Bacteriol Virusol Parazitol Epidemiol, 1995 Apr-Jun, 40(2), 153 - 7 {Staphylococcus saprophyticus isolated in blood cultures from normal-weight newborn infants with septic arthritis}; Codita U et al.; The paper deals with the identification of some Staphylococcus saprophyticus strains received by the Staphylococcus National Reference Centre, in the Cantacuzino Institute, Bucharest, Romania . The strains were isolated from blood cultures pre-elevated in a maternity in Bucharest from normoponderal newborns with septic arthritis . Recent data from literature concerning the infections caused by coagulase negative staphylococci in general, with special reference to those cause by S . saprophyticus are presented . The identification scheme used in the Cantacuzino Institute and the minimal microbiological diagnosis tests of S . saprophyticus recommended to the clinical laboratories by the International Society for the Taxonomy of Staphylococci and Micrococci are also described. Ugeskr Laeger, 1995 Mar 27, 157(13), 1862 - 4 {Is methicillin better than cloxacillin in serious infections caused by strong penicillinase-producing staphylococci (phage-type 94/96)?}; Siboni AH et al.; An intravenous drug addict was treated with cloxacillin for septicaemia with Staphylococcus aureus because of pneumonia and suspected endocarditis . After 51 days of treatment Staphylococcus aureus was still found in blood and expectorate despite continued treatment with intravenous cloxacillin 1 g three and later four times daily and oral rifampicin . The staphylococcal isolates were all of phage type 94/96 . Investigations have shown that Staphylococci aurei of phage type 94/96 produce large amounts of penicillinase, and that methicillin is the most penicillinase-resistant of the penicillinase-resistant penicillins followed by dicloxacillin and cloxacillin . The penicillinase production of the patient's Staphylococcus aureus strain was 304-362 units per mg bacteria which is high compared to typical values of 50-200 . After 50 days of cloxacillin treatment, the treatment was changed to methicillin 2 g four times daily . Within a week the staphylococci had disappeared from the expectorate, and were never again recovered from the blood . It is suggested that methicillin should have superior efficiency in serious infections with Staphylococcus aureus of phage type 94/96. Pharmacoeconomics, 1995 Apr, 7(4), 357 - 74 Teicoplanin . A pharmacoeconomic evaluation of its use in the treatment of gram-positive infections; Spencer CM et al.; Teicoplanin, a glycopeptide antibiotic, is active against Gram-positive organisms, including methicillin-resistant staphylococci . It has demonstrated similar efficacy to vancomycin in the treatment of Gram-positive infections in febrile patients with neutropenia; fewer comparative data are available in patients with other infection types . Compared with vancomycin, teicoplanin is associated with less nephrotoxicity, appears to cause fewer anaphylactoid reactions, requires less monitoring and is more convenient to administer (once daily by intravenous bolus or intramuscular injection vs 2 to 4 times daily by intravenous infusion) . Two European cost-minimisation studies have demonstrated that while the acquisition cost per dose of teicoplanin was approximately twice that of vancomycin, the cost of 2 weeks' therapy with either agent was similar (difference of 1 to 2%) . However, in order to fully explore potential differences between these agents, a full economic analysis which considers all treatment-related costs is needed . Home therapy of Gram-positive infections, a setting in which teicoplanin may be preferred over vancomycin because of its tolerability profile and ease of administration, is particularly worthy of future economic study . Thus, there are a number of areas needing further study before the optimum formulary positioning of teicoplanin can be definitely stated . Nevertheless, present evidence suggests that teicoplanin is likely to have pharmacoeconomic advantages over vancomycin in at least some situations. Acta Pol Pharm, 1995 Mar-Apr, 52(2), 153 - 60 Susceptibility of gram-positive bacteria isolated from a paediatric hospital environment to antibiotics; Zembrzuska-Sadkowska E et al.; Susceptibility of Gram-positive bacteria isolated from the hospital environment to antibiotics was determined . About 19% strains were resistant to most tested antibiotics . Among 30 coagulase-negative staphylococci, 8 of them have been found to be resistant to 6-13 antibiotics, whereas among 15 strains of S . aureus only one was resistant to 6 antibiotics . Only gentamicin was effective to all tested Gram-positive strains, whereas ceftazidim, tetracycline and doxycycline were ineffective to the most tested bacteria. Ann Thorac Surg, 1995 Mar, 59(3), 626 - 31 Bacterial wound colonization after broad-spectrum versus narrow-spectrum antibiotics; Palmer DL et al.; Broad-spectrum versus narrow-spectrum antibiotic prophylaxis for patients who undergo cardiac operations is variously advocated to reduce the incidence of all infections or, conversely, to prevent resistant superinfections . Previous studies of prophylaxis have shown a reduction in the incidence of staphylococcal infections with some increased resistance . We studied preoperative and postoperative wound colonization as a surrogate for infection . Among 78 patients undergoing cardiac procedures, the type of prophylaxis was allocated as follows: narrow-spectrum (nafcillin), 24 patients; midspectrum (cephapirin), 26 patients; and broad-spectrum (ceftriaxone), 28 patients . Seventeen patients who underwent other procedures received no antibiotics and served as controls . Cultures of the operative site were done preoperatively, and 3 and 6 days postoperatively . The incidence of preoperative skin colonization with staphylococci was identical (95%) in all groups . Postoperatively, more patients receiving nafcillin (48%) were culture-negative for all organisms than were either of the other groups receiving antibiotics (27% and 22%) (p < 0.05) . Gram-negative bacilli were infrequent colonizers and neither did the incidence of infection with these organisms increase nor did resistance develop in any group . The infection rates were not different among the treatment groups . Thus, a narrow-spectrum antistaphylococcal penicillin may offer an advantage in terms of both prophylaxis for cardiac operations and hospital costs. J Small Anim Pract, 1995 Mar, 36(3), 99 - 104 Comparison of two shampoos for treatment of Malassezia pachydermatis-associated seborrhoeic dermatitis in basset hounds; Bond R et al.; A randomised-double-blind parallel study compared the clinical and antimicrobial efficacies of a miconazole-chlorhexidine shampoo with a selenium sulphide shampoo for the treatment of seborrhoeic dermatitis associated with Malassezia pachydermatis in 33 basset hounds . All 16 miconazole-chlorhexidine treated hounds and 11 of 17 selenium sulphide treated hounds improved when shampooed at three-day intervals for three weeks . The miconazole-chlorhexidine treated hounds showed significantly greater reductions in pruritus (P < 0.01), erythema (P < 0.001), exudation (P < 0.01) and overall severity (P < 0.001), and in counts of M pachydermatis (P < 0.001), total bacteria (P < 0.001) and coagulase-positive staphylococci (P < 0.001), when compared to the selenium sulphide treated group . Improvements in scaling and coat condition did not vary significantly between the two groups . These results indicate that seborrhoeic dermatitis in basset hounds is often associated with elevated cutaneous populations of M pachydermatis and bacteria, and that the miconazole-chlorhexidine shampoo is more effective than the selenium sulphide product for the treatment for this disease. Transfus Med, 1995 Mar, 5(1), 57 - 61 Bacterial contamination of single-donor blood components; Illert WE et al.; An analysis was performed of the microbiological laboratory quality control data for the past 9 years (1985-1993) . Bacterial contamination was detected in 100 of 25,171 tested blood components . Single-donor platelet concentrates had a contamination incidence of 25 in 5889 (0.42%); whole blood samples were contaminated at a rate of 1 in 2973 (0.03%) and red cell concentrates at a rate of 73 in 15,317 (0.48%); of 992 samples of fresh frozen plasma only 1 was contaminated (0.1%) . Gram-positive staphylococci comprised 75% of cases and Gram-negative rods 10% . This frequency of laboratory-detected bacterial contamination contrasts with the low rate of transfusion-associated septicaemic events. Epidemiol Mikrobiol Imunol, 1995 Mar, 44(1), 15 - 9 {ORIDES--orientational identification of coagulase-negative staphylococci from human clinical material}; Petras P; In the National reference laboratory for staphylococci in the National Institute of Public Health in Prague a new dichotomic schema ORIDES was elaborated for the preliminary identification of 17 species of coagulase-negative staphylococci which can be isolated from human clinical material . Tests of 986 strains revealed that ORIDES can serve rapid and cheap assessment of these bacteria, the importance of which is increasing. APMIS, 1995 Mar, 103(3), 225 - 32 erm genes in erythromycin-resistant Staphylococcus aureus and coagulase-negative staphylococci; Westh H et al.; Erythromycin-resistant S . aureus from general practice and a dermatology ward with a very high consumption of erythromycin was studied for ermA and ermC content by Southern blot analysis . The prevalence of these erm genes was also studied in coagulase-negative staphylococci from the same dermatology ward and in a collection of 15 S . aureus and 18 coagulase-negative staphylococci found in the same specimen from 15 different patients . ermA was only found as a chromosomal insert and ermC only on small plasmids . In erythromycin-resistant S . aureus from general practice ermC was responsible for 84% of erythromycin resistance, while 16% of the strains contained ermA . In 17 of 18 S . aureus strains from the dermatology ward a 2.5 kb plasmid contained ermC . Among 58 erythromycin-resistant coagulase-negative staphylococci only 2 (3%) had ermA, whereas 44 strains (76%) had ermC . ermA or ermC genes were common in S . epidermidis (36/38) . However, in 20 isolates of erythromycin-resistant coagulase-negative staphylococci of other species, 10 had neither ermA nor ermC . ermC was the most common erm gene in both coagulase-negative staphylococci and S . aureus . In 11 of 15 patients with erythromycin-resistant S . aureus the co-isolated erythromycin-resistant coagulase-negative staphylococcus had another resistance mechanism, either another gene or a different phenotypic expression of the same gene . Resistance to pristinamycin, a streptogramin antibiotic only used in animals, was not found in S . aureus but was found in 14% of erythromycin-resistant coagulase-negative staphylococci. APMIS, 1995 Mar, 103(3), 219 - 24 Comparison of tests designed to identify Staphylococcus aureus thermostable nuclease; Brakstad OG et al.; The thermonuclease test has been employed for same-day identification of Staphylococcus aureus in blood cultures and a seroinhibition test to confirm S . aureus thermonuclease (TNase) by using polyclonal anti-S . aureus TNase antiserum . However, strains of non-S . aureus staphylococci may produce TNases which are neutralized by the antiserum . This study evaluated alternative reagents and confirmatory tests for the S . aureus TNase . The tests included seroinhibition by a monoclonal antibody (MAb) against S . aureus TNase, MAb-based detection of the TNase in a sandwich ELISA, and a polymerase chain reaction for amplification of the nuc gene encoding the S . aureus TNase . All these tests discriminated between TNase produced by S . aureus and TNase produced by strains of the species S . caprae, S . carnosus, S . simulans, S . capitis, and S . intermedius . Specificity for the S . aureus TNase was confirmed by an inhibition ELISA for two out of three MAbs tested . Thus, the MAb- and nuc-based tests will be useful to discriminate between TNases from S . aureus and non-S . aureus staphylococci. APMIS, 1995 Mar, 103(3), 209 - 18 Direct identification of Staphylococcus aureus in blood cultures by detection of the gene encoding the thermostable nuclease or the gene product; Brakstad OG et al.; This study compares methods for direct identification of S . aureus in blood cultures by detection of the thermonuclease (TNase) of this bacterium or the nuc gene encoding it . The protein was detected by an enzyme diffusion test in o-toluidine blue DNA agar with a test time of at least 4 h, by a monoclonal antibody (MAb)-based sandwich enzyme-linked immunosorbent assay (sELISA) with a test time of approximately 4 h, and by a MAb-based sandwich enzyme-linked immunofiltration assay (sELIFA) with a test time of 25-30 min (sample preparation included) . The nuc gene was amplified by a polymerase chain reaction (PCR) with a test time (amplification plus detection) of approximately 3.5 h . The tests were optimized for direct examination of blood-containing cultures . All tests were positive with 67/67 blood cultures which grew S . aureus, negative with 35/35 cultures which grew coagulase-negative staphylococci, and negative with 37/37 cultures with various other bacteria . These results showed positive agreement with those of the commercial AccuProbe test but not with the StaphAurex agglutination kit . With an artificially seeded blood culture, minimum total times required (incubation