J Med Microbiol, 1993 Sep, 39(3), 191 - 5 Host response to coagulase-negative staphylococci in abscesses induced within mice; Long JP et al.; A model whereby a known number of coagulase-negative staphylococci were packed into capillary tubes and implanted into the peritoneal cavity of mice proved to be a satisfactory method for generating abscesses that could be easily removed free of extraneous host tissue, and that permitted measurement of the survival of the organisms and accumulation of lipid in the lesion . Strains of S . epidermidis, S . schleiferi and S . lugdunensis, differing in their ability to produce fatty acid modifying enzyme (FAME) and lipase, were packed into either glass or plastic capillary tubes and used to generate abscesses . Abscesses produced by S . aureus served as comparators . Lipids accumulated within the abscesses caused by S . aureus in the same manner as previously described for the organism inoculated without tubes . Lipids also accumulated within abscesses produced by all the coagulase-negative staphylococci, but the rate of accumulation was slower and the lipid droplets were smaller than seen with S . aureus . The mobilisation of lipid did not differ in response to cocci in plastic or glass tubes . Strains of S . epidermidis and S . schleiferi producing FAME and lipase were better able to survive within abscesses than strains unable to produce these enzymes . However, FAME and lipase production did not appear to be the sole determinants of survival within abscesses . Regardless of whether they produced FAME and lipase, the two S . epidermidis strains were significantly better able to survive within plastic tubes than in glass tubes . No such difference was seen with S . aureus between plastic and glass tubes. APMIS, 1993 Sep, 101(9), 681 - 8 Multiplex polymerase chain reaction for detection of genes for Staphylococcus aureus thermonuclease and methicillin resistance and correlation with oxacillin resistance; Brakstad OG et al.; A multiplex polymerase chain reaction (mPCR) was used for simultaneous amplification of the staphylococcal nuc gene, encoding the thermostable nuclease (TNase), and the mecA gene, encoding the penicillin-binding protein 2a which is associated with staphylococcal methicillin resistance . A total of 219 staphylococcal strains were tested and the mPCR data were compared with coagulase production and in vitro oxacillin susceptibility . The agreement was 100% for coagulase production and nuc amplification, and 97.7%, 96.8 and 97.3% for mecA amplification and oxacillin resistance tested with MIC determination, disk diffusion and agar screen methods, respectively . Discrepant results were due to non-S . aureus isolates with borderline MICs of oxacillin (1-8 micrograms/ml) . In a pilot test the mPCR simultaneously amplified both genes of staphylococci in blood cultures . This mPCR is a rapid and reliable method for single-step identification of cultures of MRSA and may prove to be useful for direct application on clinical specimens. Am J Vet Res, 1993 Sep, 54(9), 1432 - 40 Interspecific conjugal transfer of antibiotic resistance among staphylococci isolated from the bovine mammary gland; Muhammad G et al.; In vitro transferability of penicillin, streptomycin, tetracycline, and erythromycin resistance from coagulase-negative staphylococci to Staphylococcus aureus and among the former species of bovine mammary gland origin was examined by bacterial mating on filters and by mixed-culture matings in broth and in skim milk . One hundred twenty-six (42 each on filter, in broth, and in skim milk) matings were performed among 37 isolates of different Staphylococcus species . Transfer of resistance to penicillin, tetracycline, or erythromycin was not detected . Of 51 matings performed to determine streptomycin-resistance transfer, 9 (3 each on filters, in broth, and skim milk) were successful . Nine strains representing 3 species of coagulase-negative staphylococci were tested as prospective donors of streptomycin resistance . Of these, 2 strains could transfer streptomycin resistance . A double-resistant donor, S hominis, not only transferred its streptomycin resistance to an S chromogenes strain lacking resistance, but also to an S aureus strain already carrying penicillin and tetracycline resistance . The transfer of streptomycin resistance from the donor S hominis, harboring 2 plasmids, to a plasmidless S chromogenes recipient strain was associated with apparent acquisition of the smaller plasmid of the donor by the recipient . The single-resistant donor, S epidermidis 681A, transferred streptomycin resistance to a tetracycline-resistant S aureus recipient . This strain however, failed to transfer its streptomycin resistance to another S aureus, 2 S hyicus, and 1 S xylosus recipient . Frequency of transfer of streptomycin resistance ranged from 1.1 x 10(-5) to 1 x 10(-4) . When transfer of resistance was successful, attempts were made to characterize the transfer process.(ABSTRACT TRUNCATED AT 250 WORDS) Yan Ke Xue Bao, 1993 Sep, 9(3), 129 - 35 Coagulase-negative staphylococci in conjunctivitis and blepharitis; Au YK et al.; Coagulase-negative staphylococcus (C-NS) are regarded as normal flora of the lids and conjunctiva . The ability of these organisms to cause conjunctivitis and blepharitis can be overlooked or disregarded . To elucidate the role of individual C-NS species in these eye diseases we compared Staphylococcus sp . isolated from the conjunctiva and lids of 50 healthy volunteers with 248 strains of Staphylococcus isolated from patients with staphylococcal conjunctivitis or blepharitis . S . epidermidis was the most frequent species isolated from the conjunctiva and lids of both groups . S . aureus was isolated only from infected patients . No individual C-NS species was found to be significantly associated with eye disease, but the colony count of C-NS after isolation was a useful indicator of conjunctivitis and blepharitis . The ability of Staphylococcus to ferment mannitol or mannose was associated with isolates only from infected patients. Clin Infect Dis, 1993 Sep, 17(3), 380 - 8 Widespread colonization of personnel at a Veterans Affairs medical center by methicillin-resistant, coagulase-negative Staphylococcus; John JF Jr et al.; A serial prospective survey of nasal colonization of hospital personnel by methicillin-resistant coagulase-negative staphylococci (MRCNS) was conducted at a Veterans Affairs medical center on three occasions over a 16-month period . The epidemiological typing systems used to assess relatedness included antimicrobial susceptibility profiles; biotyping; phage typing; plasmid profiles; restriction fragment length polymorphism (RFLP) analysis with ribosomal RNA; and plasmid hybridization with a 1.68-MD plasmid as the DNA probe . Forty-three percent of all personnel and 62% of all nurses were colonized with MRCNS . Nurses on the wards (72%) and in the intensive care unit (73%) were significantly more likely to be colonized with MRCNS than nurses who had less contact with patients or those who worked in the operating room . The molecular epidemiological typing systems indicated some degree of relatedness among the strains . Specifically, riboprobe analysis revealed a Dice coefficient of > 90% . However, each typing system detected dissimilarity among strains . Further studies are needed to determine the role that such human reservoirs of MRCNS serve in horizontal transmission to and subsequent infection of hospitalized patients. Zh Mikrobiol Epidemiol Immunobiol, 1993 Sep-Oct, (5), 61 - 5 {An experimental study of autovaccines prepared with different preservatives}; Kazhina MV et al.; The comparative study of the immunological potency of staphylococcal vaccines prepared on the basis of different preservatives the mixture of formaldehyde, glutaraldehyde and 0.5% novocaine solution in combination with Gorgiev's bactericidal fluid) was made in experiments on mice . The vaccine was prepared from three staphylococcal strains isolated from chronic tonsillitis patients . The optimum low concentrations of formaldehyde (0.025%) and glutaraldehyde (0.0125%), producing bactericidal effect on staphylococci, have been established . The vaccine prepared with the use of Gorgiev's bactericidal fluid and 0.5% novocaine solution was found to have the highest immunogenic potency . The vaccine prepared on the basis of the aldehyde mixture exhibited the lowest potency. Biomaterials, 1993 Sep, 14(11), 845 - 53 Adhesion of staphylococci to chemically modified and native polymers, and the influence of preadsorbed fibronectin, vitronectin and fibrinogen; Paulsson M et al.; A commercially available poly(ether urethane), polyethylene, and modifications of these polymers have been compared with respect to adsorption of fibronectin, fibrinogen and vitronectin . The adhesion of staphylococcal strains (characterized for ability to bind immobilized proteins, cell surface hydrophobicity and charge) was studied by bioluminescence with and without preadsorption of proteins to the surfaces . The least amount of proteins and the fewest bacteria adhered to the amphiphilic surfaces . When polymers were preincubated with plasma or albumin, lower numbers of bacteria adhered, except to Pellethane grafted with PEG 20,000, to which coagulase-negative staphylococci adhered to a higher extent. FEMS Microbiol Lett, 1993 Aug 15, 112(1), 73 - 9 The use of monoclonal antibodies for studying the biological properties of Staphylococcus aureus endo-beta-N-acetylglucosaminidase; Guardati MC et al.; Staphylococcus aureus endo-beta-N-acetylglucosaminidase (SaG) has been suggested to function as a virulence determinant which interferes with the host cellular immune response . To further characterize the biological properties of SaG, monoclonal antibodies (mAbs) were raised against purified SaG . Four IgG1 subclass mAbs were obtained, none of which reacted with the reduced, sodium dodecyl sulphate pretreated or boiled enzyme . The ability of the mAbs to react with the enzymes present in supernatants obtained from 197 S . aureus strains indicated that they recognized epitopes which are highly conserved; bacteriolytic enzymes produced by staphylococci other than S . aureus did not show any cross-reactivity . After pretreatment of SaG with mAbs (mAb-SaG molar ratios varying from 1 to 20), it was shown that all selected mAbs caused, at a mAb:SaG molar ratio of 10, a 90% inhibition of SaG bacteriolytic activity and a statistically significant reduction of its ability to interfere with phagocytosis by human polymorphonuclear leukocytes . All selected mAbs reacted with several commercially available exo-beta-N-acetylglucosaminidases; mAb C1/10-11 also reacted with chicken and turkey egg muramidases and, at a mAb:SaG molar ratio of 10, inhibited their bacteriolytic activity by 97% . This suggests that one or more epitopes present in the above exo-glucosaminidases and muramidases share some degree of homology with others present in SaG. J Clin Pathol, 1993 Aug, 46(8), 761 - 3 Interaction of coagulase negative staphylococci with lectins; Jones JW; AIMS--To investigate the reaction of 118 blood culture isolates of coagulase negative staphylococci with a panel of seven lectins . METHODS--The interactions between the bacterial suspensions and lectins from Arachnis hypogaea (peanut agglutinin), Bauhina purpurea, Solanum tuberosum (potato starch), Triticum vulgaris (wheat germ agglutinin), Wisteria floribunda, Concanavalin ensiformis and Limulus polphemus (horse-shoe crab agglutinin) were assayed in microtitre plates incubated for 1 hour at room temperature then left overnight at 4 degrees C . Agglutinating activity was detected by examining the pattern of cell settlement compared with that of the controls . RESULTS--Lectins from Solanum tuberosum, Triticum vulgaris, Concanavalin ensiformis and Limulus polyphemus agglutinated 90% of the strains and displayed 11 agglutination patterns which were unrelated to species, clinical relevance, or antibiotic resistance . Fifty three per cent of the isolates fell into three reaction patterns and the other patterns were represented by nine or fewer strains . Replicate cultures investigated simultaneously gave consistent results, but some strains exhibited variation in agglutination patterns on repeat testing . CONCLUSIONS--Based on these observations lectin agglutination patterns seem to offer a method with potential for strain differentiation among coagulase negative staphylococci . Reproducibility may be improved by the use of biotinylated lectins and growing the coagulase negative staphylococci on defined media . Discrimination can be increased by the inclusion of other reactive lectins. Z Gesamte Inn Med, 1993 Aug, 48(8), 404 - 5 {Isolated florid pulmonary valve endocarditis}; Fritzsche D et al.; We report on a case of isolated pulmonary valve endocarditis caused by coagulase-negative staphylococci 22 years after total correction of a pentalogy of Fallot . The M-mode and two-dimensional echocardiographic findings are presented, and the patient's clinical progress is described . An overview of the literature shows isolated endocarditis of the pulmonary valve to be an exceptionally rare occurrence . 