Microbiology, 1998 Apr, 144 ( Pt 4), 1005 - 12 The Staphylococcus aureus and Staphylococcus epidermidis transferrin-binding proteins are expressed in vivo during infection; Modun BJ et al.; Staphylococci express a 42 kDa cell-wall-associated protein which functions as a receptor for the mammalian iron-binding glycoprotein transferrin . To determine whether this transferrin-binding protein (TBP) is expressed during infection, Staphylococcus aureus and Staphylococcus epidermidis were grown in vivo in chambers implanted intraperitoneally in rats . SDS-PAGE and Western blotting of cell wall proteins prepared from staphylococci recovered directly from the chambers revealed the presence of both the TBP and bacterial-surface-associated rat transferrin . To obtain evidence for the in vivo expression of the staphylococcal TBPs in humans, sera and human peritoneal dialysate (HPD) from non-infected patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and sera from healthy human volunteers were screened for anti-TBP antibodies . Western immunoblots revealed that three out of ten samples from the latter group, seven out of ten HPD samples and ten of ten CAPD patient serum samples contained antibodies to the TBP of both S . aureus and S . epidermidis . To gain further insights into the appearance of TBP antibodies, HPD samples were collected over time from CAPD patients whose HPD samples taken immediately after catheter insertion lacked anti-TBP antibodies . In two of these patients, each of whom experienced an episode of peritonitis due to S . epidermidis or Staphylococcus hominis, antibodies to the TBP appeared in the HPD collected immediately post-infection . To determine whether such TBP antibodies were capable of blocking interactions between transferrin and its staphylococcal receptor, HPD immunoglobulin fractions were purified using protein A-Sepharose beads . In competition assays, these immunoglobulins blocked the binding of 125I-labelled transferrin both to whole bacteria and to the isolated 42 kDa TBPs of S . aureus and S . epidermidis . These provide evidence to show that staphylococcal TBPs are expressed in vivo during infection. J Antimicrob Chemother, 1998 Mar, 41(3), 329 - 40 Antimicrobial prophylaxis in orthopaedic surgery: the role of teicoplanin; Periti P et al.; Orthopaedic joint replacement is generally considered 'clean' surgery characterized by a low incidence of infection . In recent years the use of a clean theatre environment, high local concentrations of antibiotic in the cement and systemic antibiotic prophylaxis have been recognized as important measures to reduce infection rates significantly, and this has been supported by clinical trials . Staphylococcus aureus and Staphylococcus epidermidis cause at least half of all orthopaedic surgical infections . Gram-negative bacilli are involved to a much lesser extent (10-30%) . First- and second-generation cephalosporins are currently considered by most authors as standard prophylaxis in elective orthopaedic surgery . In the light of the increasing incidence of methicillin resistance in coagulase-positive and -negative staphylococci, it is becoming more important for antibiotics to act efficiently against such organisms if they are to be of value in prophylaxis in orthopaedic surgery . A combined, single-dose of vancomycin/gentamicin has been used successfully in an open, controlled study in patients undergoing total joint arthroplasty but, given the disadvantages associated with the use of vancomycin, teicoplanin may be an alternative choice in such procedures . This review analyses four comparative trials of the efficacy and safety of teicoplanin, two with cefamandole, one with cefuroxime and one with cephazolin, as prophylaxis in orthopaedic total joint replacement surgery. Biol Neonate, 1998, 73(5), 287 - 94 Use of teicoplanin in preterm neonates with staphylococcal late-onset neonatal sepsis; Degraeuwe PL et al.; OBJECTIVE: To study the clinical pharmacology of teicoplanin in babies admitted to a newborn intensive care unit, by monitoring serum levels, efficacy and potential side effects . METHODS: An open, nonrandomized descriptive study was performed in the neonatal intensive and high care unit of the University Hospital Maastricht, The Netherlands . Twenty-three preterm neonates, gestational age ranging from 26 to 32 weeks (median 28.4 weeks), postnatal age from 5 to 47 days, and birth weight from 570 to 1,740 g, presenting with (suspected) late onset septicemia, were studied . Of 21 culture-proven septicemias, 20 were caused by staphylococci . The teicoplanin loading dose was 15 mg/kg i.v., followed by a maintenance dose of 8 mg/kg every 24 h . Intravenous gentamicin was also administered pending blood culture . Serum teicoplanin concentrations were measured by fluorescence polarization immunoassay . Clinical and microbiological cure/failure rates were determined and possible side effects were monitored . RESULTS: The study of individual pharmacokinetics during multiple-dose intravenous infusions was rendered impossible by apparently inaccurate dosing . Peak (30 min after end of the infusion) and trough teicoplanin levels were stable throughout the study and averaged 27.8 (interquartile range 23.7-32.9) and 12.3 (interquartile range 9.1-16.8) mg/l, respectively . The microbiological and clinical cure rates were 90% in gram-positive septicemia . There was no apparent toxicity . CONCLUSIONS: Inaccurate drug administration was a problem in this study, making a multidose pharmacokinetic study impossible . It is possible that inaccurate drug administration and not current dosage guidelines yielded trough levels below 10 mg/l in 57 (32%) of 176 instances . This pharmaceutical aspect clearly warrants further study . However, microbiological and clinical cure rates were high in gram-positive septicemias . No side effects attributable to teicoplanin therapy were encountered. Diagn Microbiol Infect Dis, 1998 Mar, 30(3), 205 - 14 Staphylococcus aureus and coagulase-negative staphylococci from blood stream infections: frequency of occurrence, antimicrobial susceptibility, and molecular (mecA) characterization of oxacillin resistance in the SCOPE program; Marshall SA et al.; Staphylococci are major causes of nosocomial blood stream infection . The recently completed SCOPE Surveillance Program found that coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the first and second most common etiologic agents, respectively, causing nosocomial blood stream infection in the USA . The frequency of oxacillin resistance was 68% among 1553 strains of CoNS and 26% among 787 strains of S . aureus in this study . Extended susceptibility profiles were generated for a subset of 150 S . aureus and 300 CoNS against 16 antimicrobial agents . Oxacillin-susceptible strains of both CoNS and S . aureus were uniformly susceptible to beta-lactam agents with the exception of ampicillin and penicillin . Oxacillin-susceptible S . aureus were also highly susceptible to the fluoroquinolones, aminoglycosides, and trimethoprim/sulfamethoxazole . The oxacillin-susceptible CoNS were less susceptible to these agents, and only glycopeptides were reliably active against oxacillin-resistant strains . PCR detection of the mecA gene was used to scrutinize current NCCLS interpretive breakpoint MICs for determining susceptibility or resistance to oxacillin . We found complete concordance between the presence or absence of mecA and the NCCLS oxacillin interpretive breakpoint categories for S . aureus . In contrast, the NCCLS breakpoints for oxacillin significantly underestimate the degree of true oxacillin resistance among CoNS . Using the presence of mecA as the reference standard, we detected 15.7% false susceptibility to oxacillin using a MIC susceptible breakpoint concentration of < or = 2 micrograms/mL . Lowering the oxacillin MIC breakpoint to < or = 0.25 microgram/mL for CoNS would greatly improve the accuracy of the MIC test performance . We found that both the current oxacillin disk test and the 30-microgram ceftizoxime disk test functioned quite well in predicting those strains of CoNS that contain mecA . These studies have demonstrated both a high level of antimicrobial resistance among nosocomial blood stream isolates of staphylococci as well as significant problems with the current NCCLS breakpoints for oxacillin when testing CoNS. Tidsskr Nor Laegeforen, 1998 Mar 20, 118(8), 1182 - 5 {Methicillin resistant yellow staphylococci}; Andersen BM et al.; The incidence of methicillin-resistant Staphylococcus aureus in Norway is extremely low . Isolation of such strains is nearly always associated with import . From December 1993 to January 1997 at the Ulleval University Hospital Department of Medical Microbiology, methicillin-resistant Staphylococcus aureus was isolated from 22 persons in Oslo (17 patients and five healthy carriers) . A cluster of ten infected persons was detected (five patients and five carriers (nurses)) who were infected with strains showing an unusual antibiotic resistance pattern . All of the cluster strains except for beta-lactams were resistant to fucidic acid and sensitive to other antistaphylococcal agents . The cluster was associated with two hospitals . The five patients were all admitted to the same intensive care unit during the period May to July 1995 . Four of the five patients (one died) were referred to the same department in a long-term care hospital for rehabilitation and training . Problems concerning epidemiological investigation and control are discussed. Vet J, 1998 Mar, 155(2), 183 - 8 A comparison of methods used in species identification of coagulase-negative staphylococci isolated from the milk of sheep; Burriel AR et al.; Thirty reference strains of staphylococci, 76 strains isolated from confirmed cases of subclinical mastitis and 10 strains from the teat tip skin and the mouth of sucking lambs were assigned to species using four biochemical methods . These were the commercially available micromethods API Staph and Staph-Zym; the specialized laboratory method Rosco Set and Reactions in Standard Laboratory Culture Media (SLCM) . The Rosco Set assigned species to all the strains, the SLCM to 96.5%, the Staph-zym to 86.1% and the API Staph to 81.4% . API Staph and the SLCM favoured the 'aureus' group with the 'epidermidis' second, while the reverse was true for the other two methods . All the identification methods assigned the same species to only 29% of the tested isolates, causing considerable variation in the number of species identified within each group . This variation indicates that reported species prevalence from cases of ovine mastitis should be viewed with caution. Klin Padiatr, 1998 Mar-Apr, 210(2), 56 - 60 {Acute hematogenous osteomyelitis in childhood--correlation of clinical aspects, diagnostic parameters, therapy and prognosis}; Spindler T et al.; BACKGROUND: Acute hematogenous osteomyelitis is a common disease in childhood . If treated early, conservative management is possible in most cases . During recent decades, clinical picture, diagnostic techniques and treatment have changed due to various reasons, e.g . previous antibiotic treatment . New laboratory tests and improved imaging techniques such as magnetic resonance imaging enable an earlier diagnosis and thus an earlier onset of treatment and improve the prognosis of hematogenous osteomyelitis . Outcome has also been improved by new antibiotics with enhanced activity against staphylococci . METHOD: The records of 34 children aged 3 weeks to 172 months with acute hematogenous osteomyelitis were evaluated retrospectively . In some cases, the data were completed by phone calls with parents and family physicians . The results were compared with the current literature . RESULTS AND CONCLUSIONS: If diagnosed and treated early, acute hematogenous osteomyelitis in childhood has a good prognosis . For primary diagnosis, the clinical picture, parameters of inflammation and magnetic resonance imaging or scintigraphy are useful . The course of the disease can be assessed by clinical signs and the erythrocyte sedimentation rate . Complications can be recognized by conventional radiography and sonography . Initial antibiotic treatment should be carried out parenterally for at least 3 weeks . An exclusively oral treatment is not recommended. Crit Care Clin, 1998 Apr, 14(2), 339 - 46 Intravenous line infections; Cunha BA; Centrally-placed i.v.-line infections are a frequent cause of fever in the critical care unit . i.v.-line infection is not usually accompanied by local signs of infection, and usually presents as unexplained fever . The diagnosis should be considered only after other causes of fever have been ruled out . The likelihood of fever being due to i.v.-line infection increases with duration of i.v . catheterization . Skin organisms (i.e., Staphylococcus epidermidis/coagulase-negative staphylococci, and to a lesser extent, Staphylococcus aureus) are the usual pathogens in i.v.-line infection . Treatment of i.v.