plus testing) were as follows: nuc-PCR, 9.5 h; sELIFA, 12.5 h; enzymatic test, 16-36 h; AccuProbe, 14 h . Direct examination of both the nuc gene and the mecA gene encoding methicillin resistance demonstrated the mecA gene in all the coagulase-negative staphylococci (48.6%) which showed oxacillin resistance . The sELIFA had the particular advantage of its short test time, the PCR its high sensitivity and the possibility of simultaneous detection of the species-specific nuc gene and genes encoding other clinically important characters of the bacteria . These tests offer the prospect of direct application to a variety of clinical specimens for rapid diagnosis of S . aureus infection. J Appl Bacteriol, 1995 Mar, 78(3), 251 - 63 Numerical characterization study of Micrococcaceae associated with lamb spoilage; Prieto M et al.; A computer-assisted characterization of 296 Micrococcaceae isolates obtained from aerobically chill-stored lamb carcasses was carried out using a probability matrix and Bayesian identification theorems, complemented with cluster analysis . Preliminary identification was done with an original probability matrix comprising 37 previously described taxa and 32 tests . Although its statistical quality was adequate, the percentage of identification of field strains to species level was only 70% (96.6% identified with genera) . To achieve an improved characterization, cluster analysis was subsequently performed on this group and an additional 26% could be associated with defined species, with five more taxa defined . The combined use of both approaches was judged positive as new identifications and better discrimination could be achieved . The majority of our isolates belonged to the Staphylococcus species group . Many species and groups of staphylococci increased as the spoilage progressed. J Infect, 1995 Mar, 30(2), 107 - 13 The potential reduction of microbial contamination of central venous catheters; Tebbs SE et al.; The microbial contamination of stopcock entry ports attached to central venous catheters (CVC) was determined using a specially designed swab . The swab was made of a highly porous material, Porex, and was designed to fit exactly into the entry port of stopcocks . The swab was used to determine the frequency of microbial contamination of entry ports attached to CVC in patients located on an Intensive Care Unit . Of the 200 swabs obtained 44 (22%) contained microorganisms . Coagulase-negative staphylococci were recovered from 43 of the swabs and diphtheroid bacilli from 1 swab . In vitro studies were carried out to investigate the efficiency of the swab in removing excess residual fluid and organisms from entry ports . The swab absorbed relatively large numbers of bacteria within seconds . When entry ports were inoculated with between 10(3) and 10(5) cfu of either Staphylococcus epidermidis or Klebsiella pneumoniae greater than 99% of the organisms were absorbed by the swab (P < 0.01) . The absorbent swab was more efficient at removing S . epidermidis from the entry port when compared to a standard cotton swab (P < 0.01) . In vitro this absorbent swab reduced the potential for catheter contamination resulting from migration of organisms from the entry port via the intraluminal route . The use of the swab in the clinical situation may reduce the incidence of CVC-related infections. Eur J Clin Microbiol Infect Dis, 1995 Mar, 14(3), 206 - 11 Species-specific identification of methicillin resistance in staphylococci; Petersson AC et al.; The ability to identify methicillin-resistant staphylococci by the disc diffusion method was evaluated using discs containing oxacillin (1, 5 and 10 micrograms), methicillin (10 micrograms) and cephalexin (30 micrograms) . Strains of Staphylococcus aureus (67 strains) and coagulase-negative staphylococci (72 novobiocin-sensitive and 27 novobiocin-resistant strains) were studied using two inoculum densities (10(6) cfu/ml and 10(8) cfu/ml) . Inhibitory zones were recorded after 18, 24 and 42 hours of incubation . A mecA-specific application of the polymerase chain reaction was used as a reference method . The inoculum of 10(8) cfu/ml and incubation for 24 hours were optimal for the identification of methicillin-resistant strains . However, one single disc was not sufficient for the identification of methicillin resistance in the different staphylococcal species . The mecA-positive strains of Staphylococcus aureus and novobiocin-resistant coagulase-negative species were clearly separated from the mecA-negative strains when the 5 micrograms oxacillin disc was used, whereas the 1 microgram oxacillin disc was optimal for the identification of the mecA-positive novobiocin-sensitive coagulase-negative strains. Pediatr Med Chir, 1995 Mar-Apr, 17(2), 117 - 22 {Nosocomial infection caused by multiresistant Staphylococci in a neonatal and pediatric intensive care unit}; Tuo P et al.; We selected a paediatric population with a high risk of nosocomial infection formed by 116 newborns (42.8%) and 155 not newborns (57.2%) admitted into the ICU of the Giannina Gaslini Institute during the period 1-1-1992-30-9-1992; we compared it with a reference paediatric population studied in the same department during the period 1-1-1987-30-6-1988 formed by 310 newborns (44.3%) and 391 not newborns (55.7%) . The purpose of this study is to evaluate the possible change in the incidence of colonizations and ICU specific nosocomial infections, the possible increase of nosocomial infections by multiresistant Staphylococci and the appearance of new multiresistant germs . The two populations obviously present similar factors of high risk of nosocomial infection (naso-tracheal intubation, mechanical ventilation, total parenteral nutrition, surgical procedures, thoracic and/or abdominal prothesis, etc.) . The obtained data have been examined with the Chi-square method . The incidence of colonizations remained unchanged while we noted a significant increase (10.3% compared to 4.9%-p > 0.0014) of the "ICU" specific nosocomial infections; the increase regarded mainly the neonatal population (18.9% compared to 7%-p > 0.00001) . Significant increase of the nosocomial infections by multiresistant Staphylococcus (Staphylococcus haemolyticus) with in vitro and in vivo resistance to teicoplanin . Furthermore, presence in the performed study of multiresistant gram negative germs. J Pharm Pharmacol, 1995 Mar, 47(3), 193 - 6 Epidemiology and susceptibilities to mercury preservatives of staphylococci isolated from used eye-drops preserved with thiomersal; Du Bois SK et al.; Minimum inhibitory concentrations (MICs) of seven independent isolates of Staphylococcus hominis isolated in the same week from used eye-drops, preserved with thiomersal and collected from wards and clinics in the same hospital, ranged between 1 and 0.03 mg L-1 for thiomersal, 1 and 0.01 mg L-1 for phenyl mercuric nitrate and 10 and 3 mg L-1 for mercuric chloride . Although MIC values determined on solid nutrient medium indicated a 100-fold variation in susceptibility to the bacteriostatic effect of phenyl mercuric nitrate, after 5 h in an aqueous solution containing the bactericidal concentration of 10 mg L-1 phenyl mercuric nitrate, the survival levels of the six S . hominis isolates were similar, with a mean of 13.4% (s.d . 11.0), compared with 100 and 0.8%, respectively, for the most resistant and most sensitive control staphylococcal strains tested . Antibiotic susceptibilities and plasmid profiles of the S . hominis isolates indicated they were the same strain . It is concluded that laboratory indicators of preservative efficacy, such as MIC determination or susceptibility to bactericidal concentrations of preservatives, do not necessarily correlate with the epidemiology of contaminating bacterial strains or their survival in preserved pharmaceuticals. Antibiot Khimioter, 1995 Mar, 40(3), 22 - 7 {Comparative in vitro activity of ampicillin, cefoperazone, their combinations with sulbactam and other antibiotics with respect to staphylococci and pneumococci}; Sidorenko SV et al.; Antibiotic susceptibility of 225 Staphylococcus strains and 42 Pneumococcus strains was assayed with the method of serial microdilutions . Methicillin resistant Staphylococcus strains (S . aureus and coagulase negative strains) were characterized by high susceptibility to cephalosporins and ampicillin + sulbactam combination, as well as to ciprofloxacin, rifampicin and vancomycin (70 to 100 per cent of the susceptible strains) . Less than 50 per cent of the strains was susceptible to erythromycin . The methicillin resistant Staphylococcus strains preserved their high susceptibility to vancomycin and rifampicin (the coagulase negative strains also preserved their susceptibility to ciprofloxacin) . Four Pneumococcus strains with the intermediate resistance to benzylpenicillin were isolated (for 9.6 per cent of the strains the MIC was 0.12 to 1.0 micrograms/ml) . The growth of 2 out of these 4 strains was inhibited by the ampicillin + sulbactam combination in a concentration of less than 0.5 micrograms/ml and by cefotaxime and the cefoperazone + sulbactam combination in a concentration of less than 1.0 micrograms/ml . The growth of the other 2 strains was inhibited by betalactams in concentrations higher than the above mentioned. Med J Aust, 1995 Feb 20, 162(4), 210 - 3 Infection associated with central venous catheters: a prospective survey; Gosbell IB et al.; OBJECTIVE: To assess the incidence of local and systemic infection caused by central venous catheters in a general hospital population . SETTING: Concord Repatriation General Hospital, Sydney, April to August 1991 inclusive . DESIGN: A prospective survey of all patients with in situ central venous catheters . Systemic catheter-related infection was detected by blood and routine catheter tip culture, and local infection by clinical observation of the catheter exit site . OUTCOME MEASURES: Local and systemic infection and complications . RESULTS: 479 central venous catheters were surveyed in 311 patients . Local infection developed in association with 54 catheters (11%) and systemic infection with 32 (6.7%) . Local infection was predictive of systemic infection, but its absence did not exclude systemic infection . Haemodialysis catheters were responsible for a higher systemic infection rate than other catheter types, the most common organism responsible being methicillin-resistant Staphylococcus aureus . Twenty per cent of all bacteraemias (33/160) detected in the hospital occurred in patients with a central venous catheter and 24 of these (73%) were definitely or probably due to the catheter . Staphylococci were the predominant isolates and 40% of the methicillin-resistant S . aureus bacteraemias detected were due to catheter-related infection . Infection complications were few: three patients developed local abscesses; one endocarditis; and two died . CONCLUSIONS: Central venous catheter-related infection is common in general hospital populations . Staphylococcal bacteraemia and local infection in a patient with a central venous catheter are strongly suggestive of catheter-related systemic infection . Empirical antibiotic treatment should include at least antistaphylococcal cover. Gene, 1995 Feb 3, 153(1), 93 - 8 Identification of a chromosomally encoded ABC-transport system with which the staphylococcal erythromycin exporter MsrA may interact; Ross JI et al.; The energy-dependent efflux of erythromycin (Er) in staphylococci is due to the presence of msr A, which encodes an ATP-binding protein . MsrA is related to the multi-component ATP-binding cassette (ABC) transporters which characteristically also contain membrane-spanning domains . Since MsrA functions in a heterologous host in the absence of other plasmid-encoded products, the requirement for a transmembrane (TM) complex might be fulfilled by hijacking a chromosomally encoded protein . Two genes, stpA and smpA, were identified upstream from msrA on the original Staphylococcus epidermidis plasmid, encoding an ATP-binding protein and a hydrophobic TM protein, respectively . Sequences highly similar to stpA and smpA (stpB and smpB) were also found adjacent to a chromosomal copy of msrA in S . hominis . In Southern blots, internal fragments of stpA or smpA hybridized to the chromosome of the Ers S . aureus RN4220 . Cloning and sequence analysis of the region identified revealed the presence of two genes, stpC and smpC, related to stpA and smpA . The deduced amino-acid sequences of the gene products showed that StpA and StpC were 85% identical, whereas SmpA and SmpC were 65% identical . A gene similar to msrA was not present in the S . aureus chromosome . There was no further sequence similarity outside these conserved regions . These results indicate that the chromosomes of S . hominis and S . aureus contain sequences encoding a potential TM protein with which MsrA might interact. J Med Microbiol, 1995 Feb, 42(2), 96 - 101 Detection by PCR and analysis of the distribution of a fibronectin-binding protein gene (fbn) among staphylococcal isolates; Minhas T et al.; The fibronectin-binding proteins of Staphylococcus aureus are considered to be important virulence factors for colonisation and infection . The polymerase chain reaction (PCR) was used to detect part of a gene equivalent to the fbnA gene of S . aureus in 120 isolates of staphylococci (S . aureus, S . epidermidis, S . haemolyticus, S . simulans, S . hominis, S . warneri, S . cohnii and S . lugdunensis) . Primers specific for the binding domain region of the fbnA