6 months postoperatively, the patient has not been experiencing a relapse and is now in NYHA stage I. Laryngoscope, 1993 Aug, 103(8), 910 - 4 Microbial colonization of Blom-Singer prostheses in postlaryngectomy patients; Palmer MD et al.; The microbial colonization of 44 Blom-Singer valves obtained from 16 patients over an 11-month period was investigated both by standard microbial culture methods and scanning electron microscopy (SEM) . The valves were all removed from the patients after failure to function correctly . The microbiology cultures revealed that Candida species and Staphylococcus aureus were present either individually or in combination on 43 valves . SEM showed yeast hyphae attached to and penetrating the surfaces of the 5 valves examined . Colonies of staphylococci were also seen on 2 of these 5 valves . Unlike similar investigations on other voice prostheses, S aureus colonization was associated with Candida colonization and valve failure. South Med J, 1993 Aug, 86(8), 908 - 11 Necrotizing infections of the perineum; Salvino C et al.; During a 6-year period, 10 patients were treated for severe necrotizing infections of the perineum (Fournier's gangrene) at the Edward Hines Veterans Administration Hospital (Hines, Ill) . All were male, and their average age was 60 years . When known, duration of symptoms was 2 to 5 days . Prodromal signs such as edema, erythema, and pain frequently developed into rapidly spreading, full-thickness cutaneous gangrene in less than 24 hours . All patients had significant concomitant disease; 60% were diabetic . All patients had expedient and aggressive initial debridement, usually within 24 hours of presentation to the surgical service . Each patient had a "second-look" debridement within 1 or 2 days . Debridement was done an average of 2.6 times per patient . The cause of the infection was noted in seven patients--five with perirectal abscess and two with urethral trauma . Suprapubic catheters were placed in both patients with urethral trauma . Diverting colostomy was done on two patients who had perirectal abscess as a nidus; eight patients were treated without colostomy . Polymicrobial bacteriologic flora were found in all patients, with a predominance of Escherichia coli, Bacteroides sp, and staphylococci . Broad spectrum antibiotics and early nutritional supplementation were given . Hospital stay averaged 4 weeks (range, 3 to 12 weeks) . One patient died (mortality of 10%) . Successful management of these patients requires expedient diagnosis, aggressive nutritional supplementation, and early and repeated debridement as clinically indicated . We have not found diverting colostomy to be a necessary part of the management of these patients even when the nidus is perirectal. South Med J, 1993 Aug, 86(8), 891 - 7 Safety and efficacy of teicoplanin for bone and joint infections: results of a community-based trial; Weinberg WG; To evaluate the efficacy and safety of teicoplanin in the treatment of gram-positive bone and joint infections, parenteral teicoplanin was used once daily in an average dose of 10.1 mg/kg (range 6 to 12 mg/kg) after loading to treat patients with acute or chronic osteomyelitis and septic arthritis . From the 66 patients who met criteria for initial enrollment, 60 gram-positive isolates were recovered from bone and joint fluid, and each was sensitive to teicoplanin at < or = 2 micrograms/mL (median 0.25 microgram/mL) . Teicoplanin was more active in vitro against these isolates than either vancomycin or oxacillin . Among the 43 patients in whom microbiologic efficacy could be assessed, the initial pathogen was eradicated in 37 (86%) . Clinically, 45 patients infected with staphylococci (including oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus and coagulase-negative staphylococci) met predetermined criteria for completed adequate therapy . Of these, 39 (87%) responded favorably and became free of all signs of infection; 6 (13%) failed to respond or suffered relapse . Overall, 36 patients completed teicoplanin therapy at home . Adverse reactions necessitated discontinuance of therapy in 12 patients and included fever, rash, hepatic function test abnormalities, and renal insufficiency . We found teicoplanin to be effective and generally well tolerated for treatment of bone and joint infections by gram-positive organisms in a community setting. Mol Cell Probes, 1993 Aug, 7(4), 301 - 10 Thermonuclease gene as a target nucleotide sequence for specific recognition of Staphylococcus aureus; Chesneau O et al.; DNA fragments, 450 bp in length, were amplified by polymerase chain reaction (PCR) from the thermonuclease gene (nuc) carried by seven epidemiologically independent Staphylococcus aureus isolates . Sequencing of the PCR products led us to characterize 210 bp strictly conserved . A 186 bp piece from within this conserved region was cloned into pUC18 . The resulting recombinant plasmid, pIP1608, was used as a probe against the cellular DNA of 360 staphylococcal isolates belonging to 28 species . Only the 146 S . aureus isolates, including four which were not thermonuclease producers, had DNA that hybridized with pIP1608 . Among the 214 non-S . aureus staphylococci, 55 exhibited a thermonuclease activity . For 32 of these, the enzymatic activity was inhibited by a commercially available polyclonal antiserum directed against the thermonuclease of an S . aureus strain . These results are in favour of the use of pIP1608 as a probe to specifically recognize S . aureus . Furthermore, we propose a method based on colony blot hybridization and potentially useful to enumerate S . aureus cells in biological samples. J Clin Pharm Ther, 1993 Aug, 18(4), 271 - 4 Relationship between slime production, antibiotic sensitivity and the phagetype of coagulase-negative staphylococci; Boussard P et al.; Three hundred and three strains of coagulase-negative staphylococci (CNS) were collected from the fingers of healthy donors (289) and from blood cultures (14) . Twelve different species were identified (5 S . auricularis, 45 S . capitis, 15 S . cohnii, 86 S . epidermidis, 23 S . haemolyticus, 37 S . hominis, 1 S . lentus, 5 S . saprophyticus, 7 S . sciuri, 6 S . simulans, 54 S . xylosus and 19 S . warneri) . Amongst these CNS strains, 151 were slime producers, 112 were phage-typable and 188, 133, 126 and 91 were, respectively, resistant to penicillin, teicoplanin, erythromycin and kanamycin . Slime-producing strains were resistant to at least seven antibiotics with a probability of 0.01 < P < 0.05 . Non-slime-producing strains were sensitive to all the tested antibiotics with a probability of 0.001 < P < 0.01 . There was no direct relationship between antibiotic sensitivity and phage type, although a non-typable strain was more often resistant to seven or more antibiotics than a typable one (0.05 < P < 0.1). J Antimicrob Chemother, 1993 Aug, 32(2), 215 - 22 Postantibiotic effect of aminoglycosides on staphylococci; Isaksson B et al.; The postantibiotic effects (PAEs) of amikacin, gentamicin, netilmicin and tobramycin on Staphylococcus aureus and S . epidermidis were determined in vitro by a bioluminescence assay of bacterial ATP . Five strains of S . aureus and two strains of S . epidermidis were exposed for 1 h to varying concentrations of these aminoglycosides . Following removal of the antibiotics by dilution, bacterial regrowth was monitored at hourly intervals . The duration of the PAE increased with increasing aminoglycoside concentration . The mean PAEs for the five S . aureus strains ranged from 5-10 h at clinically achievable aminoglycoside concentrations (16-32 mg/L of amikacin and 4-8 mg/L of gentamicin, netilmicin and tobramycin) . The results for one of the strains of S . epidermidis were similar to those observed for the S . aureus strains, while the PAEs on the other less susceptible S . epidermidis strain were shorter (0.5-2.5 h) . For comparison, two of the S . aureus strains were exposed for 1 and 2 h to a range of concentrations of dicloxacillin (0.25-32 mg/L); this agent induced a much shorter PAE (0-2.3 h) . It may be important to take account of the PAE when designing dosing regimens. APMIS, 1993 Aug, 101(8), 651 - 4 Comparison of various methods and reagents for species identification of Staphylococcus aureus positive or negative for the mecA gene; Brakstad OG et al.; The reliability of various methods for species identification of Staphylococcus aureus was evaluated . A total of 135 coagulase-positive (SA) or -negative (SS) staphylococcal isolates were tested, including methicillin-resistant (MR) and -susceptible (MS) strains . When the nuc gene which encodes the S . aureus thermonuclease (TNase) was amplified in a multiplex PCR simultaneously with the mecA gene which encodes for the MR-associated penicillin-binding protein 2a of staphylococci, the nuc amplification showed full agreement with the results of the coagulase test . TNase detected by an enzymatic method or as protein in a sandwich ELISA identified S . aureus with nearly the same precision as the PCR . The Staphylase, Monostaph and Staphaurex agglutination kits were all reliable for identification of MSSA, but not for MRSA . Most of the negative MRSA strains were identified by the Pastorex agglutination kit, in which reagents for fibrinogen receptor and protein A detection have been supplemented with antibodies for capsular polysaccharides of the serotypes 5 and 8 . These results show that detection of the nuc gene or its TNase product is highly reliable for identification of both MRSA and MSSA strains, while various widely used agglutination kits do not show the same reliability for identification of MRSA strains. Artif Organs, 1993 Aug, 17(8), 695 - 701 Renal complications of infected ventriculoatrial shunts; Samtleben W et al.; Contamination of a ventriculoatrial shunt (VAS) with skin organisms that are usually nonpathogenic may be followed by an immunologically mediated renal injury . The bacteria characteristically involved are coagulase-negative Staphylococci (e.g., Staphylococcus epidermidis), which strongly adhere to the plastic surface of the VAS . These bacteria are protected from the body's natural defense mechanisms and respond only poorly to antibiotics . As a result, their growth persists and produces a continuous antigenic stimulation . Circulating immune complexes (CIC) are an appropriate tool to screen for chronically infected VASs . We followed CIC in 138 VAS patients . An infected VAS was seen in 20 of the 24 patients with highly elevated CIC and in 1 of the 19 patients with moderately elevated CIC, but none of the 95 patients with normal CIC had evidence of shunt infection . Of the 21 patients with shunt infections, 8 had renal involvement (4 requiring dialysis, and 4 with proteinuria, hematuria, and/or elevated creatinine) . Results from kidney biopsy specimens available from 4 patients confirmed glomerulonephritis . Of the 4 patients requiring dialysis at diagnosis, renal function recovered sufficiently to stop dialysis after successful VAS exchange in all but 1 . In the other 4 patients, renal symptoms (proteinuria, creatinine) also improved after VAS revision . Chronic infection with S . epidermidis or other bacteria is a continuing problem in patients with VASs and can lead to an immune-mediated renal injury . However, the prognosis for reversal of the renal injury is relatively good if the VAS infection is treated promptly. J Infect Dis, 1993 Jul, 168(1), 235 - 7 In vitro activity of sodium bisulfite and heparin against staphylococci: new strategies in the treatment of catheter-related infection; Kropec A et al.; Device-related infections often persist until the device is removed because systemic antibiotic therapy fails frequently . In an in vitro model, the activity of sodium bisulfite (an antioxidant added to many drugs) heparin with chlorbutol or chlorcresol as preservatives, and their combination with cefpirom for treating the internal surface of polyurethane and silicone catheters colonized with Staphylococcus aureus and Staphylococcus epidermidis was studied . Sodium bisulfite (0.05%) markedly reduced catheter colonization . Heparin combined with chlorbutol, 1000 micrograms/mL of cefpirom, and 0.05% of sodium bisulfite was not more effective than sodium bisulfite alone . A lesser effect was shown by treating adherent bacteria on both catheters with heparin plus preservatives alone . Not only antibiotics but also other substances with antibacterial activity should be evaluated for treatment and prophylaxis of catheter-related infection. Pediatr Cardiol, 1993 Jul, 14(3), 183 - 6 Endocarditis in neonatal intensive care unit; Rastogi A et al.; The clinical spectrum of infective endocarditis (IE) in infants is examined in four infants between 3 and 9 months of age . None of the patients had signs of IE; all four had an anatomically normal heart . Echocardiograms showed echo-dense vegetations in the left side of heart in three cases and in the right side in one . Three of the four patients recovered after the episode of endocarditis . Three of the four patients had necrotizing enterocolitis in the neonatal period . The important predisposing factor was the presence of indwelling central catheter for intravenous nutrition . Unlike previously reported cases, coagulase-negative Staphylococci and Enterococci were important causative organisms in this high-risk nursery population. Eur J Clin Microbiol Infect Dis, 1993 Jul, 12(7), 527 - 33 Use of a DNA hybridization method to verify results of screening for methicillin resistance in staphylococci; Olsson-Liljequist B et al.; Tests were performed by the disk diffusion method, agar dilution method and the E test to determine the susceptibility to methicillin and oxacillin of clinical isolates and control strains of Staphylococcus