Staphylococcus

J Hosp Infect, 1992 Apr, 20(4), 247 - 55
Dynamics of coagulase-negative staphylococcal colonization in patients and employees in a surgical intensive care unit; Thurn JR et al.; Because there is little information about the frequency of carriage of various species of coagulase-negative staphylococci (CNS) in hospital staff, we prospectively investigated nasal CNS in patients and personnel in a Surgical Intensive Care Unit (SICU) . The majority of CNS from personnel were Staphylococcus epidermiditis . The CNS species from patients on admission were more diverse and included multiply antibiotic-resistant S . haemolyticus . Patients' CNS became more like CNS colonizing personnel after admission with respect to both antimicrobial susceptibility and speciation . Plasmid and antibiotic sensitivity profiles of S . epidermidis resistant to multiple antibiotics from five patients were identified as those from one employee, but there was no evidence that this was of clinical significance . A variety of factors influence nasal colonization by CNS in SICUs . The nasal CNS of patients change after admission and may become more resistant and less diverse . The factors influencing changes in the antibiotic susceptibility and the aetiology of CNS infection require further study.

Antimicrob Agents Chemother, 1992 Apr, 36(4), 851 - 3
In vitro antistaphylococcal activities of two investigative fluoroquinolones, CI-960 and WIN 57273, compared with those of ciprofloxacin, mupirocin (pseudomonic acid), and peptide-class antimicrobial agents; Aldridge KE; By using broth microdilution, 373 clinical isolates of staphylococci were studied to determine their susceptibilities to CI-960, WIN 57273, ciprofloxacin, mupirocin, vancomycin, teicoplanin, and ramoplanin . Test strains comprised 179 strains of Staphylococcus aureus and 194 strains of coagulase-negative species . Strains of S . aureus were susceptible to CI-960, which had a mode MIC of 0.032 micrograms/ml and an MIC for 90% of the strains of 2 micrograms/ml . CI-960 was equally active against methicillin-susceptible and -resistant S . aureus strains as well as ciprofloxacin-resistant strains . Similarly, WIN 57273 was highly active, with a mode MIC of 0.008 micrograms/ml and an MIC for 90% of the strains of 1 micrograms/ml . No cross-resistance to CI-960 and WIN 57273 among ciprofloxacin-resistant strains was detected . Mupirocin was four- to eightfold more active than ramoplanin, vancomycin, and teicoplanin . With regard to coagulase-negative staphylococci, CI-960 and WIN 57273 were the most active of the test compounds, inhibiting all strains at 0.5 and 1 micrograms/ml, respectively . Against the same strains, mupirocin was fourfold more active than ramoplanin and eightfold more active than vancomycin . Five strains of S . haemolyticus were found to be resistant to ciprofloxacin, while resistance to teicoplanin was found among strains of S . epidermidis, S . haemolyticus, S . hominis, S . saprophyticus, S . simulans, S . warneri, and S . xylosus.

J Clin Microbiol, 1992 Apr, 30(4), 817 - 23
Ribotyping of coagulase-negative staphylococci with special emphasis on intraspecific typing of Staphylococcus epidermidis; Izard NC et al.; Coagulase-negative staphylococci (CoNS), particularly Staphylococcus epidermidis, are increasingly being recognized as opportunistic pathogens . They are often multiply antibiotic resistant and can cause nosocomial outbreaks . For clinical and epidemiological reasons, accurate species identification and typing are imperative . Ribotyping, i.e., the generation of characteristic fragment patterns by hybridization of restriction endonuclease fragments of total DNA with labeled standard rRNA from Escherichia coli, has been applied to CoNS for species identification by various investigators . The present study, involving 115 randomly collected clinical isolates of CoNS, provides ambiguous evidence with respect to those findings . Eighty six S . epidermidis strains were ribotyped intraspecifically . Eleven different ribotypes were found after digestion with EcoRI, and 10 were found with HindIII . A combination of the two restriction endonucleases resulted in an increase in the discriminatory power (DP) from 14.3 to 31.6% . A combination of ribotyping with biotyping raised the DP to a maximum of 48.6% . The reproducibility of ribotyping was 100% after greater than 400 generations of growth . No correlation between methicillin resistance and certain ribotypes among the S . epidermidis strains was observed . Ribotyping is considered a useful tool for the intraspecific typing of CoNS for epidemiological purposes . The DP can be increased by the use of additional restriction endonucleases.

Plasmid, 1992 Mar, 27(2), 164 - 8
Mobilization of recombinant plasmids from Staphylococcus aureus into coagulase negative Staphylococcus species; Thomas WD Jr et al.; pC221, a small nonconjugative staphylococcal plasmid, can be mobilized between staphylococci by pG01, a larger conjugative plasmid . pC221 carries the two transacting genes, mobA and mobB, which are needed for its mobilization . The products of these genes create a site-specific single-stranded nick (mobA) and then facilitate DNA transfer (mobB) . Several useful Escherichia coli-staphylococcal shuttle plasmids containing the cloned single-stranded nick site were created and successfully mobilized into Staphylococcus aureus and two coagulase-negative staphylococci, S . epidermidis and S . saprophyticus, by providing mob genes (pC221) and conjugative transfer genes (pG01) in trans in the donor . These vectors may offer a genetic system for the introduction of recombinant plasmids into coagulase negative staphylococci.

Infect Immun, 1992 Mar, 60(3), 922 - 7
Staphylococcal exopolysaccharides inhibit lymphocyte proliferative responses by activation of monocyte prostaglandin production; Stout RD et al.; The glycocalyx (exopolysaccharides) of Staphylococcus epidermidis has been reported to inhibit a variety of host defense mechanisms . We have examined the inhibitory effects of glycocalyx on the proliferation of human peripheral blood mononuclear cells (PBMC) and the mechanism of this inhibition . Glycocalyx isolated and partially purified under endotoxin-free conditions from defined liquid medium cultures of S . epidermidis and Staphylococcus lugdunensis inhibited the proliferative response of PBMC when added to cultures at 10 to 100 micrograms/ml . Glycocalyx-mediated inhibition of phytohemagglutinin-stimulated proliferation of PBMC required the presence of plastic-adherent peripheral blood monocytes . Culture supernatants of monocytes stimulated with glycocalyx contained a soluble factor that inhibited the proliferation of monocyte-depleted PBMC . This soluble inhibitory factor was not produced in the absence of glycocalyx or in the presence of both glycocalyx and indomethacin . Analysis of the supernatants of cultures of adherent monocytes revealed that glycocalyx from S . epidermidis and from S . lugdunensis could activate monocyte production of prostaglandin E2 (PGE2), human interleukin-1, and tumor necrosis factor alpha . The addition of purified PGE2, at the same levels of PGE2 (greater than or equal to 10(-9) M) generated in the monocyte cultures, to PBMC cultures resulted in a similar inhibition of proliferative responses . It is concluded that, contrary to previous suggestions, the bacterial glycocalyx does not have a direct inhibitory effect on T lymphocytes . However, it does appear that glycocalyx from coagulase-negative staphylococci can activate monocyte PGE2 production and that it is this activity that in turn contributes to the inhibition of T-cell proliferation.

Antimicrob Agents Chemother, 1992 Mar, 36(3), 533 - 9
Construction of a water-soluble form of penicillin-binding protein 2a from a methicillin-resistant Staphylococcus aureus isolate; Wu CY et al.; The mecA gene from methicillin-resistant Staphylococcus aureus 27r, which encodes the membrane-bound penicillin-binding protein 2a (PBP 2a), was cloned, sequenced, and expressed in Escherichia coli . PBP 2a is the major factor that mediates methicillin resistance in staphylococci . The DNA sequence of the mecA gene from strain 27r was greater than 99% identical to the DNA sequence of other S . aureus mecA genes and the mecA gene from Staphylococcus epidermidis . Analysis of the deduced amino acid sequence of PBP 2a from strain 27r revealed a hydrophobic region at the amino terminus that possessed characteristics of an uncleaved signal peptide such as those found in type II integral membrane proteins . Site-specific mutagenesis was used to modify the strain 27r mecA gene to permit removal of the region encoding the putative transmembrane region (amino acids 2 to 22) . When it was expressed in E . coli, the modified mecA gene from strain 27r encoded a water-soluble form of PBP 2a that was detectable in the cytoplasm of transformants . The water-soluble form of PBP 2a protein from S . aureus 27r retained the same binding efficiency for beta-lactam antibiotics as the unmodified membrane-bound PBP 2a from S . aureus 27r.

Zentralbl Veterinarmed B, 1992 Mar, 39(2), 144 - 8
Production of staphylococcal enterotoxins and TSST-1 by coagulase negative staphylococci isolated from ruminant mastitis; Orden JA et al.; The production of staphylococcal enterotoxins (SE) and toxic shock syndrome toxin-1 by 40 coagulase negative staphylococci isolated from sheep, goat and cow mastitis was studied . Both ELISA double sandwich and Western blot were used to detect the production of these toxins . Only two strains of S . xylosus were enterotoxigenic, producing SEC . TSST-1 was seen to be produced by 5 strains of S . xylosus, 1 S . sciuri and 2 S . epidermidis . Results obtained by ELISA and by Western blot agreed in all cases except in one strain of S . epidermidis which was only positive using ELISA.

Pathol Biol (Paris), 1992 Mar, 40(3), 218 - 22
Evaluation of a blood culture medium BHI-S-Lysis for BCB Release System Roche; Etienne J et al.; The new blood culture medium BHI-S Lysis for the BCB Release System (F . Hoffmann-La Roche AG., Basel, Switzerland), which lyses blood cells, was compared with the Hemoline performance Duo (BioMerieux, Marcy l'Etoile, France) including a diphasic medium and a modified Wilkins Chalgren broth . A total of 1998 sets were each inoculated with 7 ml of blood . In the laboratory, agar-coated paddles were attached to the BHI-S-Lysis . Overall, there was a statistically significant difference between the BHI-S-Lysis and the diphasic medium, or Wilkins Chalgren broth, in the recovery of clinically important microorganisms . The yield of pathogens with the BHI-S-Lysis, diphasic medium and Wilkins Chalgren broth was 115, 68 and 58, respectively . Staphylococci were detected by the BHI-S-Lysis significantly more frequently . Out of 50 bacteraemias, 12 were diagnosed with the BHI-S-Lysis only, three with the diphasic medium only, and three with the Wilkins Chalgren broth only . Contaminant isolates occurred with significantly greater frequency in the BHI-S-Lysis than in the two BioMerieux systems, in particular with coagulase-negative staphylococci . No speed advantage was present for all groups of micro-organisms and blood culture media . This good performance of the BHI-S-Lysis medium in detecting a larger number of pathogens should be confirmed by further evaluations.

Eur J Clin Microbiol Infect Dis, 1992 Mar, 11(3), 255 - 7
Synergism of trimethoprim and ciprofloxacin in vitro against clinical bacterial isolates; Huovinen P et al.; For the first time, the effects of combinations of trimethoprim and a fluoroquinolone (ciprofloxacin) against gram-positive and gram-negative bacterial isolates were evaluated in vitro . Synergism was found in 31% (fractional inhibitory concentration, FIC) and 33% (fractional bactericidal concentration, FBC) of 121 clinical isolates of various bacterial strains, most often in Escherichia coli, staphylococci, and enterococci . Antagonism occurred in 1% (FIC) and 3% (FBC) . The combination of trimethoprim and ciprofloxacin merits further evaluation for potential usefulness as a clinical regimen.

Res Vet Sci, 1992 Mar, 52(2), 174 - 6
Occurrence of Staphylococcus intermedius on the hair and skin of normal dogs; Allaker RP et al.; Aerobic bacterial populations were studied on the distal hair coat and at the skin surface of the shoulder, rump and abdomen of 10 healthy dogs . Coagulase negative staphylococci (CNS) were more frequently isolated from the hair than the skin at the shoulder and rump . There was no difference in the isolation rate of coagulase positive staphylococci (CPS) (Staphylococcus intermedius) between the hair and skin . Total skin counts were greatest on the abdomen whereas CNS counts from the hair were least at this site . There were no differences between CPS counts at the three sites on either hair or skin . The populations on the relatively unfavourable microenvironment of the distal hair may represent contamination rather than colonisation . The low populations of CPS at the skin surface also indicate contamination or transient colonisation rather than true resident status.

Diagn Microbiol Infect Dis, 1992 Mar-Apr, 15(3), 207 - 11
Evaluation of a mannitol-salt-oxacillin-tellurite medium for the isolation of methicillin-resistant Staphylococcus aureus from contaminated sources; Martinez OV et al.; A mannitol-salt medium supplemented with 0.002% tellurite (MSOT) supported the growth of 104 of 109 strains of methicillin-resistant Staphylococcus aureus (MRSA) while suppressing 74 of 102 strains of mannitol-positive, methicillin-resistant coagulase-negative staphylococci . MSOT was equally or more sensitive and more differential than a similar formulation without tellurite for the isolation of MRSA from the skin and nares of hospitalized patients . Only S . haemolyticus produced dark gray-to-black colonies on MSOT similar to those of MRSA . MSOT is a useful adjunct to other nonselective culture formulations for the isolation of MRSA from contaminated sources.

J Am Soc Echocardiogr, 1992 Mar-Apr, 5(2), 168 - 72
Risk of bacteremia induced by transesophageal echocardiography: analysis of 100 consecutive procedures; Nikutta P et al.; The incidence of bacteremia induced by transesophageal echocardiography (TEE) and, consequently, the need for an antibiotic prophylaxis before TEE is still controversial . Therefore, we studied the incidence of bacteremia associated with TEE prospectively in 100 consecutive patients without clinical or laboratory signs of bacterial infection . Blood samples were drawn immediately before and at 0, 5, and 15 minutes after TEE . In addition, swabs were taken from the pharyngeal region before TEE and from the distal part of the TEE-probe before and after TEE . All blood cultures taken before TEE remained sterile . After TEE, three positive blood cultures were found in two patients: the first patient had two different species of coagulase-negative staphylococci in cultures taken at 0 minutes (Staphylococcus capitis) and 15 minutes (Staphylococcus cohnii) after TEE, whereas the sample taken after 5 minutes remained sterile . In the second patient, Propionibacterium species appeared after 7 days of processing in a culture taken immediately after TEE, but not in the samples taken after 5 and 15 minutes . None of the three microorganisms found in the blood were simultaneously isolated in pharyngeal specimens or TEE-probe specimens of the same patient . Thus positive blood cultures in both patients were considered contaminated . This study demonstrates that TEE, when performed by an experienced investigator, is not associated with an increased risk of bacteremia . Accordingly, it is justified to perform TEE examinations (also in high-risk patients) without antibiotic prophylaxis.

APMIS, 1992 Mar, 100(3), 246 - 8
Coagulase-negative staphylococci in a newborn with a cardiac vascular prosthesis . Case report; Ryding J et al.; A case of septicemia with coagulase-negative staphylococci in a newborn with a vascular graft is discussed . Nineteen different isolates of coagulase-negative staphylococci were isolated from four different blood cultures . Eleven of the isolates belonged to one strain, which showed slight variation; the remaining seven isolates belonged to six different strains . The patient was treated for a prolonged period with antibiotics and seemed to respond . The diagnosis and proper treatment are discussed.

J Thorac Cardiovasc Surg, 1992 Mar, 103(3), 582 - 8
Bacteriologic and endotoxin analysis of salvaged blood used in autologous transfusions during cardiac operations; Bland LA et al.; Autologous blood transfusion is a common method of reducing the need for heterologous blood transfusion during cardiac operations . Recently we investigated an outbreak of severe, nonsurgical postoperative bleeding among patients undergoing heart operations and receiving intraoperative transfusion of blood from a cell conservation device (Cell Saver System, Haemonetics Corp., Braintree, Mass.) . As a result of this investigation, we conducted a prospective study to determine if bacterial or endotoxin contamination of the blood collected in the Cell Saver System and used for reinfusion during heart operations contributes to postoperative bleeding complications . Patients' blood samples were collected immediately before operation, at the end of cardiopulmonary bypass, 1 hour postoperatively, and from the Cell Saver System . All blood samples were cultured for bacteria, and all plasma samples were assayed for endotoxin . Preoperatively all patients having heart operations were without signs of infection, 33 of 37 blood cultures taken were negative, and none of the plasma samples had detectable endotoxin . After discontinuance of cardiopulmonary bypass but before delivery of blood from the Cell Saver System, bacteria and endotoxin were detected in 11 of 36 (30.6%) and five of 35 (14.3%) of the patients' blood samples, respectively . The blood aspirated from the open chest and collected by the Cell Saver System was culture positive in 30 of 31 (96.8%) samples, and seven of 29 (24.1%) contained endotoxin . One of 28 blood samples collected 1 hour postoperatively was culture positive, and five of 25 samples contained endotoxin . Of 61 total microorganisms isolated, 50 (82%) were coagulase-negative staphylococci, four (6.6%) aerobic diphtheroids, five (8.2%) anaerobic "diphtheroids" (Propionibacterium acnes), and two (3.2%) gram-negative bacilli . Plasma endotoxin concentrations ranged from 10 to 765 pg/ml . No signs of endotoxemia or unusual bleeding were observed intraoperatively or postoperatively in any of the 38 patients . Although blood collected in the Cell Saver System and used for reinfusion during heart operations often was contaminated with gram-positive bacterial commensals of the skin and low concentrations of endotoxin, no adverse effects were noted in the patients.

Infect Immun, 1992 Mar, 60(3), 965 - 9
Staphylococcus aureus proteins that bind to human endothelial cells; Tompkins DC et al.; The adherence of Staphylococcus aureus to human endothelial cells is saturable in both dose- and time-dependent assays . Staphylococcal surface components which bound to endothelial cells in vitro were identified by using biotin-labeled, solubilized staphylococcal proteins . Four trypsin-sensitive components with molecular sizes of 30, 55 to 57, 70, and 85 kDa were recognized . These proteins did not label with the glycan detection system . When staphylococci were harvested during the exponential phase of growth, staphylococcal adherence to endothelial cells was significantly increased and increased expression of the S . aureus binding proteins was observed . Preincubation of endothelial cells with protein A did not reduce S . aureus adherence in an in vitro infection assay . Four S . aureus surface components whose expression is growth phase dependent adhere to human endothelial cells in vitro.

Patol Fiziol Eksp Ter, 1992 Mar-Apr, (2), 50 - 2
{Ultrastructure of erythrocytes with diminished flow properties and their role in the development of microcirculatory disorders under extreme conditions}; Zakharova NB et al.; The deformability (D) of erythrocytes and their ultrastructure in the microcirculatory channel of vital tissues of the organism were studied in experiments on rabbits in two types of extreme conditions: staphylococci toxicosis and the postischemic syndrome . Erythrocyte deformability in each of these extreme conditions occurred in the late phase of the process and was manifested by destruction of the ultrastructural organization of the membrane matrix and the cytoplasm of cells in the microvessels . Destruction of the erythrocyte membranes was linked with their disintegration into micro- and macro-fragments (in staphylococci toxicosis) and separation of membrane areas in the form of microvesicles (in the postischemic syndrome) . Damage to the erythrocyte membrane and cytoplasm may be considered to be one of the typical manifestations of the organism's response to extreme effects accompanying the phenomena of disseminated intravascular clotting.

J Hosp Infect, 1992 Mar, 20(3), 173 - 84
Importance of medium and atmosphere type to both slime production and adherence by coagulase-negative staphylococci; Hussain M et al.; Marked differences in both the production of slime and adherence by Staphylococcus epidermidis were observed when comparing four culture media . Slime isolated from a strain cultured in a chemically defined medium (HHW) in air was chemically indistinguishable from that formed in both HHW and synthetic dialysis fluid (SDF) in air with 5% CO2 . The presence of a physiological level of CO2 during culture in tryptone soya broth (TSB) prevented production of slime . It was not possible to separate the constituents of slime from those of the culture medium in bacteria grown in TSB in air using DEAE cellulose . Slime production was notably poor in used peritoneal dialysis fluid (PUD) . Adherent growth was marked in HHW and SDF but was poor in TSB and PUD when air with 5% CO2 was used . These findings emphasize the advantages in using chemically defined and biological fluids when studying slime production and adherence by S . epidermidis.

J Clin Microbiol, 1992 Mar, 30(3), 577 - 80
Rapid method for epidemiological evaluation of gram-positive cocci by field inversion gel electrophoresis; Goering RV et al.; We report a rapid method for the isolation of intact chromosomal DNA from gram-positive cocci that is suitable for in situ restriction endonuclease digestion in agarose blocks . When combined with a rapid field inversion gel electrophoresis protocol, this approach allows the preparation and electrophoretic analysis of chromosomal restriction fragments produced by rare-cutting enzymes in a total time period of 2 days from start to finish . The utility of the method is demonstrated in the epidemiological evaluation of Staphylococcus epidermidis clusters from two hospitals as well as of additional representative staphylococci and enterococci.

J Med Microbiol, 1992 Feb, 36(2), 71 - 7
An experimental evaluation of the pharmacokinetics of fusidic acid in peritoneal dialysis; Rowe L et al.; Fusidic acid, an antimicrobial agent with activity against coagulase-positive and coagulase-negative staphylococci, has considerable potential for the management of staphylococcal peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD) . Whether fusidic acid reaches therapeutic levels in the dialysate once therapeutic serum levels have been achieved is not known . An animal model of CAPD that reproduced essential features of the clinical procedure was used to investigate this issue . Although oral administration was the preferred route, fusidic acid is not absorbed from the gastrointestinal tract of laboratory rats, and a subcutaneous injection of diethanolamine fusidate was used to achieve serum levels of the agent equivalent to those achieved clinically in man . In this model, fusidic acid concentrations up to 28 times the MIC for staphylococci were found in the dialysate when therapeutic levels of the agent were reached in the serum . The data provide support for continued experimental and clinical evaluation of the role of fusidic acid in CAPD-associated peritonitis.

Hepatology, 1992 Feb, 15(2), 234 - 43
Isolated hepatic lipocytes and Kupffer cells from normal human liver: morphological and functional characteristics in primary culture; Friedman SL et al.; The development of techniques for isolating hepatic lipocytes (Ito, stellate or fat-storing cells) from rodents has been instrumental in defining their role in hepatic vitamin A storage and fibrogenesis . In this study, we developed a method for the purification of lipocytes and Kupffer cell from wedge sections of normal human liver and examined their properties in primary culture . Sections of donor liver (400 to 600 gm) harvested but not used for transplantation were perfused in situ with University of Wisconsin solution and used for lipocyte isolation within 48 hr . Cells were isolated by catheter perfusion of the wedge through several large vessels with L-15 salts, Pronase and collagenase, followed by Larex density gradient centrifugation . Lipocytes were plated on either uncoated plastic or a basement membrane-like gel . Lipocyte and Kupffer cell yields were 2.3 +/- 0.6 x 10(5) and 8.6 +/- 1.4 x 10(5) cells, respectively, per gram of liver (n = 5) . Lipocyte purity was 91% as assessed by vitamin A autofluorescence, and Kupffer cell purity was 83% as determined by uptake of fluorescinated staphylococci . Lipocytes cultured on the plastic spread within 48 to 72 hr, displaying slightly more heterogeneous retinoid droplet size than comparable rat cells; on a basement-membrane gel, the cells remained aggregated and spherical with occasional spindlelike extensions . Lipocytes on plastic expressed procollagens I and III, collagen IV and laminin by immunocytochemistry, and types I, III and IV procollagen messenger RNAs by RNAse protection . Northern blot and polymerase chain reaction, respectively . Transmission electron microscopy of lipocytes at 7 days demonstrated a prominent rough endoplasmic reticulum and contractile filaments . Scanning electron microscopy revealed a smooth cell surface with perinuclear droplets beneath the cell membrane . With continued primary culture on plastic (more than 7 days), cells appeared "activated" (i.e., increased spreading and diminished retinoid droplets) and began proliferating as assessed by nuclear autoradiography and {3H}thymidine incorporation . Kupffer cells observed by scanning electron microscopy in early primary culture displayed prominent membrane ruffling and lamellipodia . In summary, we have established a reproducible method for the isolation and primary culture of human lipocytes and Kupffer cells.

J Urol, 1992 Feb, 147(2), 398 - 400; discussion 400-1
Coagulase-negative staphylococcus in chronic prostatitis; Nickel JC et al.; Three male patients with a clinical history of prostatitis with coagulase-negative staphylococci localized to the expressed prostatic secretion and who did not respond to antibiotics were studied intensively 4 weeks after cessation of therapy with repeat culture of the prostatic fluid, as well as with culture, and histological and ultrastructural examination of multiple prostatic biopsies . Coagulase-negative staphylococci were cultured in the biopsied prostatic tissue, and gram-positive staphylococci were identified in sparse and focal microcolonies adherent to the prostatic ductal walls . Coagulase-negative staphylococci may be implicated in the pathogenesis of chronic bacterial prostatitis.

Antimicrob Agents Chemother, 1992 Feb, 36(2), 429 - 34
Survey of methicillin-resistant clinical strains of coagulase-negative staphylococci for mecA gene distribution; Suzuki E et al.; A total number of 125 methicillin-resistant (MIC, greater than or equal to 16) coagulase-negative Staphylococcus strains isolated in Japan were surveyed for the distribution of the mecA gene, the structural gene for penicillin-binding protein 2', which is the causative genetic element for the intrinsic resistance of methicillin-resistant Staphylococcus aureus . Screening with colony hybridization by using a cloned mecA gene probe revealed that 121 strains (96.8%) belonging to the nine coagulase-negative Staphylococcus species (S . epidermidis, S . haemolyticus, S . saprophyticus, S . sciuri, S . simulans, S . hominis, S . capitis, S . warneri, and S . caprae) carried mecA in their genome, indicating wide distribution of the gene among coagulase-negative Staphylococcus species . Most (93.4%) of the mecA-carrying strains were producers of penicillinase . Four strains, including two S . haemolyticus and two S . saprophyticus strains, did not carry mecA in spite of their resistance to methicillin . One of them was of low-level resistance (MIC, 16), but three of them had moderate- to high-level resistance to methicillin (MIC, 64) . Analysis of gel electrophoretic banding patterns of penicillin-binding proteins of these strains showed absence of penicillin-binding protein 2' but some alterations in signal intensities of the other penicillin-binding proteins . The result indicated that about 3% of methicillin-resistant coagulase-negative staphylococci in these hospitals had a resistance mechanism different from that associated with the production of penicillin-binding protein 2', as has been reported in the case of a borderline methicillin-resistant strain of S . aureus.

Antimicrob Agents Chemother, 1992 Feb, 36(2), 394 - 400
Use of a predictor panel for development of a new disk for diffusion tests with cefoperazone-sulbactam; Bradford PA et al.; The proper disk mass for diffusion susceptibility tests with cefoperazone-sulbactam was determined by using a predictor panel of clinical isolates that included staphylococci and gram-negative bacteria intrinsically susceptible, intrinsically resistant, and of various susceptibilities because of the production of different types and amounts of beta-lactamase . A primary panel of 24 isolates was used to screen various disk masses of cefoperazone and sulbactam in disk diffusion susceptibility tests . Regression analyses were performed for each combination by comparing MICs to zone diameters . Analysis of each component demonstrated that decreasing the disk mass of cefoperazone shifted the regression line to the left while decreasing the disk mass of sulbactam diminished the slope of the line . Ten candidate disks that adequately separated susceptible and resistant strains among the primary panel were identified, and these 10 disks, along with the previously proposed 75/30-micrograms disk, were then tested against an expanded panel of 265 isolates . Results indicated that a 30/20-micrograms cefoperazone-sulbactam disk provided the best separation between susceptible and resistant strains when interpretive criteria of less than or equal to 15 mm for resistance, 16 to 19 mm for moderate susceptibility, and greater than or equal to 20 mm for susceptibility were used . They also identified discrepancies between agar and broth microdilution MICs of sufficient size to warrant separate interpretive criteria for the two methods . Overall, the use of a predictor panel to develop interpretive criteria for susceptibility tests appeared to be a very useful approach, especially when antibiotics designed to be used against drug-resistant organisms are involved.

Zentralbl Bakteriol, 1992 Feb, 276(3), 380 - 9
Small antibiotic resistance plasmids in Staphylococcus intermedius; Greene RT et al.; Antibiograms and plasmid profiles were evaluated for 116 Staphylococcus intermedius isolates collected from dogs in Germany and in the USA . Of the 26 S . intermedius isolates from Germany, 9 (34.6%) carried plasmids, while 20 (22.2%) of the 90 S . intermedius isolates from the USA were found to be plasmid-positive . Eight small resistance plasmids were identified and characterized using protoplast transformations and restriction endonuclease analyses . Five plasmids (3.8 and 3.9 kb) encoded for chloramphenicol resistance, 2 plasmids (each 2.5 kb) carried determinants for macrolide-lincosamide resistance, and one plasmid (4.5 kb) conferred resistance to tetracycline . Detailed restriction maps of these plasmids were constructed and served for structural comparisons with other small resistance plasmids found in staphylococci . These comparisons implied marked structural homologies with those prototype plasmids initially characterized in S . aureus of human origin.

J Dairy Sci, 1992 Feb, 75(2), 406 - 14
Influence of prepartum antibiotic therapy on intramammary infections in primigravid heifers during early lactation; Oliver SP et al.; Jersey heifers were assigned alternately to three groups: 1) negative control (n = 41), 2) intramammary infusion of 200 mg of sodium cloxacillin (n = 38) at 7 d before expected parturition, and 3) intramammary infusion of 200 mg of cephapirin sodium (n = 36) at 7 d before expected parturition . The percentage of mammary glands infected prior to treatment was 62.2, 50.0, and 70.1 for groups 1, 2, and 3, respectively . The percentage of mammary glands infected during early lactation was 44.5, 8.6, and 2.1 for groups 1, 2, and 3, respectively . Most infections (87.1%) were due to Staphylococcus species other than Staphylococcus aureus . Thirty-six of 460 quarters were infected with major pathogens before treatment, 3 of 22 persisted following antibiotic treatment, and 9 of 14 persisted in the control group . Infusion of sodium cloxacillin resulted in antibiotic residues in 17.4% of samples obtained .5 d postpartum . All samples were negative at 3 and 10 d postpartum . Infusion of cephapirin sodium resulted in antibiotic residues in 84.7, 28.2, and 0% of samples obtained at .5, 3, and 10 d, respectively . Prepartum antibiotic therapy was effective in eliminating many IMI, especially those caused by coagulase-negative staphylococci, but there is the potential for antibiotic residues in milk.

APMIS, 1992 Feb, 100(2), 132 - 4
Enterotoxin and toxic shock syndrome toxin-one production by staphylococci isolated from mastitis in sheep; Orden JA et al.; From 160 staphylococci isolated from ovine mastitis, 125 were identified as coagulase-positive staphylococci (CPS) and 35 as coagulase-negative staphylococci (CNS) . Of these, 108 (87.8%) S . aureus produced at least one of the staphylococcal enterotoxins (SE) described . However, no CNS was found to be enterotoxigenic . Enterotoxin C (SEC) was the type most frequently produced . TSST-1 was shown to be produced by 91 (74.0%) of S . aureus, almost invariably in combination with SEC . Three CNS strains were also found to produce TSST-1 (two strains of S . xylosus and one strain of S . epidermidis).

Immunology, 1992 Feb, 75(2), 264 - 8
In vitro desensitization to lipopolysaccharide suppresses tumour necrosis factor, interleukin-1 and interleukin-6 gene expression in a similar fashion; Ziegler-Heitbrock HW et al.; Like blood monocytes, the human monocytic cell line Mono Mac 6 can be stimulated by lipopolysaccharide (LPS) at 1 microgram/ml to produce high levels of cytokines . When Mono Mac 6 cells are stimulated for 4-6 hr at 1 x 10(6)/ml, supernatants contain tumour necrosis factor (TNF) at an average of 60 U/ml and interleukin-6 (IL-6) at an average of 1000 U/ml . IL-1 is not detected in the supernatant, but after three freeze-thaw cycles cell-associated IL-1 can be detected (100 U/ml) and with similar amounts of IL-alpha and -beta . Preculture of Mono Mac 6 cells with LPS at 10 ng/ml for 3 days results in cells refractory to subsequent stimulation by LPS at 1 microgram/ml . In the refractory desensitized cells, production of all three cytokines is down-regulated, with a more than 10-fold reduction in protein production . For all three cytokines, this desensitization appears to be regulated at the transcript level, with a strong reduction in specific mRNA as detected by Northern blot analysis . Furthermore, Mono Mac 6 cells can be stimulated by Staphylococcus aureus (LPS contamination less than 10 pg/ml) to produce cytokines . This type of stimulus is unable to overcome desensitization, in that the secretion of TNF in LPS-precultured Mono Mac 6 cells was 10- to 100-fold lower than in Mono Mac 6 cells without LPS preculture . These data show that desensitization in Mono Mac 6 cells affects all three cytokines tested and that it extends to other activating signals, such as staphylococci.

J Clin Microbiol, 1992 Feb, 30(2), 504 - 5
Use of a primary isolation medium for recovery of methicillin-resistant Staphylococcus aureus; Van Enk RA et al.; Clinical specimens frequently contain methicillin-resistant Staphylococcus aureus (MRSA) isolates in low numbers or mixed with methicillin-susceptible staphylococci, which can obscure MRSA on nonselective media . By using an oxacillin-containing mannitol-salt-based selective and differential medium on 936 respiratory specimens, we recovered 45% more MRSA isolates (29 versus 20) than on nonselective media alone.

J Clin Microbiol, 1992 Feb, 30(2), 261 - 4
Clinical significance of Staphylococcus warneri bacteremia; Kamath U et al.; Twenty-seven episodes of bacteremia caused by Staphylococcus warneri were identified at Long Island Jewish Medical Center in New York between 1984 and 1989 . Fourteen of these were thought to represent true bacteremias and 13 to represent contaminants . Of the 14 true bacteremias, 5 were in pediatric and 9 were in adult patients . Eight of 14 patients (57%) had catheter-related bacteremia and 5 of 14 had bacteremia of unknown source . There was one case of fulminant native valve S . warneri endocarditis . All cases of catheter-related bacteremia, except one, were nosocomially acquired, and 75% of these patients had an underlying immunosuppressive condition . Only 40% of patients with bacteremias of unknown source were immunocompromised, and S . warneri appeared to be noninvasive in this group . Interestingly, all five of the pediatric isolates were oxacillin susceptible, although four of five were resistant to penicillin, despite the fact these patients were hospitalized an average of 29 days . In contrast, seven of nine adult isolates were resistant to both oxacillin and penicillin . The only case of native valve S . warneri endocarditis occurred in a patient who had no known underlying valvular heart disease, but had an underlying immunosuppressive condition . Identification to species level of coagulase-negative staphylococci may lead to appreciation of the importance of bacteria such as S . warneri as human pathogens.