gene of S . aureus produced PCR products of the predicted sizes (93 and 207 bp) . The identity of the PCR products was confirmed by digestion with DdeI and nucleic acid hybridisation . The fibronectin-binding activity of the staphylococci was determined with a particle agglutination assay (PAA) . The fbn gene was found to be present by PCR in 107 of the 120 staphylococci tested, irrespective of their site of isolation, and expression of the gene was detected by PAA in 101 of the 120 strains. Int J Biochem Cell Biol, 1995 Feb, 27(2), 139 - 46 Binding and degradation of elastin by the staphylolytic enzyme lysostaphin; Park PW et al.; Lysostaphin is a bacterial zinc metalloproteinase that degrades staphylococcal cell wall peptidoglycans . We have shown that lysostaphin also binds tightly to elastin and contains elastolytic activity . The objective of this investigation was to further characterize the biochemical mechanism of elastolysis by lysostaphin . Binding of lysostaphin to elastin was demonstrated with elastin peptide affinity chromatography . Elastolysis by lysostaphin was studied using a tritium release assay with tritium borohydride-reduced elastin as substrate . Proteolysis of elastin by lysostaphin was maximal at neutral to slightly basic pH and proceeded linearly for 10 hr before reaching saturation . The elastolytic activity was not affected by inhibitors of cysteine or serine proteinases, but was inhibited by o-phenanthroline, EDTA, and by the addition of exogenous zinc . Inhibition by zinc was not due to an alteration in enzyme-ligand interaction since zinc-containing buffers did not impair the ability of lysostaphin to bind elastin . Lysostaphin elastolysis was not inhibited by trypsin treatment of the enzyme, which has been shown to inactivate the enzyme's staphylolytic properties . It is therefore concluded that: (1) lysostaphin binds and degrades elastin; (2) the elastolytic activity of lysostaphin is distinct from its staphylolytic activity; (3) sequence similarities with matrix metalloproteinases suggest the Ala-Ala-Thr-His-Glu sequence in the amino terminus of lysostaphin to be involved in elastin degradation; (4) our studies are important in establishing that metalloproteinases from staphylococci can participate in elastin degradation. Vet Microbiol, 1995 Feb, 43(2-3), 161 - 6 Staphylococcus spp . as mastitis-related pathogens in goat milk; Deinhofer M et al.; A total of 359 Micrococcaceae strains isolated from goat milk samples were differentiated with the commercially available ATB 32 Staph differentiation system . Of these strains, 303 (84.4%) were identified . Six strains were sensitive in the bacitracin resistance test, and accordingly classified as Micrococcus spp . Staphylococcal species isolated of goat milk were S . epidermidis, S . aureus, S . caprae, S . lentus, S . simulans, S . capitis, S . lugdunensis, S . xylosus, S . chromogenes, S . hominis, S . arlettae, S . warneri, S . sciuri, and S . saprophyticus . Highest somatic cell count (SCC) in milk and the highest prevalence of clinical udder alterations were associated with coagulase-positive S . aureus . Increases in milk SCC as well as pathological udder findings were observed in infections with coagulase-negative staphylococci such as novobiocin-sensitive S . epidermidis, S . simulans, S . lugdunensis, S . chromogenes, and S . warneri. Antimicrob Agents Chemother, 1995 Feb, 39(2), 462 - 6 In vitro and in vivo antistaphylococcal activities of L-695,256, a carbapenem with high affinity for the penicillin-binding protein PBP 2a; Chambers HF; L-695,256 is a synthetic carbapenem beta-lactam antibiotic that binds with a high degree of affinity to penicillin-binding protein (PBP) PBP 2a, the protein that mediates staphylococcal resistance to methicillin . The concentration of L-695,256 that inhibited binding of radiolabeled {3H}penicillin to PBP 2a by 50% was 1.2 micrograms/ml, whereas they were 14 and 68 micrograms/ml for penicillin and imipenem, respectively . Cell wall synthesis, determined by incorporation of {14C}N-acetylglucosamine into whole cells, was inhibited by 50% at concentrations of 1.3, 26, and 132 micrograms/ml for L-695,256, penicillin, and imipenem, respectively, for the methicillin-resistant strain COL . Growth of cells of each of two homogeneously resistant strains, COL and 76, was completely inhibited by 4 micrograms of L-695,256 per ml, whereas growth was inhibited by 100 micrograms or more of penicillin or imipenem per ml . The efficacies of L-695,256 (10 mg/kg given three times daily {t.i.d.}), imipenem (37.5 mg/kg t.i.d.), penicillin (300,000 units/kg t.i.d.), and vancomycin (25 mg/kg given twice daily) were compared in the rabbit model of aortic valve endocarditis established with these homogeneous strains . After 4 days of treatment, mean bacterial densities in aortic valve vegetations were reduced by 4.0 to 5.8 log10 CFU/g for L-695,256, 1.0 to 1.8 log10 CFU/g for imipenem, -1.1 to 3.9 log10 CFU/g for penicillin, and 1.1 to 3.0 log10 CFU/g for vancomycin in comparison to the densities of controls . Compounds such as L-695,256 that are bound by PBP 2a with a high degree of affinity are likely to be extremely effective in the treatment of infections caused by methicillin-resistant staphylococci. Microb Drug Resist, 1995 Winter, 1(4), 315 - 20 Antimicrobial resistance of coagulase-negative staphylococci from a Kuwait hospital; Udo EE et al.; This study investigated the incidence of antimicrobial resistance in clinically significant coagulase-negative staphylococci at the Mubarak Al Kabeer Hospital, Kuwait . A total of 104 isolates of coagulase-negative staphylococci consisting of S . epidermidis (67), S . haemolyticus (16), S . saprophyticus (6), S . simulans (2), S . hominis (4), S . albus (2), S . sciuri (3), S . warneri (2), S . capitis (1), and S . xylosus (1) were isolated from clinical specimens over a 6-7 month period and tested for resistance to 22 antibacterial agents and the ability to produce slime . They were all susceptible to vancomycin and mupirocin but intermediate resistance to teicoplanin was detected in seven isolates: 83 and 47.7% were resistant to penicillin G and methicillin, respectively, 57% were resistant to gentamicin, 49.5% to erythromycin, 50.4% to tetracycline, and 52.3% to trimethoprim . Resistance to heavy metals and the nucleic-acid binding compound was also detected . More than half of S . epidermidis, S . saprophyticus, S . simulans, S . hominis, and all of S . haemolyticus were multiply resistant to three or more groups of antibiotics and there was a significant association between slime production and resistance to multiple antimicrobial agents in S . epidermidis . The results revealed a high level of resistance to commonly used agents. Acta Microbiol Pol, 1995, 44(3-4), 243 - 54 The influence of long-lasting implantation on the function of phagocytes towards staphylococci; Rozalska B et al.; A mouse model of peritoneal staphylococcal infection in mice implanted with heparinized polyethylene (H-PE) was used in this study . The binding of staphylococci and fibronectin (Fn) to biomaterial surface was estimated in vitro and in vivo . The activity of phagocytes from the animals non-implanted or implanted for 7 days or 2 months with H-PE was determined on the basis of bactericidal activity, nitric oxide (NO) and Fn production. Acta Microbiol Pol, 1995, 44(2), 127 - 34 The interchangeability of siderophores in Staphylococci; Sobis-Glinkowska M et al.; The functional interchangeability of siderophores among 90 strains belonging to 26 species of genus Staphylococcus was tested . Among the species which synthesized siderophores most commonly utilized (the best donors) were S . epidermidis, S . aureus, S . cohnii, S . hominis and S . simulans . The species which utilized the widest range of exogenous siderophores from other species (the best recipient) were S . epidermidis, S . saprophyticus, S . kloosii and S . schleiferi . The donor and recipient of the widest range of siderophores was S . epidermidis . The potential ability to exchange siderophores as well as the range of their functional interchangeability in staphylococci were found as the features characterizing individual strains. Med Dosw Mikrobiol, 1995, 47(3-4), 133 - 9 {Evaluation of susceptibility of methicillin resistant Staphylococcus aureus strains to vancomycin}; Mlynarczyk G et al.; Susceptibility to vancomycin and teicoplanin was studied in the most frequently isolated Staphylococcus species isolated in the State Hospital Clinic Nr 1 in Warsaw in 1994 . No strains resistant to vancomycin were found in two Staphylococci most frequently isolated from clinical material: S . aureus and S . epidermidis . Occurrence of this resistance is very rare and is restricted only to coagulase-negative Staphylococci such as S . xylosus, S . capitis, S . lentus and S . cohni . Resistance to teicoplanin was observed more often (1.4% in S . aureus and from 11.8% to 39.3% in 9 species of coagulase-negative Staphylococci) . For the majority of methicillin-susceptible clinical strains (80%), the MBC value did not exceed 4.0 mcg/ml of vancomycin while for almost half of the strains in the population of methicillin-resistant strains MBC values ranged from 32.0 to 128 mcg/ml of vancomycin . Moreover, vancomycin-tolerant strains were found eight times more often in the studied MRSA (26.7%) population than in MSSA strains (3.3%). Microbios, 1995, 84(340), 161 - 9 The origin of the antiseptic-resistance gene ebr in Staphylococcus aureus; Sasatsu M et al.; The antiseptic-resistance gene ebr was detected not only in resistant strains of Staphylococcus aureus but also in sensitive strains of S . aureus, in coagulase-negative staphylococcal strains and in enterococcal strains by means of the polymerase chain reaction . The nucleotide sequence of the amplified DNA fragment of the ebr gene from a sensitive strain and that of the previously reported ebr gene were identical . It seems likely that antiseptic-resistant cells result from an increase in the copy number of a gene whose normal function is to remove toxic substances from normal sensitive cells of staphylococci and enterococci. Acta Neurochir (Wien), 1995, 133(3-4), 147 - 52 In vitro and in vivo efficacy of a rifampin-loaded silicone catheter for the prevention of CSF shunt infections; Hampl J et al.; Infection of cerebrospinal fluid (CSF) shunts is one of the major complications associated with their use and is usually managed by shunt removal, temporary insertion of an external drainage and implantation of a new shunt system . We have evaluated the efficacy of a rifampin-loaded silicone ventricular catheter to prevent bacterial colonization and infection in vitro and in an animal model . On the basis of an incorporation process a rifampin-loaded catheter was developed which is capable of releasing rifampin in bacteriocidal concentrations for 60 days and more . In a stationary bacterial adherence assay using S . epidermidis as test strain, the colonization resistance of the device was demonstrated . To assess the capability of the catheter to prevent CSF shunt infections, a rabbit model was developed which allowed the establishment of a reliable and reproducible CSF infection by implantation of silicone catheters into the ventricle and inoculating S . epidermidis (minimal dose 10(6) cfu) or S . aureus (minimal dose 10(3) cfu) . Rifampin-loaded catheters (12 animals inoculated with S . epidermidis, 8 animals inoculated with S . aureus) were compared with non-loaded (14 animals inoculated with S . epidermidis, 19 animals inoculated with S . aureus) control catheters, and infection was documented by clinical, microbiological and histological methods . In contrast to the control group, none of the animals with rifampin-loaded catheters showed clinical signs of infection . Furthermore, in none of the materials obtained after sacrifice of the animals (catheter, brain tissue, CSF, blood) could the infecting bacteria be cultured, whereas in materials from animals with the unloaded catheter the infecting strains could always be cultured from the catheter and from surrounding brain tissue . The histological examination of catheter-adjacent tissue supported these findings . We conclude that a rifampin-loaded silicone ventricular catheter is capable of completely preventing bacterial colonization and infection by staphylococci as the main causative organisms in CSF shunt infections and should be further evaluated in clinical trials. Microbiol Immunol, 1995, 39(9), 725 - 8 Subcutaneous growth of Staphylococcus aureus concomitantly inoculated with Ehrlich ascites tumor cells; Murai M et al.; Intratumoral growth of Staphylococcus aureus Cowan I-derived AP332 was examined by subcutaneous inoculation of cocci in doses ranging from 18 to 1.8 x 10(5) CFU with Ehrlich ascites tumor cells . Inoculation of 18 CFU AP332 resulted in staphylococcal growth in one of five mice, and the proportion of mice established intratumoral infection increased with the initial inocula . Six other strains of S . aureus also grew in the tumor tissue, and none of the three strains of coagulase-negative staphylococci grew at all . Ethanol-killed tumor cells did not promote staphylococcal growth as vigorously as the live tumor cells, especially when the initial inoculum of AP332 was smaller than 10(4) CFU. Drugs, 1995, 49 Suppl 2, 86 - 91 Prophylactic use of the new quinolones for prevention of nosocomial infection in the intensive care unit; Potgieter PD et al.; The new quinolone antimicrobial agents, particularly