-line infection involves removal of the i.v . line/device . Empiric antibiotic therapy directed against gram-positive cocci/aerobc gram-negative bacilli is usually started after blood cultures have been obtained and the removed catheter tip sent for semiquantitative culture. Infection, 1998 Mar-Apr, 26(2), 85 - 92 Positive blood cultures for coagulase-negative staphylococci in neonates: does highly selective vancomycin usage affect outcome? Matrai-Kovalskis Y, Greenberg D, Shinwell ES, Fraser D, Dagan R. The implication of highly-selective vancomycin usage on the outcome for infants with positive blood cultures for coagulase-negative staphylococci (CONS) was assessed retrospectively . The analysis was performed on partly prospective collected data from infants under 3 months of age with a least one CONS-positive blood culture in the neonatal intensive care unit at the Soroka University Medical Center between 1990 and 1996 . During the study period, 239 episodes of CONS-positive blood cultures were identified from among 64,226 live births (3.7 per 1,000) . Vancomycin was administered in 22 (9%) episodes, in all cases only after identification of the bacteria . The remaining 217 episodes were managed either without antibiotics or with continuation or initiation of empiric antibiotic therapy (usually ceftazidime +/- ampicillin) for suspected sepsis . Severity of the initial illness, subsequent morbidity and mortality were low regardless of the treatment administered . Only a single case of a blood-borne vancomycin resistant gram-positive organism was observed during the study period . The approach to CONS-positive blood cultures in neonates used here was associated with low morbidity and mortality . These findings support a policy of highly selective vancomycin usage in an era of emerging vancomycin resistance. Dermatology, 1998, 196(1), 59 - 66 Bacterial resistance in acne; Eady EA; Antibiotics play a major role in acne therapy . Physicians base treatment choices on personal perceptions of efficacy, cost-effectiveness or risk-benefit ratios and rarely take bacterial resistance into account . It is well documented that resistant strains of coagulase-negative staphylococci within the resident skin flora increase in both prevalence and population density as duration of therapy increases . Acne patients represent a considerable reservoir of resistant strains of these important nosocomial pathogens which can be transferred to close contacts . Resistance in cutaneous propionibacteria has received scant attention in view of the central role of Propionibacterium acnes in inflammatory acne . Isolates resistant to one or more anti-acne antibiotics (most commonly erythromycin) have been reported in Europe, the USA, Japan and New Zealand . Carriage of resistant strains results in therapeutic failure of some but not all antibiotic regimens . In our region, skin carriage of resistant strains by 60% of acne patients and 1 in 2 of their close contacts suggests that resistant strains are widely disseminated . We are beginning to gain an understanding of those factors which encourage resistance development and can identify those patients most likely to possess resistant propionibacterial floras . Recommendations for the use of antibiotics in acne therapy to help prevent the emergence of resistance in P . acnes include the implementation of antibiotic usage policies and the encouragement of improved prescribing habits. Antimicrob Agents Chemother, 1998 Apr, 42(4), 956 - 8 Killing of Staphylococcus aureus by C-8-methoxy fluoroquinolones; Zhao X et al.; C-8-methoxy fluoroquinolones were more lethal than C-8-bromine, C-8-ethoxy, and C-8-H derivatives for Staphylococcus aureus, especially when topoisomerase IV was resistant . The methoxy group also increased lethality against wild-type cells when protein synthesis was inhibited . These properties encourage refinement of C-8-methoxy fluoroquinolones to kill staphylococci. Antimicrob Agents Chemother, 1998 Apr, 42(4), 939 - 41 Effects of slime produced by clinical isolates of coagulase-negative staphylococci on activities of various antimicrobial agents; Souli M et al.; A novel in vitro semiquantitative method was developed to investigate the influence of staphylococcal slime on the activities of 22 antimicrobial agents . Pefloxacin, teicoplanin, and vancomycin demonstrated remarkable decreases in efficacy: 30, 52, and 63%, respectively . The activity of rifampin was not significantly reduced (0.99%), whereas all other agents tested were modestly affected (<15% decrease) . These data could be influential in the treatment of implant-associated infections caused by slime-producing staphylococci. Vet Res, 1998 Jan-Feb, 29(1), 73 - 88 Quantification of C5a/C5a(desArg) in bovine plasma, serum and milk; Rainard P et al.; Complement activation generates two potent inflammatory mediators from C5, C5a and its derivative C5a(desArg), which results from the removal of the C-terminal arginine by ubiquitous carboxypeptidases . In this paper we describe the purification of milligram amounts of bovine C5a(desArg) by a simplified procedure, and the preparation of mouse monoclonal antibodies (MAbs) to C5a/C5a(desArg) which do not recognize native C5 . A MAb was used to develop a sandwich ELISA which made it possible to quantify levels of C5a/C5adesArg in bovine biological fluids . Small amounts (means +/- SEM) of C5a/C5a(desArg) were found in EDTA-plasma (0.58 +/- 0.06 ng.mL-1) . The anticoagulant EDTA was more efficient than citrate or heparin in inhibiting in vitro activation of the complement system . Complement activation occurred during coagulation since the baseline concentration of C5a/C5a(desArg) (15.4 +/- 4.1 ng.mL-1) was higher than in plasma . Zymosan, a potent activator of the complement cascade, was used to generate C5a/C5a(desArg) . The time-course of the reaction and the dose-effect of zymosan were investigated . Optimal conditions were incubation at 39 degrees C for 1 or 2 h with 2 mg of zymosan per mL of serum . The maximal concentration of C5a/C5a desArg attained in zymosan-activated serum was 4.28 +/- 0.14 micrograms.mL-1 . Normal milk (from healthy, uninflamed mammary glands) contained on average 0.12 ng of C5a/C5a(desArg).mL-1 (range 0.02-0.19 ng.mL-1) . The maximal amount of C5a/C5a(desArg) which was generated in milk with zymosan was 1.1 ng.mL-1 (range 0.68-2.17 ng.mL-1) . In milk from quarters with subclinical infections by coagulase-negative staphylococci, values were 0.18 ng.mL-1 and 2.37 ng.mL-1 for spontaneous and zymosan-generated C5a/C5a(desArg) concentrations, respectively . In milk from Escherichia coli endotoxin-induced mastitis, C5a/C5a(desArg) concentrations (means of four cows) before and after zymosan activation reached 6.5 ng.mL-1 and 55 ng.mL-1, respectively . These results indicate that a C5-convertase can operate in normal milk, that only minute amounts of C5a/C5a(desArg) can be generated (less than 1/1,000 of plasma potential), but that much higher concentrations are reached in milk during endotoxin-induced inflammation . The ELISA made it possible to determine normal ranges of C5a/C5a(desArg) in bovine blood plasma and in milk, and is a valuable tool to define the variations of its concentrations in exudates during inflammatory reactions. Roum Arch Microbiol Immunol, 1996 Oct-Dec, 55(4), 323 - 31 Rapid test for the detection of methicillin-resistance of staphylococci by ATP-dependent bioluminescence; Codita I et al.; Methicillin resistance of staphylococci is a marker of multiple resistance to antimicrobial drugs . The authors present their own variant of applying ATP-dependent bioluminescence for the rapid testing of methicillin resistance . It consists in the measurements of the total bacterial ATP obtained by extraction . The authors test the method on 23 Staphylococcus strains and compare the results with those obtained by the diffusion method, the screening method with the antibiotic included in the agar and the broth dilutions method . The results obtained by ATP-dependent bioluminescence were in agreement with those obtained by broth dilutions method. J Bacteriol, 1998 Apr, 180(8), 2160 - 6 Interaction of native and mutant MecI repressors with sequences that regulate mecA, the gene encoding penicillin binding protein 2a in methicillin-resistant staphylococci; Sharma VK et al.; Methicillin resistance in staphylococci is mediated by PBP2a, a penicillin binding protein with low affinity for beta-lactam antibiotics . The gene encoding PBP2a, mecA, is transcriptionally regulated in some clinical isolates by mecR1 and mecI, genes divergently transcribed from mecA that encode a signal transducer and repressor, respectively . The biochemical basis of MecI-mediated mecA transcriptional repression was investigated by using purified MecI . In DNase I protection studies, MecI protected a 30-bp palindrome encompassing the predicted mecA -10 and the mecR1 -35 promoter sequences . The larger palindrome contained 15 bp of dyad symmetry within which was a smaller 6-bp palindrome . Electrophoretic mobility shift assays established a requirement for the entire 15-bp half-site for initial repressor binding . Fragments containing the 30-bp palindrome and the entire mecA-mecR1 intergenic region were retarded in gels as multiple discrete bands varying in molecular size, characteristic of cooperative DNA binding . Glutaraldehyde cross-linking confirmed oligomerization of repressor in solution . A naturally occurring MecI mutant (MecI*; D39G) repressed mecA transcription sixfold less well than the wild type in vivo . Although MecI* protected the same target sequences and exhibited similar gel shift patterns to MecI, 5- to 10-fold more protein was required . MecI* exhibited defective oligomerization in solution, suggesting that the MecI amino terminus is important in protein-protein interactions and that protein oligomerization is necessary for optimum repression. J Bacteriol, 1998 Apr, 180(8), 1988 - 94 Enterocins L50A and L50B, two novel bacteriocins from Enterococcus faecium L50, are related to staphylococcal hemolysins; Cintas LM et al.; Enterocin L50 (EntL50), initially referred to as pediocin L50 (L . M . Cintas, J . M . Rodriguez, M . F . Fernandez, K . Sletten, I . F . Nes, P . E . Hernandez, and H . Holo, Appl . Environ . Microbiol . 61:2643-2648, 1995), is a plasmid-encoded broad-spectrum bacteriocin produced by Enterococcus faecium L50 . It has previously been purified from the culture supernatant and partly sequenced by Edman degradation . In the present work, the nucleotide sequence of the EntL50 locus was determined, and several putative open reading frames (ORFs) were identified . Unexpectedly, two ORFs were found to encode EntL50-like peptides . These peptides, termed enterocin L50A (EntL50A) and enterocin L50B (EntL50B), have 72% sequence identity and consist of 44 and 43 amino acids, respectively . Interestingly, a comparison of the deduced sequences of EntL50A and EntL50B with the corresponding sequences obtained by Edman degradation shows that these bacteriocins, in contrast to other peptide bacteriocins, are secreted without an N-terminal leader sequence or signal peptide . Expression in vivo and in vitro transcription/translation experiments demonstrated that entL50A and entL50B are the only genes required to obtain antimicrobial activity, strongly indicating that their bacteriocin products are not posttranslationally modified . Both bacteriocins possess antimicrobial activity on their own, with EntL50A being the most active . In addition, when the two bacteriocins were combined, a considerable synergism was observed, especially with some indicator strains . Even though the enterocins in some respects are similar to class II bacteriocins, several conserved features common to class II bacteriocins are absent from the EntL50 system . The enterocins have more in common with members of a small group of cytolytic peptides secreted by certain staphylococci . We therefore propose that the enterocins L50A and L50B and the staphylococcal cytolysins together constitute a new family of peptide toxins, unrelated to class II bacteriocins, which possess bactericidal and/or hemolytic activity. Diagn Microbiol Infect Dis, 1998 Feb, 30(2), 131 - 4 Identification of oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus using commercial latex agglutination tests; Summers WC et al.; Four hundred thirteen Staphylococcus sp . were identified by Staphaurex, Staphaurex Plus, and BACTiStaph kits using tube coagulase as reference . Among 222 coagulase-positive isolates, 56 were oxacillin-resistant Staphylococcus aureus . All tests were accurate in distinguishing between coagulase-positive and -negative staphylococci with sensitivities and specificities > or = 97% and only nine discrepancies. Acta Microbiol Immunol Hung, 1997, 44(4), 343 - 9 Compact growth of Staphylococcus haemolyticus in soft agar is not due to hydrophobic interaction between the cocci; Godo ZI et al.; It was hypothesized that the formation of compact colony in soft-agar both in the presence and absence of serum, characteristic mainly for strains of the species Staphylococcus haemolyticus among coagulase-negative staphylococci {Szucs et al . Acta Microbiologica Hungarica 40:181-189 (1993)} was due to hydrophobic interaction between cocci . The effect of a number of surface active agents on this phenomenon was examined . Neither 0.1% and 1% . Tween-80 nor 5% and 10% ethylene glycol and polyethylene glycol nor 0.1%-4% trypsin influenced the colony morphology in soft-agar prepared in modified Staphylococcus 110 broth . Bovine lactoferrin and apolactoferrin at concentrations of 0.1%-0.4% made compact colonies transient to diffuse ones . Thus, cocci are not adhered to each other in compact ball-like colonies by hydrophobic interaction or trypsin-sensitive proteins . It is possible that still unknown polysaccharide-binding proteins or other trypsin-resistant proteins are responsible for the formation of compact colonies by Staphylococcus haemolyticus in soft-agar. Med Dosw Mikrobiol, 1997, 49(3-4), 123 - 30 {The influence of temperature on culture of Staphylococcus aureus for cell adhesion to