glycopeptides. Lett Appl Microbiol, 1999 Jun, 28(6), 448 - 52 Prevalence and antimicrobial susceptibility of staphylococci isolated from saliva of clinically normal cats; Lilenbaum W et al.; Samples were collected from 150 adult cats, processed for isolation of Staphylococcus species and tested for susceptibility to penicillin G, gentamicin, oxacillin, enrofloxin and tetracycline . Methicillin resistance was also determined . One hundred and four isolates were obtained (69.3% of samples) . Coagulase-negative species were most common, and the most frequently isolated (33 samples) species was Staph . felis . Other coagulase-negative species, such as Staph . haemolyticus, Staph . simulans, Staph . epidermidis and Staph . saprophyticus were also isolated . Coagulase-positive staphylococci were obtained from 30 cats, and the only species recovered in this group was Staph . intermedius . Resistance to antibiotics was frequently observed, with 68.2% of the isolates showing resistance to at least one drug . Resistance to Penicillin G was observed in 68 of the 104 isolates (65.4%), 23 samples were resistant to oxacillin (22.1%), 33 to tetracycline (31.7%) and 24 to enrofloxin (23.1%) . Gentamicin was the most active antimicrobial agent . The role of these microorganisms in the saliva of cats is discussed. Eur J Clin Microbiol Infect Dis, 1999 Apr, 18(4), 289 - 91 Staphylococcus lugdunensis endocarditis in a young, previously healthy female; Wasserman E et al.; Reported here is a case of native valve infective endocarditis in which Staphylococcus lugdunensis was isolated from blood cultures as well as from the mitral valve . It is suggested that tube coagulase-negative staphylococci isolated from blood cultures of patients with infective endocarditis be considered carefully for possible clinical significance . The use of the ornithine carboxylase test as a simple screening method for identification of Staphylococcus lugdunensis is recommended. Eur J Clin Microbiol Infect Dis, 1999 Apr, 18(4), 248 - 55 Controlled clinical comparison of three commercial blood culture systems; Frank U et al.; In a controlled clinical comparison, three commercial blood culture systems--the standard aerobic BacT/Alert bottle (STD), the aerobic BacT/Alert FAN bottle (FAN) and the Isolator system (ISO; Wampole Laboratories, USA) were compared for their ability to detect aerobic and facultatively anaerobic microorganisms . A total of 945 BacT/Alert (STD and FAN) blood culture sets were compared . Of these, 110 blood culture sets (11.6%) yielded growth of 116 clinically significant bacterial and fungal isolates . Microorganisms were recovered from 10.7% (101/945) of the FAN bottles compared to 8.9% (84/945) of the STD bottles . Of the significant isolates, 78 (67.2%) were recovered by both bottles, 29 (25%) by the FAN bottle only and nine (7.8%) by the STD bottle only (P<0.01) . Along with 56.1% (530/945) of BacT/Alert blood culture sets, a concomitant ISO tube was obtained . Of the triple (STD + FAN + ISO) blood culture sets, 54 (10.2%) yielded growth of 59 clinically relevant isolates . Microorganisms were detected in 9.1% (48/530) of the FAN bottles, 8.3% (44/530) of the STD bottles and 4% (21/530) of the ISO tubes (P<0.001) . Overall, the BacT/Alert system detected more clinically significant microorganisms than the ISO tube; the STD and the FAN bottle each recovered significantly more staphylococci (P<0.01 and P<0.001, respectively) and gram-negative rods (P<0.01, both) . In conclusion, the BacT/Alert FAN bottle performed better than the BacT/Alert STD bottle; both BacT/Alert bottles, however, were superior to the ISO tube in terms of recovery of clinically significant microorganisms, including gram-positive and gram-negative bacteria. Microb Ecol, 1999 Jul, 38(1), 58 - 68 Diversity of Microorganisms Isolated from Amber; Greenblatt CL et al.; > Abstract Claims that organisms can be cultured from amber, if substantiated, would be significant contributions to our understanding of the evolution, tenacity, and potential spread of life . Three reports on the isolation of organisms from amber have been published . Cano and Borucki recently reported the isolation of Bacillus sphaericus and Lambert et al . have described a new species designated Staphylococcus succinus from 25-40 million year old Dominican amber . These characterized organisms were phylogenetically distant from extant relatives and the Staphylococcus sp . sufficiently far removed from other extant staphylococci to be considered a new species . Here we report the culture of bacteria from Dominican and previously untested 120 million year old Israeli (Lebanese lode) amber . Twenty-seven isolates from the amber matrix have been characterized