Am J Epidemiol, 1990 Dec, 132(6), 1130 - 40 Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care unit populations: potential for confounding; Freeman J et al.; Coagulase-negative staphylococci are the most common cause of bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and the Children's Hospital, Boston, Massachusetts . In 1982, nosocomial bacteremia with coagulase-negative staphylococci occurred in 45 of 882 (5.1%) infants admitted to these units who survived and remained in intensive care for more than 48 hours and were therefore at risk . The overall cumulative incidence (attack rate) of nosocomial bacteremia rose dramatically with decreasing birth weight . The smallest infants, those with birth weights of less than 750 g, experienced an overall risk of nosocomial bacteremia 44.5 times that of infants with birth weights of greater than 2,000 g . A large part of the excess risk for small babies was attributable to their longer hospitalizations . However, after adjustment for length of stay, the smallest infants still suffered a daily rate of bacteremia (incidence density) 5.3 times that of the largest, indicating a considerable residual effect of birth weight on the daily risk of nosocomial coagulase-negative staphylococcal bacteremia . The results were similar in the two nurseries . Thus, there is still a substantially increased intrinsic risk of nosocomial coagulase-negative staphylococcal bacteremia among infants with very low birth weights, even after adjustment for duration of hospitalization, and differences in birth weight can confound comparative studies. Surg Neurol, 1990 Dec, 34(6), 366 - 72 Vancomycin pharmacokinetics in hydrocephalic shunt prophylaxis and relationship to ventricular volume; LeRoux P et al.; Vancomycin pharmacokinetics were determined in 25 patients receiving ventriculoperitoneal shunts for hydrocephalus . Computed tomography scan-derived ventricular-brain ratio as an expression of hydrocephalus varied between 9.3% and 15.4% (12.9% +/- 1.7%) . One hour prior to surgery each patient received 1 g of vancomycin infused intravenously over 60 minutes . Samples of cerebrospinal fluid and venous blood were obtained 1 hour later and vancomycin levels assayed by fluorescence polarization immunoassay . There were 11 females and 14 males, with a mean age of 44.5 +/- 10.3 years and a mean weight of 72.0 +/- 11.4 kg . All had normal renal function . Levels of vancomycin in the cerebrospinal fluid at 1 hour ranged from 0.1 to 1.5 micrograms/mL (0.9 +/- 0.3) . Weight did not affect these values (p greater than 0.1) . Simultaneous blood vancomycin levels varied between 9.1 and 38.7 micrograms/mL (22.3 +/- 8.3) . Ventricular volume, expressed as the ventricular-brain ratio, did not correlate with cerebrospinal fluid vancomycin levels (p greater than 0.5) . There was no significant increase in concentrations of vancomycin in CSF as cerebrospinal fluid protein concentration increased, nor when blood vancomycin concentration was greater than 20 mg/dL (therapeutic range) (p greater than 0.1) . No patient had evidence of infection at 6 months follow up . These results indicate minimal cerebrospinal fluid penetrance of vancomycin when administered systemically 1 hour prior to shunt surgery . In addition concentrations of vancomycin in cerebrospinal fluid bear no relationship to weight, ventricular volume, meningeal inflammation, or blood levels in the therapeutic range . The minimum inhibitory concentration of vancomycin for staphylococci is 1.5 to 3.1, and as bactericidal levels of 5 to 8 minimum inhibitory concentration are needed to kill organisms, a combination of both systemic and intraventricular vancomycin may be needed to ensure adequate cerebrospinal fluid and tissue concentration of antibiotic during shunt prophylaxis. J Clin Microbiol, 1990 Dec, 28(12), 2707 - 10 Phosphatase activity of staphylococci is constitutive in some species and repressed by phosphates in others; Soro O et al.; The phosphatase activities of colonies of staphylococcal strains belonging to the 10 species most frequently isolated from specimens of human origin were evaluated on media with undetermined inorganic phosphate contents and on media supplemented with known amounts of phosphates . All strains of all species tested were phosphatase positive on plates that were not supplemented with inorganic phosphates when the pH of the medium was high . In media supplemented with 0.3% phosphates at low and high pH, all strains of Staphylococcus aureus, almost all strains of S . epidermidis and S . xylosus, and none of the other species tested were phosphatase positive . Thirty S . simulans strains were grown in broths at pH 7 with and without phosphates, and the phosphatase activities of the cells were assayed at pH 5.5 and 8 in the absence of phosphates . At pH 8, all strains gave a strong positive reaction when grown in the absence of phosphates and a negative reaction when grown in the presence of these salts at 0.3% . It was concluded that all the species of staphylococci tested possess phosphatase activity and that the staphylococcal phosphatases are constitutive in some species and repressed in others. Clin Orthop, 1990 Dec, (261), 126 - 33 Antibiotic resistance of biomaterial-adherent coagulase-negative and coagulase-positive staphylococci; Naylor PT et al.; Whether or not bacterial populations are massively enclosed in slime, it appears that antibiotic resistance, when compared to suspension organisms, is related to surface adhesion and to the specific material of the substratum . These findings are of significance in the understanding and treatment of biomaterial-localized infections. Br J Haematol, 1990 Dec, 76 Suppl 2, 54 - 6 Role of glycopeptide antibiotics in the treatment of febrile neutropenic patients; Smith SR et al.; The exact timing of the introduction of the glycopeptide antibiotics teicoplanin and vancomycin in the management of the febrile neutropenic patient continues to be controversial . However, there are certain firm criteria now emerging . Bacteraemia can be eradicated with a success rate approaching 100% in cases where the organism can be identified and shown to be sensitive . Approximately 65% of cases of soft-tissue infection, usually occurring with the use of a Hickman or equivalent indwelling catheter, are associated with the presence on culture of Gram-positive organisms of presumed skin origin . Such infection is an indication for the early use of antibiotics with proven activity against coagulase-negative staphylococci and diptheroids . Resolution of fever in up to 50% of cases may result from using 'planned progressive therapy': the introduction of specific Gram-positive cover in patients who have failed to respond at 48-72 h to regimens such as a ureidopenicillin or a third-generation cephalosporin with or without an aminoglycoside . This approach reduces the number of patients who go on to receive empirical amphotericin B intravenously for presumed fungal infection . Using teicoplanin or vancomycin as first-line agents in the empirical treatment of first fever in febrile neutropenic patients is perhaps more controversial . Recent developments which include using quinolone-based prophylaxis more widely and introducing cytokines to reduce the period of neutropenia may increase the likelihood that a neutropenic patient's febrile episode will be due to a Gram-positive organism . The dilemma of choosing broad-spectrum monotherapy or targeted combination therapy in the situation remains unresolved . Current studies, however, should help to clarify this situation . Finally, other current studies of teicoplanin and vancomycin as prophylactic agents administered either orally or systemically, may provide additional indications for their use in the neutropenic patient. Br J Haematol, 1990 Dec, 76 Suppl 2, 30 - 4 A comparative efficacy and safety study of teicoplanin plus aztreonam versus gentamicin plus piperacillin in haematology oncology patients with clinically diagnosed septicaemia; Spencer RC et al.; Infections due to Gram-positive bacteria, especially coagulase-negative staphylococci, have been increasing in immunocompromised patients during the last 5 years because of an increased use of Hickman catheters and oral gut decontamination with quinolones . Teicoplanin, a new glycopeptide antibiotic, has a long plasma half-life which allows once-a-day bolus administration, making it a 'user friendly' agent . A randomized comparative evaluation of teicoplanin plus aztreonam versus gentamicin plus piperacillin in leukaemic patients with a clinical diagnosis of septicaemia was undertaken . The objectives of this study were (1) to evaluate the efficacy and safety of teicoplanin and aztreonam in comparison to a 'standard antibiotic' regimen and (2) to assess the local and systemic tolerance of these drugs . Results of the study in more than 70 patients to date are presented, and the role of anti-Gram-positive antibiotics in the management of severe sepsis in immunocompromised patients is discussed. Int J Pediatr Otorhinolaryngol, 1990 Dec, 20(3), 219 - 23 Ear discharge after insertion of transmyringeal tubes; Roos K et al.; The peroperative bacteriology and cytology of the middle ear have been studied in 103 ears in 65 children operated on due to longstanding secretory otitis media . Within one month postoperatively, 12 ears (12%) showed signs of infection with discharge from the tube . Ten out of these 12 ears showed peroperative growth of Hemophilus influenzae, Branhamella catarrhalis, pneumococci or staphylococci in the middle ear effusions, a significant difference compared to ears without postoperative discharge . The peroperative cytological evaluation of the middle ear effusions from 10 out of the 12 patients with postoperative ear discharge showed presence of phagocytes as a sign of infection . It is concluded that pre-existing bacteria in the middle ear effusion of patients with longstanding secretory otitis media might increase the risk of postoperative infection within the first month after insertion of transmyringeal tubes. Eur J Clin Microbiol Infect Dis, 1990 Dec, 9(12), 873 - 9 Analysis of the relationship between bacterial adherence and extracellular production of mannose, galactose, glucose and ribose in Staphylococcus epidermidis and Staphylococcus hominis; Kotilainen P et al.; Gas-liquid chromatography-mass spectrometry was used to analyze the extracellular extracts of 108 coagulase-negative staphylococcal strains for the presence of mannose, galactose, glucose and ribose, in order to determine whether production of these four monosaccharides, regarded as potential staphylococcal slime components, was associated with the adherence capacity of the individuals strains . A total of 90 Staphylococcus epidermidis and 18 Staphylococcus hominis strains were studied . Using the quantitative spectrophotometric assay, 21 Staphylococcus epidermidis strains were classified as strongly adherent, 12 as moderately adherent, 11 as weakly adherent, and 46 as nonadherent . All 18 Staphylococcus hominis strains were nonadherent . Mannose, galactose, glucose and ribose were detected as the main monosaccharide components in the extracellular extracts of all strains examined . Moreover, the mean relative concentrations of these monosaccharides were essentially the same for the different adherence phenotypes within the species Staphylococcus epidermidis . These results showed that there was no causal connection between the adherence of coagulase-negative staphylococci and the extracellular production of any of the four monosaccharides analyzed. Vet Med (Praha), 1990 Dec, 35(12), 713 - 6 {Coagulase negative staphylococci isolated from cow milk}; Havelka B; The species composition was determined in the set of 52 randomly selected strains of coagulase-negative staphylococci, which were isolated from the milk of dairy cows in 1989 . Of this set of strains, the following species were identified: Staphylococcus hyicus subsp . chromogenes (26.9% strains of the set), S . hyicus subsp . hyicus (10.3%), S . xylosus (19.3%), S . saprophyticus (11.5%), S . warneri (9.6%), S . haemolyticus (9.6%), S . hominis (3.8%) . Attention is drawn to the increasing occurrence and significance of coagulase-negative staphylococci from the point of view of mastitis in dairy cows. Oral Microbiol Immunol, 1990 Dec, 5(6), 305 - 8 Age and sex relationships of superinfecting microorganisms in periodontitis patients; Slots J et al.; The occurrence by age and sex of subgingival enteric rods and pseudomonads, yeasts, and staphylococci was studied in 3075 "refractory" periodontitis patients referred for microbiological analysis . Each subject contributed a pooled subgingival sample obtained from 3 deep periodontal pockets with paper points . Selective and nonselective media and commercial identification kit systems were used for microbial isolation and speciation . Females constituted about 60% of the study subjects, and almost one-third of all patients were in their forties . Females (47.3%) showed a higher prevalence of the study organisms than males (43.9%) . Older females (15.9%) and males (15.3%) revealed significantly higher prevalences of enteric rods and pseudomonads than younger individuals (10.9%), and older infected females yielded significantly higher viable counts than younger infected females . The sexes demonstrated a similar prevalence of staphylococci (about 28%), but younger infected females and males showed significantly higher viable counts than older infected individuals . No sex or age relationships were found for yeasts (about 14% of individuals infected) . The high level of subgingival enteric rods and pseudomonads in some individuals may be important in the pathogenesis of geriatric and other forms of periodontitis and may have therapeutic implications. Zentralbl Bakteriol, 1990 Dec, 274(3), 382 - 9 Typing of multiple isolates of coagulase-negative staphylococci from blood cultures and cerebrospinal fluid in neonates and children: an approach to discriminate contaminants; Witte W et al.; From eight neonates and children suspicious for suffering from septicemia and/or meningitis, coagulase negative staphylococci (CNS) were isolated from multiple blood cultures and from cerebrospinal fluids originating from different punctures . S . epidermidis was the predominant species . By a further typing using plasmid-profiles and exoprotein patterns besides the resistance phenotype, contaminants could be discriminated from the isolates as the probable etiologic agent exhibiting unique reaction patterns . CNS isolated from cases of septicemia together with other bacterial pathogens or from cases of presumed but not confirmed septicemia revealed as different. Zentralbl Bakteriol, 1990 Dec, 274(3), 342 - 9 Fibronectin-staphylococcal interactions in endovascular infections; Proctor RA; Fibronectin is a large molecular weight protein that is found coating the surfaces of sites where endovascular damage has occurred . These are also the sites most commonly infected by bacteremic strains of staphylococci . Epidemiologic studies show a correlation between expression of fibronectin receptors and development of invasive infections . In vitro studies using cultured cells, artificial matrices containing fibronectin, blood clots, natural inflammatory matrices, and anti-fibronectin antibodies implicate fibronectin as an important ligand for staphylococcal attachment to host tissues and prosthetic devices . In the rat endocarditis model, S . aureus strains that lack the fibronectin receptor due to site-directed mutagenesis were unable to colonize the traumatized heart valves . These data suggest that the fibronectin receptor on staphylococci is important in the pathogenesis of endovascular infections . Because the fibronectin receptor is widely expressed on pathogenic of staphylococci, a broadly protective vaccine against S . aureus might be possible. Ophthalmology, 1990 Dec, 97(12), 1684 - 8 Role of staphylococcal toxin production in blepharitis; Seal D et al.; Lid isolates of Staphylococcus aureus and coagulase-negative staphylococci (CNS) from controls (12 S . aureus and 110 CNS) and from patients with blepharitis (17 S . aureus and 171 CNS) were tested for production of alpha, beta, delta, epsilon, and previously undescribed hemolytic toxins, because toxin production has been implicated as a cause of blepharoconjunctivitis . The electrolyte content of agar media required for toxin production was first investigated . Alpha-lysin was found to be produced by all isolates of S . aureus colonizing lids of normal controls and patients with blepharitis, but by none of 281 CNS isolates . A new toxin was identified, having low molecular weight (5 kd), produced by one CNS strain isolated from a blepharitic lid . It was produced on basic nutrient agar that lacked sodium but contained glucose, which inhibited production of alpha-lysin . It hemolyzed rabbit and sheep erythrocytes and, surprisingly, was neutralized by polyclonal antiserum to alpha-lysin . This may explain occasional reports of alpha-lysin production by CNS . The overall results do not support a hypothesis of hemolytic toxin production by staphylococci as a general cause of blepharitis. Kansenshogaku Zasshi, 1990 Dec, 64(12), 1542 - 9 {Adherence ability of coagulase-negative staphylococci to catheter materials}; Koike N; Adherence ability to catheter materials for intravenous use of coagulase-negative staphylococci (CNS) which is frequently isolated from prosthetic implants and medical devices inserted into the body was studied, and the mechanism of catheter-associated infections and the prevention against that were discussed . Difference of the adherence ability of CNS to various kinds of catheter materials was found, and adherence ability to the catheter materials was correlated with that of human epithelial cells in culture . CNS isolated from intravenous catheters had higher adherence ability to the human epithelial cell cultures than isolates from other clinical sources . Among 4 kinds of catheter materials, including ethylene vinyl acetate (EVA), polyvinyl chloride (PVC), silicone (Sil) and polyurethane (PUR), the adherence ability of CNS on the EVA containing barium was highest, and Sil treated with tungsten showed the lowest . The physicochemical properties of both the bacteria and the catheter materials, hydrophobicity of the bacterial cultures and the catheter materials, negative charges on surface of the bacteria, surface structure of the catheter materials, additives to the catheter materials, and coating the catheter surface gave great effects on the adherence of CNS to the catheter materials . In addition, as biofactors, fibronectin and PROTEAMIN-HICALIQ solutions enhanced the adherence of CNS . These results suggested that catheter materials having a smooth surface and higher hydrophobicity, treated with tungsten and coated with urokinase were effective on the suppression of the adherence to catheter materials . In addition to the improvement of catheter materials, aseptic procedures in catheterization were thought to be critical for the prevention of catheter-associated infections.(ABSTRACT TRUNCATED AT 250 WORDS) FEMS Microbiol Immunol, 1990 Dec, 2(5-6), 259 - 62 Staphylococcal opsonization and anti-Staphylococcus aureus IgG subclass antibodies in patients with severe or recurrent S . aureus infections; Monteil MA et al.; Opsonization of Staphylococcus aureus (Oxford strain) and specific IgG subclass antibodies against formalised staphylococci were measured in plasmas from 27 patients with significant S . aureus infections and 35 healthy adults and 15 children . There were no statistically significant differences in the IgG2 and IgG4 levels between two groups and IgG3 was not detected, but the median plasma IgG1 level was significantly higher in patients with staphylococcal infections (P less than 0.00003) . The concentration of IgG2 anti-S . aureus antibodies was 25-47 times greater than that of IgG1 . If plasmas were decomplemented, the raised IgG1 levels were associated with increased opsonophagocytosis by normal neutrophils (P less than 0.0002). Eur J Biochem, 1990 Nov 13, 193(3), 759 - 65 Binding and activation of plasminogen at the surface of Staphylococcus aureus . Increase in affinity after conversion to the Lys form of the ligand; Kuusela P et al.; Untreated Staphylococcus aureus cells, strain Cowan I, specifically bound 125I-Glu-plasminogen . The binding was inhibited by both unlabeled Glu-plasminogen and Glu-plasmin . The Lys form of plasminogen, which lacks the 8-kDa amino-terminal activation peptide, was approximately 100-fold more effective than the Glu form in competing with the binding of 125I-labeled Glu-plasminogen . This suggests an increase in binding affinity upon removal of the activation peptide . Fibronectin, fibrinogen and IgG, plasma components known to bind to the staphylococcal surface, did not significantly interfere with the binding . The competing activity in plasma was abolished by specifically absorbing plasminogen from the plasma sample . L-Lysine and a fragment of plasminogen containing three of the first five protein attachment domains present in the molecule (kringle structures) also competed with plasminogen for binding suggesting that the lysine-binding sites of plasminogen were involved in its interaction with staphylococci . Scatchard analysis revealed high- and low-affinity binding sites . Kd and the number of high-affinity binding sites were 1.7 nM and 780 binding sites/bacterial cell, respectively . 125I-Glu-plasminogen bound to staphylococcal surface was converted to plasmin by tissue-type plasminogen activator . The conversion took place also in the presence of plasma . If the conversion was carried out in the absence of low-molecular-mass plasmin inhibitors such as aprotinin, the bound Glu-plasmin was further converted to Lys-plasmin . The surface-bound plasmin was enzymically active, as judged by digestion of the synthetic substrate, S-2251 . The plasminogen conversion shown by the present experiments not only leads to the surface-bound plasmin but seems to considerably increase the affinity of plasmin for its binding site . This may represent a physiologically relevant method for a bacterial cell to retain surface-bound active plasmin which is also protected from its soluble plasma inhibitors . This novel mechanism for staphylococci to adopt surface-bound proteolytic activity, without the interference of plasma components, may have some role in the tissue penetration and invasion of microbes during infection. Diagn Microbiol Infect Dis, 1990 Nov-Dec, 13(6), 521 - 5 Stomatococcus mucilaginosus bacteremias . Typical case presentations, simplified diagnostic criteria, and a literature review; Mitchell PS et al.; Even though Stomatococcus mucilaginosus is considered indigenous oral-pharyngeal flora, cited literature and case reports indicate that it can be the cause of infectious conditions . Tested strains were isolated from blood, the oral region, and wound sources . The organism was routinely misidentified or not identified by conventional or commercial systems (Vitek, STAPH-Trac) . Four antimicrobial diagnostic disks for example, bacitracin (0.04 units; Taxo A), furazolidone (100 micrograms), novobiocin (5 micrograms), and polymyxin B (300 units), were evaluated as possible addition to previously applied biochemical characteristics that differentiate between S . mucilaginosus, Micrococcus sp., and coagulase-negative staphylococci . Consistent antimicrobial susceptibility patterns among our isolates to the diagnostic disks produced applicable characteristics for discriminating S . mucilaginosus from similar microorganisms . However, therapeutic choices of antimicrobial agents should be guided by individual organism susceptibility test results because of variable, often resistant patterns to beta-lactams, aminoglycosides, macrolides, new fluoroquinolones, and sulfonamides. Diagn Microbiol Infect Dis, 1990 Nov-Dec, 13(6), 461 - 6 Biotyping of coagulase-negative staphylococci . 108 isolates from nosocomial bloodstream infections; Herwaldt LA et al.; Using simple, readily available typing methods, we evaluated 108 strains of coagulase-negative staphylococci that were causally related to bloodstream infections: 95% (103 of 108) of the isolates were identified as Staphylococcus epidermidis and were divided into 18 biotypes by API Staph-Trac . A single biotype (biotype A, 6606113) accounted for greater than 50% of the isolates of S . epidermidis . Biotype A was further divided into seven subtypes by slime production and synergistic hemolysis; however, 66% of the isolates in biotype A remained in two major subtypes, 1a (strongly slime-positive and synergistic hemolysis-positive) and 2a (strongly slime-positive and synergistic hemolysis-negative) . The addition of the antibiotype further separated the isolates into individual strains or into small groups of organisms . A significant correlation was noted between synergistic hemolysis and the three most resistant antibiotypes (p = 4.2 X 10(-5); OR = 5.8; CI95, 2.2-15.2) . Each biotype, subtype, and antibiotype was further divided into multiple unique strains by plasmid pattern analysis . In most clinical situations the combination of API Staph-Trac, antibiotic profile, slime production, and synergistic hemolysis provides adequate strain discrimination . Plasmid pattern analysis adds important information in specific clinical situations and may be invaluable for epidemiologic investigations. J Appl Bacteriol, 1990 Nov, 69(5), 686 - 91 The cutaneous microbiology of haired and hairless mice; Harnby D et al.; The cutaneous microflora of the mid-dorsal area of hairless and haired mice was studied by processing skin biopsies . In both C3H and CBA hairless genotype animals the prevalence of colonization and the bacterial density were significantly greater than in the haired animals . The dominant bacteria were staphylococci and aerobic coryneforms . No propionibacteria were isolated . Temporal studies with C3H mice showed that from 0 to 9 days after birth the cutaneous microflora reduced and from then on the haired genotype animals maintained a low cutaneous microflora, whilst hairless genotype animals gradually lost hair from head to tail and the microflora density increased . Reciprocal skin grafting between haired and hairless animals showed that the donor skin acquired the microflora characteristics of the recipient animal after 15 d post-grafting even though the donor skin remained morphologically true to genotype. JPEN J Parenter Enteral Nutr, 1990 Nov-Dec, 14(6), 593 - 7 Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulase-negative staphylococci; Gaillard JL et al.; Using a quantitative in vitro model simulating clinical conditions, we studied the efficacy of conventional and nonconventional 3-day therapies involving vancomycin for treating the internal surface of catheters colonized with a slime-producing strain of Staphylococcus epidermidis . When infused for 1 hr every 8 hr through the