Clin Infect Dis, 1992 Feb, 14(2), 436 - 43
Bacteremia and fungemia of unknown origin in adults; Leibovici L et al.; Two hundred fifteen (23%) of 955 episodes of bacteremia (defined as including fungemia) detected in adult patients during 2 years were of unknown origin . Sixty-six percent of episodes of unknown origin were hospital acquired . The median age of patients with bacteremia of unknown origin was 65 years, and their most common underlying disorders were solid malignancy (28% of patients) and diabetes mellitus (18%) . Only three factors were associated with bacteremia of unknown origin (as opposed to episodes with a known source): peripheral venous catheterization, hemodialysis, and plasmapheresis . Gram-negative bacteria were isolated from the blood in 62% of episodes of unknown origin; 10% of episodes were polymicrobial . Staphylococci were isolated from 67% of patients undergoing hemodialysis and from 37% of those with diabetes; Pseudomonas species from 15% of patients with hospital-acquired episodes; and Candida species from 21% of patients with a central venous catheter . Fifteen percent of episodes in cancer patients were polymicrobial . Empirical antibiotic treatment was inappropriate in 49% of episodes of unknown origin and in 35% of episodes with a known source (P less than .001) . Death rates were 44% and 25% in episodes of unknown and known origin, respectively . An unknown source of bacteremia was independently associated with a fatal outcome.

Zh Mikrobiol Epidemiol Immunobiol, 1992 Feb, (2), 59 - 62
{The methods for correcting with specific and nonspecific immunomodulators the immunopathological processes arising from the administration of a staphylococcal vaccine}; Romanov VA et al.; In mice immunized with staphylococcal vaccine the arresting of graft-versus-host reaction under the influence of small doses of staphylococcal vaccine, hyperimmune antistaphylococcal serum, cyclophosphamide, antilymphocytic serum has been demonstrated . Small doses of staphylococcal vaccine stimulated the production of antibodies to staphylococci and dermal extract in the animals, previously immunized with this vaccine, with the simultaneous suppression of cell-mediated immune reactions to both antigens . Immunosuppressing agents have been found to inhibit humoral and cell-mediated immune response to microbial antigen and dermal extract . No influence of vermox and levamisole on the outcome of the graft-versus-host reaction has been registered; the latter preparation has been found to intensify cell-mediated immune reactions to microbial and tissue antigens.

J Chemother, 1992 Feb, 4(1), 6 - 8
In vitro assessment of rokitamycin against problem gram-positive cocci; Hamilton-Miller JM et al.; Rokitamycin was more active than erythromycin against erythromycin-sensitive strains of Staphylococcus aureus and enterococci, but somewhat less active against coagulase-negative staphylococci . Strains with inducible resistance to erythromycin were uniformly resistant to erythromycin, while rokitamycin was active against such strains . Strains with constitutive resistance to erythromycin were also uniformly resistant to erythromycin, and most were also resistant to rokitamycin . However, 5 of 21 coagulase-negative staphylococci and 2 of 20 enterococci remained sensitive to rokitamycin . This is a novel finding, perhaps suggesting a new mechanism of macrolide resistance.

Antimicrob Agents Chemother, 1992 Feb, 36(2), 273 - 6
Comparison of enterococcal and staphylococcal beta-lactamase-encoding fragments; Smith MC et al.; A restriction map of a 13.5-kb EcoRI fragment encoding beta-lactamase from a plasmid isolated from enterococcal strain PA was prepared and found to differ markedly from the published maps of beta-lactamase-encoding EcoRI fragments of two staphylococcal plasmids and the plasmid from enterococcal strain HH22 . This comparison also showed that one of two contiguous EcoRV fragments that encompass the beta-lactamase gene differs in size in the PA strain from that found in the other strains . However, restriction sites in the beta-lactamase structural gene (blaZ) were identical in all four plasmids . Further studies compared the beta-lactamase genes of four clinical enterococcal isolates from various geographic locations with those described above . Isolates from Virginia and Florida generated EcoRV fragments identical to those from the plasmid from strain PA, while isolates from Lebanon and Argentina showed EcoRV fragments analogous to those from HH22 and the staphylococci studied . Although there is evidence suggesting that some of these beta-lactamase-producing enterococcal isolates represent a single strain, this study indicates that there is significant variation in the plasmids that encode beta-lactamase.

Med J Aust, 1992 Jan 6, 156(1), 53 - 7
Vancomycin and teicoplanin: something old, something new; Phillips G et al.; OBJECTIVE: To compare and contrast the pharmacology, activity and clinical efficacy of two glycopeptide antibiotics, vancomycin and teicoplanin . DATA SOURCES: English language literature search using MEDLINE, Index Medicus, relevant textbooks and product information literature . STUDY SELECTION: Over 200 publications were examined extending back to the period of initial Phase I trials with vancomycin . DATA EXTRACTION AND SYNTHESIS: Many publications covered similar ground and came to the same conclusions . In these instances one or two of the best pieces were chosen as cited reference material . Conflicting results and conclusions are discussed and an attempt is made to interpret the findings . CONCLUSION: Vancomycin and teicoplanin show differences in activity both in vitro and in vivo . Vancomycin is superior against coagulase-negative staphylococci and reliable dosage regimens are available . Teicoplanin, however, needs to be given in significantly larger doses than initially thought necessary to maximise clinical efficacy . Teicoplanin has a lower incidence of side effects but in clinical practice this advantage is small . Vancomycin remains the glycopeptide of choice for the treatment of infections due to Gram-positive bacteria.

Tex Heart Inst J, 1992, 19(1), 21 - 5
Cefuroxime prophylaxis in cardiovascular surgery: clinical, microbiological, and ecological impact; Gentry LO et al.; To determine the efficacy of cefuroxime as a prophylactic agent against infection, we retrospectively evaluated patients who had undergone cefuroxime therapy for cardiovascular surgery procedures in the years 1987 and 1990 . In the 403 evaluable patients (203 in 1987 and 200 in 1990), we noted a postoperative surgical wound infection rate of 3% and a nosocomial infection rate of 3% . These rates have remained constant in 1987 and 1990 . Despite more than a 6-fold increase in cefuroxime consumption during this same period, we have not observed a selection for staphylococcal infections in cardiovascular surgery patients, nor have we detected a selection for resistant staphylococci in our institution . Our original criteria that caused us to select cefuroxime for routine prophylaxis-notably its equivalent efficacy and safety as compared with other cephalosporins, and its lack of an adverse impact on the hospital flora-remain valid . (Texas Heart Institute Journal 1992;19:21-5)

J Antimicrob Chemother, 1992 Jan, 29(1), 49 - 55
In-vitro activity of imipenem, in comparison with cefuroxime and ciprofloxacin, against coagulase-negative staphylococci in broth and peritoneal dialysis fluid; Wilcox MH et al.; The activity of cefuroxime, ciprofloxacin and imipenem against 50 coagulase-negative staphylococci (CNS) strains isolated from patients with peritonitis while on continuous ambulatory peritoneal dialysis (CAPD) was examined . Strains were cultured in both used peritoneal dialysis fluid (PUD) and broth (ISB) in an atmosphere of air with 5% CO2 . MICs of cefuroxime, ciprofloxacin and imipenem differed significantly between the two media for 40%, 26% and 42% of strains, respectively . In three-quarters of these cases the MICs were higher in PUD compared to ISB . The ability of each antibiotic to kill six strains of CNS adherent to silicone rubber was also examined . Once again, differences in killing were noted between the two media . At least two-thirds of the strains remained viable in the presence of concentrations of antibiotic equal to the MBC of each antibiotic and at least one-third survived antibiotic concentrations equivalent to those attained during treatment . Assessment of activity in PUD may provide a more realistic test for antibiotics to be used in the treatment of CAPD peritonitis.

Clin Microbiol Rev, 1992 Jan, 5(1), 36 - 48
Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis; von Graevenitz A et al.; The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease . Infectious peritonitis, however, has limited a more widespread acceptance of this technique . The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain) . In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts . Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages . During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity . As a result, bloodstream infections are rare . Most peritonitis episodes are caused by bacteria . Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis . Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used . The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml . The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation . The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results . Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

J Clin Microbiol, 1992 Jan, 30(1), 93 - 5
Evaluation of MicroScan Rapid Pos Combo panels for identification of staphylococci; Stoakes L et al.; MicroScan Rapid Pos Combo panels (Baxter Diagnostics, Inc., MicroScan, West Sacramento, Calif.) contain substrates conjugated with fluorophores and substrates with a fluorescent pH indicator . AutoSCAn W/A, an automated panel processor equipped with a fluorometer, reads the panels after 2 h of incubation and can identify staphylococci to the species level . We tested 239 strains belonging to 17 species of staphylococci . All the strains were identified by conventional methods (W.E . Kloos and K.H . Schleifer, J . Clin . Microbiol . 1:82-88, 1975) and by the MicroScan Rapid ID system . The system correctly identified 219 (91.6%) strains; nine (3.8%) identification results were probably correct, and six (2.5%) results were incorrect . The system designated five (2.1%) strains as rare biotypes . The automated MicroScan Rapid ID system is useful and reliable in identifying most human isolates of staphylococci encountered in the clinical laboratory.

J Pediatr, 1992 Jan, 120(1), 120 - 4
Comparison of blood cultures with corresponding venipuncture site cultures of specimens from hospitalized premature neonates; Hammerberg O et al.; We compared the presence and identities of isolates from blood culture samples obtained by percutaneous venipuncture with those of commensal skin organisms cultured from respective venipuncture sites after skin cleansing; 677 blood and skin site culture pairs from 488 infants were compared . Organisms grew in 58 blood cultures; nine of these cultures had corresponding venipuncture site cultures that also grew organisms . Forty-two blood culture isolates were coagulase-negative staphylococci; five of these were associated with similar venipuncture site cultures . According to restriction-endonuclease fingerprinting of chromosomal DNA and plasmid analysis, three pairs of blood and venipuncture site cultures were identical and two pairs were different . Thus only 7% (3/42) of coagulase-negative staphylococcal blood isolates were associated with identical contamination at the venipuncture site . We conclude that, if the venipuncture site has been carefully cleansed, the growth of coagulase-negative staphylococci in blood cultures of specimens from premature neonates indicates bacteremia rather than skin contamination in the vast majority of cases.

J Emerg Med, 1992 Jan-Feb, 10(1), 89 - 91
Alexander Fleming: the spectrum of penicillin; Sternbach G et al.; The discovery of penicillin was directly linked to the inhibition by that agent of the growth of colonies of staphylococcus . However, subsequent resistance by this organism to penicillin as well as to a number of other agents has marked the history of staphylococcus in the antibiotic era . One of the most important mechanisms of this resistance has been the production of penicillinase, an enzyme that inactivates penicillin and related antibiotics . Penicillinase is currently termed beta-lactamase, and it is now recognized that there are several types of beta-lactamases produced by various organisms . The ability of staphylococci to produce this enzyme has been countered by the development of penicillinase-resistant agents and the addition of beta-lactamase inhibitors to antibiotics.

Int J Food Microbiol, 1992 Jan-Feb, 15(1-2), 191 - 4
Contamination of pig hindquarters with Staphylococcus aureus; Schraft H et al.; Swab specimens from 4357 pig hindquarters provided for production of cured raw ham were contaminated with Staphylococcus aureus in 22.7% . The bacterial counts for S . aureus on the rind surface of the raw, uncured ham were between 10(1) and 10(3) cfu/cm2 in 89% of the positive samples . In the remaining 11% of contaminated ham counts of 10(3) to 10(6) cfu/cm2 were determined . There were major differences in the rate of contamination between pork from different suppliers . Questioning the suppliers revealed that pork highly contaminated with S . aureus could be traced back to certain abattoirs . This suggests that the technique of slaughter, concomitant hygiene precautions and the subsequent refrigeration of the carcasses affect the contamination of the meat with staphylococci.

Ann Rech Vet, 1992, 23(2), 189 - 97
{Lentivirus expression at the moment of lambing modifies the leukocyte number in the milk of multiparous ewes}; Guiguen F et al.; Lambing in small ruminants is a time of high lentivirus expression; infected mononuclear phagocytes are frequent in colostrum and milk . We have studied mammary secretions in 5 multiparous ewes and shown that infected macrophages in milk are accompanied by an augmentation of leucocyte number . The lymphocyte CD8 subpopulation increased in size simultaneously with the onset of infected cell excretion . The udder infection by coagulase negative staphylococci did not modulate milk lymphocyte content . Although infected cell excretion was restricted to one half of the udder, virus-specific lesions were found in both udder halves . Milk leukocytes changes are a marker of infected macrophage presence; they do not control lentivirus spread.

Comp Immunol Microbiol Infect Dis, 1992 Jan, 15(1), 47 - 52
Identification of coagulase negative staphylococci isolated from lambs as Staphylococcus caseolyticus; de la Fuente R et al.; A group of 17 strains of coagulase negative staphylococci isolated from slaughtered lambs, and which could not be identified with the conventional methods, exhibited high levels of DNA homology (92%) with the S . caseolyticus reference strain . The isolates described in this study provide a more extensive comprehension of S . caseolyticus . The original description of this species was based on only two strains isolated from milk . To our knowledge, S . caseolyticus had never been previously associated with animal microflora.

Pathol Biol (Paris), 1992 Jan, 40(1), 36 - 9
{Comparative in vitro activity of glycopeptides against coagulase negative staphylococci isolated in pediatric hospital units}; Bourgeois F et al.; The minimum inhibitory concentrations (MICs) of vancomycin and teicoplanin were determined for 32 coagulase-negative staphylococci strains recovered from blood specimens from pediatric intensive care patients . All the strains were susceptible to vancomycin (MIC less than 4 mg/l) . Sixteen strains were susceptible to teicoplanin (MIC less than 4 mg/l) and the sixteen remaining strains exhibited intermediate susceptibility, with MICs of 8 mg/l (10 strains) or 16 mg/l (6 strains) . Inhibition zone diameters seen with vancomycin during agar diffusion susceptibility testing were consistently greater than 17 mm . Inhibition zones obtained with teicoplanin were 17 mm or more in diameter for 30 strains and under 17 mm in diameter for 2 strains . For 14 strains (44%), agar diffusion testing failed to detect the decreased susceptibility to teicoplanin revealed by MIC determinations . The agar diffusion method does not seem reliable for the determination of in vitro susceptibility to teicoplanin.

Immunology, 1992 Jan, 75(1), 23 - 8
Effects of Staphylococcus aureus cell wall products (teichoic acid, peptidoglycan) and enterotoxin B on immunoglobulin (IgE, IgA, IgG) synthesis and CD23 expression in patients with atopic dermatitis; Neuber K et al.; The influence of staphylococcal cell wall products (teichoic acid, peptidoglycan) and enterotoxin B on peripheral blood lymphocytes (PBL) from patients with atopic dermatitis (AD) was investigated . The parameters studied were spontaneous and interleukin-inducible immunoglobulin (IgA, IgE, IgG) synthesis and CD23 expression . PBL from non-atopic donors served as controls . Teichoic acid and peptidoglycan induced an enhanced synthesis of IgA and IgG in normal donors . However, IgA and IgG synthesis in PBL from patients with AD was significantly suppressed by teichoic acid and enterotoxin B . The incubation of PBL from normal donors with enterotoxin B and interleukin-4 (IL-4) or IL-5 led to a significant suppression of IgA and IgG synthesis . Co-stimulation of PBL with teichoic acid or peptidoglycan and IL-4 led to a pronounced increase in IgE synthesis and CD23 expression in patients with AD . Our data indicate that cell wall products and toxins of staphylococci modulate the cytokine-dependent humoral immunity in patients with AD and may be responsible for allergic skin reactions in AD.

Beitr Gerichtl Med, 1992, 50, 187 - 92
{Ectotoxin-forming pyogenic Staphylococcus aureus (S . aureus) as a cause of toxic shock syndrome (TSS) in man}; Lenk V et al.; Basing considerations on an extremely carefully examined case of toxic shock syndrome (TSS), an analysis of this phenomenon is presented from the clinical and forensic points of view . TSS is often associated with the term "tampon disease" but in the meantime it has turned out that it may also arise as a non-menstrual disorder, caused by local infections, for example after surgical interventions . The inevitable symptoms include: fever, exanthema, desquamation on the palms of the hands and soles of the feet as well as hypotension . The clinical symptoms would initially suggest a septic process, however bacteriological investigations (blood cultures) normally produce negative results . At the source, however, ectotoxin-producing staphylococci (S . aureus) are found . The present case which is described in detail involves a 17-year old woman who had contracted a crucial ligament injury at the knee of the right leg when playing football . She died a few days after the operation, her death being accompanied by high fever . In smears from the area of the operation it was possible to identify staphylococci (S . aureus) which by phagetyping determination were classified as belonging to lysogroup type II/71 and which produced ectotoxin B . It was not possible to culture bacteria from blood from the corpse . Criminal proceedings for involuntary manslaughter were in the end dismissed although the accused resident physician was sentenced to pay 30,000 DM damages to the parents of the young woman . He also had to pay the costs of the civil action incidental to the criminal proceedings.(ABSTRACT TRUNCATED AT 250 WORDS)

Ophthalmologica, 1992, 205(2), 64 - 8
{Treatment of Ocular Chlamydial Infection: Comparison of Tetracyclines and Norfloxacin}; Huber-Spitzy V et al.; The unilateral follicular conjunctivitis with corneal marginal infiltrates represents a clinical picture typical for two different types of bacteria: chlamydiae may cause a keratoconjunctivitis always combined with urethritis or colpitis; on the other hand staphylococci may be the reason for the same clinical features, whereas the marginal corneal infiltrates are caused in these cases by immunological reactions to the bacterial toxins . After harvesting material for bacterial investigations or direct immunofluorescence test for the detection of chlamydial antigen, 2-3 days are necessary until the results of the examinations are ready . From January 1991 until the end of 1991 a total of 60 patients with the diagnosis of chlamydial infection underwent ophthalmological investigations at our outpatient clinic . In our study we compared the efficacy and safety of topical tetracyclines and 0.3% norfloxacin solution in the treatment of chlamydial keratoconjunctivitis . Within the bacterial genus, staphylococci (S . aureus, S . epidermidis and S . saprophyticus) were the most frequently isolated organisms (60%) . Nearly one third of the staphylococci were resistant to tetracyclines . Therefore there are two indications to postulate norfloxacin as a practicable alternative: at the beginning of therapy until the results of the bacterial investigation are available and in the case of persisting bacterial superinfection.

Chemotherapy, 1992, 38(4), 206 - 10
In vitro susceptibility of methicillin-resistant Staphylococcus aureus and slime-producing and non-slime-producing coagulase-negative staphylococci to fusidic acid; Huebner J et al.; The in vitro susceptibility of 100 oxacillin-resistant Staphylococcus aureus and 100 oxacillin-resistant coagulase-negative staphylococci (CNS; 50 slime-negative and 50 slime-positive strains) was determined by agar dilution technique, with and without the addition of 50% human serum . All strains tested were highly sensitive to fusidic acid . S . aureus and CNS showed MIC50 values of 0.125 and 0.25 mg/l, respectively . MICs of all strains increased significantly in the presence of 50% human serum . Only minor differences were noted between the MICs of slime-producing and slime-deficient CNS.

Microbiol Immunol, 1992, 36(9), 947 - 59
Phage pattern and antibiotic resistance pattern of coagulase-negative staphylococci obtained from immunocompromised patients; Barcs I et al.; A total of 152 coagulase-negative staphylococcal strains were isolated from clinical samples of 14 patients hospitalized after bone-marrow transplantation in a specialized hospital ward in Hungary, during an 18-month period between 1987 and 1989 . Two species, Staphylococcus epidermidis and Staphylococcus haemolyticus, predominated (each, 45%) . Using Pulverer and co-workers' phage set for typing, 68% of the isolates were typable; 16 phage patterns were observed . A characteristic long pattern with phages Ph10/Ph13/Ph15/U4/U15/U16/U20/U33 /U46 appeared only in S . epidermidis, among 5 of 11 colonized patients (8.5% of all strains) . Single lysis with phage Ph13 was observed in 7 of the 14 patients (49% of all strains), in species S . capitis, S . epidermidis, S . haemolyticus, S . hominis, and S . warneri . In S . haemolyticus, non-typable strains predominated (66%); this character occurred only in 2% among other species . The strains colonizing the immunocompromised patients differed from each other in phage pattern, antibiotic resistance pattern, and/or slime production . No hospital infection was suggested . On the other hand, high incidence of two well-definable phage patterns raises some relationship between phage receptors or some regulatory systems in phage multiplication and factors responsible for special colonization as common surface properties.

Microbios, 1992, 71(287), 95 - 103
In vitro activity of fosfomycin against 'problem' gram-positive cocci; Hamilton-Miller JM; Fosfomycin was active in vitro against 54 of 60 'problem' Gram-positive cocci (20 methicillin-resistant Staphylococcus aureus, 20 coagulase-negative staphylococci and 20 enterococci) . Its activity was significantly greater under anaerobic conditions, especially against coagulase-negative staphylococci . Mutants resistant to fosfomycin were readily demonstrated, but their growth was prevented by rifampicin or ciprofloxacin . The combinations rifampicin+fosfomycin and ciprofloxacin+fosfomycin showed MIC synergy . It is concluded that fosfomycin in an appropriate combination would be a valuable addition to the small and dwindling range of antibiotics active against problem Gram-positive cocci.

Zentralbl Chir, 1992, 117(7), 389 - 93
{The incidence of wound healing disorders in heart surgery}; Fritzsche D et al.; In a five-year retrospective study we investigated the wound infection rate after median sternotomy in 2805 adult patients on whom elective surgery had been performed with extracorporeal circulation . On the basis of 14,700 apparently relevant data from 101 patients with wound healing disturbances at the sternotomy site, both the significance of predisposing risk profiles and the prevalence of nosocomial pathogens were evaluated . The control group was formed by 100 patients selected at random . The results were checked for statistical significance using the X2 test for alternative characters; the significance level was set at alpha = 5% . The infection rate observed in our group was 3.6%, which was assigned to 5 internally defined degrees of severity . Cases of healing by second intention were caused to 93% by coagulase-negative staphylococci and staphylococcus aureus . Factors leading to a decrease in oxygenation of the wound area (low-output syndrome, rethoracotomy), diabetes, obesity and the duration of wound drainage were accompanied by a significantly more frequent occurrence of wound healing disturbances . On the other hand, perfusion-technical parameters, operation duration, revascularisation techniques (IMA/ACVB), pulmonary conditioned hypoxemias and the end-of-year desinfection usual in our clinic had no influence on wound healing . Seasonal fluctuation of the epidermal microclimate appear to be responsible for the prevalence and virulence of the pathogen strains in the clinic environment . The preventive measures used in cardiosurgical clinics do not yet represent a fully developed prophylaxis against exposure to nosocomial pathogens.

Antimicrob Agents Chemother, 1992 Jan, 36(1), 25 - 31
Correlation between regulation of mecA transcription and expression of methicillin resistance in staphylococci; Ryffel C et al.; Total RNA was used to study the effect of penicillinase plasmid pI524 and of mecR, the regulatory region located on the methicillin resistance determinant (mec), on the expression of mecA, the gene coding for the low-affinity penicillin-binding protein PBP2', in methicillin-resistant staphylococci . In the present report, we show that the regulation of methicillin resistance occurs primarily at the level of mecA transcription and that in the presence of intact plasmid pI524 or mecR, the gene undergoes negative control . The relative amount of mecA mRNA present during exponential growth in uninduced cultures matches the type of mecA regulation and decreases in the following order: constitutive greater than pI524 greater than mecR-dependent mecA expression . Induction of mecA by methicillin is faster in pI524- than in mecR-controlled strains . The overall mRNA half-life is similar for all strains analyzed . Our results indicate that methicillin resistance under mecR control in certain staphylococcal strains could escape detection by the standard disk diffusion test and broth microdilution test because of the very slow derepression of the mecA gene . This finding is of importance for the clinical detection of this type of methicillin resistance.

Int J Syst Bacteriol, 1992 Jan, 42(1), 97 - 101
Staphylococcus muscae, a new species isolated from flies; Hajek V et al.; A new coagulase-negative species of the genus Staphylococcus, Staphylococcus muscae, is described on the basis of the results of a study of four strains that were isolated from flies . 16S rRNA sequences of the type strains of S . muscae, Staphylococcus schleiferi, and Staphylococcus sciuri were determined and used, together with the corresponding sequences of Staphylococcus aureus and Staphylococcus epidermidis, for a comparative analysis . The new species is characterized taxonomically; this species is differentiated from the other novobiocin-susceptible staphylococci by its physiological and biochemical activities, cell wall composition, and levels of genetic relatedness . The type strain of this species is strain MB4 (= CCM 4175).

Adv Perit Dial, 1992, 8, 346 - 50
Metabolic differences between persistent and routine peritonitis in CAPD; Fox L et al.; Changes in 10 metabolic parameters (body weight, blood hemoglobin, and serum albumin, urea, creatinine, cholesterol, triglycerides, potassium, calcium and phosphorus) were compared in 28 episodes of routine peritonitis and 27 episodes of persistent peritonitis . These infections occurred in 20 CAPD patients, all of whom acquired both types of peritonitis on separate occasions . Coagulase-negative staphylococci predominated in the routine infections, while Staphylococcus aureus and Gram-negative bacilli, especially Pseudomonas, were associated with persistent peritonitis . Decreases during infection were significantly larger in persistent as compared with routine peritonitis episodes for all 10 nutritional parameters . Time required for recovery of all nutritional variables except serum potassium and urea was significantly longer in the persistent episodes . Persistent peritonitis led to peritoneal catheter loss in 13 of the 27 episodes and was associated with 4 deaths, while routine peritonitis was associated with neither catheter loss nor death . In contrast to routine peritonitis, persistent CAPD peritonitis is associated with severe malnutrition, considerable morbidity, and mortality.

Adv Perit Dial, 1992, 8, 215 - 8
Adherence of Staphylococci to plastic, mesothelial cells and mesothelial extracellular matrix; Betjes MG et al.; In this study we have investigated whether mesothelial cells (MC) and mesothelial extracellular matrix (ECM) are suitable substrates for the adherence of Staphylococci . Mesothelial cells were isolated from the peritoneal dialysis effluent by making use of their lack of Fc-receptors and capacity to attach firmly to plastic . After 10 days post-confluency the MC monolayer was removed with 0.1% Triton-X100 and the presence of an ECM shown by enzyme linked immunosorbent assay (ELISA) . The ELISA showed the presence of fibronectin and laminin but not of type IV collagen and vitronectin . Bacterial adherence assays with Staphylococcus aureus (N:3 isolates) adhered well to both ECM (33.4%) and MC monolayers (40.2%; ECM vs . MC monolayers p < 0.03) . Staphylococcus aureus adhered significantly better to both ECM (p < 0.05) and MC monolayers (p < 0.05) when compared to plastic . Staphylococcus epidermidis (N:3 isolates) showed similar adherence for plastic (22.1%) and MC monolayers (23.5%); mesothelial ECM was a relatively poor substrate for adherence (6.8%, p < 0.03) . In conclusion, results obtained sofar do not indicate an increased risk for adherence of Staphylococci when the mesothelial ECM is exposed.

Dev Pharmacol Ther, 1992, 19(4), 178 - 82
Prophylactic low-dose vancomycin treatment in very-low-birth-weight infants; Moller JC et al.; For the prophylaxis of septicemia with coagulase-negative staphylococci in a high-risk very-low-birth-weight population, we administered 5 mg/kg of vancomycin every 12 h . Distribution volume and half-life of vancomycin were determined . Serum peak and trough levels were obtained on day 3 of treatment . With this low-dose regimen, serum concentrations in the therapeutic range were achieved in 35 of the 45 patients . Distribution volume and half-life were 0.692 liters/kg and 7.4 h, respectively . The distribution volume was not related to the gestational age; the half-life in the group of patients with a gestational age < 30 weeks was considerably higher . The 10 small-for-gestational-age children had a significantly smaller distribution volume . The vancomycin trough levels correlated with the serum creatinine concentrations and, therefore, with the gestational age . Our study indicates that this low vancomycin dose is sufficient in very-low-birth-weight infants to achieve therapeutic serum levels, being suitable for both prophylaxis and sepsis therapy.

Chemotherapy, 1992, 38(3), 185 - 90
Influence of azithromycin and other macrolides on the intracellular killing of Staphylococcus aureus by human polymorphonuclear leucocytes of healthy donors and a patient with Chédiak-Higashi syndrome; Paulsen P et al.; A mixture of human blood phagocytes from healthy donors and opsonized staphylococci was incubated in vitro for 30 min . After that time all the bacteria were phagocytosed . The test tubes were further incubated for 2, 4 and 24 h with or without addition of a macrolide (erythromycin, azithromycin, clarithromycin, roxithromycin) and the effect of these drugs on the survival of intracellular staphylococci (Staphylococcus aureus ATCC 25923) was measured . The minimal effective concentration of the antibiotic which killed 80-90% of the bacteria after a 4-hour incubation was 0.1 mg/l for erythromycin, azithromycin and clarithromycin and 1.2 mg/l for roxithromycin . The percentage of surviving bacteria after 2 and 4 h incubation was not significantly different between these macrolides at the minimal effective concentration . Increasing the concentration of each antibiotic above the minimal effective concentration did not alter the killing rate of intracellular staphylococci . The bacterial activity of polymorphonuclear leucocytes (PMNL) from a patient with Chediak-Higashi syndrome was less in comparison to PMNL from healthy donors, but was improved in vitro by the addition of erythromycin or azithromycin.

Nephrol Dial Transplant, 1992, 7(7), 627 - 31
Peritoneal drainage: an important element in host defence against staphylococcal peritonitis in patients on CAPD; Glancey GR et al.; The growth of Staphylococcus aureus and coagulase-negative staphylococci were studied in fresh and effluent peritoneal dialysate from patients on continuous ambulatory peritoneal dialysis (CAPD) . Peritoneal drainage during CAPD removes bacterial contaminants from the peritoneal cavity with an efficiency that depends upon the volume of peritoneal fluid remaining after drainage (residual volume) . Combination of our data on the growth of coagulase-negative staphylococci in dialysate with a mathematical model of peritoneal drainage during CAPD shows that a residual volume of less than 800 ml (normal = approximately 400 ml) will prevent survival in the peritoneal fluid . A residual volume of less than 200 ml is required to eliminate S . aureus because of its faster rate of growth in dialysate . Previous work has shown that numbers of macrophages are too few to influence bacterial growth in the peritoneal dialysate . Coagulase-negative staphylococci adhere poorly to mesothelial cells in culture . Survival within the peritoneal cavity during CAPD probably depends on colonization of the PD catheter . Coagulase-negative staphylococcal peritonitis is likely to be localized to areas of the peritoneal membrane in close contact with the PD catheter . S . aureus is able to multiply in the peritoneal dialysate during CAPD and thereby causes generalized peritonitis.

J Gen Microbiol, 1992 Jan, 138 ( Pt 1), 169 - 80
Physical mapping of the mec region of an Australian methicillin-resistant Staphylococcus aureus lineage and a closely related American strain; Dubin DT et al.; Methicillin-resistant (Mcr) staphylococci contain chromosomal DNA that is absent from Mcs cells . This extra DNA harbours the methicillin resistance determinant mec and often other resistance determinants . The mec region can differ substantially in structure among different isolates . We present studies on the mec region of a group of Staphylococcus aureus isolates prevalent in Australia and London . Southern hybridization analyses of a prototype Australian isolate, ANS46, and an isogenic Mcs deletion mutant, ANS62, allowed the physical map of the region to be extended to 55 kb . The DNA corresponding to the deletion, which includes mec and resistance determinants for mercury, cadmium (Cd) and tetracycline, amounted to 41 kb . It was bounded precisely at one end by the macrolides-lincosamides-streptogramin B (MLS)-resistance transposon, Tn554 . Near the other end was an element with homology to Tn554, psi Tn554, which carried the Cdr determinant . The mec region of an American Mcr isolate, R35, was found to be virtually the same as that of ANS46, except that it lacked Tn554 . Another class of American Mcr isolates, prevalent since 1987, differs markedly from ANS46 in mec region organization . However, this other American class also contains an insertion of Tn554 in the mec region, and the attachment site for this insertion was found to have significant homology to attachment sites for the Tn554 and psi Tn554 insertions in the mec region of the Australian strain . These results suggest possible roles of Tn554 and Tn554-like elements in the evolutionary variation of the mec region.

Arch Med Res, 1992 Spring, 23(1), 33 - 7
Oral tolerance impairment in mice with staphylococci-induced wasting syndrome; Garcia-Tamayo F et al.; The effects of staphylococci-induced experimental wasting disease on the immune response of 1 month old CD1 mice were investigated . Animals were separated into different subgroups in order to study their cellular immune competence . Malnutrition of wasted mice was associated with anorexia, diarrhea and weakness . Footpad-injected splenic cells produced normal graft vs . host (GvH) reactions in the popliteal lymph nodes of F1 hybrids . In other experiments, the SRBC intragastric feeding of wasted mice did not cause a tolerant anti-erythrocyte humoral immune response . Three weeks after the staphylococci injections, convalescent erythrocyte-fed wasted mice exhibited an anti-SRBC PFC production similar to that observed in non-tolerant immunized control healthy mice . In return, healthy SRBC-fed control mice showed the specific attenuation of antibody response characteristics of oral tolerance . Differences were found between the immune competence of the undernourished staphylococci-treated wasted mice and those shown by other authors in protein-depleted mice.

Rev Pneumol Clin, 1992, 48(5), 231 - 6
{Complications and mortality of surgery for bronchogenic cancers}; Roeslin N et al.; Resection surgery for lung cancer is beset with specific or non-specific complications which often darken the prognosis for life . The specific complications, related to surgical dissections, are mainly per- and postoperative haemorrhages of various origins and, less frequently, disturbances in respiration, nerve wound or chylothorax . Soon after pneumonectomy a bronchial fistula encouraged by different factors may appear (3.3% of the cases) and empyema, usually caused by staphylococci, may develop (3%) . Non-specific complications may disturb the post-resection period, involving the lungs (atelectasia, parenchymal infections, acute respiratory failure) or the cardiovascular system (pulmonary embolism, dysarrhythmia) . The overall perioperative mortality rate has decreased with time owing to advances in anaesthesia and intensive care: in the hands of certain medico-surgical teams it does not exceed 3% . It is significantly lower in lobar (mean: 4.5%) than in pulmonary (mean: 8.4%) resections . Enlarged resections and lymph node dissections are aggravating factors . Patients aged 70 or more do not tolerate these operations so well: their mean overall mortality rate is twice that observed in younger patients (8% on average and up to 20%) . Resection surgery for lung cancer remains a necessarily hazardous procedure but is the only treatment that can cure the patient . Its success is directly conditioned by a good preoperative risk evaluation.

APMIS Suppl, 1992, 30, 32 - 9
The modulation of the bacteriolytic effect of beta-lactam antibiotics by non-antibiotics; Wecke J et al.; The addition of cationic proteins such as lysozyme, ribonuclease and cytochrome C enhanced the beta-lactam-induced bacteriolysis of staphylococci measured as release of wall label or by optical density . The treatment of staphylococci with penicillin plus cytochrome C resulted in a reduced viability of bacteria compared with those treated with penicillin alone . The wall autolysis and the penicillin-induced bacteriolysis of staphylococci were enhanced by the lysosomal enzyme cathepsin C . The penicillin-induced bacteriolysis was also enhanced by the D-amino acids D-alanine and D-methionine, while the comparable L-amino acids did not reveal any activity . On the other hand, some polyanionic substances were able to suppress the penicillin-induced bacteriolysis . Radiochemical and electron microscopic studies revealed the participation of bacterial wall autolysins in the first steps of degradation processes of staphylococcal walls within murine bone marrow-derived macrophages.