collagen}; Krajewska-Pietrasik D et al.; The aim of this study was the investigation of adhesion of 88 S . aureus clinical isolates to collagen . The experiments were extended to determine the influence of growth temperature on collagen adhesin-collagen interaction . Bacterial adhesion to collagen was estimated by using immunoenzymatic assay at absorbance of 492 nm and compared with standard curves obtained for 8 different densities of each strain . The amount of collagen adhesin was indicated by colour reaction intensity measured by immunoenzymatic assay . Hydrophobicity of S . aureus strains was measured by aggregation in (NH4)2SO4 test . Almost all S . aureus strains isolated from bone and joint infections adhered to collagen whereas only a part of soft tissue infections isolates showed this feature . The comparison of adhesive properties of S . aureus cells cultured at 21 degrees C, 37 degrees C and 42 degrees C did not make it possible to indicate the optimal culture temperature for S . aureus adhesion to collagen . However, the intensive colour reaction of cells cultured at 37 degrees C with anti-collagen adhesin antibodies proves the production of the highest amount of this adhesin under the mentioned conditions . The influence of growth temperature as well as solid and/or liquid medium on the change of S . aureus hydrophobic properties was not observed . The obtained results show that the S . aureus growth temperature can be one of the factors influencing the staphylococci cells adhesion to collagen. Med Dosw Mikrobiol, 1997, 49(3-4), 113 - 22 {Deamination of adenine and adenosine in staphylococci}; Krasuski A et al.; Deaminations of adenine and adenosine by pattern strains of 24 staphylococcal species, were tested . During 3 hours of incubation of the suspensions of 8 staphylococci with adenine the liberation of ammonia occurred . The same staphylococci accumulated ammonia in the incubation medium with adenosine . The Staphylococcus intermedius PCM 2405 strain as opposite to the Staphylococcus aureus 536 strain in the media with adenine or adenosine accumulated hypoxanthine or inosine, respectively and ammonia . These results indicated that adenine deaminase (adenase) and adenosine deaminase activities were associated with the cells of the Staphylococcus intermedius PCM 2405 strain . Staphylococci were heterogeneous within three species groups with respect to adenine and adenosine deaminations . Adenine and adenosine determinations were absent in staphylococci belonging to the Staphylococcus simulans species group. Vet Microbiol, 1998 Jan 16, 59(2-3), 139 - 45 Exoprotein and slime production by coagulase-negative staphylococci isolated from goats' milk; Bedidi-Madani N et al.; Milk from mastitis-free goats from French herds was examined for the presence of coagulase-negative staphylococci (CNS), and 165 positive isolates were evaluated for their capacity to produce exoproteins . Most isolates were identified as Staphylococcus caprae (N = 91) or S . xylosus (N = 36), but members of at least nine other species were present . Overall, some 57% of isolates produced toxins with phenotypic properties of alpha-hemolysin, and 75% produced toxins resembling S . aureus beta and/or delta-hemolysins . Thermostable desoxyribonuclease (TNAse) was secreted by 29% of isolates and thermolabile DNAse by 66% . Slime was produced by 42% of our cultures and, although none of them showed activity to insoluble elastase, over 70% lysed the soluble substrate . No clinical consequences were observed to correlate with exoprotein production, which proved to be inconstant within individual CNS species. APMIS, 1998 Mar, 106(3), 411 - 6 Coagulase-negative staphylococci in a major Danish university hospital: diversity in antibiotic susceptibility between wards; Jarlov JO et al.; Over a one-year period, all coagulase-negative staphylococci (CoNS) from blood cultures, cerebrospinal fluids and peritoneal effluents from patients in a major Danish university hospital were investigated for susceptibility to penicillin G; methicillin; gentamicin; netilmicin; amikacin; erythromycin; clindamycin; fusidic acid; rifampicin; tetracycline; chloramphenicol; ciprofloxacin; teicoplanin; and vancomycin . Among the CoNS-isolates, 56% were resistant to methicillin, 51% to gentamicin, 28% to ciprofloxacin, and 5% to teicoplanin . Blood culture CoNS-isolates from patients with a central venous catheter (CVC) were more often resistant to various antibiotics compared to CoNS-isolates from patients without a CVC, e.g . methicillin (72% vs 21%), gentamicin (65% vs 22%) (p<0.00000001) . Great diversity in antibiotic resistance between the wards was found; methicillin resistance (in most cases multiple antibiotic resistance) was in particular associated with consumption of broad-spectrum beta-lactams, quinolones, and total antibiotic consumption in a ward . Thus, the antibiotic policy of a ward is an important factor for antibiotic resistance among CoNS. Semin Respir Infect, 1998 Mar, 13(1), 8 - 16 Management of pneumonia in the outpatient setting; Woodhead M; Most patients with pneumonia never reach the hospital but are managed in the community . Unlike patients admitted to the hospital, in most, no investigations are performed and the diagnosis is based on clinical features . Less than half of those with clinical pneumonia have radiographic infiltrates and some of those with lower respiratory tract infection that is not considered to be pneumonia do . Few studies have investigated this condition, partly because of these diagnostic difficulties . The importance of distinction of these conditions is uncertain at present . The role of microbiological investigations in patients with pneumonia in the community requires clarification . For most patients it is unlikely that such tests will alter management, but it is not possible to predict those in whom such tests may help . What little is known about the microbial cause of pneumonia managed outside of the hospital is that the causative pathogens are similar to those found in studies of hospitalized patients, with the exception of pathogens usually associated with severe illness such as legionella and staphylococci, which are uncommon . Empirical antibiotic therapy can be predicted from the above findings, but much further research is required to fill in current gaps in our knowledge. FEBS Lett, 1998 Mar 6, 424(1-2), 89 - 94 Structure of the pheromone peptide of the Staphylococcus epidermidis agr system; Otto M et al.; The agr quorum-sensing system is responsible for the regulation of several virulence factors in staphylococci, with an extracellular pheromone peptide as signalling molecule . By monitoring the biological activity of synthetic peptides, it could be demonstrated that the pheromone of the agr system in Staphylococcus epidermidis is an octapeptide containing a thiolester linkage between the central cysteine and the C-terminal carboxyl group . The peptide was active at nanomolar concentrations . The N-terminus of the peptide pheromone, which is encoded as part of a protein precursor, proved to be crucial for biological activity. J Antimicrob Chemother, 1998 Feb, 41(2), 273 - 6 Evaluation of the in-vitro activity of the glycopeptide antibiotic LY333328 in comparison with vancomycin and teicoplanin; Harland S et al.; The in-vitro activity of a new glycopeptide antibiotic, LY333328, was compared with vancomycin and teicoplanin against clinical isolates of Staphylococcus aureus, coagulase-negative staphylococci, vancomycin and teicoplanin resistant enterococci, and vancomycin sensitive and resistant enterococci . MIC, MBC, and time-kill kinetics were determined for each agent . LY333328 displayed similar or improved MIC/MBC values in comparison with vancomycin and teicoplanin . Time-kill kinetics for LY333328 demonstrated significantly improved bactericidal activity against the isolates . These findings suggest that LY333328 has improved in-vitro activity over vancomycin and teicoplanin against a range of gram-positive organisms. Antibiot Khimioter, 1998, 43(1), 4 - 14 {Comparative activity of meropenem and other antibiotics against the pathogens of nosocomial infections}; Sidorenko SV et al.; Comparative activity of meropenem and other antibacterial drugs against isolates from intensive care and reanimation units of various profiles was estimated . It was shown that the recommendations for the combined therapy with the 3rd generation cephalosporins and aminoglycosides should be revised, since none of the isolates resistant to ceftazidime or cefotaxime was susceptible to gentamicin or tobramycin . At present the most promising agents of empirical therapy are carbapenems (meropenem and imipenem) . However, the resistance of methicillin resistant staphylococci and Enterococcus faecium to carbapenems and the intrinsic resistance of some gram-negative bacteria to carbapenems are indicative of the necessity of microbiological diagnosis, especially when the treatment with meropenem fails. Zentralbl Hyg Umweltmed, 1998 Feb, 200(5-6), 479 - 90 {Effect of protamine on the microbicidal efficacy of formaldehyde}; Peters J et al.; Testing the ability of commercial compounds to provide an effective disinfection of instruments requires test conditions that are close to reality which includes the proper selection of the material used to contaminate the test objects . The adhesion of the material must be strong enough to keep it attached to the test object during and after insertion into the disinfectant solution . Its characteristics should come as close as possible to those of the contaminations encountered in practice . The guideline for instrument disinfectants published by the Robert Koch-Institute recommends the use of coagulated blood . Accordingly, heparinized sheep blood is mixed with the test germs, and protamin is added to initiate coagulation . In the present investigation we compared this contamination procedure with a second one, in which coagulation was achieved by adding a CaCl2 solution to citrate blood . We also included agarose as an almost inert contaminant in our experiments . The results showed that protamine is able to increase the microbicidal efficacy of formaldehyde on staphylococci significantly . When these test germs were embedded either in citrat blood or in agarose, it took about twice the disinfectant concentrations to achieve the same microbicidal effects as with protamine blood (Fig . 1) . Remarkably, the results obtained with citrate blood were the same as those with agarose, regardless of the differences in material between the two contaminants . It should also be noted that the microbicidal effect of the formaldehyde proved to be almost independent from the amount of contaminant per test area, hence, from the thickness of the layer . When M . terrae was employed as test germ, the results obtained with protamine blood and citrate blood, respectively, as contaminants were identical (Fig . 2) . The same was true for the other test germs investigated, except for E . faecium (Fig . 3) . The addition of even very small amounts of protamine to the embedding compound, agarose led to a substantially increased efficacy of the formaldehyde against staphylococci (Fig . 4) . This effect was especially distinct in suspension (Fig . 5) . Whenever the efficacy of formaldehyde-containing disinfectants is to be tested and evaluated, one should be aware of this synergism between protamine and formaldehyde . In these cases, it is advised to employ other contaminating agents, such as coagulated blood prepared by addition of CaCl2 to citrate blood. Zentralbl Veterinarmed B, 1998 Feb, 45(1), 43 - 52 Histopathological and ultrastructural observations of ovine mammary glands experimentally inoculated with coagulase-negative staphylococci; Burriel AR; The mammary glands of 21 primiparous Mule ewes were infected experimentally with one or other of seven isolates of coagulase-negative staphylococci belonging to one of four different species . All isolates caused inflammation that contributed to histopathological and ultrastructural changes . Histopathological changes varied from various degrees of neutrophilic inflammation at the early stages of infection to extensive mononuclear cell infiltration and development of fibrotic tissue at the late stages . The severity and extent of the lesions varied between isolates . At late stages of infection mononuclear cells were involved in active phagocytosis more often than neutrophils . Phagocytosed cocci within mononuclear cells were observed in the interstitium . These cells could become reservoirs of staphylococci that may prolong the inflammatory response. Antimicrob Agents Chemother, 1998 Feb, 42(2), 306 - 12 Determination of the chromosomal relationship between mecA and gyrA in methicillin-resistant coagulase-negative staphylococci; Fey PD et al.; mecA, the gene that mediates methicillin resistance, and its accompanying mec locus DNA, insert near the gyrA gene in Staphylococcus aureus . To investigate whether there is a similar relationship between mecA and gyrA in coagulase-negative staphylococci (CNS), mecA- and gyrA-specific DNA fragments were used to probe methicillin-resistant isolates of Staphylococcus epidermidis (MRSE) (n = 11) and Staphylococcus haemolyticus (MRSH) (n = 11) . The gyrA probe hybridized to the same SmaI DNA fragment as the mecA probe in all strains tested . However, since the size of the SmaI fragments containing mecA and gyrA varied from 73 to 600 kb, the distance between the two genes was determined more precisely . Cloned mecA or gyrA fragments plus vector