catheter at the daily dose recommended for a 10-kg child (450 mg), vancomycin alone reduced bacterial colonization but failed to sterilize the inserts . Vancomycin was more active in combination with netilmicin (25 mg for 1 hr every 8 hr), rifampin (150 mg for 90 min every 12 hr), or fosfomycin (500 mg for 4 hr every 6 hr), but the catheters were inconsistently decontaminated after 3 days of treatment . Two nonconventional modes of antibiotic administration were tested for their capacity to ensure high levels of vancomycin in the catheter lumen over a prolonged time . Vancomycin infused continuously through the catheter at a daily dose of 450 mg had the same poor sterilizing effect as vancomycin administered intermittently . On the contrary, catheters were totally decontaminated when 2.5 mg of vancomycin in a volume of 0.5 ml were injected twice daily into noninfused catheters, confirming that the antibiotic-lock technique is an approach of great interest to sterilize the internal surface of catheters colonized with staphylococci. J Clin Microbiol, 1990 Nov, 28(11), 2585 - 6 Reproducibility of API Staph-Ident system identifications of coagulase-negative staphylococci isolated from blood; Overman TL et al.; Fifty-five isolates of coagulase-negative staphylococci from blood were identified four times each by using the API Staph-Ident (API-SI) system to determine the identification reproducibility of the system . Identifications were determined by using both Version 1 and Version 2 of the API-SI Profile Index . The 75 to 100% reproducibility levels, including reproducible nonidentifications, were 98.2% for Version 1 and 96.4% for Version 2 . Version 1 gave an identification for 92.5% of the isolates with a 75 to 100% reproducibility, while Version 2 gave an identification for 100% of the isolates with a 75 to 100% reproducibility . The reproducibility of the API-SI identifications of coagulase-negative staphylococci from blood was good. J Clin Microbiol, 1990 Nov, 28(11), 2578 - 9 Differential production of slime under aerobic and anaerobic conditions; Barker LP et al.; A series of 37 clinical isolates of coagulase-negative staphylococci previously identified as negative for slime production by the tube test were reexamined by the tissue culture plate test under aerobic and anaerobic conditions . None of the strains produced slime under anaerobic conditions; however, five strains (13%) produced slime under aerobic conditions. J Clin Microbiol, 1990 Nov, 28(11), 2568 - 9 Effect of BiTek agar on lysostaphin susceptibility of staphylococci; Langlois BE et al.; Staphylococci which were considered to be lysostaphin susceptible on P agar containing Bacto-Agar showed different degrees of resistance to lysostaphin when tested on P agar made with BiTek agar . As a result, lysostaphin-susceptible strains were misidentified as lysostaphin-resistant strains. J Clin Microbiol, 1990 Nov, 28(11), 2425 - 31 Hemolysins and other characteristics that help differentiate and biotype Staphylococcus lugdunensis and Staphylococcus schleiferi; Hebert GA; Reference strains and clinical isolates representing the newly defined species Staphylococcus lugdunensis and Staphylococcus schleiferi were examined with the battery of tests previously recommended (G.A . Hebert, C.G . Crowder, G.A . Hancock, W.R . Jarvis, and C . Thornsberry, J . Clin . Microbiol . 26:1939-1949, 1988) for other species of coagulase-negative staphylococci (CNS) . The Staph-Ident system (Analytab Products, Plainview, N.Y.) supplemented with tests for synergistic hemolysis, adherence to glass, pyroglutamyl-beta-naphthylamide hydrolysis, and susceptibility to a set of five antimicrobial disks differentiated each of these species from other species of CNS and separated strains within each species into several biotypes . Most strains (95%) of S . lugdunensis produced a delta hemolysin like that seen with nine other species of CNS . Most strains (91%) of S . schleiferi produced a beta hemolysin, which is a unique characteristic among CNS . Most (95%) of the S . schleiferi but very few (12%) of the S . lugdunensis were adherence positive . Both hemolysins and adherins are potential virulence factors among CNS . Some (29%) of the S . lugdunensis were beta-lactamase positive . The S . lugdunensis were resistant to polymyxin B and bacitracin (10 U), but the S . schleiferi were susceptible to both disks . Clinical isolates of S . lugdunensis were aligned in 18 biotypes because of eight biochemical profiles and eight physiologic subtypes; isolates of S . schleiferi were in 8 biotypes because of three biochemical profiles and subtypes . These tools for correctly identifying and then biotyping two more clinical species of CNS should enhance both epidemiologic and ecologic investigations. Eur J Clin Microbiol Infect Dis, 1990 Nov, 9(11), 820 - 2 Prevalence of Staphylococcus aureus and coagulase-negative staphylococci with decreased sensitivity to glycopeptides as assessed by determination of MICs; Vedel G et al.; The prevalence of staphylococci with decreased sensitivity to glycopeptides was assessed at a Paris hospital by determination of the MICs . The values obtained using the MIC method were compared to those obtained using the routine disk agar diffusion method . One hundred independently isolated strains were tested including 57 Staphylococcus aureus isolates and 43 coagulase-negative staphylococci (CNS) . For all strains vancomycin MICs were less than or equal to 4 mg/l but for 5.3% of the Staphylococcus aureus isolates and 25.6% of the CNS isolates teicoplanin MICs were high (greater than or equal to 8 mg/l) . Moreover, teicoplanin MICs did not correlate well with zone sizes . The MIC method is therefore recommended for evaluating the susceptibility of staphylococci to teicoplanin. Eur J Clin Microbiol Infect Dis, 1990 Nov, 9(11), 804 - 9 In vitro antimicrobial activity of imipenem in combination with vancomycin or teicoplanin against Staphylococcus aureus and Staphylococcus epidermidis; Barr JG et al.; The interaction between imipenem and two glycopeptides against staphylococci was examined for potential synergy . Imipenem in combination with vancomycin or teicoplanin exerted a synergistic or additive effect against a majority of Staphylococcus aureus and Staphylococcus epidermidis isolates tested by the checkerboard method . Synergistic inhibitory effects were frequently accompanied by synergistic bactericidal effects . For a proportion of bacterial isolates of both species, the demonstration of synergy by the checkerboard method was confirmed by time-kill studies using antibiotic combinations at the MICs or at achievable serum antibiotic levels . Only with a single isolate of Staphylococcus epidermidis was antagonism with either antibiotic combination recorded. Clin Orthop, 1990 Nov, (260), 17 - 23 Antibiotic prophylaxis and tourniquet inflation in total knee arthroplasty; Friedman RJ et al.; Twenty-four patients receiving total knee arthroplasty (TKA) were randomized into one of three groups based on tourniquet inflation one, two, or five minutes after administration 1 g cefazolin . Simultaneous serum, soft-tissue, and bone samples were obtained at regular intervals during surgery . All soft-tissue and bone samples were corrected for cefazolin content . The percentage of cefazolin penetration into soft tissue and bone was calculated using the area under the concentration time curve . Adequate cefazolin concentrations for soft tissue and bone were defined as greater than or equal to 4 x minimum inhibitory concentration90 (MIC90 = 1 microgram/ml) of cefazolin to Staphylococcus aureus and coagulase-negative staphylococci . Patients were similar in age, actual body weight, creatinine clearance, and length of tourniquet inflation . The median percentage of cefazolin penetration into soft tissue and bone for the five-, two-, and one-minute groups was 14.5% and 4.6%, 6.7% and 3.0%, and 5.9% and 4.6%, respectively; the percentage of penetration into soft tissue between the five- and one-minute groups was statistically significant . A higher percentage of patients achieved the desired cefazolin concentration (greater than or equal to 4 micrograms/g) if a five-minute interval was selected . The five-minute group achieved the highest mean ratios of concentration to MIC compared with the two- and one-minute groups, although the differences were not statistically significant . The standard 1 g of cefazolin with a five-minute interval between administration and tourniquet inflation resulted in adequate mean soft-tissue and bone concentrations for prophylaxis during TKA with a tourniquet time less than two hours . Additional doses are not warranted after tourniquet release. Antibiot Khimioter, 1990 Nov, 35(11), 34 - 7 {Antibacterial activity of some trichomonacidal agents}; Kalinichenko NF et al.; In vitro and in vivo antibacterial activity of metronidazole preparations was studied in comparison to that of nitazole in various dosage forms: solution, aerosol, suspension and suppository . The metronidazole preparations inhibited only anaerobic organisms and were efficient in experimental infections caused by them . Unlike the metronidazole preparations, the dosage forms of nitazole inhibited the growth not only of anaerobic organisms but also that of staphylococci and had a therapeutic effect on infections caused by these organisms. Antibiot Khimioter, 1990 Nov, 35(11), 14 - 6 {Biochemical activity of opportunistic antibiotic and chloramine-sensitive and resistant microorganisms isolated from healthy and sick people}; Balakliets NI et al.; Activity of oxidation-reduction enzymes such as succinate dehydrogenase, peroxidase and catalase was studied in staphylococci isolated from healthy persons and patients as well as from the air and implements of medical institutions . The isolates were resistant either to antibiotics or to chloramine B or to the both . The results showed that development of resistance to antibiotics and chloramine B in the staphylococci was accompanied by a decrease in the activity of succinate dehydrogenase, peroxidase and catalase . In the strains resistant only to chloramine B the activity of the enzymes was practically at the same level as in the strains resistant only to antibiotics . In the strains resistant to both antibiotics and chloramine B, the activity of succinate dehydrogenase, peroxidase and catalase did not practically differ from that in the strains resistant either to antibiotics or to chloramine B. J Clin Immunol, 1990 Nov, 10(6 Suppl), 47S - 52S; discussion 52S-55S New uses of intravenous immune globulin in newborn infants; Baker CJ; Preterm infants are hypogammaglobulinemic at birth, a condition that worsens during the first several weeks of life . It has been postulated that periodic infusions of intravenous immune globulin in preterm infants might prevent systemic infections after age 7 days, but clinical trials have been inconclusive . To test this hypothesis in neonates weighing 500 to 1750 g at birth, a multicenter, randomized, double-blind, placebo-controlled trial was initiated . Either intravenous immune globulin (500 mg/kg) (284 infants) or placebo (5% albumin-normal saline, 10 ml/kg) (293 infants) was infused periodically for 8 weeks . Infusions were well tolerated . Mortality (4%) was similar in both groups . However, the incidence of systemic infection was significantly reduced in the treatment group, but only in those weighing less than 1500 g . More than 80% of infections were bacterial; half were caused by staphylococci . Standard use of intravenous immune globulin in preterm infants looks promising but must await full analysis of data from this and another ongoing multicenter trial. J Antimicrob Chemother, 1990 Nov, 26(5), 713 - 20 Aminoglycoside toxicity following antibiotic prophylaxis in cardiac surgery; Wilson AP et al.; We have reviewed experience with aminoglycosides in cardiac surgical prophylaxis from 1984 to 1989 . In the first two years, prospectively randomized trials (517 patients) allowed comparison of tobramycin (three-day course) with a non-toxic antibiotic, teicoplanin . A significant excess rise in serum creatinine was present at the end of the first postoperative week in patients given tobramycin (165 vs 149 patients, 95% CI 3-17 microM . P less than 0.01, which was most marked in ten oliguric patients with trough serum levels over 2 mg/l (95% CI 7-52 microM) . However, no patient needed haemodialysis and only one case of possible ototoxicity was identified . During the next three years, of 912 patients given two to three days gentamicin, 29 patients were shown to have potentially toxic serum levels and oliguria . Three individual cases are described, including one of ototoxicity and one of nephrotoxicity neeeding haemodialysis . The hazards of aminoglycoside toxicity are probably small compared with the failure of other antibiotics to cover staphylococci that may later cause wound infection or endocarditis . However, surgeons should probably be advised to check the aminoglycoside level in all patients on the first post-operative day. J Lab Clin Med, 1990 Nov, 116(5), 697 - 706 Treatment evaluation of experimental staphylococcal infections: comparison of beta-lactam, lipopeptide, and glycopeptide antimicrobial therapy; Fasching CE et al.; LY 146032, teicoplanin, vancomycin, oxacillin, cephalothin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam were studied against six isolates of staphylococci (including both Staphylococcus aureus and coagulase negative staphylococci) using