Dtsch Zahn Mund Kieferheilkd Zentralbl, 1992, 80(5), 281 - 6
{The bacteriological and clinical aspects of odontogenic soft-tissue infections}; Halling F et al.; The antibiotic treatment is proved to be an effective supplement for the surgical therapy of odontogenic soft-tissue infections . For the use of antibiotics the knowledge of the oral bacterial flora and its state of resistance is very essential . In a catamnestic study the clinical records of 250 patients with orofacial infections, who were under stationary treatment in the Dept . of Maxillofacial Surgery, University Clinic Gottingen, were analyzed . The results show, that the bacterial flora has not changed basically during the last decade . Predominantly mixed aerobic and anaerobic infections can be found . Increasing importance must be attached to penicillin-resistant Staphylococci and anaerobic pathogens . Penicillins must be further considered as antibiotics of the first choice . For an extension of the antimicrobial activity the combination with a betalactamase inhibitor is useful.

Scand J Infect Dis, 1992, 24(6), 801 - 3
Peritonitis with Mycobacterium fortuitum in a patient on continuous ambulatory peritoneal dialysis; Kolmos HJ et al.; A 35-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis due to Mycobacterium fortuitum and coagulase-negative staphylococci, following an unsuccessful renal transplantation . Infection subsided after removal of the dialysis catheter and treatment with amikacin . Clinicians and microbiologists should be aware of M . fortuitum as a potential cause of peritonitis in patients with debilitating underlying diseases . It is able to grow on ordinary culture media, but detection requires prolonged incubation, and it may be confused with poorly characterized diphtheroids.

Acta Microbiol Pol, 1992, 41(1-2), 49 - 56
Staphylococcal lipase affects phagocytosis of Staphylococcus aureus by human granulocytes and monocytes; Izdebska-Szymona K et al.; The rate of immunological and non-immunological phagocytosis of staphylococci by lipase pre-treated human granulocytes and monocytes was compared . It was found that the effect of this enzyme on two types of cells is opposite . Lipase decreases phagocytosis by granulocytes and increases by monocytes . The revealed differences between phagocytosing cells studied prompted us to investigate the influence of lipase on Fc receptors on these cells (rosette EA test) . The different susceptibility of Fc receptors on non-activated phagocytes to lipase was found . This could be at least partially responsible for the difference observed between phagocytic activity of granulocytes (decreased) and monocytes (increased) pretreated with staphylococcal lipase . Inactivated enzyme showed a similar effect as active enzyme in the case of granulocytes . However, inactivated enzyme had no effect on rosette formation by lipase pretreated monocytes, indicating an enzymatic effect.

Am J Med, 1991 Dec 30, 91(6A), 115S - 119S
Systemic antimicrobial therapy in skin and skin structure infections: comparison of temafloxacin and ciprofloxacin; Parish LC et al.; Temafloxacin is an investigational fluoroquinolone with in vitro activity against common skin pathogens and a favorable pharmacokinetic profile . A randomized, double-blind, multicenter study was conducted in 492 patients to compare the safety and efficacy of temafloxacin 600 mg with ciprofloxacin 750 mg for the treatment of bacterial infections of the skin or skin structure . Both drugs were given twice daily for 7-28 days . The most common diagnoses were abscess and superficial skin infection, which were usually caused by staphylococci . In evaluable patients, clinical success (cure plus improvement) rates were 96% in the temafloxacin group and 99% in the ciprofloxacin group . Bacteriologic eradication rates were 95% and 93% in the temafloxacin and ciprofloxacin groups, respectively . Both regimens were well tolerated . Temafloxacin appears to be safe and effective for the management of bacterial infections of the skin and skin structure.

Clin Orthop, 1991 Dec, (273), 98 - 104
Effect of time of onset and depth of infection on the outcome of total knee arthroplasty infections; Rasul AT Jr et al.; The treatment results of 24 infected total knee arthroplasties with a minimum follow-up period of two years are presented . The most common pathogens were coagulase-positive staphylococci (50%), coagulase-negative staphylococci (29.2%), and enterococci (12.5%) . Eleven patients with early postoperative infections (occurring within one month of prosthesis implantation) were treated with debridement, retention of the prosthesis, and intravenous antibiotics . Treatment was successful in all five patients with superficial infections not extending into the joint . In six patients with deep infections, treatment was successful in only two (33%), despite a longer course of antibiotic therapy (four to six weeks) and the use of tobramycin-impregnated polymethylmethacrylate beads . Three patients continued to have recurrent drainage, and one patient was subsequently successfully treated with a delayed exchange arthroplasty . Thirteen patients were diagnosed with late infections . One patient with a late, superficial infection and another with an acute (hematogenous seeding), deep infection were successfully managed with debridement and intravenous antibiotics . Prosthesis removal was not required . Eleven patients presented with late, deep infections . Of three patients who were treated without removal of the prosthesis, infection was arrested in only one . The remaining eight patients were treated with debridement, intravenous antibiotics, tobramycin-impregnated polymethylmethacrylate beads, and delayed exchange arthroplasty . The median interval to reimplantation was eight weeks (range, seven to 25 weeks) . Treatment was successful in six cases (75%) . The overall success rate in the treatment of total knee arthroplasty infections was 71% . In 19 patients with deep infections, treatment success was seen in 78% of patients treated with delayed exchange arthroplasty, but this value was only 40% in patients who were not treated with prosthesis removal.(ABSTRACT TRUNCATED AT 250 WORDS)

J Am Coll Cardiol, 1991 Dec, 18(7), 1650 - 4
Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients; Melendez LJ et al.; The incidence of bacteremia related to transesophageal echocardiography was studied in 140 consecutive patients (71 women and 69 men with a mean age of 53.7 +/- 15 years) . Thirty-four patients had one or more prosthetic heart valves . Blood cultures were obtained from each patient through separate venipuncture sites immediately before and after transesophageal echocardiography . An additional late blood culture was obtained in 114 patients 1 h later . The skin was cleaned with povidone-iodine and venipunctures were performed with separate butterfly needles with use of sterile gloves and drapes . Blood samples were drawn into separate syringes, transferred to aerobic and anaerobic culture bottles and processed with use of a semiautomated system . The overall incidence of blood cultures positive for bacteremia was 2% (8 of 394 bottles) and all positive cultures grew in a single blood culture bottle . Positive cultures occurred in 4 (1.4%) of 280 bottles before the procedure, in 2 (0.7%) of 280 bottles immediately after the procedure and in 2 (0.9%) of 228 late (1-h) blood culture bottles . Bacterial isolates were coagulase-negative staphylococci (n = 5), Propionibacterium (n = 2) and Moraxella (n = 1) . All were considered contaminants . Mean endoscopic time in these patients was not significantly different from that in the other patients . Follow-up of patients with a blood culture positive for bacteremia revealed no clinical evidence of systemic infection . It is concluded that 1) the incidence of bacteremia related to transesophageal echocardiography is very low, and 2) the incidence of blood cultures positive for bacteremia after transesophageal echocardiography is indistinguishable from the anticipated contamination rate.

J Med Assoc Thai, 1991 Dec, 74(12), 669 - 74
Synergy study of vancomycin or teicoplanin plus gentamicin against enterococci, Staphylococcus aureus and coagulase-negative staphylococci by time-kill method; Thamlikitkul V; We conducted a time-kill study comparing the combination of vancomycin plus gentamicin versus teicoplanin plus gentamicin against 20 clinical isolates each, of enterococci, S . aureus and coagulase-negative staphylococci . The concentrations of vancomycin and teicoplanin were selected so that cultures containing these drugs alone contained 10(3) to 10(6) cfu/ml after 24 hr, mostly 2 to 4 times the MIC for each isolate . In this way we could be certain that synergism or antagonism would not go undetected . One-fourth of the gentamicin MIC for each isolate was used throughout the study . In vitro bactericidal synergy was considered to be present when vancomycin plus gentamicin or teicoplanin plus gentamicin yielded at least a 2 log 10 decline in cfu/ml compared to vancomycin or teicoplanin alone . There was no significant difference between the two antibiotic combinations against these gram-positive cocci . The antibiotic combinations showed synergy against 75 per cent of enterococcal isolates, 70 per cent of S . aureus isolates and 50 per cent of coagulase-negative staphylococcal isolates when measured at 24 hr of incubation . Five (25%) enterococcal strains resistant to the synergistic effect of the antibiotic combinations had gentamicin MICs greater than 64 mg/L . For staphylococcal isolates, no association was found between synergy and gentamicin susceptibility, methicillin resistance, or tolerance to vancomycin or teicoplanin.

J Chemother, 1991 Dec, 3(6), 348 - 51
Efficiency and suitability of the penicillin-phenol red acidometric test for detection of beta-lactamase production in staphylococci; Banic S; The penicillin-phenol red acidometric test was found to be highly efficient and suitable for the detection of beta-lactamase production in staphylococci . The author presents his modification of the procedure and discusses its advantages . He recommends that all staphylococcal strains be tested for beta-lactamase production on the day of isolation.

Antimicrob Agents Chemother, 1991 Dec, 35(12), 2568 - 73
Genotypic identification of methicillin-resistant coagulase-negative staphylococci by polymerase chain reaction; Predari SC et al.; A rapid method for the detection of methicillin resistance in staphylococci was developed . The method was based on the polymerase chain reaction (PCR) and primers that targeted the internal region of the coding frame of the mec gene . The amplification reaction was carried out with crude cell lysates as a source of target DNA and provided data in less than 5 h . Seventy-four isolates of coagulase-negative staphylococci were tested by PCR, DNA hybridization with a probe derived from the mec gene, and an agar dilution susceptibility assay . PCR results showed a 100% correlation with the susceptibility assay carried out with high inocula (10(8) CFU) and incubation at 32 degrees C for 48 h . PCR was more sensitive and specific than DNA hybridization in detecting methicillin resistance in coagulase-negative staphylococci . The former technique identified the mec gene in all the strains which were phenotypically resistant but which did not hybridize with the probe . Identification of methicillin-resistant strains by PCR offers a very specific, sensitive, and rapid alternative to traditional susceptibility tests and DNA hybridization as a guide for the treatment of infections caused by staphylococci.

Antimicrob Agents Chemother, 1991 Dec, 35(12), 2500 - 4
Conjugative transfer genes in staphylococcal isolates from the United States; Archer GL et al.; Staphylococcus aureus and coagulase-negative staphylococcal isolates from various geographic areas in the United States were examined by using a conjugative transfer gene DNA probe in dot-blot hybridization assays . Of 175 S . aureus isolates, 47 (27%) hybridized with the probe, while 24 of 208 (11.5%) coagulase-negative staphylococci hybridized . However, among methicillin-resistant S . aureus 52% (45 of 89) were probe positive while only 2% (2 of 86) of methicillin-susceptible S . aureus were probe positive . In contrast, 12.5% (22 of 176) of methicillin-resistant and 6% (2 of 32) of methicillin-susceptible coagulase-negative staphylococci contained transfer genes . All but one of the staphylococci containing transfer genes were resistant to gentamicin; 91.5% of S . aureus and 65% of coagulase-negative staphylococci containing transfer genes transferred gentamicin resistance to a S . aureus recipient . Of the 12 isolates that hybridized with the probe but did not transfer resistance, 10 (6 coagulase-negative staphylococci and 4 S . aureus) carried both gentamicin resistance and conjugative transfer genes on the same plasmid . Of these 10, 6 contained plasmid target fragments of sizes different from that of the probe, suggesting additions or deletions of DNA essential for transfer, while in 4 no such alterations could be detected . In two coagulase-negative staphylococci the entire transfer region was apparently integrated into the chromosome . Thus, staphylococci carrying conjugative transfer genes are widely disseminated in the United States and are usually found in multiresistant isolates on plasmids that also encode gentamicin resistance.

Khirurgiia (Mosk), 1991 Dec, (12), 9 - 12
{The role of the adhesive activity of staphylococci in the development of suppurative-septic diseases in traumatology and orthopedics}; Arutcheva AA et al.; The authors studied the adhesive activity of clinical staphylococcal strains on a model of human erythrocytes and determined two indices: the percentage of erythrocytes participating in adhesion and the average number of staphylococci adhering to one erythrocyte . These two indices were found to be directly related to each other . The adhesive activity of epidermal staphylococcus was found to be identical to that of Staphylococcus aureus, 62.6 +/- 2.5 and 65.1 +/- 3.0%, respectively . Irregular distribution of the adhesion indices of both types was encountered, however . In Staphylococcus aureus they were in the range of 53.4-89.5% while in the epidermal staphylococcus the distribution of the adhesive indices was beyond this range . Such a variety of indices determines the clinical picture of the pathological process caused by the epidermal staphylococcus . No relationship was noted between the adhesion indices and staphylococcal antibiotic resistance.

Kansenshogaku Zasshi, 1991 Dec, 65(12), 1550 - 4
{Bacterial meningitis in the elderly with neurosurgical procedures}; Kodaira M et al.; Bacterial meningitis is one of complications in the elderly with neurosurgical procedures . In an attempt to find the clinical features of this complication we analyzed 10 cases, which were found in 30 cases of the bacterial meningitis in Tokyo Metropolitan Geriatric Hospital from 1972 to 1989 . The patients were 4 males and 6 females, 52-86 years old (the mean, 69) . While 2 Enterococcus species were isolated after craniotomy, Staphylococci were common pathogens (4 S . aureus, 4 S . epidermidis and 1 P . aeruginosa) in patients with shunt infection . Most of these patients lacked typical manifestations of meningitis except the fever . Symptoms occurred long after surgery with little abnormality in the data of serum and cerebrospinal fluid . However, blood cultures were positive in 75% of the cases . Removal of the infected catheter was effective in the cases of shunt infection.

J Hosp Infect, 1991 Dec, 19(4), 273 - 81
Observations on coagulase-negative staphylococci in a neonatal unit in India; Mehta G et al.; Fifty neonates were included in a prospective study which determined the frequency of colonization and infection with coagulase-negative staphylococci (CNS) in a neonatal unit . The isolates were characterised by species, antibiotic resistance and ability to produce slime . Twenty-four epidemiologically related isolates (including four isolates from the hands of staff) were also phage typed and had plasmid analysis performed . On the first day of birth, 18% of infants were colonized with CNS, 40% and 30% by days 3-5 and day 7 respectively, and 25% by the 14th day and beyond . Staphylococcus haemolyticus and S . epidermidis were the most frequent CNS species encountered, accounting for 36% and 35% of isolates . Resistance to four or more antibiotics was present in 37% of strains isolated on the first day and this increased to 100% of isolates from infants who stayed for more than 14 days . Forty-five percent of CNS were slime producers; no significant difference was observed in slime producing ability between the species or isolates at different days after birth . Five infants developed septicaemia due to CNS . Staphylococcus haemolyticus and S . epidermidis were recovered as the only pathogens from three and two cases respectively . Detailed typing revealed that one case of infection with S . haemolyticus was preceded by surface colonization with an identical strain . Evidence was also obtained for the transmission of CNS between babies on the hands of staff.

Am Rev Respir Dis, 1991 Nov, 144(5), 1140 - 6
Bacterial colonization and infection studies in the premature baboon with bronchopulmonary dysplasia; Coalson JJ et al.; Microbial colonization and infection patterns were prospectively evaluated in premature baboons with and without bronchopulmonary dysplasia (BPD) to assess if prolonged hyperoxia would predispose to a different pattern of microbial colonization and/or a higher risk of respiratory infection . Forty baboons were delivered by hysterotomy at 75% of gestation and randomized into two groups . Group I (control or PRN) animals were placed immediately on high-frequency oscillation at 15 Hz; I:E ratio 1:2, and changed to positive-pressure ventilation at 48 to 72 h . They were maintained on clinically appropriate oxygen at minimal ventilator settings for the remainder of the 21-day experimental period . Group II (oxygen-treated or BPD) animals were ventilated with PPV and FIO2 1.0 for 7 days followed by FIO2 0.8 for 14 days . All animals were treated with antibiotics during some portion of the 21-day course . Specimens from nose, oropharynx, trachea, and rectum were cultured for both aerobes and anaerobes throughout the neonatal intensive care unit (NICU) course . A subset of animals from both groups were killed at 21 days and lung, liver, spleen, and gastric contents were cultured quantitatively at autopsy . Findings showed that coagulase-negative staphylococci were the predominant organisms that colonized the neonate in the NICU . Lung infections were seen to evolve through sequential pathogenetic steps: colonization of the upper respiratory tract, with concomitant or subsequent colonization of the trachea with comparable organism and ultimate recovery of the same organisms at autopsy in the lungs of animals with pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect Dis, 1991 Nov, 164(5), 883 - 7
In vivo stability of heterogeneous expression classes in clinical isolates of methicillin-resistant staphylococci; Figueiredo AM et al.; To define the stability of methicillin-resistant Staphylococcus aureus (MRSA) in vivo, 22 isolates collected at one New York institution in 1989 and 1990 were studied . All 22 belonged to one of two distinct methicillin-resistant phenotypes (class 3 or 2), which were precisely identified as belonging to two distinct genotypes . Genotypic classification was based on restriction analysis of chromosomal DNA with EcoRI and HindIII and Southern analysis of ClaI digests using two DNA probes . One was specific for the mec gene; the other was specific for transposon Tn554 . The findings suggest that the MRSA isolates studied were representative of two genetically distinct MRSA "clones," each with a unique strain-specific methicillin-resistant phenotype that is stable under the conditions of invasive disease, carriage, and spread from patient to patient.

Gig Sanit, 1991 Nov, (11), 39 - 41
{The microfloral characteristics of the atmosphere and of the human respiratory tract during the performance of drilling operations}; Bukharin OV et al.; Some changing in microflora of the bore works are noted . It expressed in increasing of staphylococci index.

Enferm Infecc Microbiol Clin, 1991 Nov, 9(9), 551 - 3
{Production of slime by coagulase-negative staphylococci as a marker of systemic infection in newborn infants}; Wolff LS et al.; We studied 310 strains of Staphylococcus spp . from neonates admitted in intensive care unit from june 1988 to may 1990, with the purpose of establishing a relationship between the slime production and the occurrence of sepsis . The original technique for its determination was modified; this facilitated the performance and the reading of results . Of 105 neonates with isolation in blood, spinal fluid and/or intravascular catheter of negative-coagulase Staphylococcus (CNS), the incidence of sepsis was 57.9% when the strain was a slime-producer, and only 11.6% when the strain did not produce slime (p less than 0.001) . The risk of infection was five-fold increased when the isolated was slime-producer CNS . We proved a high predictive value when the strains were identical and isolated from two samples, one of which was blood . These results show that the production of slime is a factor which strongly support the diagnosis of neonatal sepsis due to negative-coagulase Staphylococcus.

Indian Pediatr, 1991 Nov, 28(11), 1241 - 8
Coagulase negative staphylococcal septicemia in newborns; Anand NK et al.; The case records of 2177 newborn infants admitted in the Neonatal Intensive Care Unit (NICU) from January, 1989, through July, 1990, with positive blood cultures for coagulase-negative staphylococci (C-NS) were evaluated . Seventy four (3.4%) neonates yielded C-NS in blood cultures during the study period . Of these, 58 (2.7%) infants had clinical and hematological features compatible with the diagnosis of septicemia . Remaining 16 babies with positive cultures had no evidence of sepsis, and were designated as "C-NS bacteremia" . The age at which positive cultures were obtained differed between the bacteremic and septicemic groups . In bacteremic group, the onset occurred between one to four days of age . In contrast, in septicemic group the range was 6-20 days, with a mean of 10.22 (+/- 3.53) days . More than two third of total cases of C-NS sepsis were premature and low birth weight (LBW) . Prominent clinical features included lethargy, poor feeding and fever . Besides this apneic spells were seen predominantly in babies weighing less than 1500 g . Further, before the diagnosis of C-NS sepsis, more than half of neonates had received prolonged intravenous fluid therapy, a quarter had undergone umbilical catheterization and a further quarter needed a ventilator support . Overall mortality in C-NS sepsis was 17.24%, distinctly higher in neonates with RDS and those requiring mechanical ventilation (p less than 0.05) . Only 1.34% C-NS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with newer cephalosporins, ciproflox and amikacin.

Indian J Med Res, 1991 Nov, 93, 350 - 2
Resistant coagulase negative staphylococci from clinical samples; Goel MM et al.; Antibiotic susceptibility testing against 17 antibiotics was done on 96 strains of various species of coagulase negative staphylococci by Stokes method . Hundred per cent sensitivity was found against vancomycin and cefotaxime and about 90 per cent against ciprofloxacin, clavulanate potentiated amoxycillin, cloxacillin and clindamycin . Strains showed highest resistance against cotrimoxazole (77.08%) and tetracycline (64.59%) . Clavulanate potentiated amoxycillin was found to be highly active against penicillin, ampicillin and amoxycillin resistant organisms . The results highlight the importance of antibiotic resistance typing among coagulase negative staphylococci species which are increasingly being reported from serious clinical infections making empiric therapy and selection of antibiotics difficult in these infections.

J Gen Microbiol, 1991 Nov, 137 ( Pt 11), 2561 - 70
Variation in the expression of cell envelope proteins of coagulase-negative staphylococci cultured under iron-restricted conditions in human peritoneal dialysate; Wilcox MH et al.; Strains of coagulase-negative staphylococci (CNS), including Staphylococcus epidermidis, S . hominis, S . warnerii, S . simulans, S . capitis, S . haemolyticus and S . saprophyticus, were isolated from patients with continuous-ambulatory-peritoneal-dialysis-related peritonitis . The cell wall and cytoplasmic membrane protein profiles of CNS strains cultured in either nutrient broth (NB) or pooled human peritoneal dialysate (HPD) were compared . Some interspecies variation in both the wall and membrane protein profiles was noted . However, the cell wall protein profiles of HPD-grown CNS strains differed markedly from those cultured in NB . Growth in HPD resulted in a marked reduction in the total number of cell-wall-associated proteins but up to three antigenically related proteins in the 40-56 kDa range, depending on the species, predominated . Growth in HPD also resulted in the induction of two iron-repressible cytoplasmic membrane proteins (IRMPs) of 32 and 36 kDa in S . epidermidis . Other CNS strains only appeared to express a single IRMP, which varied in molecular mass from 32 to 36 kDa . Whilst the IRMP in these CNS strains showed considerable antigenic homology with the 32 kDa IRMP, the S . warneri IRMP showed cross-reactivity with both the 32 and 36 kDa IRMPs of S . epidermidis . Immunoblotting experiments revealed that whilst the CNS cell wall proteins were poorly immunogenic, the IRMPs were the immunodominant CNS protein antigens, reacting strongly with antibodies present in HPD . This finding provides evidence to suggest that the IRMPs are expressed in vivo during infection.

Eur J Epidemiol, 1991 Nov, 7(6), 686 - 9
Species identification and detection of oxacillin resistance in coagulase-negative Staphylococcus blood isolates from neutropenic patients; Venditti M et al.; One hundred coagulase-negative staphylococcal isolates from septicemic neutropenic patients with hematologic malignancies were identified to a species level by means of the French API STAPH strip system and by the Automicrobic VITEK system . According to these two methods, which concurred in 95% of cases, S . epidermidis (80-82% of the isolates) was the most frequently identified species, followed by S . haemolyticus (6-7% of the isolates) . The susceptibility to oxacillin was also evaluated by macrodilution MIC, Automicrobic VITEK system and agar screen, and 76, 78 and 79 of the 100 isolates, respectively, were found resistant to this antibiotic . All oxacillin-resistant isolates according to Automicrobic VITEK were confirmed resistant by agar screen . A 48h incubation was required to determine oxacillin resistance in 11 of 79 isolates with agar screen and in 10 of 76 isolates with macrodilution MIC . Automicrobic VITEK system may represent a useful method for rapid identification to a species level and early recognition of oxacillin resistance in coagulase-negative staphylococci.

Kidney Int, 1991 Nov, 40(5), 934 - 8
Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine; Levin A et al.; Subclavian catheter (SCC) related infections are a major cause of morbidity in hemodialysis patients, the vast majority due to staphylococci species . Povidone-iodine (PI) has proven anti-staphylococcal activity . Therefore, a randomized controlled trial of topical PI ointment was undertaken to evaluate the impact of this prophylactic intervention on the incidence of SCC related infections in hemodialysis patients . The role of S . aureus nasal carrier state in the acquisition of infection was also evaluated . Patients requiring SCC for temporary hemodialysis access were randomized to receive the treatment (T; N = 63) or sterile gauze dressings alone (C; N = 66) . Catheter duration ranged from 2 to 210 days in both groups, with a mean of 38.6 days in T and 36.2 days in C (NS) . Exit site (ES) infections were significantly less in T (5%) versus C (18%) (P less than 0.02); tip colonization (TC) was 17% in T versus 36% in C (P less than 0.01), while the incidence of septicemia (S) was also significantly less in T (2%) versus C (17%; P less than 0.01) . S . aureus nasal carriers were at a threefold higher risk of SCC related septicemia (0.009/day) than noncarriers (0.003/day; P less than 0.05) . The beneficial effect of PI ointment was most evident in this high risk group of S . aureus carriers: ES = 0% T versus 24% C, TC = 12% T versus 42% C, S = 0% T versus 29% C, P less than 0.05 . There were no adverse effects of the treatment . The routine application of topical PI ointment to temporary hemodialysis catheter exit sites is effective in reducing SCC related infections.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Nov, (11), 53 - 6
{The extracorporeal immunostimulating effect of terrilytin in staphylococcal infection}; Prokopenko LG et al.; The intravenous injection of terrilytin-treated lymphocytes into rats infected with staphylococci enhances the formation of staphylococcal alpha antitoxin in the animals and the development of immune response to T-dependent antigen, such as sheep red blood cells (SRBC), but produces no effect on the development of immune response induced by T-independent antigen (lipopolysaccharide) . Terrilytin-treated lymphocytes induce the release of the factor promoting the development of immune response to staphylococcal antigens and SRBC by spleen cells, incapable of adherence to plastic, but have no influence on the development of immune response to lipopolysaccharide in rats infected with staphylococci . At the same time in such rats spleen cells adhering to plastic take part in the transfer of signals from terrilytin-treated lymphocytes to nonadhering spleen cells of recipients.

J Pediatr, 1991 Nov, 119(5), 748 - 54
Granulocyte and granulocyte-macrophage colony-stimulating factors for treatment of neutropenia in glycogen storage disease type Ib; Schroten H et al.; Two children with glycogen storage disease type Ib associated with numerous recurrent bacterial infections as a result of neutropenia and neutrophil dysfunction were treated with recombinant human granulocyte colony-stimulating factor (G-CSF) . One of the two patients was previously treated with recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF); therapy had to be discontinued because of severe local side effects . Both colony-stimulating factors at dosages of 3 and 8 micrograms/kg/per day, respectively, increased the average neutrophil counts from less than 300 cells/microliters to more than 1200 cells/microliters . Two subpopulations of neutrophils could be identified by their capacity to produce H2O2: one subpopulation generated H2O2 normally and a second was defective in H2O2 production . The doses of G-CSF effectively enhanced and maintained that subpopulation of neutrophils which produced normal amounts of H2O2 . Moreover, these colony-stimulating factor-induced neutrophils demonstrated effective phagocytosis of zymosan particles and killing of staphylococci . Chemotaxis was decreased and could not be normalized by treatment with G-CSF . We conclude that maintenance treatment with G-CSF improved the quality of life in both patients: The number and severity of bacterial infections decreased markedly during treatment . Long-term treatment with G-CSF (12 and 10 months, respectively) was well tolerated, and no adverse clinical events were observed.

J Hosp Infect, 1991 Nov, 19(3), 201 - 7
Nosocomial Staphylococcus epidermidis septicaemia among very low birth weight neonates in an intensive care unit; Carlos CC et al.; A cluster of cases of septicaemia caused by coagulase-negative staphylococci was observed among the infants at the Neonatal Intensive Care Unit (NICU) of the Karolinska Hospital in May 1987 . The presence of a unique antibiogram among the blood culture isolates prompted an investigation to determine whether an epidemic strain existed or not, using antibiogram, biotyping and plasmid profiles as epidemiological markers . All 14 isolates with a unique antibiogram were investigated, and 22 isolates without the unique antibiogram served as controls . Of the 14 isolates, 11 were Staphylococcus epidermidis and had similar plasmid patterns . Of the 22 control isolates, 15 were S . epidermidis, and none had the special plasmid pattern nor any other recurring plasmid patterns . The use of plasmid profile analysis together with antibiograms thus identified a possible epidemic strain of S . epidermidis which may have been responsible for the upsurge of septicaemia cases at the NICU . The presence of an epidemic strain implies that hospital cross infection control could be important in preventing neonatal septicaemia caused by S . epidermidis.

Infect Immun, 1991 Nov, 59(11), 4187 - 92
Characterization of a proteinaceous adhesin of Staphylococcus epidermidis which mediates attachment to polystyrene; Timmerman CP et al.; Coagulase-negative staphylococci (CoNS) have evolved into important agents of foreign body-related infections . Adhesion of causative bacteria to biomaterials is considered to be an essential step in these infections . We and others have shown that adhesion of CoNS to biomaterials may be mediated by protease-sensitive surface constituents . In the present study we expanded on these investigations by characterizing a biomaterial adhesin of Staphylococcus epidermidis 354 by using a strain-specific monoclonal antibody (MAb 36.4) . MAb 36.4 was strongly and exclusively reactive with strain 354 in an enzyme-linked immunosorbent assay in which whole bacteria were used as antigens . Immunoblotting of cell wall polypeptides of strain 354 revealed strong reactivity with a 200- to 220-kDa band and a weaker reaction in the 100- to 110-kDa range . Preincubation of strain 354 with MAb 36.4 resulted in a 54 to 91% (mean +/- standard deviation, 74% +/- 14%; n = 10) inhibition of adhesion to polystyrene spheres . Fab fragments prepared from MAb 36.4 also inhibited adhesion effectively, indicating specific blocking of an adhesion antigen rather than aspecific inhibition . Immunogold electron microscopy with MAb 36.4 revealed deposition of gold particles on the cell surface and possibly also on fimbrialike surface projections . It is concluded that a surface-located protein antigen of S . epidermidis 354 recognized by MAb 36.4 acts as an adhesin mediating attachment to uncoated foreign material . It is speculated that this type of adhesion to biomaterials may play an important role in the pathogenesis of foreign body-related infections caused by CoNS.

J Antimicrob Chemother, 1991 Nov, 28(5), 695 - 9
Anti-staphylococcal activity of temafloxacin, ciprofloxacin, ofloxacin and enoxacin; Barry AL et al.; Four fluoroquinolones were tested for antimicrobial activity against 300 isolates of staphylococci collected from medical centres throughout the United States . No cross-resistance to methicillin or oxacillin and the fluoroquinolones was observed . All four drugs were bactericidal agents and all ciprofloxacin-susceptible strains were inhibited at recommended breakpoint concentrations . Ciprofloxacin-resistant strains showed complete cross-resistance to the other fluoroquinolones . The relative potency of the study drugs as judged by MIC/MBC determinations was: temafloxacin greater than ciprofloxacin greater than ofloxacin greater than enoxacin.

Mayo Clin Proc, 1991 Oct, 66(10), 1036 - 9
Epidural abscess associated with intravenous drug abuse in a pregnant patient; Van Winter JT et al.; The association between intravenous drug abuse and epidural abscess is well known; however, this association has not previously been reported in a pregnant patient . The classic manifestation of epidural abscess is a febrile patient with back pain that progresses rapidly to radicular pain, spinal cord dysfunction, weakness, and then complete paralysis . Although this condition is rare during pregnancy, these serious complications necessitate prompt diagnosis and intervention . If spinal infection is suspected, magnetic resonance imaging should be performed immediately . After epidural abscess is diagnosed, emergent decompressive laminectomy and appropriate antibiotic coverage are necessary . Herein we describe a 27-year-old pregnant patient with epidural abscess probably related to use of contaminated needles for intravenous administration of drugs and subsequent hematologic spread of staphylococci to the epidural space . The differential diagnosis of epidural abscess can be difficult, and management options must consider the well-being of both the mother and the fetus.

Pol Tyg Lek, 1991 Oct 7-21, 46(40-42), 743 - 5
{Bacterial colonization of patients treated with chronic hemodialysis}; Galinski J et al.; The study was aimed at investigating the predispositions of the patients chronically treated with hemodialysis to nose and skin colonization with potentially pathogenic bacteria . The study involved 41 patients chronically hemodialysed and patients treated at the Department of Renal diseases or out-patient clinic (30 individuals) . Smears from the nose and throat were taken from all patients and used for bacteriologic tests . In case of hemodialysed patients material for bacteriologic tests was additionally taken from the skin at the site of arterio-venous fistula and groin . It was found, that patients chronically treated with hemodialyses are more frequently colonized with enteric bacilli and coagulase-positive staphylococci that both hospitalized patients and those treated in out-patient clinic . No relationship between the presence of coagulase-positive staphylococci in the nose and throat and on the skin was seen despite such suggestions of other authors.

J Clin Microbiol, 1991 Oct, 29(10), 2240 - 4
Identification of methicillin-resistant strains of staphylococci by polymerase chain reaction; Murakami K et al.; A simple and reliable method using a polymerase chain reaction (PCR) was devised to identify methicillin-resistant staphylococci . By using lysates of the strain to be tested as templates and 22-mer oligonucleotides as primers, a 533-bp region of mecA, the structural gene of a low-affinity penicillin-binding protein (PBP 2'), was amplified by PCR and detected by agarose gel electrophoresis . Results obtained by this method were compared with those obtained by broth microdilution MIC determination for 210 and 100 clinical isolates of Staphylococcus aureus and coagulase-negative staphylococci, respectively . Of 99 mecA-negative S . aureus isolates, 100% of the strains were methicillin susceptible and 98% of the strains were oxacillin susceptible . Three strains (3%) of 111 mecA-positive S . aureus isolates exhibited almost the same susceptibility to beta-lactams as the mecA-negative ones and did not produce detectable amounts of PBP 2' despite the presence of the mecA gene . One of them yielded typically methicillin-resistant variants at a low frequency with concomitant recovery of PBP 2' production . The mecA gene was also found in coagulase-negative Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus sciuri, Staphylococcus saprophyticus, and Staphylococcus caprae and conferred resistance on most of the bacteria.

J Clin Invest, 1991 Oct, 88(4), 1224 - 9
Staphylococci surviving intracellularly in phagocytes from patients suffering from chronic granulomatous disease are killed in vitro by antibiotics encapsulated in liposomes; Roesler J et al.; Granulocytes and monocytes/macrophages from patients suffering from chronic granulomatous disease (CGD) are ineffective in killing specific kinds of phagocytized bacteria, e.g., Staphylococcus aureus, due to decreased or lacking ability to produce reactive oxygen intermediates . Commonly used antibiotics like flucloxacillin are of limited therapeutic value, because the staphylococci are protected against their action in the interior of phagocytes . However, encapsulation of flucloxacillin into liposomes could enable its entrance into the interior of neutrophils from two CGD patients to kill phagocytized bacteria there . The effect of rifampicin against intracellular staphylococci could be similarly enhanced by liposome encapsulation . Dose-response relations and kinetics of killing of intracellular bacteria by antibiotics in the free and encapsulated form were studied under different conditions using J 774 mouse macrophages, because phagocytes from CGD patients are not available in great amounts . Preincubation of phagocytes with either antibiotic in liposomes subsequently endowed the cells with a strongly enhanced ability to kill phagocytized bacteria . Our data show that a drug which normally will not reach a phagosome can be delivered to this intracellular compartment by a liposome . A possible clinical use is discussed.

