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