Staphylococcus

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) by a standard protocol . RP 59500 was highly active (MIC90 < or = 2 micrograms/ml) against all strains, including those that were resistant to oxacillin, ciprofloxacin, erythromycin, and spiramycin.

J Gen Microbiol, 1993 Mar, 139 ( Pt 3), 623 - 9
Calcium- and mucin-binding proteins of staphylococci; Thomas VL et al.; The association of staphylococci with the mucus gel that overlays the mucosa of the respiratory tract may lead to clearance of cocci or, in certain conditions such as cystic fibrosis (CF), to colonization . In the present study, a quantitative radioassay was used to study the effect of Ca2+, which is elevated in CF sputa, on the adhesion of 3H-labelled Staphylococcus aureus to submaxillary gland mucin immobilized in MaxiSorp 96-well, break-apart modules . Ca2+ significantly enhanced the adhesion of S . aureus (five strains) and Staphylococcus epidermidis (four strains) . The reaction was specific because adhesion was not enhanced in the presence of Mg2+, Ca(2+) + EGTA (a Ca2+ chelator) or protamine and was not attributable to hydrophobicity of the test strains . Staphylococcal adhesion was significantly (P < or = 0.005) blocked in the presence of highly sialated and sulphated reagents, which suggests that Ca2+ binds to the sialic acid and sulphate residues of immobilized mucin . The Ca(2+)-binding sites on the surface of S . aureus were trypsin-sensitive; in addition, 125I-labelled solubilized S . aureus surface proteins reacted with immobilized mucin in a direct binding assay, and the reaction was significantly enhanced by Ca2+ . Autoradiography demonstrated that 45Ca bound directly to two polypeptides (M(r) 170,000 and 150,000) of solubilized staphylococcal surface proteins separated by SDS-PAGE, and that 125I-labelled mucin bound directly to three staphylococcal polypeptides (M(r) 40,000, 35,000, and 29,000) . These results suggest that S . aureus adhesion to mucin is mediated by at least two mechanisms: via Ca(2+)-binding surface proteins in the presence of Ca2+ and via mucin-binding surface proteins unrelated to Ca2+.

J Appl Bacteriol, 1993 Mar, 74(3), 260 - 7
Use of the polymerase chain reaction and 16S rRNA sequences for the rapid detection of Brochothrix spp . in foods; Grant KA et al.; Oligonucleotide primers were designed against rRNA sequences to give a DNA-based PCR assay for the rapid identification/detection of Brochothrix spp . The PCR products could be confirmed by hybridization to an internal oligonucleotide probe . The method successfully and sensitively detected/identified these organisms in pure cultures but was of limited value as a detection method because the detection sensitivity, in relation to conventional plate counts, varied and the assay sensitivity was reduced in the presence of staphylococci . Furthermore, sensitivity was also lost when the assay was applied directly to meat samples . However, a separation step using a lectin (from Agaricus bisporus) immobilized on magnetic beads prior to the PCR assay, allowed the direct detection of low numbers (> 10(2) cfu g-1) of Brochothrix in meat samples within a working day.

Infect Dis Clin North Am, 1993 Mar, 7(1), 81 - 96
Endocarditis due to coagulase-negative staphylococci . Microbiologic, epidemiologic, and clinical considerations; Whitener C et al.; Coagulase-negative staphylococci are the most frequently isolated pathogens in prosthetic valve endocarditis and cause 5% of infections involving native valves . Distinguishing contamination from bacteremia may be challenging . The presence of heteroresistance in many strains makes rigorous susceptibility testing a requirement for selecting appropriate antibiotic selection . Infection is frequently complicated by valvular insufficiency with congestive heart failure, local tissue invasion or synthetic embolization, making surgical intervention necessary in many cases.

Chemotherapy, 1993 Mar-Apr, 39(2), 120 - 3
In vitro activity of levofloxacin, ofloxacin and other quinolones against coagulase-negative staphylococci; Foleno BD et al.; The in vitro activity of levofloxacin against coagulase-negative staphylococci (CNS) was investigated . In vitro, on the basis of MIC90 values, levofloxacin was as active as ciprofloxacin, inhibiting both methicillin-sensitive and -resistant staphylococci at 0.5 microgram/ml . The frequency of one-step development of levofloxacin-resistant CNS was < 1 x 10(-9) . After repeated transfer of CNS in the presence of increasing concentrations of levofloxacin or other quinolones, there were 4-fold increases in MIC50 values for both levofloxacin and ofloxacin, whereas there were 64- to 128-fold increases for ciprofloxacin, norfloxacin and enoxacin . Based on MIC50 values, the concentrations of 1 or 2 micrograms/ml are clinically relevant . The mutant strains induced by levofloxacin showed less virulence based on the LD50 value in acute systemic murine infection.

Diabetes Res Clin Pract, 1993 Mar, 19(3), 195 - 201
Impairment of the oxygen-dependent microbicidal mechanisms of polymorphonuclear neutrophils in patients with type 2 diabetes is not associated with increased susceptibility to infection; Wykretowicz A et al.; Phagocytosis, bactericidal capacity and some selected parameters of oxygen-dependent bactericidal mechanisms were evaluated in 20 patients with type 2 diabetes being in similar (intermediate) state of metabolic control and in 15 healthy individuals . Polymorphonuclear neutrophils (PMNs) from diabetics showed normal ability to phagocytose staphylococci, a decreased Intracellular bacteria killing, the impaired stimulated superoxide anion (O2-) and hydrogen peroxide (H2O2) production and the low intracellular myeloperoxidase activity . The obtained data seem to indicate that the decreased bacterial killing by PMNs isolated from diabetics are partly at least related to an impairment of the oxygen-dependent bactericidal mechanisms . Since none of the diabetic patients suffered from recurrent infection the clinical significance of our finding is still uncertain.

Drugs, 1993 Mar, 45(3), 353 - 66
Optimum treatment of staphylococcal infections; Turnidge J et al.; Serious staphylococcal infections remain a significant clinical problem despite advances in antibacterial therapy . Resistance to penicillin is common and methicillin-resistant staphylococci have become troublesome nosocomial pathogens in many institutions . Penicillinase-resistant penicillins (e.g . flucloxacillin, cloxacillin and oxacillin) are the preferred drugs for all methicillin-susceptible staphylococcal infections, although first generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, clindamycin, and occasionally erythromycin and cotrimoxazole (trimethoprim/sulfamethoxazole) are alternatives . Serious infections due to methicillin-resistant staphylococci should be treated with parenteral vancomycin . Teicoplanin, where available, is a suitable alternative . Rifampicin, fusidic acid and some fluoroquinolones may be useful oral alternatives, although resistance develops rapidly if they are used as single agents . Cotrimoxazole and minocycline have also proven useful when strains are susceptible . Staphylococcal toxic shock syndrome often requires aggressive resuscitation and anti-staphylococcal therapy for generally 10 to 14 days . Staphylococcus aureus bacteraemia remains a life-threatening condition which, in all but one-third of cases, is associated with an underlying septic focus such as endocarditis, osteomyelitis or occult abscess . Differentiating between complicated and uncomplicated bacteraemia is critical to define the appropriate treatment regimen . Serious staphylococcal sepsis such as endocarditis and acute osteomyelitis generally requires prolonged (4 to 6 weeks) antibiotic treatment . Coagulase-negative staphylococci are the commonest cause of prosthetic device infection, and generally require prolonged therapy with an agent to which they have proven to be sensitive, e.g . a penicillinase-resistant penicillin or vancomycin . Removal of infected foreign or prosthetic material, and drainage of deep collections remain a critical aspect of all therapy.

Mol Cell Biochem, 1993 Feb 17, 119(1-2), 171 - 8
Antimicrobial activity of lipoprotein particles containing apolipoprotein Al; Tada N et al.; Human plasma in vitro inhibits the growth of coagulase negative staphylococci, S . epidermidis, which may be pathogenic in the immunocompromised host . To determine the antimicrobial components, serum was fractionated by column chromatography, which revealed that elution areas where lipoproteins can be yielded had high antimicrobial activity against S . epidermidis . Therefore, lipoprotein fractions, including very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL), were separated by ultracentrifugation and incubated with S . epidermidis . All 3 lipoprotein fractions suppressed bacterial growth within the first 3 h but VLDL enhanced bacterial growth after 9 h of incubation compared with the control . HDL, however, inhibited bacterial growth throughout 21 h of incubation . To confirm these results, serum from healthy volunteers was separated by ion exchange column chromatography and again by HPLC to purify the antimicrobial fraction . In the protein analysis with gradient polyacrylamide-SDS gel, apolipoprotein Al (apo Al), which is a major apolipoprotein of HDL, was detected in the antimicrobial fraction . Therefore, this fraction was loaded onto an immunoaffinity column coupled with the anti-apo Al monoclonal antibody (Mab) . Unbound fraction had no antimicrobial activity, but anti-S . epidermidis activity was recovered from the bound fraction which consisted mainly of apo Al, All and apo C in protein composition . These results indicated that the antimicrobial activity was associated with the apo Al-containing lipoprotein particles (HDL) . This property of HDL may directly affect bacterial growth and promote the self-defense mechanisms of normal and immunocompromised individuals.

Eur J Clin Microbiol Infect Dis, 1993 Feb, 12(2), 87 - 92
Serological response to coagulase-negative staphylococci in patients with peritonitis on continuous ambulatory peritoneal dialysis; Dryden MS et al.; Sera and dialysis effluent from 20 patients on continuous ambulatory peritoneal dialysis (CAPD) with coagulase-negative staphylococcal (CNS) peritonitis were examined by immunoblotting for antibody activity against CNS . Immunoblotting was highly sensitive and demonstrated significantly greater antibody activity in serum and dialysate of infected patients compared with that of uninfected CAPD patients or healthy volunteers . Fourteen of 20 infected CAPD patients had strong antibody activity (> 7 bands); one patient had equivocal activity . Five patients had weak antibody activity, two of whom suffered from recurrent peritonitis with distinguishable CNS strains despite a satisfactory CAPD technique . One patient with a poor CAPD technique had strong antibody activity, but suffered from recurrent peritonitis . Examination of sequential sera suggested that seroconversion occurred soon after insertion of the Tenckhoff catheter, possibly in the absence of clinical infection . Antibody activity against a 25 kDa staphylococcal protein was significantly associated with peritonitis.

Eur J Clin Microbiol Infect Dis, 1993 Feb, 12(2), 127 - 31
Identification of Staphylococcus epidermidis and Staphylococcus hominis from blood cultures by testing susceptibility to desferrioxamine; Lindsay JA et al.; Testing susceptibility to desferrioxamine has recently been described as a method for the identification of Staphylococcus epidermidis . This method was compared to a commercial test and the tube coagulase test for the identification of staphylococci from blood cultures and other fluid specimens . A total of 216 isolates was tested over a 13-month period . Sensitivity of the desferrioxamine test in identifying isolates of Staphylococcus epidermidis and Staphylococcus hominis was 97.3%, while specificity was 91.8% . When isolates displaying discrepant desferrioxamine results were characterized using recently described interpretive criteria, sensitivity and specificity of the desferrioxamine test improved to 100% . The desferrioxamine test was reliable, inexpensive and simple to perform, and should prove useful in the diagnostic laboratory.

Immunol Rev, 1993 Feb, 131, 27 - 42
Immunoregulatory effects of superantigens: interactions of staphylococcal enterotoxins with host MHC and non-MHC products; Cantor H et al.; Staphylococcus aureus carries a highly conserved set of genes which encode a set of secreted enterotoxins . Although it is likely that these enterotoxins affect the host/parasite in favor of the bacterium, we do not understand the molecular basis of this interaction . We summarize recent evidence that defines two types of interaction between the bacterial toxin and host cellular receptors that may subvert the host immune response to S . aureus . An interaction between the toxin and class II products on APC can result in inhibition of costimulatory activity and thus impair clonal expansion of T cells specific for bacterial antigens . Studies using anti-class II antibodies suggest that this may reflect transmission of a negative signal to APC after ligation of class II products . A second interaction between a subset of toxins, including SEC, with non-MHC products stimulates both T-cell proliferation as well as toxin-specific cytotoxic T cells (CTL) . We put forward the hypothesis that this interaction reflects binding of a VCAM-1-like subsequence of SEC to VLA-4 expressed by activated target cells . We suggest that this interaction may serve to inhibit the host response by subversion of lymphocyte homing to sites of infection by SEC-producing staphylococci and by local elimination of (VLA-4+) memory T cells.

J Surg Res, 1993 Feb, 54(2), 168 - 72
The effect of protein binding on the adherence of staphylococci to prosthetic vascular grafts; Malangoni MA et al.; Staphylococcus epidermidis is the major bacterium causing prosthetic vascular graft infections and the ability of some S . epidermidis strains to produce slime is associated with pathogenicity . This study investigated the effect of protein binding of staphylococci as a possible mechanism affecting bacterial adherence to vascular graft materials . Slime- and non-slime-producing S . epidermidis strains and an encapsulated Staphylococcus aureus were incubated with Dacron or expanded polytetrafluoroethylene (PTFE) . The slime-producing RP-62A strain had significantly greater adherence to all materials than the other bacteria tested and coincubation with serum did not affect its adherence . The adherence of all bacteria was greater to Dacron than to PTFE . Serum increased the adherence of S . aureus to PTFE (P < 0.05) but did not significantly alter the bacterial adherence to other materials . This suggests that protein binding does not affect the adherence of S . epidermidis to prosthetic vascular grafts.

Rev Clin Esp, 1993 Feb, 192(3), 123 - 6
{Psoas abscess . The diagnostic and therapeutic considerations in 5 patients}; de Miguel J et al.; Five cases of psoas abscesses are discussed, four pyogenes and one tuberculous, the current etiology of this process, together with its pathogenesis and clinical manifestations are discussed . In all of them the guided punction through Computerized Axial Tomography (CAT) has been the way to diagnose and treat the process . Utility of this technique considering both aspects is discussed because it allows to determine the etiology and avoids the surgical drainage; even tough this therapy should be individualized in each case, probably is in primary staphylococci abscesses where this therapeutic option is best indicated.

J Antimicrob Chemother, 1993 Feb, 31(2), 211 - 7
Distribution of genes encoding erythromycin ribosomal methylases and an erythromycin efflux pump in epidemiologically distinct groups of staphylococci; Eady EA et al.; Erythromycin-resistant staphylococci can be divided into two phenotypic classes based on their pattern of cross-resistance to other macrolides, lincosamides and type B streptogramins . Strains inducibly or constitutively resistant to all MLS antibiotics possess erythromycin ribosomal methylase (erm) genes, whereas strains inducibly resistant to only 14 and 15-membered ring macrolides and type B streptogramins harbour msrA, which encodes an ATP-dependent efflux pump . Dot-blot hybridization was used to study the distribution of ermA, ermB, ermC and msrA in five epidemiologically distinct groups of staphylococci . The most widely-distributed resistance determinant was ermC, which was detected in 112 (50.6%) of 221 isolates, alone in 106 isolates and in combination with a second erythromycin resistance determinant in six strains . MsrA was detected in 73 (33%) of isolates, alone in 65 and in combination with a methylase gene in eight strains . This determinant was responsible for erythromycin resistance in over one-third (36.4%) of clinical isolates of coagulase-negative staphylococci . ErmA and ermB were present in only a minority of isolates (5.9 and 7.2% of strains, respectively) . The resistance determinants present in ten strains did not hybridize to any of the four probes although, in all cases, their resistance phenotype was consistent with the possession of a methylase gene . Interestingly, ermB was found exclusively in animal isolates of Staphylococcus intermedius, Staphylococcus xylosus and Staphylococcus hyicus, but not in coagulase-negative staphylococci of human origin . This determinant has previously only been found in a small number of epidemiologically related strains of Staphylococcus aureus.

Antimicrob Agents Chemother, 1993 Feb, 37(2), 281 - 6
Analysis of vancomycin entry into pulmonary lining fluid by bronchoalveolar lavage in critically ill patients; Lamer C et al.; Vancomycin penetration into the fluid lining the epithelial surface of the lower respiratory tract was studied by performing fiberoptic bronchoscopy with bronchoalveolar lavage on 14 critically ill, ventilated patients who had received the drug for at least 5 days . The apparent volume of epithelial lining fluid (ELF) recovered by bronchoalveolar lavage was determined by using urea as an endogenous marker . Vancomycin levels in ELF ranged from 0.4 to 8.1 micrograms/ml (mean, 4.5 micrograms/ml), while the mean simultaneous level of the drug in plasma was 24 micrograms/ml (range, 9 to 37.4 micrograms/ml) . There was a significant relationship (r = 0.64, P < 0.02) between vancomycin levels in plasma and those in ELF, with a correlation whose slope (0.15) indicated that the blood-to-ELF ratio of drug penetration was 6:1 . Using the albumin concentration in ELF as a marker of lung inflammation, we found that vancomycin penetration was higher in patients with ELF albumin values of > or = 3.4 mg/ml than in patients with normal values (< 3.4 mg/ml) (P < 0.02) . These results suggest that the vancomycin distribution includes the ELF of the lower respiratory tract at a concentration that is dependent upon the levels in blood and the alveolar capillary membrane protein permeability . These concentrations were well above the MICs for most staphylococci and enterococci.

J Antimicrob Chemother, 1993 Feb, 31 Suppl B, 65 - 78
Antibiotic prophylaxis in peripheral vascular and orthopaedic prosthetic surgery; Strachan CJ; Peripheral vascular by-pass and orthopaedic joint replacement surgery have much in common . The consequences of infection are serious and occasionally fatal . The incidence of infection varies from 0.5% to 3% depending on the anatomical site; the infecting organisms and distribution of organisms are similar . In orthopaedics a clean theatre environment, high local concentrations of antibiotic in the cement and systemic antibiotic prophylaxis are well established methods of reducing infection rates and are supported by clinical trials . In contrast, scientific evidence supporting these three tenets is lacking for peripheral vascular surgery . There are wide variations in the choice of prophylaxis cover for peripheral vascular surgery and the first clinical cases of antibiotic containing graft material have only recently been described . The choice of an ideal antibiotic for the prophylaxis of infections associated with vascular surgery is debatable; wound and graft infections in those receiving antibiotic prophylaxis range from 0.9% to 5.8% and 0.0 to 0.9%, respectively . For both forms of surgery whether single dose, short course or longer periods of prophylaxis is preferred, it is agreed that the antibiotic must achieve adequate concentrations at the time of potential bacterial contamination . One of the limiting factors of single dose prophylaxis is the ability of the antibiotic to penetrate bone, soft tissue or haematoma . However, single dose prophylactic antibiotic cover in prosthetic surgery will attract increasing support whenever the criteria of spectrum and 'risk period' cover is fulfilled . This may help to contain the increase in multi-resistant bacteria, particularly staphylococci within the hospital ecosystem . Prolonged systemic administration can now be replaced by high local antibacterial activity at the site of prosthesis insertion via a bonded sealant or an impregnated cement . This permits high activity which can last for several weeks until all the lines are removed and tissue incorporation has become established.

Arch Ophthalmol, 1993 Feb, 111(2), 250 - 3
Influence of haptic materials on the adherence of staphylococci to intraocular lenses; Raskin EM et al.; A recent case-control study indicated that the insertion of an intraocular lens with polypropylene (Prolene) haptic materials was a significant risk factor for postoperative endophthalmitis (odds ratio = 4.5, P < .01) . In the present study, we used quantitative techniques to evaluate adherence of Staphylococcus epidermidis to two intraocular lens types--lenses with polypropylene haptic materials and all-polymethyl methacrylate optic and three-piece all-polymethyl methacrylate lenses--using a quantitative culture method, a radioisotope technique, and scanning electron microscopy . All three methods demonstrated approximately twice as many bacteria adherent to lenses with polypropylene haptic materials as to all-polymethyl methacrylate lenses . Scanning electron microscopy showed preferential bacterial adherence to the polypropylene haptic materials . These data provide a pathogenic mechanism to explain our epidemiologic findings of an increased risk of postoperative endophthalmitis associated with implantation of intraocular lenses with polypropylene haptic materials.

Zentralbl Hyg Umweltmed, 1993 Feb, 194(1-2), 144 - 51
{Carriers of staphylococci causing nosocomial infections}; Pulverer G; Certain parts of the skin and mucuous membranes of humans and animals are carrying Staphylococcus aureus . These staphylococci are belonging to their physiological microflora . The data discussed in this paper demonstrate clearly that the carrier frequency of Staphylococcus aureus is locally different depending on epidemiological facts . Carriers of staphylococci may become the source of nosocomial infections . Spreading ability, virulence and epidemic tendency of Staphylococcus aureus are strain-specific features . Only little is known about the underlying mechanisms.

J Infect Dis, 1993 Feb, 167(2), 323 - 8
Methicillin-sensitive and -resistant homologues of Staphylococcus aureus occur together among clinical isolates; Inglis B et al.; Clinical isolates of Staphylococcus aureus collected from hospitals in Australia were analyzed for genetic similarities using restriction fragment length polymorphisms . Methicillin-resistant (Mcr) isolates from Melbourne (1982) and from Hobart (1986) were closely related to a methicillin-multiresistant S . aureus (MRSA) strain, ANS46, originally isolated in Melbourne in 1982 and studied extensively since . Methicillin-sensitive (Mcs) isolates were isolated concurrently with the Melbourne and Hobart Mcr isolates . These were found to be similar to induced Mcs variants of ANS46; these laboratory variants have lost approximately 40-70 kb of DNA carrying multiple resistance (R) determinants clustered around the mec gene . The Melbourne and Hobart Mcs isolates appear to be natural variants lacking this region of their chromosome . A clinical Mcr and Mcs pair of isolates differing only in the presence of an R-cluster near the mec gene were also isolated in Melbourne in 1990; these are not of the same clonal line as the earlier types from Melbourne and Hobart . These data suggest that insertion or deletion (or both) similar to that produced by known mutagens occurs in the mec region of the chromosome of MRSA in clinical populations under natural selective pressures; such processes may be important in the balance of resistant and sensitive staphylococci in hospitals and other clinical environments.

J Med Microbiol, 1993 Feb, 38(2), 90 - 5
Role of fibronectin in staphylococcal colonisation of fibrin thrombi and plastic surfaces; Valentin-Weigand P et al.; The adhesive glycoprotein fibronectin has been proposed as a mediator of adherence of certain gram-positive cocci to host cells and fibrin thrombi . This study compared the role of soluble and immobilised fibronectin in the adherence of coagulase-negative staphylococci (CNS) and Staphylococcus aureus to fibrin thrombi and plastic surfaces . Adherence of S . epidermidis to fibrin thrombi was significantly reduced when fibronectin was removed from the plasma used for thrombus preparation . Adherence was restored through restitution of fibronectin . S . epidermidis also adhered substantially more to plastic surface coated with fibronectin than to non-coated plastic . Increased adherence of CNS to plastic was also observed after coating with the 29-kDa N-terminal fragment of fibronectin . Soluble fibronectin did not affect the adherence of CNS to fibrin thrombi or plastic surfaces . The adherence of S . aureus to fibrin thrombi was significantly increased by the addition of soluble fibronectin, but not by incorporation of fibronectin into the clot . These results indicate that the binding of fibronectin is an important factor in the adherence of staphylococci to fibrin clots and plastic surfaces and, thus, colonisation of these surfaces . However, the two species of staphylococci seem to employ different mechanisms of fibronectin-mediated adherence: S . epidermidis interacts mainly with fibronectin incorporated in fibrin clots or immobilised on implanted synthetic materials, whereas S . aureus adheres to the fibrin matrix through binding of soluble fibronectin present in wound exudates.

Folia Microbiol (Praha), 1993, 38(1), 74 - 6
Antimicrobial spectrum of bacteriocin-like substances produced by rumen staphylococci; Laukova A et al.; Five strains of rumen coagulase-negative adherent and ureolytic staphylococci were obtained as bacteria producing bacteriocin-like substances or lantibiotics . All examined staphylococci produced inhibitory agents which showed a wide range of inhibition against Gram-positive and Gram-negative indicator organisms from different sources . Clear zones of inhibition (diameter 1-6 mm) dominated . Most bacteriocin-like substances produced by the strains were stable and sensitive to trypsin, susceptible to chloroform vapours and heat-sensitive.