in vivo and in vitro methods . In vitro susceptibility measurements demonstrated that all six isolates were sensitive to LY 146032 and vancomycin and that five of six isolates were sensitive to tiecoplanin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam . Comparison of antimicrobial therapy in an in vivo rabbit model demonstrated that cefoperazone plus sulbactam was active against the greatest number of isolates (five of six) based on a reduction of greater than or equal to 5.0 log10 colony forming units per milliliter (CFU/ml) from growth control at the end of the animal treatment study . Vancomycin and oxacillin were equal in achieving reductions of greater than or equal to 5.0 log10 CFU/ml in four of the six isolates . Comparing each isolate's in vivo outcome to in vitro data shows that in vitro susceptibility tests overpredict the sensitivity of these six isolates to LY 146032 and vancomycin, are variable for teicoplanin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam, and underpredict for oxacillin. FEMS Microbiol Lett, 1990 Oct, 60(1-2), 93 - 6 Adhesive binding of rokitamycin to Staphylococcus aureus ribosomes; Endou K et al.; Rokitamycin (RKM), a 3"-O-propionyl derivative of leucomycin A5, is bactericidal against staphylococci near the minimum inhibitory concentrations . RKM bound to ribosomes before-hand is only slightly displaced by erythromycin or josamycin, or even by RKM itself . The adhesive binding of the RKM-ribosome complex might prove to be the lethal event for susceptible staphylococci. FEMS Microbiol Lett, 1990 Oct, 60(1-2), 51 - 3 Gel electrophoretic analysis of penicillin-binding proteins of coagulase negative staphylococci; Kanda K et al.; We analyzed gel electrophoretic banding patterns of penicillin-binding proteins (PBPs) of 16 type strains of coagulase-negative staphylococci (CNS) . S . epidermidis, S . haemolyticus, S . saprophyticus, S . hominis, S . xylosus, S . simulans, S . warneri, S . capitis, S . saccharolyticus, S . auricularis, S . caseolyticus, S . gallinarum, S . hycus subsp . hycus, S . cohnii, S . caprae, and S . sciuri subsp . sciuri . The PBP profile of each CNS species was found to be unique and was clearly distinguishable from those of the rest of the species . Together with the previous work of other researchers, this study substantiates the applicability of the PBP profile analysis to the identification of clinical CNS strains. Nippon Juigaku Zasshi, 1990 Oct, 52(5), 963 - 8 Isolation of Staphylococcus species from the tonsils of healthy cattle and phage patterns of isolates; Shimizu A et al.; Staphylococci were found in the tonsils of 121 (75.2%) of 161 cattle . There were 15 different species, 10 belonging to novobiocin-sensitive species . The most predominant species was S . simulans (79.3% of the 121 carriers), followed by S . aureus (20.7%), S . chromogenes (10.7%) and S . epidermidis (8.3%) . The other 11 species were present in 0.8 to 5.8% . Twenty-six unidentifiable isolates were isolated from 26 (21.5%) carriers . Sixty-two (51.2%) of the 121 carriers yielded two to five Staphylococcus species together while only one species could be found in each of the other 59 (48.8%) . Combinations of S . simulans and other species were most frequently encountered in 50 (41.3%) of the 121 carriers . Twenty-four (96.0%) out of 25 S . aureus isolates, 3 (42.9%) of 7 S . hyicus isolates and 45 (25.4%) of 177 coagulase-negative staphylococci (13 species and unidentifiable isolates) isolates were phage typable . Most of S . aureus isolates were lysed by bovine phages 119 (n = 16) or 116 (n = 5) . Thirty-three (25.4%) of 45 coagulase-negative staphylococci typable isolates with Pulverer's phage set showed the phage pattern ph5/ph9/ph10/ph12/ph13/U4/U14/U16/++ +U20/U46 . The tonsils of cattle thus appear to be a suitable environment for Staphylococcus species, particularly novobiocin-sensitive species. Int J Syst Bacteriol, 1990 Oct, 40(4), 409 - 11 Staphylococcus schleiferi subsp . coagulans subsp . nov., isolated from the external auditory meatus of dogs with external ear otitis; Igimi S et al.; A new subspecies, Staphylococcus schleiferi subsp . coagulans, was isolated from the external auditory meatus of dogs suffering from external ear otitis and is described on the basis of studies of 21 strains . Phenotypic studies showed that these strains are more closely related to Staphylococcus intermedius than to other staphylococci, but DNA hybridization studies indicated that they are closely related to Staphylococcus schleiferi N850274T . On the basis of biochemical distinctiveness (positive test tube coagulase test and different carbohydrate reactions) and the etiological importance (frequent isolation from otitis specimens from dogs) of these strains, we propose to classify them as a subspecies of S . schleiferi . The strains of this new subspecies are coagulase tube test, beta-hemolysin, and heat-stable nuclease positive but clumping factor negative . A simple scheme for the differentiation of S . schleiferi subsp . coagulans from the other coagulase-positive staphylococci is presented . The type strain is GA211 (= JCM 7470). J Biomater Appl, 1990 Oct, 5(2), 154 - 65 Surface proteins of coagulase-negative staphylococci: their role in adherence to biomaterials and in opsonization; Fleer A et al.; During the last decade coagulase-negative staphylococci (CN-Staph) have clearly emerged as pathogens in patients equipped with foreign devices . This has fueled the interest in these bacteria considerably and as a result, knowledge of the biology of CN-Staph as well as insight into the pathogenesis of biomaterial-associated infections due to these bacteria are rapidly expanding . Adherence of bacteria to biomaterials is a necessary step in the process of these infections . Evidence is accumulating that surface proteins of CN-Staph are essential in the early phases of adherence to biomaterials . By using monoclonal antibodies in immunoblotting and immune electron micrography we have identified a cell wall protein complex apparently located on the surface of CN-Staph and involved in adherence to biomaterials . Further studies will be oriented at characterization of the protein adhesin(s) and at identification of the surface structures with which the adhesion is associated. Zentralbl Bakteriol, 1990 Oct, 274(1), 78 - 90 Methodological aspects of a microidentification technique for the differentiation of coagulase-negative staphylococci to species level; Weidenfeller P et al.; The increasing number of coagulase-negative staphylococci (CNS) obtained from clinical material requires a biochemical identification on a broad basis in order to get a better determination of the clinical relevance of the single species . The method of differentiation presented is based on an inoculated microtiter plate provided with reagents and indicators which is evaluated by means of a coding system including most variations of the typical enzyme patterns . As a result of 7040 test series with 55 defined strains, a high degree of plausibility and reproducibility of the single reactions was found in 1320 tests under the recommended conditions . The biochemical patterns of 1380 strains taken from the diagnostic routine were established by means of this method . Comparisons with a commercially available system showed a large congruence of the single reactions and the results of identification. J Antibiot (Tokyo), 1990 Oct, 43(10), 1254 - 70 Antibacterial activity and chemical modifications of PS-5 at the C-3 side chain; Sakamoto M et al.; Using PS-5 as starting material, the effects of chemical modification at the C-3 side chain were studied on the antibacterial activity against Gram-positive and Gram-negative bacteria including beta-lactamase-producers . Among 35 side chains tested, 4-pyridylthio showed the highest antibacterial activity against the Gram-positive bacteria, and D-cysteinyl against the Gram-negative microbes . In general, compared with acetamidoethylthio in PS-5, basic side chains showed improved antibacterial activity against the staphylococci and pseudomonads, whereas the antibiotic activity against the Gram-negative bacteria decreased with bulky side chains . The introduction of 6-aminopenicillanate and 7-aminocephalosporanate to the C-3 side chain of carbapenem significantly reduced the antibacterial activity against the beta-lactamase-producing microbes. J Antimicrob Chemother, 1990 Oct, 26(4), 573 - 83 Correlations between consumption of antibiotics and methicillin resistance in coagulase negative staphylococci; Mouton RP et al.; The correlation between antibiotic consumption, expressed in defined daily doses (DDD), and antibiotic resistance rates was studied, using 976 isolates of coagulase negative staphylococci (CNS) from human pathological material . Data from four hospitals, including 14 participating departments, were analysed for this purpose . Susceptibility tests were performed according to Dutch national standards, except for methicillin, which for the majority of isolates was tested according to adapted NCCLS standards . Resistance to methicillin was most frequent in Staphylococcus epidermidis (29%) and S . haemolyticus (16%) . Among the departments, thoracic surgery (29-47%), surgical intensive care (68%) and neonatology (32%) scored highest . Significant correlations were found between percentages of methicillin resistance in CNS and consumption (DDD/month/bed) of (flu)cloxacillin (P0.008), of cephalosporins (P0.01) and of gentamicin (P0.005) . (Flu)cloxacillin was used mainly prophylactically, cephalosporins and gentamicin therapeutically . Results were similar for S . epidermidis (n = 639) alone . There was no significant correlation between consumption and resistance to trimethoprim, erythromycin (P0.08) or gentamicin (P0.09) . Analysis of data from individual patients showed significant differences in proportions of methicillin resistance rates in CNS, between use and non-use of penicillinase resistant beta-lactams or gentamicin . It is concluded that clinical use of both (flu)cloxacillin and cephalosporins selects for methicillin resistant CNS. J Trop Med Hyg, 1990 Oct, 93(5), 360 - 4 Antimicrobial agent susceptibility patterns of staphylococci isolated in urban and rural areas of Bolivia; Bartoloni A et al.; Staphylococcal strains obtained from cutaneous swabs of hospital staff and school students of Camiri and Boyuibe and healthy people living in Javillo, Bolivia, were tested for their in-vitro antimicrobial susceptibility . The highest percentages of resistance to the antibiotics tested were found in staphylococcal strains isolated from hospital personnel . All the S . aureus strains from these subjects were resistant to penicillin . Coagulase-negative staphylococci from hospital personnel evidenced a high rate of multiresistant strains, mainly to penicillin, ampicillin, tetracycline, and chloramphenicol . The staphylococcal strains isolated in the rural population of Javillo were highly susceptible to all the antibiotics tested. J Clin Microbiol, 1990 Oct, 28(10), 2312 - 9 Bovine lactoferrin binding to six species of coagulase-negative staphylococci isolated from bovine intramammary infections; Naidu AS et al.; Bovine lactoferrin (BLf), an acute-phase iron-binding secretory protein present in secretions of the bovine udder, was demonstrated to bind to the following staphylococcal species associated with bovine intramammary infections: S . epidermidis, S . warneri, S . hominis, S . xylosus, S . hyicus, and S . chromogenes . The degree of 125I-labeled BLf uptake significantly varied among the blood agar-grown cells of all six species of coagulase-negative staphylococci tested . Isolates identified as S . xylosus demonstrated the highest (mean, 35.1 x 10(6) +/- 13.3 x 10(6) nmol) and S . hyicus the lowest (mean, 10.7 x 10(6) +/- 5.9 x 10(6) nmol) binding to 125I-BLf . BLf binding was optimum at an acidic pH, with time-dependent binding saturation ranging from 70 min for S . warneri to 240 min for S . hominis . The BLf-binding mechanism was specific, with affinity constants (Ka values) ranging between 0.96 x 10(6) and 11.90 x 10(6) liters/mol . The numbers of BLf-binding sites per cell, as determined by using Scatchard analysis, were as follows: S . epidermidis, 3,600; S . warneri, 1,900; S . hominis, 4,100; S . xylosus, 4,400; S . hyicus, 6,100; and S . chromogenes, 4,700 . 