Invest Ophthalmol Vis Sci, 1991 Oct, 32(11), 2970 - 5
The role of tetracycline in chronic blepharitis . Inhibition of lipase production in staphylococci; Dougherty JM et al.; Tetracycline administered in low doses can be effective in the long-term management of patients with meibomian keratoconjunctivitis (MKC) . However, the mechanism of action does not appear to be a reduction of bacteria . Seventy-five percent of the ocular staphylococci in such patients are resistant to tetracycline . An alternative mechanism of action could be the inhibition of production of extracellular enzymes by the ocular flora . Inhibition of lipase production could result in lowered levels of toxic hydrolysis products (free fatty acids), which may exacerbate the disease process . The authors tested this hypothesis by examining the differential effect of tetracycline on growth and lipase production in a tetracycline-resistant and tetracycline-sensitive strain of Staphylococcus epidermidis and S . aureus isolated from patients with MKC and Staphylococcal blepharitis . Tetracycline caused significant decreases in the production of lipase in the sensitive and resistant strains of S . epidermidis without concominant decreases in growth . In contrast, S . aureus strains showed parallel decreases in both lipase production and inhibition of growth . The authors propose that the sensitivity of lipase production to tetracycline, in tetracycline-resistant S . epidermidis, may partially explain the clinical improvement observed in MKC patients.

Antimicrob Agents Chemother, 1991 Oct, 35(10), 2135 - 9
Susceptibility of Staphylococcus species and subspecies to fleroxacin; Bannerman TL et al.; Twenty-four Staphylococcus species or subspecies were examined for their susceptibilities to the fluoroquinolone fleroxacin (Ro 23-6240) by disk diffusion (5-micrograms disk) and by agar dilution for the determination of MICs . Resistant strains were further tested for their susceptibilities to oxacillin and the fluoroquinolone ciprofloxacin . Reference strains of the novobiocin-resistant species (Staphylococcus saprophyticus, Staphylococcus cohnii, Staphylococcus xylosus, Staphylococcus arlettae, and Staphylococcus gallinarum) had an intrinsic intermediate susceptibility (MIC, 4 micrograms/ml) to fleroxacin . Fleroxacin resistance was not observed in the reference strains of the novobiocin-susceptible species (MIC, 0.5 to 2.0 micrograms/ml) . Clinical isolates of coagulase-negative species were generally less susceptible to fleroxacin than were reference strains . Seven percent of the Staphylococcus epidermidis clinical strains were resistant (MIC, greater than or equal to 8 micrograms/ml) to fleroxacin . Of these strains, 77% were resistant to oxacillin and 50% were resistant to ciprofloxacin . Thirty-four percent of the Staphylococcus haemolyticus clinical strains were resistant to fleroxacin, and 9% had intermediate susceptibility . Of the resistant strains, 95% were resistant to oxacillin and 77% were resistant to ciprofloxacin, while 23% had intermediate susceptibility to ciprofloxacin . Fleroxacin is an effective antimicrobial agent against most staphylococci.

Clin Microbiol Rev, 1991 Oct, 4(4), 422 - 38
Applications of cellular fatty acid analysis; Welch DF; More than ever, new technology is having an impact on the tools of clinical microbiologists . The analysis of cellular fatty acids by gas-liquid chromatography (GLC) has become markedly more practical with the advent of the fused-silica capillary column, computer-controlled chromatography and data analysis, simplified sample preparation, and a commercially available GLC system dedicated to microbiological applications . Experience with applications in diagnostic microbiology ranges from substantial success in work with mycobacteria, legionellae, and nonfermentative gram-negative bacilli to minimal involvement with fungi and other nonbacterial agents . GLC is a good alternative to other means for the identification of mycobacteria or legionellae because it is rapid, specific, and independent of other specialized testing, e.g., DNA hybridization . Nonfermenters show features in their cellular fatty acid content that are useful in identifying species and, in some cases, subspecies . Less frequently encountered nonfermenters, including those belonging to unclassified groups, can ideally be characterized by GLC . Information is just beginning to materialize on the usefulness of cellular fatty acids for the identification of gram-positive bacteria and anaerobes, despite the traditional role of GLC in detecting metabolic products as an aid to identification of anaerobes . When species identification of coagulase-negative staphylococci is called for, GLC may offer an alternative to biochemical testing . Methods for direct analysis of clinical material have been developed, but in practical and economic terms they are not yet ready for use in the clinical laboratory . Direct analysis holds promise for detecting markers of infection due to an uncultivable agent or in clinical specimens that presently require cultures and prolonged incubation to yield an etiologic agent.

Int J Food Microbiol, 1991 Oct, 14(1), 19 - 25
Production of staphylococcal enterotoxin D in foods by low-enterotoxin-producing staphylococci; Pereira JL et al.; The goal of this investigation was to determine whether staphylococcal strains producing enterotoxins at nanogram levels per milliliter in laboratory medium, not detectable by gel diffusion methods, could produce sufficient enterotoxin in foods to result in food poisoning . Three low-enterotoxin D (SED)-producing strains were selected for this research because this enterotoxin is produced in smaller amounts than the other enterotoxins . The foods used were cream pie and cooked ham, divided into two portions, sterile and non-sterile . Each portion was inoculated with known concentrations of the staphylococcal strains under study and incubated for 48 h at 25, 30, and 37 degrees C . Samples were taken after 24 and 48 h . Enterotoxin was detectable in both sterilized and unsterilized cream and ham after 24 h at 37 degrees C with an inoculum of 10(3)/g . Some strains produced detectable amounts of enterotoxin in the sterilized foods after 24 h at 30 degrees C and some produced detectable amounts of enterotoxin in the sterilized foods after 24 h at 25 degrees C with inocula of 10(4)/g . It can be concluded that staphylococcal strains producing enterotoxin at ng/ml levels in laboratory medium, not detectable by gel diffusion methods, can produce sufficient enterotoxin (ng/g) in foods to cause food poisoning.

Antimicrob Agents Chemother, 1991 Oct, 35(10), 2151 - 4
Ciprofloxacin resistance in coagulase-positive and -negative staphylococci: role of mutations at serine 84 in the DNA gyrase A protein of Staphylococcus aureus and Staphylococcus epidermidis; Sreedharan S et al.; gyrA mutations in quinolone-resistant pathogenic isolates of Staphylococcus spp . have been detected by the direct HinfI digestion of polymerase chain reaction products . Homology among gyrA genes allowed rapid examination of both coagulase-positive and -negative isolates . DNA sequence analysis revealed that ciprofloxacin resistance in Staphylococcus epidermidis is associated with a novel Ser-84----Phe mutation in the DNA gyrase A protein, analogous to Ser-84----Leu changes observed in Staphylococcus aureus.

Am J Med, 1991 Sep 16, 91(3B), 86S - 89S
Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989 . National Nosocomial Infections Surveillance System; Banerjee SN et al.; More than 25,000 primary bloodstream infections (BSIs) were identified by 124 National Nosocomial Infections Surveillance System hospitals performing hospital-wide surveillance during the 10-year period 1980-1989 . These hospitals reported 6,729 hospital-months of data, during which time approximately 9 million patients were discharged . BSI rates by hospital stratum (based on bed size and teaching affiliation) and pathogen groups were calculated . In 1989, the overall BSI rates for small (less than 200 beds) nonteaching, large nonteaching, small (less than 500 beds) teaching, and large teaching hospitals were 1.3, 2.5, 3.8, and 6.5 BSIs per 1,000 discharges, respectively . Over the period 1980-1989, significant increases (p less than 0.0001) were observed within each hospital stratum, in the overall BSI rate and the BSI rate due to each of the following pathogen groups: coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida species . In contrast, the BSI rate due to gram-negative bacilli remained stable over the decade, in all strata . Except for small nonteaching hospitals, the greatest increase in BSI rates was observed in coagulase-negative staphylococci (the percentage increase ranged between 424% and 754%), followed by Candida species (219-487%) . In small nonteaching hospitals, the greatest increase was for S . aureus (283%), followed by enterococci (169%) and coagulase-negative staphylococci (161%) . Our analysis documents the emergence over the last decade of coagulase-negative staphylococci as one of the most frequently occurring pathogens in BSI.

Am J Med, 1991 Sep 16, 91(3B), 197S - 205S
The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping; Mermel LA et al.; To delineate the pathogenesis and epidemiology of catheter-related infection with Swan-Ganz pulmonary artery (PA) catheters, a prospective clinical study of hospitalized adult medical and surgical patients was done . Role of catheter material was assessed by randomizing insertions to heparin-bonded PA catheters made of polyvinylchloride or polyurethane . Sources of infection and pathogenesis were studied by culturing skin, the introducer, the PA catheter tip, all hubs, infusate from each lumen, and the extravascular portion of the PA catheter beneath the external protective plastic sleeve . Concordance between isolates from sources and infected catheters was determined by speciation, antibiogram, and for coagulase-negative staphylococci, plasmid profile analysis . Risk factors for infection were determined by stepwise logistic regression . Overall, 65 (22%) of 297 Swan-Ganz catheters showed local infection of the introducer (58 catheters) or the intravascular portion of the PA catheter (20 catheters); only two catheters (0.7%) caused bacteremia . Eighty percent of infected Swan-Ganz catheters (the introducer or PA catheter) showed concordance with organisms cultured from skin of the insertion site, 17% with a contaminated hub and 18% with organisms contaminating the extravascular portion of the PA catheter beneath the sleeve . Isolates from infected PA catheters were most likely to show concordance with concomitantly infected introducers (71%) . Cutaneous colonization of the insertion site with greater than 10(2) cfu/10 cm2 (relative risk {RR} 5.5; p less than 0.001), insertion into an internal jugular vein (RR 4.3; p less than 0.01), catheterization greater than 3 days (RR 3.1; p less than 0.01), and insertion in the operating room using less stringent barrier precautions (RR 2.1; p = 0.03) were each associated with a significantly increased risk of catheter-related infection . The risk of bacteremic infection with Swan-Ganz catheters is now low, in the range of 1%, with reasonable care . Swan-Ganz catheters are vulnerable to contamination from multiple sources, but the patient's skin is the single most important source of organisms causing invasive infection, which in most cases involves the introducer rather than the PA catheter . Heavy colonization of the insertion site, percutaneous insertion in the internal jugular vein rather than subclavian vein, catheterization longer than 3 days, and insertion with less stringent barrier precautions significantly increase the risk of catheter-related infection . These findings hold promise for application to management of Swan-Ganz catheters and research in catheter design to reduce the risk of catheter-related infection.

Am J Med, 1991 Sep, 91(3), 261 - 6
Oral ofloxacin for the treatment of acute bacterial pneumonia: use of a nontraditional protocol to compare experimental therapy with "usual care" in a multicenter clinical trial; Sanders WE Jr et al.; PURPOSE: This multicenter study was designed to compare an exclusively oral regimen with "usual care" in patients hospitalized with acute bacterial pneumonia . PATIENTS AND METHODS: One hundred forty-seven patients were enrolled . All patients presented with a clinical picture consistent with pneumonia: (1) clinical symptoms of a lower respiratory tract infection, such as chest pain, cough, and production of purulent sputum; (2) roentgenographic infiltrate compatible with acute infection; and (3) Gram's stain of purulent sputum or other appropriate bronchopulmonary specimen containing gram-negative organisms, staphylococci, or pneumococci . All patients required hospitalization . The design was a parallel-group, open-label study with randomization in blocks of four . Ofloxacin, a new fluoroquinolone antimicrobial agent, was administered orally or by nasogastric tube, 400 mg every 12 hours . This was compared with the individual investigator's best selection of therapy that was administered parenterally, at least initially . RESULTS: One hundred thirty-three patients were evaluable after exclusions for deviation from protocol, early death due to unrelated causes, incorrect diagnosis, or early adverse drug reactions . All 69 patients treated with ofloxacin and 61 of 64 control patients had favorable clinical and microbiologic responses . There were no statistically significant differences between the groups in terms of demographics, therapeutic outcome, and duration of therapy . There were few side effects overall and rates were similar for the two groups . CONCLUSIONS: An exclusively oral regimen, in this case ofloxacin, may be substituted for parenteral therapy in selected patients with pneumonia . This might significantly reduce costs and risks to the patient.

Cornea, 1991 Sep, 10(5), 408 - 10
Gentamicin resistance in staphylococcal corneal ulcers; Mader TH et al.; Gentamicin sulfate is frequently included in the initial treatment of suspected bacterial keratitis . We present the gentamicin susceptibility test results for coagulase-negative staphylococci and Staphylococcus aureus isolated from corneal ulcers in nine patients . All were resistant to gentamicin by standard disk diffusion techniques . The minimum inhibitory concentrations were very high, some exceeding the concentration normally achieved by frequent topical application of antibiotics . Clinicians should be aware that strains of staphylococci extremely resistant to gentamicin may cause keratitis . An antibiotic with broad activity against Gram-positive organisms, such as a cephalosporin or vancomycin, should be included as part of the initial therapy for corneal ulcers that might be caused by staphylococci.

Arch Dis Child, 1991 Sep, 66(9), 1075 - 6
Oxygen saturation in cystic fibrosis; Betancourt M et al.; The availability of non-invasive oxygen saturation (SaO2) measurement could prove to be a useful tool for following up the progress of patients with cystic fibrosis . The present study was undertaken to compare its use with other routine measurements in the clinic . A total of 100 patients with cystic fibrosis were compared with 50 patients with stable asthma . The children were aged between 5 and 16 years and were studied as outpatients . A positive correlation was found between forced expiratory volume in one second and SaO2 in the group with cystic fibrosis and in the comparison group . Median SaO2 in those with cystic fibrosis (94.0%) was significantly lower than in controls (97.0%) . Significant correlations were also found in the patients with cystic fibrosis for the following: Shwachman-Kulczycki score, higher weight centiles, and chronic pseudomonas lung infection with or without staphylococci . An inverse correlation was found with the Chrispin-Norman chest x ray score . SaO2 measurements are useful in the outpatient assessment of patients with cystic fibrosis and compare well with other standard tests of disease severity.

Infect Immun, 1991 Sep, 59(9), 3323 - 6
Blood proteins do not promote adherence of coagulase-negative staphylococci to biomaterials; Muller E et al.; We studied the effects of in vitro and in vivo coating of catheters with human blood proteins on binding of coagulase-negative staphylococci . Coating resulted in no enhancement of binding . Catheters coated in vitro bound fewer organisms than uncoated catheters . Host proteins do not enhance adherence of coagulase-negative staphylococci to biomaterials.

Antibiot Khimioter, 1991 Sep, 36(9), 9 - 11
{Resistance of hospital Staphylococci to beta-lactam antibiotics}; Kukulianskii AA et al.; Resistance of hospital Staphylococci to beta-lactam antibiotics was studied . The strains were isolated in two obstetric hospitals during an outbreak of purulent inflammatory infections in them . A modification of the "clover leaf" procedure providing elucidation of the resistance mechanism was used in the study . Development of the resistance to the beta-lactam antibiotics was shown to be mainly due the activity of beta-lactamases which makes it possible to discuss their role in the mechanism of resistance development.

Rev Infect Dis, 1991 Sep-Oct, 13 Suppl 10, S805 - 9
Alteration of cutaneous staphylococcal flora as a consequence of antimicrobial prophylaxis; Archer GL; Antimicrobial agents given as prophylaxis have profound effects on the microbial flora of the skin . Coagulase-negative staphylococci cultured from the skin of patients after cardiac surgery have been found to be more resistant to antimicrobial drugs than organisms cultured from the same skin sites preoperatively . Evidence exists both for the selection of resistant organisms from the preoperative flora and for the postoperative acquisition of such organisms from the nosocomial environment . Staphylococci causing postoperative infections have the same antimicrobial resistance phenotypes as do colonizing isolates; this observation suggests that colonized patients and hospital staff make up a nosocomial reservoir for resistant organisms.

J Hosp Infect, 1991 Sep, 19 Suppl B, 35 - 40
Minimal dose requirements for nasal mupirocin and its role in the control of epidemic MRSA; Casewell MW et al.; Staphylococci are still a leading cause of hospital infection . The success of nasal mupirocin for the control of epidemic methicillin-resistant Staphylococcus aureus (EMRSA), the prevention of colonization of central venous cannulae, and the prevention of septicaemia in haemodialysis patients should encourage the use of minimal dose regimens to minimize the emergence of mupirocin resistance . Mupirocin applied to the anterior nares 4-times daily usually eliminates S . aureus, including EMRSA, within 48 h . Elimination is sustained for several weeks in patients and staff . We recently found that a single dose, or a regimen of 4-times daily for 2 days, eliminated nasal carriage of S . aureus within 24 h; 7 days after a single dose, 92% of the subjects were still cleared; 7 days after the 2-day course, 96% remained free of nasal S . aureus . Ward personnel who are nasal carriers of EMRSA can, provided that other carriage sites are negative, return to work after 2 days of a 4-times daily intranasal regimen . The UK guidelines, recently published in this Journal, recommend an aggressive approach to identifying and eliminating EMRSA, including the elimination of nasal carriage . This approach is increasingly associated with the control of EMRSA in the UK and elsewhere.

J Hosp Infect, 1991 Sep, 19 Suppl B, 31 - 4
Potential inroads to reducing hospital-acquired staphylococcal infection and its cost; Kappstein I et al.; Staphylococci are still the most common agents implicated in hospital-acquired infections . In addition to Staphylococcus aureus, coagulase-negative staphylococci have attracted widespread interest, since they have emerged as the most frequent pathogen in foreign-body related infections . The emergence of methicillin-resistant S . aureus has resulted in increasing use of potentially toxic and extremely expensive antibiotics . To prevent hospital-acquired staphylococcal infections only control measures proven to be effective should be implemented and the cost of infection control procedures should always be considered . Handwashing as the simplest, cheapest, and still the most effective measure should constantly be stressed . In this article, effective procedures for the prevention of hospital-acquired staphylococcal infections are summarized, with special emphasis on cost-saving measures.

J Hosp Infect, 1991 Sep, 19 Suppl B, 3 - 17
The continuing importance of staphylococci as major hospital pathogens; Grosserode MH et al.; Rates of hospital-acquired staphylococcal infection have risen substantially in the United States over the last decade . Moreover, it has been shown that bloodstream infections caused by these organisms account for significant morbidity and mortality . It is likely that the changes in medical practice and in types of patient account for these changes, and current antibiotic therapy has helped select more resistant organisms . The increasing use of implantable and temporary medical devices and the increased use of immunosuppressive therapies correlate strongly with the rising incidence of these organisms . Likewise, more patients are predisposed to these infections because of poor immune status and factors favouring colonization . Intrinsic microbiological factors such as glycocalyx production and the presence of bacterial surface proteins allow these organisms to adhere to protein coated foreign bodies and basement membranes thus enabling them to initiate infection and cause disease . Moreover, virulence factors such as encapsulation, slime production and elaboration of extracellular enzymes aid their resistance to host defences . As a group, staphylococci are a leading cause of hospital-acquired infection, and species identification is required for both treatment and control.

Clin Lab Sci, 1991 Sep-Oct, 4(5), 299 - 302
Staphylococcus aureus identification: thermonuclease agar for direct testing of blood isolates and a new slide agglutination test; McDowell B et al.; Simulated blood cultures were used to evaluate Thermonuclease agar (Remel) for distinguishing Staphylococcus aureus from coagulase-negative staphylococci (CNS) without subculture to agar media, and a new slide agglutination test (Staphylochrome; Innovative Diagnostic Systems) was evaluated for its ability to distinguish S . aureus from CNS after growth on blood agar . A total of 125 S . aureus and 124 CNS isolates were tested by each method . Reference identification methods included tube coagulase, thermonuclease detection from solid media, and biochemical characterization . Direct thermonuclease testing with simulated blood cultures correctly identified all 249 isolates . Staphylochrome correctly identified 121 of 125 S . aureus and all CNS isolates . S . aureus was reliably distinguished from CNS by both tests evaluated in this study.

J Paediatr Child Health, 1991 Aug, 27(4), 235 - 9
Chronic granulomatous disease: a different pattern in Hong Kong?
Lau YL, Wong SN, Lawton JW, Chow CB.
From July 1988 to December 1989, six boys with chronic granulomatous disease were diagnosed in our institutions . Their clinical features were reviewed in order to delineate the pattern of infections which seems to have both similarities and differences when compared with published reports of Caucasian patients . The most striking differences was the lack of skin sepsis and chronic lymphadenitis in our six patients . Gram-negative organisms were the commonest pathogens while Staphylococci sp . were not isolated . Clinical features which should alert one to the diagnosis were also highlighted . Prophylactic co-trimoxazole was effective in reducing the frequency of bacterial infections . Early diagnosis is not only essential for optimal patient management but also for genetic counselling for the extended family.

Bol Med Hosp Infant Mex, 1991 Aug, 48(8), 559 - 64
{Induction and recovery of immunologic weakening}; Garcia-Tamayo F et al.; During this experimental work, we studied the immunological recuperation in CD1 mice in whom a weakening disease was induced using intraperitoneal injections of a sterile mixture of dead staphylococci . After a deep depression of the synthesis of anti-sheep red blood cell antibodies (SRBC) during the following 10 days after the induction of wasting, the animals regained their capability to produce anti-SRBC antibodies, significantly increasing . Two weeks after the injections were applied, the average number of antibody producing cells rose significantly and even doubled in the control group of healthy mice . Finally, after two weeks after this "rebound", the number of antibody forming cells return to normality . The article includes a discussion on the biological significance of this carried out in experimental animals while offering a hope for children with secondary immunological deficiencies or for those with repeatedly severe infections.

J Med Microbiol, 1991 Aug, 35(2), 65 - 71
Characterisation and functional aspects of monoclonal antibodies specific for surface proteins of coagulase-negative staphylococci; Timmerman CP et al.; Mouse monoclonal antibodies (MAbs) raised against whole cells of Staphylococcus epidermidis strain 354 were characterised morphologically and functionally . Nine MAbs showed strong reactivity with coagulase-negative staphylococci (CNS) . Only two MAbs were specific for CNS; both belonged to the IgG1 subclass, and one, MAb 36.4, reacted only with the strain used for immunisation . In immunoblotting, both CNS-specific MAbs 36.3 and 36.4 reacted strongly with cell-wall protein bands of 220 Kda of S.epidermidis strain 354 and weak reactivity was observed with a 110-Kda band . MAb 36.3 reacted also with 220-230 Kda bands of two other S.epidermidis strains (291 and ATCC 35984) and a 160-180 Kda band of S.epidermidis strain 354 . Only MAb 36.4 promoted phagocytosis of strain 354 by polymorphonuclear leucocytes (PMNL) and monocytes, whereas MAb 36.3 and the other MAbs lacked this activity . Opsonisation of S . epidermidis with MAb 36.4 in the presence of complement enhanced uptake by PMNL, but not by monocytes . Furthermore, S.epidermidis strain 354 opsonised with MAb 36.4 induced chemiluminescence of PMNL . Immuno-gold electronmicroscopy with both MAbs 36.3 and 36.4 demonstrated a homogeneous distribution of gold particles on the surface as well as close to the surface of S.epidermidis.

Infect Immun, 1991 Aug, 59(8), 2573 - 8
Role of neutrophil receptors in opsonophagocytosis of coagulase-negative staphylococci; Schutze GE et al.; The role of neutrophil complement receptors in the opsonophagocytosis of 10 strains of coagulase-negative staphylococci was investigated . Polymorphonuclear leukocytes from adults as well as term and premature newborn infants were tested with normal human serum, adult hypogammaglobulinemic serum, and pooled premature infant serum in an opsonophagocytic assay . Neutrophils from premature infants demonstrated significantly lower killing capacity (62%) than neutrophils from adults (86%) or term infants (84%; P less than 0.02) . Maximum inhibition of opsonophagocytosis by adult or infant neutrophils occurred with an FcIII receptor blockade (80%), whereas a blockade of complement receptors produced minimal inhibition . Opsonophagocytic activity for the coagulase-negative staphylococci was not influenced by the serum source but was influenced by reducing the serum concentration below 5% . Abrogation of the complement activity of normal human serum by heating or the addition of ethylenediamine tetraacetate reduced opsonophagocytosis by 100 and 96%, respectively, whereas selective inhibition of the classical complement pathway reduced opsonophagocytosis by only 40% . Thus, opsonophagocytosis of coagulase-negative staphylococci by human sera appears to be mediated primarily by neutrophil Fc receptors, but complement is also required . The inefficiency of these interactions with neutrophils from premature infants may partially explain the enhanced susceptibility of very-low-birth-weight neonates to disseminated, coagulase-negative staphylococcal infections.

J Antimicrob Chemother, 1991 Aug, 28(2), 261 - 9
Comparative therapeutic efficacy of teicoplanin and vancomycin in normal and in neutropenic mice infected with Staphylococcus haemolyticus; Torney HL et al.; This study describes the evaluation of a murine bacteraemia model for assessing antibiotic efficacy in normal and neutropenic mice infected with coagulase-negative staphylococci . In one such evaluation, it was found that there was no significant (P greater than 0.05) difference in the ability of teicoplanin or vancomycin to protect normal or neutropenic CD-1 mice, lethally-infected with Staphylococcus haemolyticus . However, about a four-fold increase of either antibiotic was needed to protect the immunocompromised animals.

Antimicrob Agents Chemother, 1991 Aug, 35(8), 1679 - 81
Activity of new quinolones against ciprofloxacin-resistant staphylococci; Forstall GJ et al.; Because of the development of newer fluoroquinolones with improved activity against gram-positive organisms, we elected to compare the inhibitory properties of ofloxacin, temafloxacin, sparfloxacin, PD131628, PD127391, and WIN57273 against 105 ciprofloxacin-resistant staphylococci . Based on comparison of MICs for 90% of the organisms (MIC90s), WIN57273 was the most active agent against oxacillin-resistant Staphylococcus aureus; the MIC90 was 0.5 microgram/ml . Against oxacillin-resistant, coagulase-negative staphylococci, PD127391 and WIN57273 were the most active agents; the MIC90 was 0.5 microgram/ml . Against isolates of staphylococci for which ciprofloxacin MICs were greater than or equal to 32 micrograms/ml, WIN57273 and PD127391 still exhibited high activity, inhibiting 100 and 95% of the isolates, respectively, at 2 micrograms/ml . The spontaneous mutation rates for ciprofloxacin-susceptible staphylococci were lowest for ofloxacin . The frequency of spontaneous mutations of ciprofloxacin-resistant staphylococci was low; however, the MICs of PD127391 and WIN57273 for these mutant isolates were greater than 2 micrograms/ml . WIN57273 and PD127391 are two potent new quinolones with high levels of activity against highly ciprofloxacin-resistant staphylococci . There is, however, a major concern of selection of spontaneous mutants resistant to these newer agents.

Lett Appl Microbiol, 1991 Aug, 13(2), 90 - 2
Screening of staphylococci for the toxic shock syndrome toxin-1 (TSST-1) gene; Jaulhac B et al.; Dot blot hybridization was used to screen 820 staphylococci for the presence of the gene coding for TSST-1 . The DNA of 33 strains among 70 Staph . aureus strains isolated from suspected toxic shock syndrome (TSS) cases hybridized with the probe . These results agreed perfectly with those obtained with a phenotypic method (immunodiffusion) . Among 608 Staph . aureus strains isolated over a period of one month from hospitalized patients, 66 (11%) hybridized with the probe; of these strains, 64 (97%) were found to produce TSST-1 in vitro . None of 145 coagulase-negative staphylococcal strains harboured DNA hybridizing with the probe . The data indicate that this genotypic assay is suitable for epidemiological studies.

Fortschr Med, 1991 Jul 30, 109(22), 437 - 40
{Infections caused by staphylococci . The human as a source of infection for S . aureus and coagulase negative staphylococci}; Peters G; Both Staphylococcus aureus and coagulase-negative staphylococci are among the most important pathogens of nosocomial infections . While Staphylococcus aureus can cause a variety of pyogenic infections and toxin-mediated diseases coagulase-negative staphylococci of the Staphylococcus epidermis group play an important role in infections developing in immunocompromised patients and those with temporarily or permanently implanted foreign bodies made of polymer . The major sources of staphylococcal infections are the skin and mucosa in humans . While in the case of Staphylococcus aureus the infection route may be either endogenous or exogenous, in the case of coagulase-negative staphylococci, the endogenous route predominates . This ecological-epidemiological situation forms the basis for strategies aimed at preventing nosocomial staphylococcal infections.

J Med Microbiol, 1991 Jul, 35(1), 45 - 8
Susceptibility to desferrioxamine: a new test for the identification of Staphylococcus epidermidis; Lindsay JA et al.; The ability to identify Staphylococcus epidermidis quickly and accurately has become increasingly important in clinical microbiology . Susceptibility to desferrioxamine, an iron-chelating agent, was investigated as a new test for the identification of S . epidermidis . All strains of S . epidermidis and S . hominis tested were susceptible to a 1000-micrograms disk of desferrioxamine when grown on brain heart infusion agar . All other strains of coagulase-negative staphylococci, S . aureus and micrococci were resistant . As a single test, susceptibility to desferrioxamine was 96.4% efficient in identifying S . epidermidis; when combined with additional tests such as alkaline phosphatase production and fermentation of trehalose, the efficiency improved to 100% . Desferrioxamine disks were easy to prepare, stable and inexpensive . The test was simple to perform and interpret and should readily find application in clinical microbiology laboratories.

APMIS, 1991 Jul, 99(7), 627 - 30
Routine semiquantitative cultures and central venous catheter-related bacteremia; Aufwerber E et al.; Semiquantitative cultures were compared with blood cultures during one year in order to see if the routine use of a semiquantitative catheter culture method (SQC) in unselected patients can detect or predict infection associated with central venous catheters . Catheter infection, i.e . greater than or equal to 15 colony forming units (cfu) per plate, occurred in 137 of 542 catheter tips (25%), mainly with coagulase-negative staphylococci . Catheter-associated bacteremia occurred in 17 of 93 cases (18%) where blood cultures had been drawn . In 15 of these, the catheter tip grew greater than or equal to 15 cfu . The predictive value for bacteremia of a positive SQC was only 21% . SQC is not a suitable method for the detection of catheter-associated bacteremia, but may be an indicator of the standard of central venous catheter hygiene.

J Dent Res, 1991 Jul, 70(7), 1045 - 7
Incidence and characterization of Staphylococcus aureus from the tongues of children; Miyake Y et al.; Three hundred and seven children who had no diseases other than dental disease were examined for their oral carriage of Staphylococcus aureus, the most common persistent human pathogen . Eighty-four percent of them were positive for staphylococci, and 33% were positive for S . aureus . Among the 100 strains of S . aureus isolated, 40 strains produced enterotoxin, and 19 strains produced exfoliative toxin . Their susceptibility to antibiotics was also investigated: Six strains demonstrated resistance to methicillin (MIC greater than or equal to 12.5 microgram/mL), and 50% of the isolates were borderline resistant (MIC of 3.13 to 6.25 micrograms/mL) to the drug . These data suggest that the mouths of children could be reservoirs of pathogenic S . aureus.

Antimicrob Agents Chemother, 1991 Jul, 35(7), 1277 - 83
Molecular cloning, purification, and properties of a plasmid-encoded chloramphenicol acetyltransferase from Staphylococcus haemolyticus; Schwarz S et al.; A small chloramphenicol resistance (Cmr) plasmid of approximately 3.75 kb, designated pSCS5, was isolated from Staphylococcus haemolyticus . This plasmid encoded an inducible chloramphenicol acetyltransferase (CAT; EC 2.3.1.28) . The cat gene of pSCS5 was cloned into the Escherichia coli plasmid vector pBluescript SKII+ . It differed in its nucleotide sequence and deduced amino acid sequence from the cat genes described previously in staphylococci and other gram-positive bacteria . The CAT enzyme was purified from cell-free lysates by ammonium sulfate precipitation, ion-exchange chromatography, and fast protein liquid chromatography . The native enzyme had an Mr of 70,000 and was composed of three identical subunits, each with an Mr of approximately 23,000 . Its isoelectric point was at pH 6.15 . CAT from pSCS5 exhibited Km values of 2.81 and 51.8 microM for chloramphenicol and acetyl coenzyme A, respectively . The optimum pH for activity was 7.8 . CAT encoded by pSCS5 proved to be relatively heat stable, but sensitive to mercury ions . The observed differences in the nucleotide sequence and the biochemical characteristics of the enzyme allowed the identification of the pSCS5-encoded CAT from S . haemolyticus as a CAT variant different from those described previously in gram-positive bacteria.

Ann Oncol, 1991 Jul, 2(7), 485 - 7
Home treatment of febrile neutropenia: an empirical oral antibiotic regimen; Gardembas-Pain M et al.; Between May 1988 and November 1989, 68 consecutive febrile courses supervening after polychemotherapy for lymphoma outpatients (median age 50 years) were treated by the combination of oral Pefloxacin/Amoxicillin Clavulanic acid . In terms of median data, neutropenia appeared on d9 {d1-d17}, and lasted 5 days {2-9} with a PMN nadir observed at 0.104 x 10(9) {0-0.5 x 10(9)/l}, while fever rose on d10 {1-24} . In 59 cases (87%), fever and/or focal symptoms disappeared within 3 days, after which treatment was maintained for 7 days . Nine failures were observed, of which 2 were due to abandonment of treatment, 2 to vomiting and 5 to persistence of the original symptoms . Meti Susceptible-Staphylococci were found in blood samples from 2 patients, one of whom, with grade IV lymphoma that had proved resistant to chemotherapy, died . The treatment was found to be effective and well tolerated, offering a good alternative to hospitalization during a transient chemotherapy-induced neutropenia.

J Clin Periodontol, 1991 Jul, 18(6), 411 - 20
New views on periodontal microbiota in special patient categories; Slots J et al.; The microorganisms in periodontitis of special patient categories have been only partially elucidated . The periodontitis microbiota of HIV-infected individuals, cancer patients on myelosuppressive therapy, and persons with other medical disorders includes common suspected periodontal pathogens as well as enteric rods, pseudomonads, staphylococci and yeasts . Failing implants also may be associated with classical periodontal pathogens as well as primarily nonoral potential pathogens . Refractory periodontitis in systemically healthy adults can show a great variety of oral and nonoral organisms . The frequent occurrence of unusual periodontal organisms in special patient categories may be due to a weakened host response and/or usage of various chemotherapeutic regimens . The unusual organisms may contribute to progressive periodontitis and in leukemia patients may even give rise to life-threatening systemic manifestations . The primary therapeutic goal in special periodontitis patients is control of pathogens and amid the wide range of pathogenic microfloras, an effective treatment strategy should include a comprehensive microbiological analysis, especially if systemic antimicrobial therapy is contemplated.