Vet Med (Praha), 1993, 38(2), 107 - 13
{Properties of adherent staphylococci isolated from the rumen wall in lambs}; Laukova A; Six defined strains of adherent, coagulase-negative and catalase-positive staphylococci were isolated from the rumen wall of lambs . All the strains fermented maltose and had positive acetoin production . The strains were classified as follows on the basis of diagnostic tests, according to an identification key: three strains belonged to the species Staphylococcus warneri (SW34, SW64, SW6), two to the species S . epidermidis (SE30, SE49) and one to the species S . cohnii subsp . urealyticum (SCU32)--Tab . I . The adherence index of the different isolates ranged from 1.9 +/- 0.02 to 14.9 +/- 2.12 of bacteria adhering to one epithelial cell of the rumen wall . There were large differences in urease production (2.3 +/- 0.15 to 29.3 +/- 1.16 nkat/ml) . But in general the isolated staphylococci can be taken as strains with low, medium or high adherence, and/or urease activity (Tab . II) . In the group of facultative anaerobic bacteria the staphylococci are the first, lactic acid producing bacteria and the attained production (0.164 to 0.687 mol/l) is adequate to their portion in the rumen (Tab . II) . The isolated strains produced bacteriocin-like substances which inhibited the growth of maximally four out of the six used indicator bacteria of the same species, and also of a related species (Tab . III) while they showed small but clear zones of inhibition of the size 2 to 5 mm . In general, the mentioned staphylococci can be considered as little active producers of bacteriocin-like substances . All the tested strains were resistant to the observed heavy metals.

Eur J Clin Microbiol Infect Dis, 1993, 12 Suppl 1, S6 - 8
Pharmacodynamics of antimicrobial agents as a basis for determining dosage regimens; Craig W; Pharmacodynamic parameters, such as the rate of bactericidal activity with increasing drug concentrations, post-antibiotic effect, sub-MIC effects, post-antibiotic leukocyte enhancement and first-exposure effect, more accurately describe the time course of antimicrobial activity than the MIC and MBC . Aminoglycosides and quinolones exhibit concentration-dependent killing and induce prolonged post-antibiotic effects . The amount of drug rather than the dosing frequency determines the efficacy of these drugs . However, high peak levels can reduce the emergence of resistance, and once-daily dosing of aminoglycosides can also reduce nephrotoxicity and ototoxicity . On the other hand, beta-lactam antibiotics show time-dependent killing and produce prolonged post-antibiotic effects only with staphylococci . The frequency of drug administration is an important determinant of outcome for these drugs, as the duration of time serum levels exceed the MIC is the major determinant of efficacy.

Cesk Pediatr, 1993 Jan, 48(1), 1 - 4
{New findings in chronic granulomatous disease}; Bartunkova J et al.; Chronic granulomatous disease is a rare hereditary disease characterized by repeated infections affecting in particular the skin, lymph nodes and internal organs . Histological examination in the affected tissues reveals a granulomatous inflammation . The aetiological agents of infection are most frequently staphylococci, G-bacteria, Candida and Aspergillus . From the immunological aspect it is an inborn immunodeficiency affecting professional phagocytes (monocytes and granulocytes) which are unable to kill some ingested microorganisms . The molecular basis of the defect is affection of the NADPH oxidase enzyme complex at various sites which explains the genetic heterogeneity of the disease . The condition is usually manifested in early childhood, it has a variable course; if untreated, the affected subjects frequently die in child age . By early diagnosis of the disease and suitable therapy the quality of life of the patients can be improved, serious complications can be prevented and the patients may reach adult age . The submitted paper is a review of contemporary knowledge of the disease, in particular its molecular basis and ensuing classification, as well as possible diagnosis and treatment of the disease . Several case-histories are presented.

Acta Neurochir (Wien), 1993, 121(1-2), 9 - 11
Randomized placebo-controlled trial of single-dose antibiotic prophylaxis with fusidic acid in neurosurgery; Mindermann T et al.; In neurosurgery, the antibiotic prophylaxis of choice has not yet been determined . The ideal drug should have an appropriate antimicrobial spectrum and favourable pharmacokinetic properties . In addition it should be nontoxic and easy to apply . We therefore conducted in 90 patients a prospective, randomized, placebo-controlled, double-blind trial in clean neurosurgery at increased risk of wound infection using a single pre-operative dose of 500 mg fusidic acid . Fusidic acid is a steroid-like antibiotic with a serum half-life of about 10 hours and excellent activity against gram-positive bacteria, including methicillin-resistant staphylococci . The neurosurgical infection rates for craniotomies, posterior fossa surgery and implantation of foreign bodies were 2.4% in the treatment group and 9.1% in the placebo group, respectively . This difference is statistically significant at a 95% confidence level.

Microbiol Immunol, 1993, 37(1), 69 - 73
Effects of cytochalasins B and D on Staphylococcus aureus adherence to and ingestion by mouse renal cells from primary culture; Murai M et al.; Cytochalasin B (CB) and cytochalasin D (CD), inhibitors of microfilament function of host cell, were examined for their effects on Staphylococcus aureus Cowan I adherence to and ingestion by several types of the hyperosmolarity-tolerant (HOT) cells obtained from primary culture of mouse kidney . Staphylococcal adherence to the HOT cells with epithelial appearance was extraordinarily enhanced by the treatment of those cells with both 5 micrograms/ml of CB and CD . In particular, staphylococci adhered to the periphery rather than the center of each cytochalasin-treated cell . Staphylococcal ingestion by all types of the HOT cells was markedly inhibited by CD in spite of the enhanced adherence . Contrary to our expectation, inhibition by CB was incomplete, and the enhanced adherence of staphylococci to CB-treated cells resulted in the enhanced ingestion.

Microbiol Immunol, 1993, 37(1), 55 - 62
Cholera toxin (choleragen)-polymorphonuclear leukocyte interactions: effect on migration in vitro and Fc gamma R-dependent phagocytic and bactericidal activity; Niemialtowski M et al.; PMNL leukocytosis is a feature common to many types of infectious and inflammatory diseases . How PMNL are recruited to tissues is not yet clear although it is a question that has considerable clinical importance . We investigated the function of PMNL which migrated through an artificial barrier (Chinese hamster ovary (CHO) cells, collagen and nylon cloth membrane) subjected to CT or choleragenoid treatment toward plain medium (the same RPMI in the upper and lower chamber) or medium containing chemotactic factor (fMLP or LPS or ZAS) . CT treatment significantly (P < 0.01) reduced the Fc gamma R expression on the surface of PMNL . The PMNL functions, namely, migration, phagocytic activity and intracellular killing of staphylococci, also have been reduced significantly (P < 0.01) . Fc gamma R expression and some functions of PMNL that migrate to chemoattractants were reduced, irrespective of the presence or absence of CT; however, the inhibitory effect of CT on PMNL function was observed only when PMNL migrate to the lower chamber without chemotactic factor . On the other hand choleragenoid treatment of CHO cells did not have any significant influence on PMNL function and Fc gamma R expression . In conclusion, our experiments demonstrate that CT reduces EAFc rosetting and the Fc gamma R-dependent phagocytic and bactericidal activity of bovine blood PMNL.

Kansenshogaku Zasshi, 1993 Jan, 67(1), 12 - 7
{Detection of mecA gene of methicillin resistant staphylococci from oral swabs by polymerase chain reaction}; Higashiyama Y et al.; We evaluated the polymerase chain reaction method (PCR) for the rapid detection of methicillin resistant Staphylococcus aureus (MRSA), and compared it with the conventional culture method . Primers for amplification of mecA gene were synthesized by DNA synthesizer according to the published sequences of mecA gene . The results were as follows: Specificity of PCR was excellent, as there was no cross-reaction with any organism other than MRSA . Fifty colony forming units of MRSA were detected, indicating good sensitivity . We examined oral swabs from 13 bed-ridden patients (age range: 65-82 yrs) by PCR and the conventional culture method . The PCR elicited positive results in 6 out of 13 cases . MRSA or coagulase negative Staphylococci (CNS) in Mueller-Hinton agar containing 12.5 micrograms/ml methicillin were obtained from all of these PCR-positive specimens . Two of 7 PCR-negative specimens raised MRSA or CNS colonies, but the number of colonies from these specimens was below the sensitivity threshold of the PCR . The good specificity and sensitivity of the PCR method for the detection of mecA gene obtained in this study suggest the possibility of application of this method for detection of MRSA in clinical specimens.

Infection, 1993 Jan-Feb, 21(1), 71 - 4
Efficacy and pharmacokinetics of teicoplanin in hemodialysis patients; Beckers B et al.; In order to establish guidelines for the dosage of teicoplanin, a new glycopeptide antibiotic, in patients with end stage renal failure, 40 cases of suspected or proven gram-positive infections were treated with teicoplanin . Three different dosage regimens were used and peak/trough serum levels measured . Thirty-one patients were cured and six patients died . Teicoplanin was well tolerated . For severe cases of septicemia with staphylococci in patients undergoing hemodialysis a teicoplanin therapy consisting of 800 mg on day 1 followed by administrations of 400 mg on days 2, 3, 5, 12, and 19 is recommended . Minor infections are treated initially with 800 mg followed by administration of 400 mg at weekly intervals.

Chemotherapy, 1993, 39(1), 55 - 8
Antistaphylococcal and antienterococcal activity of the new teicoplanin amide derivative MDL 62873; Qadri SM et al.; In vitro response of 469 clinical isolates of gram-positive cocci was tested against MDL 62873 by the agar dilution method . The bacteria consisted of 407 isolates of staphylococci and 62 strains of enterococci . In vitro activity of MDL 62873 was compared with that of ampicillin, augmentin, erythromycin and vancomycin . All the isolates were completely inhibited by MDL 62873 at an MIC ranging between 0.25 and 8.0 micrograms/ml . In vitro activity of this new amide derivative of teicoplanin was far superior to that of ampicillin, augmentin and erythromycin and equal to or slightly better than that of vancomycin.

Chemotherapy, 1993, 39(1), 48 - 54
Bioactivity of flurithromycin and other macrolides against intracellular susceptible staphylococci; Fietta A et al.; The intracellular activity of flurithromycin, erythromycin, roxithromycin and miocamycin against susceptible clinical isolates of Staphylococcus aureus, phagocytosed by human monocytes, was investigated . Intracellular bioactivity was studied in a 24-hour assay, using experimental conditions which allowed the intracellular growth of bacteria . A colony counting method was used to differentiate between intracellular bacteriostatic and bactericidal activity of antibiotics . Moreover, the effect of macrolides against extracellular staphylococci was assessed . All agents showed higher intracellular than extracellular activity against staphylococci . At low concentration (0.1 mg/l) they had intracellular bacteriostatic activity . At concentrations higher than the minimal inhibitory ones (1 and 5 mg/l), miocamycin only still produced a bacteriostatic effect while flurithromycin, erythromycin and roxithromycin also showed intracellular bactericidal activity.

J Antibiot (Tokyo), 1993 Jan, 46(1), 99 - 119
Excellent activity of FK037, a novel parenteral broad-spectrum cephalosporin, against methicillin-resistant staphylococci; Mine Y et al.; FK037 exhibits potent in vitro and in vivo antibacterial activity against methicillin-resistant staphylococci . In in vitro studies, FK037 was the most active of the cephalosporins and imipenem tested against the highly methicillin-resistant staphylococci (MIC > 100 micrograms/ml) . Only 2 of 57 strains of highly methicillin-resistant Staphylococcus aureus (H-MRSA) had a FK037 MIC value of 50 micrograms/ml . On the other hand, 55, 40 and 19 strains had MICs of 50 or > or = 100 micrograms/ml to cefpirome, flomoxef and imipenem, respectively . Against 13 strains of highly methicillin-resistant coagulase-negative staphylococci (H-MRCNS), FK037 inhibited all the strains at < or = 50 micrograms/ml, but there were many strains highly resistant to the reference drugs with MICs of > or = 100 micrograms/ml . The influence of culture conditions such as low temperature, high inoculum and supplementation with 4% NaCl on the anti-MRSA activity of FK037 was less than those with cefpirome, flomoxef and imipenem . The in vitro frequency of spontaneous mutant cells highly resistant to FK037 in MRSA was lower than that to cefpirome and flomoxef . These findings were supported by lack of colonies inside the inhibition zone demarcated by FK037 in a disk sensitivity test, although many colonies proliferated inside the inhibition zone demarcated by flomoxef and imipenem . The increase in MIC of FK037 against a MRSA strain during subculture in the presence of the drug was smaller than that noted with the reference drugs . FK037 had higher affinity and faster binding for the PBP 2a of MRSA than that of the reference drugs . Moreover, the capacity to induce PBP 2a was lower for FK037 than that of cefpirome but higher than that of flomoxef . In an in vitro pharmacokinetic model simulating human plasma concentrations, FK037 showed potent bactericidal activity against H-MRSA in the plasma concentrations after intravenous infusion dosing with 1.0 g . FK037 was synergistically active against H-MRSA in combination with either imipenem of fosfomycin . The in vitro post-antibiotic effect (PAE) of FK037 against H-MRSA ranged from 1.2 to 1.7 hours at one to four times the MIC . FK037 had potent therapeutic effects against lethal systemic infections and experimental local infections in mice such as pneumonia, endocarditis, subcutaneous abscess, intrauterine infection and granuloma pouch infection due to MRSA or methicillin-resistant Staphylococcus epidermidis (MRSE) . FK037 was about 4, 8 and 1.5 times more effective than cefpirome, flomoxef and imipenem, respectively, against lethal systemic infections with H-MRSA.(ABSTRACT TRUNCATED AT 400 WORDS)

Dermatol Clin, 1993 Jan, 11(1), 201 - 6
The staphylococci . Importance of their control in the management of skin disease; Williams RE et al.; For skin diseases such as impetigo and furunculosis in which infection with S . aureus is the primary pathologic event, control of that infection is obviously paramount in the management of the clinical situation . The available antistaphylococcal agents are highly effective, and topical mupirocin has been a valuable recent addition . In conditions such as AD the position is less clear . Because the presence of the underlying disease is a prerequisite for the staphylococcal colonization, the exact role of staphylococcal damage is difficult to separate from the underlying disease activity . The definitive experiment, whereby staphylococcal colonization is eradicated over a prolonged period of time by a nonirritant method, remains to be performed . Until that time it is reasonable to pursue a policy of treating S . aureus colonization when it is believed to be of clinical significance and not simply on the basis of bacteriologic findings.

Am J Clin Pathol, 1993 Jan, 99(1), 69 - 71
Mean platelet volume during coagulase-negative staphylococcal sepsis in neonates; O'Connor TA et al.; Coagulase-negative staphylococci are the most common cause of late-onset septicemia in neonates in intensive care nurseries . Clinical and laboratory diagnosis of infection with coagulase-negative staphylococci can be difficult . The authors reviewed serial mean platelet volumes of 18 infants in whom coagulase-negative staphylococci sepsis developed and found a significant increase in the mean platelet volume at the time of diagnosis and a return to baseline after resolution of the infection . The increase in mean platelet volume occurred although thrombocytopenia developed in only two of the infants and no difference was found in the mean platelet counts before and at the time of diagnosis of the infection . This finding may be a useful adjunct to the current laboratory tests used to diagnose coagulase-negative staphylococci sepsis in neonates.

Chest, 1993 Jan, 103(1), 132 - 6
Infection of pulmonary artery catheters . Epidemiologic characteristics and multivariate analysis of risk factors; Rello J et al.; Sixty-nine consecutive pulmonary artery catheters (PACs) were prospectively studied in a medical-surgical intensive care unit . Fifteen (21.7 percent) and two (2.9 percent) of the PACs were associated with colonization and bacteremia, respectively . These data represent an incidence of 4.98 and 0.66 episodes per 100 catheterization-days, respectively . Coagulase-negative staphylococci were the most common isolates . The source of the colonizing microorganism was the skin in 56 percent of cases, hubs in 28 percent, and unknown in 16 percent . From multivariate analysis, only more than 5 days of catheterization was significantly associated with a greater risk of colonization . Antimicrobial use was associated with negative cultures . The most useful method to diagnose colonization was the examination of both tip and intradermal segments . In addition, we suggest associate hub cultures when catheter-related bacteremia is suspected . These data may be useful in improving efficacy in the diagnosis and prevention of PAC-related infection.

Int Arch Allergy Immunol, 1993, 102(1), 33 - 45
Ultrastructural identification of exocytosis of granules from human gut eosinophils in vivo; Dvorak AM et al.; Twenty-two percent of 117 biopsies of human intestinal tissues had ultrastructural images of classical regulated secretion from eosinophils in vivo i.e . eosinophil granule extrusion (EGE) . Replicate intestinal biopsies that were positive for bacteria had EGE more often than not (p < 0.05); 77% of the isolates were Staphylococci . Some of the intestinal biopsies also had damaged nerves; all that had EGE and damaged enteric nerves also had positive bacterial cultures . The EGE that we observed could not account for all enteric nerve damage, suggesting multifactorial mechanisms for nerve damage in gut tissues . Among the possibilities are release of neurotoxic eosinophil granule proteins by an alternate secretory route, i.e., piecemeal degranulation, direct toxicity of tissue invasive bacteria and/or damaged nerves of unknown etiology such as those that are regularly present in uninvolved tissues of patients with Crohn's disease.

Biometals, 1993 Autumn, 6(3), 185 - 92
Purification and chemical characterization of staphyloferrin B, a hydrophilic siderophore from staphylococci; Drechsel H et al.; This paper describes the chemical characterization of staphyloferrin B, a new complexone type siderophore isolated from low iron cultures of Staphylococcus hyicus DSM 20459 . Purification of the very hydrophilic metabolite was achieved by anion exchange high performance liquid chromatography HPLC . Mass spectrometry showed a molecular mass of 448 amu . Hydrolysis with 8 M HCl revealed the presence of L-2,3-diaminopropionic acid, citrate, ethylenediamine and succinic semialdehyde . The connections between the four building blocks were determined by two-dimensional nuclear magnetic resonance measurements . UV/Vis and circular dichroism spectra are consistent with the proposed structure, which could also be confirmed by precursor feeding . The siderophore activity of staphyloferrin B was demonstrated by iron transport measurements.

Perit Dial Int, 1993, 13 Suppl 2, S367 - 70
Pharmacokinetics and pharmacodynamics of antistaphylococcal antibiotics in continuous ambulatory peritoneal dialysis patients; Keller E; Staphylococci are the leading pathogens in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis . Vancomycin appears to be an outstanding antistaphylococcal drug because resistance to it is nearly absent . The pharmacokinetics of vancomycin and clinical cure rates of peritonitis with different dosing guidelines have been studied extensively . Different dosing guidelines with IP or IV loading doses followed or not followed by IP maintenance doses are used successfully, despite the fact that some of the dosing schemes produce apparently suboptimal drug levels referring to in vitro data like the MIC value (minimum inhibitory concentration) . Alternatively, aminoglycosides, cephalosporins, isoxazolyl penicillins, and broad-spectrum penicillins combined with beta-lactamase inhibitors may be used for the treatment of gram-positive peritonitis . For the above penicillins pharmacokinetic data are scarce, and clinical experience is limited . Rifampin has excellent intracellular antistaphylococcal activity and should be used in combination with other antibiotics . Although pharmacokinetic data are lacking, rifampin dosages do not require adaptation to renal function or replacement therapy.

APMIS, 1993 Jan, 101(1), 55 - 60
Induction of oxidative burst response in human neutrophils by adherent staphylococci . Comparison between Staphylococcus epidermidis and Staphylococcus aureus; Riber U et al.; The ability of staphylococci adherent to silicone surfaces to induce superoxide anion (O2-) production by polymorphonuclear leukocytes (PMNs) was investigated and compared with the same activity induced by planktonic bacteria . The responses to Staphylococcus aureus strain E 2371 and Staphylococcus epidermidis strain ATCC 14990 were compared . The staphylococci were allowed to adhere to silicone catheters for 2 h at 37 degrees C . After opsonization of adherent bacteria in 30% human AB-positive serum, the induction of superoxide anion production by PMNs was measured in a cytochrome C reduction assay . Both bacterial strains, when adhered to the surfaces, were able to induce superoxide anion production by PMNs to about the same extent . Comparing adherent and planktonic bacteria with these two bacterial strains, it was found that planktonic S . epidermidis induced one to three times higher superoxide anion production than the adherent bacteria, whereas planktonic S . aureus induced four to seven times higher superoxide anion production than the adherent bacteria . Interstrain variation between the response to adherent and planktonic staphylococci was found . The lower phagocytic response to adherent staphylococci as compared to the response to planktonic organisms may interfere with the killing process and thereby contribute to poor clearance of these bacteria when adherent to foreign bodies such as catheters.

Vet Med (Praha), 1993, 38(5), 267 - 74
{Antagonistic activity of the rumen bacteria, Enterococcus faecium and Staphylococcus warneri}; Laukova A; The bacterial strains E . faecium and S . warneri were tested for their antagonistic activities, and/or for the antimicrobial spectrum of bacteriocin-like substances produced by these bacteria . Isolates of rumen and non-rumen origin were used as indicator strains (Tab . I) . All the isolates (except the strains SW48 and EF24c as indicators of rumen origin) produced bacteriocin-like substances inhibiting the growth of at least one of the series of the nine indicators used while clear inhibition zones 2-10 mm prevailed (Tabs . II, III) . Among the enterococci, the inhibition of non-rumen indicators was more intensive in comparison with the indicators of rumen origin, but the inhibition zones were only 2-5 mm . In general, the staphylococci showed the antagonistic activity with the lower antimicrobial spectrum in comparison with the enterococci . None of the tested strains inhibited the growth of the indicator E . faecium A26 . The summary results show that the growth of both gram-positive and gram-negative bacteria was inhibited . The prolonged cultivation time did not influence the antagonistic activity of the tested strains . In the strains EF35, SW34 and SW98, the antagonistic activity was maintained after trypsin treatment . But in the other strains, this treatment led to the loss of the antagonistic activity . The use of pronase P resulted in the loss of the activity in the strains SW24, EF35 and EF26/142 . The use of pronase P did not lead to the loss of the activity in the other tested isolates (Tab . IV).(ABSTRACT TRUNCATED AT 250 WORDS)

Med Dosw Mikrobiol, 1993, 45(2), 153 - 8
{Action in vitro of disodium ethylenediaminetetraacetic acid (Na2EDTA) and antibiotics on resistant strains of staphylococcus aureus}; Rudy M et al.; The investigation of action of Na2EDTA and doxycycline on strains of staphylococci resistant to doxycycline was performed by two methods: serial dilutions of tested substances in the fluid and solid medium . MIC values for Na2EDTA, doxycycline and both substances together were determined . Both methods resulted in an observation that for majority of tested doxycycline-resistant strains, application of various concentrations of doxycycline together with Na2EDTA resulted in a change of sensitivity of bacteria to the antibiotic by lowering concentration needed for bacterial growth inhibition . It seems that in further studies laborious and time-consuming method of serial dilutions in the fluid medium, should be replaced by more convenient and easier to perform method of serial dilutions of drugs in solid agar medium.

Med Dosw Mikrobiol, 1993, 45(2), 149 - 52
{Susceptibility of methicillin-sensitive and methicillin-resistant staphylococci to ciprofloxacin}; Namysl E et al.; Investigations were carried on 352 strains of Staphylococcus aureus and 105 strains of coagulase-negative staphylococci, isolated from various clinical materials and derived from some regions of the country . Methicillin-resistance was tested by an antibiotic dilution method in solid Mueller-Hinton medium with addition of 2% NaCl . Staphylococci with MIC higher than 4 micrograms/ml were considered as resistant . The same method for testing resistance to ciprofloxacin was used . Only one strain (S . aureus) was resistant to both ciprofloxacin and methicillin . All remaining strains of staphylococci were ciprofloxacin-susceptible . The MIC for all of them was not higher than 2 micrograms/ml, regardless of resistance to methicillin . Some slight differences in MIC50 and MIC90 values were found between MRSA and MSSA and they were, respectively, 1 microgram/ml and 0.25 microgram/ml, and 2 micrograms/ml and 1 microgram/ml . Mean MIC of ciprofloxacin for MRSA was 1.1 microgram/ml and for MSSA it amounted to 0.4 microgram/ml . Range of MIC was following: MRSA--0.12 microgram/ml--16 micrograms/ml and MSSA--0.12-2 micrograms/ml . Coagulase-negative staphylococci, both methicillin-resistant and methicillin-sensitive, exhibited same value for MIC50, MIC90 and MIC range and they were following: 0.5 microgram/ml, 1 microgram/ml and 0.12-1 micrograms/ml . Both groups differed slightly in mean MIC values which was 0.6 microgram/ml for methicillin-resistant strains and 0.47 microgram/ml for methicillin-sensitive staphylococci . It seems that within staphylococci isolated in Poland there is no correlation between resistance to methicillin and ciprofloxacin, which is frequently pointed out by other authors.

