Staphylococcus

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 staphylococci; Archer GL et al.; The gene mediating resistance to methicillin in staphylococci (mecA) and its flanking sequences (mec DNA) make up a chromosomal DNA locus that is unique to methicillin-resistant bacteria; no equivalent locus exists in methicillin-susceptible cells . The origin of mec DNA is not known, but evidence supports horizontal transfer of mec DNA between different staphylococcal species and of the mecA gene between different Gram-positive genera.

Infect Control Hosp Epidemiol, 1994 Oct, 15(10), 658 - 62
Relatedness of coagulase-negative staphylococci causing bacteremia in low-birthweight infants; Kacica MA et al.; OBJECTIVE: To investigate coagulase-negative staphylococcus (CONS) causing bacteremia in a neonatal intensive care unit (NICU) . DESIGN: A 14-month retrospective review of 47 infants in the NICU with CONS bacteremia was undertaken to determine CONS glycocalyx production, plasmid pattern, total DNA restriction fragment polymorphism, and clinical risk factors . RESULTS: The isolates included 32 Staphylococcus epidermidis, six Staphylococcus haemolyticus, four Staphylococcus warneri, four Staphylococcus saprophyticus, and one Staphylococcus hominis . Sixty-five percent of S epidermidis produced glycocalyx; other species did not . Oxacillin resistance (52%) and the antibiograms of the CONS were consistent with other units in the hospital . Five similar CONS plasmid patterns were found among 16 isolates; 31 isolates had unique patterns . Extractions of total DNA from these isolates were digested using HindIII, HaeIII, and BstEII . Those with similar restriction fragment length patterns could not linked as nosocomially transmitted among infants with bacteremia . CONCLUSION: Our observations suggest that multiple strains of CONS infect infants in the NICU who have similar risk factors . Although current infection control practices limit transmission of a pathogen, they do not prevent CONS bacteremias.

Antimicrob Agents Chemother, 1994 Oct, 38(10), 2238 - 44
Possible role of insertion sequence IS257 in dissemination and expression of high- and low-level trimethoprim resistance in staphylococci; Leelaporn A et al.; The transposon-like structure Tn4003 and related elements were found to encode high- and low-level trimethoprim resistance (Tpr) in Staphylococcus aureus and coagulase-negative staphylococci . By using transcriptional fusions in Escherichia coli, the variation in resistance levels was found to correlate with the transcriptional activity of the region presumed to carry the promoter for the operon containing the Tpr dihydrofolate reductase gene, dfrA, encoded by these elements . The reduced transcriptional activities exhibited by elements encoding low-level Tpr appear to be a consequence of deletions adjacent to the copy of IS257 which normally encodes the -35 sequences of these promoters . The data obtained not only support the involvement of IS257 in the transcription of the proposed thyE-dfrA-orf-140 operon of Tn4003 but may also implicate this insertion sequence in the mechanisms resulting in the variation in Tpr levels observed in staphylococci.

J Clin Microbiol, 1994 Oct, 32(10), 2588 - 9
Evaluation of BBL crystal MRSA ID system; Knapp CC et al.; The BBL Crystal system (Becton Dickinson Microbiology Systems, Cockeysville, Md.) was evaluated for its accuracy in identifying oxacillin resistance in Staphylococcus aureus by testing of mec-specific-gene-positive and -negative isolates . Although the manufacturer makes no claim for use of the product for testing of staphylococci other than S . aureus, the product's potential utility in detecting oxacillin resistance in isolates of mec gene-positive and -negative Staphylococcus epidermidis was also explored . All mec gene-negative staphylococci yielded a negative MRSA ID test reaction . There was a close correlation between mec gene positivity and a positive reaction in the methicillin-resistant S . aureus identification system with 63 of 69 (91%) stock isolates of S . aureus yielding a positive result in 4 h, 66 of 69 (95%) yielding a positive result in 5 h, and 68 of 69 (99%) yielding a positive result in 6 h . The corresponding percentage agreements at 4, 5, and 6 h for mec gene-positive stock isolates of S . epidermidis were 87, 91, and 96%, respectively.

Avian Dis, 1994 Oct-Dec, 38(4), 762 - 71
Capsular polysaccharide serotypes of coagulase-positive staphylococci associated with tenosynovitis, osteomyelitis, and other invasive infections in chickens and turkeys: evidence for new capsular types; Daum RS et al.; To study the role of capsular polysaccharides in staphylococcal infections in chickens and turkeys, we surveyed 101 coagulase-positive isolates obtained from investigators in geographically diverse locales in the United States and Canada . Fifty-six isolates were obtained from chickens; 51 (91%) were type 5, and 5 (9%) were type 8 . Forty isolates were obtained from turkeys; 13 (33%) were type 5, 15 (38%) were type 8, and 12 (29%) were untypable . Five type 5 isolates were obtained from poultry of uncertain species . Two untypable turkey isolates were studied further . Rabbit serum obtained after immunization with formalin-killed staphylococci was type-specific as assessed by a tube agglutination test and promoted opsonophagocytosis of the isolate that had been used for immunization . Chromatography of carboxy-reduced capsular polysaccharide from one of the isolates suggested that mannoseaminouronic acid was present in the unreduced polysaccharide . The spectrum obtained by 13C-nuclear magnetic resonance suggested the presence of N-acetyl sugars such as mannoseaminouronic acid and 6-deoxy sugars such as N-acetyl fucosamine . The structure of the polysaccharide differed from that of the type 5 and type 8 capsular polysaccharides . Thus, poultry isolates can be classified into at least four serotypes on the basis of their capsular polysaccharides . This observation provides a new focus for investigation into the epidemiology and virulence determinants of this important pathogen in chickens and turkeys.

Ann Emerg Med, 1994 Sep, 24(3), 462 - 4
Resistant gram-positive organisms; Schaberg DR; Antimicrobial resistance in Gram-positive bacteria has reemerged in the last decade as a major clinical problem . Methicillin-resistant staphylococci, penicillin-resistant pneumococci, and enterococci resistant to penicillin, vancomycin, and/or gentamicin have become new considerations in the selection of therapy . Both mutation and acquisition of new DNA on either the chromosome or plasmids can be responsible for resistance in Gram-positive species . Because therapies are often limited, renewed efforts are needed to understand the epidemiology in order to effect control.

Blood, 1994 Sep 1, 84(5), 1640 - 9
Characterization of the human neutrophil C1q receptor and functional effects of free ligand on activated neutrophils; Eggleton P et al.; The partial characterization and expression of the C1q receptor (C1q-R) in relation to other complement receptors present on the surface of neutrophils has been examined, as well as the effects of free C1q on cell function . A polyclonal anti-C1q-R antibody recognizes a 68-kD neutrophil surface protein . C1q-R expression was not upregulated upon warming, priming, or exposure to FMLP, but decreased after exposure to phorbol myristate acetate (PMA), because of shedding of the receptor into the extracellular medium, as detected by enzyme-linked immunosorbent assay . CR3 and CR1 expression was upregulated from intracellular pools after cell stimulation by PMA . No evidence of intracellular pools of C1q-R was found, as assessed by immunoblotting of subcellular fractions . But C1q-R appeared to be expressed early in cell differentiation, was detected on undifferentiated HL-60 cells, and like CR3 expression, increased upon 5 days differentiation towards a neutrophil lineage . However, C1q-R expression decreased upon additional culture, whereas CR3 expression continued to increase . A large variation in the percentage of peripheral cells expressing C1q receptors in donors was observed, ranging from 13% to 100%, contrasting with CR3 receptors that exhibited less variability . Interactions between free monomeric C1q and neutrophils were also studied . Incubation of stimulated neutrophils with 10 to 100 micrograms/mL C1q resulted in a further increase in CR3 expression and adherence to albumin-coated surfaces . Staphylococci opsonized with low quantities of C1q (0.1 to 1 microgram/mL) mediated a moderate and sustained respiratory burst in neutrophils, whereas a burst of similar magnitude was generated only with free C1q at concentrations 10- to 100-fold higher . Stimulation was only partially inhibited if cells were first treated with anti-C1q-R antibody, suggesting other C1q binding proteins may be present on the cell surface . In summary, neutrophil C1q receptor is approximately 68-kD, exhibits varying expression on different subjects, and is not upregulated from intracellular stores on exposure to soluble stimuli . Stimulated, but not resting, neutrophils selectively respond to raised levels of free C1q, resulting in altered cell function and enhanced CR3 receptor expression . These studies thus suggest complex roles for C1q in neutrophil function.

Infect Immun, 1994 Sep, 62(9), 3850 - 8
Staphylococci express a receptor for human transferrin: identification of a 42-kilodalton cell wall transferrin-binding protein; Modun B et al.; Staphylococcus aureus and the coagulase-negative staphylococci are commonly responsible for peritonitis in renal patients undergoing continuous ambulatory peritoneal dialysis . To simulate growth conditions in vivo, staphylococci isolated from peritoneal infections were cultured in used human peritoneal dialysate (HPD) . Immunoblotting experiments using cell wall preparations from these staphylococci revealed the presence of the host iron-binding glycoprotein transferrin bound to S . aureus, S . epidermidis, S . capitis, S . haemolyticus, and S . hominis but not to S . warneri or S . saprophyticus . Similar results were obtained by incubating broth-grown staphylococci with human transferrin, although, in contrast to S . aureus, the coagulase-negative staphylococci bound more transferrin after growth in iron-restricted broth . To determine whether the staphylococci express a saturable specific receptor for human transferrin, the interaction of human 125I-transferrin with the staphylococci was examined . Both S . aureus and S . epidermidis bound the radiolabelled iron-saturated ligand in a time- and concentration-dependent manner . From competition binding assays, the affinity (Kd) and number of receptors were estimated for S . epidermidis (Kd, 0.27 microM; 4,200 receptors per cell) and S . aureus (Kd, 0.28 microM; 4,200 receptors per cell) . S . epidermidis but not S . aureus receptor activity was partially iron regulated . Human apotransferrin and iron-saturated transferrin and rabbit and rat transferrins competed equally well for the staphylococcal receptor . Bovine and porcine transferrins and ovotransferrin as well as human and bovine lactoferrins were much less effective at competing with human transferrin . Treatment of whole staphylococci with protease abolished transferrin binding, indicating the involvement of cell surface protein . Western blots (immunoblots) of cell wall preparations probed with human transferrin revealed the presence of a 42-kDa transferrin-binding protein common to both S . aureus and S . epidermidis . On Western strip blots, the binding of human transferrin to this protein was blocked by labelled human transferrin but not by albumin, immunoglobulin G, or bovine transferrin or ovotransferrin . To assess the conservation of the 42-kDa transferrin-binding protein, cell wall proteins of S . epidermidis, S . haemolyticus, S . capitis, S . hominis, S . warneri, and S . saprophyticus were Western blotted and probed with human transferrin . Only S . warneri and S . saprophyticus lacked the 42-kDa wall protein, consistent with their inability to bind transferrin . These data show that the staphylococci express a specific receptor for human transferrin based at least in part on a common 42-kDa cell wall protein.

Br J Dermatol, 1994 Sep, 131(3), 331 - 6
Effects of benzoyl peroxide and erythromycin alone and in combination against antibiotic-sensitive and -resistant skin bacteria from acne patients; Eady EA et al.; Topical formulations of erythromycin and benzoyl peroxide are popular and effective treatments for mild to moderate acne vulgaris . Use of the former is associated with resistance gain in both skin propionibacteria and coagulase-negative staphylococci, whereas use of the latter is not . We evaluated the efficacy of a combination of erythromycin and benzoyl peroxide against a total of 40 erythromycin-sensitive and -resistant strains of Staphylococcus epidermidis and skin propionibacteria in vitro . Using the checkerboard technique, five erythromycin resistant strains of Propionibacterium acnes were inhibited synergistically or additively by the combination . Complete mutual indifference was exhibited between the drugs against the remaining 35 strains . However, erythromycin resistant staphylococci and propionibacteria were inhibited by the same concentration of benzoyl peroxide as erythromycin-sensitive strains . These results suggest that, although the combination of erythromycin and benzoyl peroxide is not synergistic against the majority of erythromycin-resistant staphylococci and propionibacteria, the concomitant therapeutic use of both drugs should counteract the selection of erythromycin-resistant variants and reduce the number of pre-existing resistant organisms on the skin of acne patients.

J Chemother, 1994 Sep, 6 Suppl 4, 25 - 31; discussion 39-40
The continuing problem of 'hospital staphylococci': why?
Mehtar S.
Nosocomial infections due to staphylococci continue to pose a serious health concern worldwide . Methicillin-resistant Staphylococcus aureus (MRSA) is an important and growing cause of staphylococcal infection . The incidence of MRSA varies throughout the world, but is particularly high in Japan where the incidence is four-times that seen in Europe . The emergence of coagulase-negative staphylococci (CNS) has increased as a significant pathogen in infections associated with prosthetic implants . Evidence suggests that hand carriage by hospital staff is one way in which CNS are introduced onto catheters, intravenous lines and other implant devices . Control measures in the UK have concentrated on the reservoirs of infection, with the aim of preventing infection and the resulting morbidity, mortality and economic burden . At the North Middlesex Hospital, London, UK, an aggressive prophylactic policy for MRSA has been employed since 1987 . Data show that it is six times cheaper to treat a carrier than it is to treat an infected patient . Prophylaxis therefore provides a more cost-effective way of controlling the spread of MRSA infection . Such stringent control strategies, coupled with increased awareness and adequate funding, are necessary if the spread of resistant bacteria is to be limited.

Res Vet Sci, 1994 Sep, 57(2), 240 - 4
A simple identification scheme for coagulase negative staphylococci from bovine mastitis; Devriese LA et al.; Coagulase-negative staphylococci from cases of bovine mastitis were identified to species level by using an identification scheme based on a three-plate test system which tested for DNase on DNA agar, for protease on calcium caseinate agar, and for the organism's sensitivity to novobiocin, desferrioxaminine (deferoxamine) and fosfomycin by agar diffusion tests . Testing for the inhibition of Staphylococcus delta haemolysin (Skalka 1991) can replace the protease tests.

J Clin Microbiol, 1994 Sep, 32(9), 2113 - 9
Efficacy of microbial identification system for epidemiologic typing of coagulase-negative staphylococci; Birnbaum D et al.; The lack of an adequate typing system hampers our understanding of the epidemiology of infections caused by coagulase-negative staphylococci (CoNS) . CoNS have become recognized as important nosocomial pathogens and the principal cause of infections associated with invasive devices . Sensitive, specific, and convenient methods are needed to evaluate whether implementing infection control guidelines reduces the risk of nosocomial infections from CoNS and other pathogens . The Microbial Identification System (MIDI) (Microbial ID Inc., Newark, Del.), a semiautomated system for fatty acid methyl ester analysis, shows considerable promise for clinical and epidemiologic applications . Its predictive accuracy and reliability were tested by using epidemiologically related and replicated CoNS isolates as well as CoNS from epidemiologically unrelated clinical infections, which were obtained from five established hospital culture collections in diverse geographic locations . Two hundred isolates were fully characterized in 5 days by one person using MIDI, and the results were similar to those produced by more expensive and time-consuming conventional typing methods . MIDI appears to be a useful screening tool that could be used before more expensive and labor-intensive molecular methods . It offers important advantages to hospital epidemiologists and clinical microbiologists who must identify and type CoNS isolates.

J Clin Microbiol, 1994 Sep, 32(9), 2056 - 9
Evaluation of RapiDEC Staph for identification of Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus saprophyticus; Janda WM et al.; RapiDEC Staph is a test for presumptive identification of the principal human staphylococcal species, Staphylococcus aureus, S . epidermidis, and S . saprophyticus . The test includes control and test cupules for fluorogenic detection of coagulase and chromogenic substrates for alkaline phosphatase and beta-galactosidase . These tests identify S . aureus, S . epidermidis, and S . saprophyticus, respectively . Positive results with both chromogenic substrates provide a presumptive identification of S . xylosus or S . intermedius (S . xylosus-S . intermedius) . Test cupules are inoculated with an organism suspension, and reactions are read after a 2-h incubation . RapiDEC-Staph was evaluated with 303 clinical and stock staphylococcal strains . Identifications were compared with those obtained by the tube coagulase test, a latex slide coagulase test (StaphAUREX), another commercial identification system (Staph-TRAC), and additional conventional tests . RapiDEC-Staph correctly identified 100% of 130 S . aureus strains, 70.3% of 74 S . epidermidis strains, and 81.3% of 32 S . saprophyticus strains . Four of five S . xylosus isolates were called S . xylosus-S . intermedius . Unidentified S . epidermidis and S . saprophyticus strains were called "Staphylococcus spp." Among the 62 other coagulase-negative staphylococci, 4 were misidentified as S . epidermidis and 7 were misidentified as S . saprophyticus . While the sensitivity and specificity of the fluorogenic coagulase test for S . aureus were 100%, failure to detect alkaline phosphatase activity in several S . epidermidis isolates resulted in fewer correct identifications by the RapiDEC-Staph test for this species.

Antimicrob Agents Chemother, 1994 Sep, 38(9), 2047 - 53
Effect of treatment with methicillin and gentamicin in a new experimental mouse model of foreign body infection; Espersen F et al.; A new mouse model of foreign body infection has been developed . Intraperitoneal placement of a silicone catheter followed by injection of 10(8) Staphylococcus aureus organisms resulted in a reproducible, localized foreign body infection . The infection persisted as an intra-abdominal abscess surrounding the catheter for at least 30 days . Treatment with up to nine doses of methicillin or gentamicin or both was started 3 days after infection . The treatment showed a significant effect (P < 0.05), measured as reduction of bacteria on the foreign body, for all three regimens with a reduction of up to 2 log units, but no synergism was observed . The result of the treatment was poor, despite the facts that the local concentrations of methicillin were greater than the MIC for at least 72 h and that nine peak concentrations of gentamicin of > 13 micrograms/ml were obtained . The poor result of the treatment was not caused by development of antibiotic resistance or influenced by protein concentration, pH, or local presence in the pus of inhibitors of antibiotics . Both antibiotics showed good effects in time-kill studies in vitro on bacteria on catheters taken out of infected mice and catheters infected in vitro . During treatment, the proportion of intracellular bacteria increased in all treated mice to 60 to 75% compared with 20 to 30% in nontreated mice (P < 0.05) . This indicates that intracellular survival of staphylococci may influence the outcome of the treatment in foreign body infections.

J Clin Microbiol, 1994 Sep, 32(9), 2260 - 5
Nosocomial infection by Staphylococcus haemolyticus and typing methods for epidemiological study; Degener JE et al.; A patient with chronic myelogenous leukemia became colonized with a Staphylococcus haemolyticus strain and experienced a septic episode caused by this strain during a cytostatic course . The strain was multiply resistant to antibiotics; the MIC and MBC of vancomycin were 2 and 4 mg/liter, and the MIC and MBC of teicoplanin were 4 and 16 mg/liter, respectively . We performed a surveillance study on the carriage of S . haemolyticus in medical and nursing staff of the hospital ward where the patient was treated . S . haemolyticus was isolated from 18 sites on 12 of the 39 people tested . A number of typing methods were performed in order to investigate the possible relationships among the isolates . Methods used were immunoblotting of staphylococcal peptides, plasmid analysis, restriction fragment length polymorphism of chromosomal DNA, and pulsed-field gel electrophoresis of total DNA . Compared with the immunoblotting technique, the molecular methods were more discriminative . The strain colonizing the patient showed a consistent pattern by all typing methods during isolation . When the immunoblot technique was used, similar patterns were found with isolates from hospital staff and isolates from unrelated sources . With the molecular techniques, no evidence of a local spread of the patient's strain was found . However, plasmid profiles and restriction fragment length polymorphism and pulsed-field gel electrophoresis patterns showed that S . haemolyticus isolates collected from hospital ward personnel were related, which was not the case with isolates collected from unrelated sources . Restriction fragment length polymorphism analysis was more discriminative when IS431 was used as a DNA probe instead of a probe based on the 16S rRNA gene . S . haemolyticus, as in this case, may develop resistance to vancomycin and teicoplanin . These antibiotics are considered the last-resort drugs for the therapy of nosocomial gram-positive infections . Thus, local spread of staphylococci resistant to these drugs is an important problem, which should be prevented by strict hygienic measures and antibiotic policy.

Ann Hematol, 1994 Sep, 69(3), 153 - 6
Successful treatment of chronic wound infection in neutropenia and rheumatoid arthritis with filgrastim (rhG-GSF)
Fohlman J, Hoglund M, Bergmann S.
A 73-year-old woman was diagnosed with seropositive destructive rheumatoid arthritis in 1981 . She was treated with cortisone, chloroquine, and cyclophosphamide (Sendoxan) in 1982 and 1984 and contracted severe neutropenia . After that she only received cortisone . During 1991, again low neutrophilic counts were registered, especially granulocytopenia . At first, B-cell lymphoma was suspected, but later Felty's syndrome was established . The patient was treated with high-dose cortisone with some success and had a few minor septic episodes . In May 1992 she contracted a traumatic wound on the back of the lower leg . Conservative treatment resulted in a worsening of the condition and an increased wound area, most likely related to the neutropenic condition . In mid July the patient was hospitalized . Bacterial isolates yielded mixed gram-negative enteric bacteria from the wound . Parenteral antibiotic treatment was started, followed by oral drugs, rhG-CSF (filgrastim) was given subcutaneously once a day, starting 3 days after admission . This resulted in increased numbers of peripheral granulocytes . The ulcer started to heal and by mid August the patient received a transplant with autologous skin grafting . In mid September the wound was completely healed . It is concluded that the combination of antibiotics, skin transplantation, and G-CSF was necessary for the successful result . Actually, the bacterial growth did not call for antibiotics, but it was considered necessary to cover for staphylococci . No worsening of the underlying arthritis was observed.

J Pediatr, 1994 Aug, 125(2), 259 - 63
Prevention of central venous catheter-related coagulase-negative staphylococcal sepsis in neonates; Spafford PS et al.; A randomized, double-blind, controlled trial was conducted to determine whether vancomycin added to parenteral alimentation solution given via a central venous catheter would decrease the incidence of catheter-related coagulase-negative staphylococcal sepsis . Seventy infants with a central venous catheter (CVC) in place were randomly selected to receive total parenteral nutrition--either the standard solution or a solution containing 25 micrograms of vancomycin per milliliter . Catheter-related sepsis was defined as the isolation of the same bacterial species from specimens of both peripheral and CVC blood with the concentration of bacteria at least tenfold greater in the specimen obtained from the CVC . Specimens from the CVCs were cultured on removal of the catheters to determine colonization . The colonization of catheters by coagulase-negative staphylococci was reduced from 40% to 22% (p = 0.03) in the vancomycin group; catheter-related sepsis was reduced from 15% to no cases (p = 0.004) . Fewer infants required CVC reinsertion in the vancomycin-treated group (p = 0.02), who also regained birth weight earlier (13.4 vs 17.1 days (p = 0.014)) . Adverse effects of vancomycin infusion were not observed . We conclude that vancomycin added to the solution used for total parenteral nutrition effectively reduces catheter-related sepsis in the neonatal intensive care unit and offers other potential benefits such as the need for fewer catheters and earlier weight gain . However, we do not recommend widespread implementation of this technique until there are data regarding the emergence of vancomycin-resistant organisms.

J Clin Microbiol, 1994 Aug, 32(8), 1908 - 10
Gas-liquid chromatography of cellular fatty acids for identification of staphylococci; Stoakes L et al.; A commercially available, computer-assisted microbial identification system (MIS) employs gas-liquid chromatographic analyses of bacterial fatty acids . The MIS was used to identify 470 isolates of Staphylococcus species . The accuracy of the MIS was compared with the accuracies of conventional methods . There was a complete agreement between the MIS and conventional methods in the identification of 413 (87.8%) strains . For 36 of 45 misidentified strains, the correct identification was listed by the MIS as a choice but not as the first choice . Twelve strains could not be matched . All strains of Staphylococcus cohnii, S . epidermidis, S . intermedius, S . lugdunensis, S . schleiferi, S . sciuri, S . simulans, and S . xylosus were correctly identified . Two species, S . hominis and S . saprophyticus, accounted for 52.6% (30 of 57) of the misidentifications . Seventy-eight organisms were retested . Identification of 73 organisms remained unchanged, and for five organisms, the second choice became first and vice versa . The overall performance of the MIS is acceptable, and the system can be used as an alternate identification method for staphylococci.