aureus (n = 106) and coagulase-negative species (n = 131) . Results were compared with those of a dot blot DNA hybridization test, in which the mecA gene was detected using an oligonucleotide probe selected from the mecA gene . Among the Staphylococcus aureus strains the mecA gene was found in all but two strains inhibited by > or = 8 mg/l of methicillin and all but two strains inhibited by > or = 4 mg/l of oxacillin . A disk test using either 1 microgram oxacillin or 10 micrograms methicillin and a tentative resistance breakpoint of < or = 10 mm gave the best agreement with the hybridization test . For coagulase-negative staphylococci 34 of 35 strains inhibited by > or = 8 mg/l methicillin hybridized with the probe as well as 58 of 82 strains inhibited by 1-4 mg/l; 93 of 97 strains inhibited by > or = 0.5 mg/l oxacillin were also positive in the probe test . Using the 1 microgram oxacillin disk and a resistance breakpoint of < or = 10 mm good agreement was obtained between results of the disk diffusion and DNA hybridization tests . It is suggested that this genotypic method for detection of methicillin resistance is used as a reference method for routine methods. Diagn Microbiol Infect Dis, 1993 Jul, 17(1), 85 - 91 In vitro activity of sparfloxacin, ciprofloxacin, ofloxacin, and other antibiotics against bloodstream isolates of gram-positive cocci; Rotstein C et al.; The in vitro activity of sparfloxacin was compared with the activities of ciprofloxacin, ofloxacin, and six other antimicrobial agents against 323 bloodstream isolates of staphylococci (both oxacillin susceptible and resistant) enterococci, and pneumococci . Sparfloxacin was more active than both ciprofloxacin and ofloxacin against all the isolates tested . Its activity (MIC for 90% of strains tested < or = 0.10 microgram/ml) against oxacillin-susceptible staphylococci was superior to that of ciprofloxacin and ofloxacin by at least fourfold . Sparfloxacin was also more potent against pneumococci . However, fluoroquinolone resistance was noted among oxacillin-resistant strains of Staphylococcus aureus and coagulase-negative staphylococci. Br J Clin Pharmacol, 1993 Jul, 36(1), 57 - 60 The passage of cloxacillin into cerebrospinal fluid in the absence of meningitis; Schievink HI et al.; 1 . Eleven patients undergoing lumbar discectomy received cloxacillin by continuous i.v . infusion, starting before the operation . During the operation several blood samples and one CSF sample were taken . 2 . Mean rate constants describing the passive transfer of drug from plasma to CSF (kp) and the largely active transfer in the opposite direction (kCSF) were estimated . 3 . In some subjects the CSF albumin quotient, defined as the ratio between the albumin concentration in CSF and in plasma times 1000, was slightly elevated (up to 23) which caused a significant increase in the value of kp . 4 . The estimate of mean kp for healthy individuals was 0.065 h-1, which corresponds to a half-life of 10 h . The estimate of mean kCSF was 2.10 h-1 . This predicts a steady-state CSF drug concentration which is 3% of the unbound plasma drug concentration . 5 . There was a significant lag between the time courses of plasma and CSF drug concentrations, presumably reflecting the time for drug to move from the choroid plexus to the lumbar sampling site . 6 . Four other patients received cloxacillin for prophylactic or therapeutic reasons by continuous i.v . infusion . In three of those patients the albumin quotient was normal or slightly elevated and the steady-state CCSF/Cu ratio was similar to the predicted normal value . 7 . These findings indicate that eradicating staphylococci from CSF in cases of meningitis with a low degree of inflammation may be difficult. Jpn J Antibiot, 1993 Jul, 46(7), 505 - 10 {Intravenous vancomycin treatment in children; its clinical usefulness and serum concentration monitoring}; Fujita K et al.; Fourteen pediatric patients with infections (21 episodes) were treated with intravenous vancomycin (VCM) and the clinical efficacy and side effects were evaluated . The ages of the patients ranged from 1 month to 13 years and their body weights from 1.9 to 49 kg . The drug was administered by intravenous drip infusion for 60 minutes . Doses given were 10 (except one with 20) mg/kg every 6 (8 or 12 in patients with renal dysfunction) hours for 5 to 27 days . A leukemic patient was given the drug for 3.5 months . Those episodes which responded well to the VCM treatment included 10 episodes in 8 children with methicillin-resistant Staphylococcus aureus infections, 4 in 2 children with methicillin-resistant Staphylococcus epidermidis (MRSE) infections and 2 in 2 children with methicillin-susceptible S . aureus infections . Those infections included sepsis, empyema, bronchitis, subcutaneous abscess, cellulitis and lymphadenitis . Clinical effects were fair in 1 patient with gingival abscess due to MRSE, and undetermined in 4 patients with infections of which etiologies were unknown . The drug was well tolerated, although rash, which disappeared after more prolonged infusion, was noted in 2 episodes and elevated serum concentrations of transaminases occurred in 4 episodes (both side effects occurred in 1 patient given 20 mg/kg every 6 hours) . The minimal inhibitory concentrations of VCM against isolated staphylococci were 0.5-1 microgram/ml . Monitoring for serum concentrations of drug was performed in 10 patients.(ABSTRACT TRUNCATED AT 250 WORDS) J Gen Microbiol, 1993 Jul, 139 ( Pt 7), 1461 - 7 pRJ5: a naturally occurring Staphylococcus aureus plasmid expressing constitutive macrolide-lincosamide-streptogramin B resistance contains a tandem duplication in the leader region of the ermC gene; Oliveira SS et al.; The 2.55 kb Staphylococcus aureus plasmid, pRJ5, confers constitutive resistance to macrolide-lincosamide-streptogramin B (MLS) antibiotics . pRJ5 is nearly identical to the inducible MLS resistance plasmid pT48, and has homology with the S . aureus plasmids pE194 and pSN2 . The HindIII-C and/or Hind-B fragments were required for stable maintenance of the plasmid and probably carry palA . Plasmids pRJ5 and pT48 were shown to belong to the same incompatibility group, Inc12 (L) . DNA sequencing showed that pRJ5 contains a 28 bp direct tandem duplication in the leader/attenuator region of ermC . This is likely to change the secondary structure of the methylase mRNA, allowing constitutive expression of ermC . The type of mutation found on plasmid pRJ5 is different from those observed in similar 2.5 kb constitutive MLS-resistance plasmids isolated from other Gram-positive bacteria, including staphylococci. Ophthalmic Surg, 1993 Jul, 24(7), 440 - 5 Scleral buckle removal following retinal reattachment surgery: clinical and microbiologic aspects; Smiddy WE et al.; Scleral buckle infection following retinal reattachment surgery is infrequent but not rare . We identified 45 cases among approximately 3000 scleral buckling procedures performed at our institution between July 1, 1985 and July 1, 1991 . The scleral buckle was exposed in all 45, and the subsequent microbiologic culture was positive in 33 . The most common causative organism was coagulase negative staphylococci (17 of 33 cases with positive cultures) . Risk factors for an adverse outcome included positive culture, preoperative vision < or = 20/200, and preoperative retinal detachment . Broad spectrum antibiotics covered organism sensitivity profiles in 16 of the 18 cases tested . Prompt removal of infected buckles and treatment with broad-spectrum topical antibiotics are important for maintaining vision. J Invest Dermatol, 1993 Jul, 101(1), 86 - 91 Modulation of comedonal levels of interleukin-1 in acne patients treated with tetracyclines; Eady EA et al.; To understand the basis for the anti-inflammatory activity of tetracyclines in acne, we compared the cytokine profiles {interleukin 1 (IL-1) alpha and beta, tumor necrosis factor (TNF) alpha, and IL-6} and bacterial flora of 66 open comedones removed from eleven patients before and after at least 8 weeks treatment with either tetracycline or minocycline . Pre-treatment, the only cytokine regularly recovered from comedones was bioactive IL-1 alpha-like material . The mean concentration of IL-1 alpha-like bioactivity/mg comedonal material rose from 272.0 +/- 88.6 pg to 844.3 +/- 196.7 pg following treatment (p < 0.05, Wilcoxon matched pairs) . All six minocycline-treated patients showed an increase in bioactive IL-1 alpha-like material compared with three of five tetracycline-treated patients . The incidence (p < 0.001, chi 2) and concentration (p < 0.05, Wilcoxon) of immunochemical IL-beta were also raised post-treatment, although significantly more patients assigned to minocycline therapy had detectable levels of this cytokine before therapy was initiated . However, the mean concentration of IL-1 beta/mg comedonal material post-treatment was similar in both groups (72.5 +/- 23.3 pg for tetracycline-treated compared with 78.6 +/- 41.9 pg for minocycline-treated patients) . The other cytokines were either absent (IL-6) or present in < 10% of comedones (TNF alpha) before and after therapy . Following treatment, only three of 11 patients showed a decrease of > or = 1 log10 in propionibacterial numbers/mg comedonal material, whereas six patients showed an increase of > 0.5 log10 in numbers of staphylococci . In eight patients, the increase or decrease in staphylococcal numbers correlated with the change in concentration of IL-1 alpha-like bioactivity . This is the first study to show an effect of antibiotic therapy on cytokine levels in vivo . Increased levels of IL-1 in comedones destined to become inflamed may enhance resolution and promote repair of the damaged follicular epithelium . Hence, these results provide further evidence of the augmentation of immune responses by tetracyclines and support the hypothesis that epidermal IL-1 plays a physiologic role in wound healing. J Intern Med, 1993 Jul, 234(1), 83 - 9 Clinical index to predict bacteraemia caused by staphylococci; Leibovici L et al.; OBJECTIVES . To define risk factors associated with bacteraemia caused by Staphylococcus aureus or coagulase-negative staphylococci; and to use them to define patients in need of empiric anti-staphylococcal antibiotic treatment . DESIGN . Derivation set: observational, prospective study; validation set: retrospective analysis of a prospectively collected database . SETTING . Derivation set: Beilinson Medical Centre, Petah Tiqva, Israel--a 900-bed university hospital . Validation set: St Thomas's Hospital, London, UK--an 800-bed teaching hospital . SUBJECTS . All episodes of bacteraemia detected at Beilinson Medical Centre between March 1988 and September 1990 (derivation set, n = 1410), and at St Thomas's Hospital during 1987-1990 (validation set, n = 1040) . INTERVENTIONS . None . MAIN OUTCOME MEASURES . Percentage of staphylococcal bacteraemia in groups of patients defined by the models . RESULTS . The following factors were associated with Staphylococcus aureus bacteraemia: focus of infection (whether high or low risk), haemodialysis, intravenous drug abuse and infection acquired in the orthopaedic ward . A logistic model was used to divide the derivation set into three groups with percentages of Staphylococcus aureus bacteraemia of 1.8%, 13.2% and 33.7% (P < 0.0001); and the validation group 2.5%, 18.2% and 53.2% (P < 0.0001) . Factors associated with coagulase-negative staphylococcal bacteraemia were: central or peripheral intravenous catheter as the focus of infection, a preterm neonate, the presence of a central intravenous catheter, low temperature, and a low white blood cell count . A second model including those factors was used to divide the derivation set into three groups with percentages of coagulase-negative staphylococcal bacteraemia of 1.9%, 22.8%, and 43% (P < 0.0001) . In the validation set, the percentages were 2.9%, 22.4% and 31.0% (P < 0.001) . CONCLUSIONS . The present study defines groups at high risk for staphylococcal bloodstream infection, in which empiric treatment should include an anti-staphylococcal drug. J Antimicrob Chemother, 1993 Jul, 32(1), 37 - 43 Use of the E test for methicillin sensitivity testing; Bignardi GE et al.; Performance of the E test for methicillin sensitivity testing was investigated using 21 methicillin-resistant and 28 methicillin-sensitive staphylococci . Thirty of the strains had previously given equivocal results with a strip diffusion method . The E test performed well with Mueller-Hinton agar plates incubated at 30 degrees C for 24 h but only after supplementation with 5% NaCl . Testing on agar without salt was necessary for the recognition of methicillin resistance in one strain . We recommend a breakpoint of 4 mg/L and heavy inocula . The E test can be controlled by testing a control strain on the same plate. Infection, 1993 Jul-Aug, 21(4), 259 - 61 Antimicrobial activity of josamycin against erythromycin-resistant staphylococci as compared to roxythromycin and clarithromycin; Guggenbichler JP et al.; In an in vitro study 246 clinical isolates of erythromycin-resistant staphylococci from six hospitals in Austria were investigated for susceptibility to josamycin and other, newer macrolide antibiotics, e.g . roxithromycin and clarithromycin . 