sequences each containing a SmaI site were introduced into the chromosome of three isolates each of MRSE and methicillin-resistant S . aureus (MRSA), and the sizes of the generated SmaI fragments were determined by pulsed-field gel electrophoresis . The distance between gyrA and mecA was found to be between 38 and 42 kb in both MRSE and MRSA, and the two genes were in the same relative orientation in all strains . Restriction fragment length polymorphism (RFLP) patterns around the gyrA gene in CNS were identical, but species specific, for all 10 MRSE and 10 MRSH isolates examined . In contrast, 8 of 11 methicillin-susceptible S . epidermidis isolates and 7 of 7 methicillin-susceptible S . haemolyticus isolates had different gyrA RFLP patterns . These data show that mecA is site and orientation specific, relative to gyrA, in both MRSE and MRSA . In addition, the local environment around gyrA in methicillin-resistant CNS, in contrast to methicillin-susceptible isolates, is similar, suggesting clonality or the requirement for specific DNA sequences with which the mec complex must interact for chromosomal integration to occur. Biol Trace Elem Res, 1997 Winter, 59(1-3), 153 - 8 Serum and milk iron levels during sheep intramammary infection caused by coagulase-negative staphylococci; Burriel AR et al.; The concentration of iron (Fe) in the milk and serum of sheep was determined before and during experimental intramammary infection (IMI) by coagulase-negative staphylococci (C-NS) . Fe concentration of normal milk and serum samples was 0.24 microgram/mL and 1.56 micrograms/mL respectively . Presence of C-NS in the mammary gland resulted in a significant increase in milk-iron concentration (p < 0.001) and a decrease in the serum-iron concentration . Serum-iron concentration was significantly decreased (p = 0.04) one d after the intramammary introduction of C-NS and 29 d later (p = 0.03). Harefuah, 1998 Jan 1, 134(1), 15 - 22, 79 {Incidence, antimicrobial resistance and mortality in bloodstream infections in the critically ill}; Oud L et al.; Bloodstream infections (BSI) are 7-fold more common in patients admitted to the intensive care unit (ICU) rather than to other hospital wards . The epidemiology of BSI in critically ill patients in Israel has not been systematically addressed . We examined the annual trends in BSI in patients in a general ICU of evolving patterns of antimicrobial resistance and associated mortality rates for the years 1994-1996 . The presence of the systemic inflammatory response syndrome (SIRS) when the first positive blood cultures are taken was a prerequisite for its definition as clinically significant . The unit site, staff, practice guidelines, and type of patient were unchanged during the study period . Blood cultures were positive in 220.7-332.0 patients per 1000 ICU admissions, 18-22-fold more common than in regular ward patients . SIRS was a universal finding in these ICU patients . There was multi-drug resistance for the majority of species cultured, reaching 100% in some cases . Crude hospital mortality of ICU patients, with and without positive blood cultures, was 31-54% and 5-14%, respectively . The introduction of a new blood culture system (Bactec 9240) in 1996 was associated with a 61% increase in the rate of patients with positive blood cultures, accounted for mostly by increased isolation of coagulase-negative staphylococci . However the mortality rate for the latter decreased by 59%, suggesting the possibility of a selective increase in detection of contaminated cultures . Although highly prevalent in the study population and generally defining a patient group with high mortality risk, the specificity of SIRS-associated positive blood cultures may be species and culture-system dependent . These findings re-emphasize the need for both improved control measures for the epidemic proportions of BSI and multi-drug antimicrobial resistance, as well as more specific indicators of the clinical relevance of positive blood cultures in critically ill patients. J Dairy Res, 1998 Feb, 65(1), 139 - 42 Isolation of coagulase-negative staphylococci from the milk and environment of sheep; Burriel AR; Various species of coagulase-negative staphylococci (C-NS) are reported to be common in milk and on the teat skin of domestic ruminants . The commonest C-NS species in mastitic milk of cows varies between reports, with Staphylococcus simulans (Jarp, 1991) in one and Staph . hyicus in another (Watts & Washburn, 1991) . The teat skin of heifers may be colonized by Staph . xylosus or Staph . chromogenes, while Staph . chromogenes and Staph . warneri are reported as frequent isolates from teat canals and secretion (Boddie & Nickerson, 1986; White et al . 1989) . Staph . haemolyticus was isolated frequently from the nares, the teat skin and the milk of goats (Valle et al . 1991), although others reported Staph . xylosus (Bedidi-Madani et al . 1992) or Staph . epidermidis and Staph . capitis (Kalogridou-Vassiliadou, 1991) as the most predominant C-NS in goats' milk . Staph . simulans has been found experimentally to be pathogenic for the mammary gland of meat ewes (Fthenakis & Jones, 1990), but little is known about the prevalence of this species in ewes' milk collected from cases of naturally occurring subclinical mastitis (SCM) . The aim of the present investigation was the identification of the commonest C-NS species in ewes' milk collected from field cases of SCM or predominating in the ewes' environment. J Antimicrob Chemother, 1998 Jan, 41(1), 11 - 8 The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice; Cookson BD; Mupirocin was introduced into clinical practice in the UK in 1985, and has proved to be an extremely effective treatment of skin infections and one of the most successful topical antibiotics for the clearance of nasal Staphylococcus aureus isolates including those resistant to methicillin . It is currently registered for use in more than 90 countries worldwide . Unfortunately resistance was described shortly after its initial use . Many of the issues regarding its use are reviewed here, together with the mechanisms, genetics, surveillance and epidemiology of resistance, particularly in staphylococci . The various factors that increase resistance and how they might be controlled are also discussed. J Clin Microbiol, 1998 Mar, 36(3), 812 - 3 Staphylococcus lugdunensis: report of a case of peritonitis and an easy-to-perform screening strategy; Schnitzler N et al.; We report on a severe case of peritonitis due to Staphylococcus lugdunensis . The clinical course resembled an infection due to S . aureus more than one due to other coagulase-negative staphylococci . Therefore, we strongly recommend identification and propose an easy-to-perform procedure for screening of this pathogen. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998 Feb, 85(2), 168 - 72 Fatal Staphylococcus aureus infective endocarditis: the dental implications; Younessi OJ et al.; Infective endocarditis remains an important and life-threatening infection despite improvements in diagnosis and management . There is currently a greater role for nosocomial acquisition of organisms and immunosuppression in the pathogenesis of this disease and emergence of a broader spectrum of infective organisms including those not commonly isolated from the mouth such as staphylococci . We report a case of infective endocarditis caused by Staphylococcus aureus in which the patient developed disseminated intravascular coagulation and multiple septic infarcts resulting in a frontal lobe brain abscess . Multiple dental extractions were complicated by delayed postextraction hemorrhage and the immediate cause of death was abdominal hemorrhage . The dental management in infective endocarditis should be planned in consultation with the attending physician, and should take into account both the causative organism and the presence of complications . When the oral cavity cannot be proven as the bacterial source for infective endocarditis, the immediate dental management should be directed toward improving the patient's oral hygiene and providing pain relief . Definitive long-term treatment, including any extractions, is ideally delayed until the patient has fully recovered from the infective endocarditis and its attendant complications. New Microbiol, 1998 Jan, 21(1), 49 - 54 In vivo presence of capsular polysaccharide in coagulase-negative staphylococci of ovine origin; Burriel AR; Three strains of coagulase-negative staphylococci identified as Staphilococcus warnery, Staphylococcus simulans and Staphylococcus haemolyticus were examine for evidence of capsular polysaccharide, in vitro by negative staining with India ink, and in vivo by transmission electron microscopy . In vitro, unstained materials surrounded clusters or single cocci . In vivo, capsula materials were surrounding phagocytosed bacteria cells . These capsular materials were either closely or loosely bound to bacterial cells, or projecting like "pili" from the surface of the cell wall . The evidence suggests that capsular polysaccharide is a common characteristic of coagulase-negative staphylococci causing prolonged intramammary infection of sheep. Mol Med Today, 1998 Jan, 4(1), 15 - 8 Arthritis and sepsis caused by Staphylococcus aureus: can the tissue injury be reduced by modulating the host's immune system? Tarkowski A, Wagner H. In recent years, a number of virulence factors that are either expressed, secreted or sequestered by staphylococci have been shown to affect the outcome of the infective process . Secretion of superantigens and exposure of the immune system to sequestered bacterial DNA aggravates the inflammatory response of the infected host to a point that can be life threatening . This exaggerated inflammatory response is mediated by cytokines originating from activated T cells and macrophages . Recent studies show that downregulation of lymphocyte and macrophage responses (e.g . by treatment with corticosteroids) significantly alleviates the outcome of staphylococcal infections when combined with appropriate antibiotics. Indian J Med Sci, 1997 Aug, 51(8), 275 - 80 Emerging bacterial drug resistance in hospital practice; Nema S et al.; The growing multiple drug resistance among bacteria in hospital practice is posing a serious threat to the successful antimicrobial therapy . Our data on the bacterial drug resistance at a tertiary care centre during 1995-1996 has been alarming with an incidence of 73 to 99% resistance to the common antibiotics like ampicillin, chloramphenicol, cotrimoxazole and first generation cephalosporins among the gram negative isolates . The resistance to gentamicin and ciprofloxacin ranged from 53 to 79% . Resistance to amikacin, netilmicin and the third generation cephalosporins ranged from 30 to 73% . The frightening observation was the emergence of resistant isolates which were sensitive only to two drugs, sensitive only to one drug and resistant to all the available antibiotics (2.64, 17.6 and 11.5% respectively) during 1994 to 1996 . Resistance among the gram positive bacteria was much less but the increase in methicillin resistant Staphylococci (52-65%) was a serious matter . The data were an eye opener and the infection control measures could bring marginal improvement in the situation in 1996 . It is vehemently appealed that the national antibiotic policies be formed and be stringently implemented before we are thrown back to the pre-antibiotic era. Diagn Microbiol Infect Dis, 1998 Jan, 30(1), 65 - 9 In vitro activity of cefepime and other broad-spectrum beta-lactams tested against 129 mec A-negative Staphylococcus spp . isolates: a multicenter sample; Marshall SA et al.; The in vitro activity of cefepime was compared to that of penicillin, piperacillin/tazobactam, ceftazidime, ceftriaxone, imipenem, vancomycin, and teicoplanin by using the broth microdilution method against 129 isolates of Staphylococcus {50 S . aureus and 79 coagulase-negative staphylococci (CoNS}, selected for their lack of the mec A gene as determined by the polymerase chain reaction . These isolates were obtained from a recent (1995-1996) surveillance of nearly 5000 nosocomial blood stream isolates from more than 40 geographically diverse U.S . medical centers . These results were compared to CoNS results from the same collection selected for their phenotypic susceptibility to oxacillin (OS; MIC < or = 2 micrograms/ml) regardless of their med A genotype . Cefepime, as well as piperacillin/ tazobactam, ceftriaxone, and imipenem, showed 100% susceptibility against OS and mec A-negative staphylococci . Ceftazidime showed relative resistance (30.2% resistant) against CoNS classified as OS based on phenotypic characteristics (MIC < or = 2 micrograms/mL) as compared to strains of mec A-negative CoNS (5.1% resistant) . Accurate phenotypic detection of mec A-positive staphylococci by simple standardized in vitro susceptibility tests becomes very important to guide empirical use of beta-lactams for therapy . Furthermore, previously published MIC90 and range data for broad-spectrum beta-lactams versus OS have been falsely elevated by the presence of mec A-positive strains . The greater use of these potent beta-lactams against true mec A-negative staphylococci should enhance clinical outcomes and reduce the need for vancomycin. Int J Prosthodont, 1997 May-Jun, 10(3), 283 - 6 Pumice slurry as a crossinfection hazard in nonclinical (teaching) dental technology laboratories; Verran J et al.; This research sought to compare the microbiological status of pumice slurry in clinical and nonclinical