Semin Pediatr Surg, 1994 Aug, 3(3), 134 - 41
Cervical lymphadenitis in infants and children; Bodenstein L et al.; One of the more common cervical lesions seen in children is cervical lymphadenitis . Pediatricians handle the vast majority of these children who present with an acute infection . The pediatric surgeon becomes involved only when the presumptive infection does not respond to antibiotic therapy, or if the lump becomes chronic and persists for weeks or months . In this situation the specter of malignancy looms, but benign causes still predominate . The infectious agents range from common bacteria such as staphylococci and hematologic staphylococci to atypical mycobacterium, fungi, and other much less common organisms . A broad discussion of the numerous causes of cervical lymphadenitis is presented together with a pragmatic diagnostic and therapeutic approach.

Biomaterials, 1994 Aug, 15(10), 805 - 14
Adhesion of coagulase-negative staphylococci and adsorption of plasma proteins to heparinized polymer surfaces; Yu J et al.; Protease treatment of cells of coagulase-negative staphylococci reduced the adhesion of bacteria to heparinized polyethylene preadsorbed with serum . Fibronectin (Fn), fibrinogen (Fg), vitronectin, complement factor C3c, plasminogen, laminin and to a low extent albumin were detected on tridodecylmethylammonium chloride (TDMAC)-heparinized polyvinyl chloride (PVC) catheters extirpated from the circulation of patients . Using a perfusion model we show that during the first hours of perfusion with human plasma, Fn and Vn dominate, whereas after 22 h of perfusion Fg is the dominant protein . Field emission scanning electron microscopy and atomic force microscopy studies on TDMAC-heparinized catheters as well as on end-point attached heparinized PVC catheters indicate that quantitatively more Fg than Fn is exposed on these surfaces after prolonged exposure (> 22 h) to human plasma.

Clin Infect Dis, 1994 Aug, 19(2), 231 - 43; quiz 244-5
Coagulase-negative staphylococci: pathogens associated with medical progress; Rupp ME et al.; Coagulase-negative staphylococcal bacteremia and infections of prosthetic medical devices have become major clinical problems . Efforts to differentiate contaminating from infecting isolates consume the time of microbiology laboratory personnel; decisions over when and with what to institute therapy for multiresistant isolates consume the energy of clinicians; and the need to institute expensive parenteral antimicrobial therapy consumes the hospital pharmacy budget . It is clear that the increased incidence of coagulase-negative staphylococcal infections is the result of medical progress and is due to the use of invasive and indwelling medical devices . Multiresistant organisms have evolved that will survive in the presence of antimicrobial agents designed to eradicate more traditional pathogens . They have an ecological niche on human skin from which they are difficult to eradicate, and they have adapted themselves to survive on inert devices designed to persist indefinitely in the human body . Since it is likely that the use of prosthetic medical devices will continue to increase, we need to device innovative strategies for the diagnosis, treatment, and prevention of infections of these indwelling foreign bodies . Studies that will address these issues should be a major goal of future research on hospital-acquired infections.

Antimicrob Agents Chemother, 1994 Aug, 38(8), 1868 - 70
Bactericidal activities of DU-6859a and clinafloxacin (CI-960) against staphylococci; Forstall GJ et al.; Time killing curves were calculated at concentrations of 2 and 8 times the MICs of DU-6859a and clinafloxacin against six isolates of Staphylococcus aureus . Both quinolones produced a decrease in the log10 CFU per milliliter of > or = 3 within 3 h at 2 and 8 times the MIC for the ciprofloxacin-susceptible isolates and at 8 times the MIC for the ciprofloxacin-resistant isolates; however, only 8 times the MIC of DU-6859a consistently prevented regrowth of all isolates after 24 h of incubation.

Pediatr Infect Dis J, 1994 Aug, 13(8), 728 - 34
Endemic necrotizing enterocolitis: lack of association with a specific infectious agent; Gupta S et al.; We conducted a comprehensive analysis of bacterial, parasitic and viral agents present in stool samples of 23 necrotizing enterocolitis cases and 23 matched and 10 random controls . Enterococcus spp., Staphylococcus epidermidis, and Escherichia coli were the most common aerobic bacterial species isolated . Astrovirus was identified in a stool sample from one control . Eight infants were bacteremic; in 7 of 8 the same organism was also present in the stool . No one bacterial species or strain (as identified by plasmid profile analysis) was associated with occurrence of illness . Plasmid analysis further suggested that each infant was colonized with his or her own distinctive aerobic bacterial flora . With the exception of isolates from two control patients which hybridized with a probe for diffuse adherence, no diarrheagenic E . coli was identified . Five (45%) of 11 case infants were colonized with coagulase-negative staphylococci (all S . epidermidis) that produced delta-hemolysin in vitro, as compared with 13 (87%) of 15 control infants . Necrotizing enterocolitis was not associated with an increased ability to ferment carbohydrate, as measured by in vitro beta-galactosidase activity . Our data do not support the hypothesis that endemic necrotizing enterocolitis in our institution is caused by a single infectious agent, nor was there evidence that previously proposed virulence mechanisms such as production of delta-hemolysin or increased in vitro carbohydrate fermentation play a critical role in disease occurrence.

Klin Monatsbl Augenheilkd, 1994 Aug, 205(2), 57 - 60
{Intraocular inflammation 1993 (endophthalmitis)}; Bialasiewicz AA; Despite several recently published optimistic reports on successful therapeutic regimens of postoperative endophthalmitis caused by coagulase-negative staphylococci this intraocular disease still represents a preeminent danger for ocular vision and the integrity of the globe . In this survey critical analyses of studies concerning infectious as well as the non-infectious intraocular inflammations have been reviewed . The demand for an initiation of "metastudies" seems appropriate in order to evaluate the many controversial data collections concerning the incidence, diagnosis and results of therapeutic interventions of postoperative endophthalmitis.

J Pediatr Surg, 1994 Aug, 29(8), 1055 - 7; discussion 1057-8
Platelet activating factor-antagonist improves survival in experimental staphylococcal septicemia; Dirkes K et al.; Platelet activating factor (PAF) amplifies the cytokine cascade in experimental models . This study was designed to investigate the role of PAF blockade during experimental Gram-positive shock by pretreatment with platelet activating factor-antagonist (PAF-A) . Three groups of anesthetized rabbits were studied . Control animals received either saline or PAF-A only, and all survived, without hemodynamic changes . Animals in the second group received an infusion of Staphylococcus epidermidis, and all died in septic shock . Animals in the third group were pretreated with PAF-A and given the staphylococcal infusion; five of the six were alive at 200 minutes, with near-normal hemodynamics . The survival rate for animals pretreated with PAF-A was significantly higher than that for animals receiving staphylococci alone (P < .02) . These results suggest that PAF is an important mediator of Gram-positive sepsis . Antagonism of PAF may be an effective potential therapy for sepsis.

J Clin Pathol, 1994 Aug, 47(8), 743 - 8
Pathogenicity and virulence of coagulase negative staphylococci in relation to adherence, hydrophobicity, and toxin production in vitro; Molnar C et al.; AIMS--To study the pathogenicity and virulence characteristics of Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus sapro-phyticus . METHODS--BALB/c mice were challenged intraperitoneally with graded doses of three strains belonging to each species . LD50s were measured for each strain . Haemolysin (alpha- and delta-) and enzyme (DNAase, lipase, and esterase) production in vitro were measured qualitatively and quantitatively . Adhesion to plastic was measured and related to cell surface hydrophobicity among the strains . RESULTS--S saprophyticus proved the most virulent (LD50 = 2.7-2.9 x 10(7) cfu/g body weight) while S epidermidis was the least virulent (LD50 = 6-8 x 10(7) cfu/g body weight) . An enlarged spleen was the most common macroscopic pathological feature . Kidney, liver, and more rarely peritoneal abscesses were also seen in the infected animals . No direct correlation was found between adherence in vitro, cell surface hydrophobicity, or toxin/enzyme biosynthesis and virulence in mice . CONCLUSION--The results show that coagulase negative staphylococci are pathogenic in BALB/c mice . It is clear that these bacteria can cause invasive disease . However, the in vitro characteristics of coagulase negative staphylococci are not related to the pathogenicity of the organisms in mice.

Zh Mikrobiol Epidemiol Immunobiol, 1994 Aug-Sep, Suppl 1, 48 - 51
{The characteristics of the formation of the staphylococcal landscape in the nasal mucosa of different types of bacterial carriers}; Usviatsov BIa et al.; The complex study of factors of persistence, virulence and antagonism in 473 coagulase-positive (CP) staphylococci and 489 coagulase-negative (CN) staphylococci inhabiting the nasal mucosa of resident and transitory carriers, and not carriers of CP staphylococci, was made . In the selection of virulent strains of CP staphylococci the factor of anti-interferon activity seemed to be of greater importance than the factor of antilysozyme activity, but the latter was preferable in the selection of virulent strains of CN staphylococci . Biovars of CP staphylococci with a set of factors of persistence, virulence and antagonism were isolated from resident carriers 1.6-3.1 times more frequently than from transitory ones . The selection of virulent biovars could be made among strains of CN staphylococci with pronounced persistent properties, isolated from subjects carrying no CP staphylococci.

Zh Mikrobiol Epidemiol Immunobiol, 1994 Aug-Sep, Suppl 1, 91 - 5
{Markers of the persistence of the staphylococcal air microflora in a hospital}; Deriabin DG; The presence of persistence markers of some staphylococcal species isolated from the air at an obstetric hospital was established . The presence of such markers was most pronounced in S . aureus, which was indicative of its absolute value for characterizing the sanitary state of the environment . Staphylococci of coagulase-negative species were characterized by the presence of antilysozyme activity, as well as by their ability to inactivate the antibacterial component of the preparation of interferon, most pronounced in microorganisms of the species S . epidermidis and S . haemolyticus . Disinfecting measures, carried out with the use of ozone, made it possible to normalize the quantitative and qualitative characteristics of bacterial aerosol, which was mainly manifested by the air elimination of staphylococci having a set of persistence markers, as well as the capacity for producing hemolysin.

Can J Anaesth, 1994 Jul, 41(7), 632 - 8
Spinal anaesthesia but not general anaesthesia enhances neutrophil biocidal activity in hip arthroplasty patients; Erskine R et al.; The purpose of this study was to compare neutrophil cidal activity during general or spinal anaesthesia . Assays were performed on neutrophils extracted from the blood of patients after surgery had been under way for one hour . First, the ability of the neutrophils to kill a standard laboratory strain of S . aureus was examined . Neutrophils extracted from the blood during surgery in the spinal anaesthetic group and incubated with the staphylococci for one hour killed twice as many bacteria than those from two groups of patients that received halothane or isoflurane general anaesthesia (P < 0.05) . This effect persisted, to a lesser extent, in the spinal group neutrophils after two hours of incubation with the bacteria . Second, neutrophils from patients under the same conditions of surgery and anaesthesia were tested to examine the effect of the different anaesthetic techniques on neutrophil biocidal mechanisms . Neutrophils extracted during surgery in the spinal group released more superoxide in response to phorbol-12-myristate-13-acetate (PMA) than those from both groups of patients that received general anaesthesia (P < 0.05) . It is concluded that there is an increased state of reactivity of the neutrophil cell membrane NADPH oxidase system in patients receiving spinal anaesthesia than in patients receiving general anaesthesia.

Oftalmologia, 1994 Jul-Sep, 38(3), 216 - 22
{The ocular manifestations in AIDS}; Glavici M; Ocular manifestation in two observations on patients with anti-HIV positive antibodies are presented . The primer was done on a 47-year-old patient who presented retinal micro-vasculopathy with vetous exudates, retinal and pre-retinal hemorrhages and arterial obstructions at the right eye . The right eye vision was 2/50 . The latter observation was done on a two-year and eight month old child with positive HIV who presented palpebral staphylococci and marginal keratitis at the left eye . These cases shows that AIDS, as an affection implying a small group of people, because of its epidemiological particularities and therapeutical difficulties must be known by ophthalmologists, being revealed by retinal primary vasculopathies and also by the presence of some ocular infections, as it has been in the latter observation.

Biochem J, 1994 Jul 1, 301 ( Pt 1), 139 - 44
Kinetics of penicillin binding to penicillin-binding proteins of Staphylococcus aureus; Chambers HF et al.; Reduced affinity of penicillin-binding proteins (PBPs) for binding penicillin has been proposed as a mechanism of beta-lactam antibiotic resistance in staphylococci . Penicillin binding by PBPs of three penicillin-susceptible and two penicillin-resistant strains of Staphylococcus aureus was studied in kinetic assays to determine rate constants, drug concentrations at which PBPs were bound and the relationship between concentrations that bound PBPs and concentrations that inhibited bacterial growth . PBPs 1 and 2 of the resistant strains exhibited slower acylation and more rapid deacylation than susceptible strains . In contrast PBP 4, a naturally low-affinity PBP, was modified such that it exhibited a lower rate of deacylation . The concentrations of penicillin at which modified PBPs were bound correlated with concentrations that inhibited growth of the resistant strains . Acquisition of penicillin resistance in these strains of S . aureus results, at least in part, from structural modifications affecting binding of multiple PBPs and appears to include recruitment of a non-essential PBP, PBP 4.

Clin Exp Immunol, 1994 Jul, 97 Suppl 1, 73 - 7
Use of intravenous immune globulin in newborn infants; Fischer GW; Bacterial infections remain a major cause of morbidity and mortality in neonates . Intravenous immune globulin (IVIG) may enhance immunity to neonatal bacterial pathogens by facilitating opsonophagocytosis . In early-onset neonatal sepsis, antibody has improved survival when used therapeutically in combination with antibiotics . However, some IVIG lots may not contain sufficient pathogen-specific antibody to provide effective therapy . Antibody prophylaxis has not provided protection from late-onset (nosocomial) sepsis consistently . Failure of antibody prophylaxis may also be related to variable levels of opsonic antibodies to nosocomial bacteria in IVIG preparations . Staphylococci (particularly Staphylococcus epidermidis) have become a major cause of late-onset sepsis . IVIG preparations contain variable levels of antibody to S . epidermidis, with many lots having nearly undetectable anti-staphylococcal antibody titres . This absence of antibodies to staphylococci may explain why antibody prophylaxis of neonatal sepsis has not been consistently effective . In future studies, IVIG preparations or monoclonal antibodies that possess specific antibodies to key neonatal pathogens will be needed.

J Infect Dis, 1994 Jul, 170(1), 94 - 9
Toxic shock syndrome toxin 1 contributes to the arthritogenicity of Staphylococcus aureus; Abdelnour A et al.; Although enterotoxins have been implicated in disease states such as food poisoning and toxic shock syndrome, their role in infectious arthritis is not known . To study the arthritogenic properties of toxic shock syndrome toxin 1 (TSST-1), two pairs of S . aureus strains isogenic for TSST-1 production were injected intravenously into healthy Swiss mice . Mice injected with TSST-1-secreting staphylococcal strains developed more frequent and more severe arthritis than did mice inoculated with the isogenic TSST-1-deficient counterparts . Immunohistochemical analysis of arthritic joints revealed an equal number of infiltrating phagocytes in both groups; however, mice inoculated with TSST-1-producing staphylococci had significantly more (P < .01) interleukin-2 receptor-expressing cells in the inflamed synovium than did mice that received the isogenic counterpart . Thus, TSST-1 is a virulence determinant in S . aureus arthritis in mice . The precise mechanism by which this toxin contributes to the development and progression of arthritis needs further investigation.

Ginekol Pol, 1994 Jul, 65(7), 368 - 71
{Incidence and antibiotic resistance of coagulase-negative staphylococci in a neonatal intensive are unit}; Szumala A et al.; Coagulase-negative Staphylococci (CNST) are among the most common microorganisms found colonizing the skin and mucous membranes of neonates . They are also the most common cause of bacteremia in neonatal intensive care units . We analyzed the occurrence of CNST and antibiotic resistance of CNST strains . We have found 731 strains of CNST isolated from 428 intensive treated babies . Above 50% of CNST strains were resistant to: Erythromycin, Lincomycin, Tobramycin, Gentamycin, Kanamycin, Tetracyclines and Penicillins . We have observed the very high incidence of multiresistant strains . Majority of our strains were sensitive to vancomycin . However 8% of strains showed the resistance to vancomycin.

Protein Eng, 1994 Jul, 7(7), 933 - 9
Improving protein solubility through rationally designed amino acid replacements: solubilization of the trimethoprim-resistant type S1 dihydrofolate reductase; Dale GE et al.; In recent years resistance to the antibacterial agent trimethoprim (Tmp) has become more widespread and several Tmp-resistant (Tmpr) dihydrofolate reductases (DHFRs) have been described from Gram-negative bacteria . In staphylococci, however, only one Tmpr DHFR (type S1 DHFR) has been found so far, and this is located on transposon Tn4003 . To help understand the mechanism of resistance, we are interested in determining the 3-D structure of the recombinant enzyme produced in Escherichia coli . However, the production level of the type S1 DHFR was very low and > 95% of the total recombinant protein accumulated in inclusion bodies . Furthermore, as a result of an internal start of translation, a truncated derivative of the enzyme that copurified with the full-length enzyme was produced . We were able to increase the expression level 20-fold by changing 18 N-terminal codons and to eliminate the internal start of translation . In addition, through molecular modelling and subsequent site-directed mutagenesis to replace two amino acids, we constructed a biochemically similar but soluble derivative of the type S1 DHFR that, after production in E.coli, resulted in a 264-fold increase in DHFR activity . The highly overproduced enzyme was purified to homogeneity, characterized biochemically and crystallized.

Int J Clin Pharmacol Ther, 1994 Jul, 32(7), 356 - 60
Distribution of orally administered azithromycin in various blood compartments; Wildfeuer A et al.; The concentrations of azithromycin in whole blood, plasma, erythrocytes and polymorphonuclear leucocytes (PMNLs) were measured in 6 healthy volunteers following the last administration of a three-day regimen of 500 mg once daily . Marked enrichment of azithromycin was observed in PMNLs; the drug concentration amounted to 119 +/- 31 (SD) mg/l 6 hours after the administration . Twelve days thereafter 42 +/- 10 mg/l azithromycin was still measured in the PMNLs, although the drug was no longer demonstrable in plasma (< 0.02 mg/l) . The elimination of azithromycin from the PMNLs (half-life 210 +/- 69 hours) was clearly slower than the elimination from plasma (half-life 93 +/- 70 hours) . The maximal concentrations of azithromycin in plasma (0.64 +/- 0.27 mg/l) and erythrocytes (0.17 +/- 0.06 mg/l) were much lower and occurred earlier (tmax = 3 hours) than those observed in the PMNLs . The enrichment factor for azithromycin in PMNLs relative to plasma came to 177 +/- 92 at 3 hours or 1814 +/- 706 at 120 hours after the last administration . In a parallel in vitro study, the effect of accumulation of azithromycin in PMNLs on the intracellular survival of ingested staphylococci was investigated . At subinhibitory extracellular concentrations of azithromycin as low as 0.03 mg/l (MIC = 1 mg/l), a significant reduction in bacterial viability was observed, thus demonstrating antibacterial activity of the intracellularly enriched antibiotic.

Rev Clin Esp, 1994 Jul, 194(7), 547 - 50
{Rapidly evolving pulmonary bullous degeneration in HIV-infected patients . Description of 4 cases and review of the literature}; Prada Pardal JL et al.; Cavitary lung lesions are common in intravenous drug-addicts (IVDA) and in AIDS patients . Four cases are reported of IVDA patients with HIV positive serology who developed an initially thick-walled lesion, which grew rapidly and evolved into bullous lesions . The negative results in microbiological investigations for Pneumocystis carinii, Nocardia spp., staphylococci; the topographic superposition on a previous tuberculous lesion; a prolonged asymptomatic period; and a particularly rapid evolution in all cases led us to consider the rapidly evolving bullous degeneration to be more than a casual finding . Previous infection with M . tuberculosis in AIDS patients might somehow influence on the later development of a rapidly growing, fatal, bullous degenerative lesion . The elucidation of the pathogenic mechanisms of these lesions was hampered by the lack of pathological studies.

J Clin Microbiol, 1994 Jul, 32(7), 1768 - 72
Multiplex PCR for identification of methicillin-resistant staphylococci in the clinical laboratory; Geha DJ et al.; A multiplex PCR assay for detection of the staphylococcal mecA gene (the structural gene for penicillin-binding protein 2a) was compared with agar dilution and disk diffusion susceptibility test methods for identifying methicillin resistance . The multiplex PCR assay combined two primer sets (mecA and 16S rRNA) in a single reaction . A total of 500 staphylococcal isolates (228 isolates of Staphylococcus aureus and 272 isolates of coagulase-negative staphylococci) from clinical specimens were studied . For S . aureus, 40 of 40 mecA-positive isolates and 4 of 188 mecA-negative isolates were oxacillin resistant (positive and negative predictive values of 100 and 98%, respectively) . In 3 of 4 discordant isolates, resistance was due to hyperproduction of beta-lactamase . For coagulase-negative staphylococci, 148 of 159 mecA-positive isolates and 0 of 113 mecA-negative isolates were oxacillin resistant (positive and negative predictive values of 93 and 100%, respectively) . Twenty-six isolates were categorized as indeterminate because of the absence of a detectable 16S rRNA product . Four of these 26 isolates contained mecA when retested . The assay is designed to be incorporated into the work flow of the clinical microbiology laboratory and allows for the identification of intrinsic resistance in a timely and reliable manner.

Ukr Biokhim Zh, 1994 Jul-Aug, 66(4), 51 - 8
{The effect of antibiotics on staphylococcal respiratory chain enzymes}; Vinnikov AI et al.; Comparative data were presented about the effect of tetracycline, chloramphenicol, erythromycin (antibiotics-inhibitors of protein synthesis) and penicillin (inhibitor of biosynthesis of cell wall components) on the enzymes of staphylococci respiratory chain . It was shown that antibiotics affected energetic metabolism of cells . It was proved by change of activity of electron transport chain enzymes--oxidases, dehydrogenases, and by change of functioning of membrane-bonded ATP-ase . This effect is shown both in antibiotics addition to growing staphylococci cells and in their influence in vitro on the membrane apparatus of staphylococci cells . On the basis of these results we can suppose that the mechanism of action of these antibiotics has more complex character and side by side with protein synthesis and synthesis of cell wall it influences the activity of membrane-bonded enzymes.

Zentralbl Veterinarmed B, 1994 Jul, 41(5), 344 - 50
Bovine clinical mastitis due to coagulase-negative staphylococci and their susceptibility to antimicrobials; Honkanen-Buzalski T et al.; A total of 168 coagulase-negative staphylococci (CNS) strains were isolated from milk samples taken from cows with clinical mastitis . The samples were collected between January 1990 and August 1992 from cows in the veterinary surveillance area of the Ambulatory Clinic, College of Veterinary Medicine, Hautjarvi, Finland . In 100 cases the effect of antibiotic treatment was evaluated 3-4 weeks after initial sampling . Clinical symptoms of the animals were recorded, and the inflammatory status of their udders was evaluated using the CMT test and assessing milk NAGase activity . CNS mastitis was most common in young cows during early lactation . Staphylococcus hyicus, S . simulans and S . epidermidis were the most frequently isolated CNS . Clinical symptoms were most severe with S . hyicus . Cure rates for CNS induced mastitis were high.

Diagn Microbiol Infect Dis, 1994 Jul, 19(3), 163 - 6
Inoculum effects on Etests and agar dilution minimum inhibitory concentrations . Piperacillin and piperacillin-tazobactam against Staphylococcus aureus; Bonfiglio G et al.; Inoculum effects notoriously occur with beta-lactamase-positive staphylococci in dilution susceptibility tests with substrate beta-lactams . Etests, like dilution experiments, demonstrated such effects with piperacillin and, to a lesser extent, with its tazobactam combinations . When Etests were used with the recommended inoculum of approximately 10(6) colony-forming units (CFU/plate, the minimum inhibitory concentrations (MICs) of piperacillin-tazobactam found for beta-lactamase-positive Staphylococcus aureus isolates resembled those found by agar dilution for inocula of 10(4) CFU/spot but were two- to eightfold below those found by agar dilution for inocula of 10(6) CFU/spot; MICs of piperacillin itself by Etest were about fourfold below even those found by agar dilution with inocula of 10(4) CFU/spot . Inoculum effects for beta-lactamase-negative S . aureus were minimal by both methods.