Postgrad Med J, 1993, 69 Suppl 3, S15 - 7
Prevention of haemodialysis and peritoneal dialysis catheter related infection by topical povidone-iodine; Fong IW; Catheter related sepsis, especially with staphylococci, is one of the most important complications of haemodialysis or peritoneal dialysis . In a prospective, randomized, open study of 129 haemodialysis patients, exit site infection and bacteraemia were significantly greater in the untreated group (18.2% each) than the group treated with povidone-iodine (PVP-I) ointment (4.8% each), P < 0.02 . In nasal carriers of S . aureus, PVP-I resulted in 100% risk reduction of bacteraemia and exit site infection (P < 0.05) and 70% risk reduction of catheter tip infections (P < 0.05) . Preliminary results of an on-going randomized study in patients on intermittent peritoneal dialysis suggest, in the 69 patients so far studied, a reduced S . aureus infection rate in patients who received PVP-I ointment at the catheter exit site (2.9%) compared with the untreated group (8.8%) despite a higher nasal carriage rate in the PVP-I group . Statistical significance has not been demonstrated for these interim results and the study is continuing.

Scand J Infect Dis, 1993, 25(4), 507 - 13
A study of the epidemiology of an endemic strain of staphylococcus haemolyticus (TOR-35) in a neonatal intensive care unit; Kazembe P et al.; Coagulase-negative staphylococci (CNS) are among the most prevalent microorganisms that colonize and cause sepsis in neonatal intensive care units (NICU) . We had previously identified a strain of CNS, Staphylococcus haemolyticus (TOR-35), in the NICU at Mount Sinai Hospital, that had been repeatedly isolated from blood cultures from neonates . We therefore carried out a prospective study to determine the frequency and time of colonization and the frequency of bacteremia in neonates over a 3.5 month period . This was accomplished by obtaining surface swabs within 1 h of birth and on days 3, 5, and 7 and by characterizing all blood culture isolates of CNS . We also determined what percentage of neonatal CNS bacteremias were due to this strain, between January 1, 1987 and December 31, 1990, by retrieving and typing all stock cultures of CNS from that period . All isolates were typed by species identification and antimicrobial susceptibility profile code . There were 76 (38%) neonates that became colonized with the TOR-35 strain at some time during their NICU stay . Lower birth weight was associated with colonization (p < 0.001), as was lower gestational age (p < 0.001) . Only 1 neonate had a positive blood culture isolate for the TOR-35 strain during the prospective study . Of the 4 years of neonatal bacteremias that were studied retrospectively, there were 252 episodes of CNS bacteremia, of which 27 (11%) were due to the TOR-35 strain . The TOR-35 strain has become endemic in our NICU and appears to selectively colonize premature, low birth weight newborn infants, but only infrequently causes bacteremia.

Scand J Infect Dis, 1993, 25(4), 465 - 70
Epidemiological aspects of community-acquired and hospital-acquired bacteremia in northern Norway; Iversen G et al.; 389 patients with 401 bacteremic episodes, either community-acquired (CAB) or hospital-acquired (HAB), admitted to the University Hospital of Tromso (UHT), Norway, and 3 small local hospitals in the region (LHs), were reviewed on the basis of data collected in 1985 and 1989 . As regards incidence, sex- and age distribution, distribution to either surgical, medical, or pediatric wards, compared with etiological agents and predisposing factors, the statistical significance has been evaluated . The proportion of patients < 50 years was greater at UHT than in the LHs . More patients with HAB associated with predisposing factors were hospitalized at UHT than at the LHs . Coagulase-negative staphylococci occurred less frequently in bacteremic patients at UHT than at the LHs . As opposed to reports from elsewhere, Tromso University Hospital seems to appear much more similar to the smaller local hospitals in the epidemiological aspects of bacteremia, inasmuch as both HAB and the CAB presented an even distribution pattern between the 2 hospital groups.

J Egypt Public Health Assoc, 1993, 68(1-2), 33 - 48
Incidence of nasal carriers of Staphylococcus aureus in and outside hospital environment and antibiotic sensitivity of isolated staphylococcus strains; Ali FM et al.; This study was carried out on 100 nasal swabs collected from medical personnel (nurses and doctors) and patients inside hospital environment and also from 50 individuals outside hospital . The swabs were inoculated on different culture media for isolation of /staphylococci which were further identified as S . aureus either by classic bacteriologic methods or by one of rapid screening test of S . aureus . The isolated strains were tested for antibiotic sensitivity to some of B-Lactam antibiotics and to other antibiotics . The results showed that significantly higher percentage of coagulase + ve Staph . were isolated from newborn nursery (90%), operating theatre (71.4%) and hemodialysis unit (60%) than those isolated from intensive care unit, cancer chemotherapy, surgery, chest, internal medicine departments (25%, 26.6%, 31.2%, 33.3%, 50%) respectively . It also showed significant difference in isolation rate between persons at the hospital (patients, doctors and nurses) 44% and controls (normal population) 26% . Most isolates of coagulase + ve Staph . were resistant to penicillin G (93.2%), Streptomycin (77.3%), tetracycline (61.4%) and sensitive to cefamandole (95.4%) . All coagulase+ve Staph . isolates were resistant to sulphonamide and methicillin and all sensitive to vancomycin.

Med Dosw Mikrobiol, 1993, 45(1), 7 - 10
{Production of staphylokinase and hemolysin by coagulase-negative staphylococcus}; Sawicka-Grzelak A et al.; The ability to staphylokinase production by the representative of the six of fifteen investigated species of staphylococci was detected: S . epidermidis, S . lentus, S . sciuri, S . lugdunensis, S . xylosus and S . hominis . The frequency of occurrence of this feature was different among the investigated species . Relatively, the least frequently this feature was observed with S . epidermis (2.3%) and S . xylosus (8.3%) strains . This property most frequently occurred among S . lentus--all the examined strains of this species produced staphylokinase . The hemolysins synthesis was shown among 13 of 15 investigated coagulase-negative species of staphylococci . The only two species of the examined representatives did not produce any hemolysin: S . hyicus and S . schleiferi . Complete correlation between staphylokinase synthesis and the absence of beta-hemolysin production was observed among strains: S . lugdunensis and S . lentus as with the lysogenic S . aureus strains with the double converting phages.

Med Dosw Mikrobiol, 1993, 45(1), 41 - 4
{Regulatory influence of Staphylococcal serine protease on selected functions of lung macrophages in vitro . Introduction of cellular carbonic paramagnetic probe method for evaluation of cellular phagocytic activity}; Miedzobrodzki J et al.; The study was aimed at evaluation of properties of serine protease produced by Staphylococcus aureus V8 . Influence of enzyme on chemotactic and phagocytic activity of rat lung macrophages was investigated . Chemotactic activity of rat lung macrophages was studied by application of modified Boyden chambers . Slight induction of chemotaxis of cells preincubated with enzyme was found . Phagocytic activity of rat lung macrophages was investigated by application of Varian E3 spectrometer . EPR signals emitted by paramagnetic graphite phagocytized by macrophages were measured . Increased phagocytic activity of macrophages subjected to preincubation with enzyme in concentration of 10 micrograms/ml was observed . It seems that staphylococcal proteinase is engaged in interaction of staphylococci with immunological system cells.

Med Dosw Mikrobiol, 1993, 45(1), 29 - 32
{Production of glycocalyx by coagulase negative staphylococci isolated from the oral cavity}; Krzeminski Z et al.; The study was aimed at determination whether and how frequently coagulase-negative staphylococci persisting in human oral cavity possess the same feature . The material consisted of 255 strains of coagulase-negative staphylococci isolated from oral cavity of persons of both sexes and in differing age . Glycocalyx production by these strains was tested quantitatively by a colorimetric method . Glycocalyx was produced by 222 out of 225 tested strains (87.1%) . For individual genera this frequency was following: epidermidis 164/186, hominis 14/14, warneri 12/13, saprophyticus 7/8, auricularis 4/5, haemolyticus 1/4, simulans 4/4, caseolyticus 2/2, xylosus 0/1 and for unidentified 14/18 . Majority of tested strains produced only slight amounts of the glycocalyx . Only 46 out of the -20.7% of active strains (18.0% of all tested strains) produced large amount of glycocalyx . Among these strains, 37 belonged to the genus epidermidis, 6 to hominis and one each to warneri, simulans and auricularis . There was no correlation between amount of glycocalyx produced by individual strains and their number in the oral cavity . These results indicate that production of glycocalyx is a common feature of coagulase-negative staphylococci belonging to different genera and may appear with different intensity . Oral cavity may be a source of strains producing large amounts of glycocalyx and thus potentially pathogenic.

Med Dosw Mikrobiol, 1993, 45(1), 25 - 8
{Influence of antagonistic flora on quantity of staphylococci in the oral cavity}; Krzeminski Z et al.; The study was aimed at establishment, whether in oral cavity co-inhabit bacteria demonstrating antagonistic properties against staphylococci and whether this phenomenon may influence the size of staphylococcal population in this environment . Two locations of bacteria in oral cavity were investigated--saliva and tooth plaque . It was found that total quantity of staphylococci (both coagulase-positive and/or coagulase-negative) in saliva decreases with the age of investigated persons . Mean values amount respectively for children to 3.5 +/- 1.0 log CFU/ml and for adults to 2.9 +/- 0.7 log CFU/ml . This is statistically different (p = 0.0003) . Amount of staphylococci in tooth plaques remains generally at the same level and amount to 1.4 +/- 0.6 log CFU/ml . In each tested sample of saliva and tooth plaque, presence of bacteria antagonistic to isolated from a given sample staphylococci, was detected . Among 2-4 year children and in adults, percentages of antagonistic bacteria against coagulase-positive staphylococci were higher than against coagulase-negative strains . Among children aged 5-6 and 11-13 years opposite proportions were found . Statistic analysis confirmed existence of negative correlations, both linear and ranking, between quantity of antagonistic bacteria and amounts of coagulase-positive and coagulase-negative staphylococci in the same tested samples of saliva and tooth plaque . These results suggest that antagonism between bacterial flora of oral cavity and staphylococci, is presenting one of factors limiting the quantity of staphylococci in this environment.

Intensive Care Med, 1993, 19(6), 311 - 5
Epidemiological markers of coagulase-negative staphylococci; Vandenesch F et al.; Several different epidemiological typing methods have been used in studies of coagulase-negative staphylococci; these include biotyping, antibiotic susceptibility pattern analysis, serological typing, phage typing, slime production detection, protein profile analysis, immunoblot fingerprinting and DNA typing . The most frequently used tests are antibiotic susceptibility and extrachromosomal DNA banding patterns . Comparison of chromosomal DNA restriction patterns is facilitated when the fragments are separated by pulsed-field electrophoresis . Typing variations occur quite frequently even in isolates of demonstrated clinical significance . Caution should therefore be exercised in denying the clinical relevance of coagulase-negative staphylococci, even when successive isolates show distinct typing differences.

Acta Microbiol Hung, 1993, 40(3), 181 - 9
A comparative study on growth in soft-agar, adherence to glass and haemolysis types of coagulase-negative staphylococci; Szucs I et al.; Growth properties of coagulase-negative staphylococci in the presence and in the absence of human and rabbit serum in soft-agar prepared in modified Staphylococcus 110 broth were studied . The adherent growth was examined in modified Staphylococcus 110 broth and 1% glucose-meat broth . Of 100 strains examined 69% exhibited diffuse, 18% compact, 7% transient and 6% mixed growth . Compact type colonies were mainly characteristic of Staphylococcus haemolyticus strains . The presence of serum failed to influence the types of colony morphology in any of the strains . Sixty-three percent of the strains showed adherent growth; none of the S . haemolyticus strains produced adherent growth . The glucose-meat broth, unlike modified Staphylococcus 110 broth, was suitable to study adherence . The coincidence of the compact colony morphology in soft-agar and the absence of adherent growth seems to be a taxonomic sign for the species S . haemolyticus and differentiate it from the species Staphylococcus epidermidis.

Med Dosw Mikrobiol, 1993, 45(4), 419 - 24
{Influence of antagonistic bacteria on quantity of staphylococci in the oral cavity}; Krzeminski Z et al.; The study was aimed at establishment whether antagonistic influence between physiological oral cavity bacterial flora and staphylococci do exist and whether they influence on quantity of staphylococci in oral cavity environment . In samples of saliva taken from group of 11-13 year old children and a group of adults of both sexes, determinations were performed regarding total number of bacteria, number and percentage of bacteria inhibiting in vitro growth of standard indicator strain Staphylococcus aureus Oxford 209P and total number and percentage of staphylococci (together coagulase-positive and/or coagulase-negative) . It was found that in each saliva sample bacteria inhibiting the indicator strain are present and their mean percentage is significantly higher in children than in adults and amounts respectively 47.1 +/- 28.5 and 35.0 +/- 20.3 (p = 0.0316) . Higher percentage of antagonistic bacteria in children is associated with lower percentage of staphylococci in bacterial flora of saliva . Statistical analysis has confirmed existence of negative correlation, both linear and ranking, between the number of antagonistic bacteria and percentage of staphylococci in the saliva . This correlation is more strongly expressed and significant in children than in adults and linear correlation coefficient of Pearson amounts respectively to r = 0.7521 (p < 0.0005) and r = 0.3325 (p < 0.05) . These results indicate that antagonistic bacterial flora is a significant factor limiting quantity of staphylococcal population in human oral cavity, especially in children.

Med Dosw Mikrobiol, 1993, 45(3), 277 - 9
{Bacteriophage types of staphylococcus aureus in neonatal wards of hospitals in Gdansk region during the years 1984-1991}; Wisniewska U et al.; Investigated 3558 strains of S . aureus were obtained from healthy newborn infants in neonatal wards . The staphylococci were classified as S . aureus on the basis of a positive coagulase test . Bacteriophage typing was performed with a basic set of phages and an additional phage (187), according to the method Blair and Williams, in RTD and RTD x 100 . Additionally, susceptibility of staphylococcal phagotypes isolated in the years 1988-1991 to antibiotic from penicillin and cephalosporin groups, trimethoprim-sulphamethoxazole, erythromycin, lincomycin and doxycycline, was determined by disc diffusion method . Among tested strains phagotypes of group II dominated . They constituted 31.3% of all present phagotypes . Second in frequency were phagotypes of group V and III (13.2% and 10.0%) . Large number of staphylococci (22.9%) was typable at the same time with phages belonging to different phage groups . Tested staphylococci were highly resistant to penicillin (98.8%), ampicillin (98.9%), cloxacillin (38.6%), carbenicillin (32.6%) and doxycycline (45.6%).

Roum Arch Microbiol Immunol, 1993 Jan-Mar, 52(1), 25 - 30
Susceptibility to bacteriophages of Staphylococcus aureus strains received at the National Reference Centre for Staphylococci in Romania 1978-1992; Codita I et al.; In order to determine the distribution among lytic groups of Staphylococcus aureus strains circulating in Romania 18,539 strains were phage typed in the National Reference Centre for Staphylococci between 1978 and 1992 . Strains susceptible to group II phages prevailed, representing 28.28% of all phage typed strains . The distribution on lytic groups differed in terms of the type of the clinical isolate . The results are statistically analysed and compared with those obtained in Romania by Popovici et al . between 1966 and 1978 as well as with those reported for other geographical areas by other authors.

Neurochirurgie, 1993, 39(6), 369 - 73
{Prevention of wound infections in neurosurgery}; Djindjian M; Post-operative wound infections are a serious complication in neurosurgery . The average wound infection without antibiotics ranges between 5-11% in C.S.F . shunts, 2-5% in clean and clean contaminated patients; 11-38% in C.S.F . fistula . In C.S.F . shunt procedures, common skin commensals are responsible for most post-operative infections, mainly coagulase negative and positive staphylococci . Contradictory results of the studies evaluating the efficacy of antibioprophylaxis make it impossible to conclude whether antibiotics have any impact on the incidence of infections . Neverless the decision to adopt antibioprophylaxis must be left to each surgeon and based on their own experience (mean level of infection dropped from 5-11% to 1% with ABP in France) . In clean and clean contaminated patients, the weight of evidence based on some large, prospective, randomized studies, suggest that ABP exert a protective effect, for which an antistaphylocci antibiotic would be appropriate . In case of Methi-R organisms, a second generation cephalosporin is an alternative candidate . Association of Vancomycin-Gentamycin is not recommanded routinely because of the risk of development of resistance . In skull fracture and C.S.F . fistula, the results of studies does not favour the routine administration of antibiotics.

Zh Mikrobiol Epidemiol Immunobiol, 1993 Jan-Feb, (1), 62 - 5
{Protease inhibitors as immunomodulators in experimental acute pancreatitis and staphylococcal infection}; Chalyi GA et al.; The influence of protease-inhibiting preparations on the development of humoral immune response in diseases involving the development of secondary immunodeficiency (experimentally induced acute pancreatitis and staphylococcal infection) has been studied . Five injections of contrycal and epsilon-aminocaproic acid (epsilon-ACA), starting from day 1 after the induction of acute pancreatitis, normalized the immune response induced by sheep red blood cells 24 hours after operation . In staphylococcal infection protease-inhibiting preparations (contrycal, epsilon-ACA, Amben) produced a protective effect, increasing the survival rate and the mean survival time of the animals infected with staphylococci.

FEMS Microbiol Lett, 1992 Dec 15, 79(1-3), 51 - 8
Identification of Staphylococcus epidermidis using a 16S rRNA-directed oligonucleotide probe; Zakrzewska-Czerwinska J et al.; Staphylococcus epidermidis is the most medically significant of the coagulase-negative staphylococci . An oligonucleotide probe (pSe) for identification of S . epidermidis was defined by comparing the sequences of the 16S rRNA variable region V6 from numerous coagulase-negative staphylococci . In order to increase the sensitivity of the detection, polymerase chain reaction amplification of the variable region with primers based on the conserved flanking sequences was applied . The detection limit of the polymerase chain reaction assay combined with pSe probe was shown to be 1 fg which corresponds to about one single bacterium . Additionally, a sensitive, non-radioisotopic system with chemiluminescence detection was tested.

APMIS, 1992 Dec, 100(12), 1061 - 5
Comparison of detection speed and yield in agitated and non-agitated aerobic blood culture bottles; Arpi M et al.; The influence of agitation on detection speed and yield was evaluated in 7,033 paired, identical aerobic blood culture bottles (Media Department, Statens Seruminstitut, Copenhagen, Denmark) . One bottle was agitated and the other was incubated stationary . Of a total of 943 organisms isolated in aerobic blood culture bottles, 74% were clinically significant . No difference in the total yield of significant organisms was observed between agitated and non-agitated bottles . In the evaluation of detection speed, only cultures where organisms were isolated from both bottles, but at different times, were included, to ensure that no other factors influenced the result . Staphylococci, Pseudomonas spp., and Candida spp . were detected significantly faster in agitated bottles, on average 0.5-1 day earlier (p < 0.05), and in the majority of the cases within the first incubation day . These species are frequently found and are important causes of severe generalized infections, especially in immunocompromised patients, where early detection is of great importance . The detection principle in agitated bottles in our system, darkening of blood, proved to be an easy, reliable, and fast method to detect positive aerobic blood cultures, which could probably lead to increased automation.

Zentralbl Veterinarmed B, 1992 Dec, 39(10), 723 - 31
Comparison of penicillin-G susceptibility testing methods of staphylococci isolated from bovine mastitis; Myllys V et al.; Penicillin-G susceptibility was analyzed on forty staphylococcal strains isolated from mastitic bovine quarters (29 coagulase positive and 11 coagulase negative) by the standard Kirby-Bauer agar diffusion method, the epsilon-Test, the Vetmic, turbidimetric MIC analysis in Iso-Sensitest Broth (ISB) and whey . Penicillinase production was tested . Parallel susceptibility tests were carried out in whole milk, whey and ISB using resazurin and triphenyltetrazolium as the indicators of bacterial activity . The traditional susceptibility testing methods (radial agar diffusion, MIC in broth culture) showed good agreement with each other and confirmed that the tests can be used interchangeably with the current breakpoint values (0.25 micrograms/ml and phi 26 mm) . The tests carried out in whey showed good correlation with the traditional tests . However, the susceptibility testings in milk resulted in additional variation . Therefore, traditional susceptibility tests of Penicillin-G in artificial media are limited in estimation of bacterial susceptibility when they grow in whole milk . The relevance of this observation regarding mastitis therapy is discussed.

J Antibiot (Tokyo), 1992 Dec, 45(12), 1939 - 48
Synthesis and activity of potent 3-(isoxazolidin-5-yl)- and 3-(isoxazolidinium-5-yl)cephalosporins; Huang SP et al.; The syntheses and in vitro antibacterial activities of 3-(isoxazolidin-5-yl)- and 3-(isoxazolidinium-5-yl)cephalosporins are described . 1,3-Dipolar cycloaddition of 3-vinylcephalosporin with nitrone gave diastereomeric isomers of 3-(isoxazolidin-5-yl)cephalosporin . The antibacterial activities of 3'-(S)-isomers were superior to those of 3'-(R)-isomers . The quaternarization of isoxazolidine ring increased the antibacterial activity . Among them, compound 10b with a hydroxyimino group in the C-7 side chain showed potent activities against staphylococci and compound 10f with an N-hydroxypyridone exhibited an excellent antipseudomonal activity.

Acta Ophthalmol (Copenh), 1992 Dec, 70(6), 745 - 9
Acquired dacryocystitis: microbiology and conservative therapy; Huber-Spitzy V et al.; The dacryocystitis in adults is mainly caused by postsaccal stenosis of the lacrimal ducts . The banking up of the lacrimal fluid leads to an accumulation of germs and following infection . This report describes the clinical and microbiological findings in a large consecutive series of patients that presented at the outpatient clinic of the 2nd Department of Ophthalmology of the University of Vienna with the signs of acute, chronic recurrent or chronic infections of the lacrimal system between 1983 and the end of 1990 . Within the bacterial genus Staphylococci (S . aureus, S . epidermidis and S . saprophyticus) were the most frequently isolated organisms (74 cultures = 50% out of samples with positive cultures) . It was quite interesting that a significant number of gram-negative rods (37 = 25.5%) could be isolated . Of these microorganisms Escherichia coli was most frequently growing on special media (17 cases = 11.7%) when cultures were obtained from acute inflamed lacrimal sacs of patients who suffered from chronic recurrent infections . Conservative therapy of purulent dacryocystitis constitutes the last possible preparation for a necessary surgical intervention and therefore the authors want to point out the importance of microbiological examinations so as to optimize antibiotic therapy.

FEMS Microbiol Rev, 1992 Dec, 9(2-4), 165 - 8
Poly-beta-hydroxybutyrate in staphylococci; Szewczyk EM; Staphylococci--chemoorganotrophic bacteria whose main habitats are human and animal organisms--can accumulate poly-beta-hydroxybutyrate (PHB) in their cells . The polymer is metabolized in endogenous turnovers preceding degradation of aminoacids, proteins and RNA . PHB depolymerase was not found in staphylococci but beta-hydroxybutyrate dehydrogenase was estimated, purified and characterized.

J Dairy Sci, 1992 Dec, 75(12), 3318 - 23
Plasmid pattern analysis of Staphylococcus species isolated from bovine mammary secretions; Matthews KR et al.; Plasmid profiles of staphylococci isolated from bovine mammary secretions were heterogeneous as shown by the study of 94 isolates representing six species . Plasmids were identified in 19 of 94 staphylococcal isolates . Number of plasmids per isolate varied from 1 to 4 . Size of plasmids ranged from 1.2 to 45 MDa; however, most were between 1.8 and 4.8 MDa . Some isolates with identical plasmid profiles were observed within and between species . Plasmid profiles observed in this study suggest that no specific plasmid pattern occurs within a species . Ability to differentiate isolates was not enhanced when antibiograms were used in conjunction with plasmid profiles . Plasmid pattern analysis does not appear to be an adequate method for discriminating between isolates of a species and would likely provide limited epidemiological information regarding staphylococci of bovine origin.