dental laboratories . Samples were inoculated onto selective and nonselective media . Resultant colonies were counted and identified to genus or species level . In the nonclinical laboratory, counts were constant at approximately 10(7) to 10(8) cfu/g . Pseudomonads, staphylococci and Bacillus spp comprised the major pumice contaminants in both laboratories . It was concluded that nonclinical laboratories are not immune from the presence of potentially pathogenic microorganisms in pumice slurry . Disinfection reduces contamination by oral microorganisms. Fam Pract, 1997 Dec, 14(6), 446 - 9 Stethoscopes and otoscopes--a potential vector of infection? Cohen HA, Amir J, Matalon A, Mayan R, Beni S, Barzilai A. OBJECTIVES: We aimed to determine whether stethoscopes and otoscopes used in community paediatric clinics harboured pathogenic micro-organisms, and, if so, which measures could prevent this . METHODS: Fifty-five stethoscopes belonging to paediatric physicians working in 12 community clinics were sampled for bacterial cultures by two methods: (i) direct impression of the diaphragm and bell section of each stethoscope for 5 seconds onto blood agar plates and a mannitol-salt-agar plate; (ii) swabbing the entire surface of the diaphragm of the stethoscope with a sterile cotton-tipped applicator . Forty-two otoscopes from the same physicians were sampled by rubbing the handles of the otoscopes with cotton-tipped swabs . The plates were incubated at 37 degrees C for 48 hours and examined for colony growth at 24 and 48 hours of incubation . Culture results were recorded as mean numbers of colony-forming units (CFUs) . Eight additional stethoscope diaphragms were chosen at random at the participating clinics and cultured as described above . They were then wiped with alcohol swabs (isopropyl alcohol 70%), allowed to air dry for approximately 10 minutes and cultured a second time . RESULTS: All the stethoscopes and 90% of the otoscope handles were colonized by microorganisms . Staphylococci were isolated from 85.4% of the stethoscopes and 83.3% of the otoscopes, with 54.5% and 45.2% respectively being S . Aureus . Methicillin-resistant S . aureus were found in four each of the stethoscopes (7.3%) and otoscopes (9.5%) . Cleaning with alcohol reduced the colony count by an average of 96.3% . CONCLUSIONS: Fomites can harbour potentially pathogenic bacteria, and with the increasing trend for children with more complex medical problems to be managed in an ambulatory setting, often by physicians who also work in hospitals, there is a real risk of spreading potentially serious infections to such patients . Simple cleansing with alcohol effectively eliminates the bacterial contamination of the fomites, and should be encouraged. Pacing Clin Electrophysiol, 1998 Jan, 21(1 Pt 1), 42 - 55 Infections with nonthoracotomy implantable cardioverter defibrillators: can these be prevented? Endotak Lead Clinical Investigators; Smith PN et al.; Nonthoracotomy ICDs are believed to be the best therapeutic modality for treatment of life-threatening ventricular arrhythmias . Little is known about the risk of infection with initial implantation of these devices . We studied the incidence, clinical characteristics, and risk factors associated with infections in 1,831 patients with nonthoracotomy ICD from the Endotak-C nonthoracotomy lead registry of Cardiac Pacemakers, Inc . A transvenous lead was implanted in 950 patients (51.9%) and a combination transvenous plus subcutaneous patch was used in 881 patients (48.1%) . Nine preselected data variables were studied, and all investigators identified as having patients with infections were personally contacted . Infections occurred in 22 (1.2%) of 1,831 patients receiving this nonthoracotomy ICD system . The mean time to infection was 5.7 +/- 6.5 months (range 1-25 months) . Staphylococci were isolated in 58% of patients with reported infection . The presence of a subcutaneous defibrillator patch system was associated with the development of infection . Six of 950 patients (0.63%) with a totally transvenous lead system developed infection versus 16 of 838 (1.9%) patients with a transvenous lead plus subcutaneous patch system configuration (P = 0.015, Chi-square test), with an unadjusted estimated odds ratio of 3.06 (CI 1.19-7.86) . The risk of infection encountered with the nonthoracotomy ICD is low, estimated from our data to be 1.2% . Placement of a subcutaneous defibrillator patch appears to be an independent risk factor for development of infection. Drugs, 1997, 54 Suppl 6, 39 - 52 Methicillin-resistant staphylococci in clean surgery . Is there a role for prophylaxis? Mini E, Nobili S, Periti P. The incidence of infection in clean surgery (i.e . surgery with no major contamination of the operative site) should be less than 2%, although the incidence of postoperative infections can be higher in patients with various risk factors (namely insertion of foreign bodies, a compromised immune status or prolonged duration of surgery) . Although antibiotic prophylaxis has been shown to reduce the incidence of postoperative infections in clean surgery, there is still no consensus regarding its use in this area . However, for clean surgical procedures that involve implantation of foreign material, grafts or prosthetic devices, prophylaxis is well accepted and justifiable, since this practice is indicated when the benefits exceed the expected risks . Staphylococcus aureus and coagulase-negative staphylococci are responsible for 70 to 90% of wound infections in this type of surgery . First and second generation cephalosporins are considered the drugs of choice for surgical prophylaxis . Cefazolin and other cephalosporins have good tissue penetration but poor coverage against methicillin-resistant staphylococci . The frequency with which methicillin-resistant staphylococci have been recovered in nosocomial infections has increased steadily during recent years . This provides a rationale for the use of alternative antibiotics, such as the glycopeptides (vancomycin and teicoplanin), for prophylaxis in clean surgery in hospitals where the prevalence of methicillin-resistant staphylococci is high . The effectiveness and tolerability of teicoplanin as prophylaxis for orthopaedic surgery involving joint replacement were analysed in 4 randomised controlled trials . Two compared teicoplanin with cefamandole, while the others compared teicoplanin with either cefuroxime or cefazolin . The overall early wound infection rates (within 3 months) in these studies were 1.1% for teicoplanin and 1.7% for the comparator cephalosporin . The overall late infection rate was 0.2% for both treatment groups . Adverse events were attributed to the drug in 1% of patients in both treatment groups . Therefore, on the basis of these trials, single dose teicoplanin is as efficacious and as well tolerated as multiple dose cephalosporin regimens for prophylaxis in prosthetic joint surgery. Drugs, 1997, 54 Suppl 6, 21 - 8 Management of serious staphylococcal infections in the outpatient setting; Graninger W et al.; Patients with serious staphylococcal infections, e.g . endocarditis and osteomyelitis, need prompt and prolonged parenteral antibiotic treatment to ensure eradication of the causative pathogen . The major cost in the treatment of these infections is the long period of hospitalisation required for the administration of intravenous antibiotics . To shorten the hospitalisation period, outpatient treatment can be given to some patients . In this study, patients with acute exacerbations of chronic osteomyelitis (n = 44) or endocarditis (n = 10) were treated with intravenous teicoplanin . The pathogens were Staphylococcus aureus (n = 41, 13 of which were methicillin resistant) and coagulase-negative staphylococci (n = 13, one of which was methicillin resistant) . After a mean loading dose of 15 mg/kg for 3 to 10 days, patients received teicoplanin 3 times a week at a dose (mean 15 mg/kg) individualised to achieve serum trough concentrations of approximately 10 mg/L for osteomyelitis and 20 mg/L for endocarditis . Treatment duration ranged from 28 to 150 (mean 62) days for patients with osteomyelitis and from 28 to 88 (mean 49) days for patients with endocarditis . 37 (84%) patients with osteomyelitis and 8 (80%) patients with endocarditis were treated successfully . Adverse events were observed in 9 patients and included rash (n = 3), thrombocytopenia (n = 3), and drug fever, pseudomembranous colitis, nausea, leucopenia and transient hearing impairment (one patient each) . In conclusion, this study demonstrates that teicoplanin can be administered successfully in an outpatient setting according to a 3-times weekly schedule for the treatment of patients with staphylococcal osteomyelitis and endocarditis. J Pediatr Surg, 1998 Jan, 33(1), 16 - 9 Small volumes of enteral feedings normalise immune function in infants receiving parenteral nutrition; Okada Y et al.; BACKGROUND/PURPOSE: Parenteral nutrition (PN) is associated with a risk of septicaemia . This may be caused by impairment of immune function related to PN . The authors investigated the effects of the addition of enteral feedings to PN on the immune status of human newborn infants . METHODS: Ten surgical infants (age less than 6 months) requiring PN were studied in two consecutive phases: (A) after 31.1+/-6.0 days (mean +/- SEM) of PN with no enteral feeding (total PN); and (B) after 4.7+/-1.1 days from the addition of small volumes of enteral feeding to PN . Full blood count and liver function tests were not significantly different between phases A and B . A control group (n = 9) of infants receiving a normal enteral diet was also studied . Host bactericidal activity against coagulase-negative staphylococci (CNS) was measured by an in vitro whole blood model . Bacterial killing was measured after a 45-minute bacterial challenge using the Miles-Misra technique . Tumour necrosis factor-alpha (TNF-alpha) was measured by enzyme-linked immunosorbent assay (ELISA) after 2 hours of bacterial challenge . RESULTS: The lowest level of CNS killing (37.7+/-5.2%), was observed in patients receiving total PN . This increased significantly after the addition of small enteral feeds (52.0+/-4.6%, P < .005) approaching the levels measured in controls (65.1+/-3.4%) . TNF-alpha production was low during total PN (1467+/-297 pg/mL) and rose significantly after the addition of minimal enteral feeds (4,661+/-1,311 pg/mL, P < .05) . The increase in CNS killing after the addition of small enteral feeds in patients on PN was significantly correlated with the duration of enteral feeding (r = 0.8, P = .006) . CONCLUSIONS: These results indicate that the introduction of small volumes of enteral feed improve the impaired killing of CNS and the abnormal cytokine response observed during total PN . This implies that stimulation of the gastrointestinal tract may modulate immune function in neonates and prevent bacterial infection. Ophthalmologe, 1997 Nov, 94(11), 785 - 90 {Adherence of staphylococci of different hydrophobicity . Study of various intraocular lenses}; Schloricke E et al.; BACKGROUND: A major goal in research on intraocular lenses (IOL) is the development of new polymers and modifications to reduce foreign-body reactions after implantation . This effect may be achieved by a reduction in the surface hydrophobicity of the polymers . To illustrate the influence of surface modifications on bacterial adhesiveness, the most often isolated organism in "low-grade" postoperative endophthalmitis, Staphylococcus epidermidis, was used . MATERIALS AND METHODS: For this reason three strains of this species, the type strain ATCC 14990 and two clinical isolates (8687, 6579 I) with different hydrophobic surface properties were studied . IOL, used in the experiments were either made of PMMA or silicone with modified surfaces (unpolished, polished, heparinized) . The adhesiveness of H3-thymidin-labeled bacteria was calculated/mm2 of lens surface . Each experiment was performed in triplicate and repeated three times . RESULTS: The hydrophobic-type strain showed stronger adherence to unpolished PMMA surface (8000 bacteria per mm2) compared to the polished (5200 bacteria/mm2) . In contrast, the hydrophilic strain adhered with 2000 bacteria/mm2 to the unpolished and with 4200 bacteria/mm2 to the polished surface . Polishing PMMA lenses diminished the differences between the three strains . However, surface passivation of silicone lenses increased the adhesion rate of the hydrophilic strain up to 9600 bacteria/mm2 . Treatment of PMMA lenses with heparin increased the adhesiveness of the hydrophilic strain and reduced the adhesion rate of the hydrophobic type strain to 250 bacteria/mm2 . CONCLUSIONS: It was demonstrated that bacterial adherence to IOL also involves hydrophobic interactions . Obviously, however, that adherence reflects a complex of interactions between the two surfaces. Appl Environ Microbiol, 1998 Feb, 64(2), 763 - 7 Cloning and nucleotide sequencing of a Staphylococcus aureus gene encoding a branched-chain-amino-acid transporter; Vijaranakul U et al.; We recently characterized a transposon-induced NaCl-sensitive mutant of Staphylococcus aureus (U . Vijaranakul, M . J . Nadakavukaren, D . O . Bayles, B . J . Wilkinson, and R . K . Jayaswal, Appl . Environ . Microbiol . 