Diagn Microbiol Infect Dis, 1994 Jul, 19(3), 143 - 7
Fluoroquinolone resistance among methicillin-resistant staphylococci after usage of fluoroquinolones other than ciprofloxacin in Taiwan; Chang SC et al.; The antimicrobial susceptibility to norfloxacin, ofloxacin, and ciprofloxacin of methicillin-resistant staphylococci isolated before and after the use of fluoroquinolones other than ciprofloxacin in Taiwan was studied by the agar dilution method . Before the use of fluoroquinolones, 54 isolates of methicillin-resistant Staphylococcus aureus (MRSA) and 51 isolates of methicillin-resistant coagulase-negative staphylococci (MRCNS) isolated in 1983-1985 were all susceptible to the three fluoroquinolones tested . Following the use of norfloxacin, enoxacin, and ofloxacin, the MIC90s of norfloxacin, ofloxacin, and ciprofloxacin against 46 isolates of MRSA collected during 1989-1990 increased to 64, 16, and 32 micrograms/ml, respectively, and the rates of resistant strains to these three agents were 37.0%, 30.4%, and 34.8%, respectively . The MIC90s against 42 isolates of MRCNS also increased to 64, 8, and 8 micrograms/ml, respectively, with 35.7%, 23.8%, and 33.3% resistant strains.

J Infect Dis, 1994 Jun, 169(6), 1393 - 7
Molecular epidemiology of coagulase-negative Staphylococcus blood isolates from neonates with persistent bacteremia and children with central venous catheter infections; Tan TQ et al.; Multilocus enzyme electrophoresis was used to genetically characterize sequential isolates of coagulase-negative staphylococci (CONS) from 3 neonates with persistent bacteremia and organisms cultured from several sites in 23 children with presumed catheter-related sepsis (CRS) . For 2 of 3 neonates and 21 (91%) of 23 of the patients with presumed CRS, the same CONS clone was isolated from multiple consecutive blood cultures (mean, 7.3 isolates; range, 3-19) . For the 23 children with presumed CRS, 7 (30%) had catheter hub (CH) and 7 (30%) had catheter exist site (CES) cultures positive for CONS; cultures from 3 of these patients (from both CH and CES) grew CONS . Genetic analysis of isolates recovered from the CH and peripheral and central venous catheter blood cultures of all 7 patients revealed clonal identity of the strain grown from all sites . In contrast, only 4 (57%) of 7 of the CONS isolates from the CES were the same clone as that isolated from the blood . These data suggest that repetitive isolation of CONS during the course of CRS is due to ongoing bacteremia, not culture contamination with distinct CONS isolates . The results also are consistent with the hypothesis that the CH is a more likely site of initial colonization by CONS than the exist site in patients with CRS.

Infect Immun, 1994 Jun, 62(6), 2362 - 6
Immunoglobulin G enhances C3 degradation on coagulase-negative staphylococci; Correa AG et al.; Antibody and complement are essential to host defense against infection with coagulase-negative staphylococci in the neonate . To evaluate the influence of antibody on C3 deposition, we compared the C3 fragments deposited on coagulase-negative staphylococci after opsonization with normal human serum or with hypogammaglobulinemic serum . Using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot (immunoblot) analysis, the degradation products of C3 were less apparent at 1 and 2 min after opsonization with hypo- and agammaglobulinemic serum than those from normal human serum . This finding suggested that antibody contained in normal human serum contributes to efficient C3 deposition in the early phases of opsonization . There was no clear difference in C3 deposition when slime-producing strains were compared with non-slime-producing strains . The addition of intravenous immunoglobulin to hypogammaglobulinemic serum and serum from premature neonates rendered C3 deposition comparable to that seen with normal human serum . The data from these experiments suggest that the addition of immunoglobulin G may improve host defense against coagulase-negative staphylococci in the hypogammaglobulinemic premature neonate by enhancing C3 deposition, thus promoting opsonophagocytosis of these bacteria.

Infect Immun, 1994 Jun, 62(6), 2309 - 14
Staphylococcal iron requirements, siderophore production, and iron-regulated protein expression; Lindsay JA et al.; Despite the ability of staphylococci to grow in iron-restricted conditions in vivo, their iron requirements and the mechanisms possessed by them for the uptake of iron are poorly understood . Many bacteria are known to produce siderophores . By using the chrome azurol S universal method for the detection of siderophores, all 14 isolates of Staphylococcus aureus tested grew well under conditions of iron restriction and produced iron-regulated siderophore in large quantities, while all 19 isolates of coagulase-negative staphylococci (CoNS) grew poorly under conditions of iron restriction and produced low levels of iron chelator . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis profiles of S . aureus isolates revealed altered protein patterns due to iron restriction, while altered profiles were not seen in the CoNS group . The ability to grow in iron-restricted conditions, possibly with the assistance of siderophore-mediated iron uptake, may contribute to the increased pathogenicity of S . aureus when compared with that of the CoNS.

Antimicrob Agents Chemother, 1994 Jun, 38(6), 1325 - 30
Comparative prophylactic efficacies of ciprofloxacin, ofloxacin, cefazolin, and vancomycin in experimental model of staphylococcal wound infection; Kernodle DS et al.; Recent shifts in the species and antibiotic resistance patterns of bacteria causing nosocomial infections present new challenges for providing effective prophylaxis in surgery . Traditional regimens lack activity against methicillin-resistant staphylococci and many gram-negative species causing nosocomial infections . The new fluoroquinolones exhibit in vitro activity against many emerging surgical wound pathogens . To determine the potential of this class of antimicrobial agents for use in surgery, we compared the prophylactic efficacies of ciprofloxacin and ofloxacin with those of cefazolin and vancomycin in a guinea pig model of abscess formation . Four Staphylococcus aureus strains, one Staphylococcus epidermidis strain, and one Staphylococcus haemolyticus strain were evaluated . Vancomycin was the most effective prophylactic agent, exhibiting in vivo activity against all strains which was superior or equivalent to those of all other agents tested . Cefazolin was the least effective agent and surpassed the two quinolones in prophylactic efficacy against only one organism, a quinolone- and methicillin-resistant strain of S . aureus . The two quinolones provided excellent protection against infection with all but the quinolone-resistant isolate . The in vivo emergence of quinolone resistance among quinolone-susceptible isolates was not detected . The methicillin-resistant, quinolone-susceptible S . epidermidis and S . haemolyticus isolates were extremely susceptible to prophylaxis, exhibiting 50% infective doses above 4 x 10(6) CFU for seven of the eight antibiotic-strain combinations . We conclude that ciprofloxacin and ofloxacin may be effective antistaphylococcal agents in surgery . The role of these agents remains to be defined, and the definition should include consideration of an adverse effect upon antibiotic resistance patterns of organisms causing nosocomial infections.

Neth J Med, 1994 Jun, 44(6), 191 - 7
Bacterial and clinical sequelae of the Twin bag system in continuous ambulatory peritoneal dialysis . A single centre study; Nube MJ et al.; Since the introduction of disconnect systems, a marked reduction in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis has been reported in the literature . At our centre too, a highly significant decline in the peritonitis rate was observed after the introduction of the Twin bag in 1990 . In a multivariate analysis which we published recently, the Twin bag system, in conjunction with the more frequent use of the swan neck catheter, correlated significantly (p < 0.001) with an increase in the peritonitis-free interval . In the present study we retrospectively analyzed the bacteriological cultures of the peritonitis episodes, the antibiotic treatment prescribed, and the number of hospitalization days (HDs) before (non-Twin bag group; NTG) and after the introduction of the Twin bag system in our centre (Twin bag group; TG) . In terms of absolute numbers, the decreased incidence of peritonitis in the TG was due by and large to a decline in all pathogenic micro-organisms, but mostly to a reduction of coagulase-negative staphylococci (CNS) compared with the NTG . The incidence of culture-negative episodes, however, showed no difference between the two groups . Proportionally, there was a significant increase in culture-negative peritonitis in the TG, whereas infections caused by CNS significantly decreased in comparison with the NTG (p < 0.01) . The pattern of the antibiotics prescribed, i.e . mono- versus multi-drug regimens, did not differ between the two groups . Since, of all micro-organisms involved, CNS infections showed the largest decline in absolute numbers . Staphylococcus aureus increased relatively (43%) after the introduction of the Twin bag system.(ABSTRACT TRUNCATED AT 250 WORDS)

Ther Umsch, 1994 Jun, 51(6), 425 - 30
{Infectious spondylitis--diagnosis and therapy}; Beyeler C; Spinal infections usually develop as pyogenic osteomyelitis originating from hematogenous seeding of staphylococci, escherichia coli or pseudomonas . They present with pain at rest, general symptoms, elevated ESR and radiographic findings after several weeks . Magnetic resonance imaging is the current technique of choice . Individual antibiotic treatment is established according to the sensitivity of the cultured organism . Some patients need surgical interventions in case of neurologic deficits, abscesses, chronic fistulas, severe bone destructions and unsuccessful nonoperative treatment.

J Chemother, 1994 Jun, 6(3), 177 - 83
Effect of ceftriaxone on the phagocytosis and intracellular killing of Staphylococcus aureus by human macrophages; Tullio V et al.; The efficacy of an antimicrobial agent in the treatment of infections depends upon the interactions of bacteria, antibiotic and phagocytes . The influence of ceftriaxone on the phagocytic and bactericidal activity of human macrophages in vitro and ex vivo was investigated . At concentrations one-half the minimum inhibitory concentration (1/2 x MIC) the antibiotic caused in vitro a significant enhancement of phagocytosis and a reduction in the survival of intracellular Staphylococcus aureus . The distinction between any effect of ceftriaxone on the staphylococci and the macrophages was made by exposure of each of them to the antibiotic before they were incubated together . The results suggest that ceftriaxone may have a direct positive action on macrophages, possibly by interfering with the cellular membrane functions and hence enhancing engulfment of bacteria . The ex vivo data seem to corroborate this hypothesis.

J Virol Methods, 1994 Jun, 48(1), 73 - 9
A competition immunoprecipitation assay of unlabeled poliovirus antigens; Rombaut B et al.; An assay method is described for unlabeled, unpurified N(ative) and H(eated) antigens of poliovirus . The method is based on competition between the unlabeled antigen and a standard quantity of radiolabeled antigen, in the presence of a limiting amount of a N- or H-specific, monoclonal antibody . The immune complexes are removed by protein A-bearing, fixed staphylococci . The method is free from cross-reaction between N and H antigen, and has a detection limit of approximately 2 nM . It was applied successfully to the quantitation of poliovirus antigen synthesized by recombinant yeast expressing the viral proteins P1 and 3CD.

J Hosp Infect, 1994 Jun, 27(2), 81 - 98
The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience; Hudson IR; Staphylococcal infections remain an important cause of morbidity and mortality . Methicillin-resistant Staphylococcus aureus (MRSA) present a particular problem because of the costs of treatment and containing outbreaks . The role of nasal carriage of staphylococci in the epidemiology of staphylococcal infection has been recognized for over 30 years . Until recently, eradication of nasal carriage of S . aureus has proved difficult, with a variety of topical and systemic agents yielding poor results with either little discernible effect on nasal carriage or rapid recolonization . Mupirocin is a novel topical antibiotic with excellent antibacterial activity against staphylococci, including MRSA . Intranasal administration of calcium mupirocin has achieved excellent results in the eradication of nasal carriage of S . aureus and producing an associated reduction in S . aureus infection in a variety of clinical settings, including MRSA outbreaks, neonatal nurseries, haemodialysis, cardiothoracic surgery and familial staphylococcal infections . This article reviews the efficacy and safety of intranasal mupirocin in the prevention of staphylococcal infections.

J Orthop Res, 1994 May, 12(3), 432 - 8
Role of fibronectin in staphylococcal adhesion to metallic surfaces used as models of orthopaedic devices; Delmi M et al.; Staphylococcal infection of various prosthetic and internal fixation devices is a major complication associated with orthopaedic surgery . This study investigated the role of the host protein fibronectin in promoting adhesion of Staphylococcus aureus and Staphylococcus epidermidis to metallic surfaces representing materials used for orthopaedic devices . Pure human fibronectin was adsorbed in vitro onto coverslips (0.8 x 0.8 cm) of stainless steel, pure titanium, or titanium-aluminum-niobium alloy . In vitro bacterial adhesion was promoted more strongly by the metallic surfaces coated with fibronectin than by albumin-coated controls for two strains of S . aureus and one strain of S . epidermidis . Furthermore, with the fibronectin-coated coverslips, bacterial adhesion to titanium alloy was significantly greater than adhesion to stainless steel . Adhesion of the three staphylococcal strains was promoted more strongly by coverslips explanted from the subcutaneous space of guinea pigs and tested under similar conditions than by albumin-coated controls . Incubation of either in vitro fibronectin-coated or explanted metallic coverslips with anti-fibronectin antibodies produced a significant decrease in staphylococcal adhesion . These results suggest that the presence of fibronectin on the surface of implanted metallic devices is an important determinant of colonization of orthopaedic biomaterials by staphylococci.

Br J Anaesth, 1994 May, 72(5), 587 - 91
Influence of surface morphology on in vitro bacterial adherence to central venous catheters; Tebbs SE et al.; The detailed surface topography of five polyurethane central venous catheters (CVC) (Hydrocath, Deltacath, Certofix trio, Arrow-Howes and Multicath three) was examined by scanning electron microscopy and laser profilometry . The results were correlated with the ability of Staphylococcus epidermidis to adhere to each CVC . Hydrocath CVC had the smoothest surface, as determined by profile peak values of 0.17 microns (Ra) and 0.94 microns (Rz) . These CVC also had the lowest number of staphylococci adhering to the surface . In contrast, Certofix trio CVC had an irregular surface (Ra 1.29 microns and Rz 6.35 microns) which was confirmed by scanning electron microscopy . These latter CVC had significantly more bacteria colonizing their surface compared with Hydrocath and Arrow-Howes CVC (P < 0.01) . The results suggest that a CVC with a smooth surface, absent of surface defects, may reduce the risk of colonization with bacteria and therefore subsequent sepsis.

Eur J Immunol, 1994 May, 24(5), 1161 - 6
Clonal expansion of T lymphocytes causes arthritis and mortality in mice infected with toxic shock syndrome toxin-1-producing staphylococci; Abdelnour A et al.; Erosive arthritis is a common and feared complication of staphylococcal infection . The reason(s) for the progressive course of the arthritis is unknown . It has been recently established that enterotoxins produced by Staphylococcus aureus display superantigen properties leading to stimulation of T cells carrying distinct T cell receptor V beta elements . This finding provides a potential connection between staphylococcal exoproteins and endogenous immune mechanisms participating in the infectious process . We have recently describe successful induction of infections arthritis in mice after intravenous inoculation of a toxic shock syndrome toxin-1 (TSST-1)-producing S . aureus LS-1 strain . Using this model we have now found a clonal expansion of T cells expressing V beta 11+ T cell receptor in the synovial tissue of arthritic mice . The role of TSST-1 as a superantigen inducing oligoclonal expansion was confirmed in an in vitro culture system . The expansion of V beta 11+ T cells proved to be of arthritogenic significance since mice genomically deleted of the V beta 11+ T cells did not develop arthritis and since pretreatment of healthy mice with anti-CD4 or anti-V beta 11 monoclonal antibodies inhibited arthritis . In addition, CD4+ and V beta 11+ T cells showed themselves to be of pathogenic significance in staphylococcal-induced mortality, since mice depleted of such populations showed increased survival . We propose that in hematogenously spread S . aureus-induced arthritis the TSST-1-dependent clonal expansion of CD4+ V beta 11+ T cells is a driving pathogenic force.

Mt Sinai J Med, 1994 May, 61(3), 272 - 5
Investigations of the bacteriologic factors in cervical disk surgery; Savitz SI et al.; A study was undertaken to evaluate the potential risk of wound infection in cervical disk disease, the appropriateness of the current prophylactic regimen of intravenous cefazolin at Good Samaritan Hospital, and the increasing resistance of coagulase-negative staphylococci in nosocomial infections . In addition, the methodology used in three prior studies was used to verify that double-gloving is a more effective barrier to bacterial contamination than single-gloving and that topical streptomycin lavage is superior to constant irrigation with plain saline . No wound infections were documented in the 40 patients who underwent cervical disk surgery in a 12-month period . Coagulase-negative Staphylococcus species were the most common bacterial isolate, but only 20% were resistant to cefazolin . Of the 11 S . aureus isolates, 9 were sensitive to cefazolin and 2 were methicillin resistant . A remarkable 95% (114/120) of the intraoperative wound cultures were free of bacteria . In only 2 cases was there a serial increase in colonies of the same organism over the course of the operation . There was one positive glove culture--coagulase-negative Staphylococcus sensitive to cefazolin . The patient's skin was identified as the source of contamination in 3 intraoperative cultures of the wound and 2 cultures of the ambient operating room air . Neither individual biotyping of bacteria nor antimicrobial susceptibility testing uncovered any consistent source or pattern to account for the organisms in the surgical wound or ambient operating room air . Bacteria resistant to cefazolin were found in 36% of the intraoperative environmental cultures but in only 16% of the isolates from patients' skin.(ABSTRACT TRUNCATED AT 250 WORDS)

FEMS Immunol Med Microbiol, 1994 May, 8(4), 315 - 20
Isolation of an adhesin from Staphylococcus aureus that binds Lewis a blood group antigen and its relevance to sudden infant death syndrome; Saadi AT et al.; A 67 kDa protein was isolated from cell membrane preparations of Staphylococcus aureus (NCTC 10655) by affinity adsorption with synthetic Lewis a antigen conjugated to Synsorb beads . Pre-treatment of buccal epithelial cells expressing Lewis a with the purified protein reduced binding of the staphylococcal strain to a greater extent than the material not bound to the Synsorb beads . The significance of this work is discussed with reference to expression of Lewis a antigen in infants and the proposed role of toxigenic strains of staphylococci in some cases of sudden infant death syndrome.

Clin Pediatr (Phila), 1994 May, 33(5), 319 - 20
Staphylococcus aureus cellulitis: an unusual presentation; Geunes PM et al.; Staphylococcus aureus has long been known as one of the most virulent microbes, with capabilities that make it threatening in both nosocomial and community-acquired infections . It remains the most frequent cause of skin-structure and traumatic infections in the community . S . aureus infections in the maxillofacial region are likely to be associated with a known portal of entry, but this is not always the case . Once invasion occurs, the organism may produce virulent enzymes including coagulase, hyaluronidase, proteases, DNA-ase, lipases, hemolysins, and lysozyme as well as exotoxins . Markel et al point out that cellulitis associated with coagulase-positive staphylococci will often resolve without abscess formation . Hence, there is often no site from which to obtain specimens, making this infection a diagnostic and therapeutic challenge . This report describes an infection in which the etiologic organism was identified as S . aureus . The source of the infection, however, remained unclear.

Graefes Arch Clin Exp Ophthalmol, 1994 May, 232(5), 308 - 11
Different techniques of extracapsular cataract extraction: bacterial contamination during surgery . Prospective study on 230 consecutive patients; Egger SF et al.; This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE) . Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique . All patients had posterior chamber intraocular lenses implanted . Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated . Samples of the aqueous humor were taken at the beginning and at the end of the operation . Cultures were incubated and held for 14 days . More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria . However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms . In no case did postoperative endophthalmitis develop . Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification . Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.

Support Care Cancer, 1994 May, 2(3), 191 - 6
A prospective, randomized study of pefloxacin versus teicoplanin in the treatment of gram-positive coccal infections in cancer patients: early termination due to emergence of resistance to fluoroquinolones; Aoun M et al.; A randomized prospective study comparing pefloxacin to teicoplanin in the treatment of gram-positive infections in cancer patients was prematurely terminated because of the emergence of pefloxacin resistance associated with oxacillin resistance in Staphylococcus aureus and coagulase-negative staphylococci . Among 56 patients evaluated for efficacy (26 pefloxacin and 30 teicoplanin) and infected with bacteria susceptible to both antibiotics, the clinical cure and eradication rates were similar for pefloxacin (80.5% and 77.3% respectively) and teicoplanin (66.6% and 52.2% respectively) . The relapse rates (15% and 10% for pefloxacin and teicoplanin respectively) and the overall mortalities within 1 month (42% and 31%) were similar.

Antibiot Khimioter, 1994 May, 39(5), 16 - 20
{Experimental study of the effect of antimicrobial substances on the dissemination of solizyme during its purification}; Kharlamova IuA; Microorganisms of different taxonomic groups were isolated from intermediate products of microbial lipase and shown to be able to multiply in them . Therefore, the intermediates forming during solizyme production could be potential nutrient media for growth of the contaminating microflora . The effect of chlorhexidine active against the contaminating microorganisms on the growth of the microbial biomass was studied and it was shown that chlorhexidine could lower the dissemination of the intermediates in production of solizyme . Neomycin added at the stage of the solizyme chemical purification retarded solely the growth of staphylococci contaminating the solizyme intermediate products . The use of antimicrobial agents for the solution of the problem of the solizyme microbial contamination requires the consideration of the contamination level, temperature conditions of the production process and susceptibility of the microflora to the antimicrobial agent used.

Drugs, 1994 May, 47(5), 823 - 54
Teicoplanin . A reappraisal of its antimicrobial activity, pharmacokinetic properties and therapeutic efficacy; Brogden RN et al.; Since an earlier review in the Journal substantial additional data have accumulated, further clarifying the in vitro activity, pharmacokinetic profile, clinical efficacy and tolerability of teicoplanin . Recent therapeutic trials confirm the efficacy of teicoplanin in the treatment of microbiologically confirmed Gram-positive infections, including septicaemia, endocarditis, and infections of skin and soft tissue, bone and joints, and the lower respiratory tract . As teicoplanin can be administered once daily intramuscularly as well as intravenously, it has potential for outpatient treatment of severe Gram-positive infections . Teicoplanin is appropriate as treatment of patients with fever and neutropenia, but there is still controversy over the timing for introduction of glycopeptide antibiotics into therapeutic regimens . Teicoplanin is generally reserved for secondary therapy of patients with documented bacteraemia who fail to respond to initial empirical antibiotic regimens, but probably should be part of the initial empirical regimen in the setting of a high incidence of methicillin-resistant staphylococci . Teicoplanin has a lower propensity than vancomycin to impair renal function when either drug is combined with an aminoglycoside, causes fewer anaphylactoid reactions, and appears to be of comparable efficacy . Thus, teicoplanin may be preferred to vancomycin in the treatment of Gram-positive infections, and where a glycopeptide antibiotic is deemed a necessary inclusion in a regimen for empirical treatment in patients with fever and neutropenia.

J Appl Bacteriol, 1994 Apr, 76(4), 320 - 6
Tetracycline resistance genes in staphylococci from the skin of pigs; Schwarz S et al.; Forty-seven tetracycline-resistant staphylococci from the skin of pigs were examined for genes mediating this resistance . Seventeen isolates were also resistant to minocycline and all hybridized with the tet(M) gene; 23 carried the tet(K) gene and 10 the tet(L) gene . Three carried more than one gene and two did not hybridize with any of the three probes tested . Maps were constructed for two plasmids carrying the tet(K) gene, all were very similar in size (4.35-4.7 kb) and structure and closely resembled the plasmid pT181 . Four plasmids which bore the tet(L) gene differed in size, ranging from 4.3 to 11.5 kb, and were dissimilar in structure except for the portion bearing the gene.

FEMS Microbiol Lett, 1994 Apr 1, 117(2), 131 - 6
Nucleotide sequence of the structural gene for the penicillin-binding protein 2 of Staphylococcus aureus and the presence of a homologous gene in other staphylococci; Murakami K et al.; The structural gene for penicillin-binding protein 2 (PBP2) of Staphylococcus aureus was cloned and sequenced . The nucleotide sequence of the 2,458-bp chromosomal fragment was determined, and the 2,148-bp coding region for PBP2 was identified . Determination of ten N-terminal amino acids of the PBP2 protein indicated that N-terminal methionine had been removed from the primary translational product . Thus, PBP2 is comprised of 715 amino acids with a molecular mass of 79,147 . Nucleotide sequences having some homology with the PBP2 gene and proteins cross-reactive with anti-PBP2 antibody were detected in some other species of staphylococci by polymerase chain reaction and Western blot analysis, respectively.

Am J Clin Pathol, 1994 Apr, 101(4), 443 - 5
Reproducibility of three identification systems for biotyping of coagulase-negative staphylococci; Hill RB et al.; Three commercial identification systems were evaluated as tools for biotyping coagulase-negative staphylococci . Emphasis was placed on the reproducibility of component tests and not on the ability of these kits to identify these bacteria accurately . Forty-seven clinical and reference strains of Staphylococcus were tested in duplicate with each system . The Staph-Ident profile of test results changed for 20 strains on repeat testing, the Staph-Trac profile changed for 10 strains, and the Vitek GPI profile changed for 14 strains . The component tests of each system that were responsible for these profile changes were identified.