by fatty-acid profiles (FAME) and/or 16S rRNA sequencing . We also performed a terminal restriction fragment pattern (TRF) analysis of the original amber before prolonged culture by consensus primer amplification of the 16S rRNA followed by restriction enzyme digestion of the amplicons . Sample TRFs were consistent with a sparse bacterial assemblage and included at least five of the isolated organisms . Finally, we microscopically mapped the internal topography of an amber slice.http://link.springer-ny.com/link/service/journals/00248/bibs/38n1p58.html J Spinal Disord, 1999 Jun, 12(3), 187 - 91 Risk factors associated with methicillin-resistant staphylococcal wound infection after spinal surgery; Klekamp J et al.; We used the data from a retrospective case controlled study to identify risk factors for methicillin-resistant staphylococcal wound infection after spinal surgery . Thirty-five cases and 35 uninfected control patients were matched for indication for initial surgery and approximate operative date . Preoperative, intraoperative, and postoperative risk factors were examined . At our institution between 1989 and 1995, 35 adult patients developed spinal wound infection requiring operative debridement; 16 infections were caused by methicillin-resistant staphylococci (MRS) . Significant risk factors for MRS infection were lymphopenia, history of chronic infections, alcohol abuse, recent hospitalization, and prolonged postoperative wound drainage . Patients with MRS infections were also somewhat less likely to have received vancomycin prophylaxis . In contrast, the only factor associated with infection caused by other pathogens was alcohol abuse . A number of preoperative risk factors were significantly associated with subsequent MRS spinal wound infection . Chemoprophylaxis with vancomycin should be targeted to patients at increased risk, because overuse may promote the emergence of vancomycin-resistant pathogens. Br J Ophthalmol, 1999 Jul, 83(7), 771 - 3 Identification and antibiotic susceptibility of coagulase negative staphylococci isolated in corneal/external infections; Pinna A et al.; AIMS: To identify and determine antibiotic susceptibility of coagulase negative staphylococci (CoNS) isolated from patients with chronic blepharitis, purulent conjunctivitis, and suppurative keratitis . METHODS: A retrospective review of all culture positive cases of chronic blepharitis, purulent conjunctivitis, and suppurative keratitis between July 1995 and December 1996 was performed . Cases in which CoNS were the sole isolates were analysed . Species identification was performed by using a commercially available standardised biochemical test system . Antibiotic susceptibility to penicillin, gentamicin, tetracycline, erythromycin, ciprofloxacin, and teicoplanin was determined by agar disc diffusion (Kirby-Bauer method) . Teicoplanin resistance was confirmed by agar dilution . RESULTS: 42 Staphylococcus epidermidis, four S warneri, three S capitis, two S hominis, one each of S xylosus, S simulans, S equorum, and S lugdunensis were identified . 37 CoNS were penicillin resistant, 12 gentamicin resistant, 28 tetracycline resistant, 18 erythromycin resistant, four ciprofloxacin resistant, and one teicoplanin resistant (MIC, 32 microg/ml) . In total, 16 strains were resistant to three or more antibiotics . CONCLUSION: Species of CoNS apart from S epidermidis may be isolated from patients with corneal and external infection . Antibiotic susceptibility of CoNS is unpredictable and multiresistant strains are common . As a result, antibiotic susceptibility testing should be performed in all cases of clinically significant ocular infections caused by CoNS. J Antimicrob Chemother, 1999 Jan, 43(1), 15 - 22 The distribution of mecA, mecR1 and mecI and sequence analysis of mecI and the mec promoter region in staphylococci expressing resistance to methicillin; Weller TM; The presence and sequences of genes that regulate the expression of methicillin resistance was investigated in 42 isolates of Staphylococcus aureus and 102 isolates of coagulase-negative staphylococci (CNS) . PCR was used to detect mecA and the regulatory genes mecR1 and mecI . In a selected group of isolates, the sequences of mecI and the mec promoter region were also determined and compared with the sequences obtained from pre-MRSA strain N315 . The genetic diversity of the collection was assessed by pulsed-field gel electrophoresis (PFGE) . mecA was present in 21 S . aureus and 44 CNS . mecR1 was associated with mecA in all S . aureus and in all CNS, except two isolates of Staphylococcus haemolyticus . mecI was present in 48% of mecA-positive S . aureus and 50% of mecA-positive CNS . In six S . aureus isolates, mecI contained