71 strains of Staphylococcus aureus showed an MIC > or = 4 mg/l and 100 strains of S . aureus showed an MIC > or = 256 mg/l . In addition, 25 strains of coagulase-negative staphylococci resistant to erythromycin at an MIC of > or = 4 mg/l were investigated . At an MIC of 2 mg/l 57% of the erythromycin-resistant strains of S . aureus were inhibited by josamycin, 25% by clarithromycin and 11.6% by roxithromycin . At an MIC of 2 mg/l 13.3% of erythromycin-resistant coagulase-negative staphylococci were inhibited by josamycin, 10.7% by clarithromycin and 9.3% by roxithromycin . This study suggests that josamycin is still active in vitro against more than 50% of erythromycin-resistant strains of S . aureus . This drug is also more active than roxithromycin and clarithromycin against erythromycin-resistant S . aureus. Zh Mikrobiol Epidemiol Immunobiol, 1993 Jul-Aug, (4), 6 - 10 {The interaction of staphylococci with plasmin and its inhibitors}; Zorin NA et al.; According to the data obtained by immunoblotting and other immunochemical techniques, the cell wall of Staphylococcus aureus, strain 209 P, contain proteinaceous receptors for plasminogen, plasmin and its complexes with alpha 2 glycoprotein and protein A, alpha 2 proteinase inhibitor, alpha 2 antiplasmin . Strains Cowan 1 and Wood 46 have no such receptors . All three strains have been found to contain the receptor for alpha 2 interferon, its molecular weight being equal to 50 kD. J Bacteriol, 1993 Jul, 175(14), 4436 - 47 DNA sequence and units of transcription of the conjugative transfer gene complex (trs) of Staphylococcus aureus plasmid pGO1; Morton TM et al.; The conjugative transfer genes of 52-kb staphylococcal R plasmid pGO1 were localized to a single BglII restriction fragment and cloned in Escherichia coli . Sequence analysis of the 13,612-base transfer region, designated trs, identified 14 intact open reading frames (ORFs), 13 of which were transcribed in the same direction . Each ORF identified was preceded by a typical staphylococcal ribosomal binding sequence, and 10 of the 14 proteins predicted to be encoded by these ORFs were seen when an E . coli in vitro transcription-translation system was used . Functional transcription units were identified in a Staphylococcus aureus host by complementation of Tn917 inserts that abolished transfer and by Northern (RNA) blot analysis of pGO1 mRNA transcripts . These studies identified three complementation groups (trsA through trsC, trsD through trsK, and trsL-trsM) and four mRNA transcripts (trsA through trsC {1.8 kb}, trsA-trsB {1.3 kb}, trsL-trsM {1.5 kb}, and trsN {400 bases}) . No definite mRNA transcript was seen for the largest complementation group, trsD through trsK (10 kb) . Comparison of predicted trs-encoded amino acid sequences to those in the data base showed 20% identity of trsK to three related genes necessary for conjugative transfer of plasmids in gram-negative species and 32% identity of trsC to a gene required for conjugative mobilization of plasmid pC221 from staphylococci. J Am Vet Med Assoc, 1993 Jun 15, 202(12), 1966 - 74 Effects of a high-density intramammary device on mammary glands, production, and reproductive performance in dairy cows; Goodger WJ et al.; A clinical field trial was undertaken to determine the influence of an intramammary device (IMD) on environmental mastitis and production . On 4 central California dairies, 200 Holstein first-lactation cows were randomly assigned to 2 groups . Cows in the treatment group were fitted with an IMD, and cows in the control group were not . The incidence of clinical mastitis for the 2 groups was determined during the study period . Bacteriologic monitoring at intervals over 2 lactations (lactation 2 and through 60 days of lactation 3) was used to determine the incidence of subclinical infection . In addition, data were collected to determine whether the groups differed in milk production, butterfat production, post-milking and test-day somatic cell counts, and reproductive efficiency . Total milk production and butterfat production over the 2 lactation periods did not vary significantly between the groups . Also, the groups did not differ in calving-to-conception interval, duration of lactation, calving interval, and calving-to-first service interval . Cows with IMD were significantly less likely to develop clinical mastitis (5% vs 13%) than control cows . The IMD did not appear to affect subclinical infection rates (minor pathogens only) except at day 300 of lactation 2 and at day 10 of lactation 3, when prevalence was greater in the cows with IMD . The minor pathogens were predominately (80%) coagulase-negative staphylococci . It was unusual to have coagulase-negative staphylococci in the same quarter at 2 consecutive samplings, prompting the speculation that during lactation, the duration of coagulase-negative staphylococci infection is short (resolves without intervention).(ABSTRACT TRUNCATED AT 250 WORDS) Gene, 1993 Jun 15, 128(1), 89 - 94 Cell-surface display of heterologous epitopes on Staphylococcus xylosus as a potential delivery system for oral vaccination; Nguyen TN et al.; A system has been developed for the surface expression of heterologous receptors on the cell surface of Staphylococcus xylosus . Gene fragments encoding peptides to be displayed on the cell surface can be assembled by applying a polymerization strategy based on the class-IIS restriction enzyme BspMI and thereafter subcloned into an Escherichia coli-staphylococci shuttle vector designed for targeting of produced fusion proteins to the outer cell surface of the Gram-positive host cell . A heterologous receptor was genetically assembled and expressed on the surface of S . xylosus where the separate regions could be independently probed in immunogold assays, using antisera reacting with different regions of the recombinant receptor . In addition, a receptor-specific humoral immune response could be elicited in mice by oral immunization with recombinant S . xylosus cells, suggesting that these type of Gram-positive bacteria might offer potential vehicles for oral vaccination. Epidemiol Infect, 1993 Jun, 110(3), 507 - 17 Factors enhancing adherence of toxigenic Staphylococcus aureus to epithelial cells and their possible role in sudden infant death syndrome; Saadi AT et al.; Toxigenic strains of Staphylococcus aureus have been suggested to play a role in sudden infant death syndrome (SIDS) . In this study we examined two factors that might enhance binding of toxigenic staphylococci to epithelial cells of infants in the age range in which cot deaths are prevalent: expression of the Lewis(a) antigen and infection with respiratory syncytial virus (RSV) . By flow cytometry we demonstrated that binding of three toxigenic strains of S . aureus to cells from nonsecretors was significantly greater than to cells of secretors . Pre-treatment of epithelial cells with monoclonal anti-Lewis(a) or anti-type-1 precursor significantly reduced bacterial binding (P < 0.01); however, attachment of the bacteria correlated only with the amount of Lewis(a) antigen detected on the cells (P < 0.01) . HEp-2 cells infected with RSV bound significantly more bacteria than uninfected cells . These findings are discussed in context of factors previously associated with SIDS (mother's smoking, bottle feeding and the prone sleeping position) and a hypothesis proposed to explain some cases of SIDS. Am J Med, 1993 Jun, 94(6), 602 - 7 Is the use of boxed gloves in an intensive care unit safe? Rossoff LJ, Lam S, Hilton E, Borenstein M, Isenberg HD. PURPOSE: To identify the type, rate, burden, and pattern of contamination of boxed, clean but nonsterile gloves in our intensive care unit (ICU) . MATERIALS AND METHODS: The fingertips of the first, middle, and last two pairs of gloves in 29 boxes in routine service in our ICU were cultured . The first of each of these three sets were removed aseptically, the second in a routine fashion . RESULTS: We found 16 of 29 (55%) first pairs removed aseptically to be contaminated with a mean bioburden of 1.8 colony-forming units (CFU) . The percentage contamination and bioburden did not change significantly with position in the box . Use of routine compared with strict aseptic technique increased the rate of contamination by only 11% (95% confidence interval {CI} -0.05 to +0.27 percentage points) and bioburden by only a mean of 3.4 colonies per pair (CI -0.51 to +4.90 CFU) . The length of the time the boxes were open and in use was unrelated to whether the final aseptically removed pair was sterile or contaminated . The predominant organisms were coagulase-negative staphylococci . CONCLUSIONS: One half the pairs of latex examination gloves in our ICU were sterile despite repeated barehanded access to the boxes . Those contaminated exhibited a small bioburden of low pathogenic potential . No pattern of contamination or unsafe duration of box use were observed . The use of boxed, clean, nonsterile gloves appears safe for routine use in an ICU. J Pediatr, 1993 Jun, 122(6), 847 - 53 Pediatric infective endocarditis in the modern era; Saiman L et al.; Sixty-two cases of endocarditis occurring in children between January 1977 and February 1992 were reviewed and compared with series from the 1970s and early 1980s . Changes in risk factors, pathogens, diagnostic modalities, and outcome were determined . Complex congenital heart disease (22 cases) and unrepaired ventricular septal defect (9 cases) were the most common underlying lesions . A total of 19 children with normal anatomy had endocarditis; 6 had community-acquired infection and 13 had hospital-acquired endocarditis (11 of these 13 children had central venous catheters in place, including 7 premature infants) . Echocardiograms revealed vegetations in 25 of 49 patients; 24 of these patients had positive echocardiographic findings on the first study . Echocardiographic findings were most often negative in children with complex cyanotic heart disease . Staphylococcus aureus (39%) was the most common pathogen isolated and was associated with a higher incidence of central nervous system complications (p < 0.0015) and a greater need for surgical intervention (p = 0.01) than were other pathogens . Methicillin-resistant S . aureus (eight cases) and coagulase-negative staphylococci (three cases) emerged as important pathogens but were not associated with increased morbidity or mortality rates . Fungal endocarditis (six cases) had a 67% mortality rate . Overall the mortality rate was 11% . Endocarditis remained undiagnosed in seven seriously ill patients until postmortem examination . This study indicates that, during the past decade, important changes in risk factors, pathogens, and the susceptible population have altered the presentation and management of endocarditis in children. J Biomed Mater Res, 1993 Jun, 27(6), 775 - 81 In vitro study on the integrity of a hydroxylapatite coating when challenged with staphylococci; Verheyen CC et al.; An in vitro study was performed to evaluate the effect of Staphylococcus aureus and Staphylococcus epidermidis on the integrity of a hydroxylapatite coating . The coating plasma-sprayed on poly(L-lactide), showed dissolution during a 24 h incubation period . This was indicated by an increase in pH and calcium release in the buffer solution . After 4 h of incubation, calcium levels decreased due to the precipitation of calcium phosphate complexes on the coating . The bacteria digested or dissolved the coating, creating irregularly shaped holes . Although the integrity of the hydroxylapatite coating was focally damaged within 2-4 h of incubation with staphylococci, the extent of the damage was only marginal . Due to the formation of a layer of CaP precipitates though, bacteria could not be counted accurately after 4-8 h of incubation . This model could reveal part of the failure mechanism of infected hydroxylapatite coated implants. An Esp Pediatr, 1993 Jun, 38(6), 488 - 92 {Sepsis caused by coagulase-negative Staphylococcus in the newborn infant . Clinical and therapeutic aspects}; Ginovart Galiana G et al.; This study deals with sepsis caused by coagulase-negative stapylococci in a neonatal intensive care unit over a period of four years and eleven months . The global incidence was 20.7/1000 (50 cases out of a total of 2,416 admissions) and was higher in newborns with lower weight and with a shorter gestational age . The most significant clinical manifestations were fever, paleness, and apnea/bradycardia . In all cases the germ was sensitive to vancomycin . Evolution was favourable in all patients, in spite of the initial gravity of some cases . Sepsis due to coagulase-negative staphylococci is the most frequent cause of nosocomial infection in our environment. APMIS, 1993 Jun, 101(6), 487 - 91 Improved identification of Staphylococcus aureus using a new agglutination test . Results of an international study; Croize J et al.; A new reagent for the identification of Staphylococcus aureus, SLIDEX STAPH-KIT, operates on the principle of a latex and red blood cell combination agglutination: red blood cells are coated with fibrinogen for the detection of clumping factor, and latex particles are sensitized with anti-S . aureus serotype 18 monoclonal antibody for the detection of protein A and antigen 18 . French strains belonging to serotype 18 are methicillin-resistant . The performance of this reagent was compared with STAPHYSLIDE and STAPHAUREX in Europe (France, Germany, Italy), in the United States and in Japan using 548 methicillin-resistant S . aureus strains, 392 methicillin-sensitive S . aureus strains, and 441 non-aureus staphylococci . The specificity of the three reagents was equivalent (98.8% for SLIDEX STAPH-KIT, 99.1% for STAPHYSLIDE, 98.1% for STAPHAUREX) . SLIDEX STAPH-KIT (97.3%) was more sensitive than STAPHYSLIDE (93.5%) and STAPHAUREX (89.7%) for all S . aureus strains due to a higher rate of identified methicillin-resistant S . aureus strains. Ann Pediatr (Paris), 1993 Jun, 40(6), 353 - 9 {Clinical experience with totally implantable venous access systems in pediatric hematology and oncology}; Maloisel F et al.; Forty-three children with malignant diseases who received 48 totally implanted venous accesses (TIVA) were retrospectively analyzed . More than half the patients had acute leukemia . Mean age was 6 years 10 months . Mean duration of use of the TIVA was 473 +/- 50 days (range 28 to 1,285 da; median 424 days) . Removal of the TIVA was required because of an adverse event in 33% of cases . Main reasons for removal included infection (22.9%), thrombosis (6.25%), and catheter dysfunction (4.16%) . Catheter-related infections were most often due to staphylococci (90%), especially S . epidermidis (63%) . Infection rate was 0.48 per 1,000 patient-days . Flushing with a vancomycin-heparin solution can be expected to decrease this rate . Selection of the implantation site is discussed . In children under 6 years of age, the cephalic vein and external jugular vein are often frail or absent and are therefore less appropriate than the internal jugular vein or subclavian vein. Cesk Epidemiol Mikrobiol Imunol, 1993 Jun, 42(2), 51 - 3 {Comparison of 2 methods of detecting slime production by coagulase-negative staphylococci}; Woznicova V et al.; In the series of 212 coagulase-negative staphylococci strains isolated from blood cultures, in which the slime production was tested by means of two methods--a method using agar with Congo red and a Christensen method--S . epidermidis, S . haemolyticus and S . hominis were identified most frequently (in 69.3%, 18.4% and 6.6%, respectively) . The slime production was detected by both methods in 28 strains (13%) of four species, most often in S . epidermidis (in 17%) . By comparing the Congo red agar method with the Christensen method the sensitivity and specificity of the former was determined (85% and 99%, respectively) . Thus the Congo red agar method for the detection of slime production by staphylococci seems to be a reliable tool. Infect Dis Clin North Am, 1993 Jun, 7(2), 425 - 33 Detection of methicillin-resistant staphylococci; Chambers HF; Susceptibility tests commonly used in the clinical laboratory for detection of methicillin-resistant strains of staphylococci are discussed . The biochemical and genetic basis of methicillin resistance, including heterogeneous expression of resistance, is summarized . The conditions that can affect results of disk diffusion, broth dilution, and agar screen tests and sensitivity and specificity of these tests are reviewed . DNA detection methodologies, which, with their greater accuracy, may replace susceptibility testing, also are discussed. Dtsch Tierarztl Wochenschr, 1993 Jun, 100(6), 234 - 6 {Differentiation of staphylococci from sheep and goat milk samples}; Deinhofer M et al.; A total of 447 micrococcaceae strains isolated from 88 ewe and 359 goat milk samples from cases of chronic mastitis were differentiated by means of the ATB 32 STAPH-test . Of these strains 389 (= 87%) could be identified . Fourteen strains were sensitive in the bacitracin-resistance-test and therefore classified as Micrococcus spp . In ewe milk following Staphylococcus spp . were found: S . epidermidis, S . aureus, S . lentus, S . xylosus, S . warneri, S . equorum, S . haemolyticus, S . simulans, S . hominis and S . saprophyticus . Staphylococcus spp . identified in goat milk samples 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 cell counts in the milk of both animals species, and the highest incidence of clinical udder alterations were caused by S . aureus . Increases in milk cell counts as well as pathological udder findings were observed in coagulase-negative staphylococcal infections for novobiocin-sensitive Staphylococcus spp . (S . epidermidis, S . warneri, S . simulans, S . lugdunensis, and S . chromogenes) and several S . lentus strains. Br J Dermatol, 1993 Jun, 128(6), 631 - 2 Superantigenic exotoxin-secreting potential of staphylococci isolated from atopic eczematous skin; McFadden JP et al.; Although the deleterious effect of Staphylococcus aureus on atopic eczema is well recognized, the mechanism of this effect may be more complex than pyogenic infection alone . We have shown that the majority of S . aureus cultures isolated from atopic eczema produced exotoxins with superantigenic properties, although this was no more frequent than in a control group, and was not restricted to one particular superantigen . However, the widespread nature of staphylococcal infections in atopic eczema indicates that sufficient superantigen may be released to cause T-lymphocyte activation, cytokine release, and mast cell degranulation . These mechanisms could, in part, explain the exacerbations of atopic eczema associated with S . aureus infection. Antimicrob Agents Chemother, 1993 Jun, 37(6), 1219 - 26 Distribution of mec regulator genes in methicillin-resistant Staphylococcus clinical strains; Suzuki E et al.; The distributions of the mec regulator genes mecI and mecR1, which were identified on the chromosome of mecA-carrying Staphylococcus aureus N315, in methicillin-resistant staphylococci isolated in Japan and various countries were studied . Screening by dot blot hybridization by using polymerase chain reaction (PCR)-amplified probes revealed that at least the 5'-end region of the mecR1 gene was present in all strains tested, whereas about 40% of the strains were negative for the mecI gene . The data suggested that these regulator genes were the original components of the additional mec region DNA of methicillin-resistant S . aureus as well as methicillin-resistant, coagulase-negative staphylococci of seven staphylococcal species (S . epidermidis, S . haemolyticus, S . hominis, S . sciuri, S . capitis, S . caprae, and S . warneri) . The mecI gene, which presumably codes for the repressor protein of the mecA gene, was found to harbor a point mutation in all six mecI-positive methicillin-resistant S . aureus strains, and their basal level of mecA gene transcription was elevated compared with that of strain N315, which harbors a presumably intact counterpart of the mecI gene . The data suggested that the mecI gene encodes for a strong repressor function on mecA gene transcription and is deleted or mutated in clinical methicillin-resistant S . aureus strains with high levels of resistance to methicillin. Antimicrob Agents Chemother, 1993 Jun, 37(6), 1214 - 8 Oral rifampin plus ofloxacin for treatment of Staphylococcus-infected orthopedic implants; Drancourt M et al.; We examined the effectiveness and safety of the combination of rifampin plus ofloxacin given orally for treating prosthetic orthopedic implants infected with staphylococci . The prospective cohort study was conducted in a referral public hospital with ambulatory care services between 1985 and 1991 . Consecutive patients from whom Staphylococcus organisms susceptible to the study drugs were isolated from their orthopedic implants and who had no contraindication to the treatment were eligible for the study . All patients were treated orally with rifampin, 900 mg/day, plus ofloxacin, 600 mg/day . Patients with hip prosthesis infection were treated for 6 months, with removal of any unstable prostheses after 5 months of treatment; patients with knee prosthesis infection were treated for 9 months, with removal of the prosthesis after 6 months of treatment; and patients with infected bone plates were treated for 6 months, with removal of the plate after 3 months of treatment, if necessary . Monthly clinical evaluations were conducted until the completion of the treatment and follow-up or telephone interviews were conducted at 6, 12, 24, 36, 48, and 60 months thereafter . Treatment failures were documented by clinical evaluation, sampling of the infected site for culture and antibiotic activity measurement, and fistulography, if possible . Cure was defined as the absence of clinical, biological, and radiological evidence of infection 6 months after the completion of treatment, treatment failure was defined as the absence of cure, and relapse was defined as the reappearance of infection caused by the same Staphylococcus isolate that caused the original infection, regardless of the timing of this secondary infection . Among 51 patients included in the study and evaluable for safety, 4 patients had side effects and were not evaluable for treatment effectiveness; the overall success rate was 74% among 47 patients, with a success rate of 81% for the hip prosthesis group, 69% for the knee prosthesis group, and 69% for the osteosynthesis device group . Eight treatment failures were relaxed to the isolation of a resistant bacterium . The combination of rifampin administered orally plus ofloxacin is a suitable alternative to the conventional long-term intravenous therapy for treatment of orthopedic implants infected with staphylococci. J Clin Microbiol, 1993 Jun, 31(6), 1606 - 8 Rapid methods for identification of Staphylococcus aureus when both human and animal staphylococci are tested: comparison with a new immunoenzymatic assay; Guardati MC et al.; A new immunoenzymatic assay (IEA) for the identification of Staphylococcus aureus strains of both human and animal origin was compared with rapid commercial kits . The sensitivities and specificities of the commercial kits varied from 90.2 to 96% and 90.8 to 93.7%, respectively . The IEA did not give any false-negative or false-positive results, while commercial kits gave high percentages of false-positive results among clumping factor-positive non-S . aureus strains . The IEA is particularly useful for isolates for which identification is doubtful, for large-scale epidemiological studies, and for identifying isolates from animals as S . aureus. Pathol Biol (Paris), 1993 Jun, 41(6), 531 - 6 {In vitro activity of glycopeptides on 114 coagulase-negative staphylococci: problems with the teicoplanin diffusion test, "alert" parameters indicating need for MIC determination}; Jean-Pierre H et al.; The activity of vancomycin (Va) and teicoplanin (Tc) against 114 coagulase-negative staphylococci (CNS) strains was evaluated by disk-diffusion and agar dilution minimal inhibitory concentration (MIC) determination . Results were analysed by species and methicillin-resistance (MR) status . MICs for Va were in the susceptible range (< 4 mg/l) for all strains, with inhibition zone diameters of 17 mm or more in every case . MICs for teicoplanin were 8 or 16 mg/l for 19 CNS strains (including 18 with MR) of which 14 yielded an inhibition zone diameter of 17 mm or more (false susceptibility) . Parameters which should lead to MIC determination for Tc regardless of disk diffusion findings include the species (S . haemolyticus), methicillin resistance, Tc zone diameter, and an at least 3 mm difference between the Va and Tc zone diameters. Orv Hetil, 1993 May 16, 134(20), 1077 - 81 {Immunosuppressive effect of cyclophosphamide in experimental coagulase-negative staphylococcal infection}; Nagy G et al.; BALB/c mice were given 200 mg/kg cyclophosphamide intraperitoneally . Three days later, mice were infected intraperitoneally with Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus saprophyticus at 4 inocula ranging between 2 x and 20 x 10(8) CFU/ml suspended in dextran microcarrier solution . Controls were treated only with bacteria . Lethality rates and organ persistence of cocci were significantly higher, and more peritoneal abscesses and adhesions developed in the mice pretreated with cyclophosphamide than in the untreated controls, regardless of the species of Staphylococcus injected . Splenomegaly was also more pronounced indicating a probably enhanced compensatory reactivity of the immune system liberated from suppression 13 days after the administration of cyclophosphamide . Our results show that cyclophosphamide treatment increases the susceptibility of mice to infection by coagulase-negative staphylococci and it is also responsible for a more severe course of the diseases provoked. Tijdschr Diergeneeskd, 1993 May 15, 118(10), 332 - 4 {Udder infections with coagulase-negative staphylococci in freshly calved heifers}; van der Meer C et al.; To determine the prevalence of udder infections in fresh calved heifers all quarters of 98 heifers on eleven commercial farms were sampled weekly during the first eight weeks of lactation . The samples during the first four weeks of this period were used for bacteriological examination and in all samples a somatic cell count was made . The prevalence of S . aureus after calving in these heifers was 12.5% . Coagulase-negative staphylococci (CNS) were isolated from half of the heifers . The predominant coagulase-negative staphylococcus species were S . xylosis and S . hyicus . The CNS, with exception of S . hyicus, had a very small effect on the cell count. FEMS Microbiol Lett, 1993 May 15, 109(2-3), 273 - 7 Role of bacteriophages in genomic variability of related coagulase-negative staphylococci; Lina B et al.; DNA analysis using pulsed-field gel electrophoresis (PFGE) has emerged as one of the most sensitive epidemiological tools for the characterization of coagulase-negative staphylococci (CNST) . The significance of some minor differences