Neonatal Netw, 1994 Apr, 13(3), 41 - 51
Selecting antibiotics for nosocomial bacterial infections in patients requiring neonatal intensive care; Payne NR et al.; Nosocomial infections increase neonates' morbidity, hospital costs, and mortality . These infections occur most commonly in very low birth weight infants, who frequently required plastic intravascular catheters and parenteral nutrition . Diagnosis often relies on a combination of laboratory tests and nonspecific clinical signs . Criteria for diagnosing nosocomial infections have been published by the Centers for Disease Control (CDC) and should be used to standardize the identification of cases . Initial antibiotic therapy depends on (1) the bacterial species most likely to cause infection, (2) antibiotic resistance patterns in one's own hospital, (3) the patient's clinical condition, and (4) previous antibiotic therapy . Antibiotic coverage of both gram-positive and gram-negative bacteria is necessary . Following laboratory identification of the infecting organism and the antibiotic susceptibility results, the patient should be reevaluated and definitive therapy prescribed . Multiple antibiotics may be needed as definitive therapy if (1) the infecting organism is likely to develop resistant mutants during therapy (e.g., Pseudomonas species), (2) higher bactericidal serum activity is required than can usually be achieved with a single agent (e.g., enterococci, Listeria), (3) the patient is neutropenic or otherwise severely immunocompromised, or (4) blood cultures are persistently positive for bacteria despite appropriate therapy with a single agent . Attempts to prevent nosocomial bacteremias by routinely administering prophylactic vancomycin may hasten the development of vancomycin-resistant, coagulase-negative staphylococci or enterococci and should be avoided.

New Microbiol, 1994 Apr, 17(2), 123 - 32
Antimicrobial susceptibility of ruminal coagulase-negative staphylococci; Laukova A; The species Staphylococcus sciuri subsp . sciuri, Staphylococcus sciuri subsp . lentus, Staphylococcus saprophyticus and Staphylococcus xylosus of novobiocin resistant coagulase-negative staphylococci (CNS) isolated from rumen content or wall of lambs and calves were determined . All bacteria were tested for lactic acid production, urease, adherence activities and antimicrobial susceptibility or resistance . The majority of strains presented belonged to bacteria with low affinity for epithelial cells . Only Staphylococcus xylosus SX63 was detected as a strain with high adherence activity . Urease activity in isolates reached the average value of 12.72 nkat.mL-1 . The strain SS1 showed high urease activity and SI97 strain was without urease activity . Most strains showed resistance to ionophores . All bacteria were found as sensitive to nonionophores without Staphylococcus xylosus SX63 (tylosin) and Staphylococcus sciuri subsp . lentus SL139 (nitrovin) . Each of the strains tested inhibited the growth of at least one of the indicators reaching clear inhibition zones (2-5 mm in diameter) . Of 12 strains tested, in 6 bacteria production of bacteriocin-like substances was affected using additional nutrient media . Generally, novobiocin resistant CNS are among the most frequent representatives of the staphylococcal group colonizing the rumen of young ruminants.

Int J Food Microbiol, 1994 Apr, 22(1), 55 - 62
Some factors inhibiting amplification of the Staphylococcus aureus enterotoxin C1 gene (sec+) by PCR; Wilson IG et al.; PCR amplification of the sec+ gene for staphylococcal enterotoxin C1 (SEC1) can be achieved from as little as 10 fg total genomic DNA (equivalent to less than 10 cells) using two nested primer pairs . The presence of bacterial cells, particularly thermonuclease-producing staphylococci, and the thermonuclease enzyme (TNase) itself, were found to be factors which individually and together reduced the sensitivity of PCR amplification.

Int J Food Microbiol, 1994 Apr, 22(1), 43 - 54
A non-isotopic DNA hybridisation assay for the identification of Staphylococcus aureus isolated from foods; Wilson IG et al.; A digoxygenin-labelled total genomic DNA probe was used to identify Staphylococcus aureus . Isolation and identification of organisms was possible in less than 4 days . Identification alone could be completed in less than 2 days, compared with over 5 days for identification of isolates by multipoint inoculation . The probe showed excellent discrimination of S . aureus from other staphylococci and from a wide range of bacteria commonly associated with milk and meat . The effectiveness of this probe was tested against cultural isolation of staphylococci in milk using Baird-Parker agar followed by identification using multipoint inoculation and API Staph . The probe gave comparable results to the conventional methods and, for large sample numbers, offered lower cost and greater ease of use.

Compendium . 1994 Apr;15(4):512, 514, 516 passim; quiz 520.
Reduction of oral microbes by a single chlorhexidine rinse; Buckner RY et al.; Because of the continued threat of human immunodeficiency virus and hepatitis B infection, as well as the possibility of cross-infection from microbes, such as the herpesviruses and staphylococci, infection control remains a critical issue in dentistry . A traditional response to the infection-control issue is the use of barrier protection by the practitioner and staff . Little attention has been paid to reducing the number of potential pathogens in the oral cavity before dental procedures as a means of minimizing the potential spread of contagion between patients and treatment providers . A study to determine the effectiveness and duration of a single rinse with 0.12% chlorhexidine gluconate oral antiseptic in reducing the number of microorganisms in the oral cavity is presented.

Vet Microbiol, 1994 Apr, 39(3-4), 255 - 60
Characterization of the most frequently encountered Staphylococcus sp . in cats; Igimi S et al.; Ninety three staphylococci isolated from clinical specimens from cats were characterized and identified . Because the biochemical characteristics of Staphylococcus felis were very similar to those of Staphylococcus simulans, results were submitted to numerical analysis and DNA homology . Forty-two isolates (45%) were identified as S . felis, and 4 isolates (4%) as S . simulans . The other species identified, in order of their frequency were, 12 Staphylococcus aureus (13%), 9 Staphylococcus intermedius (10), 6 Staphylococcus sciuri (6), 6 Staphylococcus epidermidis (6), 2 Staphylococcus haemolyticus (2), 2 Staphylococcus xylosus (2), 1 Staphylococcus capitis (1), 1 Staphylococcus equorum (1), 1 Staphylococcus gallinarum (1) and 1 Staphylococcus lentus (1).

Antimicrob Agents Chemother, 1994 Apr, 38(4), 724 - 8
Mechanisms of heteroresistance in methicillin-resistant Staphylococcus aureus; Ryffel C et al.; Characteristic for methicillin-resistant (Mcr) staphylococci is the heterogeneous expression of the intrinsic methicillin resistance . The majority of the cells express resistance to low concentrations of methicillin, and a minority of the cells express resistance to much higher concentrations . We show here (i) that the presence of the mecA encoding region on plasmid pBBB79 was sufficient to render a methicillin-susceptible (Mcs) Staphylococcus aureus strain heteroresistant and (ii) that this Mcr strain segregated highly resistant subclones which retained the high-resistance phenotype under nonselective growth conditions . The Mcr strain with only mecA on plasmid pBBB79 thus behaved identically to a Mcr strain carrying the complete mec determinant integrated at its proper chromosomal site . (iii) Curing a such highly resistant subclone from plasmid pBBB79 yielded an Mcs strain that was as susceptible as the original Mcs parent strain . (iv) Comparisons were made between the original parent and the cured Mcs strain by backcrossing pBBB79 into them and looking at their progeny . Transductants derived from the formerly highly resistant cured strain became resistant to high concentrations of methicillin, whereas transductants derived from the original parent strain were resistant to lower concentrations of methicillin and showed the typical heterogeneous resistance . We deduced therefrom that the high-level resistance expressed by the minority of the population of Mcr S . aureus was due to a chromosomal mutation(s) (chr*) involving neither mecA nor the additional 30 kb of mec-associated DNA . Moreover, we could show that this postulated mutation chr* was not linked to the femAB operon, which is known to affect methicillin resistance levels.

J Clin Microbiol, 1994 Apr, 32(4), 1058 - 9
Evaluation of MicroScan rapid gram-positive panels for detection of oxacillin-resistant staphylococci; Woods GL et al.; The ability of MicroScan rapid panels (Baxter MicroScan, West Sacramento, Calif.) to detect oxacillin resistance in 92 clinical isolates of Staphylococcus aureus and 103 coagulase-negative staphylococci was evaluated by comparing results with those of MicroScan 24-h MIC panels and, to resolve discrepancies, oxacillin agar screening . Both panels were interpreted by the MicroScan WalkAway-96 system . Rapid panels detected 96.7% of resistant S . aureus isolates and 72% of resistant coagulase-negative staphylococci, 22 of which did not grow in the panels.

APMIS, 1994 Apr, 102(4), 272 - 8
Identification of coagulase-negative staphylococci and typing of Staphylococcus epidermidis by a 4 h micromethod; Jarlov JO et al.; A new 4 h micromethod (Minibact-S) for identification of coagulase-negative staphylococci (CNS) important in human medicine, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus haemolyticus and Staphylococcus saprophyticus, has been investigated . The reproducibility for species identification was 100% and the reproducibility for the single reactions was 95% . When compared to a modified Kloos & Schleifer conventional identification method, discrepant identification was obtained with the Minibact-S in only 8 of 382 clinical and reference strains . The system has been used for typing and biotyping of 201 S . epidermidis strains, and gave a subdivision in 69 different types; 4 related types accounted for 91 (45%) of the isolates, whereas 44 types were represented by only 1 isolate . The discriminatory index was 0.82 . In a comparison with other typing methods performed on 81 isolates from 15 patients Minibact-S gave about the same number of types as antibiograms, but in 20% of the patients extra types were obtained with Minibact-S alone compared to antibiogram alone and vice versa . The Minibact-S is of some value in the routine clinical microbiology laboratory as a first screening method for identification of coagulase-negative staphylococci and typing of S . epidermidis in combination with the antibiogram.

Rev Latinoam Microbiol, 1994 Apr-Jun, 36(2), 71 - 7
{Numerical taxonomy of staphylococci isolated from water and beach sand from Valparaíso and viña del Mar, Chile}; Prado B et al.; A total of 85 strains of Gram positive cocci isolated from beach water and sand located in Valparaiso bay, and Vina del Mar, Chile, were examined for 59 morphological, physiological and biochemical characteristics . The taxonomic data were analysed by numerical taxonomy using Ssm coefficient and the Unweighted Pair Group Method of Association (UPGMA) . At 80% similarity level, four phenons were obtained . Of the 85 strains 31% were classified as Staphylococcus epidermidis, 9% were classified as Staphylococcus haemolyticus, 36% were classified as Staphylococcus spp . and 24% as Staphylococcus aureus . Epidemiological considerations are made in relation with the probable impact that the isolation of Staphylococcus aureus and coagulase negative Staphylococci would have on the health of the population.

Bol Asoc Med P R, 1994 Apr-Jun, 86(4-6), 37 - 41
Catheter related infections in Damas Hospital; Lugo LJ et al.; The purpose of this study is to investigate the extent of catheter-related infections in our Institution . We examined retrospectively 89 medical records of patients in whom an intravascular catheter tip culture were obtained during January through December 1991 . Forty-seven catheter related infections were identified in 43 patients . There were 33 multiple lumen infected catheters and 14 single lumen . Catheters for hemodialysis were infected in 38.3% of the patients . Twenty catheters were inserted into the subclavian vein . Fifty percent of the reinserted catheters were placed in the same site, of which 28.6% became infected . Staphylococcus epidermis was isolated in 28.1% of the patients, while in 50% of the patients with Staphylococcus aureus, bacteremia was identified . Staphylococci and Enterococci were more sensitive to Vancomycin than to any other antibiotic.

J Hosp Infect, 1994 Apr, 26(4), 239 - 50
Lack of evidence for increased adherent growth in broth or human serum of clinically significant coagulase-negative staphylococci; Wilcox MH et al.; The relevance of adherent growth of coagulase-negative staphylococci (CNS) in vitro to their clinical significance is controversial . We have investigated the accumulation on polymer surfaces of clinically significant CNS strains, isolated from blood cultures and intravascular catheter tips, compared with controls . The adherent growth of significant CNS isolates in a microtitre tray assay was not greater than controls, and this finding was repeated when different combinations of target polymer surface, culture medium and incubation atmosphere type were investigated . The surface accumulation of CNS cultured in pooled human serum was poor compared with culture in broth . Whole cell and surface protein profiles of serum grown Staphylococcus epidermidis differed markedly from broth cultured cells . We recommend the use of human body fluids, such as serum, as useful culture media to assess whether potential virulence determinants are likely to be expressed in vivo . The microtitre tray assay of adherent growth is not helpful in determining the virulence of individual CNS isolates.

Rev Assoc Med Bras, 1994 Apr-Jun, 40(2), 77 - 80
{Teicoplanin and vancomycin susceptibility in Staphylococcus aureus and coagulase-negative staphylococci}; Caiaffa Filho HH et al.; Members of the genera Staphylococcus are the most common pathogens found in the hospital environment and they are acquiring resistance to multiple drugs . PURPOSE--To evaluate the in vitro activity of teicoplanin and vancomycin against 195 strains of staphylococci isolated from in-patients . METHODS--One hundred strains of Staphylococcus aureus (50% methicillin-resistant) and 95 strains of coagulase-negative staphylococci (46.3% strains methicillin-resistant) were tested by the agar dilution and the disk diffusion techniques . RESULTS--All strains (100%) were susceptible to vancomycin, S . aureus strains presented MIC90 of 0.5 microgram/mL whereas strains of coagulase-negative staphylococci showed MIC90 of 1.0 microgram/mL . For teicoplanin, 98.5% of the strains were susceptible . MIC90 values were 0.5 microgram/mL for S . aureus strains, 2.0 micrograms/mL for coagulase-negative methicillin-susceptible staphylococci strains and 8.0 micrograms/mL for coagulase-negative methicillin-resistant staphylococci strains . CONCLUSION--From the microbiological point of view, the results showed a high potential for both drugs as therapeutic agents in staphylococcal infections due to multiresistant strains of hospital origin.

Pathol Biol (Paris), 1994 Apr, 42(4), 323 - 7
{Methicillin resistant Staphylococcus aureus and glycopeptides (vancomycin, teicoplanin): in vitro selection of resistance}; Serazin V et al.; By repeated and successive treatments of five strains of methicillin-resistant Staphylococcus aureus with sub-inhibitory concentrations of vancomycin and of teicoplanin, the authors have confirmed that selection of resistant strains could be obtained more easily with teicoplanin than with vancomycin . Moreover, we have shown that treatments with subinhibitory concentrations of teicoplanin could also influence the activity of vancomycin, although the strains have never been in contact with the latter antibiotic . This could account, at least in part, for the downhill evolution of the activity of glycopeptides against staphylococci, observed this last years . Indeed, the efficacy of these antibiotics upon which treatment of severe infections due to multiresistant staphylococci relies, is lowering . Considering the challenge, this risk is worth being not only evaluated by a reinforced epidemiologic surveillance, but also limited by more severe criteria for the prescription and the follow-up of treatments with glycopeptides.

J Chemother, 1994 Apr, 6 Suppl 2, 67 - 70
Epidemiology of staphylococcal infections--a European perspective; Vandenbroucke-Grauls C; Multiple resistant staphylococci are a major health concern worldwide . In Europe, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs widely between countries in the south and those in the north . In The Netherlands, which has one of the lowest rates of MRSA infection in Europe, stringent infection control measures are in place which include the isolation of all carriers and the treatment of patients and staff carriers with mupirocin.

Int Immunol, 1994 Mar, 6(3), 409 - 22
Some antioxidants inhibit, in a co-ordinate fashion, the production of tumor necrosis factor-alpha, IL-beta, and IL-6 by human peripheral blood mononuclear cells; Eugui EM et al.; Some antioxidants, including butylated hydroxyanisole (BHA), tetrahydropapaveroline (THP), nordihydroguiauretic acid, and 10,11-dihydroxyaporphine (DHA), were found to be potent inhibitors of the production of tumor necrosis factor (TNF)-alpha, IL-1 beta, and IL-6 by human peripheral blood mononuclear cells (PBMC) stimulated by lipopolysaccharide (LPS) (IC50s in the low micromolar range) . Inhibition of cytokine production was gene selective and not due to general effects on protein synthesis . Inhibition of cytokine production by PBMC was observed also when other inducers were used (staphylococci, silica, zymosan) . Much higher concentrations of other antioxidants--including ascorbic acid, trolox, alpha-tocopherol, butylated hydroxytoluene, and the 5-lipoxygenase inhibitor zileuton--did not affect the production of these cytokines . The active compounds did not inhibit IL-1-induced production of IL-6 in fibroblasts, showing the cell selectivity of the effect . Antioxidant-mediated inhibition of cytokine production was correlated with low levels of the corresponding messenger RNAs . Nuclear run-on experiments showed that THP inhibited transcription of the IL-1 beta gene . THP decreased the concentration of the transcription factors NF-kappa B and AP-1 detected in nuclear extracts of PBMC cultured in the presence or absence of LPS . THP and DHA markedly decreased the levels of TNF-alpha and IL-1 beta in the circulation of mice following LPS injection . Thus antioxidants vary widely in potency as inhibitors of the activation of transcription factors and of the transcription of genes for pro-inflammatory cytokines . Coordinate inhibition of the transcription of genes for inflammatory cytokines could provide a strategy for therapy of diseases with inflammatory pathogenesis and for septic shock.

J Antibiot (Tokyo), 1994 Mar, 47(3), 334 - 41
Balhimycin, a new glycopeptide antibiotic produced by Amycolatopsis sp . Y-86,21022 . Taxonomy, production, isolation and biological activity; Nadkarni SR et al.; A new glycopeptide antibiotic, balhimycin, has been isolated from the fermentation broth of a Amycolatopsis sp . Y-86,21022 . Balhimycin belongs to the vancomycin class of glycopeptides and contains a dehydrovancosamine sugar . The biological activity of balhimycin has been compared extensively with that of vancomycin against methicillin resistant staphylococci and also against anaerobes . Balhimycin is marginally superior to vancomycin in its in vitro activity against anaerobes and in its bactericidal properties.

J Dairy Sci, 1994 Mar, 77(3), 740 - 7
Evaluation of a 1% iodophor postmilking teat sanitizer; Goldberg JJ et al.; A natural exposure field trial a with positive control was conducted to evaluate bacteriological efficacy and teat conditioning qualities of an experimental postmilking teat dip . An experimental 1% iodine postmilking teat sanitizer with a 10% emollient system was compared with a 1% iodine plus 10% glycerin teat sanitizer . Efficacy of the two sanitizers was equivalent for all new IMI, major pathogens, and environmental pathogens . The products were not equivalent for efficacy against coliforms and coagulase-negative staphylococci . Fewer coliform IMI were diagnosed in the control group than in the treatment group . Differences were determined for efficacy against coagulase-negative staphylococci in favor of the treatment product . The products were equivalent for all clinical mastitis, including previously existing IMI that became clinical . The products were not equivalent for all or new clinical IMI with major pathogens, all environmental pathogens, or coliforms . Fewer infections were diagnosed in the control group than in the treatment group . Teat end and teat skin conditions improved with the use of the triple emollient, postmilking teat sanitizer under the winter conditions experienced during this field trial.

Cesk Epidemiol Mikrobiol Imunol, 1994 Mar, 43(1), 26 - 8
{Discrimination value of tests performed with the STAPHYtest Lachema from the aspect of clinical microbiology}; Pol'an D et al.; The authors characterize individual tests of the STAPHYtest Lachema and some other selected tests by calculating their discriminating capacity on 16 types of staphylococci which are most frequently isolated in clinical microbiological laboratories . Individual tests are characterized by the separating value, as described by Gyllenberg and Rypka, the variation index of Sneath and the consistency index . As regards discrimination, tests involving fermentation of trehalose, sucrose and glycerol are of no value . Conversely more important tests are lacking--sorbitol, melisitose, ONPG, DNA-ase, arginine.

J Clin Pathol, 1994 Mar, 47(3), 283 - 5
Crystal violet reactions of coagulase negative staphylococci; Freeman R et al.; Twenty four reference strains and 112 clinical isolates of coagulase negative staphylococci (CNS) were examined for their reactions in the crystal violet test . Some species gave a white reaction and others a purple reaction . Results were consistent and reproducible and each species gave only one pattern of crystal violet reaction . Within the limited variety of species represented in the clinical isolates, Staphylococcus saprophyticus and S haemolyticus gave crystal violet purple reactions, in contrast to S epidermidis, which always gave a white reaction . Investigations suggested that the mechanism of the crystal violet test in S haemolyticus may be similar to that previously described in S aureus . Further work is needed to characterise the ability of crystal violet to modify S epidermidis and other central nervous system species . The crystal violet reaction, which has strong associations with invasiveness, phage group susceptibilities, colonisation persistence abilities, and nosocomial origin in S aureus may also be useful in studies of CNS disease.

J Med Microbiol, 1994 Mar, 40(3), 214 - 20
Multidrug resistance to antiseptics and disinfectants in coagulase-negative staphylococci; Leelaporn A et al.; The occurrence of resistance to antiseptics and disinfectants in clinical isolates of coagulase-negative staphylococci (CNS) was examined . Of 164 clinical strains of CNS isolated in the early 1980s, 65 were resistant to cationic antimicrobial compounds such as cetyltrimethylammonium bromide . Further characterisation of 40 resistant isolates by DNA-DNA hybridisation analysis and phenotypic resistance studies revealed that this resistance was mediated by the multidrug export genes qacA and qacC, characterised previously in Staphylococcus aureus . Of the resistant CNS isolates, 50% contained only qacA, 10% contained only qacC, and the remaining 40% contained both qacA and qacC . Both qacA and qacC genes resided on plasmids in all cases, with qacA located on plasmids of > 10 kb, whereas qacC was located primarily on plasmids of 2-3 kb . Representative qacA and qacC plasmids were characterised by restriction endonuclease mapping, and were found to be similar in some cases, but different in others, to those plasmids on which these genes are found in S . aureus.

J Biomed Mater Res, 1994 Mar, 28(3), 311 - 7
Adherence of coagulase-negative staphylococci to heparin and other glycosaminoglycans immobilized on polymer surfaces; Paulsson M et al.; The adherence of clinical isolates of staphylococci to surfaces immobilized with various glycosaminoglycans (GAGs) was studied . In general, cells of strains of coagulase-negative (CNS) staphylococci showed a greater adherence to polyethylene surfaces than did cells of Staphylococcus aureus, as studied by bioluminescence . When the surface was heparinized, the adherence of staphylococcal cells decreased, but CNS cells still adhered in greater numbers than did cells of S . aureus . The adherence of CNS to serum-coated heparinized surfaces was of the same magnitude, or increased compared with nonheparinized surfaces . When the surfaces were preadsorbed with different proteins with known heparin-binding domains, i.e., vitronectin, fibronectin, laminin, or collagen, the S . epidermidis cells showed higher binding to heparinized surfaces than to nonheparinized ones, and also in greater numbers than did other staphylococcal cells . Different CNS strains showed a greater ability to agglutinate polystyrene beads immobilized with heparin than did S . aureus . The adherence of S . epidermidis strain 3380 to polyethylene coated with various GAGs such as heparin and chondroitin, dextran, dermatan, and heparan sulfate was shown to be pH-dependent, with the highest adherence at pH 7.2 . This may indicate that CNS have the ability to bind to other domains of host proteins when they are adsorbed to heparinized surfaces, versus to nonheparinized ones.

Res Virol, 1994 Mar-Apr, 145(2), 111 - 21
Characterization of thirteen Staphylococcus epidermidis and S . saprophyticus bacteriophages; Bes M; Thirteen bacteriophages of coagulase-negative staphylococci belonging to the Siphoviridae family (morphotype B1) were compared by seroneutralization kinetics, protein profiles, G + C content, DNA size and DNA/DNA hybridization . A previous classification into three morphological groups was confirmed . The Staphylococcus epidermidis phage group, although morphologically homogeneous, was heterogeneous by DNA/DNA hybridization (27 to 100% homology) and seroneutralization kinetics . Two new phage "species", STA1139 (STA for Staphylococcus) and STA1154A, corresponding to two morphological types of S . saprophyticus phages, were identified . Species STA1154A was particularly interesting because the size of its capsid, only 46 nm in diameter, and of its DNA, evaluated as 13 kbp, were smaller than those of other staphylococcal phages.