a termination codon at nucleotide 202 which would truncate the MecI protein . No mutation was found in the mecI gene of the four other S . aureus and 15 CNS sequenced . Seven isolates of Staphylococcus simulans had a single nucleotide substitution in the mec promoter region . Expression of methicillin resistance could be explained for all mecA-positive staphylococci with mutations within mecI or in the mec promoter region or in which mecI was deleted . However, the 'wild type' sequences observed in four S . aureus and eight CNS suggest that there is another mechanism for overcoming the repression of resistance caused by mecI. Mol Cell Probes, 1999 Jun, 13(3), 191 - 7 Rapid detection of mecA in methicillin resistant Staphylococcus aureus using cycling probe technology; Cloney L et al.; A novel method has been developed for the detection of the mecA gene, that confers the principle mechanism of methicillin resistance in staphylococci . Cycling Probe Technology (CPT) is a rapid, simple, isothermal method for the detection of specific target sequences . CPT utilizes a unique chimeric DNA-RNA-DNA probe sequence that provides an RNase H sensitive scissile link when hybridized to a complementary target DNA sequence . In the presence of target DNA, the cycling reaction converts full-length chimeric probe into cleaved probe fragments, which accumulate and are quantified . A cycling probe designed for detection of a specific sequence within the mecA gene was used to develop a culture confirmation assay for methicillin resistant Staphylococcus aureus . The CPT assay was used to screen 238 S . aureus isolates and the results were in complete agreement with detection of the mecA gene by polymerase chain reaction (PCR) . Detection of mecA should be considered the gold standard for determining methicillin resistance in S . aureus . This study demonstrates the feasibility of using CPT to meet this need . Zentralbl Bakteriol, 1999 Apr, 289(2), 185 - 201 Leukocidal toxins of staphylococci; Szmigielski S et al.; Leukocidal toxins (synergohymenotropic toxin) are cytotoxins produced by staphylococci (S . aureus and S . intermedius) and consist of two separate components . The toxic effect depends on the synergistic action of two proteins . One of them belongs to class F (e.g . LukF-PV, LukF-R, LukF-I, LukM, HlgB) and the other, to class S (e.g . LukS-PV, LukS-R, LukS-I, HlgA, HlgC) . Best known are the toxins produced by S . aureus: gamma-haemolysins, HlgA/HlgB and HlgC/HlgB and leukocidin Panton-Valentine, LukS-PV/LukF-PV (Luk-PV, PVL) . Very few data are available concerning the relationship between the production of these toxins and the pathology of staphylococcal infections, because little is known about local and general effects of these leukocidal products in vivo . Frequent isolations of staphylococcal strains producing leukocidal toxins from necrotic skin lesions and furuncles suggest a role of these toxins in the virulence of staphylococci, at least in cutaneous infections . Recent data on mechanisms of cytotoxic effects of staphylococcal leukocidal toxins in vitro as well as effects of leukocidal toxins in vitro are discussed . Cell membranes appear to be a primary target for triggering the lysis of phagocytic cells caused by staphylococcal leukocidal toxins. Int J Food Microbiol, 1999 Mar 15, 47(3), 221 - 9 Incidence of coagulase positive Staphylococcus on beef carcasses in three Australian abattoirs; Desmarchelier PM et al.; The contamination of beef carcasses with coagulase-positive staphylococci (CPS) was studied at three beef abattoirs (A, B and C) . The incidence and the number of CPS were determined on cattle hides immediately after slaughter and on three carcass sites (brisket, flank and round) at different points during processing along the slaughter line . The incidence of CPS on cattle hides ranged from 20 to 68.6% . At abattoir A, 6.5% of the carcasses sampled before evisceration were contaminated with CPS, compared to 40% of the carcasses after evisceration . The incidence on carcasses changed little during further processing; however, after chilling for 72 h, the incidence increased to 83% . After evisceration, the brisket and flank areas were more often contaminated than the round . A similar pattern of contamination was observed at abattoir B . At abattoir C, 26.7% of the samples collected before evisceration were contaminated and this fell to 16.7% after evisceration . After chilling for 72 h, the incidence of carcass contamination with CPS increased to 46.7% . The average number of CPS on contaminated carcasses prior to and after overnight chilling was less than 50 colony-forming units (cfu)/cm2 and, after weekend chilling, increased to 64 and 112 cfu/cm2 in