J Clin Pathol, 1991 Jul, 44(7), 600 - 4
Role of mesothelial cells in peritoneal antibacterial defence; Muijsken MA et al.; Whether phagocytosis of Staphylococcus aureus by polymorphonuclear neutrophils, monocytes, and peritoneal macrophages takes place when the staphylococci are adherent to monolayers of human mesothelial cells in the absence of opsonins was investigated . Adherence of S aureus to mesothelial monolayers increased significantly when the bacteria were opsonised with pooled human serum, but phagocytosis by polymorphonuclear neutrophils and monocytes occurred independently . Phagocytosis by peritoneal macrophages, however, was only marginal . Pretreatment of polymorphonuclear neutrophils with inhibitors of cellular metabolism and motility reduced their phagocytic capacity . These results indicate that the surface of mesothelial cells provides favourable conditions for the elimination of staphylococci in the peritoneal cavity . Phagocytic motility seems to be important in surface phagocytosis . The inability of peritoneal macrophages to phagocytise staphylococci adherent to the mesothelial cells suggests that they contribute little to the antibacterial defence of the peritoneal membrane of patients receiving peritoneal dialysis.

Br J Ophthalmol, 1991 Jul, 75(7), 440 - 1
Late onset endophthalmitis associated with intraocular lens: a case of molecularly proved S . epidermidis aetiology; Jansen B et al.; A case of severe endophthalmitis after cataract extraction followed by posterior chamber lens implantation is reported . Microbiological cultures from a tap of the patient's aqueous humour prior to lens explantation as well as from the explanted lens and aqueous and vitreous humour during operation yielded Staphylococcus epidermidis sensu stricto . Scanning electron microscopy showed massive colonisation of the lens loop by staphylococci . Clonal identity of all isolates was demonstrated by plasmid DNA analysis and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) of extra-cellular products . This is strongly suggestive of the aetiological role of S . epidermidis in this case of late onset endophthalmitis.

Mater Med Pol, 1991 Jul-Sep, 23(3), 226 - 8
Neonatal sepsis in Turkey: the comparison between penicillin plus aminoglycoside and ampicillin plus third-generation cephalosporin chemotherapies; Gokalp AS et al.; Bacterial infections during the neonatal period continue to be a major cause of neonatal morbidity and mortality in developing countries . In this study the etiological and clinical features and treatment regimens of 73 neonates with sepsis and suspected sepsis have been analysed . In contrast to developed countries, staphylococci were found to be still common etiological agents and the treatment regimen of ampicillin plus third-generation cephalosporin was highly effective.

J Antimicrob Chemother, 1991 Jul, 28(1), 131 - 9
Low dose intraperitoneal ciprofloxacin for the treatment of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD); Dryden MS et al.; Ciprofloxacin at a dose of 25 mg/L of dialysate was administered intraperitoneally for five days as a single agent for the empirical treatment of CAPD peritonitis . One hundred and seventeen consecutive episodes of peritonitis occurred in 65 patients during the study period, and 100 episodes were entered in the study . This therapy was successful in 79% of episodes . Resistant organisms (MIC greater than 4 mg/L) all of them coagulase-negative staphylococci, were isolated in nine (7.8%) of the 117 episodes . Mean ciprofloxacin concentrations in dialysate and serum on the last day of treatment were 6.1 mg/L (range 0.3-15.7) and 0.3 mg/L (range 0-0.9) respectively . No adverse effects were reported.

Mikrobiyol Bul, 1991 Jul, 25(3), 227 - 34
{Antibiotic sensitivity tests of methicillin-resistant staphylococci}; Sultan N et al.; In this study, 231 Methicillin-Resistant Staphylococcus (MRS) and 76 Methicillin-Susceptible Staphylococcus (MSS) strains were investigated . 23 antibiotics were tested by using Modified Kirby-Bauer Technique . The highest resistance ration in MRS strains were found for lincomycin, clindamycin and ampicillin with the ratios of 61.0%, 59.3%, and 56.2% respectively . And the lowest resistance ratios were measured for vancomycin, ciprofloxacin and ofloxacin 0.5%, 8.2%, 10.8% respectively . It was found that, resistance of MRS strains to 17 antibiotics were significantly higher than resistance of MSS strains, but not for sulbactam-ampicillin, cefoperazone, ceftriaxone, vancomycin, ciprofloxacin, ofloxacin and netilmicin.

East Afr Med J, 1991 Jul, 68(7), 507 - 14
Occurrence of toxic shock syndrome toxin-1 producing Staphylococcus aureus and the anti TSST-1 serostatus of hospital personnel in Nigeria; Olusanya O et al.; Of the 56 S . aureus strains tested, five (8.9%) isolates (four from asymptomatic nasal carriage and one from a non TSS staphylococcal disease) demonstrated TSST-1 production in vitro . Among the toxin positive strains the clinical isolate belonged to phage group I, 29/52 and the nasal carriage isolates were either non typable or ungroupable . Eighty-nine percent of isolates including all TSST-1 positive strains showed binding to crystal violet and were traced to S . aureus var . hominis (CV type C/D) . A . aureus var . bovis (CV type A/B) were found only in nasal carriage group (10.7%) and did not bind crystal violet . During the sero-surveillance 101 out of 220 hospital personnel (48.1%) showed TSST-1 antibodies of IgG class at 1:1000 sera dilution . The four individuals with asymptomatic nasal carriage of TSST-1 positive staphylococci showed no antibody to the toxin . Anti TSST-1 levels persisted in 58 (57.4%) and 10 (9.9%) individuals at higher sera dilutions of 10(-4) and 10(-5) respectively.

J Appl Bacteriol, 1991 Jul, 71(1), 38 - 45
Encapsulation of coagulase-negative staphylococci of bovine origin; Matthews KR et al.; Capsule expression was assessed in six coagulase-negative staphylococcal strains in serum-soft agar and by india ink and electron microscopy . Classification of strains as encapsulated by serum-soft agar and india ink methods differed . Staphylococcus chromogenes, Staph . hyicus, and Staph . simulans grew as diffuse colonies in serum-soft agar and unstained halos were detected in india ink preparations . Staphylococcus hominis and Staph . simulans grew as diffuse colonies in serum-soft agar but no unstained halo was seen in india ink preparations . Staphylococcus hyicus was the only strain that gave negative results with serum-soft agar and india ink assays . Conventional electron microscopy revealed the presence of capsular polysaccharides on the cell surface of Staph . chromogenes, Staph . hominis and Staph . hyicus . Conventional electron microscopic technique used to examine the surface of cells was detrimental to capsule structure . During dehydration the capsule collapsed and appeared as electron dense aggregates at the surface of cells . To confirm results of conventional electron microscopy and to visualize clearly the cell surface, encapsulated Staph . hyicus and unencapsulated Staph . simulans were observed after freeze-fracture and etching by scanning electron microscopy . The fibrous nature of capsular polysaccharides surrounding cells of Staph . hyicus were distinct and confirmed observation by conventional electron microscopy . A rapid transmission electron microscopic technique is described also for observation of capsule . Results of the rapid TEM method agreed with conventional TEM and SEM . The finding that coagulase-negative staphylococci isolated from bovine milk are capable of capsule production may be important when investigating pathogenicity of these micro-organisms.

Eur J Biochem, 1991 Jul 1, 199(1), 217 - 22
A family of bombinin-related peptides from the skin of Bombina variegata; Simmaco M et al.; A peptide fraction was isolated from the skin of Bombina variegata that showed antimicrobial activity . This fraction contained several molecular species, all of them consisting of 27 amino acid residues, with a constant C-terminal region (from residues 14-27), including an amidated carboxyl end and a variable N-terminal segment . These peptides are related but not identical to bombinin {Csordas, A . & Michl, H . (1970) Monatsh . Chem . 101, 182-189} . By using synthetic oligonucleotides corresponding to the C-terminal region of the peptides, a cDNA library from the skin of B . variegata was screened and several positive clones coding for the corresponding peptide precursors were isolated and sequenced . Each clone contained the genetic information for a different bombinin-like peptide . The antimicrobial activity towards different bacterial species of a synthetic peptide corresponding to one of the variants deduced from cDNA sequences was tested . This peptide was found to be mainly active against different isolates of Staphylococci and Escherichia coli.

Presse Med, 1991 Jun 22, 20(24), 1109 - 12
{Surgical treatment of right-sided infective endocarditis}; Pagbe JJ et al.; Between 1980 and 1989, 8 patients (5 men, 3 women; mean age 30 years) were operated upon in our department of right-sided infective endocarditis . Six patients were heroin addicts and among these 3 were HIV positive and 2 had confirmed AIDS . The most frequently encountered microorganisms (6 cases) were staphylococci . It was decided to operate because of persistent infection and haemodynamic deterioration . The infection involved the pulmonary valve in only 1 of the 8 patients . Surgery was performed during the acute phase in 5 patients and was conservative in 6 patients, consisting of excision of the vegetations or valvulectomy combined or not with valvuloplasty . A high mortality rate (3/8 cases) was observed only among patients operated upon in the acute phase . This may be due to the underlying immunodeficiency and poor haemodynamic state of these patients . Among survivors, the long-term results were excellent, with no recurrent endocarditis and no death, and with only one subsequent operation, 4 years after the first one, for residual tricuspic valve regurgitation . This study shows that patients with right-sided infective endocarditis should be operated upon outside the acute phase of the disease and as soon as complications appear, and that surgery should preferably be conservative.

J Med Microbiol, 1991 Jun, 34(6), 323 - 8
Human lactoferrin binding in clinical isolates of Staphylococcus aureus; Naidu AS et al.; Human lactoferrin (HLf) is an iron-binding protein and a host-defence component at the mucosal surface . Recently, a specific receptor for HLf has been identified on a strain of Staphylococcus aureus associated with toxic shock syndrome . We have looked for the occurrence of 125I-HLf binding among 489 strains of S . aureus isolated from various clinical sources . HLf binding was common among S . aureus strains associated with furunculosis (94.3%), toxic shock syndrome (94.3%), endocarditis (83.3%) and septicaemia (82.8%) and other (nasal, vaginal or ocular) infections (96.1%) with a mean binding (in fmol) of 29.1, 21.9, 16.9, 22.2 and 29.2 respectively; the differences between mean HLf binding values of 29.1-29.2, 21.9-22.2 and 16.9 were significant . Furunculosis-associated (low-invasive or localised) isolates were high-to-moderate binders of HLf; 50% gave positive results at a threshold of greater than 31 fmol of 125I-HLf bound . In contrast, endocarditis-associated (high-invasive or systemic) isolates demonstrated low binding and did not bind 125I-HLf at the above threshold level . S . aureus recognised human or bovine Lf . However, bound 125I-HLf was more effectively inhibited in a dose-dependent manner by unlabelled bovine Lf than by homologous HLf . Binding of 125I-HLf to staphylococci was optimal with organisms grown in agar compared with those from broth cultures . The binding capacity of S . aureus was abolished when strains were grown on carbohydrate- and salt-rich agar media . HLf-binding ability of S . aureus did not correlate with fibronectin, fibrinogen, immunoglobulin G or laminin binding.

APMIS, 1991 Jun, 99(6), 521 - 9
The effect of antistaphylococcal agents used alone and in combinations on the survival of Staphylococcus aureus ingested by human polymorphonuclear leukocytes; Roder BL et al.; The intracellular activity of a number of drugs used alone and in combinations against Staphylococcus aureus was investigated using an experimental design which imitates the clinical situation and differs from other published methods . Staphylococci were phagocytosed by human polymorphonuclear leukocytes and, after differential centrifugation and washing, the granulocytes were incubated in 90% pooled human serum with clinically relevant drug concentrations . When exposed to antibiotics, more than 40-50% of the bacteria were located intracellularly . Fusidic acid (100 mg/l), erythromycin (20 mg/l), and clindamycin (20 mg/l) all had a bacteriostatic effect during the first 6 h of incubation, whereas rifampicin (1 and 5 mg/l), vancomycin (5 and 20 mg/l), and ciprofloxacin (2 mg/l) all acted bactericidally with decreases in viable counts between 1.3-1.9 log10 . The greatest bactericidal effect was achieved with tobramycin (10 mg/l), which produced more than a 4 log10 decrease in viable counts at 6 h . Combinations of fusidic acid with other antibiotics all resulted in killing kinetics different from those achieved with the drugs used individually . The bactericidal effect of ciprofloxacin and dicloxacillin during the first 6 h was abolished when these drugs were combined with fusidic acid . However, at 24 h no significant difference was found between the effect of dicloxacillin alone versus the combination dicloxacillin and fusidic acid . The combination of fusidic acid and rifampicin resulted in a killing identical to that achieved with rifampicin used alone during the first 6 h, but at 24 h the killing by the combination was significantly greater . The bactericidal effect of the combination dicloxacillin (20 mg/l) and tobramycin (10 mg/l) equalled that obtained with tobramycin (10 mg/l) used alone . Rifampicin (5 mg/l) antagonized the bactericidal effect of ciprofloxacin (2 mg/l) during the first 6 h of incubation but at 24 h the combination acted synergistically . The results obtained are partly in agreement and partly in conflict with previous results.

Epidemiol Infect, 1991 Jun, 106(3), 467 - 75
Characterization of clinically significant isolates of Staphylococcus epidermidis from patients with cerebrospinal fluid shunt infections; Etienne J et al.; Biotyping, slime production, antibiograms, extrachromosomal DNA banding and total DNA restriction analysis were used to characterize Staphylococcus epidermidis strains causing cerebrospinal fluid shunt infections in 11 patients . Infections considered to be community acquired and those acquired in the first 2 weeks of hospital admission were due to oxacillin-susceptible isolates . Multiply resistant strains were isolated from patients who were in hospital for more than 1 month before tube implantation . Slime was detected in staphylococci for 54% of cases, but its expression varied . Strains from different patients could be differentiated from one another by the extrachromosomal DNA bandings and total DNA restriction patterns, but isolates from the same patient were usually similar . During the period of external drainage, epidemiological markers were useful in differentiating persistence of infection from contamination or re-infection by a new strain.

Am J Infect Control, 1991 Jun, 19(3), 156 - 61
Indigenous multiresistant bacteria from flowers in hospital and nonhospital environments; Kates SG et al.; The microbial flora of 60 vase water samples from cut flowers obtained from several environments, including a hospital, were examined in this study . Forty-one different bacterial species were identified, including 12 species of Pseudomonas . The mean total aerobic bacterial count per 500 ml of vase water was 4.5 x 10(8) organisms, and high levels of antibiotic resistance were found . To ascertain the origin of the bacteria found on the flowers as well as their growth patterns, natural cut flowers were compared with sterilized cut flowers in tap water over time . Although the density of organisms was similar, the flora in vase water of sterilized flowers consisted almost entirely of aerobic spore formers while mixed flora of gram-negative bacteria, staphylococci, aerobic spore formers, and fungi were isolated from natural flowers . Our results indicate that the multiply-resistant microbial flora found in vase water is indigenous to flowers, rather than originating from the environment in which they are placed, and that such water is a reservoir of large numbers of multiresistant organisms.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Jun, (6), 53 - 6
{The immunomodulating action of the surface antigens of the influenza A virus in experimental staphylococcal infection}; Lavrov VF et al.; The results of the study of influenza A virus surface antigens, hemagglutinin and neuraminidase, in the induction of nonspecific immunomodulation and protection from acute pulmonary staphylococcal infection have been studied . Protective effect, the cell composition of bronchoalveolar lavage fluid depend on the serological subtypes of surface antigens used for intranasal immunization and the infective dose of staphylococci.

Clin Perinatol, 1991 Jun, 18(2), 281 - 302
Coagulase-negative staphylococcal infection in the neonate; St Geme JW 3rd et al.; During the last decade, improved neonatal care has permitted the survival of extremely low birthweight infants who are at increased risk for the development of nosocomial infection . The coagulase-negative staphylococci currently represent the most frequent nosocomial pathogen isolated from infants in the newborn intensive care unit . This article details pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of neonatal infection with this organism.

Microb Pathog, 1991 Jun, 10(6), 443 - 50
Development and design of a novel in vivo chamber implant for the analysis of microbial virulence and assessment of antimicrobial therapy; Pike WJ et al.; An accurate reflection of the pathogenicity of microorganisms and the therapeutic effects of antimicrobial agents on their growth necessitates testing within an in vivo environment . We have developed a novel diffusion chamber, incorporating two 0.22 microns membrane filters, for the growth of in vivo organisms . The chamber, which is implanted intraperitoneally into the rat, has an external sampling portal . This portal allows multiple and sequential sampling of the microbial inoculum without killing the rat, thus significantly reducing the total number of animals used in such studies . In addition, the chamber is superior to other reported implants since it is well tolerated, reusable, easily constructed and can be used within two days of implantation . Staphylococcus epidermidis and a toxic shock syndrome toxin-1 (TSST-1) producing strain of S . aureus have been successfully grown within in vivo chambers, with 10(8)-10(9) organisms per millilitre being recovered within 48 h . Scanning electron microscopy revealed clusters of staphylococci and fibrous material adhering to the inner surface of the filters, with numerous phagocytic cells attached to the outer side . Western immunoblotting indicated that higher levels of TSST-1 were produced by S . aureus grown in vivo as opposed to cells grown in vitro.

J Clin Invest, 1991 Jun, 87(6), 2236 - 45
Fibrinogen acts as a bridging molecule in the adherence of Staphylococcus aureus to cultured human endothelial cells; Cheung AL et al.; The propensity of Staphylococcus aureus to cause acute endovascular infections during transient bacteremia is poorly understood . To examine the events leading to the attachment of staphylococci to endothelium, adherence assays were developed to study the role of blood factors in the mediation of staphylococcal adherence to cultured human umbilical vein endothelium in vitro . Results indicate that the preferential attachment of S . aureus to endothelial cells is mediated by fibrinogen adsorbed from plasma onto the endothelial surface . The binding is apparently specific because it could be blocked by goat anti-human fibrinogen antibody in a dose-dependent fashion while nonimmune goat IgG, mouse MAb against AG-1 (a platelet antigen found on the endothelial cell surface), nonspecific mouse MAb and rabbit antibodies to human vitronectin and fibronectin were not inhibitory . Our data also indicate that fibrinogen is a necessary but not the only blood constituent in the mediation of binding of S . aureus to endothelium . This was supported by the finding that fibrinogen alone, at a concentration equivalent to that in plasma, did not potentiate staphylococcal adherence as much as plasma while afibrinogenemic plasma reconstituted with fibrinogen did . Because fibrinogen is known to bind to endothelial cells, our data is consistent with the hypothesis that fibrinogen and additional plasma factor(s), possibly activated during inflammation, promote staphylococcal adherence to endothelium . In addition, the role of the fibrinogen binding receptor of S . aureus as an adherence factor to native endothelium is also suggested.

J Hosp Infect, 1991 Jun, 18 Suppl A, 367 - 75
Infection in orthopaedic implants; Sanderson PJ; The infection rate in hip prostheses should be less than 1.0% but in other joints is higher probably because of proximity to the skin surface and less experience in joint design . The organisms causing hip implant infection are Staphylococcus aureus 35%, S . epidermidis 15%, coliforms 25%, and anaerobes and others 25%; in other joints there may be a higher incidence of staphylococci . Clinical diagnosis is difficult since symptoms, X-rays and scans do not distinguish infection from loosening, but the erythrocyte sedimentation rate (ESR) moderately rises in infection . Treatment of deep infection by antibiotics alone is unlikely to succeed, but suppression of infection in patients unsuited to operation is possible . Surgeons should be encouraged to aspirate from the affected joint to obtain a bacteriological diagnosis; in the absence of this procedure broad spectrum antibiotics with good activity against S . aureus and S . epidermidis are required . Antibiotics must penetrate the membrane which forms in many patients at the implant or cement/bone interface but there is no evidence as to which antibiotics do so best . For prophylaxis there are three areas of uncertainty: (1) does antibiotic-impregnated cement provide additional effect to systemic antibiotics, since antibiotics can be found in the wound fluid after operation and gentamicin remains at the interface for many months?; (2) what proportion of late infections are haematogenous and do they demand prophylaxis for dental and surgical procedures?; (3) should greater protection from spread of staphylococci for the patient's skin and carrier sites be considered?

J Hosp Infect, 1991 Jun, 18 Suppl A, 355 - 66
Prosthetic valve endocarditis: a continuing challenge for infection control; Karchmer AW; Conventional medical thought accepts the risks of nosocomial prosthetic valve endocarditis (PVE) to be between 0.7 and 1.4%, the incidence within several months after surgery . More careful actuarial analysis of recent series suggests the risk of nosocomial PVE is 1.4-3.0%, with cases occurring throughout the year after surgery . Methicillin-resistant coagulase-negative staphylococci are the predominant cause of nosocomial PVE and account for 60% of cases . Intraoperative contamination by Staphylococcus epidermidis of nosocomial origin has led to small epidemics of PVE . Aside from the fundamental elements of aseptic surgical technique, studies have failed to identify elements of intraoperative or postoperative care that might be modified to reduce the incidence of sporadic cases of nosocomial PVE . Prophylactic antibiotics have become an essential element in the effort to prevent PVE . Some recent studies have advocated using cefamandole or cefuroxime for prophylaxis; however, other studies have failed to find these agents more effective than cefazolin . The use of vancomycin for prophylaxis requires additional study . Intensive studies are needed to define elements of perioperative and postoperative care that can be modified to reduce the frequency of nosocomial PVE.

J Hosp Infect, 1991 Jun, 18(2), 109 - 22
Recurrent CAPD peritonitis caused by coagulase-negative staphylococci: re-infection or relapse determined by clinical criteria and typing methods; Brown AL et al.; Four hundred consecutive episodes of continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis in 105 patients were analysed . Of these episodes 161 (40.25%) were caused by coagulase-negative staphylococci (CNS) . Thirty-seven patients developed recurrent attacks (3-10) of peritonitis and CNS accounted for 72 (60%) of these episodes . Classification of reinfection or relapse in 67 of these recurrent episodes of peritonitis was based on clinical criteria alone . This was compared with the results of three typing methods of CNS strains: biotyping plus antibiograms, immunoblotting and 35S-methionine-labelled protein patterns (radio-PAGE) . Radio-PAGE was the most discriminatory method followed by biotyping with antibiograms and then immunoblotting . There was total agreement between clinical diagnosis and the three typing methods in 67.2% of episodes but there was total disagreement between the clinical diagnosis and the three typing methods in 11.9%, suggesting inaccurate clinical diagnosis, and in 20.8% typing by at least one method differed from the clinical criteria . Thus, clinical criteria alone are inadequate for the accurate distinction of reinfection from relapse in recurrent CNS peritonitis . This distinction is desirable for optimal management and accurate assessment of different therapies . We suggest that CNS strains from peritoneal dialysate are stored for future typing should the patient develop repeated episodes of peritonitis, to aid in the diagnosis and management of such patients.

J Clin Microbiol, 1991 May, 29(5), 901 - 5
Clinical comparison of the recoveries of bloodstream pathogens in Septi-Chek brain heart infusion broth with saponin, Septi-Chek tryptic soy broth, and the isolator lysis-centrifugation system; Murray PR et al.; The recoveries of microorganisms in the Septi-Chek biphasic tryptic soy broth (TSB) and Isolator blood culturing systems were compared with the recovery in Septi-Chek biphasic brain heart infusion broth supplemented with the lytic agent saponin (L-BHIB; Roche Diagnostics, Division of Hoffmann-La Roche Inc.) . A total of 5,096 TSB-L-BHIB blood culture sets and 1,778 Isolator-L-BHIB sets were evaluated . There were 435 pathogenic organisms recovered in 413 (8.1%) of the TSB-L-BHIB cultures, with 348 organisms in the TSB bottles and 370 in the L-BHIB bottles (P less than 0.05) . Significantly more yeast isolates were recovered in the L-BHIB system (P less than 0.01) . Terminal subculture of the L-BHIB system was required to detect 13 clinically significant organisms . Significantly more organisms were recovered in the L-BHIB bottles than with the Isolator system (P less than 0.001), including Torulopsis glabrata, coagulase-negative staphylococci, and Pseudomonas species . The time required for detection of all major groups of organisms was the same in both comparisons . However, detection of microbial growth in the L-BHIB bottles required macroscopic inspection of the attached agar slide unit and the use of terminal subcultures after 7 days of incubation . The primary advantage of the biphasic L-BHIB system when compared with either the biphasic TSB system or the Isolator system was improved recovery of fungi.

J Clin Microbiol, 1991 May, 29(5), 857 - 61
Identification of the innate human immune response to surface-exposed proteins of coagulase-negative staphylococci; Plaunt MR et al.; The presumed host defense against coagulase-negative staphylococci (ConS), recognized pathogens in hosts with compromised immunity or indwelling medical devices, is opsonophagocytosis . Targets for opsonization remain unclear . Using radiolabeling techniques, we identified the surface-exposed proteins of ConS and determined the innate humoral immune responses to them among healthy adults . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of surface proteins extrinsically labeled with 125I demonstrated 20 to 30 proteins with molecular weights of 15,000 to greater than 130,000 . Five to ten of these proteins were immunogenic and recognized by normal human sera, including predominant 18-, 41-, 48-, and 51-kDa proteins . We also evaluated the humoral response of cancer patients with ConS bacteremia . Patients' sera obtained before bacteremic episodes demonstrated a pattern of reactivity similar to that of normal human sera . When patients' sera obtained after bacteremic episodes were used to determine whether an expanded immune response followed infection, only one of seven showed reactivity with more proteins than seen with the innate response . Western blot (immunoblot) analysis and whole-cell enzyme-linked immunosorbent assays were also evaluated . This study identifies (i) the surface-exposed proteins available for host interaction, (ii) the innate human antibody response to these proteins, and (iii) the immune response of cancer patients with ConS bacteremia.

J Surg Res, 1991 May, 50(5), 430 - 5
Antibiotic-bonded PTFE vascular grafts: the effect of silver antibiotic on bioactivity following implantation; Kinney EV et al.; Use of an infection-resistant vascular prosthesis has appeal for grafting in sites of potential contamination or to replace graft segments involved in low-grade infections caused by coagulase-negative staphylococci (CNS) . In this study, antibiotic retention on polytetrafluoroethylene (PTFE) grafts prepared using three antibiotic-bonding methods was compared following implantation into the arterial circulation . Ciprofloxacin or silver-ciprofloxacin was bonded to PTFE surfaces by surfactant-mediated or direct bonding methods . Antibiotic-bonded grafts of each type (n = 8) or control grafts (n = 2) were used to replace the carotid or femoral arteries of 10 dogs . Duplicate grafts segments (0.5 x 0.5 cm) were explanted at various time intervals ranging from 1 hr to 14 days later and imprinted onto culture plates of Klebsiella pneumonia . Antibiotic retention (micrograms/ml) was determined by measuring zones of inhibition and correlated with known disc concentrations of ciprofloxacin . Antibacterial bioactivity of grafts bonded with silver-antibiotic complexes was superior (P less than 0.02) to bonding of antibiotic alone at 3 and 24 hr following implantation . Ciprofloxacin retention in excess of the minimum bactericidal concentration (0.5 microgram/ml) of Staphylococcus epidermidis was demonstrated on all silver-antibiotic-bonded grafts after 14 days of implantation . At 7 and 14 days following implantation, the bioactivity of all antibiotic-bonded grafts exceeded 0.125 micrograms/ml of ciprofloxacin, the minimum inhibitory concentration of S . epidermidis . Bonding of silver-ciprofloxacin on PTFE grafts provided an effective source of local antibiotic release at levels which may be useful for bypass grafting in contaminated wounds or for in situ replacement of grafts infected by CNS.

J Med Microbiol, 1991 May, 34(5), 245 - 8
Epidemiological typing of coagulase-negative staphylococci by pyrolysis mass spectrometry; Freeman R et al.; Pyrolysis mass spectrometry (PMS) was evaluated for the epidemiological typing of coagulase-negative staphylococci (CNS) in situations in which it was necessary to distinguish between repeated isolation of the same strain from a single patient (genuine infection) and coincidental isolation of unrelated strains (contamination) . Thirteen CNS isolates were examined, consisting of five pairs, each pair isolated from a single patient, and three unrelated strains . PMS analysis gave results equivalent to a conventional typing system comprising antibiogram, biotype and plasmid profile analysis . Both methods facilitate differentiation between genuine infection with CNS and the isolation of contaminants . The speed, reproducibility, versatility and relatively low cost of PMS suggest that it may be a valuable new technique for the epidemiological typing of CNS in routine clinical settings.

J Antimicrob Chemother, 1991 May, 27(5), 577 - 87
Effects of carbon dioxide and sub-lethal levels of antibiotics on adherence of coagulase-negative staphylococci to polystyrene and silicone rubber; Wilcox MH et al.; Fifty coagulase-negative staphylococci (CNS) strains were investigated for adherence to both silicone rubber and polystyrene using a microtitre tray system . Culture in an atmosphere containing a physiological level of carbon dioxide (5% CO2) profoundly affected adherent growth to both surfaces . Most strains adhered less well in this atmosphere compared to in air alone, with mean reductions in adherence of 84% and 86% to silicone rubber and polystyrene respectively . Occasional strains adhered better in 5% CO2 . The effects of antibiotic concentrations equivalent to 1/4 MIC of cefuroxime, ciprofloxacin, vancomycin and teicoplanin on the adherence of 10 CNS strains were also studied . Vancomycin and teicoplanin frequently increased adherence to silicone rubber and polystyrene compared to controls . The effects of antibiotics on adherence were not only strain dependent but also sometimes atmosphere or surface specific . Antibiotic-induced changes in adherence did not appear to correlate with changes in strain protein profiles or surface hydrophobicities.

Zentralbl Hyg Umweltmed, 1991 May, 191(5-6), 457 - 77
{The activity of formaldehyde, glutardialdehyde, peracetic acid, chloramine T (N-chlor-4-toluolsulfonamide), m-cresol, ethanol and benzyldimethyldodecylammonium bromide against bacteria which are found in coagulated blood . (Model studies for chemical disinfection of instruments}; Spicher G et al.; The experiments were performed using frosted glass as carrier with its surface being contaminated with whole blood containing Staphylococcus aureus as test organism . At the time of sampling, a heparin preparation was added to the blood to prevent premature coagulation . After addition of the staphylococci, coagulation was initiated by means of a heparin antagonist . 10, 25, 50, 100, and 150 microliters, respectively, of the blood were homogeneously spread on rectangular test areas of 10 x 20 mm . After the blood had coagulated, each of the test objects was placed in 15 ml of the solution (20 degrees C) containing the active ingredient tested for 60 min . After that, the test objects were removed from the disinfectant and, in order to inactivate any adhering active components, treated with a neutralizing solution of suitable composition . The number of viable germs (colony-forming units) was determined quantitatively . The blood samples were ground together with quartz sand . Aliquots of the diluted suspensions were mixed with molten agar medium . The plates then were incubated at 37 degrees C over a period of 14 days . The relative number of viable germs (N/No) per test object was calculated from the number of colonies . Plotting of the microbicidal effects obtained (log N/No} versus the concentration of the active substance (see Figs . 1-3) yielded curves differing in some characteristics as e.g . curvature, slope of the lower curve section (log N/No) . less than -3), concentration range according to the layer thickness of the contamination . To visualize the reduction of the efficacy of the respective disinfectants caused by blood, the concentrations of active components were determined which are necessary to achieve a microbicidal effect of log (N/No) = -4 . These concentrations were plotted versus the amounts of blood per test area (Fig . 4) . The resulting curve for formaldehyde was slightly U-shaped . With a raising amount of blood, the concentration required slightly decreased in the beginning and increased again from an amount of ca . 100 microliter blood per test area . For all other active substances, the required concentration of these substances increased with the amount of blood used . The curve obtained for ethanol exhibited the lowest slope . The slope of the curves increased in the following order: ethanol, m-cresol, peracetic acid, chloramine T, glutardialdehyde, benzyldimethyldodecylammoniumbromide . The curves for chloramine T and glutardialdehyde nearly paralleled each other.(ABSTRACT TRUNCATED AT 400 WORDS)

Res Vet Sci, 1991 May, 50(3), 374 - 5
Cutaneous infection associated with Staphylococcus hyicus in cattle; Hazarika RA et al.; Forty-seven Staphylococcus hyicus strains, one each from 47 of 81 cattle examined, were isolated from cutaneous lesions on different parts of the body . Nineteen of the strains were isolated in pure culture and the rest were isolated in association with either other staphylococci or microfilariae or mange mites . Three out of 10 representative strains produced cutaneous lesions when inoculated intradermally into rabbits.

Pathol Biol (Paris), 1991 May, 39(5), 414 - 23
{Effect of fibronectin on the adhesion of staphylococci and interaction with pefloxacin's anti-adherence properties}; Etesse-Carsenti H et al.; Fibronectin (Fn) is recognized for its ability to mediate Staphylococcus aureus (SA) adhesion . The number of Fn receptors is dependent on the phase of growth, and type of media . Furthermore, it was of interest to examine SA and Staphylococcus epidermidis (SE) adherence to porcine Fn (IBF 10 ng/ml) immobilized on tissue culture plates . The aim of our study was to examine if removal of FN receptors by growing bacteria in an antibiotic containing medium decreased the ability to adhere and of pefloxacin (P) anti-adhesive properties were medium dependent . As SE usually lack Fn binding capabilities, it seemed of interest to investigate if the effects of subinhibitory concentrations of P were modified by medium or Fn . We found: a) For SA: whether Fn coated onto plastic substrata promoted adherence of strains, P's anti-adhesive properties were saved, non medium or phase of growth dependent . b) For SE: adherence properties were decreased if Fn was coated onto plates . P's anti-adhesive properties were not modified and non medium dependent . The number of Fn receptors on clinical isolates of SA correlates with the invasiveness of the isolates . As P reduced the binding of SA to Fn coated plates, this observation may have important implications for antimicrobial prophylaxis.

Kansenshogaku Zasshi, 1991 May, 65(5), 540 - 5
{Microbiological characterization of clinical isolates of Staphylococcus epidermidis}; Tobita M et al.; As a result of recent development in medical practice including use of new antimicrobial agents, coagulase-negative Staphylococci (CNS) that were once considered nonpathogenic contaminants have captured attention as causes of disease . The 43 clinical isolates of Staphylococcus epidermidis sensu stricto and 7 isolates of S . epidermidis from the medical staffs were characterized with regard to (1) their biochemical profiles, (2) slime productivity, (3) beta-lactamase productivity and (4) plasmid patterns . Most of the isolates have an identical biochemical profile code . The slime production was observed in the 9 strains isolated from pleural effusions or the tubes used for pleural drainage . These strains had a similar antimicrobial susceptibility profile that are commonly seen in multi-resistant strains of methicillin-resistant Staphylococcus aureus (MRSA) . In addition, most of these strains produced beta-lactamase . For the plasmid profiling, we selected 12 isolates that possessed 5 distinct antimicrobial susceptibility profiles . Upon agarose gel electrophoresis, 8 isolates were shown to possess a 1.9 kb plasmid . These 8 isolates had resistance against tobramycin (TOB) and erythromycin (EM) . Emergence of S . epidermidis as causes of disease will increasingly necessitate the detailed microbiological characterization of the clinical isolates.