observed between the DNA restriction pulsed patterns of two CNST strains are difficult to interpret since they can theoretically be due to minor chromosomal rearrangements or to phage DNA integration . The latter possibility was investigated by comparing DNA restriction patterns of Staphylococcus epidermidis strains with those of their lysogenized derivatives . In vitro lysogenisation was obtained by exposing the strains to phage 118II . The pulsed patterns of the lysogenized strains were compared to those of their parental strains, revealing a shift in size of approximately 50 kb in a single band which was shown by Southern blotting to contain prophage . One strain was lysogenized ten times, revealing a potential preferred attachment site for phage 118II . These results confirm that chromosomal integration of a phage can be responsible for minor stable variations in DNA restriction patterns. J Crit Illn, 1993 Jun, 8(6), 678 - 89 Managing complications in heart transplant recipients . Improved techniques and medications increase survival rates; Kobashigawa JA et al.; Major problems facing cardiac transplant recipients include rejection, infection, and transplant coronary artery disease . Commonly used antirejection drugs are high-dose corticosteroids and cytolytic agents . Bacterial infections, such as those caused by staphylococci, occur early in the postoperative period, while opportunistic infections, including viral, fungal, and parasitic diseases, occur several weeks after transplant surgery . Coronary angiography is used to detect transplant coronary artery disease, the only definitive treatment for which is retransplantation . A number of promising new immunosuppressive agents and techniques may prevent some complications and further improve the care cardiac transplant recipients receive. J Clin Microbiol, 1993 May, 31(5), 1342 - 4 New latex reagent using monoclonal antibodies to capsular polysaccharide for reliable identification of both oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus; Fournier JM et al.; A new latex agglutination test (Pastorex Staph-Plus, Sanofi Diagnostics Pasteur), consisting of a mixture of latex particles coated with fibrinogen and immunoglobulin G for the detection of clumping factor and protein A and latex particles sensitized with monoclonal antibodies directed to Staphylococcus aureus serotype 5 and 8 capsular polysaccharides, was compared with three commercially available rapid agglutination methods for the identification of 220 isolates of S . aureus (61 oxacillin resistant) and 128 isolates of coagulase-negative staphylococci . The sensitivity for identification of S . aureus was high with the Pastorex Staph-Plus test (98.6%) compared with those of the other tests, which ranged from 91.8 to 84.5% . Test sensitivities for the identification of oxacillin-resistant S . aureus were as follows: Pastorex Staph-Plus, 95.1%; Pastorex Staph, 73.8%; Staphyslide, 72.1%; and StaphAurex, 49.2%. J Clin Microbiol, 1993 May, 31(5), 1322 - 5 Evaluation of the Vitek Systems Gram-Positive Identification card for species identification of coagulase-negative staphylococci; Bannerman TL et al.; Vitek Systems' Gram-Positive Identification test (GPI) card was evaluated for the ability to identify 12 coagulase-negative Staphylococcus species and subspecies . The bionumber generated from the GPI card was examined for its potential use in epidemiological studies . Results indicated that the GPI card had a high degree of correlation with the conventional methods of identification . The species identified with the greatest accuracy were Staphylococcus epidermidis (92%), S . haemolyticus (95%), S . capitis subsp . capitis (88%), and S . saprophyticus (100%) . S . hominis (63%) was identified with the least accuracy . The bionumber was found to have limited epidemiological value because of the frequent occurrence of a few major bionumbers. Ophthalmology, 1993 May, 100(5), 724 - 9 Endophthalmitis caused by the coagulase-negative staphylococci . 2 . Factors influencing presentation after cataract surgery; Ormerod LD et al.; PURPOSE: This study, comprising 60 patients with coagulase-negative staphylococcal endophthalmitis which occurred after cataract surgery, was designed to define the variation in disease presentation and visual outcome and to evaluate statistically the role of the primary surgery and its management . METHODS: An intensive evaluation of microbiological, inpatient, outpatient, and cataract surgery charts was made retrospectively using a standardized protocol . The predictive value of surgical, iatrogenic, and clinical factors was analyzed for their influence on defined aspects of the disease pattern and of the visual results using multiple regression models, via a stepwise technique . RESULTS: There was commonly a significant asymptomatic latent period after cataract surgery . The median diagnostic delay was 7 days; 22% of patients presented after 2 weeks and 12% after 1 month . Symptoms progressed longer than 3 days in 25% of patients . Ten percent had no pain . Clinical variation proved largely unrelated to cataract surgery events and postoperative management; bacterial factors were implicated . Good visual outcome was associated statistically with intensive topical corticosteroid in the symptomatic period, but was negatively associated with operative subconjunctival corticosteroid . CONCLUSIONS: The clinical variation in cases of postoperative coagulase-negative staphylococcal endophthalmitis poses particular problems for diagnosis in the outpatient setting . Surgical and perioperative events (except corticosteroid use) probably can be disregarded in studies of endophthalmitis management. Ophthalmology, 1993 May, 100(5), 715 - 23 Endophthalmitis caused by the coagulase-negative staphylococci . 1 . Disease spectrum and outcome; Ormerod LD et al.; PURPOSE: The coagulase-negative staphylococci are the most common causes of postoperative endophthalmitis . This study investigates the variability in the disease spectrum and visual outcome of coagulase-negative staphylococcal endophthalmitis in a large, single-center series . METHODS: Ninety consecutive cases of coagulase-negative staphylococcal endophthalmitis were investigated retrospectively from two time periods, 1978 to 1982 and 1985 to 1987, separated by a transitional period in cataract surgery technique . Using a detailed protocol, inpatient, outpatient, and microbiologic records were analyzed . Six-month visual acuity results were obtained . RESULTS: Diagnosis frequently was delayed, often suspected only after hypopyon development . Thirty-seven percent of patients presented more than 1 week after the inoculating event, and 13% presented after more than 1 month . Variable asymptomatic intervals and gradually worsening inflammatory prodromes are noted . Painless endophthalmitis occurred in 16% . Non-epidermidis infections comprised 28% . With vitrectomy/intraocular antibiotic management, 38% and 68% achieved visual acuities of 20/50 and 20/400, respectively . Overall, 10% of patients developed late retinal detachments . This occurred in only 4% of patients, with endophthalmitis occurring after cataract surgery . CONCLUSION: Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmitis in which the coagulase-negative staphylococci play a prominent role. J Appl Bacteriol, 1993 May, 74(5), 521 - 5 Factors affecting spoilage microflora succession on lamb carcasses at refrigeration temperatures; Prieto M et al.; Three bacterial groups were detected during the shelf-life of lamb carcasses stored at refrigeration temperatures: coryneforms (mostly Brochothrix thermosphacta), Gram-positive cocci (staphylococci) and Gram-negative bacilli (Pseudomonas spp . and Moraxella spp.) . Influence of categorical variables such as sampling day, sampling area and sampling method on their recovery was analysed by a chi-square test of independence and loglinear analysis . Hierarchical loglinear modelling proved to be very useful as several three-way interactions of factors were observed. Scand J Immunol, 1993 May, 37(5), 575 - 80 Protective opsonic activity of antibodies against fibronectin-binding proteins (FnBPs) of Staphylococcus aureus; Rozalska B et al.; In this report, opsonic activity of hyperimmune rabbit IgG against fibronectin-binding proteins (gal-FnBP A and ZZ-FnBP B) of Staphylococcus aureus is described . Moreover, the action of IgG purified from serum of rabbits immunized with 'combined vaccine' (fibronectin-binding protein A+collagen-binding protein+alpha-toxoid) is shown . The opsonic activity has been studied in an in vitro phagocytosis assay as well as in vivo . Mice which had been infected intraperitoneally with S . aureus strain Cowan 1 pretreated (opsonized in vitro) with specific anti-FnBPs IgG were able to eliminate the staphylococci from the peritoneal cavity and liver more rapidly than controls . Also, clearance from the bloodstream of intravenously injected S . aureus Cowan 1 as well as S . aureus U320, opsonized with IgG anti-FnBPs or anti-FnBP+CnBP+alpha-toxoid, was more effective than observed in control groups . In other in vivo experiments it was shown that mice passively immunized with hyperimmune IgG anti-FnBP (one or two doses, intravenously) before challenge with S . aureus Cowan I eliminated the bacteria better than controls injected only with preimmune IgG. Infect Immun, 1993 May, 61(5), 1853 - 8 Effects of in vitro and in vivo growth conditions on expression of type 8 capsular polysaccharide by Staphylococcus aureus; Lee JC et al.; Type 8 capsular polysaccharide (CP8) is widely prevalent among clinical isolates of Staphylococcus aureus, but the role that the capsule plays in the pathogenesis of staphylococcal infections is unclear . This study was performed to identify growth conditions that would optimize the production of CP8 and to determine whether enhanced CP8 expression would influence staphylococcal virulence . S . aureus Becker grown in a chemically defined broth medium with < 1 microM ferric nitrate produced up to eightfold more CP8 per milligram of biomass than did bacteria cultivated in the same medium containing 20 microM ferric nitrate . The bacteria produced > 350-fold more cell-associated CP8 per milligram of biomass when grown on the surface of Columbia agar than when grown in Columbia broth . Most of the CP8 produced by broth-grown cells was secreted into the culture medium . S . aureus cultivated on the surface of nitrocellulose membranes floating on Columbia broth produced levels of CP8 similar to those produced by cells grown on Columbia agar . Similarly, bacteria harvested from endocardial vegetations of rabbits infected with S . aureus produced high levels of CP8 . These results indicate that staphylococci grown on surfaces, both in vitro and in vivo, produce larger quantities of cell-associated CP8 than those grown in liquid cultures . However, no differences were observed in the 50% lethal dose for mice of strain Becker grown on solid medium (high levels of capsule expression) or in liquid medium (low levels of capsule expression). J Antimicrob Chemother, 1993 May, 31(5), 731 - 7 Penetration of rifampicin into the brain tissue and cerebral extracellular space of rats; Mindermann T et al.; Rifampicin is used to treat neurosurgical shunt infections because of its excellent in-vitro activity against staphylococci and its adequate penetration into the CSF . However, nothing is known about rifampicin concentrations in the cerebral extra-cellular space (CES) . We measured the penetration of rifampicin into the CES of anaesthetized rats by microdialysis using low-flow and equilibrium methods . Depending on the method, rifampicin concentrations in the CES were 0.3-1% of the serum concentration or 3-8% of brain tissue concentration, respectively . These experimental data in animals suggest that the recommended dose of rifampicin in man might be inadequate for treatment of some brain infections. Can J Neurol Sci, 1993 May, 20(2), 118 - 22 CSF shunt infections: a fifteen-year experience with emphasis on management and outcome; Morissette I et al.; A retrospective study of patients with cerebrospinal fluid shunt infections was undertaken from 1975 to 1989 in a university hospital . The data were analyzed with emphasis on the choice of treatment and outcome . There were 44 infectious episodes in 38 patients for an overall rate of 2.6%, including 30 ventriculoperitoneal, 11 ventriculoatrial and 3 lumboperitoneal shunts . The most frequently isolated pathogens were staphylococci in 61% of the cases followed by gram-negative bacilli in 25% . Different modalities of treatment were used: support (2), intravenous antibiotics alone (6), intravenous antibiotics and shunt revision (3), intravenous antibiotics and shunt removal with or without prior externalization of the distal end (33: 13 + 20) . The cure rate was 94% (31/33) with this last modality of treatment . Only 3 patients received intraventricular antibiotics . All deaths occurred in patients treated with support only (2) or with antibiotics alone (1) . Four of the six recurrent episodes occurred in patients treated with antibiotics alone (2) or with a shunt revision (2) . We conclude that carefully chosen intravenous antibiotics combined with shunt removal preceded or not by externalization of the distal end as an alternative therapy to repeated ventricular taps or insertion of an external ventricular drainage device is an appropriate therapy. J Clin Pathol, 1993 May, 46(5), 394 - 7 