63:1889-1897, 1997) . To further characterize this mutant, we determined the nucleotide sequence at the insertion site of the transposon on the S . aureus chromosome . Nucleotide sequencing revealed a 1,326-bp open reading frame (ORF442) encoding a hydrophobic 442-amino-acid polypeptide with a calculated molecular mass of 49,058 Da . The hydrophilicity profile of the gene product revealed the existence of 12 hydrophobic domains predicted to form membrane-associated alpha-helices . Comparison of the amino acid sequence of ORF442 with amino acid sequences in the GenBank database showed extensive homology with the branched-chain-amino-acid transport genes of gram-positive and gram-negative bacteria . This is the first brnQ gene in staphylococci to be described. Zh Mikrobiol Epidemiol Immunobiol, 1997 Nov-Dec, (6), 6 - 10 {An opsonin-independent strain of Staphylococcus epidermidis}; Maianskii AN et al.; Human neutrophils, subjected to stimulation under different conditions (phorbol myristate acetate, opsonized zymosan, formylmethionyl-leucinephenylalanine, nonopsonized staphylococci), produced a factor (denoted as clumping factor, or CF) with a capacity for highly selective clumping and opsonization of staphylococci . Out of 68 strains of different species of staphylococci, only a single strains (S.epidermidis) was sensitive of CF . CF negative staphylococci were capable of inducing the release of CF by neutrophils, but were not bound by this factor . Extracts, obtained by the mechanical destruction of neutrophils (sonication, repeated freezing and thawing), had no clumping activity . CF had a mol . wt . exceeding 100 kD, was positively charged and disintegrated at 100 degrees C . The capacity of S.epidermidis 178 M for binding CF completely disappeared after the treatment of bacteria with pronase and partially disappeared after boiling and treatment with trypsin and periodate . Neuraminidase and heating at 80 degrees C produced no effect . These data are the first demonstration of highly selective (strain-specific) interaction between secretory products of neutrophils and bacteria. J Clin Microbiol, 1998 Jan, 36(1), 273 - 4 Evaluation of screening and commercial methods for detection of methicillin resistance in coagulase-negative staphylococci; Hussain Z et al.; The National Committee for Clinical Laboratory Standards recommends 48 h of incubation by the oxacillin salt agar screen (OSAS) method for the detection of methicillin-resistant coagulase-negative staphylococci (CoNS) . An earlier identification of methicillin resistance is desirable . The time to detection of the mecA gene by PCR was compared with the times to detection by OSAS, by the oxacillin disk diffusion (ODD) method, and with MicroScan Gram Positive Combo type 6 panels (MicroScan Inc . Sacramento, Calif.) and Vitek GPS-SA cards (bioMerieux Vitek Inc., Hazelwood, Mo.) . The combination of the Vitek card and the ODD method detected 92 of 99 methicillin-resistant strains of CoNS at 24 h; however, 6 mecA-positive strains were phenotypically methicillin susceptible . We conclude that most methicillin-resistant CoNS can be detected and the results can be reported after overnight incubation by a combination of methods. J Clin Microbiol, 1998 Jan, 36(1), 52 - 7 Comparison of ATB staph, rapid ATB staph, Vitek, and E-test methods for detection of oxacillin heteroresistance in staphylococci possessing mecA; Frebourg NB et al.; The performance characteristics of the E-test (AB Biodisk, Solna, Sweden), the ATB Staph, the Rapid ATB Staph, and the Vitek GPS-503 card (bioMerieux, La Balme Les Grottes, France) methods for the detection of oxacillin resistance in a collection of staphylococci with a high proportion of troublesome strains were evaluated . Sixty-four Staphylococcus aureus strains and 76 coagulase-negative staphylococcal strains were tested . All strains were mecA positive and were characterized by the oxacillin agar screen plate test; 75 (53.6%) were found to be heterogeneous by a large-inoculum oxacillin disk diffusion assay, and oxacillin MICs for 89 (63.6%) were < or = 32 microg/ml . Three (4.7%) S . aureus strains and 25 (32.9%) coagulase-negative strains were classified as susceptible by the E-test, as defined by the National Committee for Clinical Laboratory Standards (NCCLS) oxacillin breakpoint (MIC < or = 2 microg/ml) . The ATB Staph method failed to detect oxacillin resistance in 7 (11%) S . aureus isolates and 32 (42.1%) coagulase-negative isolates . The MICs for all but six of these discrepant isolates were < or = 16 microg/ml . The Rapid ATB Staph method was tested against S . aureus strains only and yielded 15 (23.4%) false-susceptible results for strains for which the MICs were < or = 32 microg/ml . The Vitek system was the best-performing system, since it failed to detect oxacillin resistance in only 3 (4.7%) S . aureus strains and 15 (19.7%) coagulase-negative strains, the MICs for all of which were < or = 2 microg/ml . These data indicate that (i) the performance of the two ATB Staph systems can be limited when the prevalence of borderline-heteroresistant staphylococci is high and (ii) the unreliability of the E-test and the Vitek methods for detecting resistant coagulase-negative strains might be reduced by the potential revision of the oxacillin breakpoint currently recommended by the NCCLS. Zh Mikrobiol Epidemiol Immunobiol, 1995 Jul-Aug, (4), 13 - 6 {The affinity binding of staphylococci with immobilized human plasminogen}; Nikolaev VL et al.; The phenomenon of the selective adhesion of staphylococci to immobilized human plasminogen was discovered and studied in the reaction of bacteriosorption . The study, made with S.aureus cells, strain Cowan 1, revealed that the degree of adhesion depended on the amount of immobilized protein and the time of its contact with bacterial suspension . The dose-dependent inhibition of adhesion with plasminogen and plasmin solutions, found to occur also with IgG, was demonstrated . Staphylococcal protein A did not inhibit adhesion . The plasminogen-binding receptor structure was shown to be highly sensitive to proteolysis, which is indicative of its protein nature. J Hosp Infect, 1997 Dec, 37(4), 305 - 16 Slime production, adherence and hydrophobicity in coagulase-negative staphylococci causing peritonitis in peritoneal dialysis; Steer JA et al.; Attachment of coagulase-negative staphylococci to plastic surfaces by means of hydrophobic interaction and slime production may be important in producing catheter associated infections . In continuous ambulatory peritoneal dialysis (CAPD), the relationship between these properties and disease is unclear and the effect of dialysate fluid is not considered . For a collection of coagulase-negative staphylococci from CAPD patients, slime production and adherence were measured by colorimetric methods and hydrophobicity was determined by autoaggregation in ammonium sulphate solution . Comparison of 73 nasal isolates with 69 isolates from peritonitis showed no significant differences with respect to three properties, with the exception of a greater adherence of peritoneal isolates in dialysate because of a greater proportion of staphylococcal species other than Staphylococcus epidermidis . Fewer strains showed adherence in dialysate (12/142 8.5%) than in broth (94/142 66%) but the proportion of strains producing slime was similar . The milieu of the bacteria rather than the organisms themselves may be of greater importance in the establishment of infection. J Hosp Infect, 1997 Dec, 37(4), 297 - 303 Low-dose vancomycin prophylaxis reduces coagulase-negative staphylococcal bacteraemia in very low birthweight infants; Cooke RW et al.; Very low birthweight (VLBW) infants undergoing neonatal intensive care are at risk of infection with coagulase-negative staphylococci (CONS) . This study investigates the efficacy of twice daily, 1 h infusions of vancomycin (5 mg kg) in reducing CONS infection in VLBW infants receiving parenteral nutrition . Of 72 infants in the study, 37 were randomized to vancomycin and 35 to the control group . Clinical variables and mortality were similar in both groups . In the vancomycin group, 11 infants had one or more episodes of CONS bacteraemia compared with 17 in the control group . Two babies in the treatment group had more than one episode of CONS bacteraemia, compared with nine in the control group (P = 0.02) . There were 13 episodes of CONS bacteraemia in the vancomycin group compared with 29 in the control group . When only positive blood-cultures associated with a rise in C-reactive protein were considered, there were six episodes of CONS bacteraemia in the vancomycin group compared with 18 in the control group . Similarly there were five infants with one or more CONS infections compared with 11 in controls and one with more than one episode compared with six in the control group (P = 0.05) . Prophylaxis with intermittent low-dose vancomycin infusions may help reduce recurrent CONS bacteraemia in VLBW infants receiving parenteral nutrition. Clin Infect Dis, 1998 Jan, 26(1), 72 - 9 The epidemiology of resistance to ofloxacin and oxacillin among clinical coagulase-negative staphylococcal isolates: analysis of risk factors and strain types; Pegues DA et al.; Coagulase-negative staphylococci are important nosocomial pathogens that increasingly are resistant to oxacillin and fluoroquinolones . To determine predictors of acquisition of oxacillin and ofloxacin resistance, we prospectively identified 150 patients from whose clinical specimens coagulase-negative staphylococci were isolated that differed in susceptibility to oxacillin and ofloxacin . In multivariate analysis, isolation of ofloxacin-resistant coagulase-negative staphylococci was associated with receipt of aminoglycosides (odds ratio {OR} = 8.45; 95% confidence interval {CI} = 2.10-34.1; P = .001) and fluoroquinolones (OR = 11.50; 95% CI = 4.15-31.6; P < .001) within 30 days; oxacillin resistance was associated with prior receipt of beta-lactam agents (OR = 5.99; 95% CI = 2.91-12.3; P < .001) . Among oxacillin-resistant strains, there was heterogeneity of pulsed-field gel electrophoresis (PFGE) types, and no type was common between ofloxacin-resistant and ofloxacin-susceptible strains . Thus ofloxacin resistance may have emerged de novo among diverse oxacillin-resistant strains following the selection pressures of antimicrobial therapy . In contrast, 50% of patients with oxacillin-susceptible/ofloxacin-resistant strains had one of two PFGE types, a finding suggesting that person-to-person transmission resulted in the dissemination of some of these strains. Infect Immun, 1998 Feb, 66(2), 853 - 5 Granulocyte-macrophage colony-stimulating factor in Staphylococcus aureus-induced arthritis; Verdrengh M et al.; Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine that is able to increase not only the production of phagocytic cells but also their efficacy with respect to, e.g., bactericidal properties . In this study, we wanted to analyze the impact of GM-CSF on experimental Staphylococcus aureus-induced arthritis . For that purpose, mice were administered GM-CSF before and after bacterial inoculation . Although there was an increase in the total number of leukocytes as well as in the granulocyte fraction, there was no favorable effect on the severity of arthritis or on survival rates . There were no obvious differences between the GM-CSF-pretreated animals and controls with regard to growth of staphylococci in joints and kidneys 4 days after the bacterial inoculation . In contrast, mice that had been pretreated with GM-CSF prior to bacterial inoculation showed approximately four times lower numbers of bacteria in their blood 24 h later . These results, along with those of our previous studies, suggest that on the one hand the granulocyte is the main protective cell during the course of S . aureus infection but that on the other hand, upregulation of granulocyte-macrophage production will not exert any additional protective effects with respect to tissue injury. Antimicrob Agents Chemother, 1998 Jan, 42(1), 100 - 7 Decreased susceptibilities to teicoplanin and vancomycin among coagulase-negative methicillin-resistant clinical isolates of staphylococci; Sieradzki K et al.; Of 41 methicillin-resistant coagulase-negative staphylococcal clinical isolates collected during a 5-month period between late 1995 and early 1996, 28 showed tube dilution teicoplanin MICs of 4 to 8 microg/ml which increased to 16 to 32 microg/ml upon prolonged incubation . Cultures of such bacteria were heterogeneous; they contained subpopulations with frequencies of 10(-5) to 10(-4) that could grow on up to 50 microg of teicoplanin per ml . The same cultures were also heterogeneous with respect to susceptibility to vancomycin; while the MICs for the majority of cells were 2 to 4 microg/ml, subpopulations that could grow on 6 to 12 microg of vancomycin per ml were also present at frequencies of 10(-5) to 10(-7) . Selective enrichment of such cultures for the resistant subpopulation occurred with relative ease under laboratory conditions . Heterogeneous phenotypes for teicoplanin (but not for vancomycin) susceptibility were also identified in several Staphylococcus epidermidis isolates collected during the preantibiotic era . The addition of half the MIC of teicoplanin inhibited autolysis and caused formation of cellular aggregates which disintegrated to individual bacteria in the stationary phase when the titer of teicoplanin in the medium fell to undetectable levels, indicating removal of the antibiotic from the culture medium by the bacteria. Chemotherapy, 1998 Jan-Feb, 44(1), 42 - 9 Phagocytosis and intracellular killing of rokitamycin-exposed staphylococci by human polymorphonuclear leukocytes; Braga PC et al.; The exposure of bacteria to antibiotics at even