abattoirs A and B, respectively . Of the isolates tested, 71.4% produced staphylococcal enterotoxin and 21% could not be classified phenotypically . The hands of workers and environmental sites associated with the evisceration process were examined for CPS at abattoir A . Hands were heavily contaminated and were the likely source of CPS contamination at this abattoir. FEBS Lett, 1999 May 7, 450(3), 257 - 62 Inhibition of virulence factor expression in Staphylococcus aureus by the Staphylococcus epidermidis agr pheromone and derivatives; Otto M et al.; The agr quorum-sensing system in Staphylococci controls the production of surface proteins and exoproteins . In the pathogenic species Staphylococcus aureus, these proteins include many virulence factors . The extracellular signal of the quorum-sensing system is a thiolactone-containing peptide pheromone, whose sequence varies among the different staphylococcal strains . We demonstrate that a synthetic Staphylococcus epidermidis pheromone is a competent inhibitor of the Staphylococcus aureus agr system . Derivatives of the pheromone, in which the N-terminus or the cyclic bond structure was changed, were synthesized and their biological activity was determined . The presence of a correct N-terminus and a thiolactone were absolute prerequisites for an agr-activating effect in S . epidermidis, whereas inhibition of the S . aureus agr system was less dependent on the original structure . Our results show that effective quorum-sensing blockers that suppress the expression of virulence factors in S . aureus can be designed based on the S . epidermidis pheromone. Diagn Microbiol Infect Dis, 1999 Jun, 34(2), 83 - 90 Rapid detection of the mecA gene in methicillin resistant staphylococci using a colorimetric cycling probe technology; Bekkaoui F et al.; A Cycling Probe Technology (CPT) assay was developed for the detection of the mecA gene from methicillin resistant staphylococcal cultures . The assay is based on a colorimetric enzyme-immuno-assay (EIA) and uses a mecA probe (DNA-RNA-DNA) labeled with fluorescein at the 5'-terminus and biotin at the 3'-terminus . The reaction occurs at a constant temperature that allows the target DNA to anneal to the probe . RNase H cuts the RNA portion, allowing the cut fragments to dissociate from the target, making it available for further cycling . CPT-EIA uses streptavidin-coated microplate wells to capture uncut probe followed by detection with horseradish-peroxidase conjugated anti-fluorescein antibody . The assay was compared to PCR and shown to accurately detect the presence or absence of the mecA gene in 159 staphylococcal clinical isolates . The CPT-EIA assay takes two hours starting from cultured cells compared with the 24-48 h required for detection of methicillin resistance by conventional susceptibility tests. J Antimicrob Chemother, 1999 Apr, 43(4), 569 - 73 Comparative in-vitro activities of moxifloxacin, trovafloxacin, quinupristin/dalfopristin and linezolid against staphylococci; von Eiff C et al.; The antistaphylococcal activities of four newly developed antibiotics, moxifloxacin (an 8-methoxyfluoroquinolone), trovafloxacin (a naphthyridone), quinupristin/dalfopristin (a semisynthetic streptogramin) and linezolid (an oxazolidinone), were examined and compared with those of ciprofloxacin, vancomycin and teicoplanin, using an agar dilution method . A total of 245 clinical isolates of staphylococci, including a large number of clonally different methicillin-resistant strains, were tested . The new agents tested exhibited wide-spectrum antistaphylococcal activity against both methicillin-susceptible and methicillin-resistant strains . In contrast to the quinolones, the in-vitro activities of quinupristin/dalfopristin, linezolid and the glycopeptides remained almost unchanged, irrespective of the resistance phenotype for methicillin . A number of isolates with elevated quinolone MICs were observed. Infect Control Hosp Epidemiol, 1999 May, 20(5), 349 - 51 Bacteremia due to persistent strains of coagulase-negative staphylococci in a neonatal intensive-care unit; Sung L et al.; This retrospective case-control study was performed to determine risk factors for bacteremia due to persistent coagulase-negative staphylococci in our neonatal intensive-care unit . Enteral nutrition and the presence of a nasogastric tube were identified as possible risk factors for coagulase-negative staphylococcal bacteremia involving one of the persistent strains. Am J Med, 1999 May 3, 106(5A), 26S - 37S; discussion 48S-52S The threat of vancomycin resistance; Perl TM; Vancomycin, produced in 1958, an essential antibiotic in the modern age, often is reserved for use in patients who are gravely ill or for infections