J Clin Microbiol, 1992 Dec, 30(12), 3217 - 9
Evaluation of methods for differentiation of coagulase-positive staphylococci; Roberson JR et al.; The purpose of this study was to determine the minimum number of tests that could be used to differentiate between the coagulase-positive strains of staphylococcus: Staphylococcus aureus, Staphylococcus hyicus, and Staphylococcus intermedius . Eighty coagulase-positive strains of each of the three species were examined . The five tests conducted were growth on modified Baird-Parker agar, growth on P agar supplemented with acriflavin, production of acetoin, anaerobic fermentation of mannitol, and presence of beta-galactosidase . Positive test percentages for S . aureus were 100% for growth on modified Baird-Parker agar, 100% for growth on P agar supplemented with acriflavin, 94% for production of acetoin, 99% for anaerobic fermentation of mannitol, and 0% for presence of beta-galactosidase . Positive test percentages for S . intermedius were 0% for growth on modified Baird-Parker agar, 0% for growth on P agar supplemented with acriflavin, 1% for production of acetoin, 0% for anaerobic fermentation of mannitol, and 100% for presence of beta-galactosidase . S . hyicus isolates were negative in all five tests . Results from the 240 coagulase-positive staphylococcus strains tested would suggest correct identification of coagulase-positive staphylococci with P agar supplemented with acriflavin and the beta-galactosidase test . These two tests are simple to conduct and result in quick and easy differentiation of the three coagulase-positive staphylococcal species.

J Hosp Infect, 1992 Dec, 22(4), 287 - 98
Colonization with coagulase-negative staphylococci in two neonatal units; Nystrom B et al.; Episodes of septicaemia due to coagulase-negative staphylococci (CNS) were more frequent in a level III than in a level II neonatal unit in Stockholm, Sweden . Colonization with CNS during the first 2 weeks of life was investigated in 10 infants from each unit . As the use of antibiotics differed between the two units, the aim was to correlate colonization and antimicrobial resistance patterns to antibiotic usage . Antimicrobial susceptibility of CNS to isoxazolylpenicillins, co-trimoxazole, erythromycin, clindamycin, chloramphenicol and gentamicin was determined . Selected isolates were typed with restriction endonuclease analysis of plasmid DNA and of genomic DNA . Infants were frequently colonized with multiple strains and species of CNS, and transmission of strains from patient to patient occurred within the unit . Qualitative and quantitative differences in antibiotic use were not correlated with colonization . The prevalence of resistant isolates, mostly of Staphylococcus haemolyticus, was higher in the level II unit with lower use of antibiotics . Staphylococcus epidermidis, which is generally more virulent, prevailed in the level III unit, where there were more severely ill children and invasive procedures were more frequently performed.

Eur J Clin Microbiol Infect Dis, 1992 Dec, 11(12), 1115 - 28
An international multicenter study of blood culture practices . The International Collaborative Blood Culture Study Group; Washington JA; An international study was organized to review blood culture practices in 67 medical centers, most of which were teaching hospitals with a total of over 58,000 active hospital beds . The number of blood cultures per admission was generally greater than 0.5 in the USA and less than 0.5 in other countries . Criteria varied for defining a septic episode, as well as for ascribing clinical importance to isolates of coagulase-negative staphylococci; however, septicemia rates tended to be lower in centers in which clinical evaluation was included among these criteria . Staphylococci were ranked first or second among etiologic agents of septicemia in the USA, whereas Escherichia coli was most frequently ranked first among European and Asian centers . All USA centers recommended collection of two blood cultures per septic episode and all but one recommended a maximum number of blood cultures per septic episode, whereas similar recommendations were less common in Europe and Asia . Collection of more than 10 ml per blood culture was more common in the USA than in Europe or Asia . A variety of broth-based systems were used, often in combination with lysis-centrifugation for special (fungal, mycobacterial) or, on occasion, routine purposes.

Zentralbl Hyg Umweltmed, 1992 Dec, 193(4), 364 - 78
{The danger of infection in inhalation rooms}; Breer M et al.; There are alarming reports about high counts of Legionella and Pseudomonas in the aerosol of inhalation-rooms . We therefore investigated 14 institutions (6 kurhauses, 5 hospitals and 3 sanatoria for children) in Schleswig-Holstein, each of them at least five-fold . For that purpose the inhalant (seawater as a rule) was investigated for the total bacterial number and the number of Legionella . Cfu/m3 air were determined at the aerosol outlet and a qualitative search for Legionella was done in the piping . In addition bacterial numbers in the air at the breathing-levels of patients were measured in order to be able to assess health hazards by germs of other patients . Detected bacterial numbers (10(1) - > 10(4)) were basically subject to the handling of the equipment and the type of apparatus used . Predominantly Staphylococci and Bacilli were found and above all when the first row of investigations was carried out large numbers of Pseudomonas, Aeromonas and others occurred . Legionella could not be detected . As a whole the investigations showed that properly maintained room-inhalators pose no higher risk of infection . These facilities, however, might be contaminated at any time and there is a certain--even though comparatively low--risk of infection due to germs exhaled by other patients . Patients, which are predisposed to infections of the respiratory tract--f.i . patients suffering from mucoviscidosis or patients with lowered resistance--should therefore generally use single inhalators.

J Antimicrob Chemother, 1992 Nov, 30(5), 603 - 14
The influence of salt concentration on the detection of methicillin resistance in coagulase-negative staphylococci; Law D et al.; The detection of methicillin resistance by the breakpoint method was examined using three different media containing varying quantities of added salt and 4 mg/L methicillin or 1 mg/L oxacillin . Three hundred clinical isolates of eight species of coagulase-negative staphylococci were tested . In 68 strains methicillin resistance was expressed only at certain salt concentrations and four distinct susceptibility phenotypes were observed . A correlation between the susceptibility phenotype and the species of the isolate was found . Testing on Columbia agar (CA) containing 4 mg/L methicillin with 0% and 4% added salt was required to detect resistance in all 68 strains . Resistance was detected less frequently using Balanced Sensitivity Test (BST) agar or Diagnostic Sensitivity Test (DST) agar containing methicillin or CA, BST or DST agar containing oxacillin . Increased production of beta-lactamase was shown to be an unlikely cause of MR in these strains . Disc sensitivity tests were performed on the 68 strains using five different media . Columbia agar gave optimum results as the other media gave enhanced zones of inhibition for some isolates . Further tests were performed on CA containing varying salt concentrations using both oxacillin and methicillin discs . A close relationship between the staphylococcal species, and the influence of increasing salt concentration on zone size was found . Discrepancies were noted between results obtained by breakpoint and the results obtained with methicillin discs particularly with Staphylococcus simulans and some Staphylococcus epidermidis strains . Results obtained with oxacillin discs more closely correlated with those obtained by breakpoint, but only when disc tests were performed on media with low and high salt content . To identify methicillin resistance in strains of CNS by disc tests, the use of Columbia agar with 0% and 5% added salt and oxacillin discs is recommended.

Immunobiology, 1992 Nov, 186(3-4), 246 - 53
Induction of cytokines in human whole blood cultures by a mitogen derived from Mycoplasma arthritidis and by staphylococcal enterotoxin B; Brand JM et al.; Mycoplasma arthritidis produces a so-far only partially characterized soluble material (MAS) that has a potent mitogenic effect on T lymphocytes of several species . Similar to staphylococcal enterotoxins and a number of related toxins secreted by other species of bacteria, nanogram quantities of these so-called superantigens are sufficient to induce significant amounts of cytokines in the supernatant of lymphocyte cultures . Induction of interleukin-6 (IL-6) by MAS in murine bone marrow-derived macrophages has recently been described . In our study, we examined the differential effects of MAS and Staphylococcus aureus enterotoxin B (SEB) on human blood cells . When compared to MAS, SEB induced a higher proliferative response and, accordingly, a higher release of IFN-gamma . In contrast, large amounts of the macrophage products IL-1, IL-6 and tumor necrosis factor alpha (TNF-alpha) were observed in supernatants of cell cultures stimulated with MAS, whereas only small amounts were induced by SEB . Staphylococci and mycoplasmas are responsible for a number of diseases with various symptoms in man and animals . Our results suggest that SEB and MAS show different qualities in lymphocyte and macrophage stimulation which may be relevant in the pathogenesis of diseases.

Nippon Saikingaku Zasshi, 1992 Nov, 47(6), 759 - 65
{Newly developed MRSA medium}; Taguchi F et al.; We have developed a new selective medium, tentatively named MR(SA)2, for rapid identification of methicillin-resistant Staphylococcus aureus (MRSA) from clinical specimens . MR(SA)2 medium contained modified Muller-Hinton agar supplemented with 75 g of NaCl, 10 g of mannit, 20 mg of bromcresol purple, 20 g of egg-yolk, 4 mg of oxacillin, and 12.5 mg of ceftisoxime per 1,000 ml . There were no differences between the growth of MRSA strains on this medium at 30 C and that of 37 C . This medium can detect the egg-yolk reaction instead of the coagulase reaction . By single streaking of a test material on the surfaces of MR(SA)2 agar, MRSAs can easily be distinguished from methicillin-resistant coagulase-negative staphylococci (MR-CNS), other bacteria and fungi from their colony morphologies in a quantitative manner . A few MRSA strains would not form colonies on this medium because of their susceptibilities to ceftisoxime, but this may not inpede its use, since most MRSA strains isolated from clinical materials showed resistance to ceftisoxime . From the above results, the MR(SA)2 medium may be suitable for rapid detection of MRSA and MR-CNS.

Br Vet J, 1992 Nov-Dec, 148(6), 523 - 8
Colonization of neonatal puppies by staphylococci; Allaker RP et al.; The composition of the normal staphylococcal flora of bitches and their litters held in a breeding unit was studied . The animals were sampled at a number of sites using moistened swabs . Six bitches were sampled daily, for 10 days, before whelping and then, together with four puppies per litter, at whelping (day 11) and at 1 and 7 days thereafter . Staphylococcus intermedius formed the predominant staphylococcal isolate . S . intermedius counts at the oral and nasal sites on the bitches did not change markedly before whelping and remained low (< 6 cfu/swab) . Significant rises in the oral counts on both the bitches (P < 0.05) and puppies (P < 0.001) were then observed after whelping (days 11-18) . Abdominal counts on both the bitches and puppies also rose (P < 0.001) after whelping . S . intermedius counts at the vaginal vestibulum of the pregnant bitches were found to be higher than at any other site sampled and did not alter markedly until whelping when a decrease (P = 0.05; days 10-12) was observed . S . intermedius was not found at the anal site in any of the six bitches and only transiently colonized five of the puppies.

Equine Vet J, 1992 Nov, 24(6), 430 - 4
Septic arthritis in 15 standardbred racehorses after intra-articular injection; Lapointe JM et al.; Case histories, results of synovial fluid analyses, treatment regimens and outcome are described for 15 adult Standardbred horses with confirmed post-injection septic arthritis . Joint sepsis followed injection of corticosteroids, hyaluronic acid, polysulphated glycosaminoglycan, or local anaesthetic . The median interval from injection to appearance of clinical signs was 2.5 days, and median interval from injection to referral was 9 days . The median initial synovial leucocyte count on admission was 57 x 10(9)/litre, but there was a wide range of values (18-258 x 10(9)/litre) . The median synovial neutrophil percentage was 95% (77-99%) . All bacterial isolates were Gram-positive cocci, 86% of which were staphylococci . All treated horses (12/15) initially received broad-spectrum parenteral antibiotic therapy, and the articulations of all horses except one were lavaged, either with non-surgical through-and-through techniques only (N = 3), or surgically with arthrotomy (N = 1) or arthroscopy (N = 7) . The owners of all treated horses were contacted and racing records were consulted . Eleven of 12 horses returned to racing . Outcome was judged as either satisfactory (3/12) if the horse had returned to racing levels similar to or better than before treatment, or unsatisfactory (9/12) if the horse had poorer performance or could not return to racing . The 3 horses with satisfactory follow-up had been treated with arthroscopy and post-surgical closed suction drainage . The results of bacterial cultures suggest that the initial antimicrobial agents used should be effective against penicillin-resistant staphylococci.

Vet Surg, 1992 Nov-Dec, 21(6), 463 - 6
Anaerobic bacteria isolated from osteomyelitis in dogs and cats; Muir P et al.; Anaerobic bacteria were isolated from 18 of 28 animals (64%) with osteomyelitis . The bones most commonly infected with anaerobic bacteria were radius and ulna, mandible, and tympanic bulla . Fights or abscesses commonly preceded the osteomyelitis . Seven anaerobic genera were isolated . Mixed infections of anaerobic and aerobic organisms occurred in 16 animals . Staphylococci were isolated in only one such mixed infection, but they were isolated commonly when there were aerobic bacteria only . Staphylococcal infections were often single.

Pediatr Infect Dis J, 1992 Nov, 11(11), 935 - 40
Relatedness of strains of methicillin-resistant coagulase-negative Staphylococcus colonizing hospital personnel and producing bacteremias in a neonatal intensive care unit; Patrick CH et al.; The emergence of methicillin-resistant coagulase-negative Staphylococcus as a major bacterial pathogen in neonatal intensive care units has stimulated interest in the epidemiology of spread of the organism . During a 12-month "epidemic" of bacteremias with methicillin-resistant coagulase-negative Staphylococcus we compared the characteristics of bacteremic and personnel nasally-carried strains by traditional and biomolecular methods . Sixty-two percent of neonatal intensive care unit nurses were colonized with methicillin-resistant coagulase-negative Staphylococcus with similar speciation to bacteremic strains . Inspection of plasmid profiles revealed a moderate degree of similarity between bacteremic and colonizing strains although genomic DNA restriction patterns showed diversity . Ribotype patterns were highly conserved (90%) in personnel strains . A 2.6-kilobase plasmid DNA probe hybridized to similarly sized plasmids and larger plasmids in one-half of the strains . We hypothesize that related methicillin-resistant strains may be transferred among personnel and neonates in the neonatal intensive care unit . Epidemiologic studies of coagulase-negative staphylococci should consider multiple molecular techniques to relate strains.

Ann Plast Surg, 1992 Nov, 29(5), 444 - 5
Misdiagnoses: a timely reminder; Marshall WR et al.; This case report of an occult infection masquerading as palindromic arthritis was misdiagnosed for almost 2 years . The episodic bouts of erysipelas were not obvious, and it was even suggested that the silicone implanted 7 years previously could possibly be inciting an autoimmune disease . Approximately 2 years after the onset of the recurrent episodes of fever, myalgias, and arthralgias, coagulase-negative staphylococci were found residing in the valve stems of bilumen breast implants, which were removed . The symptom complex disappeared and has not recurred.

J Thorac Cardiovasc Surg, 1992 Nov, 104(5), 1423 - 34
Comparative study of cefazolin, cefamandole, and vancomycin for surgical prophylaxis in cardiac and vascular operations . A double-blind randomized trial; Maki DG et al.; Three-hundred twenty-one adults undergoing cardiac or major vascular operations were randomized to receive intravenous cefazolin, cefamandole, or vancomycin for prophylaxis against surgical infection in a double-blind trial . All three regimens provided therapeutic blood levels throughout operation in patients studied undergoing cardiopulmonary bypass . The prevalence of surgical wound infection was lowest with vancomycin (4 infections {3.7%} versus 14 {12.3%} and 13 {11.5%} in the cefazolin and cefamandole groups, respectively; p = 0.05); there were no thoracic wound infections in cardiac operations in the vancomycin group (p = 0.04) . The mean duration of postoperative hospitalization was lowest in the vancomycin group (10.1 days; p < 0.01) and highest in the cefazolin group (12.9 days) . Prophylaxis with vancomycin or cefamandole, compared with cefazolin, did not prevent nosocomial cutaneous colonization by methicillin-resistant coagulase-negative staphylococci; colonization or infection with vancomycin-resistant staphylococci or enterococci was not detected . Adverse effects attributable to the prophylactic regimen were infrequent in all three groups . Eight patients given vancomycin became hypotensive during administration of a dose, despite infusion during a 1-hour period; however, slowing the rate of administration and pretreating with diphenhydramine allowed vancomycin to be resumed and prophylaxis completed uneventfully in five of the patients . We conclude that administration of vancomycin (approximately 15 mg/kg), immediately preoperatively, provides therapeutic blood levels for surgical prophylaxis throughout most cardiac and vascular operations, resulting in protection against postoperative infection superior to that obtained with cefazolin or cefamandole . Vancomycin deserves consideration for inclusion in the prophylactic regimen (1) for prosthetic valve replacement and prosthetic vascular graft implantation, to reduce the risk of implant infection by methicillin-resistant coagulase-negative staphylococci and enterococci; (2) for any cardiovascular operation if the patient has recently received broad-spectrum antimicrobial therapy; and (3) for all cardiovascular operations in centers with a high prevalence of surgical infection with methicillin-resistant staphylococci or enterococci . Guidelines for dosing and administration of vancomycin for cardiovascular surgical prophylaxis are provided.

J Hosp Infect, 1992 Nov, 22(3), 229 - 40
beta-Lactamase substrate profiles of coagulase-negative skin staphylococci from orthopaedic inpatients and staff members; Thore M; Three different beta-lactamase substrate profiles were identified in 95 isolates of coagulase-negative staphylococci (CNS), of 57 different phenotypes, from 16 orthopaedic inpatients and staff members in one ward, by applying a bacterial whole-cell assay based on the hydrolysis of cefazolin, cephaloridine and nitrocefin . The typability of the assay was 93%, and 91% of the CNS isolates could be classified . To assess the discrimination between the beta-lactamase profiles obtained in the whole-cell assay, beta-lactamase extracts from 19 of the CNS isolates were used for estimation of their relative beta-lactamase substrate affinity index (RSAI) . The RSAI assay was able to type previously unclassifiable or nontypable isolates . Two of the profiles obtained with the whole-cell assay were similar to those of the Staphylococcus aureus controls producing A or D and B or C beta-lactamases respectively . The distribution of beta-lactamase substrate profiles among the CNS isolates indicated an efficient spread of these drug resistance genes.

Medicine (Baltimore), 1992 Nov, 71(6), 369 - 85
Bacterial spinal epidural abscess . Review of 43 cases and literature survey; Darouiche RO et al.; We have reviewed our experience with 43 cases of bacterial spinal epidural abscess, as well as previously reported series of cases . We found a striking male predominance of the disease, accounting for 86% of cases . Most patients had some underlying conditions that predisposed to infection, a prior infection at a distant site, or an abnormality or trauma to the spine . Presenting symptoms included backache (72%), radicular pain (47%), weakness of an extremity (35%), sensory deficit (23%), bladder or bowel dysfunction (30%), and frank paralysis (21%) . Patients cared for in public hospitals tended to seek medical attention in later stages of the disease than patients admitted to private hospitals . Spinal epidural abscess was the suspected diagnosis in only 40% of the cases; the remainder of the time various other infections, tumors, neurologic diseases, or degenerative conditions were considered . Patients in whom the diagnosis of spinal epidural abscess was not initially entertained on admission suffered delays in diagnosis and experienced neurologic deterioration . Staphylococcus aureus was the predominant pathogen (65%) and was associated with positive blood cultures in nearly every case; aerobic or facultative gram-negative bacilli were next most common . Coagulase-negative staphylococci caused infection only in patients who had previous spinal instrumentation . Although analysis of CSF was abnormal in the majority of cases, abnormalities were nonspecific, Gram stain was always negative and culture was rarely diagnostic . Abscesses extended over an average of 4 vertebrae, and the majority were located in the lumbar region followed by thoracic and cervical regions . Unlike previous series, we noted an equal frequency of anterior and posterior epidural abscesses; although differences were not statistically significant, posterior abscesses tended to be more extensive but less commonly associated with radiographic abnormalities of osteomyelitis . Myelography revealed an abnormality in every case in which it was done . Computerized tomographic scanning after intrathecal injection of contrast material always provided additional useful information . Even though magnetic resonance imaging was diagnostic in only 4 of 5 cases (80%) in our series, this test is noninvasive and clearly delineates the location and nature of spinal lesion . It should, therefore, probably replace myelography as an initial definitive study in patients suspected of having spinal infection . Plain roentgenograms and nuclear scans contributed little useful information that was not already available from other radiographic procedures . Surgical drainage together with antibiotics was the treatment of choice; 35 of our 43 patients underwent operative intervention . The preoperative status clearly predicted the final neurologic outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

J Heart Valve Dis, 1992 Nov, 1(2), 201 - 5
Antibiotic prophylaxis and prosthetic valve endocarditis; Antunes MJ et al.; Early onset prosthetic valve endocarditis is one of the most lethal complications after valve replacement . During the first year of operation of our new cardiac surgical program, we observed 10 cases of prosthetic valve endocarditis, the majority being caused by staphylococci, making an incidence of 10.6% . Subsequent investigations uncovered a very high prevalence of methicillin-resistant strains which led to a radical change in the antibiotic prophylaxis, from a cephalosporin-based protocol to a two drug regime of vancomycin and netilmicin . There were no cases of prosthetic infection among the 138 patients operated on in the one year period following the institution of this protocol . Because there were no other changes, either in the types of prostheses used or the techniques of implantation, the eradication of prosthetic valve endocarditis can be related only to this alteration in the prophylaxis . Therefore, we may conclude that the inter-institutional transfer of protocols is not adequate before a thorough investigation of the prevalent hospital pathogens and their sensitivity to antibiotics is carried out . We have not registered resistances to vancomycin and this drug remains the most important antimicrobial agent, both in the prophylaxis and in the treatment of prosthetic valve endocarditis.

J Antimicrob Chemother, 1992 Nov, 30(5), 625 - 32
The bactericidal activity of sparfloxacin; Lewin CS et al.; Sparfloxacin was found to display a biphasic response against Escherichia coli, Staphylococcus aureus and Staphylococcus epidermidis in nutrient broth . Its optimum bactericidal concentration was found to be identical for all three species which contrasts with other clinically available fluoroquinolones that are more active against E . coli than against staphylococci . Bacterial protein and RNA synthesis as well as cell division were not found to be essential for all the lethality of sparfloxacin, which hence displays bactericidal mechanism B . However, sparfloxacin was unable to kill bacteria in absence of oxygen.

Plasmid, 1992 Nov, 28(3), 235 - 46
Multiple copies of IS256 in staphylococci; Dyke KG et al.; EcoRI-digested cellular DNAs of 150 staphylococcal clinical isolates were probed with a plasmid containing a DNA piece from within the open reading frame of IS256 . Most of the Gmr staphylococcal isolates tested contained more copies of IS256 than those associated with Tn4001 carried by these isolates . Three distinct copies of IS256 together with their flanking DNA were isolated by cloning from an EcoRI digest of the cellular DNA of the Gmr isolate, BM3121 . These three copies of IS256 were shown to be intact . The results from DNA sequencing revealed that one of the three copies is flanked by 8-bp direct repeats, and it is suggested that this may be the result of insertion of the IS256 at this site by autonomous movement of the IS element . The insert DNA of all three clones hybridized to the cellular DNA prepared from a Staphylococcus aureus strain that carries neither IS256 nor the aacA-aphD gene . Two of the clones hybridized to several EcoRI fragments of the cellular DNA of this strain, indicating that in these cases IS256 is flanked by DNA present as several copies on the chromosome.

East Afr Med J, 1992 Nov, 69(11), 606 - 8
Beef and dressed chickens as sources of enterotoxigenic Staphylococcus aureus in Nairobi; Ombui JN et al.; Staphylococcus aureus (S . aureus) isolates from beef carcasses, minced beef, and dressed chicken were assayed for production of enterotoxin A, B, C and D using reverse passive agglutination technique . The highest isolation rate was from chickens followed by minced beef . Chickens yielded the highest percentage of enterotoxigenic strains . Staphylococcal enterotoxin C (SEC) was the most frequently produced type from all the three sources while enterotoxin A ranked second and enterotoxin B third . These data show that chickens and minced beef are potential sources of food poisoning staphylococci in Kenya, and that increased handling of the products increases contamination suggesting that man is the major source.