J Antimicrob Chemother, 1994 Mar, 33(3), 465 - 81
beta-Lactamase types amongst Staphylococcus aureus isolates in relation to susceptibility to beta-lactamase inhibitor combinations; Bonfiglio G et al.; Relationships between beta-lactamase type and antimicrobial susceptibility were investigated for Staphylococcus aureus isolates collected recently at UK and Irish hospitals, and for reference producers of types A, B, C and D enzymes . Producers of types A and C beta-lactamases predominated amongst the isolates . Tazobactam and clavulanate combinations were studied, as previous observation showed that these inhibitors incompletely reversed the in-vitro amoxycillin and piperacillin resistance of beta-lactamase-positive staphylococci . Further penicillins and cephalosporins served as controls . Organisms with type C beta-lactamase were less susceptible than those with type A enzyme to piperacillin/tazobactam and amoxycillin/tazobactam in disc and MIC tests, and to co-amoxiclav in disc tests only . Conversely, producers of type A enzyme were less susceptible to cephazolin than those with type C enzyme . Kinetic assays showed that type A enzymes bound piperacillin and amoxycillin less tightly than did type C enzyme (higher Kmapp), and were more susceptible to inhibition by clavulanate and tazobactam (lower I50s) . However, the susceptibility to beta-lactamase inhibitor combinations for the few producers of types B and D enzymes tested could not be similarly explained by Kmapp and I50 data . It therefore seems that other factors besides beta-lactamase affinity co-determine the susceptibility of the staphylococci . Possible variables include the exact chemistry of the enzyme-inhibitor interaction, and the degree of beta-lactamase induction . Both tazobactam and clavulanate induced staphylococcal types A and C penicillinases.

Diagn Microbiol Infect Dis, 1994 Mar, 18(3), 151 - 5
Comparison of identification systems for Staphylococcus epidermidis and other coagulase-negative Staphylococcus species; Perl TM et al.; Three commercially available systems (API Staph-Trac, API 20GP, and Vitek GPI), used to identify coagulase-negative staphylococci, were evaluated against 277 bloodstream isolates, including 94 isolates of Staphylococcus epidermidis and 183 isolates of other coagulase-negative Staphylococcus species . The conventional method of Kloos and Schleifer served as the reference method . Controls included 14 ATCC type culture strains of coagulase-negative staphylococci . The API Staph-Trac system showed the highest rate of agreement with reference method, correctly identifying 73% of the isolates . The Vitek GPI System had an overall rate of agreement of 67% and the API 20GP system correctly identified 61% . The API Staph-Trac system correctly identified 94% of the isolates of S . epidermidis compared with 64% by both Vitek GPI and API 20GP . The most common error for both Vitek GPI and API 20GP systems was the failure to identify organisms contained within the database of the systems . Because none of the tested commercial identification systems identified "non-epidermidis" coagulase-negative Staphylococcus species with a high degree of accuracy, the systems need to be markedly improved or new systems developed.

Antimicrob Agents Chemother, 1994 Mar, 38(3), 447 - 54
Dissemination among staphylococci of DNA sequences associated with methicillin resistance; Archer GL et al.; DNA probes consisting of pUC19 containing cloned Staphylococcus aureus chromosomal fragments were constructed from two methicillin-resistant S . aureus strains with different DNA sequences 5' to mecA, the gene that mediates methicillin resistance . The probe from one strain, BMS1, contained a portion of the regulatory sequences (the terminal 641 bp of mecR1 and all of mecI) associated with the induction and repression of mecA transcription (pGO195) . The second probe, from strain COL (pGO198), contained DNA not found in strain BMS1 . This DNA was within the sequences added at the site of a mecR1 deletion . Genomic digests of 14 S . aureus isolates recovered between 1961 and 1969 all hybridized with pGO198 . In contrast, 78% (36 of 46) of the S . aureus organisms isolated since 1988 hybridized with pGO195 but not with pGO198; the remainder hybridized with pGO198 . No S . aureus isolates hybridized with both probes . Staphylococcus epidermidis digests hybridized with pGO198 (46%), pGO195 (14%), or both probes (35%); all 20 Staphylococcus haemolyticus isolates hybridized with pGO198 . The restriction fragment length polymorphism patterns of all pGO198-hybridizing regions in S . aureus were identical to those in strain COL . In addition, the mecR1 deletion junction nucleotide sequences of eight S . aureus and six S . epidermidis isolates were identical . However, 21 of 23 S . epidermidis and all 20 S . haemolyticus isolates had from 5 to more than 20 additional chromosomal bands that hybridized with pGO198; none of 21 S . aureus isolates had additional hybridizing bands . These data suggest that the additional DNA responsible for the mecR1 deletion was part of a repetitive, and possibly mobile, element resident in coagulase-negative staphylococci but not in S . aureus . These data also support a hypothesis that the deletion event occurred in a coagulase-negative staphylococcus with subsequent acquisition of the interrupted sequences by S . aureus.

Ann Plast Surg, 1994 Feb, 32(2), 118 - 25
Fibroblast behavior in vitro is unaltered by products of staphylococci cultured from silicone implants; Dobke MK et al.; Our previous clinical study supported the concept that capsular contracture is associated with subclinical infection of silicone implants . If bacterial presence, indeed, contributes to capsular contracture, then fibroblast behavior might be expected to change in the presence of bacteria by-products . Therefore, study of possible alteration of fibroblast behavior by bacteria products was undertaken using an in vitro model with cultured dermal fibroblasts . Coagulase-negative staphylococci from silicone mammary and penile implants were isolated and their phenotypic features were characterized . All represented nonbiofilm-producing strains . Products of isolate cultures were noncytotoxic and did not alter matrix reorganization (collagen gel contraction model) or collagen production by fibroblasts . Isolates from either mammary or penile implants exerted similar effects.

J Dairy Sci, 1994 Feb, 77(2), 446 - 52
Effect of abrasion of teat orifice epithelium on development of bovine staphylococcal mastitis; Myllys V et al.; The predisposing effect of teat damage on mastitis caused by staphylococci and the pathogenicity of Staphylococcus aureus, Staphylococcus hyicus, and Staphylococcus epidermidis were investigated with an experimental model . The study included three experiments in which the teat canal orifice of 5 cows was slightly abraded . Experimental and control quarters were challenged with a staphylococcal suspension, and the status of the quarters was monitored . Virulence of the staphylococcal strains was studied using a protein-binding test with 125I-labeled proteins (fibronectin, fibrinogen, vitronectin, collagen type I and II, and IgG) . Abrasion on the teat orifice epithelium was a predisposing factor for staphylococcal infections . Teat canal infection or colonization developed in 93% of experimental quarters and in 53% of control quarters; IMI developed in 73% of experimental quarters, but in none of the control quarters . Quarter IMI developed more consistently when the contaminating agent was S . aureus . Staphylococcus hyicus was very effective in causing teat canal infections, but S . epidermidis appeared to be less infectious . The S . aureus strain had strong binding sites for most of the proteins tested . The S . hyicus and S . epidermidis strains showed no binding, or only very weak binding, which correlated with lower infection rates.

APMIS, 1994 Feb, 102(2), 112 - 8
Staphylococcus aureus fibronectin-binding proteins (FnBPs) . Identification of antigenic epitopes using polyclonal antibodies; Rozalska B et al.; Polyclonal antibodies against recombinant fibronectin-binding proteins (gal-FnBP A and ZZ-FnBP B) of Staphylococcus aureus were analyzed by both solid-phase and solution-phase methods . These antibodies were found to bind homologous antigen and to cross-react with heterologous antigen . It was also found that antibodies recognize native FnBP on the cell surface . It has been shown, by the inhibition assay, that the majority of antibodies recognize a fibronectin-binding D1-D2 sequence of FnBP A . Anti-FnBP A Fab fails to bind the D3 sequence, though this peptide used in a solution inhibits binding of fibronectin to immobilized FnBP A, similarly to D1 and D2 peptides . Since the anti-FnBP A antibodies are able to block fibronectin binding to staphylococci by about 50%, it is reasonable to assume that the bacterial receptor has additional binding sites outside the D domain.

Kansenshogaku Zasshi, 1994 Feb, 68(2), 171 - 6
{A prospective study of septic episodes due to Staphylococcus aureus and the background of the patients}; Reshad K et al.; From January 1983 to December 1991, 94 cases of Staphylococcus aureus septicemia were identified at Matsue Red Cross Hospital and were evaluated . Methicillin-resistant Staphylococci aureus counted 49% . Seventy two percent of the patients were 60 years or over in age . Intravascular catheters were the most common foci (33%), respiratory infections in 25% and so on . Administration of antibiotics before isolation of Staphylococcus aureus were thought to be the most significant factor in producing the methicillin-resistant septicemia, used in 41% of MSSA and 91.3% of MRSA cases . Especially, the trend of unproper usage of the 3rd generation cephems derivative antibiotics had a major role in producing multi-drug resistant bacteria . No significance was seen in the clinical background, underlying diseases, primary site of infection in between the two groups of methicillin resistant and sensitive cases . Mortality due to septicemia was 47.9% in the MSSA group of patients, while it was much higher in cases of MRSA (73.9%) . In conclusion, as the administration of antibiotics even in non-infectious episodes is common in daily clinical activities in some out-patient clinics, the indications should be restricted, in order to prevent the further MRSA infections.

J Clin Microbiol, 1994 Feb, 32(2), 433 - 6
Evaluation of differential inoculum disk diffusion method and Vitek GPS-SA card for detection of oxacillin-resistant staphylococci; Knapp CC et al.; This study was conducted in order to compare the accuracy of detection of oxacillin-resistant staphylococci, defined by microdilution MICs, population analyses, and mec gene hybridization, with the Vitek GPS-SA Susceptibility Card with that of the standard inoculum (10(7) CFU) and high-inoculum (10(9) CFU) disk diffusion tests . By the standard inoculum disk diffusion test, 10 of 67 (15%) isolates of oxacillin-resistant Staphylococcus aureus and 3 of 47 (6%) isolates of Staphylococcus epidermidis were falsely susceptible after 24 h of incubation at 35 degrees C . By the high-inoculum disk diffusion test (10(9) CFU), 4 of the 10 isolates of S . aureus remained falsely susceptible, whereas none of the isolates of S . epidermidis was falsely susceptible . Of the 10 isolates of S . aureus falsely susceptible by the standard disk test, only one remained falsely susceptible after an additional 24 h of incubation at 22 degrees C . All four isolates of S . aureus that were falsely susceptible by the high-inoculum disk diffusion test after 24 h of incubation at 35 degrees C became resistant after an additional 24 h of incubation at 22 degrees C . Thus, extended incubation of both the standard and high-inoculum disk diffusion tests increased their accuracy in detecting oxacillin resistance . All isolates of oxacillin-resistant staphylococci were accurately detected with the Vitek software upgrades (6.1 and 7.1) of the GPS-SA card.

Br J Ophthalmol, 1994 Feb, 78(2), 115 - 9
Aggressive management of an epidemic of chronic pseudophakic endophthalmitis: results and literature survey; Rogers NK et al.; Six cases of chronic endophthalmitis following extracapsular cataract extraction and lens implantation are reviewed . All were referred for tertiary management by one surgeon over a period of just over 2 years . In two of the cases coagulase negative staphylococci were isolated and in three Propionibacterium spp were retrieved . In the remaining case a mixed growth of coagulase negative staphylococci and Propionibacterium acnes was cultured . The surgical management, microbiological results, and eventual visual outcome are discussed . To our knowledge, this is the first documented outbreak of chronic pseudophakic endophthalmitis with commensal organisms from a single centre.

Epidemiol Infect, 1994 Feb, 112(1), 171 - 6
Some properties of coagulase-negative staphylococci isolated from cases of ovine mastitis; Fthenakis GC et al.; Of 41 coagulase-negative staphylococcal isolates from cases of ovine mastitis, 80% were speciated by the 'API-Staph SYSTEM' and 90% by a combination of biochemical tests . Staphylococcus simulans and Staph . xylosus were the two most prevalent species.

Arch Biochem Biophys, 1994 Feb 1, 308(2), 432 - 8
Isolation and characterization of a novel 20-kDa sulfated polysaccharide from the extracellular slime layer of Staphylococcus epidermidis; Arvaniti A et al.; Slime-producing coagulase-negative staphylococci have emerged as important pathogens especially in immunocompromised hosts and patients with implanted devices . Although the extracellular slime layer is considered an important virulence factor, the chemical composition of the slime polysaccharide(s) remains unknown . The crude slime product derived from two reference Staphylococcus epidermidis strains (ATCC 35983 and 35984) and two clinical isolates was found to contain protein (11-20.5%), hexosamines (8-19%), neutral sugars (12.2-14%), phosphates (4-9.5%), uronic acids (1-13%), and small amounts of sulfates (0.5-3%) . Preparative anion-exchange chromatography separated a main carbohydrate component which was isolated by combined chromatographies on DEAE-Sephacel and Sepharose CL-6B . HPLC and electrophoreses on polyacrylamide gel and cellulose acetate membrane revealed the presence of one species of low-sulfated polysaccharide with a relative molecular mass of 20-kDa . Chemical analyses of the polysaccharide showed that it is rich in glucosamine (46%) and neutral sugars (30-34%) with small amounts of sulfates (5.7-6.5%) and glucuronic acid (2.9-3.4%) . Ten percent of the glucosamine is sulfated at the amino group . The neutral monosaccharides present are glucose, fucose, and xylose with glucose as the predominant one . It is estimated that the polysaccharide consists of 61-65 molecules of glucosamine (6-7 of which are N-sulfated), 30-35 neutral monosaccharides, 3-4 molecules of glucuronic acid, and 1-3 of fucose and xylose . Isolation and characterization of such a polysaccharide from the extracellular slime layer of S . epidermidis has not been previously reported . Its role to pathogenicity remains to be elucidated.

Eur J Clin Microbiol Infect Dis, 1994 Feb, 13(2), 148 - 52
Prevalence of antibiotic resistance among clinical isolates of methicillin-resistant staphylococci; Tripodi MF et al.; The prevalence of methicillin-resistant and multiply antibiotic-resistant staphylococci causing infections in hospitalized patients was studied over a two-year period . Among 122 clinically significant staphylococci, the prevalence of methicillin resistance was 66%, with a higher prevalence of Staphylococcus haemolyticus (85%) and Staphylococcus epidermidis (83%) observed than of Staphylococcus aureus (49%) . Multiple antibiotic resistance was observed more frequently among coagulase-negative staphylococcus (52 to 70%) than among Staphylococcus aureus (17%) . All strains of methicillin-resistant Staphylococcus aureus were susceptible to glycopeptide antibiotics and to trimethoprim-sulfamethoxazole, whereas approximately 50% of coagulase-negative staphylococci exhibited either moderate susceptibility or resistance to teicoplanin . For these latter strains, vancomycin remains the agent of choice, whereas teicoplanin cannot be recommended unless its efficacy is established by MIC determination.

J Hosp Infect, 1994 Feb, 26(2), 99 - 104
The sensitivity to chlorhexidine and cetyl pyridinium chloride of staphylococci on the hands of dental students and theatre staff exposed to these disinfectants; Millns B et al.; The aim of this investigation was to study the possible emergence of resistant isolates of the genus Staphylococcus on the hands of dental personnel who use 'Hibiscrub' (chlorhexidine-detergent preparation) and cetyl pyridinium-coated gloves . Resistance was determined by a rate-of-kill technique . In four dental student groups (first, second, third and fourth years) no microorganisms survived 30 min exposure to cetyl pyridinium chloride (CPC) or to chlorhexidine diacetate (CDA) . In a theatre staff group, no microorganisms survived 30 s exposure to CPC; and only one of 23 isolates survived 30 min exposure to CDA, but was killed after 60 min exposure . It is concluded that staphylococci resistant to either of these disinfectants do not present a problem in dental students or theatre staff.

J Invest Dermatol, 1994 Feb, 102(2), 150 - 4
Interferon gamma-treated keratinocytes activate T cells in the presence of superantigens: involvement of major histocompatibility complex class II molecules; Strange P et al.; During inflammation in the skin keratinocytes can express major histocompatibility complex class II molecules but are unable to present nominal antigens to resting T cells . Certain bacteria including staphylococci produce a new class of antigens termed superantigens that are very potent T-cell activators . Using an in vitro model with cultured normal human keratinocytes and purified allogeneic T cells, we demonstrated that major histocompatibility complex class II+ keratinocytes can activate T cells in the presence of the superantigen staphylococcal enterotoxin B . Major histocompatibility complex class II+ keratinocytes activated T cells at concentrations of staphylococcal enterotoxin B as low as 100 pg/ml . The activation required contact between keratinocytes and T cells, was inhibited with a monoclonal antibody to human leukocyte antigen DR, -DQ, and was not affected by fixation of the keratinocytes . These data show that major histocompatibility complex class II+ keratinocytes activate T cells in the presence of the superantigen staphylococcal enterotoxin B.

FEMS Microbiol Lett, 1994 Jan 15, 115(2-3), 125 - 30
Isolation and biological characterization of staphyloferrin B, a compound with siderophore activity from staphylococci; Haag H et al.; A highly hydrophilic compound with siderophore activity has been isolated from the supernatant of Staphylococcus hyicus DSM 20459 grown under iron-restricted conditions . The metabolite, named staphyloferrin B, is strictly iron-regulated and produced by a large variety of staphylococci strains . In vivo iron transport measurements and the growth-promoting activity in a bioassay establish staphyloferrin B as the second siderophore for staphylococci besides the previously described staphyloferrin A . The structure elucidation revealed 2,3-diaminopropionic acid, citrate, ethylenediamine and 2-ketoglutaric acid as structural components of the compound . Thus, staphyloferrin B is a structurally new siderophore of the complexone type.

J Med Microbiol, 1994 Jan, 40(1), 37 - 42
Attachment of staphylococci to different plastic tubes in vitro; Espersen F et al.; Adherence of 18 staphylococcal strains to 13 types of uncoated plastic tubes made from 10 different plastic materials were investigated by binding of radiolabelled bacteria in phosphate-buffered saline for 2 h at 37 degrees C . The different materials could be divided into five groups based on their ability to bind staphylococci . Lowest adhesion was found for plasticised polyvinylchloride . Simple assays for the relative binding of peroxidase-labelled human IgG or fibrinogen did not predict the result of adhesion studies . Neither bacterial surface hydrophobicity measured in a two-phase partitioning assay, nor hydrophobicity of materials (wettability) as measured by their contact angles in water correlated with bacterial adhesion . Adhesion of staphylococci to certain plastic materials was greatly influenced by the method used for sterilisation of the material.

J Leukoc Biol, 1994 Jan, 55(1), 73 - 80
Distinct patterns of differentiation induced in the monocytic cell line Mono Mac 6; Ziegler-Heitbrock HW et al.; The human Mono Mac 6 cell line exhibits many characteristics of mature blood monocytes including expression of the CD14 molecule and production of cytokines, such as interleukin-1 (IL-1), IL-6, and tumor necrosis factor . To determine whether these cells can be further differentiated, we treated the cells for up to 3 days with either prostaglandin E2 (PGE2; 10(-5) or 10(-6) M), lipopolysaccharide (LPS; 10-20 ng/ml), or tetradecanoylphorbol-13-acetate (TPA; 10-50 ng/ml) . All three reagents reduced proliferation and expression of the early myelomonocytic antigen CD33, and all increased phagocytosis of staphylococci and constitutive expression of mRNA for the macrophage colony-stimulating factor (M-CSF) receptor . By contrast, with respect to CD23 (Fc epsilon RII) expression, CD14 expression, and production of O2-, the three reagents induced distinct responses . Expression of CD23 (Fc epsilon RII) on Mono Mac 6 cells (36%) was not increased by LPS and TPA but was increased by PGE2 treatment to 48%, with a 50% increase of fluorescence intensity . The CD14 antibody My4 stained more than 75% of untreated Mono Mac 6 cells with a specific mean fluorescence intensity of 87.5 channels . This staining was increased more than twofold by both PGE2 and LPS . Staining with the CD14 antibody UCHM1 (6%) was increased to 43% by PGE2 and to 43% by LPS . This increase in CD14 cell surface expression was accompanied by a rise in soluble CD14 and enhancement of CD14 mRNA . By contrast, TPA treatment resulted in a twofold decrease of CD14 cell surface staining with no significant change in sCD14, while CD14 mRNA was transiently down-regulated . Secretion of O2- (stimulated by TPA) was already detectable in untreated Mono Mac 6 cells (6.1 mmol/10(6) cells/30 min), and this response was enhanced 10-fold by pretreatment with LPS but not with PGE2 or TPA . The kinetics of M-CSF receptor mRNA, CD14 expression, and O2- production revealed that these monocytic features started to increase at 6-24 h and were maximal at 2 days . These data suggest that the three reagents induce maturation of the Mono Mac 6 cells to different levels or into different branches of the monocyte system with the notable differences that PGE2 enhances CD23 expression, LPS enhances O2- secretion, and TPA down-regulates CD14.

Stomatologiia (Mosk), 1994 Jan-Mar, 73(1), 19 - 22
{The patient's own staphylococcal strains of nasal origin as potential causative agents of inflammatory processes in the maxillofacial area}; Diachenko IuV; Buccal mucosa was microbiologically examined in 1169 stomatologic patients, nasal mucosa (anterior segments) in 1035, and foci of involvement in 494 patients . High staphylococcal contamination of the nasal mucosa of stomatologic patients was found to be a stable parameter not depending on patients' age, sex, disease entity, or season . The intensity of oral contamination depends on a number of factors, such as age, sex, disease entity, and season, as well as the degree of nasal cavity contamination with staphylococci . These factors' effects appear to be realized via salivary antibacterial properties . Phage typing results and antibioticograms of the defected staphylococci indicate that the majority of these microorganisms contaminating the oral cavity originate from the nasal cavity . A conclusion is made about advisability of nasal cavity treatment with antistaphylococcal agents to prevent pyoinflammatory complications after surgical interventions, as well as in patients with maxillofacial injuries.

Ophthalmologica, 1994, 208(2), 77 - 81
Bacterial contamination during extracapsular cataract extraction . Prospective study on 200 consecutive patients; Egger SF et al.; Postoperative endophthalmitis remains one of the most devastating complications of eye surgery . In recent years infections with so called 'nonpathogenic' organisms like Propionibacterium acnes or coagulase-negative staphylococci have gained in importance . 200 patients were included in this study, from whom preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber (at the start and at the end of the operation) had been taken . All samples were investigated for aerobe and anaerobe microorganisms and fungi . 75% of the preoperative smears had been contaminated, with coagulase-negative staphylococci the most commonly isolated bacteria . But, in addition, 28% of the patients had culture-positive anterior chamber aspirates, also with coagulase-negative staphylococci as the most frequent organisms . In all cases inoculum sizes were extremely small (10-20 c.f.u./ml) . Probably because of this small inoculum, but also due to the bacteriocidal qualities of the aqueous humor and the integrity of the posterior capsule sac, in no case had postoperative endophthalmitis developed . For the first time, our study tried to correlate the contamination of the anterior chamber aspirate to the used operation technique: first results show that the contamination of the aqueous humor is significantly lower (p < 0.03) if the cataract extraction is performed by phacoemulsification than if done without.

Intern Med, 1994 Jan, 33(1), 45 - 7
Efficacy of steroid therapy on liver metastasis of thymic carcinoid; Hayashi R et al.; We present a 61-year-old man who was hospitalized because of dyspnea, abdominal pain and liver dysfunction accompanied by ascites due to hepatic metastasis of a thymic carcinoid 20 years after the primary tumor was excised . His symptoms and liver function were well controlled by prednisolone, 30 to 60 mg daily, for the next 2 years, with a reduction in the size of the hepatic tumors and in the accumulation of ascites . He subsequently contracted pneumonia due to methicillin-resistant staphylococci, developed disseminated intravascular coagulation (DIC) and died . Thus, prednisolone should be considered for treating patients with metastasis of a thymic carcinoid.