sub-minimum inhibitory concentrations (sub-MICs) induces physicochemical and biochemical modifications that facilitate phagocytosis and intracellular killing by polymorphonuclear leukocytes (PMNs) . These PMN functions were investigated by exposing Staphylococcus aureus strains to different sub-MICs (1/2 to 1/32 MIC) of rokitamycin (RKM) . Although phagocytosis and the index of phagocytosis of the antibiotic-exposed staphylococci were not significantly modified with respect to controls, the percentage of killing significantly increased after exposure to 1/2 and 1/4 MIC by 31 and 22%, respectively . Taking into consideration the other aspect of a possible direct interaction between RKM and PMNs, it was observed that up to 10 micrograms/ml of RKM did not interfere with phagocytosis but significantly enhanced killing activity by up to 33% . This effect can be correlated with the high uptake of RKM by PMNs (cellular/extracellular ratio congruent to 30.5) . The relevance of these in vitro observations to clinical situations remains to be further investigated. Isr J Med Sci, 1997 Nov, 33(11), 734 - 8 Sepsis at a neonatal intensive care unit: a four-year retrospective study (1989-1992); Leibovitz E et al.; During the 4-year period 1989-1992, 18,227 neonates were born at Kaplan Hospital and 614 (3.4%) were admitted to the neonatal intensive care unit . During this period, 120 episodes (6.6/1000 live births) of neonatal sepsis were recorded in 109 neonates (6/1000 live births) . The incidence of early-onset sepsis was 19/109 (17%) . The main pathogens of early-onset sepsis were S . agalactiae (42%) and E . coli (32%) . Seven of the 8 S . agalactiae cases were recorded during 1989-1990 . The main pathogens of late-onset sepsis were Klebsiella spp . (31%), coagulase-negative staphylococci (18%) and Candida spp (16%) . There were 11 cases (10%) of meningitis, 5 due to Klebsiella spp . The overall fatality rate due to sepsis was 14% (0.8/1000 live births) with an early-onset sepsis death rate of 37% . The mortality from S . agalactiae sepsis was 63% . The main trends recorded during the period of the study were 1) the emergence of S . agalactiae as the main pathogen of early-onset sepsis, followed by a sharp decrease in its incidence during the last part of the study, 2) the emergence of extremely virulent, multi-antibiotic-resistant Klebsiella organisms, and 3) the persistent high incidence of Candida sepsis. J Foot Ankle Surg, 1997 Nov-Dec, 36(6), 452 - 6 Complications with infection and foreign body reaction after silicon implant arthroplasty in the second metatarsophalangeal joint in an adolescent: a case report; Fellander-Tsai L et al.; A 21-year-old otherwise healthy male was referred to our clinic due to severe pain, deformation, development of fistules, and swelling of the second metatarsophalangeal joint of the right foot . He presented a history of two previous operations . At the age of 13, a 2-cm . resection of the distal part of the proximal phalanx was performed due to severe hammertoe deformity . At the age of 19, a partial phalanx resection and implantation of a silicon elastomer ball-shaped joint spacer was performed due to second metatarsophalangeal joint instability . After this operation, the patient suffered from fistules that appeared in the second metatarsophalangeal region . Following referral to our clinic, the patient was operated on . The proximal phalanx was removed along with the prosthesis which had slipped from the metatarsophalangeal joint into the proximal phalanx with the ends of the prosthesis perforating the skin . Debridement of infected tissue and implantation of gentamicin containing beads were performed . Bacterial specimens revealed growth of coagulase-negative staphylococci . Microscopic examination of the debrided tissue showed signs of acute and chronic inflammation . Postoperatively, the patient was treated with antibiotics and healing was uneventful . This case advocates the need for proper selection criteria and strict indications in patients with joint disease needing an arthroplasty. Acta Microbiol Pol, 1997, 46(3), 325 - 7 New plant glycoprotein against methicillin resistant staphylococci and enterococci; Fik E et al.; New glycoprotein (CML) isolated from Chelidonium maius exhibits good antibacterial activity against methicillin resistant staphylococci and enterococci . It may constitute new antimicrobial agent against methicillin and vancomycin-resistant staphylococci as well as multiresistant enterococci. Res Vet Sci, 1997 Sep-Oct, 63(2), 189 - 90 Resistance of coagulase-negative staphylococci isolated from sheep to various antimicrobial agents; Burriel AR; Staphylococcal resistance to a variety of antimicrobial agents, defined as inhibition of bacteria growth in the presence of an antimicrobial agent, was approximately 75 per cent among coagulase-negative staphylococci isolated from milk and the teat skin of sheep . Resistance to broad spectrum antibiotics such as chloramphenicol and tetracycline as well as resistance to the combination of trimethoprim/sulphamethoxazole commonly used for the treatment of animals, was high in both groups of isolates . Four isolates of Staphylococcus epidermidis and three Staph xylosus isolated from the milk of dairy ewes were resistant to methicillin . Methicillin resistance is prevalent among human staphylococcal isolates and resistance to this antibiotic may reflect human handling of sheep. Gene, 1997 Nov 20, 202(1-2), 133 - 8 Characterization of a new staphylococcal gene, vgaB, encoding a putative ABC transporter conferring resistance to streptogramin A and related compounds; Allignet J et al.; The Staphylococcus aureus plasmid gene, vgaB, conferring resistance to streptogramin (SgA) and related compounds (PIIA, virginiamycin M, mikamycin A, synergistin A, Dalfopristin) was cloned and sequenced . This gene potentially encodes a 552-aa protein, VgaB, of 61,327 Da, which exhibits a significant similarity with the ATP-binding domains of numerous proteins . VgaB has two ATP-binding domains containing each of the A and the B motifs described by Walker et al . {Walker, J.E., Saraste, M., Runswick, M.J., Gay, N.J., 1982 . Distantly related sequences in the alpha- and beta-subunits of ATP synthase, myosin, kinases and other ATP-requiring enzymes and a common nucleotide binding fold . EMBO J., 1, 945-951}, but does not include TM hydrophobic domains . The 155-amino-acid sequence between the two ATP-binding domains of VgaB is richer in Glu than the rest of the protein . The vgaB gene was found in 21 of the 52 SgA(R) and independent wt staphylococci investigated . In each of the 21 staphylococci, vgaB was carried on a plasmid of 50-90 kb also harboring the vatB gene encoding an acetyltransferase inactivating SgA . In all plasmids, vgaB and vatB have the same relative positions. Sangre (Barc), 1997 Oct, 42(5), 407 - 9 {Staphylococcal sepsis associated with platelet transfusion: report of a new case and review of the literature}; Cid J et al.; Bacterial contamination of blood components is an infrequent although potentially fatal event . Bacterial contamination rate of platelet concentrates (PC) varies between 1/900 to 1/2,000 random donor units . However the risk of symptomatic bacteriemias is lower (between 1/2,000 to 1/12,000 random donor units) . The organisms most commonly implicated in contaminated PC are gram-positive bacteria such as coagulase negative Staphylococci, Bacillus cereus or Propionibacterium acnes, although gram-negative organisms are also found that generally are associated to a higher mortality . Here, a fatal case of sepsis due to Staphylococcus carnosus associated to transfusion of a contaminated random donor platelet unit is reported. Pathology, 1997 Nov, 29(4), 406 - 10 The reliability of Microscan conventional and rapid panels to identify Staphylococcus aureus and detect methicillin resistance: an evaluation using the tube coagulase test and mecA PCR; Farrell DJ; Microscan (Dade Diagnostics, Brisbane) Positive Combo Type 6 (312 panels) and Rapid Positive Breakpoint Type 1 (62 panels) were evaluated for Staphylococcus aureus identification, using the tube coagulase test (TC), and oxacillin susceptibility, using mecA . A total of 374 consecutive clinical staphylococci were tested, with TC and Microscan having 100% correlation (335 identified as S . aureus and 39 as coagulase negative staphylococci by both methods) . A 93% correlation was observed between Microscan and mecA PCR for oxacillin susceptibility . No very major errors (0/374 false oxacillin susceptibility) and 26 (7%) major errors (26/374 false oxacillin resistance) were found showing false resistance to oxacillin to be a problem in our population . Oxacillin Etest (AB Biodisk, Sweden) was performed on all oxacillin resistant isolates . A bimodal distribution was observed between mecA positive and negative isolates . A testing algorithm (using the Microscan panels and Etest) was developed for this laboratory to detect mecA encoded methicillin resistance . Retrospective application of this algorithm to the 374 isolates gave 100% correlation with mecA detection. Wiad Lek, 1997, 50 Suppl 1 Pt 2, 257 - 8 The present role of staphylococci in development of surgical hospital infection; Sidorchuk II et al.; At present the problem of staphylococcal infection appears to be highly important . The research aim was to establish the role and significance of Staphylococci, particularly methicillin resistant in development of complications in modern surgery, sources and ways of Staphylococci appearance and spread in today surgical departments . Particularly seasonal chronorythms of microflora carriage by the medical personnel and students was studied . Most of the strains were resistant to traditional antibacterial remedies . Since the begin of the half-century antibiotic era Staphylococci are still a problem in Surgery . Adequate microbiologic monitoring of stuff and students is recommended to prevent a lot of complications. Microbiology, 1997 Dec, 143 ( Pt 12), 3861 - 70 Adhesion of coagulase-negative staphylococci grouped according to physico-chemical surface properties; van der Mei HC et al.; Physico-chemical cell surface properties of 23 coagulase-negative staphylococcal strains, including contact angles, zeta potentials and elemental cell surface composition were measured, together with the adhesion of all strains to hexadecane . The data were employed in a hierarchical cluster analysis, revealing that the 23 strains comprised essentially four different groups . Groups I-III were somewhat similar to each other, but group IV was markedly distinguished from the other strains, predominantly through an elevated acidity of the cell surface . These group distinctions were not related to the presence of a capsule or slime on the strains . Adhesion of the strains to hexadecane depended critically on electrostatic interactions between the hexadecane and the staphylococci, and adhesion only occurred when the electrostatic repulsion between hexadecane and the micro-organisms was less than 500 kT at closest approach . Adhesion of six representative strains from all four groups in a parallel plate flow chamber to silicone rubber, an implant material with similar hydrophobicity to hexadecane, did not show such a critical dependence, nor did it relate with the group distinction . Possibly, microbial adhesion to substratum surfaces like silicone rubber is more complicated than adhesion to an ideally smooth and homogeneous hexadecane surface in an aqueous solution . Adhesion of all six strains to silicone rubber with an adsorbed conditioning film of plasma proteins was less than that to bare silicone rubber: initial deposition rates dropped from 2000-3000 cm-2 s-1 to 100-300 cm-2 s-1 after adsorption of plasma proteins, while the stationary end-point adhesion decreased from 10 x 10(6)-15 x 10(6) cm-2 to 1 x 10(6)-5 x 10(6) cm-2 . The adhering staphylococci poorly withstood the passage of an air-bubble through the parallel plate flow chamber, regardless of the presence of a conditioning film, indicating a low affinity of these relatively hydrophilic strains for hydrophobic substratum surfaces. Infect Dis Clin North Am, 1997 Dec, 11(4), 813 - 49 Antimicrobial resistance in staphylococci . Epidemiology, molecular mechanisms, and clinical relevance; Maranan MC et al.; Staphylococcal infections continue to pose important clinical problems in children and adults . Antibiotic resistance among the staphylococci has rendered therapy of these infections a therapeutic challenge . Despite early, uniform susceptibility to penicillin, staphylococci acquired a gene elaborating beta-lactamase that rendered penicillin inactive and that is borne by nearly all clinical isolates . "Penicillinase-resistant beta-lactams," such as methicillin, were introduced in the early 1960s, but resistance to them has become an increasing concern . The mechanism of the so-called "methicillin resistance" is complex . Moreover, once confined to the ecology of hospitals and other institutions, a recent increase in community-acquired methicillin-resistant S . aureus infections has been observed . Glycopeptides, until now the only uniformly reliable therapeutic modality, have been increasingly used for therapy of staphylococcal infections . The recent recognition of clinical isolates with reduced susceptibility to glycopeptides is of concern. J Antimicrob Chemother, 1997 Nov, 40(5), 701 - 6 The relationship between the use of flucloxacillin, vancomycin, aminoglycosides and ciprofloxacin and the susceptibility patterns of coagulase-negative