those with less activity against anaerobes, selectively prevent colonisation of the alimentary tract by Gram-negative bacilli and staphylococci without substantially affecting the normal anaerobic flora, which preserve the colonisation resistance of the gut . These properties ideally position this class of antibacterial agent for selective decontamination of the digestive tract (SDD) in the prevention of nosocomial infection . The rationale for this procedure is based on the presumption that a significant proportion of infections in compromised patients are endogenous in origin, arising from the host's own microbial flora . If this colonisation by potentially pathogenic microflora within the normal flora can be significantly reduced without being replaced by other more pathogenic microorganisms, the risk of endogenous infection should be minimised . The quinolones have proved to be ideal agents for use in preventing infection in bone marrow transplant and other neutropenic patients . They have been used for SDD in the general intensive care unit population, although the technique has not received widespread acceptance . There have been only 4 reported randomised studies using quinolones as part of SDD regimens and only 301 patients have been evaluated . Although the incidence of ventilator-associated pneumonia has been significantly reduced from 36 to 15%, no effect has been shown on mortality . The cost of using SDD is significantly less with the quinolones than with other regimens, and induction of resistance has not been noted . The new quinolones, and in particular the more recently developed agents with extended Gram-positive activity, appear to be ideally suited for SDD, and their careful evaluation in further large, well designed trials is warranted. J Acquir Immune Defic Syndr Hum Retrovirol, 1995 Jan 1, 8(1), 51 - 7 Bacteremia in hospitalized patients infected with the human immunodeficiency virus: a case-control study of risk factors and outcome; Fichtenbaum CJ et al.; We reviewed all episodes of nonmycobacterial bacteremias in human immunodeficiency virus (HIV)-infected patients from 1990 to 1991 to determine the incidence, risk factors, and outcome . Forty-five patients had a total of 63 episodes of bacteremia (9% of 689 HIV-related hospitalizations) . In this cohort, the median CD4+ lymphocyte count was 17 cells/mm3, 71% had AIDS, and 78% were homosexual men . The most frequently isolated bacteria were Staphylococcus aureus (25%) and coagulase-negative staphylococci (22%) . The most common site of infection was intravenous catheter-related, accounting for 35% of the bacteremias . Compared to HIV-infected, nonbacteremic controls, patients with bacteremia detected at admission were more likely to have an indwelling intravenous catheter (p = 0.003) and less likely to be likely zidovudine (p = 0.04) . The overall in-hospital mortality rate was 24% . There was no significant difference in the in-hospital mortality rates in bacteremic patients with or without HIV infection . Seventeen patients had more than one episode of bacteremia (71% had recurrence with the same organism) . We conclude that bacteremia is a significant problem in HIV-infected persons with low CD4+ lymphocyte counts, often related to the presence of an intravenous catheter; recurrence is common . In addition, HIV infection does not appear to increase the mortality rate for bacteremia. Adv Perit Dial, 1995, 11, 296 - 301 Treatment of peritoneal dialysis-associated peritonitis with continuous versus intermittent vancomycin/teicoplanin and ceftazidime in children: preliminary results of a prospective randomized trial . Members of APN Arbeitsgemeinschaft Paidiatrische Nephrologie; Klaus G et al.; A recent treatment update for continuous peritoneal dialysis (CPD)-associated peritonitis recommends first-line use of continuously or intermittently administered intraperitoneal vancomycin and ceftazidine . Teicoplanin has recently been introduced as a potentially less toxic alternative glycopeptide antibiotic . However, efficacy and safety have not been demonstrated for intermittent treatment schedules or for the use of teicoplanin in prospective studies . Therefore, a prospective trial on the treatment of CPD-associated peritonitis was started in 15 pediatric dialysis units using vancomycin or teicoplanin, in combination with ceftazidine . Vancomycin or teicoplanin was administered either continuously with each bag of dialysate for 10 days or as a single dose on days 1 and 8, and ceftazidime either continuously or in one bag of dialysate per day . Until December 31, 1994, 81 episodes of peritonitis including 16 relapses occurred in a cohort of 120 patients . The incidence of peritonitis was 1 episode/13.7 months, regardless of treatment modality {continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD)} . Thirty-six (57%) primary peritonitis episodes were caused by staphylococci (21 Staphylococcus aureus, 15 coagulase-negative), 12 (19%) by gram-negative bacteria, 7 by other germs, and in 8 (13%) cases cultures remained sterile . Primary treatment response was achieved in 43/46 (93%) gram-positive and 4/12 (33%) gram-negative peritonitis episodes . Relapses occurred only with gram-positive bacteria (16/63, 25%) . In cases of gram-positive peritonitis, no differences in primary response (25/25 vs 15/18) or relapse rates (10/36 vs 6/27) were observed between groups on continuous and intermittent treatment, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) Microbiology, 1995 Jan, 141 ( Pt 1), 197 - 203 Staphylococcus aureus but not Staphylococcus epidermidis can acquire iron from transferrin; Lindsay JA et al.; Staphylococci grow and cause infection under the iron-restricted conditions found in vivo . They therefore must possess mechanisms to obtain iron for metabolism from this environment . To determine if staphylococci can extract iron bound to human transferrin, we labelled transferrin with 55Fe and performed uptake assays on cells grown in iron-restricted and iron-plentiful conditions . Growing cultures of Staphylococcus aureus NCTC 8532 could take up radioactive iron during mid- to late-exponential phase of growth . This process was iron-regulated and did not require direct contact between the cell and the labelled transferrin . Siderophore production was detected during this phase, but reductase or protease activity was not . S . epidermidis ATCC 14990 could not access 55Fe bound to transferrin, nor did this isolate produce siderophore, reductase or protease . This difference in the ability to acquire iron bound to transferrin may contribute to the increased virulence of S . aureus when compared to S . epidermidis. Semin Thorac Cardiovasc Surg, 1995 Jan, 7(1), 2 - 6 Bloodstream infections in patients with implanted prosthetic cardiac valves; Gordon SM et al.; A bloodstream infection in a patient with a recently implanted prosthetic cardiac valve is an ominous sign . In the six studies reviewed, the overall mortality rate for patients with bloodstream infections with and without prosthetic valve endocarditis (PVE) were 48% and 51%, respectively . Patients with PVE usually die from a complication of endocarditis . The high mortality rate in patients without endocarditis can be attributed to a severely ill cohort of hospitalized patients, who have a prolonged postoperative course and require life support in intensive care units for multiple organ failure . Although gram-positive cocci (especially coagulase-negative staphylococci) are the most common organisms associated with PVE, any microorganism isolated from the bloodstream must be considered as a potential cause of endocarditis in patients with prosthetic cardiac valves . The conclusion of earlier studies, that PVE was unlikely if infection was due to a gram-negative aerobic bacillus or if a portal of entry could be established, has not been supported by recent studies . An aggressive search for evidence of endocarditis must be performed in all patients with implanted heart valves and bloodstream infections . Successful treatment for most cases of early-onset PVE is primarily surgical. Int J Syst Bacteriol, 1995 Jan, 45(1), 169 - 72 Staphylococcus pulvereri sp . nov., isolated from human and animal specimens; Zakrzewska-Czerwinska J et al.; A new coagulase-negative species of the genus Staphylococcus, Staphylococcus pulvereri, was isolated from human and animal specimens . The complete 16S rRNA sequence of the type strain of S . pulvereri, NT215, was determined and compared with the sequences of 16S rRNAs from the other staphylococci . Strains of S . pulvereri were differentiated from other novobiocin-resistant Staphylococcus species by their biochemical activities, cell wall composition, and levels of genetic relatedness . The type strain of this species is NT215 (= PCM 2443T). Lett Appl Microbiol, 1995 Jan, 20(1), 34 - 6 Inhibition of ruminal staphylococci and enterococci by nisin in vitro; Laukova A; A collection of 59 ureolytic and lactic acid-producing ruminal staphylococci and enterococci, isolates from domestic and wild ruminants, were tested for sensitivity or resistance to lantibiotic nisin . All strains tested were sensitive with zones of inhibition, around wells containing 250 micrograms nisin, from 6 to 26 mm . 74.6% of isolates had zones of inhibition more than 10 mm and 11.1% more than 20 mm . Nisin was more effective against enterococci than staphylococci . Sensitivity of ruminal isolates to nisin may be used to control bacterial growth during the colonization of the rumen or to study the role of antibacterial activity in microbial interactions . Results obtained can be also used in experiments on gnotobiotic animals. Klin Lab Diagn, 1995 Jan-Feb, (1), 45 - 7 {Identification of staphylococci isolated from suppurative-inflammatory processes using the STAPHYtest}; Lazareva EB et al.; Ninety-four strains of staphylococci isolated from patients with pyoinflammatory processes were identified with the use of STAPHYtest system . This test system helps identify 72% of strains . 80.9% of coagulase-positive staphylococci isolated mainly from the wounds were identified as S . aureus . Half of coagulase-negative staphylococci were referred to S . epidermidis . Coagulase-negative staphylococci are isolated almost equally frequently from all types of pathologic material. Nephrol Dial Transplant, 1995, 10(2), 247 - 51 Infection associated with double lumen catheterization for temporary haemodialysis: experience of 168 cases; Hung KY et al.; A total of 227 patients with renal failure requiring acute haemodialysis with placement of a total of 260 Medcorp double lumen catheters at National Taiwan University Hospital from July 1992 to July 1993 were reviewed . Among them, only 135 patients receiving a total of 168 catheter placements and a complete infectious work-up were selected for this study . The mean age of the patients was 55 years (range 15-89 years); 63 (46.7%) were male and 75 (53.3%) were female . The three major reasons for dialysis were chronic glomerular disease (CGN; 49%), diabetic nephropathy (13%) and nephritis associated with systemic lupus erythematosus (SLE; 11%) . The catheters remained in place for an average of 27.8 days (9-73 days) and each catheter was used for an average of eight treatments (2-26) . The reasons for catheter removal were classified as: availability of permanent vascular access (48%), recovery of renal function (10%), scheduled duration (30 days, not every case; 4%), expiration of patient (10%), suspicion of catheter-related infections (15%), and catheter thrombosis/occlusion (9%) . Seven cases with local haematoma and one case of pneumothorax were also identified (total 5%) . In total, a 21.4% catheter-related infection rate was observed and micro-organisms such as Staphylococcus aureus (33%), coagulase-negative staphylococci (36%) and Enterococcus (19%) were isolated . The cumulative probability of patients remaining free from catheter-related infections was about 75% by the end of the fourth week post-catheter insertion, and decreased to less than 50% near the end of the second month of persistent catheterization.