Transpl Int, 1994, 7(2), 101 - 8
Bacterial and fungal colonization and infections using oral selective bowel decontamination in orthotopic liver transplantations; Steffen R et al.; Bacterial and fungal infections are a major cause of morbidity and mortality after orthotopic liver transplantation . In the immunocompromised host, infections are thought to arise from the gut, which is almost always colonized with potential pathogens . Using oral selective bowel decontamination (SBD), potential pathogens can be eradicated from the gut and infections prevented . In this catamnestic study we have reviewed gastrointestinal colonization, bacterial and fungal infections, and bacterial resistance to standard antibiotics in our first 206 liver transplant patients while under SBD . With few exceptions, gram-negatives were eradicated from the gastrointestinal tract and secondary colonization was inhibited . In spite of unsatisfactory elimination of Candida, probably because nystatin doses were too low, Candida infections were rare (n = 4) and none was fatal . One and two-year survival rates were 93% and 92%, respectively . The bacterial and fungal infection rate was 27.8% with an infection-related mortality of 1.95% . Infections with aerobic gram-positive bacteria prevailed and only 11 gram-negative and 11 fungal infections occurred; among the latter, Aspergillus and Mucor were the most serious and responsible for three of the six deaths in this series . With regard to the development of resistance, we found an increasing number of enterococci and coagulase-negative staphylococci resistant to ciprofloxacin and imipenem, respectively, but unlikely as a consequence of SBD.

J Orthop Trauma, 1994, 8(1), 28 - 33
Antibiotic resistance in staphylococci adherent to cortical bone; Webb LX et al.; The surface-adherent mode of bacterial growth has been shown to play a pivotal role in the persistent nature of infections involving retained foreign bodies, biomaterials, or dead bone (e.g., osteomyelitis) . The hypothesis tested herein is that bone and implant materials--polytetrafluoroethylene (PTFE), and polymethylmethacrylate (PMMA)--provide a surface environment that promotes a type of bacterial growth characterized by an enhanced antibiotic resistance . The antibiotic resistance estimates of three staphylococcal subtypes were determined for organisms grown in an adherent state on the aforementioned surfaces as well as in their nonadherent or suspended state . Antibiotic resistance was found to vary with mode of bacterial growth . Secondly, for the staphylococcal subtypes, antibiotics and modes of growth studied herein, adherent growth on bone was associated with the most antibiotic resistance.

Eur J Clin Microbiol Infect Dis, 1994 Jan, 13(1), 86 - 9
Use of commercial particle agglutination systems for the rapid identification of methicillin-susceptible and methicillin-resistant Staphylococcus aureus; Adams J et al.; The performance of a recently introduced Staphylococcus aureus identification system (Slidex Staph-Kit) was compared with that of currently available systems (Immuno Scan Staphlatex, Staphyloslide, Staphaurex and SeroSTAT II) for the identification of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus . The new system, which detects a capsular antigen common in MRSA, performed with equal or greater sensitivity than the other systems . None of the commercial systems was adversely affected by the methicillin susceptibility of the staphylococci when isolates were recovered from non-selective media . The greatest advantage of the anti-capsular monoclonal reagent was its improved performance on isolates recovered from selective media.

Eur J Clin Microbiol Infect Dis, 1994 Jan, 13(1), 28 - 32
Evaluation of two commercial blood culture media for the detection of blood-borne pathogens; Rohner P et al.; To determine their ability to detect blood-borne pathogens, the blood culture media BCB Release (Becton Dickinson, USA) and Signal (Oxoid, UK) were evaluated on a total of 5,122 blood culture sets . Each of the two bottles was inoculated with an equal amount of blood from 2,262 patients at bedside (2.3 cultures per patient) . In the laboratory, agar-coated paddles were attached to the BCB Release bottles and the Signal device was mounted onto the Signal bottles . Both systems were incubated at 35 degrees C for seven days . A total of 608 (11.9%) sets were positive, from which 549 pathogenic microorganisms could be isolated . These could be grown significantly (p < 0.0001) more often from the BCB Release broth (n = 483) than from the Signal system (n = 384) . Mainly staphylococci, Escherichia coli and yeasts were isolated more often from the BCB Release, anaerobes were more often detected from the Oxoid Signal . The time to positivity was significantly shorter (p < 0.0001) with the BCB Release . The Signal system proved a valuable complement to the BCB Release broth.

Zentralbl Bakteriol, 1994 Jan, 280(3), 304 - 11
Susceptibility to desferrioxamines and other chelators of coagulase-negative staphylococci; Heuck D et al.; A total of 233 staphylococci and micrococci belonging to 17 species were tested for their susceptibility to desferrioxamines B, G and E, respectively . Using an agar diffusion method on iron poor media, all of the S . epidermidis, 12 out of 22 S . hominis and 5 out of 22 S . capitis strains were susceptible to desferrioxamines . Among the S . capitis strains tested, two of them were susceptible to desferrioxamine E and resistant to desferrioxamines B and G . All other staphylococci and micrococci tested were resistant to desferrioxamines B, G and E . Different susceptibility to 5 mM ethylenediaminedi-(o-phenylacetic acid) as an artificial chelator demonstrated the existence of additional iron-supplying systems in staphylococci and micrococci.

Biotech Histochem, 1994 Jan, 69(1), 31 - 7
Detection of Staphylococci in mouse phagocytic cells by in situ hybridization using biotinylated DNA probes; Matsuhisa A et al.; In situ hybridization was used to detect intracellular Staphylococcus aureus and S . epidermidis in mouse phagocytic cells after experimental infection of C3H mice with Staphylococci via abdominal or intravenous injection . Isolated ascites or whole blood were tested by the phagocyte smear technique, using bacteriolytic enzymes to preserve phagocytic cell morphology . The exposed bacterial DNA was visualized as intracellular hybridized signals by use of biotinylated DNA probes and by immunocytochemistry using streptavidin-alkaline phosphatase conjugates as detector molecules . These DNA probes, prepared from randomly cloned genomic DNA fragments of S . aureus and S . epidermidis, were strain-specific and did not cross-hybridize either in situ or on dot-blot hybridization . This technique of in situ hybridization with phagocyte smears is useful for detection and diagnosis of intracellular bacteria regardless of viability.

Zentralbl Hyg Umweltmed, 1994 Jan, 195(2), 97 - 110
{Model tests for effectiveness assay of disinfectants on surfaces . III . Dependence of test results on the type of substances and the test microbes (Staphylococcus aureus, Mycobacterium terrae)}; Peters J et al.; A new test method for surface disinfectants was applied to investigate the efficacy of the most important active components of disinfectants to Staphylococcus aureus and Mycobacterium terrae . The test germs were embedded in coagulated blood . Frosted glass served as test surface . The disinfection was performed by applying a fixed amount of the disinfectant and mixing it with the contamination by rubbing . The number of surviving germs was determined quantitatively . Generally, the two test germs showed a distinctly different behaviour towards the active substances applied . Mycobacteria proved to be clearly more resistant than staphylococci, except with formaldehyde and the cresol-soap solution . The formaldehyde, the mycobacteria were only a little more resistant, while to cresol-soap solution they were even a little more sensitive than were staphylococci . Compounds containing active chloride showed a sufficient effect on mycobacteria only if the consumption of the active component by blood was nearly excluded . The quaternary ammonium compound and glyoxal, even the high concentrations, showed a totally insufficient efficacy to mycobacteria . The results shall provide the basis for a new guideline to be established by the Federal Health Office concerning the efficacy testing of surface disinfectants effective against mycobacteria, especially tuberculosis bacteria.

Wien Klin Wochenschr, 1994, 106(1), 20 - 6
{Resistance spectrum of staphylococci at the Vienna general hospital (July to December 1991)}; Aspock C et al.; This study describes the antibiotic resistance of 1961 staphylococcal strains that were isolated at the University Hospital of Vienna from July to December 1991 . Staphylococcus aureus (SA) represented 43.2%; coagulase-negative (CNS) staphylococci 56.8%, three quarters of which were Staphylococcus epidermidis . Excepting netilmicin, the proportion of resistant strains to all antibiotics was higher with CNS than SA . Methicillin resistance (M(r)) was found in 11.8% of SA and 30.3% of CNS . Borderline oxacillin resistance (BOR) was noted in 7.4% of SA and 32.5% of CNS . It is important to note that severe or generalized infections due to M(r) staphylococci should be treated with glycopeptide antibiotics such as vancomycin or teicoplanin from the very beginning, whereas chemotherapy of those with BOR strains may also be carried out with beta lactamase-stable beta lactam antibiotics . Comparing the results of this study with those of the first half of 1991, the respective proportion of M(r) staphylococci was significantly lower than 23.6% for SA and 47.6% for CNS recorded then . As compared with the foregoing period, however, these strains demonstrated increased resistance frequencies to gentamicin (from 81.3 to 90%), amikacin (from 35.4 to 69%), netilmicin (35.4 to 55%), and ciprofloxacin (56.2 to 64%) . This is taken as an indication for the epidemic spread of a clone of resistant strains.

J Clin Microbiol, 1994 Jan, 32(1), 143 - 7
Rapid detection of methicillin-resistant Staphylococcus aureus strains not identified by slide agglutination tests; Kuusela P et al.; Seventy-nine methicillin-resistant Staphylococcus aureus (MRSA) strains, isolated during 1980 to 1990, were classified as MRSA Aggl- (14 strains) and MRSA Aggl+ (65 strains) strains on the basis of test results in slide agglutination assays designed to detect fibrinogen-binding protein (clumping factor) and protein A on the staphylococcal surface . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis revealed that lysostaphin digests of MRSA Aggl- strains contained a high-molecular-weight protein which was not detected in digests of MRSA Aggl+ strains . Immunization of rabbits with an MRSA Aggl- strain produced an antiserum which agglutinated all MRSA Aggl- strains and also 64 of 65 MRSA Aggl+ strains . Only 1 of 68 coagulase-negative staphylococci showed agglutination in this assay . The anti-MRSA Aggl- antiserum reacted mainly with a 230-kDa staphylococcal surface protein but also with a 175-kDa protein, probably formed by proteolysis of the former and a few slightly smaller proteins . These could not be immunologically detected in lysostaphin digests of MRSA Aggl+ strains . Purified antibodies reacting with the 230-kDa protein agglutinated all MRSA Aggl- strains, indicating that the protein is located on the surfaces of staphylococci . The results suggest a tentative role for the 230-kDa protein or its fragments as a novel target to develop more efficient rapid identification methods for S . aureus, including MRSA.

Clin Microbiol Rev, 1994 Jan, 7(1), 117 - 40
Update on clinical significance of coagulase-negative staphylococci; Kloos WE et al.; The clinical significance of coagulase-negative Staphylococcus species (CNS) continues to increase as strategies in medical practice lead to more invasive procedures . Hospitalized patients that are immunocompromised and/or suffering from chronic diseases are the most vulnerable to infection . Since CNS are widespread on the human body and are capable of producing very large populations, distinguishing the etiologic agent(s) from contaminating flora is a serious challenge . For this reason, culture identification should proceed to the species and strain levels . A much stronger case can be made for the identification of a CNS etiologic agent if the same strain is repeatedly isolated from a series of specimens as opposed to the isolation of different strains of one or more species . Strain identity initially can be based on colony morphology, and then one or more molecular approaches can be used to gain information on the genotype . Many of the CNS species are commonly resistant to antibiotics that are being indicated for staphylococcal infections, with the exception of vancomycin . The widespread use of antibiotics in hospitals has provided a reservoir of antibiotic-resistant genes . The main focus on mechanisms of pathogenesis has been with foreign body infections and the role of specific adhesins and slime produced by Staphylococcus epidermidis . Slime can reduce the immune response and opsonophagocytosis, thereby interfering with host defense mechanisms . As we become more aware of the various strategies used by CNS, we will be in a better position to compromise their defense mechanisms and improve treatment.

Ann Med Interne (Paris), 1994, 145(4), 234 - 7
{Synergy between tobramycin and netilmicin on three strains of methicillin and gentamicin resistant staphylococci (S . epidermidis, S . aureus)}; Ratovohery D et al.; The antibacterial effect of tobramycin-netilmicin combination on multiresistant strains of staphylococcus was performed to determine the signification of synergy images on diffusion plates . Meticillin and gentamicin resistant strains of S . epidermidis (2 strains) and S . aureus (1 strain) were examined and showed an index of combined effect < 0.05 demonstrating synergy . These values were obtained with aminoglycoside concentrations < or = 4 mg/l, levels which can be considered as pharmacologically acceptable . This synergic action can be explained by specific inhibition of the resistance enzyme in the strains, possibly in combination with a cooperative effect on the classical targets of aminoglycosides . This type of combination using tobramycin and netilmicin could define a new use of aminoglycosides based on the conception of combining antibiotic enzyme inhibition.

Vet Med (Praha), 1994, 39(7), 389 - 95
{Resistance to heavy metals in ruminal staphylococci}; Laukova A; Ruminal, coagulase-negative, urease and bacteriocin-like substances producing staphylococci were screened for their heavy metal ions and antibiotics resistance . All strains tested were resistant to disodium arsenate at a minimal inhibition concentration (MIC > 5 g/l) and cadmium sulphate (MIC > 4 g/l) . MIC = 50-60 mg/l was determined in eight staphylococci screened in mercury chloride resistance test (Tab . I) . Silver nitrate resistance was detected in seven of the bacteria used (MIC = 40-50 mg/l) . All strains were novobiocin resistant . Staphylococcus cohnii subsp . urealyticum SCU 40 was found as a strain with resistance to all heavy metal ions and 5 antibiotics (Tab . II) . In addition, this strain produced bacteriocin-like substance which inhibited growth of six indicators of different origin (Tab . II) . The most of staphylococci were detected as heavy metal ion polyresistant strains and antibiotic polyresistant strains producing antimicrobial substances with inhibition effects against at least one indicator of different origin . These results represent the first information on heavy metal ion resistance in ruminal bacteria . They also show relation or coresistance between heavy metal ions and antibiotics . Resulting from this study, staphylococci can be used as a bioindicator model for animal environmental studies . In addition, it can be used for specific interactions studies within the framework of ruminal bacterial ecosystem and also mainly with regard to molecular genetic studies.

Clin Infect Dis, 1994 Jan, 18(1), 73 - 6
Periareolar nonpuerperal breast infection: treatment of 38 cases; Giamarellou H et al.; Periareolar nonpuerperal breast infection is a troublesome entity whose treatment is still a matter of debate . Thirty-eight female patients--9 with acute infection and 29 with chronic infection--were prospectively studied over a 3-year period . Sixty isolates were harvested from 50 pus specimens obtained by fine-needle aspiration, with a predominance of staphylococci (23 isolates) and peptostreptococci (18 isolates) . On the basis of these findings, an antimicrobial regimen consisting most often of amoxicillin plus clavulanic acid was administered for 6-8 weeks . Simultaneous surgery was required in 13 cases (34.2%) . Despite a good response during therapy, 7 (21.9%) of 32 patients relapsed during a follow-up period of < or = 3 years; all 7 patients had presented with chronic infection . We conclude that prolonged therapy with agents active against both staphylococci and anaerobes is essential in periareolar breast infection; in cases with an established fistula, radical surgery (i.e., fistulotomy or fistulectomy) appears inevitable.

Arch Microbiol, 1994, 161(5), 393 - 9
Urease from Staphylococcus saprophyticus: purification, characterization and comparison to Staphylococcus xylosus urease; Schafer UK et al.; Urease from Staphylococcus saprophyticus was purified more than 800-fold by liquid chromatography reaching homogeneity, as shown by isoelectric focussing, at a maximum specific activity of 1979 U/mg . The molecular weight of the native enzyme was 420,000; it consisted of subunits with molecular weights of 72,400 (alpha), 20,400 (beta), 13,900 (gamma) in an estimated (alpha beta gamma)4 stoichiometry . In native gradient polyacrylamide gel electrophoresis urease exhibited a multiple activity band pattern with molecular weights ranging from 420,000 to 100,000 . In the native enzyme, 4.09 (+/- 0.25) atoms of nickel per molecule were detected . The N-terminal amino acids of the urease subunits were identical to those from Staphylococcus xylosus, and amino acid analysis revealed high similarities in both enzymes; no cysteine was detected after acid hydrolysis of vinylpyridinylated urease . Electron micrographs of negatively stained urease specimens from both staphylococci showed identical size and structure.

Arch Microbiol, 1994, 161(5), 370 - 83
A novel, "hidden" penicillin-induced death of staphylococci at high drug concentration, occurring earlier than murosome-mediated killing processes; Giesbrecht P et al.; In log-phase cells of staphylococci, cultivated under high, "non-lytic" concentrations of penicillin G, there occurred a novel killing process hitherto hidden behind seemingly bacteriostatic effects . Two events are essential for the appearance of this "hidden death": (i) the failure of the dividing cell to deposit enough fibrillar cross-wall material to be welded together, and (ii) a premature ripping up of incomplete cross walls along their splitting system . "Hidden death" started as early as 10-15 min after drug addition, already during the first division cycle . It was the consequence of a loss of cytoplasmic constituents which erupted through peripheral slit-like openings in the incomplete cross walls . The loss resulted either in more or less empty cells or in cell shrinkage . These destructions could be prevented by raising the external osmotic pressure . In contrast, the conventional "non-hidden death" occurred only much later and exclusively during the second division cycle and mainly in those dividing cells, whose nascent cross walls of the first division plane had been welded together . These welding processes at nascent cross walls, resulting in tough connecting bridges between presumptive individual cells, were considered as a morphogenetic tool which protects the cells, so that they can resist the otherwise fatal penicillin-induced damages for at least an additional generation time ("morphogenetic resistance system") . Such welded cells, in the virtual absence of underlying cross-wall material, lost cytoplasm and were killed via ejection through pore-like wall openings or via explosions in the second division plane and after liberation of their murosomes, as it was the case in the presence of low, "lytic" concentrations of penicillin . Bacteriolysis did not cause any of the hitherto known penicillin-induced killing processes.

Microbios, 1994, 78(316), 133 - 43
Examination of the glycocalyx of four species of Staphylococcus by transmission electron microscopy and image analysis; Lambe DW Jr et al.; The coagulase-negative staphylococci have become important pathogens in human infections involving foreign bodies . The bacterial glycocalyx is a major mediator of attachment of these organisms to medical devices, but the glycocalyx is sometimes difficult to demonstrate . A combination of the techniques of transmission electron microscopy (TEM) and image analysis enabled investigators to reveal the glycocalyx which was previously indiscernible . Eight strains of coagulase-negative staphylococci, including Staphylococcus epidermidis, S . hominis, S . lugdunensis, and S . schleiferi subspecies schleiferi, were grown, treated with anti-staphylococcal serum to stabilize the glycocalyx, and examined by TEM . Image analysis of negatives was then used to enhance the visual images which showed far more glycocalyx than previously seen by TEM alone.

Ala Med, 1994 Jan, 63(7), 12 - 4
Disc space infection; Harris LF et al.; Disc space infection or discitis, an infection of the intervertebral disc with contiguous subchondral vertebral osteomyelitis, most frequently follows prior intervertebral disc surgery or arises by hematogenous dissemination . The majority of cases are located in the lumbosacral spine and are caused by staphylococci . Clinical findings include localized spinal pain and fever . The diagnosis is suggested by radiologic studies (plain x-ray, bone scan, CT scan and MR imaging) and confirmed by culturing blood or material obtained from the involved disc space . Treatment consists of antimicrobial therapy, spinal immobilization and surgical intervention in selected circumstances . Discitis is associated with a good prognosis but residual back pain, limited spinal mobility and neurologic deficit may occur.

Adv Perit Dial, 1994, 10, 154 - 7
Carrier-status for nasal staphylococci does not predict infections in CAPD patients; Lubrich-Birkner I et al.; It has been reported that nasal carriage of staphylococci may contribute to infections of the continuous ambulatory peritoneal dialysis (CAPD) catheter exit site or cause peritonitis due to this pathogen . Recently, a nasal ointment to eradicate these bacteria in patients and staff has been marketed with the implication that this treatment may reduce infection rates . In this study, we investigated 37 patients treated with CAPD for a mean of 38.8 +/- 6.4 months . Presence of nasal carriage of staphylococci was assessed using standard nasal swab techniques and related to bacteria identified at the time of previous infections . Results were analyzed using Spearman rank order correlation and linear regression analysis . In 119.5 patient years at risk, 50 infections with staphylococci (24 episodes of peritonitis and 26 exit-site infections) were evaluated . Nineteen patients were carriers of S . aureus or S . epidermidis; 6 patients were carrying both species . There was no correlation of current nasal carriage of staphylococci with previous infection . Although 23 of 37 patients were carriers, 14 of these never had infections due to nasal staphylococci . Only in 14 of 50 infections were bacteria species the same in the nose and at the site of infection . We conclude that prospective trials demonstrating a reduction of CAPD-related infections are needed before general use of prophylactic nasal antibiotic treatment can be recommended in these patients.

Med Dosw Mikrobiol, 1994, 46(3), 133 - 44
{Use of western-blotting technique and computer analysis for comparing cellular antigens of coagulase-negative staphylococci}; Tyski S et al.; Western-Blotting technique and computer programme have been used to analyse cellular antigenic patterns of coagulase-negative staphylococci mainly of S . epidermidis and S . saprophyticus species . It was shown that antigenic pattern among strains of one species was similar . Intra strains differences are mainly quantitative . The qualitative differences concern not quantitatively dominant antigens . The main antigens of S . epidermidis and S . saprophyticus strains were of 28 and 44 kD molecular weight respectively . The antigens of molecular weight around 44, 48, 89 and 105 kD were detected in antigenic extract of strains from different species . Only one of the quantitatively dominant antigen of m . w . 48 kD, was localised in all analysed materials . The method presented here was used for the first time to analyse staphylococcal antigens . Such analysis could be performed not only for bacterial antigens.

Microbios, 1994, 79(319), 87 - 95
Effects of temperature on the bactericidal activities of ciprofloxacin and levofloxacin against Staphylococcus aureus and Staphylococcus epidermidis; Parte AC et al.; The bactericidal activities of the 4-quinolones ciprofloxacin and levofloxacin against Staphylococcus aureus and Staphylococcus epidermidis in nutrient broth were dramatically reduced when the temperature of incubation was decreased from 37 to 20 degrees C . For S . aureus the relative reduction in the activities was 86- and 46-fold with ciprofloxacin or levofloxacin, respectively . For S . epidermidis the corresponding reduction in activities was 82- and 19-fold, respectively . At infectious sites which are at lower-than-body temperature the reduced activity of 4-quinolones may contribute to clinical failure and/or the development of resistance . Levofloxacin was more bactericidal than ciprofloxacin against either of the staphylococci at every temperature tested . These results tend to suggest that levofloxacin may be preferable to ciprofloxacin for staphylococcal infections especially at skin and soft-tissue sites.

Folia Microbiol (Praha), 1994, 39(2), 112 - 4
A rapid method for the differentiation of Staphylococcus aureus hemolysins; Ruzickova V; A rapid method for the differentiation of hemolytic staphylococci is described . Instead of a beta-hemolysin monoproducing Staphylococcus culture, a test strip, soaked in a stabilized product of the S . aureus strain CCM 6188 with defined cytolytic activity, is used . The results of the rapid method can be read one day earlier than those of the conventional method . A set of 137 strains of S . aureus from various sources, including 46 enterotoxin-producing (SE-positive) ones, were examined by both methods . A higher proportion of alpha- and delta-hemolysin-producing strains was found among the SE-positive strains, while (alpha + beta)-hemolysin production prevailed among the SE-negative ones.

Infection, 1994, 22 Suppl 2, S135 - 9
Control of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) by hygienic measures in a general intensive care unit; Lingnau W et al.; Infections are a major cause of death in critically ill patients . As gram-positive organisms are more widespread and methicillin-resistant staphylococci (MRSA, MRSE) are easily distributed in overcrowded Intensive Care Units (ICU), extended hygienic procedures for infection control are most important . We hypothesize that strict regulations and educational programs for medical and nursing personnel are able to control the spread of resistant bacteria . In a four-room 16-bed medico-surgical ICU, we reinforced hygienic procedures and introduced the separation of clean postoperative and multiply injured patients from those with infectious complications, subsequent to an outbreak of MRSA in 1991 . MRSA and MRSE isolated from surveillance cultures of bronchial secretions were reduced from an annual rate of 60.0% to 37.7% and 36.4% to 6.2% respectively between the years 1991 and 1992 . Accordingly, the number of lower respiratory tract infections and the crude mortality could be reduced . We conclude that prompt implementation of control measures and continuous education of medical personnel are able to control an outbreak of infection with resistant staphylococci in an ICU setting.