Eur J Clin Microbiol Infect Dis, 1992 Nov, 11(11), 985 - 9
Association between Staphylococcus aureus nasopharyngeal colonization and septicemia in patients infected with the human immunodeficiency virus; Weinke T et al.; In an attempt to identify risk factors for Staphylococcus aureus septicemia, 136 consecutive HIV-infected patients were investigated for the presence of nasopharyngeal colonization with Staphylococcus aureus and subsequent Staphylococcus aureus infection . Sixty of 136 (44.1%) HIV-infected patients had staphylococci which were detected in the nasopharynx on initial culture compared to 12 of 39 (30.8%) patients with chronic diseases and 11 of 47 (23.4%) healthy hospital staff . Another 12 HIV-infected subjects proved to be Staphylococcus aureus carriers on follow-up cultures . Patients with full-blown AIDS had a higher carriage rate compared to subjects who were only HIV-positive (p < 0.05), indicating that Staphylococcus aureus colonized patients were more severely ill . Eight patients with Staphylococcus aureus septicemia were observed, all of whom were carriers; no septicemia occurred in the non-colonized patients (p < 0.01) . Colonized patients with neutropenia (< 1000/microliters) were significantly more likely to develop septicemia (p < 0.01) . Nasopharyngeal colonization with Staphylococcus aureus and the presence of an indwelling catheter were established to be factors that help identify patients at risk of acquiring subsequent Staphylococcus aureus infection.

Infection, 1992 Nov-Dec, 20(6), 350 - 4
Intracellular bactericidal activity of fosfomycin against staphylococci: a comparison with other antibiotics; Trautmann M et al.; The intracellular bactericidal activity of fosfomycin was compared to that of other anti-staphylococcal agents . Two staphylococcal strains (one isolate of Staphylococcus aureus and one isolate of Staphylococcus epidermidis) were incubated in vitro with human granulocytes isolated from volunteers . After phagocytosis and removal of residual extracellular bacteria, the cells were resuspended in the presence of clinically relevant concentrations of fosfomycin, teicoplanin, vancomycin and rifampin . The number of bacteria surviving intracellularly was determined by colony counts after osmotic lysis of the granulocytes at different time intervals . Incubation with fosfomycin resulted in a mean reduction of intracellular bacteria by approximately two logs of ten within 18 h for both staphylococcal strains . Although less effective than rifampin, fosfomycin showed a significantly higher intracellular activity than the glycopeptide antibiotics in this model.

Nippon Rinsho, 1992 Nov, 50(11), 2765 - 72
{Coagulase-negative staphylococcal infections}; Kobayashi H; Coagulase-negative staphylococci are resident flora of the human being and not harmful for ordinary patients . However they cause serious infection for the compromised host, especially the patients with prosthetic valve, prosthetic joint, cerebrospinal fluid shunt, or intravascular catheter . Recent progress of medicine has resulted in the increase of compromised hosts . So, coagulase-negative staphylococci became one of the significant pathogens of hospital infections . Moreover, some hospital strains of coagulase-negative staphylococci demonstrate the resistance against most of the antibiotics recently . To prevent the hospital infection caused by those strains, the contamination control of the prosthetic insert is essential . When once the infection is caused on the prosthetic insert, they have to be removed in most cases.

Eur J Clin Microbiol Infect Dis, 1992 Oct, 11(10), 943 - 5
Comparative activity of the topical quinolone OPC-7251 against bacteria associated with acne vulgaris; Vogt K et al.; The antibacterial activity of the topical quinolone OPC-7251 against bacteria commonly found in acne vulgaris was tested in vitro by an agar dilution method . The MIC50 was 0.25 mg/l for Propionibacterium acnes, 0.125 mg/l for Propionibacterium granulosum, 0.03 mg/l for Staphylococcus aureus and 0.06 mg/l for coagulase-negative staphylococci . Compared with seven other antibiotics tested (ciprofloxacin, penicillin, erythromycin, tetracycline, clindamycin, fusidic acid and gentamicin), OPC-7251 had potent activity against both propionibacteria and staphylococci and the lowest incidence of resistant strains.

Pathol Biol (Paris), 1992 Oct, 40(8), 831 - 44
{A comparative microbiological and pharmacokinetic activity of vancomycin and teicoplanin}; Cohen R et al.; Vancomycin and teicoplanin are two commercially available glycopeptide antibiotics . They have identical spectra of activity and similar mechanisms of action, and both are complex molecules . In vitro, vancomycin is more active against coagulase-negative staphylococci, while teicoplanin is more active against enterococci and pneumococci . The activity of the two antibiotics against Staphylococcus aureus is similar . The serum pharmacokinetics of vancomycin and teicoplanin are highly different, teicoplanin having a longer elimination half-life (40 hours versus 6-8 hours for vancomycin), but a higher degree of protein binding (90% versus 55%) . We compared the two antibiotics on the basis of their inhibitory quotient kinetics, using the MIC90 values for the above bacterial species as the microbiological parameters, and the total and free (non-protein bound) serum concentrations as the pharmacokinetic parameters . The inhibitory quotient kinetics of vancomycin were always more favorable in terms of the free concentrations, even against those bacteria for which the teicoplanin MIC was lower.

Pathol Biol (Paris), 1992 Oct, 40(8), 797 - 804
{Evaluation of three types of empirical antibiotherapy in patients with febrile neutropenia: imipenem-cilastatin versus ceftazidime-vancomycin versus ticarcillin-amikacin-vancomycin}; Bosseray A et al.; A three-arm prospective randomized trial was designed to compare the effectiveness of single drug therapy with imipenemcilastatin (IC), two-drug therapy with ceftazidime-vancomycin (CV), and three-drug therapy with ticarcillin-vancomycin-amikacin (TVA) for the empirical antimicrobial treatment of febrile neutropenia events . The objectives of the study were to determine whether IC monotherapy was as effective as combination drug therapy (CV or TVA) and to assess the value of adding vancomycin at initiation of treatment . One hundred eighty-three febrile neutropenia events were randomized and 125 were evaluable . Success rates were 73% with IC, 67% with CV, and 72% with TVA . There were no statistically significant differences between the three treatment groups, regardless of the duration and severity of neutropenia . Fifty-four bacterial isolates were recovered from 43 patients . Among recovered bacterial strains, 55% were Gram-negative and 45% were Gram-positive . Rates of bacteriologically documented failures (14/33) and superinfections (3/33) were similar in the three groups . Adverse events were rare but two patients given CV and three given TVA developed severe skin toxicity requiring modification of the antimicrobial regimen . IC alone showed similar effectiveness and less toxicity, as compared with CV or TVA . Vancomycin given initially increased toxicity but failed to improve the success rate . Vancomycin may be appropriate only in patients at high risk for infection with methicillin-resistant staphylococci.

Ir J Med Sci, 1992 Oct, 161(10), 589 - 92
The prevalence, antibiotic susceptibility and phage-type of nasally carried Staphylococcus aureus in the Dublin community; Shuhaibar MN et al.; A study was undertaken to determine the distribution, antibiotic susceptibility and phage type pattern of nasally-carried Staphylococcus aureus in the community . Coagulase-positive staphylococci were isolated from 180 of 440 individuals . The rate was higher in the inner city and among young adults and middle-aged males . The isolates were examined for phage-type patterns and antibiotic susceptibility . Most (60.6%) of the isolates were typable either at Routine Test Dilution (RTD) or at 100 RTD . Most belonged to phage group I (53.2%) and phage group III (21.1%) . Susceptibility to penicillin and ampicillin was low at 12.3 and 15.5% respectively . All were susceptible to vancomycin . Methicillin-resistance was unexpectedly low at 0.6% whereas tetracycline and erythromycin resistance were in line with recent trends at 4.5 and 2.7% . The rate of multiple resistance was low at 2.3%.

Ophthalmology, 1992 Oct, 99(10), 1569 - 74
Effects of povidone-iodine chemical preparation and saline irrigation on the perilimbal flora; Boes DA et al.; PURPOSE: To analyze the effects of 5% povidone-iodine preparation and saline irrigation on the species composition of perilimbal flora . METHODS: Cultures were taken from the perilimbal conjunctiva in 100 eyes before preparation for ophthalmic surgery, after instillation of povidone-iodine solution, and after saline irrigation . RESULTS: Bacteria were isolated in 75% of eyes before preparation, in 28% after povidone-iodine instillation, and in 24% after saline irrigation . Fifty-one culture-positive eyes became negative with povidone-iodine, while only four culture-negative eyes became culture-positive (P < 0.001) . The number of eyes yielding coagulase-negative staphylococci, Staphylococcus aureus, and Propionibacterium were significantly decreased after povidone-iodine instillation . Twenty-three culture-positive eyes became negative after saline irrigation, while 19 culture-negative eyes became culture-positive (P > 0.25) . CONCLUSION: Povidone-iodine solution is effective in reducing bacterial recovery from the perilimbal conjunctiva, where most incisions for intraocular surgery occur . Saline irrigation after povidone-iodine preparation has no significant effect.

J Biomater Appl, 1992 Oct, 7(2), 130 - 41
Factor analysis in the evaluation of the relationship between bacterial adherence to biomaterials and changes in free energy; Carballo J et al.; The relative surface charge and free energy of forty-one coagulase-negative staphylococci were found to be normally distributed; therefore, they can be considered a homogeneous group under strict statistical criteria . The adherence of these bacteria to eight different biomaterials (seven synthetic and one biologic) was found to be independent of charge and variations in free energy during adhesion . Adherence can be explained as a thermodynamic process (free energy decreased with adherence), except in the case of bovine pericardium in which free energy increases . With these biomaterials, a correlation was found between adherence and bacterial charge . Bacterial adherence and bacterial charge correlate with the surface parameters of the biomaterials . This correlation does not occur when the relationships between parameters are evaluated by means of factors analysis, thus indicating the importance of the statistical method selected for the evaluation of bacterial adherence.

Zentralbl Mikrobiol, 1992 Oct, 147(7), 489 - 94
Physiological and biochemical characteristics of staphylococci isolated from the rumen of young calves and lambs; Laukova A et al.; Six strains of rumen ureolytic staphylococci were isolated from young calves and lambs . Three isolates were allotted to the species Staphylococcus xylosus . Staphylococcus saprophyticus and Staphylococcus gallinarum . The taxonomy of remaining three isolates was uncertain . Total numbers of staphylococci varied between 10(4) and 10(6) per 1 ml of the rumen fluid . Rumen Staphylococci utilized a wide range of substrates and produced a bacteriocin-like substance . No strain hydrolysed gelatin . All strains produced catalase and reduced nitrate . The main product of anaerobic carbohydrate metabolism was lactate accompanied by formate, acetate and ethanol . Most of strains were sensitive to ionophores, avoparcin, bacitracin and tylosin . All strains were sensitive to rifampicin, tetracycline and chloramphenicol.

Am J Kidney Dis, 1992 Oct, 20(4), 372 - 5
Specific opsonic activity for staphylococci in peritoneal dialysis effluent during continuous ambulatory peritoneal dialysis; Nielsen H et al.; In a prospective study of intraperitoneal opsonins in 30 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), the IgG concentration, the fibronectin concentration, the specific antistaphylococcal antibody level, and the opsonic activity against Staphylococcus epidermidis were measured in peritoneal dialysis effluent from the initiation of CAPD and monthly for 6 months . Significant correlation was found between the four assays, but the interindividual and intraindividual variations were considerable . No statistically significant correlation was observed between susceptibility of the patients to CAPD-related infectious peritonitis and any of the above-mentioned parameters of humoral defense . We conclude that at the present time it is not feasible to use these assays for the establishment of prognosis with regard to peritonitis in CAPD.

Transfusion, 1992 Oct, 32(8), 771 - 4
Staphylococcus epidermidis bacteremia from transfusion of contaminated platelets: application of bacterial DNA analysis; Muder RR et al.; Septicemia is a rare complication of platelet transfusion . A case is reported of transfusion-associated septicemia in a 66-year-old man who received a 10-unit pool of platelets . During transfusion, he experienced rigors, wheezing, dyspnea, and fever . A total of four blood cultures drawn 10 and 36 hours after discontinuation of the transfusion grew Staphylococcus epidermidis . Culture of the residual platelet pool yielded S . epidermidis with a colony count of 10(5) organisms per mL . Strain identity of all four blood isolates and the platelet pool isolate was confirmed by gel electrophoresis of EcoRI and HindIII restriction digests of whole-cell DNA . There have been 31 prior reported cases of platelet transfusion-associated septicemia, of which 9 have been caused by coagulase-negative staphylococci . Systemic reactions to platelet transfusions should prompt consideration of transfusion-associated bacteremia as the cause.

J Med Microbiol, 1992 Oct, 37(4), 232 - 4
The production of fatty acid modifying enzyme (FAME) and lipase by various staphylococcal species; Long JP et al.; Eighty-six strains encompassing 11 species of coagulase-negative staphylococci were examined for the production of fatty acid modifying enzyme (FAME) and lipase . Staphylococcus schleiferi and S . saprophyticus most closely resembled S . aureus in that 80% of the strains produced both enzymes . In contrast, no strains of S . lugdunensis and S . haemolyticus tested produced these enzymes . S . simulans was unusual in that eight of 10 strains produced FAME, but only one produced lipase . Among the other species the proportion of strains producing both enzymes ranged from 10 to 60% . Generally there was a strong correlation between FAME and lipase production.

Int J Syst Bacteriol, 1992 Oct, 42(4), 577 - 81
Staphylococcus piscifermentans sp . nov., from fermented fish in Thailand; Tanasupawat S et al.; New coagulase-negative staphylococci were isolated from fermented fish in Thailand . These organisms were differentiated from other Staphylococcus species on the basis of DNA relatedness and biochemical characteristics . Staphylococcus piscifermentans sp . nov . is described, and the type strain is strain SK03 (= NRIC 1817 = JCM 6057 = TISTR 824).

Antibiot Khimioter, 1992 Oct, 37(10), 34 - 8
{Energy metabolism in Staphylococci containing plasmids of resistance to a number of antibiotics}; Oriabinskaia LB et al.; Activity patterns of membrane-bound enzymes of an antibiotic sensitive strain of Staphylococcus aureus 8325-4 and its variants containing the plasmids of resistance to penicillin, tetracycline, erythromycin and chloramphenicol were studied . It was shown that acquiring of resistance to the above mentioned antibiotics influenced cellular energy metabolism . The resistant strains exhibited an increase in the specific activity of NADN, malate and succinate oxidases, intensification of the ATP-hydrolyzing activity, changes in the activity of definite dehydrogenases and a decrease in the specific content of cytochromes . No changes in the composition of respiration carriers were detected.

Clin Infect Dis, 1992 Sep, 15(3), 495 - 501
Resistance of enterococci to aminoglycosides and glycopeptides; Leclercq R et al.; High-level resistance to aminoglycosides in enterococci often is mediated by aminoglycoside-modifying enzymes, and the corresponding genes generally are located on self-transferable plasmids . These enzymes are similar to those in staphylococci but differ from the modifying enzymes of gram-negative bacteria . Three classes of enzymes are distinguished, depending upon the reaction catalyzed . All but amikacin and netilmicin confer high-level resistance to the antibiotics that are modified in vitro . However, the synergistic activity of these last two antibiotics in combination with beta-lactam agents can be suppressed, as has always been found in relation to high-level resistance to the aminoglycosides . Acquisition of glycopeptide resistance by enterococci recently was reported . Strains of two phenotypes have been distinguished: those that are resistant to high levels of vancomycin and teicoplanin and those that are inducibly resistant to low levels of vancomycin and susceptible to teicoplanin . In strains of Enterococcus faecium highly resistant to glycopeptides, we have characterized plasmids ranging from 34 to 40 kilobases that are often self-transferable to other gram-positive organisms . The resistance gene vanA has been cloned, and its nucleotide sequence has been determined . Hybridization experiments showed that this resistance determinant is present in all of our enterococcal strains that are highly resistant to glycopeptides . The vanA gene is part of a cluster of plasmid genes responsible for synthesis of peptidoglycan precursors containing a depsipeptide instead of the usual D-alanyl-D-alanine terminus . Reduced affinity of glycopeptides to these precursors confers resistance to the antibiotics.

J Med Microbiol, 1992 Sep, 37(3), 195 - 200
The typing of Staphylococcus epidermidis by a lectin-binding assay; Jarlov JO et al.; A new typing method for Staphylococcus epidermidis was developed . Four biotinylated lectins--wheat germ agglutinin (WGA), soy bean agglutinin (SBA), lentil agglutinin (LCA) and Concanavalin A (ConA)--were added to immobilised whole cells of coagulase-negative staphylococci (CNS) in microtitration plates . The amount of bound lectin was measured by peroxidase-conjugated avidin followed by a peroxidase reaction . The method was compared to antibiotic-resistance analysis, phage typing, plasmid DNA profiles and slime production . A total of 113 isolates of CNS from 21 patients was investigated and 71 strains of CNS, including 64 strains of S . epidermidis, were detected if all typing methods were taken into consideration . If only one typing method was used the highest discriminatory power among the S . epidermidis isolates was obtained with the lectin-binding assay which allowed 49 different strains to be detected . If the lectin-binding assay was combined with plasmid-profile analysis, all 64 different strains could be identified . The typability of lectin-binding assay was 96.9% among the S . epidermidis isolates and 25 different lectin-binding patterns were established among the 64 strains . The highest number of strains belonging to one lectin-binding pattern was 13 (20.3%) . The assay was reproducible, easy to perform, relatively inexpensive and therefore applicable to large scale typing of S . epidermidis.

J Antimicrob Chemother, 1992 Sep, 30(3), 321 - 6
Comparative activity of glycopeptide antibiotics against coagulase-negative staphylococci embedded in fibrin clots; Cunningham R et al.; The susceptibilities of 16 strains of coagulase-negative staphylococci to vancomycin and teicoplanin were determined by three microdilution methods run in parallel; (i) a reference method in which the medium was Iso-Sensitest broth, (ii) a method in which the organisms were suspended in plasma and (iii) one in which the bacteria were incorporated into a fibrin clot . In comparison with the reference method there was a less than two-fold change in the geometric mean MICs of both antibiotics in plasma, while in clot the increase was 12-fold for vancomycin and 28-fold for teicoplanin . MBCs showed a similar trend although the increase was greater for teicoplanin . These results suggest that protein binding may have a much greater impact on antimicrobial activity when the mobility of the protein is reduced within a clot.

Pediatr Infect Dis J, 1992 Sep, 11(9), 708 - 12
Value of C-reactive protein determination in the initial diagnostic evaluation of the febrile, neutropenic child with cancer; Katz JA et al.; We studied prospectively the value of administration C-reactive protein (CRP) in the diagnostic evaluation of the child with cancer hospitalized for fever and neutropenia . During a 7-month period 74 patients with malignant disease had 122 hospital admissions because of fever and neutropenia . All patients had a serum CRP obtained 8 to 24 hours after the onset of fever as part of their initial evaluation . There was a borderline correlation between serum CRP concentration and temperature at admission (P = 0.06) . Patients with fever without an identifiable source had significantly lower CRP concentrations compared with those having focal or microbiologically documented infection (34.9 +/- 6 vs . 70.2 +/- 12 mg/liter; P = 0.0005) . Twelve patients had positive blood cultures, 5 of which were coagulase-negative staphylococci considered to be central venous catheter-related infection or colonization . CRP concentrations were significantly lower in these 5 patients compared with the 7 patients with septicemia caused by other organisms (21 +/- 9 vs . 113 +/- 23 mg/liter; P = 0.01) . In distinguishing between septicemic and nonsepticemic children, serum CRP was found to have excellent sensitivity and negative predictive value at concentration limits of 20, 50 and 100 mg/liter . However, both specificity and positive predictive value were low at these respective levels, thus limiting the overall utility of serum CRP in the initial empiric management of the febrile, neutropenic child with cancer.

Kansenshogaku Zasshi, 1992 Sep, 66(9), 1270 - 5
Drug-resistant Staphylococcus aureus contamination in the ward environment; Tanaka Y et al.; A total of 282 strains of Staphylococcus were isolated from University Hospital ward environment from April 1991 to January 1992 and drug-susceptibility tests were performed . The main isolates were 84 strains of S . epidermidis (30%), 65 strains of S . aureus (23%), and 58 strains of S . haemolyticus (21%) . One hundred and thirty-six strains of all staphylococci (48%) and 13 of 65 strains of S . aureus (20%) were methicillin (DMPPC)-resistant . The DMPPC-resistant strains of S . aureus were multiple drug-resistant to three to seven antibiotics; ampicillin . cephaloridine, cephametazole, tetracycline, erythromycin, gentamicin, and methicillin, while the DMPPC-susceptible strains were resistant to less than two drugs . These results indicate that this routine testing, along with testing of the anterior nares of the medical staff, is necessary to prevent nosocomial transmission.

Infect Dis Clin North Am, 1992 Sep, 6(3), 719 - 29
Diagnosis and treatment of biomaterial-associated vascular infections; Bandyk DF; Management of biomaterial-associated vascular infections requires an understanding of pathogenetic mechanisms, risk factors, and microbiologic characteristics . Staphylococci sp., especially slime-producing strains of S . epidermidis are the prevalent pathogens . Experimental and clinical studies have indicated in situ replacement, particularly with an antibiotic-bonded prosthesis, as effective treatment for infections caused by coagulase-negative staphylococci . When sepsis is a presenting sign, prompt intervention, total excision of the prosthesis, and antibiotic administration are required.

Diagn Microbiol Infect Dis, 1992 Sep-Oct, 15(7), 601 - 8
The rapid emergence of fluoroquinolone-methicillin-resistant Staphylococcus aureus infections in a community hospital . An in vitro look at alternative antimicrobial agents; Aldridge KE et al.; The introduction of ciprofloxacin on an unrestricted basis into a 900-bed community hospital resulted in the emergence of high-level fluoroquinolone resistance among methicillin-resistant Staphylococcus aureus (MRSA) during the subsequent 18 months . Susceptibility testing revealed several old and new compounds to which all the S . aureus strains were susceptible . When an MRSA strain became resistant to ciprofloxacin it also exhibited high-level resistance to ofloxacin, fleroxacin, norfloxacin, and enoxacin . Two new experimental fluoroquinolones, WIN 57273 and CI-960, exhibited good activity against all test strains . Among the glycopeptide compounds, mupirocin and teicoplanin were approximately fourfold more active than vancomycin and ramoplanin . Rifampin and trimethoprim-sulfamethoxazole (TMP/SMZ) showed good activity against most strains as did imipenem . For clindamycin, gentamicin, and tetracycline susceptibilities exhibited a bimodal distribution with at least 10% of strains having resistant MIC values . Surprisingly, the addition of sulbactam potentiated the activity of ampicillin against the ciprofloxacin-resistant MRSA strains, however, sulbactam had little effect on cefoperazone activity against these same strains . Time-kill kinetic studies of selected antimicrobials against ciprofloxacin-resistant strains indicated good killing by vancomycin, ampicillin-sulbactam, and TMP/SMZ . Teicoplanin was less bactericidal than vancomycin while these same strains rapidly developed resistance to rifampin even at concentrations 8 x MIC . These data indicate certain alternative compounds within our study warrant further investigation, especially in vivo, against multiply-resistant staphylococci.

J Clin Microbiol, 1992 Sep, 30(9), 2246 - 55
Flow cytometric assay for quantifying opsonophagocytosis and killing of Staphylococcus aureus by peripheral blood leukocytes; Martin E et al.; We describe a novel flow cytometric method for quantifying opsonophagocytosis and killing of Staphylococcus aureus in cell-rich plasma obtained after dextran sedimentation of erythrocytes . To analyze opsonophagocytosis, phagocytes were labeled with a phycoerythrin-conjugated monoclonal antibody and were incubated with viable staphylococci containing carboxyfluorescein as a vital fluorescent dye . Phagocytosing cells assumed a dual, orange-green fluorescence . The relative numbers of bacteria associating with phagocytes could be determined by quantifying the decrease of free green fluorescent particles . A parallel incubation of fluorescent bacteria with unlabeled cell-rich plasma was performed to assess phagocytic killing . Blood cells were lysed with 3-{(3-cholamidopropyl)-dimethyl-ammonio}-1-propanesulfonate . This detergent spared viable bacteria, and residual green fluorescent particles were counted . The decrease in the number of these particles relative to the controls yielded the degree of killing . At bacteria-to-phagocyte ratios of 1:1 and 10:1, approximately 36 and 75% of the phagocytes participated in opsonophagocytosis, respectively . Over 90% of the staphylococci were phagocyte associated after 30 to 60 min . Killing rates were on the order of 66% +/- 12% and 80% +/- 7% after 1 and 2 h of incubation, respectively . These numbers, which were confirmed by colony countings, were significantly lower than those reported in the majority of past reports.