(ABSTRACT TRUNCATED AT 250 WORDS) Kansenshogaku Zasshi, 1995 Jan, 69(1), 15 - 20 Molecular epidemiology of Staphylococcus spp . contamination in the ward environment: study on mecA and femA genes in methicillin-resistant strains; Ashimoto A et al.; Staphylococcus spp . were isolated from the ward environment and antibiotic susceptibility tests were performed . Twenty-nine strains out of 274 isolates were S . aureus, and 41.4% of the S . aureus strains were methicillin resistant (MRSA) . All 12 strains of MRSA were also resistant to oxacillin, ceftizoxime, ampicillin and clindamycin . Among the coagulase-negative staphylococci (CNS), methicillin-resistant (MR) strains of S . epidermidis, S . capitis, S . warneri, S . haemolyticus, S . hominis, S . auricularis, S . saprophyticus and S . cohnii were isolated . Eight of the 10 S . Haemolyticus strains were methicillin resistant . The femA gene was detected in S . aureus (MSSA and MRSA), but not in CNS by polymerase chain reaction (PCR) analysis and Southern blot analysis . The mecA gene was found in all the MRSA and MR-S . epidermidis strains tested, and one of the two MR-S . hominis strains, but not in MSSA, MS-S . epidermidis, MS-S . hominis, or MS-S . haemolyticus . DNA from one strain of MR-S . hominis and 2 strains of MR-S . haemolyticus was not amplified by PCR using the mecA gene primer, or hybridized by Southern blotting . The ambiguity that mecA was detected in some MR-CNS strains, but not in others is discussed. Bone Marrow Transplant, 1995 Jan, 15(1), 77 - 80 Central venous catheter-related infections after bone marrow transplantation in patients with malignancies: a prospective study with short-course vancomycin prophylaxis; Vassilomanolakis M et al.; Infections associated with double-lumen central venous catheters (CVCs) in patients undergoing BMT are presented . We prospectively studied infections occurring with 46 CVCs in 40 patients with malignancies during and up to 30 days after BMT . We randomised patients with insertions of CVCs to receive either a short course of vancomycin 500 mg x 3 peri-operatively (16 CVCs) or no VCM (11 CVCs) . Six per cent of CVCs in the group with vancomycin prophylaxis became infected with Gram positive microorganisms compared with 55% in the control group (P < 0.05) . Next, 19 patients with CVCs were all given prophylaxis, so finally 35 patients were given vancomycin compared with 11 patients with no vancomycin . In a total of 11 CVC-related infections, 79% of the microbiological isolates were staphylococci, all of which were sensitive to vancomycin . Vancomycin prophylaxis reduced the number of infected CVCs to 11% compared with 45% (P < 0.05) and bacteraemias to 6% compared with 45% (P < 0.01) . All infections responded to antibiotic treatment . Prophylactic short-duration vancomycin during insertion of CVCs may reduce the incidence of line-associated infections and Gram positive bacteraemias in patients undergoing BMT. J Hosp Infect, 1995 Jan, 29(1), 35 - 43 Epidemiological typing of clinically significant strains of coagulase-negative staphylococci; Martin de Nicolas MM et al.; This study was undertaken to determine the characteristics of 202 isolates of coagulase-negative staphylococci (CNS) isolated from 78 patients (two-seven per patient) using biochemical identification, bacteriophage susceptibility patterns, reverse-typing, plasmid profiles, antimicrobial susceptibility testing and slime production . All the strains could be typed by using the six markers consecutively . In addition, we have been able to deduce the similarity of 58 strains from 24 patients by means of one marker or another (these are similar or different strains within one patient but not between one patient and another) . The use of a combination of markers is the ideal method for typing the strains; thus making it possible to confirm if two or more isolates from the same patient are similar or not and if they produce infection or are simple contaminants. Zentralbl Bakteriol, 1995 Jan, 282(1), 1 - 6 Importance of staphylococci that produce nanogram quantities of enterotoxin; Bergdoll MS; Many staphylococcal strains produce enterotoxin, the toxin that is the cause of staphylococcal food poisoning . If a strain is enterotoxigenic it is possible for it to be involved in food poisoning . The gel diffusion methods were the first methods developed for detection of the enterotoxins and were thought adequate to detect their production . However, they were not adequate to detect enterotoxin in foods involved in food poisoning . When researchers began using the sensitive methods, such as enzyme-linked immunosorbent assay (ELISA) and reversed passive latex agglutination (RPLA), to check strains for enterotoxin production, some strains produced nanogram quantities of enterotoxin . When it was reported that several coagulase-negative species produced less than 10 ng/ml of enterotoxin, it was imperative to determine whether these strains produced enough enterotoxin in foods to cause food poisoning . At the present time research is under way to determine whether these strains produce enough enterotoxin in foods to cause food poisoning. Eur J Clin Microbiol Infect Dis, 1995, 14 Suppl 1, S6 - 11 Fluoroquinolone resistance in staphylococci: new challenges; Sanders CC et al.; Staphylococci show only marginal susceptibility to the newer fluoroquinolones . Minimum inhibitory concentrations (MICs) for susceptible strains usually range from 0.25 to 2.0 mg/l . As a single mutational event involving the gyrase target or permeability diminishes fluoroquinolone susceptibility fourfold on average, such a mutation in staphylococci would lead to a clinical level of resistance . Therefore, it is not surprising that in some institutions, the use of fluoroquinolones has been quickly followed by greatly increased prevalence of fluoroquinolone-resistant staphylococci . The greatest increase in resistance has been seen among methicillin-resistant staphylococci although increased prevalence of resistance among Staphylococcus saprophyticus and other methicillin-susceptible staphylococci has also been reported . Clinical isolates of staphylococci recovered since the introduction of the fluoroquinolones fall into three fluoroquinolone susceptibility groups: susceptible (MIC < 0.5 mg/l), moderately resistant (MIC 0.5 to 4 mg/l) and highly resistant (MIC > 4 mg/l) . The first group represents wild type strains while the second and third groups represent single- and multiple-step mutants, respectively . To prevent increasing prevalence of isolates in the second and third groups, it would be prudent to avoid use of quinolones whenever possible . However, when it is necessary, a fluoroquinolone, which achieves serum/tissue levels eight times the MIC of the infecting strain, should be used. Adv Pediatr Infect Dis, 1995, 10, 337 - 68 Intravenous catheter-related infections; Salzman MB et al.; Vascular catheter-related infection is an important cause of mortality and morbidity in hospitalized patients . The mean incidence of catheter-related bloodstream infection in hospitalized pediatric patients is 2.4 episodes per 1,000 days . Totally implantable central venous catheters may be associated with a lower risk of infection . Coagulase-negative staphylococci are the predominant cause and account for about one third of episodes of catheter-related bloodstream infection . The diagnosis of catheter-related bloodstream infection is often difficult because there are frequently no signs of inflammation around the catheter . Diagnosis depends on either a positive quantitative catheter culture yielding the same microorganism recovered from the bloodstream or differential quantitative blood cultures with significantly greater colony counts from blood drawn through the catheter than from blood drawn through a peripheral vein . Alternatively, probably catheter-related sepsis can be diagnosed when clinical sepsis is refractory to antimicrobial therapy but responds to catheter removal . Often these criteria are not met but catheter-related bloodstream infection is presumed because a common skin microorganism is isolated from the blood when clinical manifestations of bloodstream infection are present and there is no other apparent source of infection . Microorganisms causing catheter-related bloodstream infection gain access to the bloodstream predominantly from either the catheter insertion site or the catheter hub . Most catheter-related infections occurring shortly after catheter insertion probably gain access to the bloodstream by extraluminal migration along the catheter from the skin at the catheter insertion site . When catheters are in place for extended periods, especially greater than 30 days, the catheter hub probably plays a major role in microorganisms gaining access and then migrating endoluminally until reaching the bloodstream . Recently employed strategies for the prevention of catheter-related infections include topical antibiotics or antiseptics at the catheter insertion site, flush solutions containing vancomycin, and bonding antimicrobial agents to the catheter . Infection of peripheral and central venous catheters generally resolves after catheter removal . For tunneled silicone catheters, most episodes of catheter-related infection can be initially managed with antimicrobial therapy infused through the catheter without catheter removal . Staphylococcus aureus is generally more aggressive and associated with more complications than coagulase-negative staphylococci . Microorganisms that usually require catheter removal include Candida and Bacillus species . Adjunctive treatments of catheter infections include the use of urokinase . Catheter-related infection remains an important complication of vascular access . Novel prevention and treatment strategies are currently being investigated . In the near future bonding of antibiotics or other agents to catheters may become routine.(ABSTRACT TRUNCATED AT 400 WORDS) J Endod, 1995 Jan, 21(1), 21 - 5 Isolation of methicillin-resistant staphylococci in the dental operatory; Horiba N et al.; The state of contamination by methicillin-resistant Staphylococci, including methicillin-resistant Staphylococcus aureus (MRSA) at the conservative dentistry section of the School of Dentistry, Aichi-Gakuin University, was investigated . Methicillin-resistant coagulase-negative Staphylococci (MRCNS) were detected in 8 (20.5%) of 39 dental staff (28 dentists, 8 dental hygienists, and 3 dental assistants), but MRSA was not detected . MRCNS was also detected in locations such as the dental chair, dental bracket, dental cabinet, and floor, as well as in airborne samples . The presence of the same strain in both the oral cavity of staff persons and the dental chair/floor locations was determined by biochemical properties, antibiotic sensitivity tests, and electrophoretic patterns. Int J Food Microbiol, 1995 Jan, 24(3), 363 - 73 Numerical taxonomy of an 'atypical' population of gram-positive cocci isolated from freshly dressed lamb carcasses; Sierra M et al.; One hundred Gram-positive, catalase-positive strains were isolated from freshly dressed lamb carcasses . They were randomly selected from a non-selective medium and tested for 75 characters . Only nine cultures could be identified by conventional methods . A numerical taxonomic study was conducted on the whole population and 25 reference strains . At the 80% similarity level (Ssm), ten clusters were formed . Five of them were entirely composed of reference strains . Phena V and VIII contained seven isolates and two reference strains of Micrococcus . Phena VI (six unidentified isolates), VII (nine staphylococci) and IX (69 unidentified isolates) were more related to M . kristinae than to the remaining reference strains . Properties with possible implications in meat spoilage were: strong lipolytic activity (76%), anaerobic growth (85%), tolerance to 15% (w/v) NaCl (95%) and ability to grow at 15 degrees C (95%) and 4 degrees C (26%). Pediatr Res, 1995 Jan, 37(1), 70 - 4 Comparative virulence of Staphylococcus epidermidis isolates in a murine catheter model; Patrick CC et al.; Among coagulase-negative staphylococci, Staphylococcus epidermidis is the species most commonly implicated in catheter-related infections . Whether some staphylococcal organisms are inherently more virulent than others, or whether their ability to infect relates more to the sheer numbers of organisms at the catheter site, remains unclear . We therefore compared eight S . epidermidis isolates and two other coagulase-negative staphylococci using a murine model that allowed us to quantify catheter colonization and abscess formation in the same animal . The organisms were isolated from different clinically relevant settings and were classified according to their slime phenotype . The ability to evoke abscesses or colonize catheters in half of the animals (ID50) was assessed . ID50 inoculum titers (log10 data +/- SD) ranged widely, from 8.5 +/- 0.3 to 10.2 +/- 0.2 for abscess formation (p < 0.005) and from 7.5 +/- 0.5 to 10.3 +/- 1.0 for catheter colonization (p < 0.005) . ID50 values by statistical criteria suggested variability among organisms in the ability to induce abscess formation . High slime production correlated with both parameters, but not with the clinical source of the isolate . Our findings demonstrate impressive heterogeneity in the ability of a representative group of S . epidermidis isolates to colonize catheters and to evoke abscess formation and implicate slime productivity as a major virulence factor . The murine model used permitted simultaneous analysis of multiple factors involved in pathogenesis and should be useful in establishing the basis of S . epidermidis pathogenicity. J Clin Microbiol, 1995 Jan, 33(1), 50 - 2 Rapid identification of Staphylococcus aureus from blood culture bottles by a classic 2-hour tube coagulase test; McDonald CL et al.; The rapid, reliable identification of Staphylococcus aureus from positive blood cultures provides important information . While multiple methodologies for detection of S . aureus from blood culture broths exist, none is satisfactory . Immunologic tests have shown varied sensitivities, the thermonuclease test, while sensitive, is not practical for routine use, and probe tests are expensive . Few studies have addressed using the tube coagulase test (TCT) . This study compared two immunologic methods, the Staph Latex kit (Remel Laboratories) and the Staphaurex kit (Wellcome Diagnostics), with a rabbit plasma TCT (Difco Laboratories) to identify S . aureus within 2 h directly from blood culture broths and pelleted supernatants from BACTEC (Johnston Laboratories) bottles . One hundred twelve unique clinical blood culture isolates consistent with a Gram stain for staphylococci and 68 negative blood culture bottles seeded with a variety of gram-positive organisms were evaluated . Sensitivity and specificity among clinical specimens for the 2-h TCT were 