staphylococci recovered from blood cultures; Mulder JG et al.; Antibiotic use is a cause of selection of multiresistant bacterial strains . Over three years (1990-1992) we studied the relation between the use of flucloxacillin, vancomycin, aminoglycosides and ciprofloxacin and the susceptibility of coagulase-negative staphylococci (CNS) recovered from blood cultures . Although there was no increase in the use of flucloxacillin, the susceptibility of CNS to this antibiotic decreased from 25% to 6% . No increase in aminoglycoside use was seen, though the use in the non-surgical intensive care unit was 40 times the average use in the hospital . The susceptibility to gentamicin declined from 36% to 15% for the rest of the hospital and to zero for the non-surgical intensive care unit . Vancomycin use did not change in the hospital as a whole, but the use in the haematological unit was about ten times that in the rest of the hospital . No single resistant strain (vancomycin MIC > or = 4 mg/L) was found . A three-fold increase in ciprofloxacin use was seen . After a decline in the susceptibility to ciprofloxacin from 72% to 58% in 1991, there was a small recovery to 62% in 1992 . The use in the haematological unit was about 20 times that in the rest of the hospital . Ciprofloxacin susceptibility declined from 40% to 25% in that unit in 1991 . In 1992 there was a small recovery to 29%. Bacteriol Virusol Parazitol Epidemiol, 1997 Jul-Sep, 42(3), 155 - 7 {The demonstration of the production of "slime"--a marker of pathogenicity in coagulase-negative staphylococci}; Codita I et al.; The authors tested for "slime" elaboration 48 S . epidermidis s.s . strains; 24 of these strains were isolated from bloodstream infections and 24 from resident cutaneous microbiota . The semiquantitative method of Christensen was used for testing "slime" elaboration . The predictive value of the positive test of "slime" elaboration was 92% in this study. Indian J Med Res, 1997 Nov, 106, 461 - 4 Norfloxacin induced resistance to fluoroquinolones & structurally unrelated antimicrobial agents in coagulase negative staphylococci; Deshmukh SR et al.; Nine clinical isolates of coagulase negative staphylococci (CONS) susceptible to norfloxacin (MIC 1.8-2 micrograms/ml) were manipulated in vitro to induce norfloxacin resistance by means of serial passage in brain heart infusion broth containing increasing concentrations of norfloxacin . Exposure of CONS to norfloxacin resulted in 18 to 20 times increase in MIC of norfloxacin and change in in vitro susceptibility to ciprofloxacin, pefloxacin, ofloxacin, kanamycin, neomycin and tobramycin, indicating development of cross resistance to fluoroquinolones and aminoglycosides . These results show that exposure to increasing concentrations of norfloxacin can induce the development of resistance to various antimicrobial agents, suggesting its mutagenic role. Diagn Microbiol Infect Dis, 1995 Dec, 23(4), 157 - 60 Preliminary interpretive criteria for disk diffusion susceptibility testing of SCH 27899, a compound in the everninomicin class of antimicrobial agents; Cormican MG et al.; As antimicrobial resistance among Gram-positive species becomes more common, alternative agents need to be developed for the therapy of serious infections . SCH 27899 is a compound from the everninomicin class of antimicrobial agents that possesses a potent Gram-positive spectrum . We evaluated three disk concentrations (0.25, 1, and 5 micrograms) of three SCH 27899 formulations including SCH 27899 base (SCHB), N-methylglucamine SCH 27899 (NMG-SCH), and NMG-SCH complexed with hydroxypropyl beta-cyclodextrin . Disk zone diameters were correlated with minimum inhibitory concentration for 209 aerobic, nonfastidious Gram-positive strains and selected Gram-negative bacilli to develop disk diffusion interpretive criteria . No significant differences in activity were noted among the three SCH 27899 preparations . Of the three disk concentrations, the correlation coefficient was greatest (r = 0.88) for the 5-micrograms SCHB disk test . For a tentative break point of < or = 2 micrograms SCHB/ml, preliminary disk interpretive criteria were: susceptible at > or = 12 mm, intermediate at 10-11 mm, and resistant at < or = 9 mm (absolute categorical agreement, 99.5%) . Zones were small secondary to drug solubility and diffusion limitations . Using these criteria for the SCHB 5-micrograms disks, nearly all of the tested Gram-positive organisms were susceptible including methicillin-resistant staphylococci and vancomycin-resistant enterococci. Berl Munch Tierarztl Wochenschr, 1997 Sep, 110(9), 324 - 32 {Resistance to protein biosynthesis inhibitors in Staphylococci: resistance genes and their spread--a review}; Werckenthin C et al.; The rapid spread of antibiotic resistances in a wide variety of bacteria is mainly due to the location of antibiotic resistance genes on mobile genetic elements such as plasmids and transposons . Principal ways of transfer of plasmid- and transposon-encoded resistance genes are presented using examples of the predominant genes mediating resistances to protein biosynthesis inhibitors such as tetracyclines, aminoglycosides, macrolide-lincosamide-streptogramin B antibiotics, and chloramphenicol in staphylococci . Transfer between different staphylococcal cells is substantially based on transduction, transformation, conjugation and mobilization while transfer of resistance genes within the same bacterial cell often includes interplasmidic recombination events and chromosomal integration of resistance plasmids or transposons . The abilities of the transferred resistance plasmids or transposons to integrate or to be integrated into DNA molecules, plasmids or chromosomal DNA, of the new host cell are of major importance to circumvent strain-, species- or genusspecific barriers such as restriction/modification systems, plasmid incompatibilities or deficiencies of plasmid replication which may limit efficient resistance gene transfer. Med Dosw Mikrobiol, 1997, 49(1-2), 45 - 53 {Animal systemic iron sources utilized in vitro by staphylococci}; Lisiecki P et al.; Under iron-restricted conditions staphylococcal strains could utilize in vitro several animals body iron sources in form of bovine haemoglobin, hemin, lactoferrin and transferrin, ovotransferrin, horse myoglobin ferritin and cytochrome C . Spectrum of utilized iron sources was not dependent on species affiliation and kind of siderophores system . Strains isolated from clinical materials utilized largest spectrum of animal iron body sources. Med Dosw Mikrobiol, 1997, 49(1-2), 35 - 43 {Susceptibility to cefazolin, cefamandole and ceftazidime in Staphylococcus strains}; Wiktorowicz-Belzyt E et al.; 365 S . aureus and 165 Coagulase Negative Staphylococci were tested for susceptibility to methicillin, cefazolin, cefamandole and ceftazidime by standard broth microdilution and disc method . In staphylococci resistance to methicillin normally parallels resistance to beta-lactams, and it has been suggested that cephalosporins are not be used clinically if susceptbility tests show resistance to methicillin . Populations of methicillin resistant staphylococci are made up of a mixture of methicillin-susceptible and methicillin-resistant cells (heteroresistant isolates) . This phenomenon is the cause of differences in resistance in vitro to methicillin and tested cephalosporins . Cefamandole was the cephalosporin which retained most antibacterial activity against some methicillin-resistant isolates (MICm MRSA = 63.2 mg/L, MICm MRCNS = 67.4 mg/L) . This antibiotic has extremely small resistant subpopulations, only detectable by high-inoculum screening or prolonged incubation of isolates in the presence of the drug . Cefazolin was the cephalosporin which had most antibacterial activity against all methicillin-susceptible isolates (MICm MSSA = 1.3 mg/L, MICm MSCNS = 1.6 mg/L) . Among the 3 studied cephalosporins ceftazidime was found to be the least active against methicillin-resistant and methicillin-susceptible Staphylococci (MICm MSSA = 25 mg/L, MICm MRSA = 334.5 mg/L, MICm MRCNS = 414.6 mg/L, MICm MSCNS = 26.7 mg/L). Med Dosw Mikrobiol, 1997, 49(1-2), 19 - 25 {Comparison of several methods for detection of methicillin resistance in clinical strains of Staphylococcus sp}; Rokosz A et al.; 108 Staphylococcus spp . strains from 300 clinical specimens from hospitalized patients were isolated . Identification and drug resistance were determined using automated ATB system . 37 S . aureus strains, 44 S . epidermides strains and 27 strains of other coagulase-negative staphylococci were cultured . Sensitivity to methicillin of S . aureus was determined with four methods: ATB system, disc-diffusion (Oxa 1 microgram), Crystal MRSA ID System and agar screen test in TSA medium with methicillin (25 micrograms/ml) . 13 S . aureus strains (about 1/3 of strains) were methicillin-resistant (MRSA) . Complete conformity of the results was obtained with Crystal MRSA ID, disc-diffusion and agar screen tests . In the case of three S . aureus strains the results of determination in ATB system were not consistent with the results obtained with the use of the methods mentioned above . Susceptibility to methicillin of 71 coagulase-negative strains (CNS) was determined using two methods at first: ATB and disc-diffusion . In the case of 25 methicillin-resistant strains identical results were obtained . For 20 coagulase-negative strains non-conformity with the results of these two methods was observed . As the decisive method, the agar screen test (TSA-MET) was applied . 18 of these 20 CNS strains were categorized as methicillin-resistant . Finally, 43 MRCNS (i.e . 60%) were detected among 71 coagulase-negative strains . The results of methicillin resistance determination of staphylococci in an automated system should be confirmed with a second test such as agar screen, disc-diffusion or Crystal MRSA ID System (in the case of S . aureus). Biofizika, 1997 Jul-Aug, 42(4), 919 - 25 {Effect of heliogeophysical factors on the biological activity of Staphylococcus aureus}; Shestopalov IP et al.; In 1988-89, an experimental was carried out to study the effect of heliogeophysical factors on the biological activity of Staphylococcus aureus, one of the most widespread causative agents of infectious diseases in man and animals . For comparison, both individual heliogeophysical factors and interrelated phenomena in the system Sun-Earth arising from solar flashes were used . Two types of solar flashes were revealed . A near-annual cycle of changes in DNase activity of staphylococci in vitro was revealed, which correlates with the cycle of changes in electron concentration of layer F2 of the ionosphere . The correlation coefficient is 0,96% . It was found that the threshold of susceptibility of test-microorganisms to heliogeophysical influences is different in different years . There is an "amplitude window" of the influence whose upper boundary varies in different periods. Acta Biol Hung, 1997, 48(3), 319 - 22 Rapid detection of Staphylococcus saprophyticus using primer specific PCR; Gaszewska-Mastalarz A et al.; Staphylococcus saprophyticus is one of the most frequently encountered clinically significant members of the coagulase-negative staphylococci . A set of species-specific PCR primers was defined for the detection of Staphylococcus saprophyticus . These primers target variable regions (V3 and V6) of the 16S rRNA gene . Primer-specific PCR has potential applications in epidemiological studies and diagnosis of Staphylococcus saprophyticus. Dermatology, 1997, 195 Suppl 2, 10 - 3 Nondevelopment of resistance by bacteria during hospital use of povidone-iodine; Lanker Klossner B et al.; Since the bacterial ability to develop resistance against various factors of their surroundings is a well-known phenomenon, resistance against iodine and specifically against povidone-iodine (PVP-I) has been widely investigated . Yet there is little known about bacterial resistance in long-term daily use of disinfectants in continuous ambulatory peritoneal dialysis (CAPD) patients . The aim of our study was to investigate whether on daily use of PVP-I over a period of at least 6 months coagulase-negative staphylococci (CNS)--the predominant infective organisms of peritonitis--developed resistance against PVP-I . At the catheter exit site of 40 CAPD patients we isolated 36 CNS . 23 CNS (CNS + PVP) orginate from patients using PVP-I, 13 CNS (CNS + CI) from patients using sodium hypochlorite (NaOCl) as disinfectant . The strains were biotyped, antibiotic resistance patterns were determined and resistance against PVP-I or NaOCl was calculated as reduction factor using the quantitative suspension test combined with a turbidimetric standardization . Resistance against PVP-I 0.01% and against NaOCl 0.005% was determined at two contact times (30 and 300 s) for each patient group . In addition, we investigated the effects of plasmid loss on sensitivity to PVP-I . Out of 5 multiple-antibiotic-resistant CNS, 3 strains showed no difference in reduction factor against PVP-I before and after curing . There was no significant difference in reduction factor against NaOCl . CNS + PVP were even significantly more sensitive to PVP-I than CNS + Cl . Taken together, our results demonstrate that long-term use of PVP-I does not cause any bacterial resistance in CNS of CAPD patients. Indian J Pathol Microbiol, 1996 Apr, 39(2), 127 - 30 Study of pathogenicity markers of staphylococci isolated from clinical specimens; Fule RP et al.; A total of 165 strains of coagulase positive staphy