J Med Microbiol, 1992 Sep, 37(3), 180 - 6
Intra- and inter-species mobilisation of non-conjugative plasmids in staphylococci; Udo EE et al.; The ability of Staphylococcus aureus conjugative plasmids to mobilise non-conjugative resistance plasmids from clinical isolates of S . aureus and S . epidermidis was studied . Plasmids which could not be transferred by transduction or mixed-culture transfer were transferred from phage-typable and non-typable S . aureus and from S . epidermidis . Plasmids encoding single resistance determinants were transferred by mobilisation whereas multiple-resistance plasmids were transferred as co-integrates between the conjugative and non-conjugative plasmids . This study demonstrates that mobilisation is a useful tool for the transfer and study of staphylococcal plasmids and illustrates how antibiotic resistance could be transferred between staphylococci in vivo.

East Afr Med J, 1992 Sep, 69(9), 500 - 7
Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital; Ako-Nai AK et al.; The incidence of postsurgical clean wound infection in 101 consecutive operations was 1.98% . Staphylococci were the predominant bacteria cultured from the anterior nares of the patients and attending surgical personnel--and were found to colonize the wounds . The nasal carriage rates of Staphylococcus aureus amongst the patients and surgical staff were 12.1% and 17.% respectively . Group III and non-typeable (NT) S . aureus strains accounted for about 65% of S . aureus isolates cultured from the anterior nares . A low incidence of nasal carriage of S . aureus isolates correlated with low incidence of wound sepsis . The operating room air seemed considerably contaminated but this did not reflect in high incidence of postsurgical wound sepsis . Our results suggest patients microflora and operating room air were the major sources of intra-operative bacterial colonization of wound at this centre.

FEMS Microbiol Lett, 1992 Aug 15, 74(2-3), 181 - 5
Pulsed-field gel electrophoresis of genomic restriction fragments as a tool for the epidemiological analysis of Staphylococcus aureus and coagulase-negative staphylococci; Linhardt F et al.; Thirteen Staphylococcus aureus and S . epidermidis strains obtained from nose and hand of two employees and one patient of a medical ward as well as two S . hemolyticus strains were analysed according to their restriction fragment length patterns (RFLP) by pulsed-field gel electrophoresis (PFGE) using the restriction enzymes SmaI and SstII . Species identification of the isolates was performed by a system which includes 20 biochemical reactions . Furthermore, the antibiotic resistance patterns of the strains were determined . While several isolates exhibited identical antibiotic susceptibilities and biochemical profiles, differences in the RFLP were obtained . In three cases, S . epidermidis strains colonizing the skin showed an identical restriction profile as isolates from the mucous membranes of the same person . We concluded that the analysis of staphylococcal strains by PFGE is an important epidemiological tool with high discrimination power.

J Infect Dis, 1992 Aug, 166(2), 393 - 9
Low-inoculum model of surgical wound infection; Kaiser AB et al.; A model of surgical wound infection that uses low inocula of bacteria and closely simulates clinical infection involved inoculating suspensions of Staphylococcus aureus and dextran microbeads into intermuscular sites on the dorsum of guinea pigs, harvesting lesions at 72-96 h, identifying as a positive end point lesions yielding staphylococci on subculture, and using logistic regression for data analysis . Prophylaxis was placebo, ampicillin, or cefazolin, and three representative strains of S . aureus were used . A highly significant correlation (P less than .001) was observed between inoculum sizes and infection rates . Without antimicrobial prophylaxis, ID50 for each strain was less than 10 organisms; with antimicrobials, ID50 was significantly higher . Differences in the virulence of strains and in the efficacy of the antimicrobial regimens also were observed . The model should prove useful for understanding mechanisms of virulence among pathogenic bacteria and for elucidating subtle but important differences in efficacy among antibiotics used in prophylaxis.

J Med Microbiol, 1992 Aug, 37(2), 109 - 17
Evaluation of methods for typing coagulase-negative staphylococci; Dryden MS et al.; One hundred and forty-two coagulase-negative staphylococci (CNS) isolated from dialysate effluent or skin of patients receiving continuous ambulatory peritoneal dialysis (CAPD) were typed by extended antibiogram (16 antibiotics) and biotype (26 reactions) . These isolates were then typed by supplementary methods to determine the most suitable typing method for an epidemiological study of antibiotic resistance . These included phage typing, reverse phage typing, plasmid typing, whole-cell protein typing by SDS-PAGE with analysis by densitometry, and immunoblotting . The percentage of isolates typed successfully by the supplementary methods were: phage typing 20%, reverse phage typing 0%, plasmid typing 66%, SDS-PAGE 100%, immunoblotting 100% . The discrimination of each method was: phage typing 20%, plasmid typing 37%, SDS-PAGE 69%, immunoblotting 57% . Reproducibility was 88% for phage typing and 97% for plasmid typing . The reproducibility of the whole-cell protein typing was 83% if the same extracts were used but only 43% when separate protein extracts were analysed on separate occasions . However, strain relatedness was highly reproducible . The determination of an antibiogram-biotype profile was not a sufficiently accurate typing method for an epidemiological study of antibiotic resistance . Whole-cell protein typing by SDS-PAGE or immunoblotting was technically demanding but was the most effective of the supplementary methods for detecting erroneous discrimination and false matching produced by antibiogram-biotype combinations.

J Oral Pathol Med, 1992 Aug, 21(7), 305 - 8
Oral carriage of yeasts, coliforms and staphylococci in patients with advanced malignant disease; Jobbins J et al.; Many patients with advanced cancer have oral problems, some of which may have a microbiologic basis . The oral flora in such patients has not, however, been characterized . This study has assessed the prevalence of yeasts, coliforms and coagulase positive staphylococci in the oral flora of 197 patients with advanced cancer . Both imprint cultures (n = 197) and oral rinses (n = 161) were collected . Yeasts were isolated from the mouths of 83% of the patients, coliforms from 49.1% and coagulase-positive staphylococci from 28% . All these percentages are considerably in excess of reported levels for healthy individuals . The results indicate a loss of colonization resistance of the oral mucosa in terminal cancer, with potential implications for the development of mouth care regimes for such patients.

Epidemiol Infect, 1992 Aug, 109(1), 97 - 112
The epidemiology of ciprofloxacin resistance in coagulase-negative staphylococci in CAPD patients; Dryden MS et al.; Ciprofloxacin was used as empirical therapy for peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) for 26 months, providing an opportunity to study the epidemiology of ciprofloxacin resistance amongst coagulase-negative staphylococci (CNS) . Swabs were collected from the CAPD patients, staff, and clinic environment before, during and after the time this antibiotic was prescribed . Clinical isolates were also studied, and records kept of patient hospital attendance . Ciprofloxacin-resistant staphylococci were typed by antibiogram, biotype, plasmid profile, SDS-PAGE, and immunoblotting . No resistant strains were detected before the use of ciprofloxacin . During its use 30% of patients became skin carriers, and resistant strains caused 8% of peritonitis episodes in 7% of patients (38% of carriers) . Resistant strains were isolated from the environment, but never from attending members of staff . A total of 208 resistant isolates with MIC's between 8 and 128 mg/l was collected and identified as Staphylococcus epidermidis or S . haemolyticus . Sixteen strain types were distinguished . There was epidemiological evidence for selection of resistant strains derived from the host commensal flora and also for cross-colonization, and cross-infection . Carriage of resistant strains fell to 15% of patients, 6 months after the use of ciprofloxacin had ceased.

Voen Med Zh, 1992 Aug, (8), 28 - 30
{The combined therapy of chronic pyoderma taking into account body immunological reactivity and staphylococcal antibiotic resistance}; Rodionov AN et al.; Summarizing the results of treatment in 23 patients the authors propose an effective two-staged method to treat chronic pyoderma . This method is based on administration of synthetic peptide of thymus--"thymogen", which is used to correct the immune status and increase sensitivity of staphylococci to antibiotics at the zones of cutaneous affection . The second stage of this method consists in administration of antibiotics in combination with stimulators of phagocytosis and humoral immunity . The results prove the high efficiency of thymogen application in complex management of chronic pyoderma: up to 73.9% of clinic recoveries.

Monatsschr Kinderheilkd, 1992 Aug, 140(8), 464 - 71
{Percutaneous Silastic catheters in newborn and premature infants . A report of experiences with 497 catheters in 5 years}; Harms K et al.; BACKGROUND AND METHODS . Central catheters are an important prerequisite for adequate parenteral nutrition in preterm infants . However, a variety of complications have been shown to be associated with central lines: septicemica, thrombotic complications, mechanical complications . In this retrospective analysis we summarize our recent experience with central silastic catheters . RESULTS . Within a five-year-period (1986-1990) . 497 silastic-catheters were inserted in 366 high risk neonates (mean birthweight 1360 g; 1060-1740 g, 25.-75 . percentile) treated at the NICU, Department of Pediatrics, University of Gottingen . 451 catheters which were placed in a central position, were removed after an average duration of 11 days (mean; 8-18 days, 25.-75 . percentile) . During the observation period, 62.8 percent of the catheters were purposely removed . Making use of the Kaplan-Meier-curve, we calculated how long the catheter could stay without complications; 50% of all catheters could be expected to be in place for 25 days . The incidence of septicemia was 1.9%, bacterial contamination of the catheters was evident in 22% of all central lines . The most predominant microorganisms responsible for catheter-contamination were coagulase-negative staphylococci . In addition, catheters were removed because of signs of phlebitis or suspected thrombotic complications (11.1%), and mechanical complications (dislocation, occlusion; 11.7%) . Due to malposition of the central catheter two preterm infants developed pericardial effusions . There was no correlation between the site where the catheter was inserted and these complications . CONCLUSION . Central silastic catheters wherever clinically indicated are a valuable adjunct in the parenteral nutrition on high risk neonates.

Eur J Clin Microbiol Infect Dis, 1992 Aug, 11(8), 732 - 7
Effect of subinhibitory concentrations of cefamandole and cefuroxime on adherence of Staphylococcus aureus and Staphylococcus epidermidis to polystyrene culture plates; Carsenti-Etesse H et al.; The ability of cefamandole and cefuroxime to inhibit adherence of staphylococci to polystyrene culture plates was tested in an in vitro assay using eight strains each of Staphylococcus aureus and Staphylococcus epidermidis . The results indicated that subinhibitory concentrations of cefamandole and cefuroxime altered the adherence ability of both staphylococcal species, inhibition of adherence being more marked in the presence of cefamandole . It may be important to consider antiadherence properties in association with bactericidal activity when selecting agents for antibiotic prophylaxis.

J Antimicrob Chemother, 1992 Aug, 30(2), 203 - 14
A randomized trial of high-dose ciprofloxacin versus azlocillin and netilmicin in the empirical therapy of febrile neutropenic patients; Johnson PR et al.; A prospective, randomized trial comparing monotherapy with high-dose ciprofloxacin versus a standard combination regimen of azlocillin and netilmicin in the empirical treatment of febrile episodes in neutropenic patients was performed . One hundred and forty-six patient episodes were randomized, but ten (seven ciprofloxacin and three azlocillin/netilmicin) were considered unevaluable for efficacy, and three episodes were withdrawn due to incorrect randomization or non-neutropenia . Of the remaining 133 episodes, infections resolved without modification of therapy in 25/66 (38%) versus 28/67 (42%) of ciprofloxacin and azlocillin/netilmicin treated groups respectively (P = 0.72) . Considering all randomized episodes, therapy was modified in 46/73 (63%) episodes with ciprofloxacin and 39/70 (56%) with azlocillin/netilmicin (P = 0.40) . Of 73 patient episodes randomized to ciprofloxacin, 25 (34%) received oral follow-on therapy after a median of three days of intravenous therapy . Infections were microbiologically documented in 31/73 (42%) ciprofloxacin and 32/70 (46%) azlocillin/netilmicin, of which 8/27 (30%) and 14/31 (45%) of evaluable episodes resolved without modification of therapy respectively (P = 0.28) . Gram-positive organisms accounted for 78% of all organisms cultured with 36% coagulase-negative staphylococci . Bacteriological eradication was recorded in 18/24 (75%) and 26/29 (90%) evaluable patient episodes treated with ciprofloxacin and azlocillin/netilmicin respectively (P = 0.27) . Superinfections were seen in 14% of episodes in both groups, and subsequent infections in 12% ciprofloxacin and 14% azlocillin/netilmicin treated patients . Two patients (one ciprofloxacin and one azlocillin/netilmicin) died within 48 h of randomization, and a further 13 patients (four ciprofloxacin and nine azlocillin/netilmicin) died before resolution of neutropenia . Adverse events were recorded in 9% and 15% of ciprofloxacin and azlocillin/netilmicin treated patients respectively, with skin rash (five ciprofloxacin and four azlocillin/netilmicin), nephrotoxicity (two azlocillin/netilmicin), abnormal liver function tests (two azlocillin/netilmicin), ototoxicity (one azlocillin/netilmicin) and nausea (one ciprofloxacin) being the major events recorded . It was concluded that monotherapy with ciprofloxacin at this dosage is a safe alternative to combination therapy with azlocillin/netilmicin, and has the advantages of twice daily administration, iv and oral presentations, no cross allergy in beta-lactam-hypersensitive patients, and no nephro- or oto-toxicity.

Clin Infect Dis, 1992 Aug, 15(2), 290 - 4
Piperacillin plus amikacin vs . piperacillin plus amikacin plus teicoplanin for empirical treatment of febrile episodes in neutropenic patients receiving quinolone prophylaxis; Martino P et al.; A prospective, randomized trial was initiated to evaluate the efficacy of two antibiotic regimens, differing in the agent included with activity against gram-positive bacteria, for the empirical treatment of febrile episodes in neutropenic patients with hematologic malignancies (group 1, piperacillin plus amikacin; group 2, piperacillin plus amikacin plus teicoplanin) . After 72 hours of therapy, patients in group 1 who were still febrile were administered teicoplanin and those in group 2 were administered amphotericin B . A total of 158 evaluable episodes were observed within 8 months . The success rate was 50.6% in group 1 and 60% in group 2 . The response rate among patients who did not respond to the original regimen increased to 86.7% with the addition of teicoplanin (group 1) and to 90% with the addition of amphotericin B (group 2) . There were 86 unexplained febrile episodes and 56 documented episodes of bacteremia (34 caused by gram-positive organisms) . Our results indicate that teicoplanin is safe, well tolerated, and effective for the treatment of documented episodes of gram-positive bacteremia and as an empirical agent . The inclusion of teicoplanin in the initial empirical regimen appears unnecessary if a combination of antibiotics active against gram-positive organisms is used, unless infections are due to oxacillin-resistant staphylococci.

J Clin Invest, 1992 Aug, 90(2), 631 - 6
Evidence for reactive nitrogen intermediates in killing of staphylococci by human neutrophil cytoplasts . A new microbicidal pathway for polymorphonuclear leukocytes; Malawista SE et al.; In anucleate, granule-poor, motile fragments from human blood neutrophils (cytokineplasts; CKP), the nitric oxide synthase inhibitor N omega-monomethyl-L-arginine (NMMA) produced a modest decrease in uptake of staphylococci from supernatants (P less than 0.02, n = 7), and a marked decrease in the killing of cytoplast-associated bacteria (P less than 0.001, n = 7) . After 60 min of incubation with bacteria, NMMA-treated cytoplasts had a mean of over 3.5 times as many live, CKP-associated staphylococci as did controls (51% of the inocula versus 14%), despite having taken up fewer . Effects on both uptake and killing were reversible by L-arginine but not by D-arginine . Results were the same with other granule-poor cytoplasts (U-cytoplasts, U-CYT), which, unlike CKP, retain activatable oxidase activity . Killing by intact PMN, including those from a patient with chronic granulomatous disease, was not inhibited by NMMA . Thus, the ability to discern effects of NMMA correlated with the paucity of granules, without regard to the presence or absence of activatable oxidase . We propose that the generation of reactive nitrogen intermediates serves as an additional microbial killing pathway in PMN, and that cytoplasts can be used to help delineate the spectrum of susceptible targets.

J Hosp Infect, 1992 Aug, 21(4), 275 - 89
An analysis of the microbial flora of premature neonates; Savey A et al.; An analysis of the microbial flora of 10 premature neonates hospitalized in a neonatal intensive care unit (NICU) was made . The babies had received neither antibiotics nor antiseptics and nine out of 10 were born by caesarean section . Samples were collected on the fourth or fifth day of life from 18 skin or mucosal sites . Detailed bacterial counts were obtained by plating out suitable dilutions of the samples on to selective media . Representative samples of each colony type were then subcultured and identified, using standard laboratory methods . Two hundred and fifty-six isolates of staphylococci were obtained and their susceptibility to 23 antibiotics tested . Only 11% of the samples were sterile . Coagulase-negative staphylococci (CNS) were the commonest species isolated and were predominant in every site studied . They were found in 79% of the samples and represented almost 81% of the neonates' flora . Eight species and biotypes of CNS were identified . In decreasing order of frequency, they comprised S . epidermidis (biotypes 1 and 2), S . hominis (biotype 1), S . warneri, S . haemolyticus, S . capitis, S . cohnii and S . hominis (biotype 2) . CNS distribution appeared to be highly heterogeneous with no significant specificity of any species for a particular body site . The main quantitative and qualitative variations seemed to relate to the method of delivery, and the intensity and nature of exposure of the neonate to its local environment . A high level of antibiotic resistance was found among the CNS isolates (especially S . epidermidis and S . haemolyticus): penicillin G (96%), oxacillin (31%), erythromycin (52%) and gentamicin (28%) . Moreover, multiresistant strains were numerous, supporting the nosocomial origin of CNS.

Diagn Microbiol Infect Dis, 1992 Aug, 15(6), 557 - 9
In vitro activity of l-ofloxacin against norfloxacin-resistant coagulase-negative staphylococci; Foleno B et al.; The in vitro activity of l-ofloxacin was determined against coagulase-negative staphylococci that were induced to norfloxacin resistance . l-Ofloxacin was the most active agent tested with an MIC90 of 4 micrograms/ml compared with greater than 128, 32, and 128 micrograms/ml for norfloxacin, ciprofloxacin, and enoxacin, respectively . Rifampin-resistant, coagulase-negative staphylococci were not cross-resistant to the quinolones tested . Among the rifampin-resistant organisms tested, l-ofloxacin was also the most active agent with an MIC90 of 0.25 micrograms/ml.

N Engl J Med, 1992 Jul 23, 327(4), 213 - 9
Intravenous immune globulin for the prevention of nosocomial infection in low-birth-weight neonates . The Multicenter Group for the Study of Immune Globulin in Neonates; Baker CJ et al.; BACKGROUND . Nosocomial infection is a major risk for premature infants with very low birth weights . One reason for their susceptibility to infection may be antibody deficiency, since there is little transfer of maternal IgG to the fetus before 32 weeks' gestation . METHODS . We conducted a multicenter, double-blind study of neonates weighing 500 to 1750 g at birth . A total of 588 neonates were randomly assigned, with stratification for birth weight, to receive periodic intravenous infusions of either immune globulin (500 mg per kilogram of body weight per day) or a placebo . Mortality, morbidity, and nosocomial infection during the next 56 days were assessed . RESULTS . The infusions were well tolerated; mild, reversible adverse reactions occurred in five infants in each group . There was a significant reduction in the risk of a first nosocomial infection in the recipients of immune globulin as compared with the placebo recipients (relative risk, 0.7; 95 percent confidence interval, 0.5 to 0.9) . About 85 percent of the nosocomial infections were bacterial; the majority of these were caused by coagulase-negative staphylococci or Staphylococcus aureus . The neonates who received immune globulin had fewer mean days of hospitalization than the controls (62 vs . 68, P = 0.15); among the infants with infections, the difference in the mean length of the hospital stay was even greater (80 days vs . 101 days, P = 0.02) . CONCLUSIONS . For premature infants weighing between 500 and 1750 g at birth, treatment with intravenous infusions of immune globulin is safe and reduces the risk of nosocomial infection.

J Clin Microbiol, 1992 Jul, 30(7), 1728 - 33
Rapid detection of the mecA gene in methicillin-resistant staphylococci by enzymatic detection of polymerase chain reaction products; Ubukata K et al.; In order to identify methicillin-resistant staphylococci from clinical sources with ease and reliability, enzymatic detection of polymerase chain reaction (ED-PCR) was applied . ED-PCR is based on the capture of amplified products via biotin-streptavidin affinity and the detection of an incorporated hapten in amplified products with an enzyme-linked antibody . In order to identify methicillin-resistant staphylococci of all species, a 150-bp fragment of the mecA gene was targeted for ED-PCR . After PCR was performed with a pair of biotin and dinitrophenol 5'-labeled primers, the reaction mixture was applied to a microtiter well precoated with streptavidin . Thereafter, bound PCR products were detected colorimetrically with alkaline phosphatase-conjugated anti-dinitrophenol antibody . The extraction of DNA from staphylococcal cells for PCR was simplified so that it could be performed within one tube . The total assay, including PCR, took less than 3 h . The sensitivity of mecA gene detection ranged from greater than 5 x 10(2) CFU per tube for Staphylococcus aureus to greater than 5 x 10(3) CFU per tube for Staphylococcus epidermidis . Genotyping results obtained by ED-PCR of 161 tested strains from the colonies (97 strains of S . aureus and 64 strains of coagulase-negative staphylococci) were compared with the phenotypic susceptibilities of the strains to oxacillin . The results of ED-PCR showed excellent agreement with the MICs of oxacillin with very few exceptions; only one strain of S . aureus and two strains of coagulase-negative staphylococci were found to possess the mecA gene, which was discrepant with their phenotypes . Fifty-five blood culture samples were also tested by ED-PCR . For staphylococcal isolates in 33 of the cultures, oxacillin MICs were >4 microgram/ml; 31 of the 33 staphylococcal isolates were determined by ED-PCR to be mecA gene positive . These results suggest that ED-PCR can be used with reasonable confidence in the clinical microbiological laboratory.

J Clin Microbiol, 1992 Jul, 30(7), 1685 - 91
Detection of methicillin-resistant staphylococci by using the polymerase chain reaction; Unal S et al.; A polymerase chain reaction (PCR)-based test was developed for the detection of mecA in staphylococci . To facilitate this process, a rapid cell lysis procedure was established for the release of DNA from staphylococcal strains . Primers based on the DNA sequence of the mecA gene from Staphylococcus aureus were used in PCRs to screen for the presence of this gene in a total of 98 staphylococcal isolates . Fifty-one isolates were mecA positive (17 S . aureus strains and 34 coagulase-negative staphylococci including S . epidermidis, S . haemolyticus, and S . simulans) . Results obtained with PCRs were generally consistent with those of standard microbiological assays . PCRs designed to detect the femA gene (factor essential for methicillin resistance) revealed the presence of the gene in all S . aureus strains examined regardless of the susceptibility profiles of the strains to methicillin . In contrast, femA could not be detected in coagulase-negative staphylococci by PCR with the same primers . Low-stringency hybridization suggested the presence of a gene structurally related to femA in S . epidermidis and other coagulase-negative staphylococci examined.