79.5 and 100%, respectively . Sensitivities for the immunologic methods were 12.8 and 10.2% for the Staphaurex and Remel Staph Latex, respectively, and specificities for both were 100% . These results contradict previously reported results for both immunologic and TCT methods and dictate that a specific as well as a sensitive method be employed . The 2-h TCT was found to be a cost-effective, reliable, and rapid method for identifying S . aureus from positive blood cultures. Ann Fr Anesth Reanim, 1995, 14(1), 8 - 12 {Infections related to external ventricular drainage}; Mahe V et al.; Infection is the main complication of external ventricular drainage (EVD) . This retrospective study assessed the relationships between EVD duration, antibiotics and cerebrospinal fluid (CSF) infection . From January 1990 to December 1991, 53 neurosurgical patients, aged 7-76 years, a simplified acute physiological score (SAPS) of 1-20 and having a total of 64 EVD, were included in this study . CSF withdrawn from the drain was collected daily for bacteriological, biochemical and cytological analysis, until the EVD removal . CSF colonization was defined by a positive direct examination or a positive culture of CSF, in the absence of biochemical and cytological abnormalities . CSF drain infection was defined by a low glucose concentration or leucocytosis without blood contamination . However the results of bacteriological analysis were modified by the antibiotics . The group of non infected patients and the group of those with an infected or a colonized drain were comparable with regard to underlying neurosurgical diseases, age, SAPS, Glasgow coma scale and delay between hospital admission and day of drain insertion and antibiotic administration . The EVD duration was significantly longer in infected EVD and colonized EVD . Staphylococci were the most frequently recognized bacteria and coagulase-negative staphylococci predominated in CSF of colonized EVD . In five patients, antibiotics were unable to cure a meningitis . Their leucocyte count was increased . The glucose concentration was low, but the culture, remained negative . It is concluded that duration and rate of EVD influence more the incidence of infections than the systemic administration of antibiotics. Vopr Pitan, 1995, (1), 15 - 7 {Study of possibilities of accumulation of S . aureus enterotoxins during the production and storage of processed cheeses}; Karlikanova NR et al.; The conditions of survive of enterogenic staphylococci in models of production and storage of processed cheeses were studied . The possibilities of S.aureus propagation and accumulation of great doses of thermo-stable enterotoxin were observed in cheese mass before processing . It was established probability of detection of staphylococcus enterotoxins in processed cheeses, produced from the poor quality raw materials. Khirurgiia (Mosk), 1995, (3), 49 - 51 {Use of antegrade endolymphatic administration of antistaphylococcal and antipseudomonal plasma in the treatment of infectious complications in severe multiple trauma}; Eriukhin IA et al.; The article deals with the treatment of infectious complications in persons with severe concurrent trauma . Microbiological study of the wound discharge and damaged tissues showed staphylococci and blue pus bacillus to be the principal causative agents of infectious complications . In view of the poor response of the immune system to the opportunistic flora, the performance of passive immunization with antistaphylococcal and antipseudomonal plasma is pathogenetically grounded . Taking into account the involvement of the lymphatic system in the infectious process, endolymphatic administration of the immune plasma is suggested. J Clin Pediatr Dent, 1995 Winter, 19(2), 117 - 9 Slime production by coagulase-negative staphylococci in the infected pulps; Alacam T et al.; In this study; slime factor which is produced by coagulase negative Staphylococci was investigated in infected pulps of 145 primary and permanent teeth . Staphylococci were isolated in 27% of the cultures and all of the isolated Staphylococci were coagulase negative (CNS) in permanent teeth whereas 75% of isolated Staphylococci were coagulase negative in primary teeth . Slime production rate was the same for both groups and 22% of CNS were found slime positive . It is thought that slime production is important not only in endodontic microbiology, but also in other fields of dentistry for the explanation of the pathogenesis of infection. Microbiol Immunol, 1995, 39(8), 545 - 50 Detection of methicillin-resistant Staphylococcus aureus (MRSA) with antibodies against synthetic peptides derived from penicillin-binding protein 2'; Sekiguchi K et al.; Ten kinds of peptides (21 to 32 amino acids in length) were synthesized based on the reported amino acid sequences of the penicillin-binding protein 2' (PBP2') of methicillin-resistant Staphylococcus aureus (MRSA) . Antibodies against these synthetic peptides (SPs) were generated by immunizing rabbits . The antibodies raised against all the peptides except for one reacted to PBP2' of MRSA and to SPs used for immunization but not to any other protein of MRSA or methicillin-susceptible S . aureus (MSSA) tested by ELISA and Western blotting . A sandwich immunoradiometric assay (IRMA) for the detection of PBP2' was developed using these antibodies . The method could detect PBP2' extracted from as few as 3 x 10(4) cells of a clinical MRSA isolate, and a good correlation between cell number and signal radio-count was observed . IRMA was positive for all 51 methicillin-resistant staphylococci isolated from patients, and was negative for all the 28 methicillin-susceptible ones and 19 strains of other bacterial species . IRMA could be a simple and reliable method for MRSA detection in the clinical bacterial laboratory. Nephrol Dial Transplant, 1995, 10(7), 1212 - 7 Effect of interferon-gamma in dialysis fluid on peritoneal defence in rats; Calame W et al.; BACKGROUND . A major drawback of continuous ambulatory peritoneal dialysis (CAPD) is the occurrence of peritoneal infection . This might be explained by a non-optimal phagocytic capacity of peritoneal cells which can be improved by stimulating factors . AIM . To investigate the effect of addition of interferon-gamma (IFN) to dialysis fluid with various glucose concentrations or to saline (as control) on the peritoneal defence against Staphylococcus aureus in an experimental dialysis model in rats . METHODS . Twenty-four hours after the administration of either dialysis fluid containing various glucose concentrations or saline with or without IFN, bacteria were injected intraperitoneally . At the time of the bacterial infection and 24 h later cellular and bacterial parameters were studied . RESULTS . The addition of IFN to dialysis fluid or saline resulted in a significant (P < 0.01) increase in the number of peritoneal macrophages at the time of infection; this was accompanied by a significant increase in both the number of Ia-positive peritoneal macrophages (P < 0.01) and the production of nitrite by macrophages (P < 0.05) at the time . IFN in dialysis fluid as well as in saline significantly (P < 0.01) reduced the recovery of bacteria from the peritoneal cavity 24 h after infection . Only the absence of IFN glucose increased the recovery of bacteria from the peritoneal cavity at the same time . CONCLUSION . In this experimental model the addition of IFN to dialysis fluid lowered the recovery of staphylococci from the peritoneal cavity by means of activation of an increased number of macrophages. Proc Natl Acad Sci U S A, 1994 Dec 6, 91(25), 12178 - 82 Three-dimensional structure of the platelet integrin recognition segment of the fibrinogen gamma chain obtained by carrier protein-driven crystallization; Donahue JP et al.; We have developed a method for crystallizing small functional protein segments so that their three-dimensional structure can be determined by x-ray diffraction analysis . This method consists of linking a small protein segment of unknown tertiary structure to either the amino or carboxyl terminus of a larger carrier protein of known tertiary structure . Crystallization of the small segment is then driven by crystallization of the carrier protein . Using this approach, we have obtained crystals of the human fibrinogen gamma-chain carboxyl-terminal segment linked to the carboxyl terminus of chicken egg white lysozyme . The three-dimensional structure of the carboxyl-terminal segment of the fibrinogen gamma chain was determined by x-ray diffraction analysis at a resolution of 2.4 A . This segment encompasses the recognition site for the integrin alpha IIb beta 3 receptor on activated platelets and for the clumping receptor on pathogenic staphylococci and also bears donor and acceptor sites for factor XIIIa-catalyzed crosslinking of fibrin . Therefore, the structural information derived from our analysis will provide a rational basis for the design of inhibitors of these important functions of fibrinogen . Moreover, carrier protein-driven crystallization will facilitate the determination of the three-dimensional structure of functional segments of other proteins that are, like fibrinogen, difficult to crystallize in toto. J Hosp Infect, 1994 Dec, 28(4), 287 - 95 Rapid and sensitive detection of the femA gene in staphylococci by enzymatic detection of polymerase chain reaction (ED-PCR): comparison with standard PCR analysis; Kizaki M et al.; Despite its recent cloning and characterization, the physiological role of FemA remains unclear . To easily and reliably identify femA in staphylococci, we analysed 45 blood isolates of staphylococci using enzymatic detection of polymerase chain reaction (ED-PCR) . ED-PCR is a new method that detects amplified PCR products using biotin-streptavidin affinity and an enzyme-linked antibody . Of 45 samples, 34 strains contained the femA gene as detected by ED-PCR . Phenotyping analysis showed that these 34 strains (femA-positive) were Staphylococcus aureus and that the other 11 (femA-negative) were S . epidermidis . These results were completely consistent with the results of femA detection using standard PCR and subsequent Southern blot hybridization . The ED-PCR procedure was complete within 4 h and could be done in one tube . We conclude that ED-PCR is a rapid, simple and reliable method for detecting the femA gene and that it provides an important means of classifying staphylococcal strains in the clinical field. Eur J Clin Microbiol Infect Dis, 1994 Dec, 13(12), 1063 - 6 Production of siderophore by coagulase-negative staphylococci and its relation to virulence; Lindsay JA et al.; The ability to produce siderophore is considered to be a virulence factor for many pathogenic bacteria . To determine if siderophore production by coagulase-negative staphylococci (CNS) was related to virulence, 40 clinical isolates of CNS cultured from peritoneal dialysis fluid were compared with 38 commensal skin isolates . Siderophore activity was detected using the chrome azurol S liquid assay . Using precursor studies, Staphylococcus epidermidis isolates were shown to be more likely to produce the siderophore staphyloferrin A . Production of staphyloferrin B amongst non-Staphylococcus epidermidis species was associated with clinical isolates rather than commensal isolates, and therefore may play a role in pathogenicity. Epidemiol Mikrobiol Imunol, 1994 Dec, 43(4), 151 - 7 {Microbiological identification of coagulase-negative staphylococci and the present status of their sensitivity to antibiotics}; Bebrova E et al.; Reliable laboratory diagnosis of coagulase-negative staphylococci and subsequent assessment of the MIC of these strains is part of the essential routine work of clinical laboratories with regard to the rising incidence of nosocomial coagulase-negative staphylococci infections, in particular in specialized departments concerned with important clinical issues. Curr Opin Pediatr, 1994 Dec, 6(6), 668 - 75 Chronic granulomatous disease: newly defined molecular abnormalities explain disease variability and normal phagocyte physiology; Forehand JR et al.; Chronic granulomatous disease (CGD) typically presents as recurrent abscess formation beneath the skin and in the mononuclear phagocyte system . Common infecting organisms are staphylococci and enteric bacteria; Aspergillus organisms are a major threat . All CGD cases analyzed to date have revealed a defect in one of four proteins, each encoded on a separate gene . These four proteins are the major constituents of an enzyme complex that transfers electrons from NADPH to oxygen, creating microbicidal (yet tissue-toxic) oxidants . Recent research has defined the gene abnormalities in CGD and set the stage for gene therapy and pharmacologic modulation of host defense and inflammation. FEMS Microbiol Lett, 1994 Dec 1, 124(2), 131 - 9 Pulsed-field gel electrophoresis of the genomic restriction fragments of coagulase-negative staphylococci; Snopkova S et al.; The genomes of 47 coagulase-negative staphylococcal strains assigned to different species were analysed by pulsed-field electrophoresis . The strains were clustered on the basis of their similarity in the SmaI restriction patterns into various groups, each group consisting of the type strain and the strains whose SmaI restriction patterns were similar to that of the type of strain . The SmaI restriction groups seem to correspond to the following species: Staphylococcus warneri, S . hominis, S . xylosus, S . lugdunensis, S . kloosii, S . haemolyticus, S . lentus, S . cohnii, S . equorum, S . chromogenes, S . saprophyticus, S . simulans, S . carnosus, S . capitis and S . auricularis . The species S . sciuri, S . caseolyticus, S . gallinarum, S . epidermidis and S . schleiferi were represented only by their type strains and showed no similarity in their SmaI restriction patterns neither to each other nor to all the other species investigated here . Thus, the classification of coagulase-negative staphylococcal strains into the above species seems to be confirmed also by genome restriction analysis carried out by pulsed-field gel electrophoresis. Curr Eye Res, 1994 Dec, 13(12), 875 - 8 Efficacy of tobramycin drops applied to collagen shields for experimental staphylococcal keratitis; Callegan MC et al.; Treatment of staphylococcal keratitis includes tobramycin drops at repeated intervals, a prolonged therapy that is disruptive to the patient . To identify a regimen involving less frequent drug application, we compared the efficacy of fortified tobramycin (1.36%) administered by collagen shields or in topical drop form to rabbit corneas intrastromally infected with staphylococci . Eyes were treated with shields hydrated in and supplemented with fortified tobramycin drops (1.36%) applied every 1, 2, 5, or 10 h, from 10 to 20 h postinfection . For topical drop treatment alone, tobramycin was applied following the identical regimen . Untreated corneas contained 10(6) colony forming units . Shields supplemented with tobramycin drops applied every 1, 2, or 5 h sterilized 100% of the corneas . Shields supplemented with tobramycin drops applied at 10 h sterilized 58% of the corneas . Topical delivery of tobramycin every h sterilized all corneas; drops alone applied at longer intervals, such as 2, 5, or 10 h, sterilized 83%, 17%, and 0% of the corneas, respectively . Collagen shield delivery of tobramycin with supplemental topical drops can eradicate staphylococci in this model with less frequent dosing intervals than are required with topical therapy alone. Int J Food Microbiol, 1994 Dec, 24(1-2), 329 - 35 Characterization of Staphylococcus spp . and Micrococcus spp . isolated from Iberian ham throughout the ripening process; Rodriguez M et al.; The Iberian dry cured ham is an uncooked meat product highly appreciated because of its characteristic flavour . This product is obtained from highly marbled Iberian pig hindlegs after 18-24 months of maturation under natural environmental conditions . The role of Micrococcaceae in the development of the aroma characteristics of this products remains unclear . Identification of Gram-positive, catalase-positive cocci isolated from Mannitol Salt Agar plates showed that Staphylococcus xylosus followed by Staphylococcus equorum are the predominant organisms, even after 16 months of maturing . A remarkable variety of types of both staphylococci and micrococci are detected at any sampling time . The metabolic activities of these organisms could contribute to the characteristics of the final product. J Chemother, 1994 Dec, 6(6), 368 - 76 Use of frequency distribution curves, scattergrams and regression analyses to compare in vitro activities and describe cross-susceptibility and cross-resistance among four quinolones; Fass RJ; Minimum inhibitory concentrations (MICs) of ciprofloxacin, ofloxacin, lomefloxacin, and fleroxacin for 852 recent clinical isolates were determined by a standardized broth microdilution method . Frequency distribution curves, scattergrams and regression analyses were used to compare in vitro activities and describe cross-susceptibility and cross-resistance . All four quinolones were active against most species tested except Xanthamonas maltophilia, enterococci, methicillin-resistant staphylococci and Bacteroides species . Relative in vitro activities were ciprofloxacin > ofloxacin > lomefloxacin = fleroxacin . Some of the in vitro advantages of ciprofloxacin, particularly when compared to ofloxacin, were negated when percents susceptible, based on pharmacokinetically derived breakpoints, were considered . Despite differences in in vitro activities, organisms relatively susceptible to one quinolone were relatively susceptible to all quinolones and organisms relatively resistant to one were relatively resistant to all; using regression analysis, coefficients of determination (R2) were 0.91-0.96 for all drug pairs . There was, therefore, a high degree of cross-susceptibility and cross-resistance . Differential categorizations of susceptibility to the quinolones would be justified only if validated by comparative clinical trials. J Pediatr, 1994 Nov, 125(5 Pt 1), 798 - 804 Prospective analysis of coagulase-negative staphylococcal infection in hospitalized infants; Nataro JP et al.; Coagulase-negative staphylococci are the major cause of late-onset nosocomial neonatal sepsis . We prospectively examined all infants less than 6 months of age hospitalized at Children's Hospital of Philadelphia from whom at least one of two or more blood cultures grew coagulase-negative staphylococci . We considered as infections only those episodes in which multiple blood cultures grew identical isolates . Among 59 episodes that yielded specimens meeting study criteria, 25 were considered infection and 34 contamination . Cultures from infected infants yielded significantly higher numbers of coagulase-negative staphylococci than cultures representing contamination (p = 0.001) . Infected infants were more likely to have central venous lines (p = 0.009), and to have received any parenteral nutrition (p = 0.002) or lipids (0.017) . Hematologic values were not helpful in distinguishing between infected and uninfected infants . Isolates representing true infection were not different from contaminants in the frequency of positivity for putative virulence phenotypes . Our data corroborate previous studies indicating risk factors and predictors of coagulase-negative staphylococcal infection. J Infect, 1994 Nov, 29(3), 295 - 303 Coagulase-negative staphylococcal bacteraemia with special reference to septic shock: experience in an intensive care unit; Dahmash NS et al.; During a period of 4.5 years, 48 patients with bacteraemia due to coagulase-negative staphylococci were studied prospectively in order to evaluate their clinical profile, management and outcome . There were 25 males and 23 females with ages ranging between 13 and 100 years . Over 60% of patients belonged to the age group 30 to 69 years . Shock was recorded in 23 (48%) of the 48 patients . Of the shocked patients, 16 were immunocompromised and also had abnormal coagulation . Their mortality was 44% . By contrast, none of the immunocompromised patients without shock died . Abnormal coagulation was found in 17 patients without septic shock . Their mortality was 5.9% . The commonest underlying disease was respiratory failure especially in shocked patients . The source of infection was identified in the majority of cases . In addition, most patients had an indwelling intravascular catheter especially an arterial one . The overall mortality was 16.7% (8/48) . It was significantly higher in patients with shock than in those without shock (30.4% vs . 4.0%, P < 0.05). APMIS, 1994 Nov, 102(11), 855 - 64 Comparison of genotypic and phenotypic methods for species identification of coagulase-negative staphylococcal isolates from blood cultures; Hedin G; Coagulase-negative staphylococci are often isolated from blood cultures . Simple methods are needed for correct identification of those species most frequently found . In this study, PCR methods were developed for the identification of S . epidermidis and S . haemolyticus, based on DNA sequences in their 16S rDNA . The results obtained by these methods were compared with those obtained using a number of phenotypic methods, including two commercial kits API Staph and Staphzyme . Fifteen type collection strains and 133 blood culture isolates were tested . The sensitivity of the PCR for identification of S . epidermidis was 99% compared with API Staph, but the specificity was lower, 94%, because of positive results also for S . capitis . The results by the PCR for identification of S . haemolyticus correlated closely with the Staphzyme results, 13 isolates being identified by Staphzyme and 16 by the PCR . API Staph, however, identified only four clinical isolates as S . haemolyticus, probably too few . Among the individual phenotypic tests performed, a trehalose-mannitol agar method and a desferrioxamine disc diffusion test for the identification of S . epidermidis were found to be very accurate . Anaerobic growth after overnight incubation could be used to distinguish S . epidermidis from S . hominis . The conclusion is that a majority of all Gram-positive, catalase-positive and coagulase-negative blood culture isolates can be typed as regards species level using only a few genotypic and/or phenotypic tests. J Biomed Mater Res, 1994 Nov, 28(11), 1289 - 94 Inhibition of Staphylococcus adherence to biomaterials by extracellular slime of S . epidermidis RP12; Giridhar G et al.; Adherence of selected strains of coagulase-negative staphylococci to various biomaterials, and the inhibition of their adherence by extracellular slime obtained from the RP12 strain of Staphylococcus epidermidis were studied in vitro . S . epidermidis RP12 adhered considerably more to polymethylmethacrylate (PMMA) discs than did the SP2 strain of S . hominis and the SE-360 strain of S . hyicus . Strain RP12 was less adherent to titanium alloy, ultrahigh molecular weight polyethylene (UHMWPE), and Teflon discs than to PMMA discs . Exposure of PMMA discs to extracellular slime extracted from strain RP12 greatly reduced adherence of strain RP12, SP2, SE-360, and S . epidermidis RP-62A . The active component(s) was present in the > 10 kD mol wt fraction obtained by Amicon YM10 ultrafiltration of crude slime; heat treatment of the fraction did not affect its inhibitory activity . When the bacteria and RP12 slime fractions were added simultaneously to the PMMA discs, the > 10 kD mol wt fraction of slime competitively inhibited adherence of strain RP12 to PMMA discs; in contrast, the < 10 kD mol wt fraction enhanced adherence of strain RP12 to PMMA discs. Anasthesiol Intensivmed Notfallmed Schmerzther, 1994 Nov, 29(7), 385 - 99 {Total hip endoprostheses--characteristic aspects from the anesthesiologic viewpoint}; Ullrich W et al.; Total hip replacement is a frequently practised operation . Depending on age, circumstances and individual assessment, cemented, non-cemented and hybrid forms are used . Apart from general risks, such as vascular and/or neural injuries, thrombosis and infections, there are specific risks, depending on the surgical technique . If cemented systems are used, the anesthesiologist must be on the alert in respect of a possible multi-causal cardiopulmonary depression during the implantation of the prosthesis . Incidents may be reduced or moderated by measures such as reduction of pressure from the femoral cavity or anesthetic measures such as avoidance of N2O during or after cementation, use of anti-histamines, etc., but there is no absolute protection from severe reactions by the cardiopulmonary system . In these cases it is imperative to recognise and treat hypoxic conditions immediately, whatever the cause, such as cardiac or pulmonary depression . If a non-cemented hip replacement is used or a revision is necessary the main problem is usually a higher blood loss . Especially in such cases it is necessary to apply a well-organised sequence of blood-saving methods to protect patients from the general risks of homologous blood transfusion . Even though the main concern of the public is the possibility of contamination of donor blood with the AIDS virus, transmission of hepatitis C virus is a much more common problem . Depending on the diagnostic methods the occurrence of thrombosis after total hip replacement has been reported to be as much as 55% . To minimise this high incidence, sufficient prophylaxis, adequate fluid therapy, suitable anesthetic techniques and cutting down on the duration of the operation should be taken into account . The use of low molecular weight heparins has certain advantages . If deep vein thrombosis has occurred, therapy consists of anticoagulation with intravenous heparin and immobilisation . A rare but severe complication is a deep hip prosthetic infection . More than 50% of infections are caused by coagulase-negative staphylococci and anaerobic bacteria . To avoid sepsis it is imperative to employ adequate high-dosage antibiotics, revisional surgery and, if necessary, even excision arthroplasty . There is no "ideal" anesthesiological method for total hip replacement . Regional techniques as well as general anesthesia have their specific pros and cons which are controversially discussed in respect of their priority . To achieve early diagnosis of embolism, especially in the case of high risk patients, the exigency of extensive haemodynamic monitoring as well as Doppler-ultrasound is discussed.