caused by organisms resistant to penicillin, cephalosporin, or other antibiotics . Bacterial resistance to vancomycin has caused great concern among many healthcare professionals . First reported in 1986 in Europe and in 1988 in the United States, vancomycin-resistant enterococci (VRE) have become a major cause of nosocomial infections . During this time, scattered reports of clinical infections caused by vancomycin-resistant coagulase-negative staphylococci also were reported . Recently, enterococci that require vancomycin in media for growth, vancomycin-dependent enterococci (VDE), have been reported to cause clinically significant infections . Vancomycin or other glycopeptide intermediately resistant Staphylococcus aureus (VISA/GISA) also has emerged . The mechanisms of resistance to vancomycin for VRE, and probably for VISA/GISA, relate to the acquired ability of these organisms to circumvent the vancomycin-mediated disruption of bacterial cell wall synthesis . Risk factors that lead to VRE colonization or infection include prior antibiotic therapy, prolonged hospitalization, hospitalization in an intensive care unit, concomitant serious medical and surgical illnesses, exposure to equipment contaminated with VRE, and exposure to patients with VRE . Patients colonized or infected with VRE, healthcare workers with contaminated hands, and environmental surfaces in healthcare facilities are major reservoirs of VRE . Risk factors for VDE and VISA/GISA are less well understood, although both organisms emerge in patients receiving vancomycin or other glycopeptide antibiotics . Infection and antibiotic control procedures for both organisms, including restriction of vancomycin use, optimization of the antibiotic formulary, education of hospital personnel, early detection and reporting of vancomycin resistance, isolation of colonized patients, and appropriate cleansing of the environment are used to prevent the spread of these organisms in healthcare settings. J Biol Chem, 1999 May 28, 274(22), 15847 - 56 Multiple enzymatic activities of the murein hydrolase from staphylococcal phage phi11 . Identification of a D-alanyl-glycine endopeptidase activity; Navarre WW et al.; Bacteriophage muralytic enzymes degrade the cell wall envelope of staphylococci to release phage particles from the bacterial cytoplasm . Murein hydrolases of staphylococcal phages phi11, 80alpha, 187, Twort, and phiPVL harbor a central domain that displays sequence homology to known N-acetylmuramyl-L-alanyl amidases; however, their precise cleavage sites on the staphylococcal peptidoglycan have thus far not been determined . Here we examined the properties of the phi11 enzyme to hydrolyze either the staphylococcal cell wall or purified cell wall anchor structures attached to surface protein . Our results show that the phi11 enzyme has D-alanyl-glycyl endopeptidase as well as N-acetylmuramyl-L-alanyl amidase activity . Analysis of a deletion mutant lacking the amidase-homologous sequence, phi11(Delta181-381), revealed that the D-alanyl-glycyl endopeptidase activity is contained within the N-terminal 180 amino acid residues of the polypeptide chain . Sequences similar to this N-terminal domain are found in the murein hydrolases of staphylococcal phages but not in those of phages that infect other Gram-positive bacteria such as Listeria or Bacillus. J Clin Microbiol, 1999 Jun, 37(6), 2034 - 6 Oxacillin susceptibility testing of staphylococci directly from Bactec Plus blood cultures by the BBL Crystal MRSA ID system; Kubina M et al.; The BBL Crystal MRSA ID test (Becton Dickinson) was applied directly to blood culture vials containing clusters of gram-positive cocci . The sensitivity and specificity of the test were 84 and 100% and 54 and 100% for vials containing Staphylococcus aureus and coagulase-negative staphylococci, respectively . This test is a reliable method for direct detection of methicillin resistance in positive blood culture vials when S . aureus is identified in parallel by rapid identification procedures. Int J Dermatol, 1999 Apr, 38(4), 265 - 9 Comparative study of staphylococci from the skin of atopic dermatitis patients and from healthy subjects; Higaki S et al.; BACKGROUND: Bacterial infections occur frequently on the skin of atopic dermatitis (AD) patients . The objectives of this study were to evaluate the microbiology of the skin of AD patients for staphylococci, the frequency and density of each species, and their susceptibility to antimicrobial drugs . METHODS: To study the staphylococci present on the skin of 21 AD outpatients and of 12 healthy subjects (HS), cutaneous organisms were obtained using the contact-plate method . RESULTS: Staphylococcus aureus was isolated in 85.7% of