Effects of culture media on detection of methicillin resistance in Staphylococcus aureus and coagulase negative staphylococci by disc diffusion methods; Milne LM et al.; AIMS--To test 10 culture media for their ability to detect resistance and sensitivity of staphylococci to methicillin by disc diffusion . METHODS--Fifty strains of Staphylococcus aureus and 135 strains of coagulase negative staphylococci were tested using Columbia, Diagnostic Sensitivity Test, Mueller Hinton, Sensitest and Iso-sensitest agars with and without 5% added sodium chloride . Cultures were examined after 18 and 40 hours of incubation . The diameter of the zone and its characteristics were recorded and these media were assessed for their ability to produce clear, readable zones of inhibition . Changes in the variables which determined resistance were investigated . Results were analysed allowing a zone diameter reduction of 8 mm and 10 mm compared with the control in addition to the standard 6 mm . RESULTS--Columbia agar with added sodium chloride supported the growth of all strains, detected the highest number of resistant strains, and was the easiest to read . Resistance was detected after 18 hours in most resistant strains, but some required 40 hours of incubation . There was poor agreement, however, on this medium (63-94%) between disc diffusion and the reference MIC method for sensitive strains . Allowing a greater reduction in zone size resulted in more agreement with sensitive strains but with consequently lowered detection of resistant strains . The other media showed some growth failures and more zones that were difficult to read . More resistance was detected when incubation was prolonged to 40 hours but this was consistently less than on Columbia agar with added salt . CONCLUSIONS--None of the media detected all of the resistant strains . Columbia agar with added salt was the most satisfactory medium in this respect, but it misidentified up to 37% of the sensitive strains as resistant . Methicillin susceptibility testing by disc diffusion testing is unreliable. Zh Mikrobiol Epidemiol Immunobiol, 1993 May-Jun, (3), 3 - 6 {A molecular biology approach to the species identification of coagulase-negative staphylococci}; Akatova EA et al.; A 1.3 DNA fragment isolated from Staphylococcus haemolyticus strain DSM 20264 can be used as a specific probe for this species . 28 collection strains including type strains of 26 Staphylococcus species, as well as 135 clinical isolates representing 8 species, have been studied with this probe by the dot hybridization method . The probe has been found to hybridize with all 42 S . haemolyticus strains, but with none of 121 strains belonging to other Staphylococcus species. Schweiz Rundsch Med Prax, 1993 Apr 6, 82(14), 410 - 3 {Arthritis in adolescence}; Schwarz HA; Joint problems in adolescence are often monoarticular . In the acute form the differentiation between trauma and infection is of utmost importance, whereas in chronic joint diseases the differentiation will be mainly between mechanical disorders and true rheumatic diseases . In pauci- or polyarticular arthritis of short duration viral infections have to be considered, since true rheumatic diseases tend to run a more chronic course . In girls true sero-positive juvenile rheumatoid arthritis typically appears in this age group . In adolescent boys seronegative Spondylarthropathies involving the lower extremities and not uncommonly with enthesopathies may occur . The typical involvement of the sacro-iliac-joint usually starts after the age of 18 years . Bacterial arthritides are predominantly monoarticular and are caused in more than 50% by staphylococci. Jpn J Antibiot, 1993 Apr, 46(4), 331 - 6 {Chemoprophylaxis of ophthalmia neonatorum through vertical infection . Evaluation of Crede's method using norfloxacin and gentamicin}; Seiga K et al.; Crede's method was evaluated using norfloxacin (NFLX) and gentamicin (GM) to show the clinical significance of chemoprophylaxis against ophthalmia neonatorum occurring through vertical infections . The obtained results are summarized as follows . 1 . NFLX and GM were separately instilled using Crede's original method in 171 cases selected from all cases of delivery encountered in this hospital during a period of 5 months in 1991 . The two groups had similar backgrounds . 2 . NFLX and GM were effective in 70 of 71 cases and in 96 of 100 cases, respectively . No side effects were found in either groups . 3 . From 4 of 5 ineffective cases were isolated staphylococci, which were sensitive to NFLX and GM. Clin Infect Dis, 1993 Apr, 16(4), 567 - 73 Course and outcome of bacteremia due to Staphylococcus aureus: evaluation of different clinical case definitions; Lautenschlager S et al.; In a retrospective survey of patients hospitalized in the University Hospital of Basel, Switzerland, the course and outcome of 281 cases of true bacteremia due to Staphylococcus aureus over a 7-year period were analyzed . The main purpose was to evaluate different case definitions . In 78% of cases the source of bacteremia was obvious; vascular access sites (27%) and wounds (10%) were the most common sources . Metastasizing foci were more common in cases of primary vs . secondary bacteremia (P < .001) . The incidence of endocarditis was higher in cases in which no portal of entry was defined (P < .03) . The overall mortality rate was high at 34% partly because of inappropriate initial antibiotic therapy . With the introduction of an infectious disease service at the hospital, the fraction of misjudged results of blood culture diminished 2.5-fold . Among the differently defined cases, the mortality rate was significantly higher for cases of complicated vs . uncomplicated bacteremia (P < .01), for cases of primary vs . secondary bacteremia (P = .05), and for patients with endocarditis or other secondary foci (P < .001) . Since only one methicillin-resistant strain was isolated, multiresistant staphylococci were not a problem in the hospital . Different case definitions allowed the detection of patients at increased risk for complications and death . In the treatment of sepsis with no evident focus, initial antimicrobial therapy should include the use of agents with antistaphylococcal activity. Vet Microbiol, 1993 Apr, 34(4), 373 - 80 Characteristics of coagulase-negative Staphylococci isolated from bovine intramammary infections; Todhunter DA et al.; Coagulase-negative Staphylococci (CNS) isolated from 86 different bovine intramammary infections (IMI) were investigated for their plasmid content, antimicrobial resistance, and infection characteristics . Plasmids were isolated from 30.2% of CNS . Number of plasmid bands ranged from 1 to 5 . With the exception of tetracycline resistance, the presence of plasmids was not related to antibiotic resistance . Staphylococcus chromogenes was the CNS most frequently isolated from bovine IMI . Intramammary infections were of long duration (mean = 222 days) and resulted in a low incidence of clinical mastitis (8.1% of IMI) . The greatest percentage of IMI (55%) were detected in heifers with 57% of these IMI first detected at calving . A total of 56% of IMI originated during the dry period in second lactation or older cows . The number of plasmid-positive CNS IMI was greater (P < 0.05) in multilactational cows when compared to heifers . The presence of a plasmid-positive CNS had no influence on duration of IMI, origin of IMI, clinical status of the infection, and elimination of IMI. Antimicrob Agents Chemother, 1993 Apr, 37(4), 921 - 3 Effects of subinhibitory concentrations of vancomycin and teicoplanin on adherence of staphylococci to tissue culture plates; Carsenti-Etesse H et al.; Bacterial adhesion is the first step in infection of medical devices . Staphylococcus aureus and Staphylococcus epidermidis are the pathogens recovered most often . The effects of subinhibitory concentrations of vancomycin and teicoplanin on the adherence of eight clinical strains of S . aureus and eight strains of S . epidermidis to tissue culture plates in vitro were tested . The mean relative inhibitions of adherence at one-fourth and one-eighth the MIC were statistically different for teicoplanin and vancomycin . Slime production seemed not to be involved in adherence. Antimicrob Agents Chemother, 1993 Apr, 37(4), 741 - 5 In vitro antimicrobial activity of a new antibiotic, MDL 62,879 (GE2270 A); Goldstein BP et al.; MDL 62,879 (GE2270 A) is a new peptide antibiotic that inhibits protein synthesis through an interaction with elongation factor Tu . MDL 62,879 was very active against gram-positive clinical isolates, particularly staphylococci and enterococci, for which MICs for 90% of isolates were < or = 0.13 micrograms/ml . It was equally active against isolates resistant to beta-lactams, erythromycin, gentamicin, and glycopeptides . It also had activity against Mycobacterium tuberculosis . MDL 62,879 had moderate bactericidal activity against staphylococci. Clin Microbiol Rev, 1993 Apr, 6(2), 176 - 92 Pathogenesis of infections related to intravascular catheterization; Goldmann DA et al.; Over the past few decades, there have been major technological improvements in the manufacture of intravenous solutions and the manufacture and design of catheter materials . However, the risk of infection in patients receiving infusion therapy remains substantial, in part because of host factors (for example, increased use of immunosuppressive therapy, more aggressive surgery and life support, and improved survival at the extremes of life) and in part because of the availability of catheters that can be left in place for very long periods . Microbial components of normal skin flora, particularly coagulase-negative staphylococci, have emerged as the predominant pathogens in catheter-associated infections . Therefore, efforts to prevent skin microorganisms from entering the catheter wound (such as tunnelling of catheters and use of catheter cuffs and local antimicrobial agents) are logical and relatively effective . The specific properties of microorganisms that transform normally harmless commensals such as coagulase-negative staphylococci into formidable pathogens in the presence of a plastic foreign body are being explored . For example, Staphylococcus epidermidis elaborates a polysaccharide adhesin that also functions as a capsule and is a target for opsonic killing . However, the interactions between microorganism and catheter that lead to adherence, persistence, infection, and dissemination appear to be multifactorial. J Vasc Surg, 1993 Apr, 17(4), 768 - 73 In situ replacement of infected vascular prostheses with rifampin-soaked vascular grafts: early results; Torsello G et al.; Based on the excellent results of experimental studies with antibiotic-bonded vascular prostheses for prevention of graft infection, gelatin-sealed grafts soaked with rifampin were implanted in situ in five patients with vascular infection . All patients were at risk for limb loss or death and could not be treated by standard techniques such as graft excision and extra-anatomic bypass . In one patient an infected aortic stump aneurysm with involvement of both renal and visceral arteries was found . He was treated by implantation of a bifurcation rifampin-soaked graft between the subdiaphragmal aorta and both renal arteries and reimplantation of celiac and superior mesenteric artery into the graft . In four patients with in-flow or runoff problems on angiography, an antibiotic-soaked graft was used for replacement of a partially or totally infected graft . Cultures were positive for Staphylococcus aureus in three and coagulase-negative staphylococci in two patients . Wound healing was uncomplicated; there was no need for amputation . After a follow-up of at least 6 months, all grafts were patent without any evidence of reinfection on computed tomographic scan . We conclude that infected vascular prostheses can be replaced in situ by rifampin-soaked grafts in patients at high risk for death or major amputation. J Clin Microbiol, 1993 Apr, 31(4), 812 - 8 Characterization of unrelated strains of Staphylococcus schleiferi by using ribosomal DNA fingerprinting, DNA restriction patterns, and plasmid profiles; Grattard F et al.; The molecular characteristics of 31 unrelated strains of Staphylococcus schleiferi isolated from 13 hospitals between 1973 and 1991 were determined by ribosomal DNA fingerprinting by using a digoxigenin-labeled DNA probe, genomic DNA restriction patterns, and plasmid profiles . Only six strains harbored one or two plasmids . DNA restriction analysis, which was carried out with five endonucleases (EcoRI, HindIII, PstI, PvuII, and ClaI), did not allow us to discriminate between isolates . Ribotyping with HindIII, ClaI, or EcoRI enzymes generated six, seven, and nine distinct patterns, respectively . With the combination ClaI-EcoRI, 13 ribotypes were obtained among the 31 strains, suggesting a relative heterogeneity within the species . Moreover, all strains shared two or three common bands, according to the endonuclease used, which were relatively specific for S . schleiferi in comparison with the ribosomal banding patterns described for other coagulase-negative staphylococci . These results illustrate that ribotyping can be used for the epidemiological investigation of S . schleiferi isolates and possibly for taxonomic analysis in this species. Avian Dis, 1993 Apr-Jun, 37(2), 284 - 9 Heterophil chemotaxis in chickens with natural Staphylococcal