125I-BLf binding to all species was inhibited by unlabled BLf and unlabeled human lactoferrin, whereas none of the various plasma, connective tissue, or mucosal secretory proteins or carbohydrates tested caused significant interference . BLf-binding receptors of the six coagulase-negative staphylococcal species demonstrated marked differences in patterns of susceptibility to proteolytic or glycolytic enzyme digestion and to heat or periodate treatment . These data suggest that the BLf-binding components in S . epidermidis and S . warneri are proteins containing glycosidyl residues . In the remaining four species, the proteinaceous nature of the BLf-binding component was evident, but the involvement of glycosidyl residues was not clear . Results of this study establish the presence of specific binding components for BLf on coagulase-negative staphylococci isolated from bovine intramammary infections. Am J Perinatol, 1990 Oct, 7(4), 384 - 8 Relationship of maternal to neonatal colonization with coagulase-negative staphylococci; Hall SL et al.; Infections with coagulase-negative staphylococci (C-S) have become problems of major clinical importance among very low birthweight infants in neonatal intensive care units . Colonization with slime-producing strains of C-S may be a risk factor for these infants in the development of invasive infections . The present study evaluated the maternal genital tract as a possible source for neonatal colonization with C-S . Specific objectives were to determine the incidence of vaginal colonization with C-S in pregnant women with special reference to slime-producing strains and whether transmission of C-S occurs from mother to infant during the process of vaginal delivery . Antenatal vaginal cultures were done on 465 women at different gestations of pregnancy . Additionally, 101 women and their newborn infants were cultured after vaginal delivery . Fifty-one percent of women were colonized with C-S during pregnancy, and no significant differences in colonization rates by trimester were found . Slime-positive isolates from pregnant women increased significantly from the first to the third trimester (40 to 68%; chi-square, 11.21, p less than 0.005) . However, the proportion of slime-positive strains among the 30 infants who were colonized with C-S at birth was 40% (12 of 30) . Although 30 infants were colonized with C-S at birth, only three were shown to have acquired the organism by maternal transmission determined by similarity of species, biotype, antibiotic sensitivity pattern, slime production, phage type, and plasmid pattern profile . Therefore 27 infants (26% of the total) most likely acquired C-S from environmental sources, including nursery attendants.(ABSTRACT TRUNCATED AT 250 WORDS) Am Rev Respir Dis, 1990 Oct, 142(4), 892 - 4 Manual ventilation bags as a source for bacterial colonization of intubated patients; Weber DJ et al.; A group of 14 intensive care unit (ICU) patients were studied to determine if manual ventilation bags (MVB) could serve as a source of bacterial or fungal pathogens that could colonize the respiratory tract of intubated patients . A total of 51 cultures were simultaneously obtained of patient's sputum, the exterior MVB surface, MVB port, and MVB interior (postexhalation valve) . Pathogens colonizing or infecting the respiratory tract of intubated ICU patients were frequently simultaneously present on the exterior surface of the MVB and inside the MVB port used to connect the MVB with the endotracheal tube . In addition, coagulase-negative staphylococci and yeast were frequently present on the exterior surface of the MVB . The interior of the MVB was usually sterile . In three instances pathogens were isolated from the MVB before isolation from the patient's sputum . MVB may serve as a source for colonizing the respiratory tract of intubated ICU patients and/or the hands of medical personnel . The exterior surface and port of MVB should be cleaned of visible debris and disinfected at least once a day. J Antimicrob Chemother, 1990 Oct, 26 Suppl B, 7 - 15 Usual and unusual antibacterial effects of quinolones; Furet YX et al.; Recently documented antibacterial effects of quinolones are reviewed . DNA gyrase is most likely to be the primary target site for these agents . Quinolones rapidly kill susceptible bacteria; the mechanisms of the bactericidal activity, still poorly understood, probably involve new protein synthesis . Quinolones alter membrane integrity before cell death, leading to leakage of cytoplasmic constituents . In Gram-negative bacteria, quinolones act as chelating agents for outer membrane divalent cations, disorganizing the bacterial lipopolysaccharide layer and facilitating the further entry of quinolone molecules in a 'self-promoted' pathway . Quinolones inhibit plasmid replication and reduce the efficacy of plasmid conjugation . Subinhibitory concentrations of quinolones can interfere with bacterial virulence factors, such as bacterial adherence to the host cell, phagocytosis and production of enzymes implicated in virulence . Recent studies also indicate synergism of quinolones with oxacillin against methicillin-resistant staphylococci and describe improved activity of newer compounds against Gram-positive pathogens. Zh Mikrobiol Epidemiol Immunobiol, 1990 Oct, (10), 11 - 5 {The mechanism of the resistance of methicillin-resistant Staphylococcus aureus to phages from the International Collection}; Zueva VS et al.; The resistance of methicillin-resistant staphylococci to phage 85 is due to the presence of a certain system restriction modification in microbial cells . The loss of the capacity for restricting phage DNA by the cell as the consequence of the loss of the mec determinant is not accompanied by the loss of its capacity for modifying phage DNA. J Clin Microbiol, 1990 Oct, 28(10), 2183 - 6 Influence of carbon dioxide on growth and antibiotic susceptibility of coagulase-negative staphylococci cultured in human peritoneal dialysate; Wilcox MH et al.; Used peritoneal dialysis fluid was collected from patients undergoing continuous ambulatory peritoneal dialysis, and its pH and composition were assessed after incubation in either air or air with 5% CO2 . Precipitation of calcium, magnesium, phosphate, and proteins occurred in the dialysis fluid incubated in air at 37 degrees C and was associated with a mean pH increase of 1.23 U . Incubation of dialysis fluid in air with 5% CO2 prevented precipitation and maintained pCO2 and pH levels at those found physiologically . Coagulase-negative staphylococcal strains isolated from patients with peritonitis tended to grow less well in dialysis fluid incubated in air than in dialysis fluid incubated in the carbon dioxide-enriched atmosphere . MICs of cefuroxime, ciprofloxacin, and vancomycin for seven strains of coagulase-negative staphylococci in dialysis fluid were markedly affected by atmosphere type (16 of 21 MICs) . Of these 16 atmosphere-dependent MICs, 14 were at least fourfold higher in air than in air with 5% CO2. Br J Dermatol, 1990 Oct, 123(4), 493 - 501 Assessment of a contact-plate sampling technique and subsequent quantitative bacterial studies in atopic dermatitis; Williams RE et al.; The aerobic bacterial flora of 20 patients with atopic dermatitis and 19 control subjects was extensively sampled using the Williamson and Kligman scrub technique and a contact-plate method (cysteine lactose electrolyte deficient media) . Comparison of the two quantitative techniques showed that the contact plate is a reliable and convenient alternative to the scrub technique for the quantification of Staphylococcus aureus, micrococci and coagulase negative staphylococci . Quantification of bacterial flora using both techniques showed high rates of colonization by S . aureus on both involved and clinically normal skin of patients with atopic dermatitis . A linear increase in S . aureus counts with increasing severity of dermatitis was found . In contrast, diphtheroids showed a trend of decreasing isolation rates and counts as the severity of the dermatitis increased . Isolation rates and absolute counts for micrococci/coagulase negative cocci were unaffected by the severity of the dermatitis. J Hosp Infect, 1990 Oct, 16(3), 241 - 7 Perioperative wound infection in elective orthopaedic surgery; Taylor GJ et al.; Between 1981 and 1987, 12,907 {corrected} consecutive open elective orthopaedic procedures were performed . The in-patient infection rate was 1.43% . There was a significantly greater risk of infection in revision total knee replacement (15.3%), ankle fusion (9.3%), subtalar fusion (5.8%), primary total knee replacement (5.7%), spinal fusion (5.7%) and revision total hip replacement (4.5%) . Revision surgery carried approximately a threefold greater risk than primary procedures . Staphylococci were present in 83% of positive wound cultures . Infection rates varied among surgeons but when number and type of procedure were taken into account only two surgeons differed significantly from that expected . Patients undergoing spinal and hindfoot fusion suffered considerable morbidity as a consequence of wound infection . Antibiotic prophylaxis may be helpful in these procedures. J Med Microbiol, 1990 Oct, 33(2), 97 - 100 Diversity of staphylococci exhibiting high-level resistance to mupirocin; Rahman M et al.; Plasmids mediating high-level resistance to mupirocin (MIC greater than 1000 mg/L) in staphylococci from various sources were studied by restriction endonuclease cleavage . Several patterns were obtained but six plasmids isolated from various Staphylococcus aureus and S . epidermidis strains were indistinguishable . The diversity and spread of these plasmids is illustrated. J Lab Clin Med, 1990 Sep, 116(3), 354 - 62 Species variation in the mechanism of killing of inhaled pneumococci; Coonrod JD et al.; Detailed studies in murine models show inhaled staphylococci are killed mainly by alveolar macrophages . Recently, using histology and lung lavage to determine the site of killing of inhaled 59Fe-labeled pneumococci in rats, we found unexpectedly that most of the organisms were killed extracellularly . In the present studies we compared clearance of inhaled 59Fe-pneumococci in rats, guinea pigs, and rabbits to determine if extracellular killing of pneumococci is species-dependent . Absolute clearance rates were measured using Andersen plates . lung lavage and differential centrifugation were used to measure leukocyte-associated and free 59Fe-pneumococci and nonsedimentable 59Fe . Clearance was rapid in all species but was fastest in rabbits, which killed pneumococci almost as quickly as they were deposited (p less than 0.025 versus rats and guinea pigs) . At 1-1/2 hours after pneumococcal deposition in rats, when clearance had reached 92%, alveolar macrophages contained only 31% of the total 59Fe while 56% was in the nonsedimentable, extracellular fraction . At 1-1/2 hours in guinea pigs, when clearance was 96% complete, macrophages contained 51% of the 59Fe and 34% was nonsedimentable (p less than 0.002 versus rats) . In rabbits at 1-1/2 hours, macrophages had 94% of the 59Fe and only 4% was nonsedimentable (p less than 0.001 versus the other species) . In no species were opsonic antibodies detected in sera or concentrated lavage . In vitro, rabbit and guinea pig alveolar macrophages killed pneumococci opsonized with both specific antibody and fresh serum, while rat macrophages had little activity (p less than 0.001) . We conclude that the role of alveolar macrophages in killing inhaled pneumococci varies in different species. Antimicrob Agents Chemother, 1990 Sep, 34(9), 1843 - 5 Antistaphylococcal activities of sparfloxacin (CI-978; AT-4140), ofloxacin, and ciprofloxacin; Chaudhry AZ et al.; The activity of sparfloxacin (CI-978; AT-4140) was compared with those of ofloxacin and ciprofloxacin against clinical isolates of Staphylococcus aureus and Staphylococcus epidermidis . All 10 ciprofloxacin-resistant staphylococci had reduced susceptibility to sparfloxacin and ofloxacin . Against 105 ciprofloxacin-susceptible strains of S . aureus, the sparfloxacin MIC for 90% of strains tested was at least fourfold lower than those of ciprofloxacin and ofloxacin, while against 104 ciprofloxacin-susceptible strains of S . epidermidis, the MIC of sparfloxacin for 90% of strains tested was twofold lower than that of ciprofloxacin and fourfold lower than that of ofloxacin . MBCs of sparfloxacin were less than or equal to 4 x MICs . The effects of inoculum size and pH variations, as well as the presence of serum, on the MICs of sparfloxacin were minimal . Subinhibitory concentrations of sparfloxacin did reduce adherence of S . epidermidis. Antimicrob Agents Chemother, 1990 Sep, 34(9), 1830 - 2 In vitro activities of ampicillin-sulbactam and cefoperazone-sulbactam against oxacillin-susceptible and oxacillin-resistant staphylococci; Barry AL et al.; Ampicillin-sulbactam and cefoperazone-sulbactam were tested against staphylococci that were collected from 40 different medical centers throughout the United States . Oxacillin-resistant strains were resistant to both drug combinations, but oxacillin-susceptible strains were uniformly susceptible . The latter included strains with borderline susceptibility to oxacillin and methicillin. Antimicrob Agents Chemother, 1990 Sep, 34(9), 1720 - 4 Detection of methicillin resistance in staphylococci by using a DNA probe; Archer GL et al.; A DNA probe derived from the PBP 2a gene of the methicillin-resistant Staphylococcus aureus COL was compared with phenotypic microbiologic tests for its ability to identify methicillin-resistant and -susceptible staphylococci . Lysates were applied to nitrocellulose with a dot blot apparatus . Isolates tested were both S . aureus and coagulase-negative staphylococci that had been recovered from a variety of geographic and clinical sources . When compared with a spread plate phenotypic test, the DNA probe gave sensitivity, specificity, and predictive values for both positive and negative tests of 100% for 204 S . aureus isolates (103 positive, 101 negative) and 99, 95, 99, and 95%, respectively, for 249 coagulase-negative staphylococci (210 positive, 39 negative) . The probe was more sensitive than broth microdilution and more specific than agar dilution in identifying methicillin-resistant and -susceptible coagulase-negative staphylococci; all tests were equally accurate in identifying the methicillin susceptibility of S . aureus . DNA probe analysis for determining the methicillin susceptibility of staphylococci was rapid, easily interpretable, and equally accurate with radioactive and nonradioactive probes, and it gave results