Am J Perinatol, 1992 Jul, 9(4), 261 - 4
Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications; Klein JF et al.; A prospective study of 35 patients in the neonatal intensive care unit was conducted to examine the safety and feasibility of percutaneous Silastic central venous catheters for the provision of prolonged parenteral alimentation . Particular attention was directed to the possibility of maintaining these lines through intercurrent episodes of infection . Catheters were placed in 34 infants (97%) . At the time of insertion, 21 patients (62%) weighed less than 1000 gm and 13 patients (38%) weighed less than 750 gm . The average duration of catheterization was 32.0 +/- 18.2 (SD) days; 19 patients (56%) had lines in place for more than 30 days . Mechanical difficulties complicated the course of five patients (15%) . Four cases of bacteremia were identified; this represents 3.7 infections/1000 days of catheter use . All infections were caused by methicillin-resistant staphylococci . Two patients required catheter removal to clear their infection, but in two of the four bacteremic patients, the infection was cleared and the line was sterilized by the administration of antibiotic therapy through the central catheter . We conclude that Silastic central venous catheters can be used safely to deliver intravenous nutrition to extremely small preterm infants over a prolonged period of time, and in carefully selected patients, successful treatment of complicating infections may be achieved without catheter removal.

J Infect Dis, 1992 Jul, 166(1), 58 - 64
Contribution of tumor necrosis factor to host defense against staphylococci in a guinea pig model of foreign body infections; Vaudaux P et al.; The contribution of the cytokine tumor necrosis factor (cachectin; TNF) to host defenses against staphylococcal foreign body infections was studied in vivo . In tissue cages subcutaneously implanted into guinea pigs, progressive infection was initiated by a very low inoculum (100 cfu) of Staphylococcus aureus with a success rate of 100%, as is frequently encountered in related clinical situations . Locally injected autologous bacterial components derived from the cell wall of S . aureus, in particular peptidoglycan, were very active in raising TNF levels in tissue cage fluid and in preventing the development of infection by the 100% infective dose of the test strain . Furthermore, injection of murine recombinant TNF into tissue cages could substitute for the bacterial components in preventing experimental infection by S . aureus . The protective effect of TNF-eliciting bacterial components could be neutralized by anti-TNF antibodies . A local increase in TNF levels might improve host defenses against staphylococcal foreign body infections.

FEMS Microbiol Lett, 1992 Jul 1, 73(1-2), 133 - 8
Improved method for electroporation of Staphylococcus aureus; Schenk S et al.; We have developed a significantly improved method for the electroporation of plasmid DNA into Staphylococcus aureus . The highest transformation efficiency achieved with this procedure was 4.0 x 10(8) transformants per microgram of plasmid pSK265 DNA . This represents a 530-fold improvement over the previously reported optimum efficiency of 7.5 x 10(5) transformants per microgram of plasmid DNA after electroporation of S . aureus cells {9} . Identical results were obtained when electrocompetent cells, which had been stored frozen at -80 degrees C, were used . The improved efficiency is due primarily to the use of a modified medium (designated as B2 medium) and secondarily to the use of 0.1-cm cuvettes . Several other plasmids (pI258, pMH109, and pSK270) were also electrotransformed into competent cells using our procedure, and for each plasmid, the transformation efficiency was significantly reduced compared to that observed when pSK265 DNA was used . With respect to plasmid pI258, the transformation efficiency was 3500-fold higher than that reported previously for transformation of this plasmid into S . aureus RN4220 {9} . The optimized electroporation procedure was less successful in transforming other staphylococci . Electrocompetent cells of S . aureus ATCC 29213 and S . epidermidis ATCC 12228 produced 5.5 x 10(5) and 5 x 10(3) transformants per microgram of pSK265 DNA, respectively.

J Dairy Sci, 1992 Jul, 75(7), 1835 - 9
Prevalence of Staphylococcus species during the periparturient period in primiparous and multiparous cows; Matthews KR et al.; During a 14-mo period, 77 multiparous and 36 primiparous cows were sampled to determine the prevalence of staphylococci during the periparturient period . Distal streak canal swabs were taken at 14 d prepartum, and foremilk was sampled the first 5 consecutive wk of lactation . Staphylococcus aureus was isolated from 7.6% of quarters of primiparous cows but from only .6% of quarters of multiparous cows at parturition . Prevalence in primiparous cows declined to 3.5% by the wk-1 sampling . Quarter prevalence of coagulase-negative Staphylococcus species prepartum, at parturition, and wk 1 to 5 in primiparous cows was 38.9, 27.8, 15.3, 14.6, 13.2, 15.3, and 14.6%, respectively . In multiparous cows, prevalence at these times was 50.3, 12.3, 6.2, 8.1, 10.7, 7.1, and 8.1% . Staphylococcus chromogenes was the predominant species isolated, accounting for over 50% of the staphylococci isolated at each sampling time . Results suggest that high prevalence of staphylococci isolated prepartum is a reflection of natural skin flora and that a higher postpartum prevalence of these organisms was observed in primiparous cows than in multiparous cows . These data suggest also that the peripartum heifer could be a source of Staphylococcus aureus in the lactating herd.

J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 67 - 75
Activity of RP 59500, a new parenteral semisynthetic streptogramin, against staphylococci with various mechanisms of resistance to macrolide-lincosamide-streptogramin antibiotics; Leclercq R et al.; RP 59500 is a semisynthetic streptogramin (Sg) composed of two synergic components: RP 57669 and RP 54476 . The activities of RP 59500, RP 57669 and RP 54476 were tested against 20 strains of staphylococci susceptible to macrolide, lincosamide and streptogramin antibiotics (MLS) and against strains exhibiting different MLS resistance mechanisms . RP 59500 was active against 14 strains harbouring emrA or ermC genes which were inducibly or constitutively resistant to erythromycin (MICs of 0.5-2 mg/L) . Neither RP 59500, RP 57669 nor RP 54476 induced MLSB resistance . Constitutive mutants appeared at frequencies of 10(-7)-10(-8) when two MLSB-inducible strains of staphylococci were exposed to 40 mg/L each of clindamycin and RP 57669 . No such mutants appeared on plates containing RP 59500 or RP 54476 . The emergence of mutants was prevented if the cultures were exposed to RP 54476 (40 mg/L), indicating that such mutants are unlikely to be selected in vivo by RP 59500 . However, for some constitutive mutants, MBCs of RP 59500 were as high as 8 mg/L . Strains producing acetyltransferase and hydrolase, inactivating SgA- and SgB-type antibiotics respectively, were resistant to RP 59500, RP 57669 and RP 54476 . Production of Pincosamide nucleotidyltransferase-4, which inactivates lincosamides, had no effect on the MICs of RP 59500, RP 57669 and RP 54476.

J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 59 - 65
In-vitro activity of streptogramin RP 59500 against staphylococci, including bactericidal kinetic studies; Hoban DJ et al.; The in-vitro activity of RP 59500 and comparative agents was determined against 270 clinical isolates of the genus Staphylococcus . MICs were performed by micro-dilution dilution . MIC90 and MBC90 (mg/L) of RP 59500 were as follows: oxacillin-sensitive Staphylococcus aureus (0.5/0.5), oxacillin-resistant S . aureus (0.5/0.5), oxacillin-sensitive Staphylococcus epidermidis (0.5/0.5), oxacillin-resistant S . epidermidis (0.25/0.25), oxacillin-resistant Staphylococcus hominis (1.0/1.0), oxacillin-resistant Staphylococcus haemolyticus (1.0/1.0), oxacillin-sensitive Staphylococcus saprophyticus (1.0/1.0) . Killing kinetic methods were used to assess the bactericidal activity of inhibitory (1 x, 2 x MIC) concentrations of RP 59500 in comparison with that of vancomycin (1 x, 2 x MIC) and oxacillin (1 x, 2 x MIC) against 20 strains of oxacillin-sensitive and -resistant S . aureus and S . epidermidis . RP 59500 was as active as vancomycin, displaying rapid bactericidal activity against the majority of strains tested and reducing initial inoculum counts by greater than 99.9% in 2-12 h . Regrowth was seen with some S . epidermidis strains after 12-24 h.

Eur J Biochem, 1992 Jul 1, 207(1), 327 - 33
Multiple binding sites in fibronectin and the staphylococcal fibronectin receptor; Bozzini S et al.; The binding of fibronectin to Staphylococci exhibits the properties of a ligand-receptor interaction and has been proposed to mediate bacterial adherence to host tissues . To localize staphylococcal-binding sites in fibronectin, the protein was subjected to limited proteolysis and, of the generated fragments, Staphylococci appeared to preferentially bind to the N-terminal fragment . Different fibronectin fragments were isolated and tested for their ability to inhibit 125I-fibronectin binding to Staphylococci . The results indicate that only the N-terminal region effectively competed for fibronectin binding . However, when isolated fragments were adsorbed to microtiter wells, we found that two distinct domains, corresponding to the N-terminal fragment and to the heparin-binding peptide mapping close to the C-terminal end of fibronectin, promoted the attachment of both Staphylococcus aureus Newman and coagulase-negative strain of Staphylococcus capitis 651 . These same domains were recognized by purified 125I-labeled staphylococcal receptor, either when immobilized on microtiter wells or probed after adsorption onto nitrocellulose membrane . The heparin-binding domain is comprised of type-III-homology repeats 14, 15 and 16 . To determine which repeats participate in this interaction, we isolated and tested repeats type III14 and type III16 . We found that the major staphylococcal binding site is located in repeat type III14 . The staphylococcal receptor bound the N-terminal domain of fibronectin with a KD of 1.8 nM, whereas the dissociation constant of the receptor molecule for the internal heparin-binding domain was 10 nM . Since the fusion protein ZZ-FR, which contains the active sequences of fibronectin receptor (D1-D3) bound only to the N-terminus, it is reasonable to assume that the bacterial receptor may have additional binding sites outside the D domains, capable of interacting with the internal heparin-binding domain of fibronectin.

J Bone Joint Surg Br, 1992 Jul, 74(4), 600 - 4
Calcium hydroxyapatite ceramic used as a delivery system for antibiotics; Shinto Y et al.; Porous blocks of calcium hydroxyapatite ceramic were evaluated as delivery systems for the sustained release of antibiotics . We tested gentamicin sulphate, cefoperazone sodium, and flomoxef sodium in powder form placed in a cylindrical cavity in calcium hydroxyapatite blocks, using in vitro studies of elution and in vivo studies in rats . Gentamicin sulphate gave a maximum concentration within the first week, which gradually decreased but was still effective at 12 weeks, when 70% of the antibiotic had been released . Even at this stage the antibiotic concentration from a 75 mg dose was five times the minimum inhibitory concentration for staphylococci . In the in vivo studies the release of gentamicin sulphate into the normal bone of rats was at similar rates and levels . The bacteriocidal activity of the drugs was not affected by packing into calcium hydroxyapatite ceramic and the blocks were completely biocompatible on histology . This new system overcomes the disadvantages of other drug delivery systems, avoiding thermal damage to the antibiotics and a second operation for the removal of the carrier . Some mechanical strength is provided by the ceramic and healing may be accelerated by bone ingrowth into its micropores.

Vet Microbiol, 1992 Jun 1, 31(2-3), 181 - 9
Species identification and some characteristics of coagulase-negative staphylococci isolated from bovine udders; Birgersson A et al.; The species of 203 strains of coagulase-negative staphylococci (CNS), isolated from bovine udder quarters was determined; all were tested for hydrophobicity and encapsulation, attributes that may relate to virulence . Twelve species were identified, of which Staphylococcus simulans, (34.5%), S . chromogenes (16.7%), S . epidermidis (13.8%) and S . xylosus (8.9%) were the most frequent . The majority of strains possessed a hydrophilic cell surface . However, strains from two species (S . chromogenes and S . epidermidis) were more hydrophobic than the others . Only five strains were encapsulated (S . xylosus, 3; S . saprophyticus, 1; and S . sciuri, 1) . Judging from the low frequencies of hydrophobic and encapsulated strains, and comparing with strains isolated from clinical cases, it is suggested that these properties are not major virulence determinants of CNS.

J Med Microbiol, 1992 Jun, 36(6), 414 - 9
Ribotyping of coagulase-negative staphylococci; Cookson BD et al.; The discriminative capacity of ribotyping was initially assessed without knowledge of results obtained for the same isolates by use of more established typing methods . Forty-eight isolates of coagulase-negative staphylococci (CNS) from peritoneal fluids were studied . They were collected prospectively during 31 consecutive episodes of infection associated with peritoneal dialysis in 17 patients . DNA was digested by the restriction endonucleases EcoRI or HindIII and ribotyped by means of a biotinylated cDNA probe to 16S + 23S staphylococcal ribosomal RNA gene sequences . These methods in combination produced a total of 27 types which compared well with numbers of groups distinguished by other typing methods: limited biotype-antibiotic resistogram (ARB; 28), antibiotic resistogram alone (25), API-Staph (12), phage typing (9) and plasmid analysis (22) . Ribotyping was highly reproducible and typed all isolates, including those that were not phage-typable (35) or did not contain plasmids (4) . When used in a hierarchical manner with ARB, ribotyping results produced 13 additional types in comparison with the other three methods . When used hierarchically with all other typing systems, a further five types were found among isolates from two patients . However, some of the differences observed as a result of ribotyping could have been due to subtle changes produced by mutation, lysogenisation or gene transposition . Since the method requires additional time, expense and technical expertise, it is likely to be useful only when answers to specific epidemiological problems are required or as an initial screen before using other methods of genetic analysis.

Infect Immun, 1992 Jun, 60(6), 2551 - 3
Cell envelope proteins of Staphylococcus epidermidis grown in vivo in a peritoneal chamber implant; Modun B et al.; Staphylococcus epidermidis was grown in vivo in chambers implanted intraperitoneally in rats . The cell wall and cytoplasmic membrane protein profiles of the in vivo-grown organisms were compared with those of S . epidermidis grown in vitro in nutrient broth (NB), in iron-restricted NB, or in pooled human peritoneal dialysate (HPD) . Compared with growth in broth and in common with growth in HPD, growth in vivo in chambers resulted in the repression of many S . epidermidis wall proteins, with proteins of 27, 42, 54, and 70 kDa predominating . Growth in vivo also resulted in the induction of two iron-repressible cytoplasmic membrane proteins of 32 and 36 kDa, which were also present in staphylococci grown in HPD and in iron-restricted NB . Immunoblotting experiments revealed that in sera taken 21 days after inoculation of the intraperitoneal chambers, the predominant antibody response to cell envelope proteins was directed against the 32- and 36-kDa iron-repressible membrane proteins.

J Infect Dis, 1992 Jun, 165(6), 1064 - 8
Staphylococcal skin colonization in children with atopic dermatitis: prevalence, persistence, and transmission of toxigenic and nontoxigenic strains; Hoeger PH et al.; Staphylococcal skin colonization is a common feature of atopic dermatitis (AD) in adults . Little is known about prevalence and persistence of staphylococci in children . Forty-one AD children (mean age, 70 months) and 41 age-matched controls were studied . S . aureus was isolated from 38 AD patients (93%; 32% of controls, P less than .001) and 37% of AD patients (5% of controls, P less than .001) harbored toxigenic (enterotoxins, toxic shock syndrome toxin) S . aureus strains . No individual biotype prevailed . On follow-up (mean interval, 9 months), 70% of S . aureus strains were reisolated . Nasal and cutaneous S . aureus strains were identical in 73% of AD patients (7% of controls, P less than .001), reflecting increased self-contamination . Identical staphylococcal strains in AD children and their mothers were observed in 38% (S . aureus) and 16% (coagulase-negative strains; P less than .001) . The prevalence of staphylococcal colonization in AD children is comparable to that in adults . High rates of self-contamination, transmission to contacts, and prevalence of toxigenic strains in AD children may have clinical and epidemiologic implications.

Br J Dermatol, 1992 Jun, 126(6), 586 - 90
Antibiotic resistance patterns in coagulase-negative staphylococci after treatment with topical erythromycin, benzoyl peroxide, and combination therapy; Harkaway KS et al.; Antibiotic resistance of the resident cutaneous bacterial flora is a well recognized consequence of systemic antibiotic therapy . In this study, we followed the development of antibiotic resistance of coagulase-negative staphylococci (CNS), the most numerous aerobic bacteria found on the skin surface, during treatment with three topical antimicrobial agents used to treat acne vulgaris . Groups of 20 subjects received either topical erythromycin, benzoyl peroxide or a combination of the two for 16 weeks . After 12 weeks of treatment with erythromycin, the aerobic flora was dominated by S . epidermidis which was completely resistant to erythromycin . In addition there was an increase in resistance to clindamycin and tetracycline . Treatment with benzoyl peroxide and the combination of erythromycin and benzoyl peroxide resulted in a significant reduction in the number of aerobic bacteria without any change in the resistance pattern to erythromycin or other antibiotics.

J Invest Dermatol, 1992 Jun, 98(6), 895 - 901
Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris; Ingham E et al.; The factors that initiate the inflammatory response in acne are not known . The presence of pro-inflammatory cytokines in acne comedones was therefore investigated . One hundred eight open comedones were collected from 18 untreated acne patients (10 male, 8 female) . Each comedone was homogenized and centrifuged, and the supernatant was analyzed for bioactive and immunochemically detectable IL-1 alpha, IL-1 beta, and TNF alpha . Viable counts of propionibacteria, staphylococci, and Malassezia spp . were determined in the comedone pellet . Bioactive IL-1 alpha-like material was demonstrated in 76% of open comedones (range of 23-4765 pg IL-1 alpha-like bioactivity/mg of comedone material) . In 58% of comedones, levels exceeded 100 pg/mg . There was no correlation between IL-1 alpha-like bioactivity and IL-1 alpha determined immunochemically . Bioactive IL-1 beta was not detected in any comedones . Twenty-four percent contained low levels of immunochemical IL-1 beta (range 12-103 pg IL-1 beta/mg comedone material) . Bioactive TNF alpha was detected in three comedones with a further five comedones containing immunochemical TNF alpha (range of 61-820 pg TNF alpha/mg comedone material) . The majority of open comedones (97%) contained microorganisms . There was, however, no significant correlation (Spearman's rank) between levels of any cytokine, in particular IL-1 alpha-like bioactivity, and numbers of microorganisms . Thus, bioactive IL-1 alpha-like material in the majority of open comedones may be concerned in the initiation of inflammation in acne following spongiosis or rupture of the pilosebaceous follicle wall.

Zentralbl Hyg Umweltmed, 1992 Jun, 193(1), 78 - 90
Influence of the pH-value on the growth of Staphylococcus epidermidis, Staphylococcus aureus and Propionibacterium acnes in continuous culture; Korting HC et al.; A cutaneous isolate of Staphylococcus epidermidis, Staphylococcus aureus and Propionibacterium acnes was grown in continuous culture at varying pH-values ranging from 5.0 to 8.5 . In terms of the specific growth rate as well as the bacterial density during the plateau phase there were remarkable differences . In particular, Propionibacterium acnes grew much better in the pH 6.0 to 7.0 range than in a more acidic or alkaline milieu . Staphylococcus epidermidis resembled Staphylococcus aureus showing no major difference at pH 5.5 and 7.0 . These findings substantiate the hypothesis that minor changes of the pH in the pH 5.5 to pH 6.0 range as to be induced by chemically neutral or alkaline skin cleansers on the human skin surface can increase the number of propionibacteria but not staphylococci remarkably due to the relative alkalinity by itself.

Med J Malaysia, 1992 Jun, 47(2), 128 - 33
Oral pefloxacin in the treatment of CAPD peritonitis; Tan HW et al.; Continuous ambulatory peritoneal dialysis (CAPD), a widely used replacement therapy for end stage renal failure, is frequently complicated by bacterial peritonitis . The infecting organisms are mainly staphylococci and gram negative aerobes . Pefloxacin is a fluorinated quinolone with good in-vitro activity against these pathogens . The objective of this open non comparative study is to determine the effectiveness and safety of oral pefloxacin mesylate as a single first line antimicrobial treatment of CAPD peritonitis . 28 episodes of CAPD peritonitis were treated with a stat dose of pefloxacin 800 mg . followed by 400 mg . 12 hourly for about 15-18 days . A pefloxacin sensitive organism was isolated in 17 episodes . 11 episodes were culture negative . Treatment results showed a cure in seventeen (60.7%), no treatment response in seven (25%), and relapses in four (14.2%) . Side effects encountered were not serious except for one incident of a generalized seizure . We conclude that oral pefloxacin is convenient, safe and effective enough as a single first line antimicrobial treatment for CAPD peritonitis.

Int J Food Microbiol, 1992 Jun, 16(2), 109 - 15
Influence of aw value and storage temperature on the multiplication and enterotoxin formation of staphylococci in dry-cured raw hams; Untermann F et al.; Growth and enterotoxin A production in dry-cured raw ham, with different aw and pH values, was investigated for Staphylococcus aureus strain FRJ-100 over a temperature range of 20-35 degrees C when stored for up to 7 days . Enterotoxin production took place at all temperatures tested in the meat of ham that was cured, but not dried (aw 0.95) . In dry-cured raw ham with an aw-value of about 0.92, and stored at 20 degrees C, no enterotoxin production was detectable within the 7-day storage period, whereas enterotoxin was produced at the higher temperatures . In ham with an aw of about 0.89, enterotoxin was produced only when stored for 7 days at 35 degrees C . Critical points for S . aureus multiplication and enterotoxin-formation during production and storage of dry-cured raw ham are discussed.

Acta Paediatr, 1992 Jun-Jul, 81(6-7), 542 - 6
Enhanced basal and stimulated PMN chemiluminescence activity in children with atopic dermatitis: stimulatory role of colonizing staphylococci?
Hoeger PH, Niggemann B, Schroeder C.
In adults, intense staphylococcal skin colonization and hyperactivity of polymorphonuclear leukocyte (PMN) oxidative metabolism are characteristic features of atopic dermatitis . Precise data on childhood atopic dermatitis are lacking . In a prospective study we analysed the PMN chemiluminescence activity with special reference to staphylococcal stimuli in 19 children (mean age 6.2 years) with mild to moderate atopic dermatitis . Staphylococcus aureus was isolated from 17/19 (90%) of children with atopic dermatitis and 13/45 (29%) of healthy age-matched controls (p less than 0.001) . The mean (SEM) chemiluminescence activity of unstimulated atopic dermatitis-PMN was 0.34 (0.009) (controls: 0.092 (0.003) x 10(6) cpm/10(6) PMN/min (p less than 0.02) . Staphylococcal antigens (S . aureus, S . epidermidis, S . haemolyticus) induced a 1.9-3.1-fold higher peak chemiluminescence response in children with atopic dermatitis than in controls (p less than 0.05) . The time interval until peak chemiluminescence activity was considerably shorter for all stimuli in atopic dermatitis . We conclude that PMN of children with atopic dermatitis are "primed", showing enhanced release of reactive oxygen metabolites even in the "resting" state, and are easily stimulated by staphylococcal antigens present on the skin of patients with atopic dermatitis from early childhood on . We speculate that PMN hyperreactivity may contribute to chronic skin damage in atopic dermatitis.

J Clin Pharm Ther, 1992 Jun, 17(3), 165 - 8
Phage typing of coagulase-negative staphylococci; Boussard P et al.; Seventy-nine staphylococcal strains isolated from blood cultures (57 coagulase-negative staphylococci (CNS) and 22 S . aureus) and 308 CNS isolated from the skin of healthy donors were phage typed . S . epidermidis and S . capitis were readily typed with 91 strains out of 124 and 24 strains out of 43 strains being successful . Species such as S . haemolyticus, S . hominis and S . simulans could be moderately phage typed . Others gave only a few strains capable of being typed, such as S . saprophyticus and S . sciuri . Under our experimental conditions the S . warneri, S . xylosus and S . cohnii could not be typed with our set of phages.

Kinderarztl Prax, 1992 Jun, 60(4-5), 119 - 23
{Infections after bone marrow transplantation in childhood}; Ludwig S et al.; In 66 children having undergone bone marrow transplantation (BMT) the occurrence of infections was studied retrospectively . Bacterial infections were mostly found in the early period after transplantation before marrow engraftment . The analysis of positive blood cultures showed a dominance of gram-positive bacteria, especially of coagulase-negative staphylococci . Cytomegalovirus (CMV) infections were most important, because of its high rate and the risk of CMV associated interstitial pneumonia (IP), two patients suffered from . Infections from herpes simplex virus (HSV), varizella zoster virus (VZV) and Epstein Barr virus (EBV) had no influence on prognosis . In fungal infections the systemic aspergillosis was the most important complication . To increase the effectiveness and safety of therapy the serum levels of antibiotics and antifungal drugs should be determined.