(ABSTRACT TRUNCATED AT 400 WORDS) Antibiot Khimioter, 1994 Nov, 39(11), 42 - 7 {Synergistic action of recombinant preparations of gamma-interferon and tumor necrosis factor on the course of experimental staphylococcal infection}; Grabchenko NI et al.; The action of recombinant gamma-interferon (rINF-gamma) and tumor necrosis factor (rTNF-alpha) as well as that of their combinations was studied in a model of staphylococcal infection . It was observed that the use of rINF-gamma alone was not sufficient for the activation of the effector antibacterial function of macrophages with respect to staphylococci . At the same time it was shown that rTNF-alpha and rINF-gamma had a synergistic action on the process of the infection in mice evident from an increase in the pathogen elimination in the host . The use of the combination in the optimal doses increased the bactericidal activity of macrophages in the infected animals. J Antimicrob Chemother, 1994 Nov, 34(5), 755 - 64 Staphylococcal osteomyelitis--a comparison of co-amoxiclav with clindamycin and flucloxacillin in an experimental rat model; Gisby J et al.; A rat model of Staphylococcus aureus osteomyelitis was used to compare treatment with co-amoxiclav, flucloxacillin and clindamycin . Co-amoxiclav (amoxycillin/clavulanic acid 200/50 mg/kg), flucloxacillin (200 mg/kg) and clindamycin (50 mg/kg) were injected subcutaneously tds for 28 days, commencing 14 days after infection . Eight days after cessation of treatment, high numbers of staphylococci were recovered from the infected tibiae of all control rats . All treatments, at clinically achievable concentrations, significantly (P < 0.05) reduced the bone bacterial titres . However, 50% of tibiae from co-amoxiclav-treated animals were sterile, compared with 17% and 25% from flucloxacillin- or clindamycin-treated animals respectively . Histopathological examination of tibiae reflected the bacteriological results, and showed that the severity of the osteomyelitis was greatly reduced in antibiotic-treated animals compared with non-treated controls . Twenty-eight days after cessation of therapy, bacterial counts from co-amoxiclav and clindamycin-treated animals remained significantly (P < 0.05) lower than those of non-treated controls, although the gross and microscopic appearance of clindamycin and flucloxacillin-treated tibiae suggested that recrudescence of the infection may have occurred . The results of this study demonstrated that co-amoxiclav was as effective as flucloxacillin and clindamycin in the treatment of an experimental chronic staphylococcal osteomyelitis. Intensive Care Med, 1994 Nov, 20 Suppl 4, S35 - 42 Teicoplanin: a well-tolerated and easily administered alternative to vancomycin for gram-positive infections in intensive care patients; Charbonneau P et al.; A prospective, randomized multicentre study was conducted in order to evaluate the potentially superior tolerability profile of teicoplanin plus netilmicin compared with vancomycin plus netilmicin in patients in ICUs . We considered that these glycopeptides have been shown to have comparable efficacy and that comparative tolerability is of paramount importance, particularly in severely ill patients . A total of 56 patients were enrolled into the study (36 males and 20 females) . Twenty-four patients were included in the teicoplanin plus netilmicin group (15 males, 9 females: mean age 56.8 years) . The mean simplified acute physiological score (SAPS) was 9.4 (range 4-20) . Thirty-two patients were randomized to receive vancomycin plus netilmicin (21 males, 11 females; mean age 56.4 years) . The mean SAPS was 9.3 (range 2-16) . Septicaemia was the most common infection (14 cases in each group) . Most infections were caused by Staphylococcus aureus or coagulase-negative staphylococci . The mean daily doses were: for teicoplanin, 457 mg (6.7 mg/kg); for vancomycin, 1678 mg (24.4 mg/kg); and for netilmicin 263.3 mg (3.9 mg/kg) in the teicoplanin group and 248 mg (3.8 mg/kg) in the vancomycin group . The trough levels of teicoplanin in the serum remained mostly between 7 and 10 mg/l, while more fluctuation was seen in patients receiving vancomycin . The mean trough levels of netilmicin in the serum were 1.2 (SD 0.9) mg/l in the teicoplanin group, compared with 1.7 (SD 1.4) mg/l in the vancomycin group (NS: p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) Proc Natl Acad Sci U S A, 1994 Oct 25, 91(22), 10615 - 9 Activation of the human immunodeficiency virus long terminal repeat in THP-1 cells by a staphylococcal extracellular product; Klebanoff SJ et al.; Staphylococcal strains can release a factor that strongly activates the human immunodeficiency virus type 1 (HIV-1) long terminal repeat (LTR) in THP-1 cells transfected with the HIV-1 LTR-driven luciferase reporter gene (THP-1 LTRluc) . The factor is present in the overnight culture fluid and is readily released from the organisms into aqueous medium by vigorous mixing . Staphylococcal extracellular material is a complex mixture of polysaccharide and protein containing peptidoglycan and teichoic acid, released in part by cell wall turnover . The importance of the carbohydrate component is emphasized by concanavalin A (Con A) inhibition of staphylococcal product-induced LTR activation but not of activation by phorbol 12-myristate 13-acetate or tumor necrosis factor . The effect of Con A was decreased or abolished by sugars in the order methyl alpha-D-mannopyranoside > methyl alpha-D-glucopyranoside > mannose > glucose = fructose > N-acetylglucosamine . Wheat germ agglutinin was less inhibitory than Con A; in this instance N-acetylglucosamine decreased inhibition, whereas methyl alpha-D-mannopyranoside or methyl alpha-D-glucopyranoside did not . The induction of luciferase activity in THP-1 LTRluc by the staphylococcal extracellular product also was inhibited by fetal bovine and normal human serum . A comparison of 31 staphylococcal isolates (9 Staphylococcus aureus, 11 Staphylococcus epidermidis, 2 Staphylococcus haemolyticus, 4 Staphylococcus hominis, 2 Staphylococcus capitis, 2 Staphylococcus warneri, 1 Staphylococcus saprophyticus) revealed wide variation in LTR activating activity that did not correlate closely with slime production . Our findings, using induction of luciferase in THP-1 LTRluc as a model for upregulation of HIV infection, raise the possibility that staphylococci, as well as certain other microorganisms, release carbohydrate-containing exopolymers, which can activate the HIV-1 LTR, thus influencing progression of HIV infection. Ugeskr Laeger, 1994 Oct 10, 156(41), 6028 - 32 {Bacterial endocarditis at a county hospital department, 1983-1992 . Prognosis in relation to bacteriology, disease localization and treatment}; Seibaek MB et al.; The case records of 69 patients with a diagnosis of bacterial endocarditis were reviewed . Forty-nine patients had native valve endocarditis (NVE) and 20 patients had prosthetic valve endocarditis (PVE) . Among patients with NVE left-sided endocarditis was treated surgically more often than right-sided endocarditis . Involvement of the aortic valve was the most important indicator of death and acute/subacute surgical intervention . The mortality was 29% . No patient with right-sided endocarditis died . The infective agent did not seem to influence outcome or frequency of surgical intervention . Among patients with PVE the most frequently isolated organism was coagulasenegative staphylococci . Surgical intervention occurred most frequently in those with infection with coagulase-negative staphylococci or culture negative endocarditis . The mortality was 25%, identical for early and late cases . The patients who died were all infected with staphylococci . The localization did not seem to influence treatment or outcome . In spite of advances in surgical and medical treatment bacterial endocarditis is still a life-threatening disease with a high mortality. Am J Epidemiol, 1994 Oct 1, 140(7), 621 - 8; discussion 629-31 "Thucydides syndrome" reconsidered: new thoughts on the "Plague of Athens"; Morens DM et al.; A recently published theory (N Engl J Med 1985;313:1027-30) argues that the famous Athenian epidemic of 430 B.C . was caused by a combination of influenza and toxin-producing staphylococci (the "Thucydides syndrome") . Although it is accepted by some medical authorities, and ostensibly supported by identification of modern cases, the theory's plausibility has not been carefully examined . The authors used an epidemiologic approach supplemented by historical and clinical observations to examine the likelihood that a "Thucydides syndrome" could have caused the Athenian epidemic . Arguing against the influenza theory are epidemiologic and clinical features of the disease, mathematical models of the spread of influenza, and empirical observations of epidemic influenza in premodern populations of known size and crowding . The authors conclude that neither influenza nor a "Thucydides syndrome" could have produced the Athenian epidemic . Epidemiologic features suggest either a zoonotic or vectorborne disease, a disease associated with an environmental source, or a respiratory infection with unusual alternative mechanisms of spread. Epidemiol Infect, 1994 Oct, 113(2), 259 - 66 Detection of mecA, femA, and femB genes in clinical strains of staphylococci using polymerase chain reaction; Kobayashi N et al.; MecA, a structural gene located on the chromosome of Staphylococcus aureus, characterizes methicillin-resistant S . aureus (MRSA), and femA and femB(fem) genes encode proteins which influence the level of methicillin resistance of S . aureus . In order to examine effectiveness of detecting mecA and fem genes in identification of MRSA, the presence of these genes in 237 clinically isolated strains of staphylococci was investigated by polymerase chain reaction (PCR) . An amplified mecA DNA fragment of 533 base pairs (bp) was detected in 100% of oxacillin-resistant S . aureus, in 16.7% of oxacillin-sensitive S . aureus, in 81.5% of S . epidermidis, and in 58.3% of other coagulase-negative staphylococci (CNS) . While the PCR product of femA (509 bp) or femB (651 bp) was obtained from almost all the S . aureus strains except for five oxacillin-resistant strains (2.5%), neither of these genes were detected in CNS . Therefore, the detection of femA and femB together with mecA by PCR was considered to be a more reliable indicator to identify MRSA by differentiating it from mecA-positive CNS than single detection of mecA. Eur J Clin Microbiol Infect Dis, 1994 Oct, 13(10), 793 - 6 Teicoplanin versus cefamandole in the prevention of infection in total hip replacement; Suter F et al.; In a prospective, controlled, single-blind study the efficacy of teicoplanin versus cefamandole in preventing infections in total hip replacement was investigated in 496 consecutive patients . A single intravenous dose of teicoplanin (400 mg) was as effective as two intravenous doses of cefamandole (2 g before and 1 g after surgery) . No major complications were observed in either group . Infective wound complications were observed only in the cefamandole group . These infections, although not dangerous for the patients, required supplementary antibiotic treatment in all cases . Teicoplanin is a reasonable choice as a prophylactic agent in orthopaedic surgery when a high risk of infection due to staphylococci is present. Eur J Epidemiol, 1994 Oct, 10(5), 567 - 72 A multicentre study: Staphylococcus and Enterococcus susceptibility to antibiotics; Turano A et al.; A multicentre study to evaluate the susceptibility of Gram-positive cocci isolated from clinical samples, was performed by six centres working in different areas of Italy . We examined 4,544 strains of Staphylococcus aureus, 4,381 strains of coagulase-negative staphylococci and 2,478 strains of enterococci . The following antibiotics were tested: penicillin G, ampicillin, amoxicillin, piperacillin, imipenem, oxacillin, ofloxacin, pefloxacin, ciprofloxacin, gentamicin, tobramycin, amikacin, netilmicin, rifampicin, clindamycin, tetracycline, cotrimoxazole, erythromycin, chloramphenicol, vancomycin and teicoplanin . Oxacillin-susceptible staphylococci confirmed their susceptibility to many other antimicrobial agents while oxacillin-resistant strains confirmed their multiple and frequent resistance to antibiotics . Resistance to oxacillin, cotrimoxazole and chloramphenicol was more frequent in coagulase-negative staphylococci than in Staphylococcus aureus . Aminoglycosides, rifampicin and quinolones were more active against coagulase-negative staphylococci than against Staphylococcus aureus . Enterococci were susceptible to penicillins and imipenem, and moderately susceptible to ciprofloxacin . Susceptibility of 70-79% was observed with high levels of aminoglycosides . Excellent results against staphylococci and enterococci were observed with vancomycin and teicoplanin. Trends Microbiol, 1994 Oct, 2(10), 389 - 93 Expression of resistance to methicillin; Berger-Bachi B; Methicillin-resistant staphylococci have an additional low-affinity penicillin-binding protein, PBP2a (PBP2'), encoded by the mecA gene . The typical heterogeneity seen in the expression of resistance to methicillin and in levels of resistance depends on the concerted action of chromosomally encoded genes, including fem and aux, that are also present in the genome of susceptible staphylococci. Trends Microbiol, 1994 Oct, 2(10), 385 - 8 Bacterial resistance to the cyclic glycopeptides; Shlaes DM et al.; Cyclic-glycopeptide antibiotics, such as vancomycin and teicoplanin, have been almost uniformly active against pathogenic Gram-positive bacteria since their discovery in the 1950s . Resistance is now emerging among enterococci and staphylococci by acquisition of novel genes or by mutation, respectively . The mechanism of resistance for enterococci appears to be synthesis of an altered cell-wall precursor with lower affinity for the antibiotics. Trends Microbiol, 1994 Oct, 2(10), 343 - 7 Origin and evolution of DNA associated with resistance to methicillin in