equivalent to the most sensitive microbiologic test for all staphylococcus species studied. Diagn Microbiol Infect Dis, 1990 Sep-Oct, 13(5), 357 - 61 Antistaphylococcal activity of amoxicillin and ticarcillin when combined with clavulanic acid . Evaluation of oxacillin-resistant and oxacillin-susceptible isolates; Barry AL; The beta-lactamase inhibitor, clavulanic acid, was combined with amoxicillin and with ticarcillin for in vitro studies with 586 staphylococci: 97 stock cultures of oxacillin-resistant strains recovered before 1982, and 489 blood or wound isolates collected from 40 separate medical centers during 1987-1988 (300 were oxacillin resistant) . Over 92% of the staphylococci produced beta-lactamase enzymes and were thus resistant to both penicillins . However, with the addition of clavulanic acid, oxacillin-susceptible strains were rendered susceptible to low concentrations of amoxicillin and ticarcillin . Staphylococcus aureus strains with borderline or partial borderline resistance to penicillinase-resistant penicillins occurred infrequently (72 of 325 S . aureus isolates) . Those strains were susceptible to both clavulanic acid combinations, because their methicillin resistance is thought to be due to an excess beta-lactamase production . Strains with chromosomally mediated intrinsic heteroresistance were relatively resistant to both drug combinations . Minimal inhibitory concentration (MIC) breakpoints that best separated those heteroresistant strains from oxacillin-susceptible isolates were as follows: amoxicillin/clavulanic acid, less than or equal to 2.0/1.0 micrograms/ml for susceptible; and ticarcillin/clavulanic acid, less than or equal to 4.0/2.0 micrograms/ml for susceptible . When the broth was supplemented by 2% NaCl, MICs for both drug combinations were increased by less than one doubling dilution . Although oxacillin and methicillin broth microdilution tests were more reliable when 2% NaCl was added, tests with the two drug combinations were only minimally improved by adding 2% NaCl to the broth medium. FEMS Microbiol Lett, 1990 Sep 1, 59(1-2), 11 - 5 A novel labeling procedure of anteiso-fatty acid-containing lipids in staphylococci for investigating the effect of penicillin on lipid release; Rozgonyi F et al.; L-{4,5-3H}isoleucine was introduced to label anteiso-fatty acid (AIFA)-containing lipids in Staphylococcus aureus SG 511 . After an overnight incubation in peptone broth in the presence of 37 kBq L-{4,5-3H}isoleucine/ml, 8.5-13% of the total radioactivity applied was found to be incorporated into the cells . 22.4-25.6% of the incorporated radioactivity was found in AIFA-containing lipids extracted by chloroform-methanol-water (2:1:0.2, v/v/v) at pH 2 . The interphase contained 70-75% of the incorporated radioactivity . Lipoteichoic acid, extracted by phenol-water (80:20, w/v) contained less than 1% of the incorporated radioactivity, as measured after purification by hydrophobic interaction chromatography on octyl sepharose gel . Within 1 h after addition of 10 micrograms/ml penicillin G to exponentially growing cultures of S . aureus, that led to non-lytic death of the cells, 11.9-18.1% of the incorporated L-{4,5-3H}isoleucine label were released . Lipids containing AIFA were excreted to 5.4-8.4% of total incorporated activity; this amount represents more than 1/4 of the labeled cellular lipids. Z Kardiol, 1990 Sep, 79(9), 615 - 20 {Perioperative preventive antibiotic treatment with fosfomycin in heart surgery: serum kinetics in extracorporeal circulation and determination of concentration in heart valve tissue}; Hirt SW et al.; A prospective clinical study was carried out to assess the adequacy of perioperative antibiotic prophylaxis using fosfomycin in patients undergoing open-heart surgery for valve diseases for the prevention of early postoperative endocarditis, as well as for serious mediastinal infections that are caused mostly by multiresistant staphylococci and Gram-negative bacteria . Perioperative pharmacokinetics and tissue penetration were determined within the harvested heart valves and subcutaneous tissue . Reliable bactericidal serum levels were established at the first measurement 10 min after the end of intravenous infusion (203.7 +/- 44.7 micrograms/ml) and were maintained during surgery for at least 120 min (124.6 +/- 58.4 micrograms/ml), even in cases of prolonged extracorporeal circulation . Cardiopulmonary bypass did not alter the serum elimination of fosfomycin in comparison with patients not undergoing extracorporeal circulation . Peak tissue concentrations were achieved in both aortic and mitral valves after 30 min, ranging between 27.1 and 76.9 micrograms/g for aortic valves and 39.6-69.4 micrograms/g for mitral valves, depending on the degree of valvular degeneration . MIC values of 16 micrograms/g were maintained in both valves for at least up to 60 min . There was no evidence of renal impairment, adverse reactions or infections during the postoperative course or thereafter for a period of 3 months . It is concluded that perioperative intravenous antibiotic prophylaxis using fosfomycin (5 g t.i.d . in adults), beginning with induction of anesthesia and continued for 48 h postoperatively, provides rapid, reliable bactericidal serum levels and valvular tissue concentrations that will inhibit most Gram-positive and Gram-negative organisms that cause bacterial endocarditis and other serious infections following cardiac surgery. Res Vet Sci, 1990 Sep, 49(2), 248 - 9 A new type of macrolide resistance in staphylococci from bovine subclinical mastitis; Buragohain J et al.; Staphylococcal (nine Staphylococcus aureus and 14 coagulase negative) strains, isolated from subclinical bovine mastitis, showed three patterns of macrolide resistance: (i) macrolide-lincosamide constitutive resistance; (ii) macrolide generalised resistance; and (iii) lincosamide generalised resistance . The second pattern of resistance appeared to be a new resistance phenomenon . None of the strains showed dissociated or inducible resistance, neither was there any strain which could inactivate erythromycin, oleandomycin, lincomycin or clindamycin. J Med Microbiol, 1990 Sep, 33(1), 67 - 70 Bactericidal action of PD127,391, an enhanced spectrum quinolone; Lewin CS et al.; The 4-quinolone PD127,391 displays a biphasic effect on Escherichia coli, Staphylococcus aureus and S . epidermidis in nutrient broth . It is as active as ciprofloxacin in terms of its optimum bactericidal concentration against E . coli . However, against staphylococci it is six times as active as ciprofloxacin or any other 4-quinolone previously investigated . Although protein and RNA synthesis are not required for bactericidal activity, cell division is essential. J Clin Microbiol, 1990 Sep, 28(9), 2064 - 8 Vancomycin resistance in Staphylococcus haemolyticus causing colonization and bloodstream infection; Veach LA et al.; The increase in the incidence of infections due to beta-lactam-resistant coagulase-negative staphylococci has resulted in expanded use of vancomycin for such infections . Despite this, coagulase-negative staphylococci have remained susceptible to vancomycin in recent years . This report describes a strain of Staphylococcus haemolyticus with increased resistance to vancomycin (MIC, 8.0 to 16 micrograms/ml) . S . haemolyticus was initially isolated from a patient with acute leukemia and neutropenia in surveillance throat and stool cultures . The microdilution vancomycin MICs for these isolates were 1.0 to 2.0 micrograms/ml . Subsequent S . haemolyticus isolates from the bloodstream and tracheal aspirate occurred in the setting of prolonged empirical vancomycin therapy . MICs for these isolates were 8.0 to 16 micrograms/ml . Further vancomycin resistance (MIC, 32 micrograms/ml) could be selected for in vitro in all four isolates . Restriction endonuclease analysis of plasmid DNA indicated that the isolates were very closely related and likely to be of the same strain . We conclude that colonization with a vancomycin-susceptible strain of S . haemolyticus was subsequently linked to a nosocomial bloodstream infection with an apparently identical strain with intermediate levels of vancomycin resistance . Prolonged empirical vancomycin therapy was temporally associated with this episode. Infect Dis Clin North Am, 1990 Sep, 4(3), 377 - 90 Animal models of osteomyelitis . Knowledge, hypothesis, and speculation; Rissing JP; Each animal model has provided insights . Particularly important was the considerable resistance of bone to infection without manipulation (no morrhuate, fracture, rod, wax, or prosthesis) . Such perturbations allow bone infection with much smaller inocula . Typical inocula decreases are 1000 to 10,000 fold . Staphylococci may have a selective advantage in bone because of specialized or tropic binding, perhaps to cartilage or collagen . Osteoclast-induced resorption of hydroxyapatite might explain the distribution of some osteomyelitis . Increased osteoclast activity could link the susceptible metaphyseal regions, the repetitively traumatized diabetic foot, a history of blunt bone trauma, fracture, and perhaps even nearby soft tissue infection . Diagnosis remains difficult; gallium-67 and indium111 labeled WBC probably deserve additional investigation . Therapeutic failures in the rabbit and rat models mirror clinical experience . Clindamycin, rifampin, and quinolones are promising . Neither systemic nor local antimicrobial prophylaxis is well studied yet. Cesk Epidemiol Mikrobiol Imunol, 1990 Sep, 39(5), 288 - 93 {Slime production, hemolysis and proteolysis in coagulase-negative staphylococci isolated in hemoculture from humans}; Votava M et al.; Of 162 strain of coagulase negative staphylococci isolated from haemocultures most frequently the following were identified: S . epidermidis (56.8%), S . haemolyticus (17.3%) and S . hominis (14.2%) . By means of the STAPHYtest first 138 strains were assessed (85.2%) . Mucus formation was proved in 26 strains (16.0%) of six different species . Haemolytic activity was present in 131 strains (80.9%) in seven species, significantly more frequently in S . haemolyticus . Proteolytic activity was displayed by 118 strains (72.8%) of all nine identified species, significantly more often in S . epidermidis . Mucus and protease formation, haemolysin and protease formation as well as simultaneous formation of all three factors was observed most frequently in S . epidermidis . Strains of S . epidermidis thus have more frequently signs considered virulence factors than strains of the other species of coagulase negative staphylococci. N Engl J Med, 1990 Aug 2, 323(5), 301 - 8 Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units; Freeman J et al.; BACKGROUND AND METHODS . Coagulase-negative staphylococci are now the chief cause of bacteremia in neonatal intensive care units . To investigate potential risk factors for this nosocomial infection, we conducted a case--control study among 882 infants treated in two neonatal intensive care units during 1982 . RESULTS . The 38 case patients and 76 controls were similar with respect to 27 indicators of the severity of the underlying illness . In addition, of the 20 potential risk factors for bacteremia that we investigated, only 2 met conventional criteria for causality . Infants with coagulase-negative staphylococcal bacteremia were 5.8 times as likely as controls (95 percent confidence interval, 4.1 to 8.3) to have received intravenous lipid emulsion before the onset of bacteremia . Because the use of lipids was common, 56.6 percent of all of the cases of nosocomial bacteremia could be attributed to lipid administration . Infants with bacteremia were also 3.5 times as likely as controls (95 percent confidence interval, 1.4 to 8.3) to have had a percutaneously inserted central venous catheter (attributable risk, 14.9 percent) . The induction time for bacteremia after lipid administration, usually through peripheral catheters, was often less than one day . In contrast, the average induction period for nosocomial bacteremia associated with the use of central catheters, which were rarely used for lipid administration, was at least 5.5 days . Similar analyses of data on an additional 31 neonates treated in 1988 confirmed the strong and apparently independent association of coagulase-negative staphylococcal bacteremia with the intravenous administration of lipids (adjusted odds ratio, 5.3; 95 percent confidence interval, 3.5 to 6.7) . CONCLUSIONS . The risk of coagulase-negative staphylococcal bacteremia in infants in neonatal intensive care units can be attributed primarily to the intravenous administration of lipid emulsions . Since lipids are critical for the nutritional support of premature infants, further studies are needed to examine the pathogenesis and prevention of lipid-associated bacteremia. Epidemiol Infect, 1990 Aug, 105(1), 139 - 62 Health effects of beach water pollution in Hong Kong; Cheung WH et al.; Prospective epidemiological studies of beach water pollution were conducted in Hong Kong in the summers of 1986 and 1987 . For the main study in 1987, a total of 18741 usable responses were obtained from beachgoers on nine beaches at weekends . The study indicated the overall perceived symptom rates for gastrointestinal, ear, eye, skin, respiratory, fever and total illness were significantly higher for swimmers than non-swimmers; and the swimming-associated symptom rates for gastrointestinal, skin, respiratory and total illness were higher at 'barely