J Dairy Sci, 1991 May, 74(5), 1544 - 9
Isolation of Staphylococcus aureus from sites other than the lactating mammary gland; Matos JS et al.; The body sites of 163 heifers, bedding and feedstuff samples, flies, and hands and nares of the research personnel were sampled in order to determine the sources of Staphylococcus aureus in a dairy herd other than the lactating mammary gland . Lesions on the udder of lactating animals and the air in the milking parlor were also sampled . Staphylococci isolated from bedding samples were identified as to species . Staphylococcus aureus was isolated from all sources examined except flies . An enrichment procedure was necessary for isolating S . aureus from two bedding samples although other Staphylococcus species were present in high numbers . The designation "environmental staphylococci" is proposed for Staphylococcus species that were apparently free-living in the environment.

Rev Infect Dis, 1991 May-Jun, 13(3), 387 - 96
Bacterial infection as a complication of liver transplantation: epidemiology and risk factors; George DL et al.; A retrospective survey was undertaken to characterize the epidemiology of bacterial infection in 79 patients who underwent 103 operations for orthotopic liver transplantation . Fifty-four patients (68%) developed 115 bacterial infections (1.46 episodes per patient), and seven patients died as a result of these infections . Fifty-three percent of bacterial infections occurred within 2 weeks after transplantation and were designated as early infections . The most common sites of infection were the abdomen (35 cases), the bloodstream (31 cases), and the surgical wound (19 cases) . Aerobic enteric gram-negative bacilli were the predominant pathogens, and other pathogenic organisms were enterococci, staphylococci, and Pseudomonas bacteria . Logistic regression analysis identified prolonged duration of surgery (greater than or equal to 8 hours) and an elevated bilirubin level (greater than or equal to 12 mg/dL) as risk factors for early bacterial infection at any site; risk factors for abdominal or wound infection were prolonged duration of surgery, increased operative transfusion requirement (greater than or equal to 2 blood volumes), and prior hepatobiliary surgery . Awareness of the sites, pathogens, and time of onset of bacterial infection provides a basis for improved prophylaxis and empiric therapy.

Clin Nephrol, 1991 May, 35(5), 198 - 206
Vaccination for prevention of CAPD associated staphylococcal infection: results of a prospective multicentre clinical trial; Poole-Warren LA et al.; 124 stable CAPD patients from 8 Australian and 3 New Zealand centers were randomly assigned in a blinded fashion to one of two groups to study the effect of vaccination using commercial preparations consisting of a combined staphylococcus toxoid and whole killed staphylococci (SB) or normal saline solution (SS) on the incidence of peritonitis and exit site infection and S . aureus nasal carriage over a 12-month prospective period . In addition, levels of IgG, IgA, IgM, C3 and C4 were monitored during the trial period in serum and dialysate; serum levels of anti-alpha hemolysin and dialysate levels of fibronectin and specific antistaphylococcal antibodies were also measured . Over the period, treatment with SB or SS did not affect the incidence of peritonitis, catheter-related infection or S . aureus nasal carriage . However, vaccination with SB elicited a significant increase in the level of serum anti-alpha hemolysin throughout the 12 month duration of the study, although the level of increase was unrelated to the subsequent rate of peritonitis . Vaccination with SB but not SS elicited a significant increase in the dialysate level of specific antibodies against S . aureus . Serum levels of IgG, IgA, IgM, complement C3 and C4 were within the normal range in the CAPD patients studied and remained unaffected by vaccination with SB . In addition, dialysate levels of IgG, IgA, IgM, complement C3 and C4 were 50-100 times lower than corresponding serum levels and remained unaffected by vaccination . In summary, immunisation with an anti-staphylococcal agent was not successful in reducing peritonitis or exit site infection in CAPD patients.

Cesk Epidemiol Mikrobiol Imunol, 1991 May, 40(3), 158 - 63
{Long-term study of the sensitivity of staphylococci to antibiotics and their combinations}; Simkovicova M et al.; The results of the long-term follow up of the sensitivity of S . aureus in our catchment area to nine commonly used antibiotics indicate that unaltered state of sensitivity to OXA, SPI, GEN, CFT, LIN (97.2%-99.5%) . In coagulase negative staphylococci tested with 11 antibacterial substances the authors recorded a decline of sensitivity KAN, LIN, SPI, ERY by 15.7% to 24.8% From five tested antibiotic combinations to a group of strains of S . aureus (n = 87-117) the combination CFT + GEN was most effective having a synergic action on 64.3% strains . No antagonistic effect was recorded.

Zhonghua Yi Xue Za Zhi (Taipei), 1991 May, 47(5), 373 - 7
{The use of rifampin in the treatment of infection due to Staphylococcus aureus}; Tseng LL et al.; Infection due to Staphylococcus aureus continues to be a source of significant morbidity and mortality . However, its treatment is increasingly complicated by the rising prevalence of resistance to antibiotics . Apart from the two recognized modes of staphylococcal resistance, namely, penicillinase production and intrinsic resistance, Sabath and associates have described a third type in which resistance is manifested by susceptibility to growth inhibition but tolerance to the lethal action of bactericidal agents . The mechanism of tolerance is attributed to a deficiency of autolytic enzyme activity in the part of bacteria, possibly secondary to an inhibition of autolysins in the tolerant staphylococcal strains . These strains are found in patients with infections responding poorly to treatment with cell-wall active antibiotics including vancomycin . Because of its unique mechanism of action and pharmacokinetic properties, rifampin has been reported to be the most active among 65 antistaphylococcal agents tested and have the capacity to kill intraleukocytic staphylococci . We present 2 cases who were cured following the addition of rifampin to previously established regimens . Case 1 was a 40-year-old male who had fever, cough, dyspnea, a right elbow abscess and left leg swelling for 2 weeks prior to admission . Culture of purulent material from the elbow abscess grew staphylococcus aureus . Chest X-ray showed bilateral septic embolism and phleborheography showed partial deep vein occlusion of the left ileofemoral vein . Case 2 was 22-year-old female with fever, chills and cough for 3 weeks . Blood culture grew staphylococcus aureus, and Chest X-ray revealed bilateral septic embolism with pneumonia . Neither of them responded to standard antibiotics which were judged adequate by in vitro sensitivity tests . Clinical cure was later obtained after rifampin was added to the regimens . These results suggest that rifampin may be a useful adjunct in the therapy of staphylococcal infections.

Minerva Chir, 1991 Apr 30, 46(8), 369 - 73
{Microbiological analysis of postoperative infectious complications}; Di Palo S et al.; A variation among the strains responsible of nosocomial infections was noted in the last years with a revival of Gram + bacteria . Coagulase-negative staphylococci assumed a great importance, particularly those resistant to methicillin . Staphylococcus epidermidis is now an important infective agent, especially in patients with prostheses or other devices . To value the impact of these microbiological variations on surgical patients, we studied data related to 1271 specimens from postoperative septic complication from 1980 to 1988 . The incidence of Gram + strains in surgical infections was 46.8% in 1980-1983 period and 59.2% in 1984-1988 period with statistical significance (p less than 0.05).

Am J Ophthalmol, 1991 Apr 15, 111(4), 473 - 9
Role of cell-mediated immunity to staphylococci in blepharitis; Ficker L et al.; We studied cell-mediated immunity to staphylococcal antigens in 116 patients with chronic blepharitis and eight normal subjects . Antibodies in tears and blood were measured . Enhanced cell-mediated immunity to Staphylococcus aureus was demonstrated in 46 of 116 patients (40%) in the absence of antibodies to teichoic acid but not among normal subjects . Symptoms of grittiness and morning stickiness were more frequent among patients without enhanced responses . Folliculitis occurred more commonly among patients with enhanced immunity . Marginal keratitis occurred equally among patients with and without enhanced systemic immunity, but patients with enhanced response more commonly required topical corticosteroid therapy . Desensitization to staphylococcal antigens could be investigated as a potential therapeutic approach in selected patients.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 764 - 6
Multicenter evaluation of the in vitro activities of three new quinolones, sparfloxacin, CI-960, and PD 131,628, compared with the activity of ciprofloxacin against 5,252 clinical bacterial isolates; Fuchs PC et al.; The in vitro activities of three new quinolones (sparfloxacin, CI-960, and PD 131,628) were compared with that of ciprofloxacin against 5,252 routine clinical aerobic and facultatively anaerobic bacterial isolates . Overall, CI-960 was the most active drug in vitro (MIC for 90% of the strains tested, 0.13 micrograms/ml); ciprofloxacin and sparfloxacin were the least active (MIC for 90% of the strains tested, 1.0 micrograms/ml) . All three new quinolones, but particularly CI-960 and PD 131,628, exhibited significantly greater activity than ciprofloxacin against enterococci and staphylococci.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 685 - 90
Beta-Lactam-beta-lactamase-inhibitor combinations are active in experimental endocarditis caused by beta-lactamase-producing oxacillin-resistant staphylococci; Hirano L et al.; Optimal therapeutic strategies for serious infections caused by borderline and heterotypic oxacillin-resistant Staphylococcus aureus (BORSA and ORSA) strains have not been fully characterized . Recent evidence suggests that the dominant penicillin-binding protein of ORSA strains (PBP 2a) shows good affinity for ampicillin and that these strains commonly produce beta-lactamase . Therefore, we compared the in vivo efficacy of the combination of ampicillin plus sulbactam with that of vancomycin against ORSA strains . Also, the moderate resistance of BORSA strains appears to be attributable mainly to the hyperproduction of beta-lactamase . Therefore, we also studied the in vivo efficacy of ampicillin plus sulbactam against such organisms . Experimental aortic endocarditis was induced in rabbits by the following three strains: beta-lactamase-producing BORSA strain VP-986, beta-lactamase-producing ORSA strain 67-0, and its beta-lactamase-negative clone . In animals with BORSA endocarditis, ampicillin plus sulbactam and oxacillin were highly effective in reducing mean intravegetation bacterial densities, with each being significantly better than either ampicillin alone or no therapy . In animals with endocarditis caused by the beta-lactamase-producing ORSA strain, ampicillin plus sulbactam was significantly better at reducing mean vegetation bacterial densities than the other regimens . For endocarditis caused by the beta-lactamase-negative ORSA clone, ampicillin was better than vancomycin in reducing mean intravegetation bacterial densities . These data show that infections caused by beta-lactamase-producing BORSA strains respond therapeutically in a manner similar to that of infections caused by oxacillin-susceptible strains, with both oxacillin and ampicillin plus sulbactam being highly efficacious . Moreover, high-dose ampicillin treatment strategies were effective in the therapy of ORSA endocarditis; this efficacy is presumably related to the relatively high affinity profile of this compound (compare with that of oxacillin) for the functionally dominant ORSA PBP 2a.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 632 - 9
Multiple mechanisms of methicillin resistance and improved methods for detection in clinical isolates of Staphylococcus aureus; de Lencastre H et al.; The mec gene of a number of clinical methicillin-resistant Staphylococcus aureus isolates exhibiting a variety of heterogeneous expression modes was selectively inactivated by allelic replacement mutagenesis . While the resistance level of each of the transformants was reduced, the methicillin MIC for these transformants was well above the MIC for susceptible laboratory strains of S . aureus and was similar to the methicillin MIC for many contemporary clinical isolates which did not react with the mec-specific DNA probe but which showed a low or borderline level of resistance to methicillin . A number of those strains had no detectable beta-lactamase, and for about half of the isolates that did carry plasmid-borne beta-lactamase, elimination of the plasmid caused only partial reduction of the methicillin MIC or no reduction at all . The findings suggest that many contemporary strains of staphylococci harbor a combination of at least three distinct beta-lactam resistance mechanisms: (i) the mechanism related to the acquisition of the foreign mec gene and (ii) a beta-lactamase-dependent and (iii) a beta-lactamase-independent mechanism, each one of which can provide a certain degree of resistance against penicillinase-resistant beta-lactam antibiotics.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 627 - 31
Effect of topical antimicrobial treatment on aerobic bacteria in the stratum corneum of human skin; Hendley JO et al.; The efficacy of antimicrobial agents applied topically to the skin surface in eradicating coagulase-negative staphylococci (CNS) residing in the stratum corneum underlying the surface was examined . Glabrous skin was sampled with a 26-cm2 contact plate containing Trypticase soy agar . Five antiseptic solutions and four antimicrobial ointments were evaluated . The antiseptic solutions (10% povidone-iodine, 2% aqueous iodine, 2% tincture of iodine, 70% ethanol, and 0.5% chlorhexidine-ethanol) were applied for 15 s with a gauze sponge . The antimicrobial ointments (iodophor, silver sulfadiazine, mupirocin, and a triple-antibiotic ointment containing neomycin, polymyxin, and bacitracin) were applied and covered for 6 h with gauze . After treatment, the surface was sampled, 15 to 25 keratinized layers were subsequently removed by sequential stripping with cellophane tape, and the stratum corneum was sampled . All agents were effective in eradicating CNS from the surface (80 of 88 trials) . However, only 2% iodine (17 of 20 trials), iodophor (8 of 12), mupirocin (6 of 10), and the triple-antibiotic ointment (9 of 11) eradicated CNS from the stratum corneum reliably (greater than or equal to 50% of trials) . The stratum corneum was repopulated with resident flora within 24 h of treatment with 2% iodine (4 of 4 trials), iodophor (6 of 7), or mupirocin (5 of 6), but repopulation occurred in only 1 of 7 trials with the triple-antibiotic ointment . Topical treatment of skin with antimicrobial agents usually eradicates CNS from the skin surface but may not eradicate CNS from the stratum corneum . Only the triple-antibiotic ointment eradicated CNS from the stratum corneum and prevented repopulation with resident flora.

Berl Munch Tierarztl Wochenschr, 1991 Apr 1, 104(4), 130 - 3
{Elevation of the bacteriological content of milk of clinically unaffected lactating bitches of a canine research stock}; Kuhn G et al.; In the years 1987-1989 a bacteriological investigation of the milk was made in 44 clinically healthy postparturient bitches . In 30 animals bacteria most commonly isolated were staphylococci . 30.3% (40 samples) of the samples yielded pure cultures and 6.8% (9 samples) anacultures . Small numbers of bacteria were isolated in most of the samples; 67.4% showed moderate bacterial growth (less than or equal to 10(4)/ml sample) . In vitro drug sensitivity tests revealed lincomycin, erythromycin and polymyxin B proved to be most efficient . Moreover neomycin, kanamycin and chloramphenicol showed low resistance rates while colistin sulfate and carbenicillin were less effective . A direct influence of lactiferous gland colonization with bacteria on mortality of puppies was not observed . With respect to clinical aspects, the application of antibiotics for sanitation of the lactiferous gland colonization with bacteria in clinically healthy bitches has to be considered carefully . However, for this the estimation of drug sensitivity tests is not satisfactory and should be completed by accurate bacteriological identification.

Vet Microbiol, 1991 Apr, 27(2), 151 - 8
Classification of coagulase-negative staphylococci isolated from bovine clinical and subclinical mastitis; Jarp J; One hundred and forty eight strains of coagulase-negative staphylococci (CNS) from bovine clinical and subclinical mastitis were classified by conventional biochemical testing . Staphylococcus simulans was the most frequently isolated species . The distribution of CNS species in the two groups was similar regardless of whether the cow suffered from clinical or subclinical mastitis . There was no significant difference between the grades of severity of the clinical mastitis associated with the various CNS . The small difference in pathogenicity observed between species in this study, and the similarity of distribution in the various species of clinical and subclinical mastitis could indicate that the species per se is of minor importance in the development of mastitis.

J Antimicrob Chemother, 1991 Apr, 27 Suppl B, 31 - 5
Gram-positive infections related to CAPD; Williams JD et al.; The majority of infections associated with continuous ambulatory peritoneal dialysis (CAPD) are caused by Gram-positive bacteria . The coagulase-negative staphylococci are the most common cause of peritonitis and Staphylococcus aureus is the organism most frequently associated with tunnel and exit site infections . The advent of newer techniques for bag change in CAPD has significantly reduced the incidence of peritonitis but relapse is still common among a few isolated individuals . Carriage of staphylococci in the nose is important in predisposing individuals for exit site infections . The possibility that eradication of nasal carriage may prevent CAPD infection has yet to be evaluated.

Ann Cardiol Angeiol (Paris), 1991 Apr, 40(4), 171 - 4
{Value of systematic preventive antibiotherapy in cardiac pacemaker implantation}; Bru P et al.; The aim of this study was to assess the usefulness of prophylactic antibiotics during insertion of a cardiac pacemaker, in order to avoid infection of exteriorisation of infectious origin . The study involved two groups . One hundred and eight patients made up group I, a control group without the use of prophylactic antibiotics . Group II consisted of 101 patients who were given an intravenous injection of 1 or 2 g of oxacillin before surgery, followed up by four days of oral oxacillin (3 g per day) . Serum oxacillin levels at the end of the procedure were 0.37 +/- 0.09 mcg/ml, falling within the range of minimum inhibitory concentrations of methicillin-sensitive staphylococci . In the patients of the control group, followed up for 1 to 36 months (mean 12 +/- 11 months), during the first 2 months there were 2 infections, 4 exteriorisations and one cutaneous erosion over the pacemaker . In addition, one exteriorisation and one infection occurred at 17 and 29 months respectively . In patients with exteriorisation of their pacemaker device, there was nothing to suggest an infection and bacteriological specimens were sterile . No obvious infections nor any cutaneous complications occurred in the patients of group II, with prophylactic antibiotics, followed up for 1 to 21 months (mean 6 +/- 5 months) . In conclusion, anti-staphylococcal antibiotic treatment appears not only to be capable of avoiding cardiac pacemaker infections but also of preventing exteriorisation of the pacemaker device, which may be linked to hidden infections . A randomised study is nevertheless necessary to confirm this hypothesis.

Epidemiol Infect, 1991 Apr, 106(2), 239 - 46
Rapid inter-strain comparison by pyrolysis mass spectrometry of coagulase-negative staphylococci from persistent CAPD peritonitis; Freeman R et al.; Pyrolysis mass spectrometry (PyMS) was used as a method of rapid inter-strain comparison of 19 isolates of coagulase-negative staphylococci from episodes of CAPD peritonitis . Thirteen isolates were from multiple, but distinct, episodes of peritonitis in 6 patients and the remaining 6 isolates were from 6 patients with single episodes . The results, expressed in terms of identity/non-identity of strains, were compared with those obtained using an established typing system comprising an extended antibiogram, determination of biotype and plasmid profile analysis . The PyMS results for inter-strain comparison were in agreement with the reference typing scheme results . PyMS can be used in this setting to rapidly obtain evidence that persistent infection is/is not likely to be due to the same organism, although it cannot be used for formal typing . The results by both methods showed that serial, apparently distinct, episodes of peritonitis over periods as long as 120 days may be due to the same strain of coagulase-negative staphylococcus . Clinically based distinctions between recurrence of infection (same strain) and re-infection (different strains) may not always be supported by the microbiological evidence.

Epidemiol Infect, 1991 Apr, 106(2), 231 - 7
Serological typing of coagulase-negative staphylococci using monoclonal antibodies; Gabelish C et al.; This investigation was to determine whether monoclonal antibodies (Mabs) could be used to differentiate coagulase-negative staphylococci (C-NS) at species and strain level . Mabs were produced to four Staphylococcus epidermidis strains, two S . haemolyticus strains, one S . saprophyticus strain and one S . warneri strain . A panel of nine antibodies was tested for species and strain specificity against five type strains and 65 clinical isolates of C-NS by enzyme-linked immunosorbent assay (ELISA) . Species specificity was found with Mab D150 produced to one S . haemolyticus strain . Using Mab D150 and Mab D198 in conjunction, identification of 90% of S . haemolyticus isolates to species level was achieved . S . saprophyticus Mab K84 reacted with most other strains of C-NS tested but only three S . haemolyticus strains (16%) . This finding provides further evidence that S . haemolyticus possesses different surface determinants to other C-NS which could form the basis of a typing scheme for S . haemolyticus using Mabs D150, D198 and K84.

Med Lab Sci, 1991 Apr, 48(2), 99 - 105
A rapid test to detect the most clinically significant Staphylococcus species; Geary C et al.; A new two-hour test system (RAPIDEC staph) to detect the main staphylococci was evaluated . Of 124 reference strains tested, 83 represented species most often found in clinical specimens, the remaining 41 strains representing five species primarily of animal origin . RAPIDEC staph detected all Staph, aureus, Staph . epidermidis and seven of eight Staph . saprophyticus strains . Of the animal species, all Staphylococcus intermedius strains were assigned to the correct category, the remainder were misidentified as Staph . epidermidis . With 121 catalase-positive Gram-positive cocci isolated from urines the test system correctly detected all Staph . aureus strains, 39 of 41 Staph . epidermidis, and 34 of 36 Staph . saprophyticus . Of 25 atypical Staph . aureus strains which were either slide or tube coagulase negative the test system correctly detected all 17 slide coagulase negative strains but failed to detect eight which were tube coagulase negative . There were no false positives . RAPIDEC staph is a rapid, accurate system for the detection of the three main clinically important species of staphylococci.

Med Lab Sci, 1991 Apr, 48(2), 106 - 9
Detection of Staphylococcus aureus in blood cultures: evaluation of a two-hour method; Mitchell CJ et al.; Aurease--one of three tests on the RAPIDEC staph system for two-hour identification of the main clinically important staphylococci--was used for the direct detection of Staphylococcus aureus from 102 blood culture broths in which Gram-positive cocci were seen . A pellet of centrifuged blood culture broth was used as the inoculum . The method was compared with the thermonuclease test and subsequent isolates subjected to probabilistic identification based on biochemical reactions . A positive aurease test and the presence of thermonuclease were detected in 27 samples, subsequent identification showing all to be Staph . aureus . A further Staph . aureus strain was aurease negative but thermonuclease positive . None of the remaining 74 specimens was positive by the aurease test, which is rapid, sensitive and specific for detection of Staph . aureus in blood culture broths.

Nippon Ganka Gakkai Zasshi, 1991 Apr, 95(4), 369 - 76
{Endophthalmitis in Japan--a nationwide study with reference to type and etiology}; Hatano H et al.; A nationwide clinical study on bacterial and fungal endophthalmitis was done with special reference to their type and etiology . Two hundred and eighty cases of endophthalmitis were reviewed . All cases were divided into two categories such as exogenous (trauma, surgery, and ulcer) and endogenous (metastasis) . Penetrating trauma was responsible for 93 cases (33.2%), surgery for 88 cases (31.4%), ulcer for 11 cases (3.9%) and metastasis for 88 cases (31.4%) . Out of the 280 cases, 79 cases (28.2%) were microbiologically diagnosed through aqueous or vitreous tap or biopsy . The total numbers of isolated organisms amounted to 87 consisting of 43 Gram-positive bacteria, 30 Gram-negative bacteria and 14 fungi . The positive isolation was 31 out of 86 (36%) from the aqueous and 52 out of 103 (50%) from the vitreous . Exogenous types associated with trauma, surgery or ulcer were mainly caused by Gram-positive bacteria of 37 strains, led by coagulase-negative staphylococci in 14 cases . On the other hand, endogenous cases were mainly due to Gram-negative bacteria of 14 strains including Klebsiella pneumoniae in 5 cases, E . coli in 4 cases and fungi of 11 strains including candida spp in 9 cases.

J Chemother, 1991 Apr, 3(2), 67 - 74
A retrospective view of beta-lactamases; Abraham EP; The discovery of a penicillinase (later shown be a beta-lactamase) 50 years ago in Oxford came from the thought that the resistance of many Gram-negative bacteria to Fleming's penicillinase might be due to their production of a penicillin-destroying enzyme . The emergence of penicillinase-producing staphylococci in the early 1950s, particularly in hospitals, raised the question whether the medical value of penicillin would decline . The introduction of new semi-synthetic penicillins and cephalosporins in the 1960s began to reveal many beta-lactamases distinguishable by their different substrate profiles . In this period it was established that genes encoding beta-lactamases from Gram-negative bacilli could be carried from one organism to another on plasmids and also that penicillin inhibited a transpeptidase involved in bacterial cell wall synthesis . During the last two decades a number of these enzymes have been purified and the genes encoding them have been cloned . Much has now been learned, with the aid of powerful modern techniques, about their structures, their active sites, their relationship to penicillin-sensitive proteins in bacteria and to their likely evolution . Further knowledge may contribute to a more rational approach to chemotherapy in this area . Experience suggests that a need for new substances will continue.

Z Kardiol, 1991 Apr, 80(4), 294 - 8
{Micrococcus luteus: a rare pathogen of valve prosthesis endocarditis}; Durst UN et al.; A rare case of prosthetic valve endocarditis caused by Micrococcus luteus is described and compared with the few cases reported in the literature, as well as the clinical features, microbiological profile, therapy, and prognosis of common prosthetic valve endocarditis . Micrococcus luteus is a constituent of the normal human buccal bacterial flora which forms yellowish colonies and appears as a gram-positive coccus typically arranged in tetrades . Although of low virulence, the germ may become pathogenic in patients with impaired resistance, colonizing the surface of heart valves . In contrast to staphylococci (for which it may easily be mistaken) it is usually penicillin-sensitive . However, the most promising antibiotic regimen proposed for treatment of Micrococcus luteus seems to be a combination of vancomycin, amikacin, and rifampicin . If the infection leads to severe hemodynamic alterations, however, valve replacement may become necessary similar to the situation in prosthetic valve endocarditis caused by more aggressive and highly resistant bacteria.

J Antimicrob Chemother, 1991 Apr, 27(4), 475 - 80
Coagulase-negative staphylococci emerging during teicoplanin therapy and problems in the determination of their sensitivity; Chomarat M et al.; Four strains of coagulase-negative Staphylococcus spp . were isolated from blood cultures taken from two neutropenic patients; in three cases while they were receiving teicoplanin as part of an antimicrobial therapeutic regimen . Results of teicoplanin susceptibility tests carried out on these strains varied according to the technique used . The strains were susceptible by disc-diffusion testing, but the MIC of teicoplanin was 8-16 mg/l, when tested according to the recommendations of the Antibiogram Committee of the French Society of Microbiology, and thus categorized as of intermediate susceptibility . It seems reasonable to avoid using teicoplanin for the treatment of infections caused by coagulase-negative staphylococci until technical problems encountered in the in-vitro determination of susceptibility have been resolved.

J Antimicrob Chemother, 1991 Apr, 27 Suppl B, 51 - 60
The role of gram-positive therapy in the neutropenic patient; Menichetti F et al.; The increasing prevalence of Gram-positive infections in neutropenic cancer patients seems to be related to the use of central venous catheters, chemotherapy-induced oral and gastrointestinal mucositis, and the prophylactic use of fluoroquinolones . The need for anti-Gram-positive therapy in the neutropenic patient is supported by the increasing prevalence and the changing resistance of Gram-positive pathogens, as well as by the poor response of Gram-positive bacteraemia to aminoglycoside plus beta-lactam regimens . Combined therapy with either vancomycin or teicoplanin and other empirical antibiotics, has proved efficacious in adults and children with neutropenia, fever and Gram-positive infection . Vancomycin exerts greater antibacterial activity against strains of coagulase-negative staphylococci than teicoplanin and there is more data on its routine clinical use . In its favour, teicoplanin is less toxic and easier to administer . The time when a glycopeptide antibiotic should be introduced is still a matter of debate; support for both initial therapy and subsequent rescue therapy is found in the current literature . Large clinical trials are warranted to clarify further the role of anti-Gram-positive therapy in the neutropenic patient.

Rev Latinoam Microbiol, 1991 Apr-Sep, 33(2-3), 141 - 4
Evaluation of staphylococcal food contamination in four different culture media; Soto Esteras T et al.; The efficiency of Baird-Parker agar, mannitol-salt agar, Vogel-Johnson agar and Giolitti-Cantoni broth for the detection of Staphylococcus aureus from food samples, was studied by comparing the numbers of Staphylococcus recovered from the samples, the degree of selectivity reached and the recovery of coagulase and thermonuclease positive staphylococci . Lowest counts of Staphylococcus were obtained with Giolitti-Cantoni broth . The mannitol-salt agar proved to be the most efficient media system with respect to the number of staphylococci recovered and the degree of selectivity reached . None of these media was highly selective for the isolation and detection of S . aureus; therefore, it is necessary to identify the isolated colonies in all cited media, in order to use rightly the current guidelines for microbiological quality of foods.

J Dairy Sci, 1991 Apr, 74(4), 1218 - 26
Bovine lactoferrin receptors in Staphylococcus aureus isolated from bovine mastitis; Naidu AS et al.; A total of 103 Staphylococcus aureus strains isolated from bovine mastitis were tested for bovine lactoferrin binding in a 125I-labeled protein binding assay . More than 85% of the strains demonstrated high to moderate and a few showed little or no binding . Bovine lactoferrin binding to S . aureus cells was high when grown on blood, nutrient, or proteose-peptone agar, but the binding capacity was low with cells grown on salt rich media, in skim milk, or in broth . The kinetics of 125I-labeled bovine lactoferrin binding required approximately 90 min for complete saturation with optimal interaction in the pH range 4.0 to 7.0 . The lactoferrin-staphylococci interaction was specific with a high affinity (association constant, Ka 14 x 10(6) L/mol) . Scatchard plot analysis estimated the number of binding sites per cell at 7200 on strain SA-340 . Unlabeled bovine lactoferrin effectively displaced the binding of the labeled ligand to strain SA-340 in a dose-dependent manner . Bovine lactoferrin binding was inhibited or displaced by human lactoferrin . Various plasma, connective tissue, or mucosal secretory proteins tested did not inhibit lactoferrin-staphylococci interaction . Bovine lactoferrin binding components on SA-340 were resistant to glycolytic enzymes and moderately susceptible to proteolytic digestion . Two proteins with an estimated molecular weight of approximately 92 and 67 kDa were identified as bovine lactoferrin binding components of S . aureus strain SA-340.

J Dairy Sci, 1991 Mar, 74(3), 1115 - 23
Effects of a 1.94% sulfonic acid teat dip and a 1% iodophor teat dip on teat canal infections in lactating dairy cows; Watts JL et al.; Sixty-three cows were used in a natural exposure trial for 1 yr to determine the effects of a 1.94% linear dodecyl benzene sulfonic acid and a 1% iodophor teat dip on teat canal and intramammary infections . Overall, total teat canal infections increased 28.9% and total intramammary infections increased 30% in quarters dipped with the linear dodecyl benzene sulfonic acid compared with a 14.3% increase in teat canal infections and a 17.4% decrease in intramammary infections for the iodophor group . Higher frequencies were observed for teat canal and intramammary infections caused by Staphylococcus epidermidis in the linear dodecyl benzene sulfonic acid group . Staphylococcus hyicus was the predominant organism isolated from teat canal and intramammary infections in the iodophor group . No difference was observed between the two teat dips in the persistence of Staphylococcus aureus teat canal infections . A greater number of S . hyicus teat canal infections persisted in the iodophor group, whereas teat canal infections produced by S . epidermidis and Staphylococcus xylosus persisted longer in the sulfonic acid group . Results of this study indicated that use of a linear dodecyl benzene sulfonic acid teat dip for 1 yr was not associated with increased S . aureus teat canal infections and intramammary infections . However, linear dodecyl benzene sulfonic acid appeared to affect the distribution of coagulase-negative staphylococci isolated from teat canal infections and intramammary infections.

Eur J Clin Microbiol Infect Dis, 1991 Mar, 10(3), 168 - 71
Antistaphylococcal activity of the fluoroquinolones CI-960, PD 131628, sparfloxacin, ofloxacin and ciprofloxacin; Barry AL et al.; Five fluoroquinolones were tested against 300 staphylococci from a wide variety of US medical centers including 150 strains resistant to penicillinase-resistant penicillins (PRP-resistant) . Ten ciprofloxacin-resistant strains of PRP-resistant Staphylococcus aureus were relatively resistant to the other fluoroquinolones, but the remaining 290 isolates were susceptible to all five drugs at established or anticipated breakpoint concentrations . The relative potency of the study drugs could be ranked as follows: CI-960 greater than PD 131628 greater than sparfloxacin greater than ciprofloxacin greater than ofloxacin . All five drugs were bactericidal against PRP-resistant and PRP-susceptible staphylococci.

Appl Environ Microbiol, 1991 Mar, 57(3), 889 - 91
Toxic shock syndrome toxin 1 (TSST-1) production by staphylococci isolated from goats and presence of specific antibodies to TSST-1 in serum and milk; Valle J et al.; The ability of staphylococcal strains isolated from different anatomical sites in 133 healthy goats to produce toxic shock syndrome toxin 1 (TSST-1) and the presence of antibodies to this toxin in serum and milk were studied . The enzyme-linked immunosorbent assay method was used to detect both the toxin and the presence of antibodies . Of a total of 342 staphylococcal strains studied, 86 (25.2%) were found to produce TSST-1 . Specific antibodies to TSST-1 were found in the serum of 57 (42.9%) of the animals studied and the milk of 63 (47.4%) of the animals . These results suggest that goats are frequently in contact with staphylococci that produce TSST-1, a toxin usually associated with Staphylococcus aureus strains isolated from cases of toxic shock syndrome in humans.

Appl Environ Microbiol, 1991 Mar, 57(3), 863 - 6
In vitro measurement of the adherence of Staphylococcus epidermidis to plastic by using cellular urease as a marker; Dunne WM Jr et al.; A rapid and sensitive in vitro assay was developed to quantitatively assess the adherence of Staphylococcus epidermidis to a hydrophobic plastic surface . The assay is based upon the detection of cell-associated urease activity as a marker of bacteria remaining adherent to the polystyrene microwells of flat-bottomed, 96-well tissue culture plates . Using ATCC 35984, a slime-producing strain of S . epidermidis, the assay could detect as few as 3 x 10(3) bacteria and was linear to 3.5 x 10(7) bacteria . The adherence of both slime-positive and slime-negative coagulase-negative staphylococci could be evaluated by using this method . This assay could be used to examine factors which influence the adherence of individual S . epidermidis strains to hydrophobic surfaces and to develop agents or coating materials which suppress the adherence of coagulase-negative staphylococci to biomedical implants.

Am J Vet Res, 1991 Mar, 52(3), 474 - 9
Quantitative and qualitative properties of host polymorphonuclear cells during experimentally induced Staphylococcus aureus mastitis in cows; Daley MJ et al.; Polymorphonuclear cells have a critical role in the pathogenesis of bovine mastitis . We have documented that experimentally induced Staphylococcus aureus mastitis is associated with cyclic increase and decrease in the quantity of viable bacteria shed in the milk . Concomitant with this cycling of bacteria is an inverse cycling of the hosts cells within the milk . Such somatic cells were determined to be greater than or equal to 95% polymorphonuclear cells . The quality of these cells was evaluated by measuring their relative efficiency of bacterial killing and phagocytosis at various times during an infection . Host polymorphonuclear cells had as much as 10,000-fold variation in the bactericidal failure rate for staphylococci during cell cycling . The most efficient bactericidal effect was observed at or near the peak of the somatic cell count (SCC) . The ability of these cycling cells to ingest fluorescent beads was also quantitated by use of flow cytometry . The percentage of phagocytic polymorphonuclear cells that ingested fluorescent latex beads ranged from 15 to 80% of the total cell population during cell cycling, and tended to be optimal at or near peak SCC . In addition, the average number of beads ingested varied between 1 and 2 particles/polymorphonuclear cell, with as many as 17% of the phagocytic cells ingesting 4 or more beads at maximal efficiency . Polymorphonuclear cells from quarters infected with S aureus varied quantitatively (total SCC) and qualitatively (bactericidal activity and phagocytic ability) during the course of an infection . Not only is the quantity of host's phagocytic cells in the mammary gland central to the defense mechanism against infection, but the biological activation state appears to be equally important . The role of these cells in the pathogenesis of a cycling infection is presented in a model to explain the cyclic nature of mastitis.