Acta Microbiol Immunol Hung, 1994, 41(1), 51 - 72
Suppressed phagocytosis but promoted bacterial growth upon the effect of virus free supernatants of infected lymphocytes; Ongradi J et al.; The pathomechanism of suppressed phagocytosis and bacterial superinfections which follow viral diseases is not completely understood . Both polymorphonuclear leukocytes (PMNL) and mononuclear phagocytes (MNPh) as well as bacterial growth are controlled by several cytokines produced by other immune cells . The effect of disturbed production of cytokines on phagocytes and microbes have not been studied yet . Peripheral T lymphocytes were infected with human adenoviruses (Ad) and herpes simplex virus type 1 (HSV-1) or were activated by phytohaemagglutinin (PHA), then culture supernatants containing no infectious virus were mixed to phagocytes swallowing viable Staphylococcus aureus . Influence of supernatants on eukaryotic and bacterial cell growth was compared to cytokine assays . Supernatant mediators, different from interferon (IFN) and tumour necrosis factor (TNF), induced by oncogenic Ad-12 or HSV-1 diminished phagocytosis of both PMNL and MNPh in a dose dependent manner, promoted bacterial growth free and inside MNPh, while those of latent Ad-5 and nononcogenic Ad-8 exerted moderate effects . Plating efficiency of HEp-2 cells was decreased by all of them . Supernatants of PHA treated lymphocytes containing IFN-gamma enhanced both phagocytosis and bacterial replication free and inside MNPh, while it suppressed HEp-2 plating . Neither viruses nor PHA affected phagocytic process directly . Staphylococci inside PMNL were not affected . Presumably, production of a single mediator by infected T lymphocytes is responsible for the multiple effects . Relationship with another soluble factors is discussed.

Mycoses, 1994, 37 Suppl 1, 57 - 9
{Pulsed-field gel electrophoresis for the epidemiological analysis of yeast isolates}; Willinger B et al.; Up to now, pulsed field gel electrophoresis (PFGE) has been used successfully for the analysis of the chains of infection of multiresistant staphylococci, enterococci and other germs involved in hospitalism . The purpose of this study was to find out whether yeast isolates from mothers and those from their newborns differed in genotypes . In this investigation, 103 parturient mothers and their children were examined for colonization by yeasts in sampling the vaginal secret at delivery and by taking swabs from the oral mucosa and the anus of the children on the third day after parturition . The samples were cultured on Sabouraud glucose agar and incubated for 48 hrs at 37 degrees C . The differentiation of the isolates was done biochemically by means of the VITEK-AMS system and morphologically on rice-extract agar . Subsequently DNA-fingerprinting analysis was carried out . In 6 cases we could prove the presence of Candida spp . in the mothers as well as in their children . In all cases the strains from mother and child showed the same banding pattern . Likewise, the strains isolated out of the vaginal secretion and the vaginal epithelium of individual women were identical . The differences observed between strains isolated from various women were of low or medium degree . This shows the PFGE to be an efficient procedure to demonstrate the relation of strains derived from mothers and their newborns.

Vopr Pitan, 1994, (4), 29 - 31
{Detection of enterotoxigenic staphylococci in milk and cheese}; Kuvaeva IB et al.; The enzyme immunoassay examinations of 123 milk and cheese samples for enterotoxigenic staphylococci have revealed contamination of raw milk with coagulase-positive staphylococci producing A and B enterotoxins . "Rossiysky" cheese samples were also contaminated with S . aureus producing enterotoxins . The capacity to produce enterotoxins was found in 19.6% (21 strains) of 107 identified strains.

Appl Theor Electrophor, 1994, 4(1), 19 - 24
A classification of one-dimensional electrophoresis gels using wave packet decomposition; Zahnd A et al.; A classification of one-dimensional electrophoresis gels was achieved using a fast approximation of the Karhunen-Loeve transformation . The algorithm was based on wave packet decomposition theory, using in particular quadrature mirror filters derived from orthogonal bases of wavelets . Bacterial proteins from two different species of staphylococci were separated by SDS-PAGE electrophoresis . The gel images were analyzed by computer and the protein bands were clustered, after an orthogonal projection onto a space of lower dimension, by standard statistical methods.

Acta Microbiol Immunol Hung, 1994, 41(2), 163 - 72
Typing of coagulase-negative staphylococci isolated from immunocompromised patients; Barcs I et al.; A total of 3121 coagulase-negative staphylococcal strains sourced from clinical samples were characterized during a 4-year period . Biotype, antibiotic resistance pattern, phage pattern and slime production was determined . Plasmid profile analysis was performed on related isolates . Thirty percent of strains originated from the Bone Marrow Transplantation Unit, The National Institute of Haematology, Blood Transfusion and Immunology (NIHBTI), Budapest . Staphylococcus epidermidis occurred most frequently (48.8% in total, 58.2% source from NIHBTI) . Total bacteriophage typability was 75.9%, and 603 phage patterns were observed . NIHBTI isolates differed in the incidence of multiply resistance, slime positivity and average frequency of phage patterns from the total suggesting spread of a selected hospital population . Statistical analysis of data obtained by typing showed no predominance of any endemic clone: the strains colonizing the immunocompromised patients and isolated from staff and inanimated environment differed from each other in biotype, phage pattern, antibiotic susceptibility, slime production and/or plasmid profile.

Microbiol Immunol, 1994, 38(8), 639 - 48
Possible mechanism of action of beta-lactam-enhancing factor on methicillin-resistant Staphylococcus aureus; Tajima Y et al.; We have recently found a factor (Factor T) in aged mixtures of tungstate and phosphate which greatly enhances the antibacterial effects of beta-lactams on methicillin-resistant strains of staphylococcal species such as methicillin-resistant Staphylococcus aureus (MRSA), but shows only weak effects on methicillin-susceptible S . aureus and bacterial strains other than staphylococci . Factor T alone did not strongly inhibit cell metabolism and bacterial growth unless an excess amount was added . When Factor T was added to the culture medium beforehand, the growth of MRSA cells was rapidly suppressed just after addition of oxacillin (MPIPC) . However, the growth of the cells was inhibited gradually when these two reagents were added in reverse order . For full expression of the enhancing effect, it seemed necessary for cells of MRSA strains to be incubated with Factor T for at least 2-3 hr . When the cells were washed after being sensitized by incubating them for 5 hr with Factor T, it took approximately 1 hr for the cells to recover their resistance to MPIPC . Factor T reduced the amount of penicillin-binding protein-2' (PBP 2'), and thus sensitized the MRSA strains to beta-lactams.

Akush Ginekol (Sofiia), 1994, 33(3), 13 - 7
{The current aspects of hospital infections in maternity and neonatal wards}; Ribarova N et al.; The epidemiologic, etiologic and clinical structure of HAI in the maternity and neonatal wards in the country for the 1982-1992 period has been specified . 934 women in child-birth and 2357 neonates acquire nosocomial infections at an average annually . A comparatively constant level in HAI epidemic process intensity is observed with inconsiderable diversions in the beginning and by the end of the studied period . Staphylococci like causative agents of HAI take up a leading place in both types of wards with especially marked incidence rate among the newborn children . The predominant clinical forms in the women in child-birth are the surgical wound infections, skin and genital infections and in the neonates--the staphylodermatites, upper respiratory airway infections, pulmonary and enteric infections.

Ann Fr Anesth Reanim, 1994, 13(5 Suppl), S93 - 5
{Antibiotic prophylaxis in neurosurgery}; Djindjian M; Postoperative wound infections are a serious complication in neurosurgery . The average infection rate without antibiotics ranges between 5-11% in CSF shunts, between 2-5% in craniotomies and spinal surgery in clean and clean contaminated patients, and 11-38% in CSF fistulas . In CSF shunt procedures as well as in craniotomies, common skin commensals, mainly coagulase negative and positive staphylococci are responsible for most postoperative infections . Contradictory results of the studies evaluating the efficacy of prophylactic antibiotics (PA) make it impossible to conclude whether antibiotics have any impact on the incidence of infections or not . Nevertheless the decision to use PA must be left to each surgeon and based on own experience (the mean rate of infection decreased from 5-11% to 1% with PA in France) . In clean and clean contaminated surgery, the weight of evidence based on some large, prospective, randomized studies, suggests that PA exerts a protective effect, for which an antistaphylococci antibiotic would be appropriate . In case of methi-R organisms, a second generation cephalosporin is an alternative . Association of vancomycin-gentamicin is not recommended routinely because of the risk of development of resistance.

Acta Microbiol Pol, 1994, 43(1), 33 - 45
Occurrence, purification and properties of the staphylococcal beta-hydroxybutyrate dehydrogenase; Szewczyk E et al.; beta-Hydroxybutyrate dehydrogenase (EC 1.1.1.30.)-an enzyme involved in degradation of polymer store material-was found in staphylococci . The enzyme was isolated from Staphylococcus xylosus NCTC D100694 cells, purified and characterized . The native enzyme is a tetramer and consists of equal subunits . Its relative molecular mass is M(r) = 140 kDa and pI = 4.7 . The enzyme activity is stimulated by Mg+2 and Ca+2 ions . Staphylococcal beta-hydroxybutyrate dehydrogenase is relatively stable and active in a wide temperature range . The optimum pH for oxidation is 8.6 and for reduction 6.7 . The enzyme is highly specific for D(-)stereoisomer of beta-hydroxybutyrate . Km values for beta-hydroxybutyrate and acetoacetate are 39.1 microM and 5.47 microM, respectively.

Acta Microbiol Pol, 1994, 43(1), 21 - 31
The occurrence of siderophores in staphylococci; Lisiecki P et al.; In 180 staphylococcal strains of diverse origin belonging to 26 species a hydroxamate class siderophore was detected with chemical test . In 65% of investigated strains it was identified by biological assay as aerobactin . A correlation between hydroxamate siderophore production, species affiliation and pathogenicity was not found . In 14 (7.8%) strains a catechol class siderophore, beside aerobactin, was detected.

J Clin Microbiol, 1993 Dec, 31(12), 3170 - 3
Evaluation of Biolog for identification of members of the family Micrococcaceae; Miller JM et al.; The Biolog Identification System (Biolog, Inc., Hayward, Calif.) was challenged at two separate laboratories with 113 coded isolates, including 33 type strains of staphylococci, 5 strains of Micrococcus spp., and 1 strain of Stomatococcus mucilaginosus . Test parameters between the sites were controlled as much as possible . Discrepancies were arbitrated by using conventional biochemicals . Overall accuracies (correct to the species level) upon initial testing were 47.7 and 59.3%, respectively, at the two laboratories . After repeat testing of isolates generating "no identification" responses or errors, the overall accuracies increased to 69.0 and 74.3% at the two sites, respectively, revealing no significant difference in the final results at the two laboratories (78 of 113 versus 84 of 113; P > 0.05) . Error rates were 7.1% at one site and 9.7% at the other . The Biolog is not yet accurate enough to serve as a primary method for identifying staphylococci.

Kansenshogaku Zasshi, 1993 Dec, 67(12), 1203 - 10
{Study on mec gene in methicillin-resistant staphylococci}; Yokoyama T; Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus epidermidis and methicillin-resistant Staphylococcus haemolyticus strains which were isolated in 1992 were surveyed for distribution of mecA, mecR1 (putative mecA gene inducer gene) and mecI gene (putative mecA gene repressor gene) by the method of polymerase chain reaction (PCR) . All the 30 strains (100%) of MRSA carried mecA gene and mecR1 gene-1 (32-357 bp, closer to mecA gene) . In contrast, mecI gene (putative mecA gene repressor gene) and mecR1 gene-2 (987-1221 bp, closer to mecI gene) were detected in only 23 (73%) of the MRSA strains . By RT-PCR, the mecI gene existing in these highly resistant MRSA strains was demonstrated to remain inactivated . In 28 strains of MSSA and two strains of methicillin with MIC of 6.25 micrograms/ml, all of the mec genes (mecA, mecR1 and mecI) were not detected . In contrast, in the other three strains, which were sensitive to methicillin in spite of the presence of mecA gene and defined as MSSA, the mec genes other than mecA were detected except for one strain . Methicillin-resistant (with MIC of 12.5 micrograms/ml or more) coagulase-negative staphylococci (15 S . epidermidis and 9 S . haemolyticus) strains were surveyed as well . As results, all the mec genes mentioned above were detected in all the strains except for one of S . epidermidis, but only mecA gene in the strains of S . haemolyticus . Thus, it was found that the composition of the mec genes of methicillin-resistant S . haemolyticus were more variant from that of methicillin-resistant strains of S . aureus and S . epidermidis.

J Med Microbiol, 1993 Dec, 39(6), 450 - 3
Mupirocin resistance in coagulase-negative staphylococci; Connolly S et al.; High-level mupirocin resistance in coagulase-negative staphylococci isolated from patients undergoing peritoneal dialysis was investigated by transfer of the resistance determinants, usually in the form of a plasmid, to Staphylococcus aureus strains, cleavage of the plasmid by restriction endonuclease and hybridisation with a probe comprising a 4.05 kb EcoRI fragment of a plasmid from a S . aureus strain . In most instances the mupirocin-resistant staphylococci isolated from each patient were different according to the species, antibiogram and plasmid profile data . The mupirocin resistance determinant was carried on various plasmids as judged by EcoRI restriction fragment length polymorphisms . All hybridised at about 4 kb with the S . aureus probe.

J Med Microbiol, 1993 Dec, 39(6), 446 - 9
Probes for the study of mupirocin resistance in staphylococci; Rahman M et al.; Probes constructed from a 4.05-kb EcoRI digest fragment of a mupirocin resistance plasmid and a 751-bp internal part of this fragment hybridised with DNA from all of 36 independent high-level mupirocin-resistant staphylococci tested from seven centres; most were Staphylococcus aureus . In most instances the probes detected an EcoRI digest fragment of approximately 4 kb . Probes did not hybridise to DNA from low-level resistant strains, nor from strains sensitive to mupirocin.

No To Shinkei, 1993 Dec, 45(12), 1145 - 50
{Cranioplasty using cryopreserved autogenous bone}; Asano Y et al.; Various materials and methods can be used for cranioplasty following external decompression craniotomy . We generally use cryopreserved autogenous bone for cranioplasty following external decompression . We assessed several factors, including histological changes in the stored bone, postoperative skull X-ray changes, postoperative changes in skull morphology, and the incidence of postoperative infections . The purpose of this study was determined if our materials and preservation methods were appropriate . The subjects were 110 patients who underwent cranioplasty using cryopreserved autogenous bone following external decompression at our hospital . They were followed up for at least one year . Bone fragments removed at the time of external decompression were stored at -40 degrees C an ultra-low temperature freezer and returned to room temperature before using them for cranioplasty . Follow-up skull x-ray films were obtained for 1-10 years postoperatively . Almost all of the 46 patients showed bone union at least one year after cranioplasty, but seven patients (15%) had marked bone resorption and bone atrophy after 3 years or longer . Five of these patients had a concomitant ventriculo-peritoneal shunt . Two of them developed collapse of the skull due to bone resorption, and this was considered to have been influenced by the shunt . Epidural empyema occurred postoperatively in five patients (4.5%), and staphylococci were the causative organisms in all five cases . The infections were completely cured by removal of the bone graft, debridement of the wound, and epidural drainage . Cranioplasty following external decompression craniotomy using cryopreserved autogenous bone fragments is a simple procedure, and the materials are inexpensive . Many of our patients who underwent cranioplasty using cryopreserved autogenous bone experienced no serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)

APMIS, 1993 Dec, 101(12), 926 - 32
Influence of some plasma proteins on in vitro bacterial adherence to PTFE and Dacron vascular prostheses; Zdanowski Z et al.; The in vitro adherence of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli (one strain of each species) to commercially available, microporous polytetrafluoroethylene (PTFE) and woven Dacron vascular grafts before and after coating with human plasma was compared . Standard size segments of the materials were incubated with 35S-labeled bacteria for 0.5-18 h and, following washes, the radioactivity associated with the segment was measured . The binding of each of the tested species to native Dacron was higher than to PTFE . After coating with human plasma, however, the binding of all three species to PTFE was significantly enhanced, whereas the binding to Dacron was reduced . In addition, the influence of coating with serum albumin (HSA), immunoglobulin G (IgG), fibrinogen (Fg) or fibronectin (Fn) rather than whole plasma was tested . We found that coating with HSA reduced the binding of all three species to Dacron and of staphylococci to PTFE . IgG decreased the binding of S . epidermidis and E . coli to Dacron and of S . epidermidis to PTFE . In contrast, Fg enhanced the binding of S . aureus both to Dacron and PTFE, and that of E . coli to PTFE, but decreased the binding of S . epidermidis and E . coli to Dacron . Fn enhanced the binding of S . aureus to Dacron, and of E . coli to PTFE, but decreased the binding of S . aureus to PTFE and of S . epidermidis both to PTFE and Dacron . Thus, both whole plasma and some isolated plasma proteins were found to modulate bacterial adherence to two tested graft materials . From a clinical point of view, bacterial binding to plasma-coated rather than native materials may more adequately determine the likelihood of in vivo colonization of the various materials . Furthermore, precoating of materials with selected proteins may be of value in the prevention of graft colonization.

Antibiot Khimioter, 1993 Dec, 38(12), 21 - 8
{Semisynthetic penicillins: their importance in the current antibiotic therapy of infections . Penicillinase-resistant penicillins with predominantly antistaphylococcal action}; Navashin SM et al.; The status of isoxazolylpenicillins in the modern antibiotic therapy of staphylococcal infections is discussed from various viewpoints: the role and distribution of methicillin resistant staphylococci (MRSA), the methicillin tolerance, the clinical pharmacology and pharmacokinetics, the preferable administration routes and regimens depending on the disease severity and renal function, the prophylaxis of purulent infections, the indications to the combined therapy and possible side effects . It is indicated that one of the conditions providing the efficacy of penicillinase stable antistaphylococcal penicillins is the absolute knowledge of their properties and the joint efforts of the clinicians and bacteriologists in providing a rapid change of the drug after the detection of MRSA or methicillin tolerant staphylococci . This excludes any discredit of the drugs which are useful in the modern antistaphylococcal therapy.

Lett Appl Microbiol, 1993 Dec, 17(6), 264 - 8
The incidence of inducible macrolide-lincosamide-streptogramin B resistance in methicillin-resistant staphylococci in clinical isolates from the Eastern Cape area of South Africa; Gardee Y et al.; The incidence of inducible macrolide-lincosamide-streptogramin B resistance in methicillin-resistant staphylococci in clinical isolates from the Eastern Cape area of South Africa is shown to be higher than might be expected . A significant difference in the frequency between different hospital and different population groups was identified . RAPD fingerprinting of the strains suggests that this difference is mirrored in the presence of different Staphylococcus aureus strains in the different hospitals . It is proposed that the significantly higher level of overcrowding in certain hospitals in worsening the problem of multiple antibiotic resistance in the Eastern Cape.

Presse Med, 1993 Nov 20, 22(36), 1815 - 7
{Continuous infusion of vancomycin in post-neurosurgical staphylococcal meningitis in adults}; Brinquin L et al.; Eight adult patients with post-surgery meningitis caused by methicillin-resistant staphylococci were treated with continuous intravenous infusion of vancomycin in mean doses of 50 mg/kg/day . This treatment, which lasted 3 to 6 weeks, was well tolerated by the kidneys and resulted in cure in all cases; its effect on the ear was not evaluated . Stable concentrations of 4 to 7 mg/l in cerebrospinal fluid were obtained after the 48th hour of treatment.

Ugeskr Laeger, 1993 Nov 8, 155(45), 3650 - 4
{Peritonitis in patients undergoing continuous ambulatory peritoneal dialysis . Evaluation of cephalothin/cephalexin monotherapy as initial treatment}; Hornstrup MK et al.; To evaluate the initial antibiotic regime of cephalothin monotherapy in the treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD), the frequency of peritonitis was registered retrospectively together with the frequency of recurrent episodes and change of antibiotic . A median frequency of 0.96 episodes per year of dialysis was found . In 24% of the episodes no microorganism was cultured . 82% of the microorganisms were gram-positive cocci, 17% gram-negative rods . The frequency of recurrent episodes was 7% . The initial antibiotic treatment with cephalothin had to be changed in 33% of the cases due to microbial resistance . In another 33% the antibiotic treatment was changed to something with a narrower spectrum . More than one third of the resistant microorganisms were methicillin-resistant coagulase-negative staphylococci . With quick and reliable microbiological diagnostic technique that makes it possible to change the antibiotic treatment early, we find cephalothin to be a suitable initial monotherapy.

Zentralbl Bakteriol, 1993 Nov, 279(4), 537 - 43
Identification of staphylococci from bovine milk in Argentina; Rampone H et al.; Two hundred and thirty three strains of staphylococci isolated from bovine milk from 17 dairies in Argentina were classified into 16 species . Most of the strains (78%) belonged to 4 species; S . aureus, S . haemolyticus, S . hominis, and S . warneri (38.5, 20.5, 9.4 and 9.0%, respectively) . The remaining 12 species appeared with low frequencies . Twenty-one of the strains were isolated from mammary quarters with signs of clinical mastitis . The majority of the milk samples infected with S . aureus or S . haemolyticus showed very high somatic cell counts.

J Burn Care Rehabil, 1993 Nov-Dec, 14(6), 589 - 94
Burn care in Africa: reducing the misery index: the 1993 Everett Idris Evans Memorial Lecture; Sowemimo GO; Burn care in Africa is hampered by inadequate facilities, inadequate infrastructure, and inadequately trained staff . Burn units with burn teams are few . Burn injuries carry a high mortality rate with delayed healing and high complication rates among survivors . Most burns occur in the home from flame and scalding, and children are more affected than adults . Burn sepsis is mostly from staphylococci and pseudomonas . Various studies on epidemiology, sepsis, protein metabolism, and repigmentation indicate methods of prevention and improved care, including greater resort by surgeons to skin grafting, which speeds healing and both prevents and treats scarring, contractures, and depigmentation . Governments, industries, and entrepreneurs are exhorted to promote burn prevention, research, improved care, and rehabilitation, particularly through the establishment of burn units with burn teams, to reduce the misery and suffering caused by the high mortality and morbidity from burns in Africa.

Cesk Pediatr, 1993 Nov, 48(11), 675 - 7
{Polymicrobial infections in recurrent tonsillitis and adenoiditis in children}; Virgala J et al.; Bacteriological examination focused on the aerobic and anaerobic flora from ectomized tonsils in 17 patients with recurrent tonsillitis, in 8 patients with hypertrophy of the tonsils and 122 children with an adenoid vegetation confirmed microbial aetiology . In ectomized tonsils and adenoids aerobic gram-positive bacteria comprised most frequently staphylococci, and gram-negative bacteria H . influenzae . As to anaerobic gram-positive bacteria, they isolated most frequently peptostreptococci, and as to gram-negative ones B . fragilis from tonsils and Bacteroides sp . from adenoids . In the treatment of recurrent infections of the upper respiratory pathways it is important to use preferentially aminopenicillins combined with beta-lactamase inhibitors and lincosamides.

J Clin Immunol, 1993 Nov, 13(6), 424 - 38
Analysis of high and low responses to Staphylococcus aureus and interleukin 2 in human B lymphocytes; Peckham DW et al.; Fixed protein A-bearing staphylococci (SAC) stimulate human B cells via surface Ig, whereas IL-2 has been reported to provide a sufficient second signal for proliferation and differentiation . Using an ELISPOT assay to count cells secreting IgM, IgA, and IgG and flow cytometry with acridine orange to assess cell cycle progress, we have found that the purified B lymphocytes of a substantial minority (5/13) of healthy volunteers with normal serum Ig levels failed to differentiate to Ig secreting cells (ISC) in response to SAC + IL-2 (IgM, IgA, or IgG secreting cells, < 5% of input B cells) . High-responders generally formed 10-35% ISC . The proportions of B cells expressing IgG, IgA, IgM, or IgD were not different in the two groups . By average linkage cluster analysis, SAC/IL-2 high- and low-responders were shown to fall into two separate populations with respect to ISC . High- and low-responders tended to remain in the same group with repeated testing over several months, although some convergence was seen . The low-responders also showed significantly less advancement to late G1 and S phase than the high-responders, in the presence of SAC +/- IL-2 . Induction of IL-2 receptors on B cells by SAC + IL-2 was much greater in high-responders than in low-responders, as shown by flow cytometry with phycoerythrin-conjugated IL-2 . However, SAC + IL-2 induced transferrin receptors normally in low-responders, showing that some early activation steps occur in these cells . Low-responder B cells often improved their responses in the presence of macrophages and T cell supernatants . Finally, bypassing the surface Ig pathway using anti-CD3-activated T cells to stimulate B cells produced normal differentiation in low-responder B cells . Thus a subset of clinically normal individuals possesses B cells which fail to express IL-2 receptors, proliferate, and differentiate normally in vitro in response to SAC + IL-2 yet can respond well to alternative activation pathways via T cells, monocytes, and their products.