acceptable' beaches than at 'relatively unpolluted' ones . Escherichia coli was found to be the best indicator of the health effects associated with swimming in the beaches of Hong Kong . It showed the highest correlation with combined swimming-associated gastroenteritis and skin symptom rates when compared with other microbial indicators . A linear relationship between E . coli and the combined symptom rates was established . Staphylococci were correlated with ear, respiratory and total illness, but could not be used for predicting swimming-associated health risks . They should be used to complement E . coli . The setting of health-related bathing-water quality standards based on such a study is discussed. Am J Kidney Dis, 1990 Aug, 16(2), 142 - 6 Methicillin-resistant staphylococcal infections in an outpatient peritoneal dialysis program; Holley JL et al.; In view of the increasing concern about hospital-acquired methicillin resistance, we examined the sensitivities and outcome of staphylococcal infections related to outpatient peritoneal dialysis over a 5-year period . Data on all episodes of peritonitis (n = 360) and catheter infections (n = 507) were gathered prospectively from January 1984 to December 1988 . The numbers of patients on peritoneal dialysis each year ranged from 136 in 1984 to 109 in 1987 . Fifteen methicillin-resistant staphylococcal infections (MRSI) related to outpatient peritoneal dialysis occurred . Three were due to methicillin-resistant Staphylococcus aureus found in infected exit sites (2.3% of all S aureus catheter infections) . Two of these infections occurred in a continuous ambulatory peritoneal dialysis (CAPD) patient who carried methicillin-resistant S aureus in his nares . The other 12 methicillin-resistant organisms were coagulase-negative staphylococci that caused peritonitis . There was a significant increase in the percentage of episodes of coagulase-negative staphylococci peritonitis caused by methicillin-resistant organisms; from 5% (3/57) in 1984 through 1986 to 28% (9/32) in 1987 through 1988 (P less than 0.005) . In view of the high percentage of coagulase-negative staphylococci peritonitis that is methicillin-resistant, vancomycin rather than cephalosporins should be used for initial treatment. J Infect Dis, 1990 Aug, 162(2), 435 - 41 Antibody to the capsular polysaccharide/adhesin protects rabbits against catheter-related bacteremia due to coagulase-negative staphylococci; Kojima Y et al.; A rabbit model of catheter-related bacteremia was developed to study immunity to the capsular polysaccharide/adhesin (PS/A) of coagulase-negative staphylococci . Catheters colonized by coagulase-negative staphylococci were inserted into the right jugular vein and attached to a subcutaneous osmotic pump, and blood cultures were obtained over 14 days . Nonimmune rabbits were bacteremic for 6-8 days after infection, hypoglycemic, and hyperlipidemic and had strong immune responses to teichoic acid but not to PS/A . PS/A immunization, but not teichoic acid immunization, reduced the number of bacteremic days by approximately 60%, diminished the hypoglycemia and hyperlipidemia, and ablated the immune responses to teichoic acid . Passive infusion of PS/A-specific polyclonal and monoclonal antibodies using a separate, noninfected catheter-pump combination implanted in the left jugular protected against both bacteremia and hematogenous colonization of this contralateral catheter. Pediatrics, 1990 Aug, 86(2), 157 - 62 Distinguishing sepsis from blood culture contamination in young infants with blood cultures growing coagulase-negative staphylococci; St Geme JW 3rd et al.; In the ideal situation, the evaluation for sepsis in the young infant should include collection of multiple blood cultures before the institution of antibiotics . Unfortunately, in some infants, it may not be possible to obtain more than a single blood culture at the time of initial evaluation . If this single culture ultimately grows coagulase-negative staphylococci and the infant has been treated with antimicrobial therapy in the interim, it is often difficult to determine whether the positive culture represents true infection or contamination . Our data suggest that peripheral blood cultures yielding high colony counts most likely represent infection . Furthermore, in this high-risk patient population, low colony-count growth should not be ignored as contamination, particularly if there are significant clinical findings or if the infant has a central catheter or hematologic abnormality . Future studies should examine these important issues. J Chemother, 1990 Aug, 2(4), 252 - 6 Prophylactic mezlocillin-netilmicin combination in permanent transvenous cardiac pacemaker implantation: a single-center, prospective, randomized study; De Lalla F et al.; A prospective, randomized study was carried out in order to assess the efficacy and safety of the mezlocillin-netilmicin combination in the prophylaxis of first permanent transvenous cardiac pacemaker implantation . Five hundred and fifty-two consecutive patients were randomly administered either 2 g mezlocillin and 200 mg netilmicin both as an i.v . bolus before implantation or 2g mezlocillin before and then 6 and 12 hours after surgery and 200 mg netilmicin before and then 12 hours after implantation . No adverse events were seen . Neither pocket nor electrode infections were observed in the 457 subjects still alive (mean follow-up: 29.2 months) or in patients who died after 1 year of follow-up (mean follow-up: 20.1 months) or before this time (mean follow-up: 4.7 months) . The serum and pocket concentrations of mezlocillin and netilmicin at the end of surgery were found to be adequate to cover microorganisms that most often cause infections, including methicillin-resistant staphylococci. J Antimicrob Chemother, 1990 Aug, 26(2), 269 - 78 Resistance to beta-lactam antibiotics and ciprofloxacin in gram-negative bacilli and staphylococci isolated from blood: a European collaborative study . European Study Group on Antibiotic Resistance; Dornbusch K; In 1987 and 1988 members of the European Study Group on Antibiotic Resistance collected 3440 consecutive isolates of Gram-negative bacilli (63%) and staphylococci (37%) from blood cultures and performed susceptibility testing by the microdilution method . The MICs of ampicillin and cefazolin for susceptible Gram-negative bacteria were 1-8 mg/l, of piperacillin less than or equal to 0.5-4 mg/l, of aztreonam, imipenem, cefotaxime and ceftazidime less than or equal to 0.125-1 mg/l and of ciprofloxacin less than or equal to 0.125-0.5 mg/l . For susceptible staphylococci the MICs of cefazolin were less than or equal to 0.5-8 mg/l, of cefotaxime 1-4 mg/l, of ceftazidime 4-16 mg/l, of imipenem and ciprofloxacin less than or equal to 0.125-1 mg/l . The antibiotic resistance rates varied between laboratories, being generally lower in northern Europe, except for imipenem, which showed uniform, low resistance rates . In Escherichia coli resistance to ampicillin, piperacillin and cefazolin could be seen to have increased since a previous survey. Eur J Clin Microbiol Infect Dis, 1990 Aug, 9(8), 588 - 94 Typing of coagulase-negative staphylococci by Southern hybridization of chromosomal DNA fingerprints using a ribosomal RNA probe; Bialkowska-Hobrzanska H et al.; Ribotyping consists of restriction endonuclease fingerprinting of ribosomal RNA (rRNA) genes visualized by Southern hybridization with an rRNA probe . This method was developed and compared with restriction endonuclease fingerprinting of chromosomal DNA for typing coagulase-negative staphylococci . Twenty-five American Type Culture Collection reference type strains and 53 clinical isolates were typed . Both methods clearly distinguished all 15 species of coagulase-negative staphylococci and most individual strains within each species . Except in the case of Staphylococcus warneri, ribotyping was most discriminating with the use of ClaI, one of eight endonucleases tested . HpaI and AvaI were more specific than ClaI for discrimination between strains of Staphylococcus warneri . The patterns produced by ribotyping were much simpler and thus easier to interpret than corresponding chromosomal fingerprints . However, ribotyping was slightly less discriminating . It is concluded that ribotyping offers an alternative method for molecular typing of coagulase-negative staphylococci . The application of both methods needs to be further evaluated in the clinical setting. Zentralbl Bakteriol, 1990 Aug, 273(3), 319 - 26 International collaborative evaluation of the ATB 32 staph gallery for identification of the Staphylococcus species; Brun Y et al.; This international collaborative study evaluates a new system (ATB 32 Staph) for the identification of staphylococci taking into account the new novobiocin-sensitive and -resistant species reported . This study involved eight laboratories and 792 strains were tested . The reproducibility obtained for the cumulative results of the inter- and intra-laboratory tests was more than 90% . For 713 strains relevant of a species 95.5% were correctly identified by the system . Eight strains (1.2%) were misidentified and 24 strains (3.3%) were not identified . For 79 strains initially considered as not-classified, 62% were identified at the species level by the new system . The newer ATB 32 Staph gallery is a performant and useful method for routine identification of the currently described staphylococci species from clinical and animal origin. Epidemiol Infect, 1990 Aug, 105(1), 95 - 105 Drug-resistant coagulase-negative skin staphylococci . Evaluation of four marker systems and epidemiology in an orthopaedic ward; Thore M et al.; Drug-resistant coagulase-negative staphylococci (DRCNS) in orthopaedic patients and ward staff were studied . A significant increase in the DRCNS carriage rate was observed among the 16 patients studied after 14 days of hospitalization with levels approaching that of the staff . Patients receiving dicloxacillin prophylaxis (n = 9) were more likely to be colonized with methicillin-resistant CNS, while patients receiving no antibiotics (n = 7) became to a larger extent colonized with multiple DRCNS . The combined data from species determination, biochemical, plasmid, and antibiogram typing revealed a considerable diversity among DRCNS; 64 types were distinguished among 112 DRCNS isolates selected for study after exclusion of apparently duplicate isolates . Plasmid plus antibiogram typing yielded almost as many types (61); whereas species determination plus antibiogram distinguished only 33 types . Although a novel computerized 96-reaction biotyping method alone enabled differentiation of 17 biotypes, most DRCNS isolates belonged to one of three major biotypes limiting the usefulness of this method . Ten of the 64 (16%) DRCNS types identified comprised 50 of the 112 (45%) isolates . These were isolated from staff and from patients on day 14, suggesting a nosocomial origin. Antimicrob Agents Chemother, 1990 Aug, 34(8), 1565 - 9 Emergence of 4',4"-aminoglycoside nucleotidyltransferase in enterococci; Carlier C et al.; Enterococcus faecium BM4102 was resistant to macrolide-lincosamide-streptogramin B-type (MLS) antibiotics; tetracycline-minocycline; and high levels of kanamycin, neomycin, tobramycin, and dibekacin but not gentamicin . This aminoglycoside resistance phenotype is new in enterococci . The genes conferring resistance to aminoglycosides and MLS antibiotics in this strain were carried on a plasmid, pIP810, that was self-transferable to to other Enterococcus strains . Resistance to tobramycin and structurally related aminoglycosides, kanamycin, neomycin, and dibekacin, was due to synthesis of a 4',4"-aminoglycoside nucleotidyltransferase . Homology was detected by hybridization between pIP810 DNA and a probe specific for a gene encoding an enzyme with identical site specificity in staphylococci . The bacteriostatic activity of amikacin apparently was not affected by the presence of the enzyme, although it was modified in vitro . However, the bactericidal activity of amikacin and the synergism of this aminoglycoside with penicillin were abolished. Rev Med Chil, 1990 Aug, 118(8), 841 - 5 {Numerical taxonomy of Staphylococci isolated from clinical samples}; Prado B et al.; A taxonomic study of 82 strains of Staphylococci and 6 reference samples isolated from clinical cases was carried out . Results of 47 phenotype tests were submitted to a numerical analysis using the similarity coefficient of Sokal and Michener and a grouping technique (UPGMA) . Based on a 75 similarity level, 4 phenons were identified . 