Res Vet Sci, 1991 Mar, 50(2), 245 - 6
In vitro and in vivo inhibition of Dermatophilus congolensis by coagulase-negative antibiotic-producing staphylococci from pigs; Zaria LT; When tested on solid media the growth of 19 Dermatophilus congolensis strains was inhibited by antibiotic-producing staphylococci isolated from pigs . Two strains, D congolensis D11 and D15, which were very sensitive to the producers and caused lesions of dermatophilosis in a mouse model, were further used to investigate the ability of the producers to inhibit lesion formation by the strains of D congolensis . The simultaneous application of the antibiotic-producing staphylococci and D congolensis suppressed formation of the lesions in the mouse.

J Appl Bacteriol, 1991 Mar, 70(3), 227 - 32
Expression of glycocalyx by coagulase-negative Staphylococcus species isolated from bovine milk; Matthews KR et al.; Two hundred and six strains of coagulase-negative Staphylococcus species were assessed for expression of glycocalyx on serum soft agar, india ink and adherence techniques . The organisms were maintained on trypticase soy agar plates at 4 degrees C for 30 d (120 strains) or stored at -80 degrees C in skim milk for 90 d (60 strains) . Additionally, 26 milk samples from cows known to have excreted coagulase-negative staphylococci were used to inoculate serum soft agar directly . Nine of 26 direct culture samples and 43 of 180 strains maintained for an extended period had diffuse-type growth on serum soft agar . The proportion that exhibited an unstained halo by india ink was similar regardless of storage time . Slime production determined by in vitro adherence revealed a higher proportion of positive strains than had been predicted by serum soft agar or india ink techniques . More strains of Staphylococcus chromogenes, Staph . epidermidis, Staph . hominis, Staph . simulans and Staph . warneri expressed glycocalyx than other coagulase-negative Staphylococcus species . These results suggest that most coagulase-negative staphylococci produce slime rather than a capsule . However, evidence for classical encapsulation was demonstrated in several strains by india ink . The finding that Staphylococcus species other than Staph . aureus isolated from bovine milk are capable of glycocalyx production may be of importance in investigations on the relationship between staphylococci and host defence mechanisms.

J Med Microbiol, 1991 Mar, 34(3), 143 - 7
A chemically defined medium for slime production by coagulase-negative staphylococci; Hussain M et al.; In a chemically defined medium in which the principal constituents were glucose, 18 amino acids, two purines and six vitamins, eight strains of coagulase-negative staphylococci grew as rapidly and heavily as in tryptic soy broth . Slime formation was slightly better in the defined medium than in tryptic soy broth.

Surgery, 1991 Mar, 109(3 Pt 1), 259 - 64
Bacteriologic quality of intraoperative autotransfusion; Ezzedine H et al.; Controversies remain about the bacteriologic aspects of intraoperative blood salvage despite the widespread use of this technique . In this prospective study, intraoperative salvaged blood was cultured in 401 patients, according to a direct plating technique . Bacterial growth was detected in 12.7% of cases . These results were compared with those obtained in control studies with sterile water and blood bank units under the same culture conditions . Most microorganisms were coagulase-negative staphylococci, followed by other skin and environmental contaminants . Quantitative estimates of contaminations showed low counts of colony-forming units (CFU/ml): 82% of positive cultures yielded 1 or 2 CFU/ml and 6% had 5 to 20 CFU/ml . Patients were followed up for a minimum of 3 months to detect septic complications . No statistically significant correlation could be found between bacteriologic results of autotransfused blood and infectious complications . This study suggests that bacteriologic monitoring of patients who have undergone autotransfusion may help in detecting surgical field contamination . It also confirms that intraoperative autotransfusion adds little septic risk to cardiac surgery.

Clin Orthop, 1991 Mar, (264), 232 - 4
Closed suction drainage following knee arthroplasty . Effectiveness and risks; Willemen D et al.; A prospective investigation was performed to determine when to remove a suction drain following total knee arthroplasty (TKA) . Forty-one TKAs were randomly allocated to closed suction drainage for either 24 or 48 hours . The drain was removed and the tip was cut off and processed by a method giving quantitative cultures . In the 48-hour group, 85% of the total volume was drained during the first 24 hours . During the following 24-hour period, a mean volume of only 50 ml was drained . No organism was isolated from cultures of drain tips sampled at 24 hours . However, at 48 hours, 25% of the drain tips yielded light growths of coagulase-negative staphylococci (four drain tips) and Staphylococcus aureus (one drain tip) . Clinical evaluations of wound healing were comparable in the two groups . Clearly, nothing is to be gained by continuing drainage beyond 24 hours . If drainage is maintained for longer periods, there is an increased risk of contamination by bacteria.

J Infect Dis, 1991 Mar, 163(3), 534 - 41
Isolation and composition of the extracellular slime made by coagulase-negative staphylococci in a chemically defined medium; Hussain M et al.; Slime isolated after growth of four strains of coagulase-negative staphylococci on chemically defined medium plus agar was rich in galactose . However, when sterile agar plates were extracted with saline, high-molecular-weight material with similar properties was obtained that also was galactose-rich . Most of the dry weight attributed to slime, and probably all the galactose, originated from agar . Slime isolated by gel and ion-exchange chromatography from liquid culture in the same medium contained glycerol phosphate, glucose (no galactose), glucosamine, alanine, uronate, an unidentified component, and protein . Separation of protein from carbohydrate was achieved by affinity chromatography . {14C}glucose in the medium labeled the carbohydrate polymer; {14C}amino acids chiefly labeled extracellular proteins . Slime from bacteria grown on medium solidified with silica gel or on dialysis membrane above an agar surface showed essentially the same composition and behavior after purification as the material isolated from liquid culture.

Br Vet J, 1991 Mar-Apr, 147(2), 126 - 32
Pathogenicity of different species of staphylococci in caprine udder; Maisi P et al.; Aseptic foremilk samples were collected from Finnish landrace goats . Ten different species of staphylococci, causing subclinical infections were detected . Twelve goats with persistent subclinical staphylococcal infection were followed on a monthly basis and compared with foremilk samples of nine goats suffering from clinical mastitis . Parameters of inflammation based on the activity of the California Mastitis Test (CMT) . N-acetyl-beta-D-glucosaminidase (NAGase) and antitrypsin were determined from the milk . Staphylococci were further classified using the API STAPH system . On the basis of elevations of activities of CMT, NAGase and antitrypsin, Staphylococcus aureus was the most pathogenic in clinical and subclinical mastitis, S . hyicus showed only marginal pathogenicity . Subclinical infections were persistent and the infective organism was not always detected from milk by culture . The biochemical reactions of subclinical staphylococci seemed to vary within the same gland by time . Antitrypsin was most effective in differentiating between subclinical and clinical infection . A teat cistern puncture technique was found to be suitable for the goat.

Zentralbl Veterinarmed B, 1991 Mar, 38(2), 81 - 9
Staphylococci isolated from healthy goats; Valle J et al.; A study was made of the staphylococcal population on the skin and on the nasal mucosa and in the milk of 133 healthy goats . Of a total of 346 strains isolated and characterised as belonging to the genus Staphylococcus, 74 (21.4%) were coagulase-positive (68 S . aureus and 6 S . hyicus), and 272 (78.6%) coagulase-negative . The novobiocin-sensitive species S . haemolyticus (23.5%), S . warneri (16.5%), S . epidermidis (11.8%), S . chromogenes (8.5%), S . caprae (6.6%) and S . hyicus (2.6%), and the novobiocin-resistant species S . xylosus (8.5%), S . sciuri (7.4%), S . saprophyticus (4.8%), S . cohnii (2.2%), S . lentus (1.1%), S . equorum (1.1%) and S . kloosii (1.1%) were identified . Twelve (4.4%) of coagulase-negative strains remained unidentified . Strains isolated in the skin of the udder and teats of the 133 goats were mainly novobiocin-sensitive coagulase-negative staphylococci, the most prevalent species being S . haemolyticus, S . warneri and S . epidermidis . Staphylococci indicative of subclinical infection were determined in the milk of 47 (35.3%) of the 133 goats sampled.

Spec Care Dentist, 1991 Mar-Apr, 11(2), 59 - 62
Oral health in the terminally ill: a cross-sectional pilot survey; Aldred MJ et al.; This study of 20 hospice patients provided baseline information on oral and dental status in the terminally ill . For each patient, a questionnaire was completed, the mouth was examined, and an oral rinse and imprint cultures were collected to establish the prevalence and intra-oral density of yeasts, staphylococci and coliforms . Oral symptoms reported included disturbance of taste (26%), dysphagia (37%), soreness (42%), and dryness (58%) . Of the 75% who wore dentures, 71% had difficulty with their prosthesis (es) . A clinical diagnosis of oral candidiasis was made in 70% of subjects . The high prevalence of oral symptoms, denture problems, and candidiasis clearly affect the quality of remaining life in terminally ill patients.

Antimicrob Agents Chemother, 1991 Mar, 35(3), 584 - 6
Activities of two new teicoplanin amide derivatives (MDL 62211 and MDL 62873) compared with activities of teicoplanin and vancomycin against 800 recent staphylococcal isolates from France and the United States; Jones RN et al.; MDL 62211 is the amide derivative of the teicoplanin complex and MDL 62873 is a more focused amide derivative of the teicoplanin A2-2 peak . Each investigational compound had nearly identical activity and was 2- to 16-fold more active than teicoplanin or vancomycin . The MDL 62873 MICs for 90% of the strains tested were as follows: Staphylococcus aureus, oxacillin susceptible, 0.12 micrograms/ml; S . aureus, oxacillin resistant, 0.25 micrograms/ml; coagulase-negative staphylococci (CNS), oxacillin susceptible, 0.25 micrograms/ml; and CNS, oxacillin resistant, 2 micrograms/ml . CNS isolates from France were generally more susceptible than those tested in the United States . Teicoplanin-resistant U.S . isolates were usually Staphylococcus haemolyticus (1.8% of all tested strains), for which MICs ranged from 32 to greater than 128 micrograms/ml . MDL 62873 was not active against the Bacteroides fragilis group but was generally effective against gram-positive anaerobic strains.

J Appl Bacteriol, 1991 Mar, 70(3), 211 - 5
Streptomycin and tetracycline resistance plasmids in Staphylococcus hyicus and other staphylococci; Rahman M et al.; Plasmids associated with resistance to streptomycin, to streptomycin plus chloramphenicol or to tetracycline in Staphylococcus hyicus isolated from the skin of pigs have been compared, by restriction endonuclease digest patterns, with similar staphylococci from human sources and with published DNA base sequences . Several plasmids from Staph . hyicus have proved to have a very similar structure to those described from Staph . aureus but others appeared very dissimilar . This confirms the opinion that staphylococci from animal skin share a pool of plasmids with those from human skin but may also possess some of quite different structure.

S Afr Med J, 1991 Feb 2, 79(3), 139 - 42
Ventriculoperitoneal shunt infections in children . A 6-year study; Cotton MF et al.; In a study of ventriculoperitoneal shunt infections conducted retrospectively between 1983 and 1987 and prospectively in 1988 39 infections from 372 shunt procedures (incidence 10.5%) were identified . The most common organism isolated was Staphylococcus aureus (18; 47%) followed by S . epidermidis (10; 26%) . Forty-two per cent of staphylococci were methicillin-resistant . Gram-negative infections were associated with myelomeningoceles and Gram-positive infections with other forms of hydrocephalus (P = 0.048) . Lymphocyte predominance was found more frequently than polymorphonuclear predominance in cerebrospinal fluid.

FEMS Microbiol Immunol, 1991 Feb, 3(1), 53 - 8
Detection of antibodies to staphylococcal enterotoxins in the serum and milk of healthy goats; Valle J et al.; A study was made of the presence of antibodies (Ab) to staphylococcal enterotoxins A to E (SEA-SEE) in the serum and milk of 133 healthy goats, using a competitive ELISA method . Antibodies to some enterotoxins were detected in 83 sera (62.4%) and in 41 (30.8%) milk samples . In serum, antibodies to all SE types were detected, the most frequent being antibodies to SEA (24.8%) . Milk contained antibodies to SEA, SEB and SEC, the latter being the most frequent (24.8%) . A statistical study was performed to correlate the number of animals harbouring antibodies to a given enterotoxin with the presence in these animals of staphylococci producing that enterotoxin.

J Dairy Sci, 1991 Feb, 74(2), 426 - 8
A convenient method for differentiation of coagulase-negative staphylococci isolated from bovine mammary glands; Watts JL et al.; The utility of trehalose-mannitol broth and arabinose-cellobiose broth for identification of Staphylococcus epidermidis and novobiocin-resistant staphylococci was determined using 236 coagulase-negative staphylococci isolated from bovine mammary glands . None of the 49 S . epidermidis strains was positive in trehalose-mannitol broth; whereas, all strains of Staphylococcus hyicus, Staphylococcus chromogenes, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warneri, and Staphylococcus simulans were positive . Of the novobiocin-resistant staphylococcal species, only Staphylococcus saprophyticus was negative in arabinose-cellobiose broth . Except for one strain of Staphylococcus sciuri and one strain of Staphylococcus kloosii, all remaining strains of novobiocin-resistant staphylococcal species were positive in arabinose-cellobiose broth . Results indicate that trehalose-mannitol broth is an acceptable method for identification of S . epidermidis isolated from bovine mammary glands . Furthermore, arabinose-cellobiose broth is a useful method of screening for novobiocin-resistant staphylococci.

Antibiot Khimioter, 1991 Feb, 36(2), 19 - 21
{Study of beta-lactamase activity of staphylococci from different sources}; Ermolina GB et al.; The beta-lactamase activity of staphylococci isolated from the nasopharynx and skin of children with destructive affections of the lungs and from blood of patients with cardiovascular diseases subjected to surgical operations was determined with acidometric and microbiological procedures . Interrelation between synthesis of beta-lactamase by the staphylococcal strains and their resistance to beta-lactam antibiotics was demonstrated . No correlation of the antibiotic resistance and the taxonomic position of the staphylococcal strains was observed.

J Clin Microbiol, 1991 Feb, 29(2), 315 - 22
Application of gas-liquid chromatographic analysis of cellular fatty acids for species identification and typing of coagulase-negative staphylococci; Kotilainen P et al.; Gas-liquid chromatography (GLC) of bacterial cellular fatty acids was used to analyze 264 isolates of coagulase-negative staphylococci, of which 178 were Staphylococcus epidermidis . The presence and amounts of individual fatty acids were determined to generate fatty acid profiles for each of the seven coagulase-negative species tested . The fatty acid profiles were then analyzed by computerized correlation and cluster analysis to calculate mean correlation values between isolates belonging to the same or different species, as well as to establish cluster analysis dendrograms . These data ultimately allowed the clustering of individual samples into species-specific clusters . Species identification by the GLC clustering was highly consistent with species identification by biochemical assays; the results were similar in 92.4% of the cases . The GLC profile correlation analysis was further used to analyze multiple blood isolates from 60 patients in order to determine the usefulness of this methodology in establishing identity, as well as differences, between consecutive patient isolates . The correlation between those multiple S . epidermidis isolates determined to be identical by standard techniques (such as the antibiogram, biotype, and plasmid profile) was significantly (P less than 0.001) higher than that between random isolates of the same species . The correlation coefficient was greater than 97 for 40 (97.6%) of the 41 patients with multiple identical blood isolates, compared with less than 95 in all 19 (100.0%) patients with multiple nonidentical isolates . The successful use of the computerized GLC analysis in this study demonstrated its appropriate application for species identification and typing of coagulase-negative staphylococci.

J Surg Res, 1991 Feb, 50(2), 150 - 5
The role of fibrinogen in mediating staphylococcal adherence to fibers; Cheung AL et al.; The use of tampons and surgical gauze pads and colonization with Staphylococcus aureus have been established as risk factors for the development of toxic shock syndrome . To elucidate the role of blood factors in the mediation of staphylococcal adherence to fibers used in tampons and surgical packing, an adherence assay with cotton fibers was developed . Results demonstrated that cotton disks precoated with fibrinogen in the presence of human serum albumin bound a significant percentage of the inoculum for both staphylococcal strains tested when compared to human serum albumin controls . Likewise, fibers pretreated with plasma or defibrinated blood containing a small amount of fibrin revealed comparable staphylococcal adherence to that of fibrinogen . In contrast, fibers pretreated with serum, fibronectin, or vitronectin did not exhibit significant augmentation in staphylococcal attachment in comparison to human serum albumin controls . The attachment of staphylococci to fibrinogen and/or fibrin appeared to be specific and is blocked by goat anti-human fibrinogen antibody, but not fibronectin, vitronectin, or nonimmune goat IgG . Thus, our data indicate that fibrinogen/fibrin is the dominant blood component in the mediation of staphylococcal adherence to fibers used in tampons and surgical gauze pads.

J Immunol, 1991 Feb 1, 146(3), 826 - 32
Mechanism of Staphylococcus aureus exotoxin A inhibition of Ig production by human B cells; Moseley AB et al.; Staphylococcus enterotoxins and toxic shock syndrome toxin 1 are members of a family of exoproteins that are produced by staphylococci and bind specifically to MHC class II molecules . Upon binding to MHC class II molecules, these exoproteins are potent stimulators of T cell proliferation via interaction with specific TCR V-beta segments of both CD4+ and CD8+ T cells . These exoproteins also directly stimulate monocytes to secrete IL-1 and TNF-alpha . Furthermore, these exoproteins have a profound inhibitory effect on Ig production by PBMC . We examined the effects of Staphylococcus enterotoxin A (SEA) on proliferation and Ig production of highly purified human B cells . Our results demonstrated that the binding of SEA to MHC class II molecules on B cells does not alter their ability to proliferate in response to Staphylococcus aureus Cowan strain I (SAC) or to produce Ig in response to SAC plus rIL-2 . In contrast, the anti-DR mAb L243 inhibited both B cell proliferation and Ig production . Unable to determine a direct effect of SEA on B cell function, we investigated whether the capacity of SEA to inhibit SAC-induced Ig production by PBMC was T cell-dependent . Our results demonstrated that in the presence of T cells, under appropriate conditions, SEA can either function as a nominal Ag for stimulation of B cell proliferation and Ig production or induce T cell-mediated suppression of Ig production . SEA-induced Ig production required T cell help, which was dependent on pretreatment of the T cells with irradiation or mitomycin C; Ig production was not induced by SEA in the absence of T cells or in the presence of untreated T cells . Furthermore, SEA inhibited Ig production in SAC-stimulated cultures of autologous B cells and untreated T cells; pretreatment of the T cells with irradiation or mitomycin C abrogated SEA-induced inhibition of Ig production . Thus, T cell suppression of SAC-induced Ig production was dependent on T cell proliferation . Similar results were observed with both SEA and toxic shock syndrome toxin 1.

J Clin Microbiol, 1991 Feb, 29(2), 390 - 2
Identification of coagulase-negative staphylococci by using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and rRNA restriction patterns; Pennington TH et al.; A total of 1,417 staphylococcal and micrococcal strains were collected from the beards and scalps of 10 subjects over a period of 8 months . Sixteen strains identified as Staphylococcus epidermidis with an API system had distinctive yellow colonies on nutrient agar plates and sodium dodecyl sulfate-polyacrylamide gel electrophoresis whole-cell polypeptide profiles similar to those of Staphylococcus capitis; this identification was confirmed by analysis of rRNA gene restriction patterns.

Am J Physiol, 1991 Jan, 260(1 Pt 2), R126 - 33
Macrophages produce somnogenic and pyrogenic muramyl peptides during digestion of staphylococci; Johannsen L et al.; Muramyl peptides have a variety of biological effects in mammals, including enhancement of the immune response, sleep, and body temperature . Although mammals lack biosynthetic pathways for muramyl peptides, they are found in mammals and are well known as components of bacterial cell walls . This suggests that phagocytic mammalian cells digest bacterial cell walls and produce biologically active muramyl peptides . Staphylococcal cell walls were radioactively labeled during growth of the bacteria . During the digestion of these radiolabeled bacteria, murine bone marrow macrophages produced low-molecular-weight substances that coeluted chromatographically with the radioactive cell wall marker . Further separation of these substances using reversed-phase high-performance liquid chromatography resulted in the isolation of substances with high specific biological activity . Intracerebroventricular injection of rabbits with these substances induced an increase in slow-wave sleep and body temperature and a suppression of rapid-eye-movement sleep . The characteristics of the biological responses and the chromatographic behavior of the active components are consistent with those of muramyl peptides . The ability of macrophages to tailor muramyl peptides from peptidoglycan may provide an amplification step for the immune response . Muramyl peptides released by macrophages may also act as mediators for various facets of the acute phase response elicited by bacterial infections such as fever and sleep.

JAMA, 1991 Jan 2, 265(1), 64 - 9
Escherichia coli bacteriuria and contraceptive method; Hooton TM et al.; We evaluated the effects of contraceptive method on the occurrence of bacteriuria and vaginal colonization with Escherichia coli in 104 women who were evaluated prior to having sexual intercourse, the morning after intercourse, and 24 hours later . After intercourse, the prevalence of E coli bacteriuria increased slightly in oral contraceptive users but dramatically in both foam and condom users and diaphragm-spermicide users . Twenty-four hours later, the prevalence of bacteriuria remained significantly elevated only in the latter two groups . Similarly, vaginal colonization with E coli was more dramatic and persistent in users of diaphragm-spermicide and foam and condoms . Vaginal colonization with Candida species, enterococci, and staphylococci also increased significantly in diaphragm-spermicide users after intercourse . We conclude that use of the diaphragm with spermicidal jelly or use of a spermicidal foam with a condom markedly alters normal vaginal flora and strongly predisposes users to the development of vaginal colonization and bacteriuria with E coli.

Revmatologiia (Mosk), 1991 Jan-Mar, (1), 12 - 5
{Effect of allopurinol on the indicators of immunity in podagra and experimental hyperuricemia}; Siniachenko OV et al.; The authors studied the immunity indices in patients with gout against the background of a long-term (one year) therapy with allopurinol, and in animals with experimental hyperuricemia . During treatment the authors observed normalization of blood immunoglobulin M level, a considerable decrease in circulating immune complexes and anti-renal antibodies, a tendency to a rise in the function of T-lymphocytes, great enhancement of the activity of polymorphonuclear phagocytes in tests with Staphylococci and nitro-blue tetrazolium . Mechanisms of action of the given drug are discussed.

Eye, 1991, 5 ( Pt 1), 70 - 4
Quantitative alterations of the commensal eye bacteria in contact lens wear; Larkin DF et al.; A study was performed on the commensal external eye flora in 34 long-term contact lens wearers and a matched control group, in order to identify the effect of lens wear . Samples were taken from the lid margin and conjunctiva by semi-quantitative, and tear film by quantitative methods . Cultured bacteria were identified with particular attention to coagulase-negative staphylococci . No qualitative alteration in the commensal bacteria was found, although lens wearers were found to have a significantly higher number of species at all sites than controls . Significant quantitative changes were identified on the lid margin, with particularly high counts in some lens wearers, and tear film . Increased numbers of bacteria obtained from the conjunctiva were not statistically significant . Quantitative changes in the tear film are thought to be secondary to changes at the lid margin, for which no explanation is apparent.

Clin Ther, 1991 Jan-Feb, 13(1), 172 - 80
Host-pathogen relationships in respiratory tract infections; Verhoef J; The respiratory tract is continuously exposed to inhaled particles . The mucous membrane and the mechanisms of sneezing, coughing, and mucociliary clearance are the first line of defense . For the bronchioli and alveoli, the phagocytic cells are the cornerstone of defense against invading microorganisms . Alveolar macrophages and polymorphonuclear leukocytes are responsible for phagocytosis . For optimal phagocytosis, antibodies and complement are needed; phagocytic cells possess receptors for the Fc fragment of the immunoglobulin (IgG) molecule and complement . Receptors for cytokines are also present . These cytokines are important for activating the alveolar macrophage and recruiting other phagocytic cells and lymphocytes to the site of infection . Alveolar macrophages also contain cytophilic antibodies, IgG molecules that are bound to the cell via the F(ab)2 fragments . These cytophilic antibodies can interfere with the process of phagocytosis . They can bind to bacteria containing an Fc receptor (eg, Staphylococcus aureus protein A) and therefore provide the alveolar macrophage with a means to bind and digest staphylococci . Pulmonary surfactant proteins enhance the uptake of bacteria and viruses by alveolar macrophages and viruses . Thus surfactant contributes to the defense mechanisms of the lung . Phagocytic cells can injure alveoli . During the process of phagocytosis, toxic oxygen species and enzymes, needed for killing bacteria, are produced . These toxic substances may leak out of the cell and damage the surrounding tissues . All these phenomena contribute to the processes of inflammation . The function of phagocytic cells is decreased in smokers and by certain air pollutants . Phagocytic cells are crucial for the elimination of microorganisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1991 Jan, 35(1), 124 - 9
Stable classes of phenotypic expression in methicillin-resistant clinical isolates of staphylococci; Tomasz A et al.; A collection of coagulase-positive and -negative clinical strains of staphylococci, all of which gave a positive reaction with a mec-specific DNA probe, was analyzed for the mode of phenotypic expression of methicillin resistance by using population analysis on agar plates containing different concentrations of the antibiotic . Strains could be divided into four arbitrary expression classes . Cultures of class 4 strains were composed of uniformly and highly resistant bacteria (MIC greater than or equal to 800 micrograms/ml) . In contrast, cultures of strains belonging to classes 1, 2, and 3 were heterogeneous: they were composed of two or more subpopulations of cells that differed from one another in MICs and frequencies . In cultures of strains belonging to expression class 1, most of the cells had methicillin MICs of 1.5 to 3 micrograms/ml, i.e., only two to three times higher than those for truly susceptible strains . In cultures of strains belonging to expression classes 2 and 3, the methicillin MICs for the majority of bacteria ranged from 6 to 12 and up to 50 to 200 micrograms/ml, respectively . While the definition of the expression classes was arbitrary, the modes of phenotypic expression were specific and reproducible: randomly picked colonies of a given strain produced identical population profiles . The strain-specific mode of expression was also retained after numerous single-colony picks and sequential passages in antibiotic-free medium . We suggest that these classes represent stages in an evolutionary sequence leading to progressively improved phenotypic expression of methicillin resistance in staphylococci.

J Biomater Appl, 1991 Jan, 5(3), 204 - 26
Adherence of coagulase-negative staphylococci onto polyethylene catheters in vitro and in vivo: a study on the influence of various plasma proteins; Brokke P et al.; Bacterial adherence on PE catheters inserted into the carotid artery of rabbits was assessed at 5, 30, and 240 min after injection with bacteria of five coagulase-negative staphylococci (CN Staph) . These studies revealed that CN Staph adhere onto PE catheters 5 min after injection with bacteria . At 240 min after injection with bacteria almost all catheters were sterile, indicating that initially adherent bacteria on PE catheters disappear with time . EM studies revealed high numbers of platelets and leukocytes and many fibrin deposits on the surface of the PE catheter . In addition, the adherence of the five test strains on PE catheters was determined in vitro . In these in vitro studies the bacteria and catheters were pretreated with either fibrinogen, fibronectin, albumin or citrated whole plasma or the liquid adherence medium was supplemented with these proteins or the adherence assay was done in citrated whole plasma . The presence of proteins in the adherence medium or pretreatment of the catheter or bacteria with either fibronectin, albumin or whole citrated plasma markedly inhibited bacterial adherence . In contrast, pretreatment of bacteria or both bacteria and catheters with fibrinogen enhanced bacterial adherence suggesting the presence of ligands for fibrinogen on the cell surface of CN Staph.

Chemotherapy, 1991, 37(1), 43 - 9
Efficacy of cefcanel on staphylocci; Bergan T et al.; The minimum inhibitory concentration (MIC) of cefcanel, a new oral cephalosporin, has been tested against 153 staphylococci subdivided into the species Staphylococcus aureus . S . epidermidis sensu lato and S . saprophyticus, with and without beta-lactamase production . The concentration inhibiting 50% of the strains was 0.5 mg/l for all three species while the corresponding values for 90% of the strains were 1, 2 and 1 mg/l, respectively . These values apply to all the strains . The MICs of the non-beta-lactamase-producing strains were identical to the MICs of the beta-lactamase-producing strains for S . aureus, three twofold steps lower for S . epidermidis and one step higher for S . saprophyticus . Consequently, beta-lactamase production had no consistent consequences for the activity of cefcanel against S . aureus and S . saprophyticus . In contrast, the beta-lactamase production of S . epidermidis did influence the activity of cefcanel . Among the tested cephalosporins, cefcanel had the highest antistaphylococcal activity, and no strain was resistant to this new cephalosporin.

Infection, 1991, 19 Suppl 1, S52 - 6
{Use of antibacterial chemotherapy . A historical comparison}; Spitzy KH; The real breakthrough to successful antibacterial chemotherapy was caused by the development of sulfonamides and penicillin . Subsequently numerous other antibiotics were developed and successfully applied . Whilst both the percentage share as well as the resistance pattern with different bacterial strains has remained more or less stable in Europe as well as in the US over the past ten years, staphylococci, especially Staphylococcus epidermidis, appear to increase consistently . This fact can above all be seen with blood cultures . Within the Viennese clinical material, the staphylococcal share increased between 1984 and 1989 from 40 to 48%, with material from intensive care units from 42 to 60% and at the burn care unit up to almost 90% with S . epidermidis counting for the largest share . The resistance pattern has hardly changed . The lethality of patients with staphylococcal sepsis only depended on the timing of treatment: even with targeted treatment starting within two days from onset of clinical symptoms we lost 29%, when therapy was started later, lethality increased to 50%, and without treatment to 90% . Only fast diagnosis can help to fully utilize the benefits offered by antibacterial chemotherapy.

J Clin Microbiol, 1991 Jan, 29(1), 59 - 61
Evaluation of the Staph-Zym system with staphylococci isolated from bovine intramammary infections; Watts JL et al.; A total of 148 staphylococci isolated from bovine intramammary infections were used to evaluate the Staph-Zym system (ROSCO, Taastrup, Denmark) . The overall accuracy of the system was 91.9% . The system correctly identified all strains of Staphylococcus aureus, Staphylococcus simulans, and Staphylococcus xylosus and 95% of Staphylococcus intermedius strains . Of 33 Staphylococcus hyicus strains, 31 (93.9%) were classified correctly by the Staph-Zym system, as well as 8 (80%) of 10 Staphylococcus chromogenes strains . All 11 Staphylococcus epidermidis strains and the 1 Staphylococcus haemolyticus strain included in the study were identified, but the Staph-Zym system had difficulty distinguishing strains of Staphylococcus warneri and Staphylococcus hominis from other species in the S . epidermidis group . The Staph-Zym system correctly identified all six S . xylosus strains and two of three Staphyloccus sciuri strains . The Staph-Zym system was considered an acceptable alternative to conventional methods for identification of bovine mammary gland isolates.

Infect Immun, 1991 Jan, 59(1), 279 - 88
Thrombospondin binds to Staphylococcus aureus and promotes staphylococcal adherence to surfaces; Herrmann M et al.; Bacterial adherence to surfaces is the determining first step in staphylococcal infections . Activated platelets mediate adherence of staphylococci to tissues during inflammation or infection; however, the molecular mechanisms of this interaction are not clearly understood . Thrombospondin, a large multifunctional glycoprotein, is the principal platelet-stored glycoprotein . It is secreted upon platelet activation and either bound to receptors on the platelet surface or released and incorporated into blood clots and extracellular matrices . To characterize thrombospondin binding to staphylococci, we incubated {125I}thrombospondin with Staphylococcus aureus Cowan 1 in the presence of albumin and separated bound and free thrombospondin by centrifugation . We found that binding was (i) specific, since it was up to 76% inhibitable and up to 60% reversible in the presence of a 100-fold excess of unlabeled thrombospondin, (ii) saturable, with an apparent dissociation constant (Kd) of 5.6 x 10(-9) M and a maximal number of 2,600 binding sites per microorganism, and (iii) Ca2+ dependent, since omission of this ion from the medium decreased significantly the binding capacity . The binding reaction was insensitive to previous trypsin treatment of bacteria, but it was strongly inhibited in the presence of heparin . Protein A-negative and -positive strains had similar binding characteristics . To determine the promotion of staphylococcal adherence to surfaces by solid-phase thrombospondin, we incubated 3H-labeled S . aureus Cowan 1 and 26 pathogenic staphylococcal isolates with thrombospondin-coated polymethylmethacrylate disks and found that adherence was significantly promoted as a function of adsorbed thrombospondin . These results indicate a role for thrombospondin as an important mediator of staphylococcal adherence to activated platelets, to blood clots, or to extracellular matrices in pyogenic infections.

Scand J Thorac Cardiovasc Surg, 1991, 25(2), 127 - 32
Prosthetic valve endocarditis; Janatuinen MJ et al.; Prosthetic valve endocarditis is an infrequent but serious complication of valve surgery . It occurred in 25 (3.2%) of 772 patients who received aortic, mitral or double valve replacement in 1971-1987 . The total follow-up time was 3,976 patient years, giving an incidence of 0.63/100 patient years . Staphylococci were the most common of the cultured organisms in early and late infections-60% and 64%, respectively . The endocarditis was disclosed at autopsy in two cases . Treatment was antibiotics alone in 11 cases, and surgery was required in 12, the indication always being congestive heart failure . C-reactive protein level fell more rapidly than erythrocyte sedimentation rate in response to antibiotic or surgical management . The mortality rate was 73% in the antibiotic group and 33% in the surgical group . The findings demonstrated that an infected valve prosthesis should be replaced without delay if complications develop.

J Postgrad Med, 1991 Jan, 37(1), 14 - 6
Microbiological study of breast milk with special reference to its storage in milk bank; Deodhar L et al.; Sixty five breast milk samples were subjected to bacteriological studies; each sample thrice (in fresh state, after heating at 1000C and freezing for 5 days at -20 degrees C) . In fresh State, Staphylococci and diphtheroids were predominant organisms . After heating, none of the samples showed any micro-organisms while after freezing for 5 days, all the samples showing presence of micro-organisms earlier, showed decrease in colony counts . None of the milk samples showed inclusions of cytomegalovirus . Serum samples of mothers tested for Hepatitis B surface antigen and human immunodeficiency virus antibodies gave negative results . Such studies i.e . screening of breast milk samples are important if human milk is to be stored in banks and supplied to premature (high risk group) children.