Antimicrob Agents Chemother, 1993 Nov, 37(11), 2401 - 6
Use of intravenous rifampin in neonates with persistent staphylococcal bacteremia; Tan TQ et al.; Ten neonates with persistent staphylococcal bacteremia (positive blood cultures for > or = 5 days despite appropriate antibiotic therapy) received intravenous (i.v.) rifampin in combination with vancomycin with or without aminoglycoside . Their mean birth weight and length of gestation were 900 g and 27 weeks, respectively . Their ages at the time of infection ranged from 6 to 64 days (mean, 26 days) . The staphylococcal isolates were methicillin-resistant Staphylococcus aureus (five isolates), methicillin-susceptible S . aureus (two isolates), and coagulase-negative staphylococci (three isolates) . The mean number of bacteremia days prior to administration of i.v . rifampin was 8.3 (range, 5 to 15 days), despite a mean peak vancomycin concentration of 33 micrograms/ml . The dosing of rifampin varied from 2.5 to 10 mg/kg of body weight every 12 h . The mean duration of the rifampin course was 9.7 days (range, 3 to 16 days) . Of the 10 neonates, 8 (80%) had sterile blood cultures within 24 h, 1 (10%) had a sterile blood culture within 48 h, and 1 (10%) had a sterile blood culture within 5 days of being placed on i.v . rifampin . No adverse effects were noted in this small group of infants . Seven of the 10 neonates survived; three died from unrelated complications . The MIC ranges of amikacin, vancomycin, and rifampin for the isolates were 2.0 to 16, 0.5 to 2.0, and 0.0013 to 0.04 micrograms/ml, respectively . We also studied eight infants, with a mean age of 23 days, who were receiving i.v . or oral rifampin at a dose of 10 mg/kg/day . For i.v . administration, the peak serum concentration of rifampin (mean +/- standard deviation) was 4.02 +/- 1.22 microgram/ml . The mean trough level at 12 h postifution was 1.11 +/- 0.48 micrograms/ml . For oral administration, the concentrations of rifampin in serum ranged from 0.59 to 2.86 micrograms/ml (mean, 1.86 +/- 0.96 microgram/ml) at 2 h postingestion, increasing to a peak concentration of 2.8 micrograms/ml at 8 h postingestion . The mean 12-h postingestion level was 0.77 +/- 0.03 microgram/ml . From the study of this limited series of neonates, rifampin appears to be a safe and effective addition to therapy when staphylococcal bacteremia is persistent despite vancomycin treatment.

Rinsho Byori, 1993 Nov, 41(11), 1223 - 31
{MRSA--detection of mecA and its regulatory genes}; Kagawa S et al.; Methicillin resistance in S.aureus and S.epidermidis strains is primarily due to production of a new penicillin-binding protein PBP2' with extremely low binding affinity to most beta-lactam antibiotics . The structural gene for PBP2', mecA, is detectable in clinical specimens by using the polymerase chain reaction (PCR) . Amplified target DNA of 630bp can be resolved on ethidium bromide-stained gels, and hybridized with a probe conjugated to alkaline phosphatase . Survey for the mecA gene in 304 staphylococci revealed a good correlation between the presence of mecA and cultivation on agar plates with 4 micrograms/ml of oxacillin, although 3% of sensitive S . aureus strains had the mecA gene . On the other hand, analysis of the regulatory genes (orf 1 and 2) of methicillin resistance was performed on methicillin-resistant S.aureus strains N315 and MR108, demonstrating that the genome of MR108 lacks orf 2 which encodes the repressor protein (Hiramatsu et al., see Ref.5) . The regulatory genes of mecA were surveyed for 192 staphylococci by using PCR and allele-specific oligonucleotide probes: 76% of resistant S . aureus strains and 48% of resistant S . epidermidis strains possessed orf 1 corresponding to MR108 (constitutive-type strain), while the remainder of the resistant strains and two strains of sensitive S . epidermidis had two orfs of N315 (inducible-type strain) . Furthermore, it appeared that mutation of the femA gene might not be an additional factor for expression of methicillin resistance . These observations suggest that mecA and its regulatory genes should be examined to understand how the genetic background contributed to the phenotypic expression of methicillin resistance in clinical strains.

Clin Infect Dis, 1993 Nov, 17 Suppl 2, S527 - 36
Emerging antimicrobial resistance and the immunocompromised host; Shlaes DM et al.; Infections caused by gram-positive bacteria have become the most important cause of infectious morbidity among some groups of immunocompromised patients over the last decade . Among the gram-positive bacteria, the emerging problems of resistance to antimicrobial agents include the development of resistance to beta-lactam and aminoglycoside drugs among the enterococci, making synergistic bactericidal therapy impossible; the continued spread of methicillin-resistant staphylococci; resistance to both vancomycin and teicoplanin among enterococci and staphylococci; the emergence of intrinsically vancomycin-resistant species as important pathogens; and resistance to the fluoroquinolones . It is unlikely that new therapeutic classes of antibacterial drugs will be released this decade . Therapeutic alternatives now include unusual combinations of antibiotics to which the strains may appear resistant but that exhibit synergistic activity, although this area has not yet been thoroughly explored . Therefore, control of emergence and spread of resistance through the more judicious use of existing agents, good infection control practices, and the use of imaginative combination therapy for those infected with resistant strains seem to be our best alternatives.

J Trauma, 1993 Nov, 35(5), 742 - 9
The frequency of bacteremia and fungemia following wound cleaning and excision in patients with large burns; Vindenes H et al.; Twenty-eight patients with large burn injuries (mean total body surface area burned, 47.1%) who underwent 112 wound cleaning and staged early excision procedures were studied prospectively for bacteremia and fungemia induced by wound manipulation . The patients were given an aminoglycoside preoperatively, perioperatively, and postoperatively . Blood samples were obtained immediately before removal of dressings, after wound cleaning, after 30 minutes of surgery, at the end of each procedure, and 1 hour after surgery was completed . In a group of control patients blood samples were obtained immediately before the dressings were removed, after wound cleaning was completed, and 1 hour afterward . In a second group of control patients blood samples were obtained serially while the burn wounds remained undisturbed . None of the control patients received prophylactic aminoglycosides . Induced bacteremia or fungemia was documented in 50 instances of burn wound cleaning and excision; 31 cases of bacteremia or fungemia occurred after wound cleaning alone . Spontaneous bacteremia, i.e., that occurring in the absence of burn wound manipulation, was demonstrated in 3 of 18 blood culture series, whereas induced bacteremia was observed after 11 of the 17 burn wound cleaning procedures alone . The frequency of bacteremia tended to be higher for patients with inhalation injury than for those with no lung involvement . However, lung infection did not seem to account for many of the positive results of blood culture in this study . In contrast, burn wound infection contributed significantly to both spontaneous and induced bacteremia or fungemia . The micro-organisms most frequently isolated were staphylococci (50%) and enterococci (15.1%).(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Orthop, 1993 Nov, (296), 192 - 9
Comparison of tuberculous and pyogenic spondylitis . An analysis of 122 cases; Buchelt M et al.; One hundred twenty-two patients with tuberculous or pyogenic spondylitis were investigated retrospectively . Patient histories, laboratory tests, and radiographic findings were compared statistically between the two groups . Significant differences were calculated for the interval between onset of symptoms and diagnosis, erythrocyte sedimentation rate, mean vertebral loss at discharge, and sclerosis of the vertebral bodies involved . Open or closed biopsy was performed in 91 patients . The result provided a clear distinction between tuberculous and pyogenic spondylitis in 62.2%, either by means of histology or by culture growth . In pyogenic spondylitis, staphylococci were the most predominant bacteria isolated . Neurologic deficits were demonstrated in 17.8% of patients with tuberculous spondylitis and 22.7% with pyogenic spondylitis . At follow-up examinations, only two patients still had a motor deficit . Additionally, pain, gibbus formation, and bony fusion were evaluated, but no significant differences were found . The combination of several unspecific findings such as patient history, erythrocyte sedimentation rate, and radiographic assessment can lead to the correct diagnosis . A definitive diagnosis is established by means of biopsy, histologic evidence, and bacterial culture.

Eur J Epidemiol, 1993 Nov, 9(6), 658 - 62
In vitro activity of ceftriaxone and other cephalosporins against 602 clinical isolates of staphylococci from geographically diverse medical centers; Pfaller MA et al.; The in vitro activity of ceftriaxone and six additional antimicrobial agents (ceftizoxime, cefoperazone, cefuroxime, fleroxacin, ciprofloxacin, and trimethoprim/sulfamethoxazole) was assessed or 602 recent clinical isolates of staphylococci from six geographically distinct medical centers in North America . All seven antimicrobial agents were active (90-100% of strains susceptible) against oxacillin-susceptible (OS) strains of Staphylococcus aureus (OSSA) and coagulase-negative staphylococci (OSCNS) but had limited activity against oxacillin resistant (OR) staphylococci . Our assessment of the in vitro antistaphylococcal activity of ceftriaxone against contemporary isolates of Staphylococcus aureus and coagulase-negative staphylococci indicates that the activity versus OS staphylococci has not changed over the past decade despite widespread use of the drug . It appears that these agents will continue to be useful for empiric therapy in those centers in which OR strains are uncommon.

Infection, 1993 Nov-Dec, 21(6), 407 - 9
MIC and serum bactericidal activity of clindamycin against methicillin-resistant and -sensitive staphylococci; Lemmen S et al.; Six volunteers were given 600 mg clindamycin intravenously to investigate the serum bactericidal activity (SBA) against 50 methicillin susceptible (MSSA) and 50 methicillin resistant Staphylococcus aureus (MRSA) strains . Minimal inhibitory concentrations (MIC) against MSSA, MRSA and 50 methicillin resistant strains of Staphylococcus epidermidis (MRSE), of which 50% were slime-producing, were determined . SBA of clindamycin against MSSA and MRSA was equally high (mean reciprocal SBA titer against MSSA vs MRSA 1 h after application was 13.0 vs 13.45), although MICs against MRSA were markedly higher than against MSSA (MIC 90 of MRSA vs MSSA: 0.06 vs > 32 mg/l) . There was no difference in MICs between slime- and non-slime-producing MRSE.

J Antimicrob Chemother, 1993 Nov, 32(5), 695 - 703
The entry of meropenem into human macrophages and its immunomodulating activity; Cuffini AM et al.; The uptake of meropenem by human macrophages and its consequences upon subsequent phagocytosis and killing of intracellular staphylococci has been studied . The cellular to extracellular concentration ratios (C/E) of meropenem were always high (range 3-12) at extracellular concentrations ranging from 0.125 to 1 mg/L . The uptake was not energy-dependent, being similar when viable and formalin-killed cells were used and was influenced neither by environmental temperature nor by the addition of a metabolic inhibitor . Meropenem at half the MIC caused a significant enhancement of phagocytosis and a reduction in the survival of intracellular Staphylococcus aureus . Pre-exposure of either staphylococci or macrophages to sub-MIC concentrations of meropenem led to an increase in uptake of bacteria and intracellular bactericidal activity by macrophages.

Acta Paediatr, 1993 Nov, 82(11), 939 - 43
Exchange transfusion in neutropenic septicemic neonates: effect on granulocyte functions; Mathur NB et al.; Depletion neutropenia caused by overwhelming bacterial infection is associated with fatal outcome and is an objective indicator of the severity of sepsis . Studies on controlled evaluation of exchange transfusion in the management of severe neonatal sepsis have not considered neutropenia as an inclusion criterion, and randomized, controlled trials on evaluation of neutrophil functions after exchange transfusion are scarce . This prompted us to carry out the present study . Septicemic neonates were enrolled if they had neutropenia and were randomized to undergo exchange transfusion (study group, n = 20) or not (controls, n = 10) . Granulocyte functions were assessed using the nitro blue tetrazolium (NBT) reduction test and the staphylococcidal index . Blood was drawn for granulocyte function tests once from controls and donors, and before, immediately after and 6 h after exchange transfusion in the study group . Mortality was 35% in the study group and 70% in controls . Gram-negative organisms accounted for 80% in the study group and 90% in controls . Mean total leukocyte count and neutrophil count increased significantly immediately after exchange transfusion and 6 h later . Absolute band count decreased significantly immediately after exchange transfusion and increased 6 h later . NBT reduction in septicemic neonates in the study group, as well as in controls, was significantly decreased as compared to donor cells . NBT reduction improved significantly immediately after exchange transfusion and 6 h later . The values of the percentage of viable staphylococci recovered from neutrophils also improved significantly immediately after exchange transfusion and 6 h later.(ABSTRACT TRUNCATED AT 250 WORDS)

Ophthalmology, 1993 Oct, 100(10), 1468 - 74
Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies . National Eye Trauma System; Thompson JT et al.; PURPOSE: To determine the risk factors and prognostic indicators of infectious endophthalmitis in eyes with penetrating injury and retained intraocular foreign body . METHODS: From the National Eye Trauma System (NETS) Registry, 492 eyes with intraocular foreign bodies were reviewed for signs of infectious endophthalmitis . RESULTS: Thirty-four eyes (6.9%) with intraocular foreign bodies had evidence of infectious endophthalmitis, and 31 (91.2%) of those eyes had signs of infection at the time of removal of the intraocular foreign body . The majority of eyes with an intraocular foreign body with or without endophthalmitis were in patients between 10 and 39 years of age, but the risk of endophthalmitis developing increased with age, especially in patients 50 years of age or older with delayed primary repair (P = 0.005) . Endophthalmitis was more likely to develop in eyes with home or occupational injuries (33/358, 9.2%) than in those with injuries from other settings (1/128, 0.8%; P = 0.001) . Infectious endophthalmitis was much less likely to develop in eyes with primary repair within 24 hours of the injury (10/287 = 3.5%) than in eyes with primary repair more than 24 hours after the injury (22/164, 13.4%; P < 0.0001) . Bacilli or staphylococci were isolated in 21 (95%) of 22 eyes with positive cultures . Visual prognosis was reasonably good with 15 (58%) of 26 eyes attaining a visual acuity of 20/200 or better . CONCLUSIONS: Removal of a retained intraocular foreign body within 24 hours of injury markedly reduces the risk of infectious endophthalmitis developing . Older persons are at high risk for endophthalmitis developing after retaining an intraocular foreign body when there is delayed surgical repair.

Infect Immun, 1993 Oct, 61(10), 4167 - 72
Induction of release of tumor necrosis factor from human monocytes by staphylococci and staphylococcal peptidoglycans; Timmerman CP et al.; The role of cytokines in gram-positive infections is still relatively poorly defined . The purpose of this study was to establish whether or not intact staphylococci and purified peptidoglycans and peptidoglycan components derived from staphylococci are capable of stimulating the release of tumor necrosis factor (TNF) by human monocytes . We show here that intact staphylococci and purified peptidoglycans, isolated from three Staphylococcus epidermidis and three S . aureus strains, were indeed able to induce secretion of TNF by human monocytes in a concentration-dependent fashion . TNF release was detected by both enzyme immunoassay and the L929 fibroblast bioassay . In the enzyme immunoassay, a minimal concentration of peptidoglycan of 1 micrograms/ml was required to detect TNF release by monocytes, whereas in the bioassay a peptidoglycan concentration of 10 micrograms/ml was needed to detect a similar amount of TNF release . Peptidoglycan components such as the stem peptide, tetra- and pentaglycine, and muramyl dipeptide were unable to induce TNF release from human monocytes.

Clin Infect Dis, 1993 Oct, 17(4), 701 - 4
Breast abscess: coagulase-negative staphylococcus as a sole pathogen; Surani S et al.; Breast abscesses in nonlactating women are very uncommon . Rarely have cases been reported in which coagulase-negative staphylococci have been isolated in pure culture . We describe a 67-year-old patient who had such an abscess . Specimens obtained by fine needle aspiration, incision and drainage, and biopsy of the breast mass all showed acute inflammation and many gram-positive cocci on gram stain and histologic examination; cultures of all specimens yielded many coagulase-negative staphylococci . The patient responded well to incision and drainage and therapy with antibiotics.

New Microbiol, 1993 Oct, 16(4), 351 - 7
Enterococci and staphylococci isolates from rumen of fallow deers and their antimicrobial activity; Laukova A; This work presents enterococci and staphylococci isolated from the rumen content of fallow deers, their characteristics and antimicrobial activity . On the basis of biochemical tests, strains isolated were allotted to the species Enterococcus solitarius, E . malodoratus, Staphylococcus warneri, S . aureus, S . sciuri subsp . sciuri and S . xylosus . All strains produce lactic acid in the range from 0.303 to 0.500 mol.l-1 . Isolated strains were found to be resistant or sensitive to the antimicrobial additives screened . Most isolates showed antimicrobial activity against both Gram-positive and Gram-negative test organisms reaching clear zones of inhibition (diam . 2-5 mm) with bacteriocidic effect.

Antimicrob Agents Chemother, 1993 Oct, 37(10), 2159 - 65
Analysis of pristinamycin-resistant Staphylococcus epidermidis isolates responsible for an outbreak in a Parisian hospital; Loncle V et al.; In 1990, over a 6-month period, an increase from 1 to 10% in the incidence of pristinamycin resistance among coagulase-negative staphylococci was observed in four intensive care units of a Parisian hospital . Twenty-three such isolates, as well as 25 pristinamycin-susceptible Staphylococcus epidermidis isolates, were collected and typed by analyzing various bacterial constituents . Two structurally related plasmids of 7.3 and 14.3 kb, carrying the gene vga encoding resistance to pristinamycin, were detected in the 23 pristinamycin-resistant coagulase-negative staphylococci which were identified as S . epidermidis . Although related by numerous common characteristics, 20 of these 23 isolates could be divided into two types, A (17 isolates) and B (three isolates) . These types were characterized on the basis of their plasmid contents and hybridization patterns obtained when the EcoRI-digested DNA was probed with plasmid pIP1551 containing an internal fragment of the insertion sequence IS256 . These findings suggest that the dissemination of type A epidemic strains was, in large part, responsible for the outbreak.

Rinsho Byori, 1993 Oct, 41(10), 1159 - 66
{Detection of methicillin-resistant Staphylococcus aureus using PCR and non-radioactive DNA probes (II)}; Muraki C et al.; Methicillin resistance in staphylococci is primarily due to the presence of a mec A gene which encodes the novel penicillin-binding protein 2' . Some chromosomal factors, fem A and fem B, also participate in the expression of methicillin resistance in S . aureus . This study was designed to detect mec A, fem A and fem B genes for identification of staphylococcal species and for discrimination of methicillin-resistant cells . Three different pairs of DNA primers (PBP2'AF-PBP2'AR, fem AF-fem AR and fem BF-fem BR) complementary to unique regions of mec A, fem A and fem B genes were synthesized for use in polymerase chain reaction with DNAs of methicillin-sensitive S . aureus (MSSA), S . epidermidis, methicillin-resistant S . aureus (MRSA) and S . epidermidis . Amplified target DNAs of 630, 509, and 651 bp were resolved on ethidium bromide-stained gel, and hybridized to DNA probes conjugated to alkaline phosphatase . When applied to pure cultures on the MRSA screen agar, all three DNA probes tested detected MRSA in 47 of 61 culture-positive specimens (77.1%); the detection ratio of MRSA with mec A and either fem A or fem B probes was increased to 95.9% . By contrast, the fem A and fem B probes did not detect S . epidermidis . The result of detecting these species streaked on mannitol-salt agar were similar, while the detection of MSSA with the fem A and fem B probes was incomplete irrespective of the presence or absence of mec A . These findings suggest a good correlation between cultivation and DNA probe assay with respect to MRSA detection.

J Clin Microbiol, 1993 Oct, 31(10), 2683 - 8
Two percent sodium chloride is required for susceptibility testing of staphylococci with oxacillin when using agar-based dilution methods; Huang MB et al.; The need to add NaCl to agar media to ensure accuracy of results when testing staphylococci with oxacillin was investigated . The results of four antimicrobial susceptibility testing methods (agar and broth dilution, E test, and disk diffusion) in which the growth medium contained 0, 2, 4, or 5% NaCl were compared with the results of a hybridization assay using a mec gene probe . We tested 223 strains of staphylococci, 128 of which were mec gene positive . A total of 7 of the 128 positive strains were coagulase-negative staphylococci with 24-h oxacillin MICs of < or = 2 micrograms/ml . Ninety-five isolates were mec gene negative, including seven strains of Staphylococcus aureus with oxacillin MICs of > or = 4 micrograms/ml . The oxacillin MICs for mec gene-positive, oxacillin-resistant strains of staphylococci increased two- to fourfold with the addition of NaCl to the test medium, while the MICs for mec gene-negative strains did not change in the presence of added salt . Very major error rates for the agar dilution and E test methods in the absence of salt ranged from 18.2 to 20.2% . Major error rates for mec gene-negative S . aureus isolates were > 17% for all test methods when 4 or 5% NaCl was added to the test medium . The addition of 2% NaCl to Mueller-Hinton agar for testing of oxacillin resulted in very major error rates of < 1% for the agar dilution and E test methods although the major error rates for the two methods with added NaCl were 8.5 and 6.9%, respectively . The disk diffusion test did not perform well in this study, showing essential error rates of > or = 18.3% . We recommended the addition of 2% NaC1 to Mueller-Hinton agar when testing staphylococci with oxacillin by either the agar dilution or E test method . NaC1 should not be added for the disk diffusion test.

Int J Syst Bacteriol, 1993 Oct, 43(4), 813 - 8
Micrococci demonstrate a phosphatase activity which is repressed by phosphates and which can be differentiated from that of staphylococci; Satta G et al.; The phosphatase activities of 114 micrococcal strains belonging to seven different species and of an additional 150 unspeciated micrococcal strains were evaluated on solid media at various pHs containing or not containing phosphates . In the presence of phosphates, only nine strains (five unspeciated strains, one Micrococcus luteus strain, and three Micrococcus varians strains) yielded a positive reaction on plates at pH 8 . In media (at pH 8) deprived of phosphates, in contrast, all but 15 strains demonstrated clear-cut phosphatase activity . Acid phosphatase could not be evaluated on solid media since none of the strains grew satisfactorily on plates at pH 5 . The phosphatase activities of seven (one or two for each species, which included phosphatase-negative strains) of the strains whose colonies proved phosphatase negative at pH 8 and of 18 (two or three strains per species) of those with phosphatase-positive colonies were evaluated at pH 5 and 8.5 in toluene-treated cells which had been grown in liquid media at pH 7 containing or not containing phosphates . All strains demonstrated distinct phosphatase activity at both pHs when grown in media not containing phosphates . In contrast, when strains were grown in the presence of such substances, virtually no activity was observed at pH 8.5, and, generally, a much reduced activity was observed at pH 5 . The phosphatase activity of micrococci of the various species (three to eight strains per species) was also compared with that of staphylococci of different species (5 to 10 strains per species) by the methyl green-phenolphthalein diphosphate method, the sensitivity of which can be varied by using different enzyme substrates.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1993 Sep, 31(9), 2396 - 401
Automated interpretation of disk diffusion antibiotic susceptibility tests with the radial profile analysis algorithm; Hejblum G et al.; An original algorithm referred to as the radial profile analysis algorithm was implemented on a Macintosh Quadra 700 computer to provide an automatic determination of the inhibition zone diameters of antibiotic susceptibility tests performed with the disk diffusion method . After digitization of the petri plate image, each antibiotic disk is recognized and labeled . Pixels of the local zone around each disk are then used for generating a profile pattern that is subjected to decision rules . The resulting estimate of the inhibition zone diameter is then automatically compared with conventional breakpoints for classifying the tested strain in one of the clinical categories of antibiotic susceptibility . The program is also able to request a human reading for some rare plates difficult to interpret . The algorithm accuracy was tested by comparing the results with a combination of independent human measurements performed on the tested plates . The test sample was composed of 98 strains, and 2,552 tests of 40 distinct antibiotics were subjected to the analysis . The difference between the automatic and human diameter estimates was less than 4 mm in 90% of the tests . The agreement between the automatic and human clinical categorizations amounted to 95.5%, and severe (major and very major) disagreements were found in 5.6% of the tests performed with staphylococci but only 0.3% of the tests with gram-negative rods . We conclude that the radial profile analysis algorithm is a solid backbone for an automatic system dedicated to the clinical interpretation of disk diffusion antibiotic susceptibility tests.

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