Mol Microbiol, 2001 Mar, 39(6), 1651 - 60 The puzzle of zmpB and extensive chain formation, autolysis defect and non-translocation of choline-binding proteins in Streptococcus pneumoniae; Berge M et al.; Choline-binding proteins (CBPs) from Streptococcus pneumoniae are involved in several important processes . Inactivation of zmpB, a gene that encodes a surface-located putative zinc metalloprotease, in a S . pneumoniae serotype 4 strain was recently reported to reveal a composite phenotype, including extensive chain formation, lysis defect and transformation deficiency . This phenotype was associated with the lack of surface expression of several CBPs, including the major autolysin LytA . LytA, normally 36 kDa in size, was reported to form an SDS-resistant 80 kDa complex with CinA . ZmpB was therefore proposed to control translocation of CBPs to the surface, possibly through the proteolytic release of CBPs (and RecA) from CinA . Based on the use of 12 independent mariner insertions in the zmpB gene of the well-characterized R6 laboratory strain, we could not confirm several of these observations . Our zmpB mutants: (i) did not form chains; (ii) lysed normally in the presence of deoxycholate, which indicates the presence of a functional autolysin; (iii) transformed at normal frequency; and (iv) contained bona fide CinA and LytA species . Polymorphism of ZmpB between R6 and the serotype 4 isolate could not account for the discrepancy, as inactivation of zmpB (through replacement by transposon-inactivated zmpB R6 alleles) in the latter strain did not affect separation of daughter cells and autolysis . The conflicting observations could be explained by our finding that the reportedly serotype 4 zmpB 'mutant' differed from its S . pneumoniae parent in lacking capsule and in exhibiting characteristic traits of the Streptococcus viridans group, including resistance to optochin. Mol Microbiol, 2001 Mar, 39(6), 1610 - 22 Identification of the teichoic acid phosphorylcholine esterase in Streptococcus pneumoniae; Vollmer W et al.; Streptococcus pneumoniae is a major human pathogen and many interactions of this bacterium with its host appear to be mediated, directly or indirectly, by components of the bacterial cell wall, specifically by the phosphorylcholine residues which serve as anchors for surface-located choline-binding proteins and are also recognized by components of the host response, such as the human C-reactive protein, a class of myeloma proteins and PAF receptors . In the present study, we describe the identification of the pneumococcal pce gene encoding for a teichoic acid phosphorylcholine esterase (Pce), an enzymatic activity capable of removing phosphorylcholine residues from the cell wall teichoic acid and lipoteichoic acid . Pce carries an N-terminal signal sequence, contains a C-terminal choline-binding domain with 10 homologous repeating units similar to those found in other pneumococcal surface proteins, and the catalytic (phosphorylcholine esterase) activity is localized on the N-terminal part of the protein . The mature protein was overexpressed in Escherichia coli and purified in a one-step procedure by choline-affinity chromatography and the enzymatic activity was followed using the chromophoric p-nitrophenyl-phosphorylcholine as a model substrate . The product of the enzymatic digestion of 3H-choline-labelled cell walls was shown to be phosphorylcholine . Inactivation of the pce gene in S . pneumoniae strains by insertion-duplication mutagenesis caused a unique change in colony morphology and a striking increase in virulence in the intraperitoneal mouse model . Pce may be a regulatory element involved with the interaction of S . pneumoniae with its human host. Am J Rhinol, 2001 Jan-Feb, 15(1), 47 - 8 Leukotriene B4 levels in rabbit maxillary sinusitis: limitations of the current model; Hurley DB et al.; Since the late 1980s, the rabbit model for sinusitis has been widely used for experimental studies on sinusitis; however, the clinical relevance of these experimental data has been questioned . To elucidate the role of leukotrienes in the pathogenesis of sinusitis, leukotriene B4 (LTB4) levels were determined in acute Streptococcus pneumoniae sinusitis