AD patients (mild type, 77.8%; moderate type, 87.8%; and severe type, 100%) and in 25% of HS, while Staphylococcus epidermidis was isolated in 83.3% of HS and in 38.1% of AD patients . Among the coagulase-negative staphylococci (CNS) identified, S . epidermidis was the common type and several other CNS were detected in both AD patients and HS . As the eruption grade of dermatitic skin became more severe, the average density of S . aureus increased (severe, 2.68 +/- 0.86; moderate, 2.49 +/- 0.48; mild, 2.28 +/- 0.44) . A reversed tendency was seen in S . epidermidis (severe, 1.80; moderate, 1.90; mild, 2.10) . Among nine antimicrobial drugs tested against S . aureus, S . epidermidis, and some other types of CNS isolates, vancomycin (VCM) and minocycline (MINO) were the most active, gentamycin (GM) was the less active, and ampicillin (ABPC) was the least active . CONCLUSIONS: The skin of AD patients was more frequently colonized with S . aureus than that of normal controls . As the severity of the AD lesions increased, the numbers of S . aureus isolated increased . The skin of HS was more colonized with S . epidermidis . Other species of CNS were isolated from several cases of AD patients and HS . In addition, S . aureus, S . epidermidis, and the other CNS showed poor susceptibility to some of the tested antimicrobial drugs. APMIS Suppl, 1999, 91, 1 - 42 Phenotypic characteristics of coagulase-negative staphylococci: typing and antibiotic susceptibility; Jarlov JO; The present thesis deals with various aspects of handling coagulase-negative staphylococci (CoNS) in the local clinical microbiology laboratory . CoNS are normal inhabitants of the skin and mucus membranes and are increasingly being recognised as opportunistic pathogens causing infection in the immunocompromised host, in particular patients with indwelling plastic devices . In particular the finding of CoNS in specimens which should normally be sterile, such as blood cultures, is of interest . The isolation of the same strain of an opportunistic pathogen, such as CoNS, enhance the likelihood of the bacteria causing infection . Multiple antibiotic resistance, in particular methicillin resistance, is frequent among CoNS hospital-strains on a global scale . beta-lactam antibiotics are the most valuable antibiotics for the treatment of infection with susceptible CoNS . A reliable method for the detection of methicillin resistance, and hereby resistance to all beta-lactam antibiotics, is therefore important . A simple identification method, Minibact-S, has been developed . Minibact-S can identify the CoNS species, which are the most frequently occurring in human specimens . Furthermore, Minibact-S can subtype Staphylococcus epidermidis . Another phenotypic typing method, lectin typing, has been developed for typing S . epidermidis . Lectin typing involves the binding of various biotinylated lectins to the surface of whole immobilised cells of CoNS . Lectins are proteins or glycoproteins which bind specifically to various glycans . When the lectins: Wheat Germ Agglutinin (WGA), Soy Bean Agglutinin (SBA), Concanavalin A (ConA), and Lens Culinaris Agglutinin (LCA) were included, typing of S . epidermidis gave a discriminatory power of the same magnitude as found for DNA-plasmid profile analysis . Lectin typing could be used as a supplementary typing method for S . epidermidis in the local clinical microbiology laboratory, since the method is simple, reproducible and does not require expensive and sophisticated equipment . Various typing schemes for S . epidermidis, i.e . typing which involves several typing methods, have been tested: lectin typing, DNA-plasmid profile analysis, antibiotic susceptibility testing, phage typing, and slime production lectin typing, antibiotic susceptibility testing, biotyping (Minibact-S), phage typing antibiotic susceptibility testing and biotyping (Minibact-S) For use as a "first line" typing scheme in the local clinical microbiology laboratory, the typing of S . epidermidis by combined antibiotic susceptibility testing and biotyping is easy to handle . Antibiotic susceptibility testing should include antibiotics from several groups of antibiotics having different resistance mechanisms . Antibiotic susceptibility among Danish CoNS-strains from blood cultures was studied . A major diversity in species distribution and antibiotic susceptibility was found between different Danish regions, for example methicillin resistant CoNS accounted for 40% in Copenhagen County and only for 21% in Northern Jutland County . Diversity in species distribution was also marked; an example of this is that 73% of the strains from Copenhagen Municipality were identified as S . epidermidis compared to only 46% in