Vet Rec, 1992 May 23, 130(21), 466 - 8
Staphylococci on the skin of pigs: isolates from two farms with different antibiotic policies; Noble WC et al.; Staphylococci isolated from pigs on two farms were identified and their antibiotic resistance and plasmid profiles were examined . A highly resistant Staphylococcus hyicus was epidemic on one of the farms which was also that at which antibiotic-containing feedstuffs were used most often . Staphylococci from this farm were more often resistant to two or more antibiotics than were the strains from the other farm . The many plasmids present in these staphylococci prevented the determination of the genetic nature of the antibiotic resistance.

FEMS Microbiol Lett, 1992 May 15, 72(1), 93 - 6
A DNA-probe for the detection of the species Staphylococcus haemolyticus; Akatova E et al.; A 1.3-kb DNA fragment isolated from Staphylococcus haemolyticus strain DSM 20264 can be used as a specific probe for this species . The probe hybridized with 39 clinical isolates of S . haemolyticus but not with any of the 121 isolates representative of the other 25 species of staphylococci described to date.

J Appl Bacteriol, 1992 May, 72(5), 386 - 92
Synthetic DNA probes for detection of genes for enterotoxins A, B, C, D, E and for TSST-1 in staphylococcal strains; Jaulhac B et al.; A dot blot hybridization technique with oligonucleotide probes was developed for the specific detection of the TSST-1 gene and the staphylococcal enterotoxin (SE) genes A, B, C, D and E . For each toxin gene a probe sequence was chosen from the previously determined sequence . A total of 145 staphylococcal strains (133 Staphylococcus aureus and 12 coagulase-negative staphylococci (CNS) were studied by this genotypic method and by two phenotypic assays (gel immunodiffusion and ELISA) . An excellent correlation (96%) was observed between the genotypic and phenotypic assays . DNA from two CNS strains hybridized with a probe without detection of the corresponding toxin (SEB for one strain and SEC for the other strain) . One Staph . aureus strain was shown to be an SEC producer, but was not detected by the corresponding probe . Gene probe and immunological assays seem to be complementary methods for studies of staphylococcal strains producing (or potentially producing) TSST-1 or enterotoxins.

J Med Microbiol, 1992 May, 36(5), 332 - 6
The accumulation of bactericidal lipids in staphylococcal abscesses; Shryock TR et al.; Abscesses were generated in the peritoneal cavity of mice by the inoculation of 10(9) staphylococci . Abscess weight increased rapidly, reaching about 200 mg by the fourth day; for the next 60 days, abscess weight increased only slightly . The amount of total lipid increased during abscess development, attaining a peak level of about 19 mg per abscess at 7 days before decreasing . Almost all of this lipid resulted from the accumulation of neutral lipids . The small increases seen in the phospholipid and glycolipid fractions could be accounted for through the accumulation of host cellular elements in the abscess . Leucocytes containing cytoplasmic lipid droplets were first seen 4-12 h after infection and these cells were widely scattered around the periphery . During the next 2 days, the number of cells with lipid droplets increased markedly and lipid droplets were also found in the deeper portions of the abscesses . Although lipid droplets were found subsequently throughout the abscess, the greatest amounts always occurred in the leucocyte zone immediately proximal to the connective tissue capsule . During abscess development, the bactericidal activity also increased rapidly, reaching a maximum by the seventh day and declining thereafter.

J Med Microbiol, 1992 May, 36(5), 321 - 31
An epidemiological assessment of coagulase-negative staphylococci from an intensive care unit; Walcher-Salesse S et al.; Detection of an unusual combination of four resistance markers among coagulase-negative staphylococci (CNS) isolated in the same intensive care unit led to the undertaking of an epidemiological assessment . Seventeen CNS isolates from the same unit and 38 epidemiologically unrelated Staphylococcus epidermidis isolates were typed by eight methods, including analysis of immunoblot patterns and hybridisation patterns (HP) obtained with three probes . The probes comprised plasmids carrying the genes encoding 16S rRNA (pBA2), aacA-aphD (pSF815A), and aacA-aphD with part of IS256 (pIP1307) . Immunoblot patterns and HP with pIP1307 indicated that 14 of the 17 CNS isolates from the same unit resulted from the spread of an epidemic strain.

J Clin Microbiol, 1992 May, 30(5), 1194 - 7
Novel immunoenzymatic assay for identification of coagulase- and protein A-negative Staphylococcus aureus strains; Guzman CA et al.; A purified monoclonal antibody (MAb) which specifically reacts with Staphylococcus aureus glucosaminidase was obtained . This MAb was utilized to develop an immunoenzymatic assay for the identification of S . aureus strains . The sensitivity of this assay, based on the simultaneous detection of S . aureus glucosaminidase and protein A, was evaluated by analyzing a total of 196 strains, 26 of which did not exhibit one or more of the following properties: protein A, clumping factor, and staphylocoagulase . All strains yielded positive results by the MAb-based immunoenzymatic test . The assay's ability to differentiate between S . aureus and other staphylococci was then analyzed by testing a total of 277 non-S . aureus strains that yielded negative results . Our data demonstrate that this immunoenzymatic assay can be used as a single S . aureus identification criterion, particularly useful for those strains negative for clumping factor, staphylocoagulase, or protein A.

J Bacteriol, 1992 May, 174(9), 3042 - 8
Regulation of Staphylococcus xylosus xylose utilization genes at the molecular level; Sizemore C et al.; We have investigated the regulation of the operon encoding xylose utilization in Staphylococcus xylosus C2a and Staphylococcus carnosus TM300 . For in vivo studies, transcriptional fusions of the xylAB regulatory region to the lipase gene from Staphylococcus hyicus were constructed . Repression of lipase activity depended on a functional xylR gene and an xyl operator palindrome downstream of the promoter, while induction was obtained in the presence of xylose . Inactivation of either xylR or the xyl operator led to constitutive expression in the absence of xylose . Crude protein extracts from xylR+ staphylococci led to gel mobility shifts of the xyl regulatory DNA in the absence but not in the presence of xylose . A copper-phenanthroline footprint of the shifted band revealed protection of 28 phosphodiesters from cleavage in each strand of the xyl operator . Thus, the Xyl repressor covers the DNA over more than 2.5 helical turns . Glucose repression of the xyl operon occurs at the level of transcription and is independent of a functional xylR gene . A potential cis-active sequence element for glucose repression is discussed on the basis of sequence similarities to respective elements from bacilli.

Jpn J Antibiot, 1992 May, 45(5), 459 - 67
{A study on the disc sensitivity test for cefodizime}; Kanazawa Y et al.; Susceptibilities of 289 strains of 34 bacterial species to cefodizime (CDZM) were determined using the 2-fold agar dilution method in parallel with the measurement of inhibition zone diameters in the single-disc method under the experimental conditions established by Kanazawa . The experiments demonstrated a significant correlation between MIC by the dilution method and diameter of inhibition zone in each of the conventional, overnight assay (about 16 hours incubation), thus the applicability of the single-disc assay for CDZM was established . Analysis of the data obtained using discs containing 30 micrograms of CDZM/disc revealed that the primary regression equation was in the form: D (Diameter, mm) = 32.3-13.5 log MIC (micrograms/ml) in the conventional assay for staphylococci, Enterococcus group and glucose-non-fermentative Gram-negative rods . For other bacteria, the primary regression equation was in the form: D (diameter, mm) = 24.1-8.4 log MIC (micrograms/ml) in the conventional assay . The range of variations in MICs estimated from diameters of inhibition zones in the disc test was then calculated in comparison with that in MIC determined by the 2-fold agar dilution test to estimate experimental errors which may be involved in the determination of MICs of CDZM using the single-disc assay.

Nippon Rinsho, 1992 May, 50(5), 938 - 44
{Molecular genetics of MRSA}; Hiramatsu K; Methicillin resistance in staphylococci is explained by any of the several alterations of penicillin-binding proteins . In most (97%) of the cases, however, it is caused by acquisition of mecA gene . The mecA gene seems to be laterally transmissible among various staphylococcal species, although the frequency of transmission may not be high in view of the observed rather homogeneous nature of genetic backgrounds of the MRSA strains which were isolated all over the world . Evolution of MRSA to acquire higher level of resistance to beta-lactam antibiotics has been noticed in recent years . Such phenotypic evolution is explained by a genetic alteration involving the mec regulator genes, mecR1 and mecI, of the prototype MRSA strain.

Pathol Biol (Paris), 1992 May, 40(5), 466 - 70
{In vitro kinetics of the activity of fusidic acid and fluoroquinolones combinations against staphylococci according to methicillin-resistance phenotype . Implications for the treatment of osteoarticular infections}; Reynaud AE et al.; The kinetics of the effect of fusidic acid and of two fluoropiperazinyl quinolones (ofloxacin and pefloxacin), used alone or in combination, on ten methicillin-susceptible or methicillin-resistant strains of staphylococci were studied . Little or no bactericidal effects were seen with fusidic acid . With ofloxacin and pefloxacin, the bactericidal effect was delayed and occurred only with high concentrations . Used in combination, fusidic acid and the fluoroquinolones exhibited no synergistic effects and occasionally antagonized each other in vitro . The methicillin-resistance phenotype of organisms had no influence on results.

Eur J Clin Microbiol Infect Dis, 1992 May, 11(5), 408 - 15
In vitro and in vivo effect of antibiotics on catheters colonized by staphylococci; Guggenbichler JP et al.; An in vitro model was used to study whether and how catheter infections can be cured . Silastic catheters were "infected" with Staphylococcus aureus ATCC 25923 and Staphylococcus epidermidis KH11 and V2; these "infections" were then treated with 24, 48 and 96 h continuous infusions of various antimicrobial agents administered both as monotherapy and in combination . The Staphylococcus aureus strain was considerably more difficult to eliminate from catheters than were the Staphylococcus epidermidis strains . This experience gained in the laboratory was then applied in vivo to 16 episodes of catheter sepsis in seven children . Treatment for at least six days with imipenem/cilastatin combined with fosfomycin or an aminoglycoside successfully eliminated the pathogens isolated from 11 of the 16 episodes of infection . The broad-spectrum combination was chosen because it could not be assumed that individual pathogens would be sensitive to a single substance . Nine of the infected catheters could be retained in the patients . This experience suggests that it may be possible to successfully eliminate the colonization of central venous catheters by coagulase-negative staphylococci using the antimicrobial agents employed here.

Antibiot Khimioter, 1992 May, 37(5), 7 - 9
{Plasmid analysis of cadmium- and penicillin-resistant strains of staphylococci isolated in maternity hospitals}; Troshkina DM et al.; The plasmid analysis of a collection of the staphylococci isolated was made in the obstetric hospitals of Nizhny Novgorod and Arzamas in 1986-1989 . It revealed the presence of large complex plasmids with a molecular weight of 22 MD carrying the determinants of resistance to penicillins and cadmium and mercury ions in polyresistant strains . Conjugation transfer of the plasmid even between the staphylococci of different species was performed under experimental conditions . It was suggested that occurrence of the strains carrying the complex cadmium-penicillinase plasmid was due to violation of the sanitary or ecological requirements.

Virology, 1992 May, 188(1), 93 - 101
Antigenic N to H conversion of poliovirus by a monoclonal antibody at low ionic strength; Delaet I et al.; Monoclonal antibody 35-1f4 at low ionic strength converted native virions (N antigen) to noninfectious H-antigenic, empty capsids . The reaction was stoichiometric, as the amount of N antigen that could be converted to H was limited to an average of 2 virions per molecule of antibody . The antibody remained associated with virus aggregates after antigenic conversion . Using antibody immobilized onto protein A-bearing staphylococci, it could be shown that the loss of antigen-converting power was concomitant with the loss of antigen-binding ability . Only a small amount of viral protein (equivalent to 0.02 empty capsid per molecule of antibody) remained attached to the antibody . Heating to 56 degrees caused most of this material to be released and restored the antibody's antigen-binding and antigen-converting abilities . Several possible explanations for the heat-reversible inactivation of the antibody are discussed.

FEMS Microbiol Lett, 1992 Apr 15, 71(2), 133 - 38
Comparison of coagulase-negative staphylococci by pulsed-field electrophoresis; Lina B et al.; Five pathogenic strains each of Staphylococcus epidermidis, S . haemolyticus, S . lugdunensis and S . schleiferi were analysed by conventional electrophoresis and field inversion gel electrophoresis . For these coagulase-negative staphylococci, the restriction endonuclease SmaI emerged as the most suitable enzyme for pulsed-field electrophoresis by providing an adequate number of clearly separated DNA fragments . Field inversion gel electrophoresis confirmed the differences among strains already discriminated by conventional electrophoresis, and furthermore, differentiated strains which had previously appeared identical . Among the species that were studied, S . epidermidis showed great genomic diversity with a few common bands . On the contrary, S . haemolyticus, S . lugdunensis and S . schleiferi showed less diversity . Although these minor variations may be epidemiologically significant, this question has to be investigated on a larger number of strains.

Neurosurg Clin N Am, 1992 Apr, 3(2), 375 - 85
Craniotomy infections; Blomstedt GC; The incidence of craniotomy infections, usually less than 5%, is dependent on many factors, such as how the information is collected and how the percentage is calculated . Because these factors may vary from report to report, incidence figures should be read with skepticism . It is difficult to prove that a given factor contributes to infection . Most routines are based more on personal convictions than on solid evidence . CSF leak is one factor known to have great impact; it should be avoided with painstaking technique and, if it occurs, it should be treated promptly . Solid evidence favoring prophylactic antibiotics for persistent CSF leak is not available; but, until a well-designed randomized study tells otherwise, the high risk of meningitis justifies prophylaxis . Penicillin is adequate for leaks through the nose or the ear . For leaks through the skin, the antibiotic should be effective against staphylococci . The infection register should provide information about prevailing bacteria . In many hospitals, the prophylaxis should cover gram-negative bacilli . CRP is a useful diagnostic aid for detecting postoperative infections . The operation, however, also causes a CRP rise . Daily CRP monitoring, at least for patients with elevated temperature, is recommended . The third-generation cephalosporins are a welcome contribution to the treatment of bacterial meningitis . To avoid side effects, and to keep them potent when they are really needed, they should be used with caution . Most postoperative cases of meningitis are in fact aseptic . If the patient is moderately ill, chloramphenicol is still eligible as the first choice antibiotic . When the bacterial culture is negative, the antibiotic should be stopped . The standard treatment for bone flap infection is removal of the bone flap . The bone flap is essentially devascularized and comparable to a foreign body . The justification of vancomycin prophylaxis has been shown in a randomized study.

Mikrobiyol Bul, 1992 Apr, 26(2), 103 - 7
{Staphylococcal biotyping and the use of computers}; Akan OA et al.; Ninety coagulase negative staphylococci isolated from various clinical specimens in Clinical Microbiology laboratory of Hacettepe University Faculty of Medicine, were biotyped using a special computer program . Types of 30 strains isolated from pus were found to be S . epidermidis (36.7%), S . haemolyticus (20%), S . simulans (13.3%) and S . hominis (10%) respectively . Among the strains isolated from blood S . epidermidis was again the predominant microorganism (40%), followed by S . haemolyticus (20%) and S . simulans (10%).

Invest Ophthalmol Vis Sci, 1992 Apr, 33(5), 1723 - 6
Penetration of norfloxacin into the aqueous humor of the human eye; Huber-Spitzy VN et al.; Forty six patients received a topical application of a 0.3% norfloxacin (Zoroxin; MSD, Austria) solution into the lower fornix at different time intervals and frequencies before undergoing planned extracapsular cataract extraction . Aqueous humor was sampled at the beginning of surgery and assayed for the level of the antibiotic with high performance liquid chromatography . The highest aqueous humor level observed 30 min after the administration of the last drop in four patients who received five drops of norfloxacin into the lower fornix was 660.25 +/- 378.2 ng/ml . These concentrations are above the minimum inhibitory concentration of norfloxacin for 90% (MIC90) of most of the gram-negative microorganisms, but below the MIC90 of most of the staphylococci (coagulase negative Staph . and Staphylococcus aureus range between 0.25-1 mg/ml).

Pediatrics, 1992 Apr, 89(4 Pt 2), 696 - 700
An endemic strain of Staphylococcus haemolyticus colonizing and causing bacteremia in neonatal intensive care unit patients; Low DE et al.; Coagulase-negative staphylococci are now the major cause of bacteremia in neonatal intensive care units . To date, coagulase-negative staphylococci causing neonatal infections have been found to be distinct when typed by standard techniques . To determine whether or not an endemic strain could be identified using more discriminatory techniques, we characterized coagulase-negative staphylococci isolates obtained from a prospective study of coagulase-negative staphylococci bacteremia in a neonatal intensive care unit during 1984 through 1985, by standard techniques supplemented with DNA-DNA hybridization and restriction endonuclease analysis . We typed 58 strains that were isolated from 52 episodes of bacteremia in 38 neonates . There were 46 isolates of Staphylococcus epidermidis . Three pairs of strains were identical, and each strain was from a different patient . There were 12 isolates of Staphylococcus haemolyticus . Ten were identical, referred to as strain TOR-35, and had been isolated from eight different infants . Characterization of strains obtained in 1986 from a prospective study of coagulase-negative staphylococci-colonizing neonates admitted to the same neonatal intensive care unit found the TOR-35 strain had colonized 6 of 17 neonates by day seven . A point prevalence survey of all neonates in the same neonatal intensive care unit in 1990 found 5 of 30 neonates to be colonized with the TOR-35 strain . Therefore, we were able to identify an endemic strain of S haemolyticus that caused multiple episodes of bacteremia during a 6-month period and remained present in the same environment for a 5-year period.

J Infect Dis, 1992 Apr, 165(4), 638 - 43
A recalcitrant, erythematous, desquamating disorder associated with toxin-producing staphylococci in patients with AIDS; Cone LA et al.; Although staphylococcal infections are common in patients with AIDS, staphylococcal toxin-related disorders have rarely been described . Five cases of a staphylococcal toxin-associated syndrome characterized by prolonged erythema, extensive cutaneous desquamation, hypotension, tachycardia, and multiple organ involvement are described in patients with AIDS . These illnesses were recurrent and recalcitrant with a mean duration of 50 days . Toxic shock syndrome toxin-1-producing staphylococci were isolated from three and staphylococcal enterotoxins B and A from one patient each . Sources of organisms were blood, one patient, and soft tissues and nasal accessory sinuses, two patients each . Three of the five patients died of renal failure and central nervous system abnormalities . One survivor required intubation for respiratory failure . All individuals manifested a marked diminution of CD4+ cells . Other laboratory abnormalities included azotemia and prolongation of partial thromboplastin time . Oliguria occurred in three patients . Thus, this recalcitrant erythematous desquamative disorder appears to be a variant of staphylococcal toxic shock syndrome in certain subsets of immunocompromised individuals.

J Bacteriol, 1992 Apr, 174(7), 2241 - 52
Fan-shaped ejections of regularly arranged murosomes involved in penicillin-induced death of staphylococci; Giesbrecht P et al.; Electron microscopic research into the murosomes of staphylococci has shown that the number of murosomes involved in penicillin-induced death varies depending on the experimental conditions employed . With 0.1 micrograms of penicillin G per ml, only 1 of a total of about 20 murosomes, the "killing murosome," completely perforated the pressure-stabilized peripheral cell wall during a three-step process . This strictly localized event was mainly attributed to a mechanical effect being comparable to the process of aneurysm formation . Wall perforation was also considered to mark the very moment of penicillin-induced death ("nonlytic killing event"), while bacteriolysis started only postmortem . By varying the osmolarity of the growth medium, the number of murosomes involved in penicillin-induced killing increased considerably, which resulted in the ejection of a fan-shaped row of murosomes at the second division plane . These data are compatible with the finding that, in untreated or chloramphenicol-treated staphylococci, the activation of the murosomes resulted in (i) the formation of regularly arranged "blebs" on the cell surface, containing traces of disintegrated wall material, and (ii) the subsequent liberation of the murosomes lying underneath, leaving behind their former sites in the peripheral wall as a row of regularly arranged "pores" in every division plane . The number, distribution, and positioning of these blebs corresponded with those of the pores and the original murosomes . The significance of wall autolysins liberated from the first division plane for penicillin-induced wall perforation at the second division plane is discussed.

Infect Immun, 1992 Apr, 60(4), 1363 - 7
Role of the Staphylococcus epidermidis slime layer in experimental tunnel tract infections; Patrick CC et al.; An experimental animal model was used to assess the slime layer of Staphylococcus epidermidis as a pathogenic factor in tunnel tract infections . Mice were inoculated with high-slime-producing or non-slime-producing strains of S . epidermidis, either along the length of a subcutaneous catheter or in the area where a catheter had been placed and immediately removed (controls) . Among the catheter-bearing mice, the phenotypically distinct staphylococci produced similar, high frequencies of abscess formation (72% {44 of 61} versus 81% {31 of 38}; P = 0.29) . In controls, the non-slime-producing organisms were significantly more pathogenic (87% {40 of 46} versus 57% {25 of 44} abscess formation; P = 0.001) . No consistent difference was detected between blood isolates obtained from patients with central venous catheter bacteremia and those from neonates with bacteremia in the absence of a prosthetic medical device . Quantitative culture of removed catheters showed greater adherence by the slime-producing isolates (P = 0.014) . In this mouse model, slime production by S . epidermidis did not increase the risk of catheter tunnel tract infection, despite the greater catheter adherence of the slime-producing organisms . These findings suggest that traumatized tissue may be a sufficient condition for the development of S . epidermidis catheter-associated infections.

Antimicrob Agents Chemother, 1992 Apr, 36(4), 854 - 5
In vitro antistaphylococcal activity and testing of RP 59500, a new streptogramin, by two methods; Aldridge KE et al.; The in vitro antistaphylococcal activity of RP 59500, a new streptogramin, was comparable to those of vancomycin and teicoplanin against Staphylococcus aureus, and RP 59500 was the most active agent against coagulase-negative staphylococci . All staphylococcal strains were inhibited by 4 micrograms of RP 59500 per ml, including multiply resistant strains . Broth microdilution and agar dilution testing gave comparable results in 97% of the tests with RP 59500.

Eur J Ophthalmol, 1992 Apr-Jun, 2(2), 58 - 66
The safety and efficacy of topical norfloxacin compared with placebo in the treatment of acute, bacterial conjunctivitis . The Norfloxacin-Placebo Ocular Study Group; Miller IM et al.; Two hundred and eighty-four patients with acute conjunctivitis were enrolled in a double-masked study comparing norfloxacin ophthalmic solution with placebo . The proportion of patients who were clinically improved after 5 days treatment was 88.1% in the norfloxacin group and 71.6% in the placebo group (p less than 0.01) . The proportion of patients who had all organisms eradicated, including the coagulase-negative staphylococci, after two to three days treatment was 52.7% for norfloxacin and 23.9% for placebo (p less than 0.01) and 64.7% and 26.3% (p less than 0.01) respectively when the coagulase-negative staphylococci were not included . Adverse experiences occurred in 4.2% of the patients receiving norfloxacin compared to 7.1% of the placebo patients . None of the adverse experiences was serious.

Zh Mikrobiol Epidemiol Immunobiol, 1992 Apr, (4), 4 - 6
{Staphylococci in the microbiocenosis of the skin of the hands}; Sytnik AN; The skin autoflora on the pad of a forefinger and the back and palm of a hand was studied in 40 healthy males aged 18-60 years by the modified washing and scraping method of P . Williamson and A . Kligman . 638 cultures of aerobic microorganisms, including coccal (55.3%) and bacilliform (44.7%) microbes, were isolated . In 6 persons (15%) coagulase-positive staphylococci were detected . Out of 10 coagulase negative species of this genus, S . epidermidis, S . saprophyticus and S . warneri occurred most frequently on the skin of hands . The highest density of bacterial populations (10.970 +/- +/- 1.845 cells/sq . cm) was registered on the back of hands, the surface of palms was found to have somewhat lower density (8.679 +/- 1.282 cells/sq . sm) and the skin of forefingers, the lowest density of bacterial populations (6.878 +/- +/- 1.137 cells/sq . sm) . 17.5% of examined persons were found to be carriers with S . aureus isolated from their nasal mucosa . S . aureus isolated from the skin surface and the nasal cavity of different persons belonged to different phage variants, but S . aureus isolated from the nasal cavity and the skin of the same person belonged to one phage variant.

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