in this model . The rabbit model for acute maxillary sinusitis was utilized . Briefly, the right maxillary ostium of each New Zealand white rabbit was occluded with cyanoacrylate under general anesthesia . Twenty-four hours after occlusion, the occluded sinus received an inoculation of 10(8) Streptococcus pneumoniae (ATCC 10813) or a sham inoculation of saline alone . Rabbits were then sacrificed one week later, and the maxillary sinus mucosae were harvested . Leukotriene B4 levels were determined by ELISA assay . LTB4 levels in the sinuses inoculated with bacteria tended to be higher; however, statistical analysis did not reveal significant differences between the experimental and control groups . It is possible to reliably assess leukotriene B4 levels in this model of sinusitis . Although the data suggest a trend for elevated LTB4 levels, statistical analysis did not support this conclusion . The study also demonstrated significant limitations in the current rabbit model for sinusitis; that is, the standard human sinus bacterial pathogens are minimally pathogenic in rabbit sinuses and the small size of the sinus limits the material available for assay . Further modifications of the model are necessary . After such adjustments, the role of leukotrienes in sinusitis may be further explored. Arch Med Res, 2000 Nov-Dec, 31(6), 592 - 8 Clinical outcome of invasive infections in children caused by highly penicillin-resistant Streptococcus pneumoniae compared with infections caused by penicillin-susceptible strains; Gomez-Barreto D et al.; BACKGROUND: In this report based on data from the Institutional Surveillance System during 1994-1998, we document the continuing emergence of drug-resistant Streptococcus pneumoniae strains at the Hospital Infantil de Mexico Federico Gomez in Mexico City . METHODS: We evaluate the clinical course of 49 invasive pneumococcal infection outside the central nervous system (CNS) by a number of factors including the site, severity, and place where the infection was acquired, the underlying health of the patient, and the adequacy of antimicrobial therapy . RESULTS: An underlying illness was present in 21 of 49 (43%) patients, 37 (75%) patients had taken previous antimicrobial therapy, and 25% of the infections were nosocomially acquired . Overall, 25 of 49 (51%) of the pneumococcal strains tested were pencillin-resistant; strains with the highest resistance to penicillin were also resistant to cephalosporins . Twenty-two percent of all strains were considered to be multidrug-resistant . Eleven of 25 penicillin-resistant strains were identified as multidrug-resistant, i.e., to erythromycin, TMP/SMX, and chloramphenicol . Ten serotypes accounted for 88% of the isolates, the most frequent serotypes being 23F, 14, 19V, 6A, and 6B . The overall case-fatality rate was 37% (18 of 49), with most deaths occurring within 3-5 days after antibiotic therapy was initiated . There was no difference in the case fatality rate between children with penicillin-nonsusceptible and penicillin-susceptible pneumococcal infections; instead; case-fatality rate correlated with severity of illness on admission and presence of underlying disease . CONCLUSIONS: Characterizing groups at risk for invasive pneumococcal disease could aid in the development of preventive programs and increase the benefits from wide use of future conjugated vaccines. Antimicrob Agents Chemother, 2001 Apr, 45(4), 1104 - 8 Multiple mutations modulate the function of dihydrofolate reductase in trimethoprim-resistant Streptococcus pneumoniae; Maskell JP et al.; Trimethoprim resistance in Streptococcus pneumoniae can be conferred by a single amino acid substitution (I100-L) in dihydrofolate reductase (DHFR), but resistant clinical isolates usually carry multiple DHFR mutations . DHFR genes from five trimethoprim-resistant isolates from the United Kingdom were compared to susceptible isolates and used to transform a susceptible control strain (CP1015) . All trimethoprim-resistant isolates and transformants contained the I100-L mutation . The properties of DHFRs from transformants with different combinations of mutations were compared . In a transformant with only the I100-L mutation (R12/T2) and