Northern Jutland County . In a study from Rigshospitalet, Copenhagen, great diversity in antibiotic susceptibility was detected between the different wards . In four wards investigated, high consumption of carbapenems, Third-generation cephalosporins, and quinolones was associated with high prevalence of methicillin resistance . Furthermore, for ciprofloxacin, ciprofloxacin-resistant CoNS-strains were practically not detected in the Neonatal Ward where ciprofloxacin is not used . In contrast to the nationwide study, glycopeptide resistance was found at Rigshospitalet: 5% of the CoNS strains were teicoplanin-resistant but all strains were vancomycin-susceptible . In both the above mentioned studies, antibiotic resistance was strongly associated with J Med Microbiol, 1999 May, 48(5), 451 - 60 Use of semi-quantitative and quantitative culture methods and typing for studying the epidemiology of central venous catheter-related infections in neonates on parenteral nutrition; Mueller-Premru M et al.; To study the epidemiology - especially the impact of contaminated stopcocks - on central venous catheter (CVC) infection and catheter-related sepsis (CRS), semi-quantitative (SQ) and quantitative (Q) culture methods and typing of coagulase-negative staphylococci (CNS) were employed in 49 neonates with clinical signs of sepsis while receiving parenteral nutrition in the paediatric intensive care unit . The patients were divided into two groups according to stopcock contamination: group A consisted of 18 patients (36%) with contaminated stopcocks and group B consisted of 31 patients (64%) with sterile stopcocks . Five specimens were obtained from each patient, in addition to that from the stopcock: a swab taken from the skin surrounding the catheter puncture site; the CVC tip; the intradermal segment (IDC); and samples of parenteral fluid and blood . A total of 294 specimens (392 sites) was cultured and micro-organisms were identified . All CNS isolated were typed by biotyping, antibiogram, plasmid analysis and pulsed-field gel electrophoresis (PFGE), and the discriminatory power of the typing methods was compared . The CVC tips were infected in 25 patients (51%); 15 (83%) in group A and 10 (32%) in group B . Sepsis was detected in 24 neonates (49%), 13 in group A and 11 in group B . This was catheter-related in 15 patients (63%), 12 in group A and 3 in group B . CNS were recovered from 13 (52%) of 25 infected CVCs, nine in group A and four in group B . Sixty-five CNS isolates were recovered from these patients and belonged to 14 biotypes, 22 antibiograms, 22 plasmid profiles and 26 PFGE types . Typing showed that in six of nine patients in group A, CNS of the same type were recovered from the catheter tip and the stopcock, in one patient the catheter tip and skin isolates were the same and in two others the catheter tip isolates were different from stopcock and skin isolates . In all four patients in group B, different CNS types were recovered from CVC tips and skin . Bacteraemia was caused by CNS in 14 patients (58%), six in group A and eight in group B . Typing confirmed that nine cases (six in group A and three in group B) were catheter-related but five were not . SQ and Q culture methods and typing, especially by PFGE, allowed the study to determine that bacteria from contaminated stopcocks were frequently the source of CVC infection and CRS. World J Surg, 1999 Jun, 23(6), 589 - 95 Catheter-related bloodstream infections; Sitges-Serra A et al.; Catheter-related bloodstream infections (CBIs) rank among the most frequent and potentially lethal nosocomial infections . Intravascular devices become contaminated on the outer surface during nonaseptic insertion or maintenance of the catheter exit site or endoluminally during hub manipulation . CBI is heralded by spiking fever, malaise and rigors and should be promptly diagnosed to prevent endocarditis and septic metastasis . In about two-thirds of the cases the offending organisms are coagulase-negative staphylococci; Staphylococcus aureus, gram-negative bacilli, and Candida sp . are responsible for one-third of these infections and carry a worse prognosis . Diagnosis of CBI relies on proper bacteriologic techniques, some of which can be performed in situ avoiding withdrawal of the device . Prevention strategies should aim at avoiding extra- and endoluminal contamination and should be based on three main pillars: maximal aseptic barriers at insertion, appropriate site maintenance, and junctional (hub) care and protection . Treatment includes catheter withdrawal and appropriate antibiotic coverage . For long-term cuffed catheters, local treatment with intraluminal administration of antibiotics is effective and can save a significant