infections; Andreasen JR Jr et al.; Heterophil chemotaxis using heterophils isolated from the peripheral blood of five commercial broiler chickens naturally infected with staphylococcal bacteria was compared by the modified Boyden-chamber technique with chemotaxis of heterophils from two chickens from the same flock not infected with Staphylococcus (field controls) and from four healthy laboratory control broiler chickens . The infected chickens had gross and histologic lesions of staphylococcal tenosynovitis and osteomyelitis . Staphylococci were isolated from the lesions . Hematologic parameters and histologic lesions of infected chickens also were examined . Compared with field and laboratory controls, Staphylococcus-infected chickens had heterophilic leukocytosis . The heterophils of Staphylococcus-infected chickens had significantly lower chemotactic activity than both control groups in terms of random movement and directed chemotactic movement in response to stimulus . Toxic changes were observed in heterophils of some of the Staphylococcus-infected broilers. Oral Microbiol Immunol, 1993 Apr, 8(2), 75 - 9 Changes in the prevalence of subgingival enteric rods, staphylococci and yeasts after treatment with penicillin and erythromycin; Helovuo H et al.; The changes in the balance of microbial flora in the periodontium after antibiotic treatment were investigated in a blind study . The prevalence of gram-negative enteric rods, staphylococci and yeasts was followed before and during penicillin or erythromycin treatment of 72 periodontitis patients without periodontal cleaning . The prevalence of subgingival coagulase-positive staphylococci increased significantly following systemic penicillin therapy . After systemic erythromycin therapy, the prevalence of subgingival gram-negative enteric rods increased . Ten of 24 (42%) patients receiving systemic penicillin therapy developed clinical evidence of periodontal abscesses . In the absence of conventional mechanical cleaning, systemic administration of penicillin and erythromycin antibiotic to patients with pre-existing periodontitis may lead to periodontal superinfection with opportunistic organisms. APMIS, 1993 Apr, 101(4), 311 - 8 Detecting methicillin-resistant Staphylococcus epidermidis--disc diffusion, broth breakpoint or polymerase chain reaction? Hedin G, Lofdahl S. Growth conditions are important for the expression of resistance to methicillin among staphylococci . Consequently a phenotypic susceptibility test has to be chosen carefully to avoid false susceptible results . In this study we wanted to devise rapid and simple phenotypic tests whose results completely correlate with the presence of the methicillin resistance gene, mecA . A simplified polymerase chain reaction (PCR) method not needing separate DNA extraction from the tested bacteria was used to amplify a 449 bp region of the mecA gene . One hundred and ten strains of S . epidermidis were tested . The results were in complete agreement with those from a broth tube breakpoint test, known to identify more strains as resistant than does the method recommended by NCCLS . In disc diffusion test it was possible to clearly distinguish resistant from susceptible strains by using discs containing oxacillin, cephalexin and cephradine . A 5 micrograms cephradine disc was further analysed by testing another 441 consecutive clinical isolates of staphylococci . All resistant coagulase-negative staphylococci grew out to the edge of this disc, whereas susceptible strains showed an inhibition zone at least 10 mm in diameter . The 5 micrograms cephradine disc is recommended for routine work . The PCR method and broth tube breakpoint test are both reliable reference methods. Pathol Biol (Paris), 1993 Apr, 41(4), 392 - 8 {Mechanisms of adhesion of Staphylococci to biomaterials: effect of fusidic acid}; Drugeon HB et al.; The production of slime, adherence to plastics and hydrophobicity are factors which regulate the colonisation of biomaterials by Staphylococci . The influence of fusidic acid on these 3 factors was studied by using 3 pairs of pathogenic strains of S . aureus and S . epidermidis . Each pair presented differences in the expression of one or several of these factors . The influence of fusidic acid was initially studied by determining the expression of these factors by these strains cultured in the presence of 0.03 mg/l and 0.5 mg/l of antibiotic . Hydrophobicity was measured by the Bath-test method, slime was detected by Trypan blue staining after fixation with Carnoy's fixative and adherence was determined on polystyrene . The variations observed were generally minor, except for S . epidermidis, high slime produces, which showed a reduced production . Using this collection of strains, we then selected mutants resistant to 2 micrograms/ml of fusidic acid . This resistance induced a reduction in the 3 colonisation factors and it can be proposed that strains resistant to fusidic acid have a lesser capacity to colonise than sensitive strains . The bacteria adhere to and colonise the majority of surfaces proposed to them {3, 7, 10} . This was the case for biomaterials used in medicine, whose number and diversity (catheters, prostheses) are continually increasing . Apart from thrombosis, the major complication is the development of infection . Coagulase positive or negative Staphylococci are very frequently responsible for this type of infection.(ABSTRACT TRUNCATED AT 250 WORDS) Pathol Biol (Paris), 1993 Apr, 41(4), 323 - 8 Determination of MICs for staphylococci using the API ATB quinolone and API ATB macrolide systems; Rohner P et al.; The determination of minimal inhibitory concentrations (MICs) is cumbersome, but remains necessary in certain cases . We tested the two ATB MIC experimental strips (Biomerieux SA), of which each contains 4 antimicrobials of the same class . These strips can be read automatically . The MIC quinolone strip contains nalidixic acid, pefloxacin, ofloxacin and ciprofloxacin, whereas the MIC macrolide (lincosamide-streptogramin) strip contains erythromycin, clindamycin, lincomycin, and pristinamycin . In order to evaluate these strips, 102 S . aureus and 63 coagulase negative staphylococci were used . Correlation coefficients for these MICs (micrograms/ml) and disk diffusion inhibition zone diameters (mm) were nalidixic acid -0.59, pefloxacin -0.95, ofloxacin -0.95, ciprofloxacin -0.91, erythromycin -0.98, clindamycin -0.96, lincomycin -0.96, and pristinamycin -0.64 . Using the Biomic system (Giles Scientific USA), the same zone diameters were converted to MICs (micrograms/ml) . Rates of agreement (+/- 1 dilution) between ATB MICs and Biomic MICs were nalidixic acid 96 p . cent, ciprofloxacin 98 p . cent, erythromycin 99 p . cent and clindamycin 98 p . cent . Rates of agreement between MICs for the same strains determined using agar dilution and ATB MICs were nalidixic acid 93 p . cent, pefloxacin 100 p . cent, ciprofloxacin 99 p . cent, ofloxacin 94 p . cent and erythromycin 96 p . cent . The ATB MIC strips are an easy-to-use tool for MIC determination and their composition is well-suited to the study of phenotypic resistance and detection of low-level resistance. Pathol Biol (Paris), 1993 Apr, 41(4), 302 - 6 {Action of teicoplanin on coagulase negative staphylococci in hospital units of the hospital Hôtel-Dieu in Paris}; Desroys Du Roure F et al.; Teicoplanin, a glycopeptide antibiotic, is active against Staphylococci, with the exception of some strains of coagulase negative Staphylococci (SCN) . Determination of the in vitro activity of teicoplanin by standard disk methodology is not sufficient, and has to be confirmed by the determination of the minimal inhibitory concentration (MIC) for all strains presenting an inhibition zone diameter below 17 mm . We have studied during four months, the susceptibility of SCN to teicoplanin isolated from different units of the hospital, and in particular from the haematology unit (HU) . 186 strains were isolated, 35 p . cent from HU and 65 p . cent from the other units of the hospital . All strains belonged to 11 species: 136 S . epidermidis, 14 S . haemolyticus, 8 S . lugdunensis, 5 S . warneri, 4 S . saprophyticus, 3 S . sciuri, 3 hominis, 2 S . chromogens, 2 xylosus, 2 S . cohnii and 1 S . schleiferi . Twenty five strains out of 186 (13.4%) presented a MIC of 8 or 16 mg/l (MIC verified by the agar dilution method): 7 S . haemolyticus, 16 S . epidermidis, 1 S . warneri et 1 S . capitis . During this study SCN resistant to teicoplanin were never isolated . Twelve out of 25 came from the HU, which correspond to 18 p . cent of the isolated strains in this unit . This result was not significantly different, compared to that of the other units. Orv Hetil, 1993 Mar 7, 134(10), 517 - 22 {Pathogenic properties of coagulase-negative staphylococci in experimental infections}; Molnar C et al.; The frequency of persistence of three Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus saprophyticus strains, respectively, was studied in BALB/c mice at the 10th day of intraperitoneal (ip) challenge . 245 out of 416 mice survived after infections with four bacterial suspensions of different colony forming units (CFU) of each strain . Staphylococci persisted in 61 mice (24,9%) . The main sites of persistence were the kidneys, while cocci were rarely isolated from the spleen and the liver . S . epidermidis persisted with a significantly higher rate than the other two species, because S . epidermidis in 28,8%, S . haemolyticus in 4,9%, and S . saprophyticus in 3,6% were reisolated from the organs of the respective infected and surviving animals . The organ persistence was proportional to the amount of bacteria injected . The persistence resulted in subacute microabscesses in the organs . Reisolates of persisting bacteria remained stable in phenotype and genotype concerning antibiotic resistance patterns and biochemical activities for the taxonomic implication, whereas cell surface properties characterizable with phage types altered considerably during persistence . It is concluded that cocci of all three Staphylococcus species are invasive and can persist to a certain extent in the organs of animals with normal immune system, too, after artificial inoculation into the peritoneum i . e . to the serosal surfaces. Mikrobiol Zh, 1993 Mar-Apr, 55(2), 13 - 8 {The microbiocenosis of the skin of the hands in the workers of a mechanical engineering plant}; Sytnik AN; Microbiocenosis of skin on hands of 160 men aged 16-60 (of them 40 healthy men not dealing with production (control) and 120 workers of the combine plant) has been studied . The level of bacterial dissemination of persons of the control group has been stated to vary within 3.62 +/- 0.07-3.78 +/- 0.08 1g KOE/lm2 . This level in workers of the assembling and metal-working shops essentially decreases and depends on the peculiarities of the production process . The constant contact of skin on hands with oil causes an increase in the amount of bacteria and the contact with emulsions, on the contrary, promotes their decrease . Among the different ecological groups of microorganisms on skin of hands in workers staphylococci occupy a dominating position . The species composition of the latter is nonuniform in workers of different shops . The high level of contamination of skin on hands by Staphylococcus aureus belonging, mainly, to the second phage group has been determined. J Antibiot (Tokyo), 1993 Mar, 46(3), 478 - 85 Implication of cohesive binding of a macrolide antibiotic, rokitamycin, to ribosomes from Staphylococcus aureus; Endou K et al.; In a previous paper we reported that rokitamycin (RKM) which killed some types of RKM-susceptible staphylococci bound cohesively to ribosomes obtained from such bacteria whereas other macrolides such as erythromycin and josamycin, which are generally known to be bacteriostatic, bound to these ribosomes only reversibly . From this observation, we speculated that such cohesive binding of RKM to certain ribosomes probably resulted in cell killing (Endou, K . et al., FEMS Microbiology Letters, 72: 93-96, 1990) . However, this speculation was based only on circumstantial evidence and we did not show directly that reversible binding of RKM to ribosomes from other strains would bring about bacteriostasis only . A clinically isolated strain . Staphylococcus aureus S704, was found to be susceptible to RKM, mycinamicin and tylosin as well as lincosamide and streptogramin type B antibiotics but not to other macrolides (erythromycin, josamycin, rosamicin, etc.) . RKM showed bacteriostatic, but not bactericidal activity, on the strain . Determinant(s) responsible for the bacteriostatic phenotype was transferred into strain NCTC8325 using bacteriophage 80L2; the obtained transductant was referred to as strain 8325MMT7 . The drug bound reversibly, not cohesively, to the ribosomes from both strains S704 and 8325MMT7, confirming our earlier hypothesis that rokitamycin can cause bacteriostasis or cell death depending upon whether it binds reversibly or cohesively to the ribosomes of a given strain. Diagn Microbiol Infect Dis, 1993 Mar-Apr, 16(3), 223 - 6 RP 59500, a new streptogramin highly active against recent isolates of North American staphylococci; Archer GL et al.; To assess the potential clinical utility of RP 59500, 10 investigators from separate locations in the United States and Canada each tested approximately 200 current isolates of staphylococci (Staphylococcus aureus and coagulase-negative staphylococci