37 strains identified as S aureus were grouped in phenon A; 32 strains of S hominis in phenon B; 5 strains of S epidermidis in phenon C and 8 strains of S ssp in phenon D. Infect Immun, 1990 Aug, 58(8), 2593 - 8 Peptide analogs to a fibronectin receptor inhibit attachment of Staphylococcus aureus to fibronectin-containing substrates; Raja RH et al.; Binding of cells of Staphylococcus aureus to fibronectin has been proposed as a mechanism of bacterial adhesion to host tissues . In this study, we have attempted to define the role of a recently identified fibronectin receptor in the adhesion of staphylococcal cells to fibronectin-containing substrates by using different receptor analogs as potential inhibitors of bacterial adherence . The results showed that synthetic peptides D1, D2, and D3, corresponding to variations of a repeated unit in the fibronectin-binding domain of the receptor, and ZZ-FR, a chimeric protein containing the fibronectin-binding domain of the receptor with the D1, D2, and D3 sequences, inhibited the attachment of staphylococcal cells to microtiter wells coated with intact fibronectin or with the 29-kilodalton amino-terminal fragment of fibronectin . The chimeric protein ZZ-FR also partially inhibited the adherence of staphylococci to human plasma clots formed in vitro but had no effect on bacterial adhesion to clots formed from fibronectin-depleted plasma . These data confirm previous reports suggesting that fibronectin may serve as a substrate for adhesion of staphylococcal cells and indicate that bacterial adhesion is mediated by the identified fibronectin receptor . Furthermore, analogs to the fibronectin receptor can be used to inhibit the adhesion of bacterial cells to these model substrates, and these analogs may be of clinical use. J Clin Microbiol, 1990 Aug, 28(8), 1813 - 7 Influence of carbon dioxide on the surface characteristics and adherence potential of coagulase-negative staphylococci; Denyer SP et al.; Coagulase-negative staphylococci obtained from patients with continuous ambulatory peritoneal dialysis-related peritonitis were cultured in nutrient broth in an atmosphere of air containing 5% carbon dioxide (reflecting the CO2 tension found in freshly used dialysate) . Significant differences were observed between the surface chemistries of cells grown in the two atmospheres, as determined by X-ray photoelectron spectroscopy and changes in the cell wall protein profile . The growth atmosphere also influenced the adherence potential toward polystyrene and silicone in a proportion of strains examined . Thus, gaseous conditions can profoundly influence the nature of the staphylococcal surface, and this should be considered in any in vitro study of in vivo behavior. Oral Microbiol Immunol, 1990 Aug, 5(4), 233 - 6 Leukocidal activity of staphylococci isolated from human periodontal lesions; Iwase M et al.; Staphylococci isolated from subgingival samples of patients with advanced periodontitis were tested for leukocidal activity . Intact organisms, bacterial sonicates or bacterial culture supernatants were incubated with human neutrophils that had been prelabeled with 51chromium . The majority of Staphylococcus aureus periodontal isolates provoked dose-dependent extracellular release of the radiolabel . By contrast, other strains of staphylococci had marginal or no demonstrable leukocidal activity . Leukocidal activity was heat-sensitive and was neutralized by horse anti-leukocidin antibodies . The results indicate that S . aureus colonizing human periodontal lesions elaborate a leukocidin that may conceivably destroy neutrophils that emigrate into the gingival region . This could adversely affect the overall status of this antimicrobial defense system in the gingival area and contribute to the pathogenicity of S . aureus as well as other potential periodontopathic organisms. Eur J Biochem, 1990 Jul 20, 191(1), 65 - 74 Staphyloferrin A: a structurally new siderophore from staphylococci; Konetschny-Rapp S et al.; Two ferric ion-binding compounds, designated staphyloferrin A and B, were detected in the culture filtrates of staphylococci grown under iron-deficient conditions . Staphyloferrin A was isolated from cultures of Staphylococcus hyicus DSM 20459 . The structural elucidation of this highly hydrophilic, acid-labile compound revealed a novel siderophore, N2,N5-di-(1-oxo-3-hydroxy-3,4-dicarboxybutyl)-D-ornithine, which consists of one ornithine and two citric acid residues linked by two amide bonds . The two citric acid components of staphyloferrin A provide two tridentate pendant ligands, comprising of a beta-hydroxy, beta-carboxy-substituted carboxylic acid derivative, for octahedral metal chelation . The CD spectrum of the staphyloferrin A ferric complex indicates a predominant A configuration about the ferric ion center . The uptake of ferric staphyloferrin A by S . hyicus obeys Michaelis-Menten kinetics (Km = 0.246 microM; vmax = 82 pmol.mg-1.min-1), indicating active transport of this siderophore . The staphyloferrin A transport system is different from that of the ferrioxamines as shown by an antagonism test . Production of staphyloferrin A is strongly iron-dependent and is stimulated by supplementation of the medium with either D- or L-ornithine . DL-{5-14C}ornithine was incorporated into staphyloferrin A, demonstrating that ornithine is an intermediate in staphyloferrin A biosynthesis. Am Surg, 1990 Jul, 56(7), 440 - 4 Delayed breast abscesses after lumpectomy and radiation therapy; Keidan RD et al.; The incidence of delayed breast abscess as a complication following the treatment of breast cancer has not been reported . A retrospective review of 112 patients (pts) undergoing lumpectomy and radiation therapy (RT) in our institution revealed a six per cent incidence of delayed breast abscess (range 1.5-8 months, median 5 months) . Prophylactic antibiotics (P = 1.0), postoperative chemotherapy (P = 1.0), primary vs . re-excisional lumpectomy (P = 1.0), and different surgeons (P = 0.514) were not associated with increased risk of delayed abscess . All abscesses occurred in the first 32 pts of this series . The size of the lumpectomy cavity correlated with the incidence of infection (P = 0.0440) . Since six of seven abscess cultures grew staphylococci (coagulase negative three pts, coagulase positive three pts), and four of these pts experienced prior biopsy site infection, skin necrosis or repeated seroma aspirations, a skin source for contamination was suggested . Treatment of the abscesses with antibiotics and immediate drainage produced acceptable but inferior cosmesis . We conclude that a small but significant subset of patients treated with lumpectomy and RT will develop delayed wound infections and that expeditious treatment affords satisfactory cosmesis. G Chir, 1990 Jul-Aug, 11(7-8), 439 - 42 {Interference of clindamycin in skin infection in rabbits caused by suture threads infected with slime-producing S . epidermidis}; Gismondo MR et al.; The authors have carried out an experimental study to evaluate the interference of sub-inhibitory concentrations of clindamycin on the adherence of slime producing S . epidermidis to surgical nets and its ability to infect rabbits . 80 rabbits divided into 4 groups, (A, B, C, and D), underwent sham operation of the abdominal zone and were sewn up with sterile nets, infected nets and sub MIC of clindamycin equal to 1/8 MIC, respectively . The results obtained stressed a different survival rate 12 days after operation: 95% in group A, 35% in group B; 100% in group C and 95% in group D . This data were confirmed by the results obtained using MES (Cambridge Stereosecan 150 KM2) . From our research an excellent clindamycin inhibitory activity on the pathogenicity of slime producing staphylococci emerged. Microbiologica, 1990 Jul, 13(3), 179 - 84 Staphylococcal protease assay with dye hide powder, elastin, collagen and udder extract; Eraso AJ et al.; Colorimetric determinations of proteolytic activity were performed to measure the effects on dye protean substrates including tissue powders . The substrates were assayed with 98 strains obtained from the milk of cows with mastitis . Trypsin was employed as positive control and it verified the susceptibility of the method . Enzymatic activity was estimated in trypsin units per milliliter of incubation mixture . The percentages of strains active on specific proteins were 47.8% for elastin, 61.6% for collagen and when hide powder and udder extract were used as dye substrates, the proteolytic staphylococci were 76.5 and 92.4% respectively . There was no significant difference in hydrolytic activity on proteins between coagulase positive and coagulase negative cocci. J Indian Med Assoc, 1990 Jul, 88(7), 189 - 90 Clinicobacteriological study of empyema thoracis in infants and children; Ghosh S et al.; Forty-one cases of empyema thoracis admitted in hospital during April, 1985 to August, 1987 were studied . Majority were males (65.9%) and were of less than 2 years of age (70.7%) . Right side (60.9%) was predominantly involved . Abdominal distension (43.9%) was very characteristic, with other usual features like fever, cough and respiratory distress . A large majority of them were victims of malnutrition (73.2%) and anaemia (53.7%) with haemoglobin level ranging from 5-9 g/dl . Mortality was high (17.1%) . Therapy with parenteral cloxacillin and gentamicin and continuous intercostal tube drainage accounted for loss of 15.8 bed days (average period of hospitalisation) . Staph aureus was the principal aetiopathogen (68.3%) . No anaerobe could be isolated . Strains of staphylococci were mostly resistant to penicillin and ampicillin but sensitive to gentamicin, cloxacillin and erythromycin. Mol Microbiol, 1990 Jul, 4(7), 1207 - 14 Inducible erythromycin resistance in staphylococci is encoded by a member of the ATP-binding transport super-gene family; Ross JI et al.; A Staphylococcus epidermidis plasmid conferring inducible resistance to 14-membered ring macrolides and type B streptogramins has been analysed and the DNA sequence of the gene responsible for resistance determined . A single open reading frame of 1.464 kbp, preceded by a complex control region containing a promoter and two ribosomal binding sites, was identified . The deduced sequence of the 488-amino-acid protein (MsrA) revealed the presence of two ATP-binding motifs homologous to those of a family of transport-related proteins from Gram-negative bacteria and eukaryotic cells, including the P-glycoprotein responsible for multidrug resistance . In MsrA, but not these other proteins, the two potential ATP-binding domains are separated by a Q-linker of exceptional length . Q-linkers comprise a class of flexible interdomain fusion junctions that are typically rich in glutamine and other hydrophilic amino acids and have a characteristic spacing of hydrophobic amino acids, as found in the MsrA sequence . Unlike the other transport-related proteins, which act in concert with one or more hydrophobic membrane proteins, MsrA appears to function independently when cloned in a heterologous host (Staphylococcus aureus RN4220) . MsrA might, therefore, interact with and confer antibiotic specificity upon other transmembrane efflux complexes of staphylococcal cells . The active efflux of {14C}-erythromycin from cells of S . aureus RN4220 containing msrA has been demonstrated. Can J Microbiol, 1990 Jul, 36(7), 455 - 63 Pathogenicity of Staphylococcus lugdunensis, Staphylococcus schleiferi, and three other coagulase-negative staphylococci in a mouse model and possible virulence factors; Lambe DW Jr et al.; Staphylococcus lugdunesis and Staphylococcus schleiferi, two newly described species, have been isolated from numerous types of human infections . We compared the pathogenicity of 30 strains of S . lugdunensis, S . schleiferi, Staphylococcus epidermidis, Staphylococcus warneri, and Staphylococcus hominis, using a mouse model in which a foreign body preadhered with the test strain was implanted subcutaneously, followed by injection of the test strain . All five species of staphylococci produced abscesses . Staphylococcus epidermidis, S . schleiferi, and S . lugdunensis yielded species means of 76-91% abscess formation; 80-100% of the infected foreign bodies and tissues were culture positive . These three species were more virulent than S . warneri or S . hominis, which produced abscesses in 54 and 65% of mice, respectively; only 10-48% of the infected samples were culture positive . Transmission electron microscopy of pure cultures of selected strains showed that all species possessed glycocalyx . All species produced a variety of possible virulence factors, such as alpha and delta hemolysins, as well as the aggressins lipase and esterase . The production of exoenzymes did not always correlate with virulence as demonstrated by abscess formation in mice. J Clin Microbiol, 1990 Jul, 28(7), 1649 - 51 Comparison of Vitek Gram-Positive Identification system with API Staph-Trac system for species identification of staphylococci of bovine origin; Matthews KR et al.; Staphylococci (n = 130) of bovine origin representing 14 species were evaluated . Agreements of Vitek and API systems with conventional methods were 44.6 and 80.8%, respectively . The poor performance of the Vitek system was attributed primarily to inability to identify S . chromogenes . Incorporation of additional veterinary strains into the Vitek data base is needed to increase accuracy. DICP, 1990 Jul-Aug, 24(7-8), 714 - 20 Coagulase-negative staphylococci: incidence, pathogenicity, and treatment in the 1990s; Bailey EM et al.; Coagulase-negative staphylococci (CNS), which historically have been viewed as contaminants when recovered in culture media, are now recognized as opportunistic pathogens of increasing importance in hospital-acquired infections . They are frequently found colonizing prosthetic devices and intravenous lines . CNS are capable of producing a variety of infections including deep-seated infections such as endocarditis and meningitis . Staphylococcus epidermidis is the most commonly isolated CNS and it appears to be the most resistant to antibiotics, making antimicrobial therapy challenging . Treatment of the infection will very often require removal of a prosthetic device, if present . An adequate infection control program is imperative in prophylaxis against this infection. Rev Infect Dis, 1990 Jul-Aug, 12(4), 644 - 52 High-level gen