Hosp Pract (Off Ed), 1991, 26 Suppl 4, 40 - 5; discussion 54-6
Use of third-generation cephalosporins . Staphylococci; Sheagren J; A large percentage of S . aureus infections occur by autoinoculation of the organism associated with persistent nasal carriage . Thus, newer modalities to interrupt nasal carriage may be useful in decreasing hospital-acquired S . aureus infections . The combination of a first-or, in some cases, a third-generation cephalosporin with an aminoglycoside is highly effective empiric treatment of putative infections due to S . aureus . And, the third-generation cephalosporins appear to be effective alone against beta-lactam antibiotic-sensitive staphylococci . For example, ceftriaxone has excellent inhibitory and bactericidal concentrations against these organisms and because of its superior pharmacokinetic properties is an indicated option for long-term treatment of defined beta-lactam antibiotic-sensitive S . aureus infections.

Microbiol Immunol, 1991, 35(1), 15 - 26
Platelet aggregation induced by strains of various species of coagulase-negative staphylococci; Usui Y et al.; Major species of coagulase-negative staphylococci (CNS) were tested for their ability to induce platelet aggregation in rabbit platelet-rich plasma (PRP) . Among 11 species of CNS tested, a majority of the strains of 10 species of CNS (S . epidermidis, S . simulans, S . capitis, S . hyicus, S . sciuri, S . cohnii, S . xylosus, S . hominis, S . haemolyticus, S . warneri) caused induction of the platelet aggregation and serotonin release, while S . saprophyticus did not show such activity . The addition of aspirin (10 mM) or quinacrine (1 mM) to PRP resulted in no remarkable effect on the platelet aggregation induced by these strains and it was shown that the platelet aggregation did not require arachidonate pathways . Complement system components were shown to be one of the plasma factors required for platelet aggregation by ten strains of each species of CNS . The bacterial substance participating in the platelet aggregation by ten species of CNS tested was indicated to be heat-stable and trypsin-resistant, while the activity of a strain of S . epidermidis was susceptible to trypsin.

Wien Med Wochenschr, 1991, 141(8), 172 - 6
{The treatment of septicemia in childhood using time-spaced administration of antibiotic combinations}; Riedl M et al.; Theoretical consideration, empirical findings since 1972 and in vitro results had suggested that a combination of antibiotics for treatment of sepsis is more effective if the 2 or 3 antibiotics are not applied simultaneously but individually and sequentially at short intervals of 4 hours . Between January 1986 and March 1990 100 children were treated with spaced administration of antibiotic combinations at the University Hospital Innsbruck (Department of Paediatric) . Causative agents isolated compared well to data published for other institutions; staphylococci were the dominating species . Anaerobic bacteria and fungi accounted for only 1% each, 60% of the cases were nosocomial infections . Overall, the fatality was 4%, a result significantly below the values reported in the literature for conventional therapeutic regimens.

Scand J Infect Dis, 1991, 23(3), 325 - 32
Antibiotic susceptibility of coagulase-negative staphylococcal blood isolates with special reference to adherent, slime-producing Staphylococcus epidermidis strains; Kotilainen P et al.; The epidemiologic relationship between slime-producing coagulase-negative staphylococci and antibiotic resistance was evaluated by analyzing the in vitro susceptibility of 278 blood isolates to 10 different antimicrobial agents . The strain collection consisted of 60 coagulase-negative staphylococcal septicemia isolates, recovered from at least 2 successive blood cultures from 59 septicemia patients and 218 single blood isolates defined as insignificant . When the slime-producing Staphylococcus epidermidis isolates were compared with all non-slime-producing S . epidermidis isolates, the slime-producing isolates exhibited higher MIC50 and/or MIC90 values than the non-slime-producing isolates, and were also more commonly resistant against many of the antimicrobials tested . The association between slime production and resistance against tobramycin, gentamicin and rifampicin was statistically significant (p less than 0.05) . A similar finding was observed among the S . epidermidis septicemia isolates when they were analyzed separately from the single (suspected blood contaminant) S . epidermidis isolates . Further characterization of the septicemia isolates revealed that the positive correlation between slime production and antibiotic resistance reflected, to some extent, multiresistance of 1 epidemic slime-producing S . epidermidis strain . No difference in resistance was observed between the slime-producing and non-slime-producing single S . epidermidis blood isolates.

Scand J Infect Dis, 1991, 23(3), 315 - 23
Evaluation of coagulase-negative staphylococci in blood cultures . A prospective clinical and microbiological study; Ringberg H et al.; Coagulase-negative staphylococci (CNS) are the commonest microorganisms in blood cultures, and sorting out patients with CNS septicemia from sample contamination a persistent problem . We prospectively evaluated 73 patients with CNS-positive blood cultures during 1 year and analysed the corresponding 122 isolates in order to determine the rate of septicemia and define the role of microbiological markers of identity such as plasmid profile for that purpose . Three patients had true septicemia, all of them with implanted foreign devices . The plasmid analysis, being the most reliable identity marker, had its greatest implication in reducing the intermediate group of patients clinically suspected of septicemia from 12 to 4 . Strict clinical criteria and serial blood cultures are most important in sorting out patients with CNS septicemia from cases of sample contamination . In high risk patients--critically ill with implanted foreign devices--plasmid analysis or other reliable markers of identity are of great additional value.

J Hyg Epidemiol Microbiol Immunol, 1991, 35(1), 65 - 71
Latex agglutination and hemagglutination tests for the rapid identification of methicillin sensitive and methicillin resistant Staphylococcus aureus; Qadri SM et al.; Ten latex agglutination (LA) and hemagglutination (HA) kits for the identification of Staphylococcus aureus were compared with reference methods for their reliability and performance . The ten commercial kits consisted of Accu-Staph, Bacto-Staph, Hemastaph, Staphaurex, Staph-Latex, Staphylochrome, Staphyloslide, Staph-Rapid, Sero-Stat and Veri-Staph . The conventional methods included slide coagulase test, tube coagulase test (4 hr, 24 hr), thermonuclease and growth on mannitol salt agar (MSA) . A total of 583 clinical isolates of staphylococci were used and all the kits correlated well with the conventional methods (93.1-99.4% sensitivity) in their ability to identify both methicillin sensitive (MSSA) and methicillin resistant S . aureus (MRSA) . Although all were rapid, easy to perform and simple to interpret, Staphaurex and Staphyloslide gave the best sensitivities and specificities.

Gig Tr Prof Zabol, 1991, (4), 20 - 2
{The toxicological hygienic evaluation of the manufacture of epoxy resins based on complex glycidyl ethers}; Talakin IuN et al.; The workers engaged in the processing of the UP-671, UP-671D, UP-677, UP-680 and UP-682 epoxide resins are influenced by both initial and intermediate industrial products, as well as the resins' volatile components in MAC threshold concentrations . The workers engaged in major professions displayed upper respiratory allergic diseases, contact and allergic dermatitis, sensibilization to epichlorhydrine, staphylococci and kidney allergen . Euthyroid goiter was diagnosed in most workers, along with thriiodothyronine decrease in blood serum and a higher rate of chromosomal aberrations in lymphocytes . The experimental studies performed revealed moderate-degree toxicity in the resins, their cumulation properties, as well as allergenic, irritating, mutagenic and embryotoxic characteristics . Basing on the results of the study, the USSR Health Ministry adopted the working zone air MAC for the resins at the level of 0.5 mg/m3, vapours, 2nd degree of hazardousness.

Plasmid, 1991 Jan, 25(1), 70 - 5
4',4'' adenyltransferase activity on conjugative plasmids isolated from Staphylococcus aureus is encoded on an integrated copy of pUB110; Byrne ME et al.; In staphylococci, linked resistance to the aminoglycosides kanamycin, neomycin, paromomycin, and tobramycin (KmNmPmTmr) is generally mediated by an aadD determinant which encodes production of an adenyltransferase aminoglycoside modifying enzyme, AAD(4',4'') . The aadD resistance determinant is located on small multicopy plasmids such as pUB110, and has also been found on large multiresistance plasmids and on the chromosome in some strains . Examination of two conjugative plasmids from strains of Staphylococcus aureus isolated in North America indicated that the aadD determinant on these plasmids is located on an integrated copy of pUB110 . The integrated pUB110 is flanked by direct repeats of the staphylococcal insertion sequence IS257 . Analysis of the conjugative plasmid pSK41 showed an 8-bp duplication of the pUB110 sequence immediately adjacent to flanking IS257 elements, suggesting that integration of pUB110 was mediated by IS257.

Pneumonol Alergol Pol, 1991, 59(9-10), 5 - 10
{The effect of tienamycin on selected cellular immunologic parameters in mice during the course of viral-bacterial infections of the respiratory system}; Ciebiada I et al.; The effect of tienamycin on selected parameters of the immunological system in mice infected with the influenza virus and Staphylococcus aureus was studied . Tienamycin was administered 24 hours, 2 hours prior the infection and 2 hours after the infection (model I), 24 hours and 48 hours after infecting the mice (model II) . The authors analysed phagocytosis, bactericidal activity of peritoneal exudate cells and the LIF release induced by the staphylococcus antigen and the viral antigen by the spleen mice leukocytes . The authors found that the antibiotic given to non-infected mice inhibited phagocytosis of staphylococci by the peritoneal exudate cells . In mice that were infected a positive effect of the antibiotic on all studied parameters . Administering the antibiotic before infecting the mice produced an even better effect.

Folia Microbiol (Praha), 1991, 36(6), 582 - 4
Rapid method for detecting thermostable nuclease in staphylococci; Ruzickova V; A rapid test for the detection of staphylococcal thermostable nuclease (TNase) is described . The procedure consists of heat inactivation of solid cultures of staphylococci and microslide agar diffusion in toluidine blue agar containing deoxyribonucleic acid . Using this method the results are obtained about 1 d sooner than with the conventional method.

J Hyg Epidemiol Microbiol Immunol, 1991, 35(4), 407 - 18
Characterization of coagulase-positive staphylococci isolated from free-living birds; Hajek V et al.; A total of 129 coagulase-positive staphylococcal strains were isolated from the nasopharyngeal region of free-living birds--81 (16%) from 501 birds of prey, 29 (25%) from 117 water birds, and 19 (2%) from 937 pheasants . Staphylococcus aureus and Staphylococcus intermedius were identified in 64 (79%) and 17 (21%) strains from birds of prey, in 1 (3%) and 28 (97%) strains from water birds, and in 4 (21%) and 15 (79%) strains from pheasants, respectively . Of the total number of the 69 S.aureus strains 45 (65%) could be biotyped . Biotype D prevailed in the strains from birds of prey . Among all the 60 S.intermedius strains 41 (68%) biotype 1 and 19 (32%) biotype 3 strains could be recognized . Biotype 1 predominated in strains from water birds and pheasants, while biotype 3 in strains from birds of prey . Resistance to antibiotics was recorded in 8 (12%) S.aureus and 5 (8%) S.intermedius strains only . Fifty-six (81%) of the 69 S.aureus strains could be typed with human phages, 30 (44%) with bovine and 41 (51%) with chicken phages . It is evident that the host range of Shimizu's (CH) phages involves not only S.aureus from chicken but also from any other birds . None of these strains was typable with canine phages . Out of the 60 S.intermedius strains 45 (75%) were lysed with Blouse and Meekins' canine phages . When human, bovine, and chicken phages were used, all the 60 strains were completely resistant.

Arch Dermatol Res, 1991, 283(8), 524 - 8
Effects of subminimal inhibitory concentrations of minocycline on neutrophil chemotactic factor production in comedonal bacteria, neutrophil phagocytosis and oxygen metabolism; Akamatsu H et al.; Comedonal bacteria, Propionibacterium acnes, P . granulosum and coagulase-negative staphylococci (CNS) seem to play an important initiating role in the inflammatory process by producing neutrophil chemotactic factors . The attracted neutrophils, after phagocytosis, release inflammatory factors such as reactive oxygen species (ROS) . We investigated the effects of minocycline at subminimal inhibitory concentrations (sub-MIC), i.e . one-tenth MIC, on the production of human neutrophil chemotactic factors in comedonal bacteria, and on several inflammatory parameters of neutrophils, including neutrophil phagocytosis and generation of ROS (O2-, H2O2, OH.) . ROS generation in a cell-free, xanthine-xanthine oxidase system was also assessed . Production of neutrophil chemotactic factors in all strains of P . acnes, P . granulosum and CNS were significantly suppressed by sub-MIC minocycline . Sub-MIC minocycline effectively reduced three kinds of neutrophil-generated ROS (O2-, H2O2, OH.) . However, neutrophil phagocytosis and the ROS generated in a cell-free system were not markedly changed in the presence of sub-MIC minocycline . The results suggest that sub-MIC minocycline has an anti-inflammatory effect by inhibiting the production of neutrophil chemotactic factors in comedonal bacteria as well as ROS generated by neutrophils in the inflammatory process of acne.

J Antimicrob Chemother, 1991 Jan, 27(1), 71 - 9
Development of in-vitro resistance to glycopeptide antibiotics: assessment in staphylococci of different species; Biavasco F et al.; Forty-two clinical isolates belonging to ten species of staphylococci were studied for their ability to develop single-step resistance, in vitro, to glycopeptide antibiotics . Selection was attempted through separate exposure to four glycopeptides (vancomycin, teicoplanin, and two investigational semisynthetic derivatives of the latter, TD-A3 and CTA-A1) on agar containing 10 mg/l of the test drug . No survivors from any test strain were recovered after exposure to TD-A3 or CTA-A1 . After exposure to vancomycin or teicoplanin, surviving clones were only recovered from strains of three species, Staphylococcus aureus, S . epidermidis, and S . haemolyticus . Emergence of resistant clones was easier to observe from strains of S . haemolyticus exposed to teicoplanin . When tested for susceptibility, many survivors exhibited vancomycin and teicoplanin MICs below the drug concentration used for in-vitro selection, probably due to an inoculum effect in the plating procedure . In particular, the vancomycin MICs did not exceed 8 mg/l for S . aureus and S . epidermidis clones, and reached 16 mg/l for some clones from a S . haemolyticus strain . Teicoplanin MICs did not exceed 8 mg/l for S . aureus clones, but reached 64 mg/l for some clones of S . epidermidis, and were particularly high (64 to greater than or equal to 128 mg/l) for most clones of S . haemolyticus . In contrast, against all clones selected from all three species, the MICs of TD-A3 and CTA-A1 did not exceed 2 and 4 mg/l, respectively . Morphological investigations indicated that the colonies of a highly resistant S . haemolyticus clone were smaller and more butyraceous in consistency than those of the parent strain . In transmission and scanning electron microscopy studies, this same S . haemolyticus clone showed a more irregular cell wall than the parent strain.

Folia Microbiol (Praha), 1991, 36(4), 401 - 5
Identification of Staphylococcus and Micrococcus species with the STAPHYtest system; Sedlacek I et al.; A collection of 216 well-characterized strains of Staphylococcus, Micrococcus and Stomatococcus was examined by a commercially available STAPHYtest system (Lachema, Brno, Czechoslovakia) . The results of STAPHYtest agreed with those of conventional tests . The STAPHYtest permitted a clear-cut separation of Staphylococcus from Micrococcus and Stomatococcus strains and correctly identified 104 of 145 (72%) Staphylococcus strains after 24 h of incubation . However, it allowed the identification only of 19 of 29 validly published Staphylococcus species . The STAPHYtest proved to be a simple and rapid system for the separation of staphylococci from micrococci and for the identification of most frequent clinically significant staphylococci.

Acta Vet Scand, 1991, 32(4), 543 - 9
Evaluation of three slide agglutination tests for rapid identification of Staphylococcus aureus; Niskanen A et al.; Three slide agglutination tests for identification of Staphylococcus aureus were compared . The agglutination tests used for evaluation were Staphaurex (Wellcome Diagnostics), Staphyslide-Test (BioMerieux), and ANI S . aureus TEST (Ani Biotech Oy) . A total of 347 isolates were analyzed, including 288 strains of S . aureus, 49 of S . epidermis, 11 of S . intermedius, 12 strains of other staphylococci and 14 non-staphylococcal strains . One hundred of the S . aureus strains were isolates from cases of food poisoning, 129 from mastitis and 59 from other clinical cases . The sensitivities of the tests were also compared using diluted suspensions of S . aureus strains and with purified Protein A dilutions . The results showed that the sensitivities of the tests were 98.6%, 97.9% and 99.0% for Staphaurex, Staphyslide-test and ANI S . aureus TEST, respectively . The specificities were 100% for the Staphyslide test and 98.8% for both the ANI S . aureus TEST and the Staphaurex test . The sensitivities measured with diluted S . aureus strain suspensions and Protein A solutions were equal with the Staphaurex and ANI S . aureus TEST . All the agglutination tests studied proved to be practical, easy to use and accurate for the rapid identification of S . aureus strains from culture isolates.

Klin Wochenschr, 1991, 69 Suppl 27, 1 - 5
{Selective intestinal decontamination--yes or no?}; Daschner F et al.; Various studies have shown that as a result of selective decontamination of the digestive tract, the incidence of pneumonia in artificial ventilation caused by gram-negative bacteria is reduced; however, a few studies have pointed out that, at the same time, the rate of pneumonia caused by gram-positive bacteria is increased . Most investigators agree that mortality cannot be reduced . A few studies have demonstrated that simultaneous administration of cefotaxime is not necessary . Various recent reports indicate that under certain conditions selective decontamination of the digestive tract undoubtedly leads to the development of resistance to gram-negative bacteria and in particular, to oxacillin-resistant staphylococci, S . epidermidis, and enterococci . Multicenter, randomized, and prospective double-blind studies will have to investigate and establish definitively which antibiotics have to be applied in which patients in order to reduce the rate of pneumonia as well as mortality . In addition, these studies will have to determine the microbiological and hospital hygiene measures necessary to avoid the risk of resistance or colonization developing by certain agents . As long as this is not the case, broad, non-selective use of SDD is not justified, especially in intensive care units.

Infection, 1991, 19 Suppl 7, S359 - 64
The scope of lower respiratory tract infection; Winter JH; Lower respiratory tract infections (LRTI) are commonly classified as either bronchitis or pneumonia, and these infections are associated with an extremely high morbidity in the community, as well as a high mortality in those patients that require hospitalisation . Therefore, such infections place a huge burden, both economically and as a user of health services, on the entire health care system . The antibiotic treatment of community-acquired pneumonia caused by gram-negative organisms or staphylococci is controversial, and these organisms may cause one-third of the cases of community-acquired pneumonia . Nosocomial pneumonia is caused even more often by gram-negative bacteria, and as such the development of rational and effective antibiotic therapy to cover these organisms is very important.

Acta Vet Scand, 1991, 32(2), 155 - 61
Comparison of three commercial rapid agglutination test kits for identification of coagulase positive staphylococci from foods and animals; Holme IJ et al.; Three rapid agglutination assays for the identification of Staphylococcus aureus Monostaph (Bionor A/S, Skien, Norway), Staphyslide-Test (BioMerieux, Lyon, France) and Staph-Rapid-Test (Roche, Basel, Switzerland), were compared . A total of 104 Gram-positive, catalase positive cocci were tested: Nineteen Staphylococcus reference strains comprising 15 spp . (4 strains were coagulase positive), and 7 Micrococcus reference strains comprising 4 spp.; 22 food isolates comprising 13 S . aureus, 8 coagulase positive Staphylococcus spp., and 1 Micrococcus sp.; 56 animal isolates comprising 11 S . aureus, 9 S . hyicus subsp . hyicus, 2 S . intermedius, 15 coagulase positive and 19 coagulase negative Staphylococcus spp . Totally 54 strains were coagulase positive . Considering agglutination of a coagulase positive strain as a correct identification, Monostaph, Staph-Rapid-Test, and Staphyslide-Test correctly identified 52 (96.3%), 47 (87.0%) and 48 (89.0%) of the coagulase positive staphylococci, respectively . Monostaph, Staph-Rapid-Test and Staphyslide-Test showed 1 (2.0%), 4 (8.0%) and 4 (8.0%) false positive reactions respectively . Monostaph, Staph-Rapid-Test and Staphyslide-Test gave 0 (0.0%), 6 (5.8%) and 7 (6.7%) non-interpretable reactions, respectively . Monostaph may be a good alternative to the tube-coagulase test for rapid and reliable identification of coagulase positive staphylococci from both food and veterinary sources . However, false negative reactions may occur with coagulase positive strains of S . hyicus subsp . hyicus and S . intermedius.

Infection, 1991, 19 Suppl 6, S337 - 44
Prophylaxis of postoperative infections; Wittmann DH et al.; The antibiotic most appropriate for prophylaxis of postoperative infections depends on the nature of the operation . In aseptic (clean) operations, gram-positive postoperative infections are the primary concern, and cefazolin is recommended because of its excellent pharmacokinetics and good activity against gram-positive pathogens, including staphylococci . In those operations where violation of the digestive tract creates a contaminated field, a cefotaxime-generation cephalosporin is the agent of choice because of the excellent safety profiles and the capability of agents of this class to kill essentially all pathogenic gram-negative aerobes as well as a substantial portion of anaerobes . Selection of resistant bacteria has not been significant and is unlikely to become so with single-dose prophylaxis . Occasionally, if there is a high probability that the operative field may be heavily contaminated by anaerobes, metronidazole should be added . Dosing should be sufficient to cover the operative period . Only a single prophylactic dose is necessary, given at the time of induction of anesthesia . For particularly long operations, a second dose of those antibiotics with half-lives shorter than 60 min is required two hours after the first . Single-injection prophylaxis is effective, inexpensive, has no side effects and does not induce bacterial resistance.

Akush Ginekol (Sofiia), 1991, 30(3), 37 - 40
{The coagglutination reaction (CoA)--a rapid test for the diagnosis of vaginal candidiasis}; Kantardzhiev T et al.; Vaginal candidiasis is frequently encountered disease . The question about quick and exact diagnosis is still a problem for the practice . The method, proposed by us, is the first attempt for diagnosis by the method of co-agglutination . Staphylococci, sensibilized by hyperimmune anti-candidiasis serum, are used . The preparation, proposed by us, is in no way inferior to the well known latex-agglutination tests for vaginal candidiasis.

Int J Immunopharmacol, 1991, 13(7), 931 - 41
Application of purified polysaccharides from cell cultures of the plant Echinacea purpurea to test subjects mediates activation of the phagocyte system; Roesler J et al.; Polysaccharides purified from large-scale cell cultures of the plant Echinacea purpurea were tested for their ability to activate human phagocytes in vitro and in vivo . These substances enhanced the spontaneous motility of PMN under soft agar and increased the ability of these cells to kill staphylococci . Monocytes were activated to secrete TNF-alpha, IL-6 and IL-1 whereas class II expression was unaffected . Intravenous application of the polysaccharides to test subjects immediately induced a fall in the number of PMN in the peripheral blood, indicating activation of adherence to endothelial cells . This fall was followed by a leukocytosis due to an increase in the number of PMN and a lesser increase of monocytes . The appearance of stab cells and some juvenile forms and even myelocytes indicated the migration of cells from the bone marrow into the peripheral blood . The acute phase C-reactive protein (CRP) was induced, probably due to activation of monocytes and macrophages to produce IL-6 . In addition a moderate acceleration of the erythrocyte sedimentation rate was observed . Altogether, as in mice, the polysaccharides could induce acute phase reactions and activation of phagocytes in humans . The possibility of clinical use is discussed.

Trop Geogr Med, 1991 Jan-Apr, 43(1-2), 238 - 41
Felty's syndrome in a Nigerian; Onyewotu II et al.; The first case of Felty's syndrome to be reported in a Nigerian, a fifty five-year-old woman who developed splenomegaly and leukopenia during the course of strongly seropositive rheumatoid arthritis of ten years duration is presented . her arthritis had lasted for about ten years, but she did not have the severe deforming disease known to be associated with Felty's syndrome . Radiologically there were no erosions and subcutaneous nodules were absent . She had a positive granulocyte specific anti-nuclear factor, cryoglobulins containing IgA and IgM and her polymorph-nuclear granulocytes showed evidence of impaired killing of staphylococci.

Nephrol Dial Transplant, 1991, 6(9), 643 - 8
Epidemiology of CAPD-associated peritonitis caused by coagulase-negative staphylococci: comparison of strains isolated from hands, abdominal Tenckhoff catheter exit site and peritoneal fluid; Brown AL et al.; We identified twenty patients maintained on continuous ambulatory peritoneal dialysis who suffered repeated episodes of peritonitis caused by coagulase-negative staphylococci . We documented hand and exist-site coagulase-negative staphylococcus-associated peritonitis over a total period of 32 months, and compared hand and exit-site strains with strains isolated from dialysate fluid using three typing methods: biotyping using the API Staph kit plus antibiograms, immunoblotting using sera raised in rabbits to three standard strains of coagulase-negative staphylococci, and 35S-methionine-labelled coagulase-negative staphylococcal profiles separated on sodium dodecylsulphate polyacrylamide gel electrophoresis and visualised by autoradiography (radioPAGE) . In 5 of 84 episodes, strains isolated from skin were indistinguishable by all three typing methods from the dialysate strain . In a further two episodes, hand or exit-site isolates were indistinguishable by all three typing methods from the dialysate strain isolated in the subsequent, but not the same, episode . Thus in the majority of episodes, no inference of hand or exit-site origin of dialysate infection could be drawn.

Lab Delo, 1991, (5), 54 - 6
{Evaluation of the efficacy of collection media used in hospital inspections}; Zharikova MS et al.; A total of 2303 parallel studies of washings off hospital environmental objects were carried out with 1% sugar broth and 1% peptone water used as enrichment media . Sugar broth was found preferable for the isolation of Staphylococci and gram-negative nonfermenting bacteria . Direct inoculations of washings off the environmental objects collected at treatment and prophylactic institutions for Staphylococci were found ineffective.

Lab Delo, 1991, (4), 64 - 5
{The rapid determination of the hemagglutinating and the blood coagulating activity of staphylococci}; Morar' NN et al.; A solid-phase preparation, designated by the authors "plasma pencil", has been developed for rapid measurements of plasma-agglutinating and plasma-coagulating activities of microorganisms . Plasma pencil employed instead of liquid plasma is economic, ready-to-use, may be stored for a long time, makes the procedure more rapid and simple . Measurements of the aforesaid activities in 388 staphylococcal clinical strains, carried out with the use of this pencil, have demonstrated a high efficacy of the preparation; the results coincided with those obtained by the routine methods.

Lab Delo, 1991, (2), 59 - 62
{Coagulase-negative staphylococci in pyoseptic pathology and methods for their identification}; Degteva GK et al.; Analysis of clinical material from cardiosurgical and cardiotherapeutic patients and that from neonates with pyoseptic infections, hospitalized in Moscow and Gorky, has demonstrated the etiologic significance of coagulase-negative Staphylococci (CNS) . Since many strains did not belong to S . aureus, S . epidermidis, or S . saprophyticus, they were species-identified in accordance with the classification by W . Kloos and K . Schleifer (1975) . A variety of CNS species was observed, and their role in the development of pyoseptic infections shown, the contribution of S . epidermidis and S . haemolyticus being the greatest here . Besides S . aureus, S . xylosus was often isolated from purulent foci . A certain specificity in CNS spectrum, related to the hospital profile, was revealed . A brief modified scheme of CNS classification was developed, based on analysis of about 700 strains, in accordance with the classification of W . Kloos and K . Schleifer, that included the tests available for practical laboratories.

Adv Perit Dial, 1991, 7, 129 - 32
Divergent etiologies of CAPD peritonitis in integrated double bag and traditional systems?
Honkanen E, Kala AR, Gronhagen-Riska C.
Thirty-four patients on integrated double bag systems (IDBS) without disinfectants were compared with 33 patients on traditional single bag systems for incidence, probability of remaining free of peritonitis, type, and association of peritonitis (PE) . In another 13 patients, the influence of a change in bag system was analyzed . On IDBS, the probability of remaining free of PE was 59% at 12 months and the incidence of PE was 0.44/year (1/27.3 months) while on traditional systems the probability of remaining PE free was 29% (p = 0.03) and the incidence was 1.06/year (1/11.3 months) . The switch from single bag systems to IDBS decreased the incidence from 1.7/year to 0.7/year . The distribution of microbes that caused peritonitis on IDBS was different from patients on traditional systems, where the causative microbes were mainly coagulase negative Staphylococci . The use of IDBS decreased considerably the occurrence of infections caused by these skin bacteria . Some associated disorder (e.g., exit site infection, dental infection, broken transfer set) was found significantly more often in patients on IDBS . In conclusion, IDBS affect both the occurrence and type of PE by diminishing effectively intraluminal contamination by skin bacteria . Thus, other sources of infection have a proportionally greater significance.

J Hosp Infect, 1991 Jan, 17(1), 61 - 5
Postoperative infections in breast surgery; Chen J et al.; The rate of infections in mastectomy wounds is apparently higher than normally allowed for in clean operations . A retrospective analysis of our results over two time periods shows a 6.4% infection rate for a one-step operation and 11.1% for a two-step operation between 1970 and 1976, compared with 2.6% and 7.6% for 1980-86, respectively . In accordance with other published reports, we found that a two-step operation, and advanced age, increase the danger of infection . The predominant pathogens were staphylococci . We advise the employment of a one-step operation in conjunction with prophylactic use of antibiotics.

J Immunol, 1990 Dec 15, 145(12), 4279 - 83
Staphylococcus aureus infection of human endothelial cells potentiates Fc receptor expression; Bengualid V et al.; Vasculitis, a recognized complication of staphylococcal-endovascular infections, may result in part, from the expression of FcR by Staphylococcus aureus-infected endothelial cells . FcR were measured using {51}Cr labeled SRBC preincubated with rabbit anti-SRBC IgG . FcR were not detected on uninfected endothelial cells, but were demonstrated on S . aureus infected cells using IgG, but not IgM labeled SRBC . FcR expression was dependent on the initial bacterial density (greater than or equal to 8 x 10(7) cfu/ml) and on phagocytosis of the staphylococci, but not on new protein synthesis . IgG labeled SRBC binding was blocked by aggregated IgG but not IgM . SRBC coated with the F(ab')2 portion of IgG did not bind, thus confirming that FcR were specifically involved in this interaction . FcR are expressed after S . aureus invasion of human endothelial cells and may contribute to the vasculitis which often accompanies S . aureus-endovascular infections.

Med Klin (Munich), 1990 Dec 15, 85(12), 707 - 14
{Non-tropical pyomyositis in Germany}; Piper C et al.; Haematogenous primary pyomyositis predominantly caused by staphylococcus aureus is a well-known entity in tropical regions . It is sporadicly observed in non-tropical areas . Lack of clinical familiarity not seldom contributes to delayed recognition of pyomyositis in the suppurative or complicated state . Initially, healing usually can be achieved by antibiotic treatment adjusted by antibiotic treatment adjusted to pyogenic staphylococci . Late stages require concomitant surgical or transcutaneous drainages of pus . In addition, treatment for osteomyelitis or bacterial carditis as typical complications may be necessary . The review of pyomyositis is illustrated by three case-reports from Germany.

J Antimicrob Chemother, 1990 Dec, 26 Suppl F, 73 - 6
A comparison between oral ciprofloxacin and intra-peritoneal vancomycin and gentamicin in the treatment of CAPD peritonitis; Bennett-Jones DN et al.; Fifty-one patients were included in a prospective, randomized comparison of oral ciprofloxacin and intraperitoneal vancomycin/gentamicin in the treatment of CAPD peritonitis . Staphylococcal species accounted for 40% of the isolates with an equal incidence of Staphylococcus aureus and coagulase negative staphylococci . Although, overall, there was no significant difference between the regimens in outcome, ciprofloxacin was significantly less effective when peritonitis was due to coagulase negative staphylococci.

Nippon Juigaku Zasshi, 1990 Dec, 52(6), 1219 - 27
Identification of staphylococci from bovine mastitis and an examination of their susceptibility to antibiotics and beta-lactamase production; Matsunaga T et al.; Strains of Staphylococcus species isolated from bovine mastitic milk at 66 dairy farms in Japan during the period from November 1988 to May 1989 were identified, and examined for their drug susceptibility and beta-lactamase production in order to clarify an epidemiological aspect of bovine mastitis caused by staphylococci . The results of bacteriological identification showed that the most predominant species was S . xylosus . Other major species isolated were S . aureus, S . sciuri and S . hyicus . Thirty-eight (71.7%) isolates of S . xylosus, 21 (45.7%) of S . aureus and 5 (71.4%) of S . epidermidis were positive for beta-lactamase production . Most of the beta-lactamase-producers of S . aureus were classified as high producers, although all of the beta-lactamase-positive S . xylosus isolates remained to be low producers . All isolates of S . aureus were sensitive to methicillin and cloxacillin at 6.25 micrograms/ml and 1.56 micrograms/ml, respectively, and none of methicillin-resistant S . aureus were detected . Isolates of other species were considered to be susceptible to 6 beta-lactams, in contrast to human isolates, but antibacterial activities of penicillin G and ampicillin were affected more strongly by beta-lactamase than those of methicillin, cloxacillin, cefazolin and cefoperazone.

J Clin Microbiol, 1990 Dec, 28(12), 2779 - 85
Association of coagulase-negative staphylococcal slime production and adherence with the development and outcome of adult septicemias; Kotilainen P; The relationship of coagulase-negative staphylococcal slime production and adherence with the development and outcome of bloodstream infections in two Finnish hospitals was evaluated . Analysis of 64 strains from 62 adult septicemias disclosed 34 (53%) adherent slime producers . In comparison, only 142 (29%) of 489 single blood culture isolates were adherent slime producers . Although tube adherence test-positive strains were significantly (P less than 0.001) more common among the septicemia strains than among clinically insignificant isolates, almost half of the septicemia cases were caused by tube test-negative strains . Thus, regarding any single patient isolate, a cautious posture to the clinical impact of positivity in the tube adherence test seems warranted . Moreover, adherence and slime production, as such, apparently played no role in the clinical outcome of these infections . The epidemiologic findings revealed that slime-producing coagulase-negative staphylococci were common in the hospital environment and suggested that epidemic spread of such strains was influenced by antimicrobial therapy . Collectively, these results indicate that, at least in these two hospitals, positivity in the tube was of minor importance in guiding clinical decisions in treating adult septicemias.

Br Heart J, 1990 Dec, 64(6), 381 - 4
Increase in native valve endocarditis caused by coagulase negative staphylococci: an Anglo-French clinical and microbiological study; Etienne J et al.; Native valve endocarditis caused by coagulase negative staphylococci has become more common . A study of 35 cases showed that the infections were usually acquired in the community and occurred in men (mean age 51 years) . A pre-existing cardiac abnormality (mitral leaflet prolapse in a third of patients) was detected in 26 (74%) . The source of the organisms in the community acquired infections was assumed to be the skin, though lesions were seldom demonstrated; most hospital acquired infections resulted from intravenous devices . Community acquired organisms were usually sensitive to penicillin, whereas those acquired in hospital were often multiresistant . Most infections were caused by Staphylococcus epidermidis . The frequency of acute presentation (26%) and of major neurological abnormality (23%), together with the need for valve replacement (often emergency) (51%) and the mortality (36%) suggest that coagulase negative staphylococci can be virulent aggressive pathogens, mimicking Staphylococcus aureusPublication Types:

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Last modified: May 25, 2005