a D92-A mutation also found in the DHFRs of susceptible isolates, the enzyme was much more resistant to trimethoprim inhibition (50% inhibitory concentration {IC50}, 4.2 microM) than was the DHFR from strain CP1015 (IC50, 0.09 microM) . However, Km values indicated a lower affinity for the enzyme's natural substrates (Km for dihydrofolate {DHF}, 3.1 microM for CP1015 and 27.5 microM for R12/T2) and a twofold decrease in the specificity constant . In transformants with additional mutations in the C-terminal portion of the enzyme, Km values for DHF were reduced (9.2 to 15.2 microM), indicating compensation for the lower affinity generated by I100-L . Additional mutations in the N-terminal portion of the enzyme were associated with up to threefold-increased resistance to trimethoprim (IC50 of up to 13.7 microM) . It is postulated that carriage of the mutation M53-I-which, like I100-L, corresponds to a trimethoprim binding site in the Escherichia coli DHFR-is responsible for this increase . This study demonstrates that although the I100-L mutation alone may give rise to trimethoprim resistance, additional mutations serve to enhance resistance and modulate the effects of existing mutations on the affinity of DHFR for its natural substrates. Antimicrob Agents Chemother, 2001 Apr, 45(4), 1099 - 103 rho is not essential for viability or virulence in Staphylococcus aureus; Washburn RS et al.; We have identified the gene for transcription termination factor Rho in Staphylococcus aureus . Deletion of rho in S . aureus reveals that it is not essential for viability or virulence . We also searched the available bacterial genomic sequences for homologs of Rho and found that it is broadly distributed and highly conserved . Exceptions include Streptococcus pneumoniae, Streptococcus pyogenes, Mycoplasma genitalium, Mycoplasma pneumoniae, Ureaplasma urealyticum, and Synechocystis sp . strain PCC6803, all of which appear not to possess a Rho homolog . Complementation studies indicate that S . aureus Rho possesses the same activity as Escherichia coli Rho and that the Rho inhibitor bicyclomycin is active against S . aureus Rho . Our results explain the lack of activity of bicyclomycin against many gram-positive bacteria and raise the possibility that the essentiality of rho may be the exception rather than the rule. Antimicrob Agents Chemother, 2001 Apr, 45(4), 1078 - 85 Penicillin pharmacodynamics in four experimental pneumococcal infection models; Erlendsdottir H et al.; Clinical and animal studies indicate that with optimal dosing, penicillin may still be effective against penicillin-nonsusceptible pneumococci (PNSP) . The present study examined whether the same strains of penicillin-susceptible pneumococci (PSP) and PNSP differed in their pharmacodynamic responses to penicillin by using comparable penicillin dosing regimens in four animal models: peritonitis, pneumonia, and thigh infection in mice and tissue cage infection in rabbits . Two multidrug-resistant isolates of Streptococcus pneumoniae type 6B were used, one for which the penicillin MIC was 0.016 microg/ml and the other for which the penicillin MIC was 1.0 microg/ml . Two additional strains of PNSP were studied in the rabbit . The animals were treated with five different penicillin regimens resulting in different maximum concentrations of drugs in serum (C(max)s) and times that the concentrations were greater than the MIC (T(>MIC)s) . The endpoints were bacterial viability counts after 6 h of treatment in the mice and 24 h of treatment in the rabbits . Similar pharmacodynamic effects were observed in all models . In the mouse models bactericidal activity depended on the T(>MIC) and to a lesser extent on the Cmax/MIC and the generation time but not on the area under the concentration-time curve (AUC)/MIC . Maximal bactericidal activities were similar for both PSP and PNSP, being the highest in the peritoneum and blood (approximately 6 log10 CFU/ml), followed by the thigh (approximately 3 log10 CFU/thigh), and being the lowest in the lung (approximately 1 log10 CFU/lung) . In the rabbit model the maximal effect was approximately 6 log10 CFU/ml after 24 h . In the mouse models bactericidal activity became marked when T(>MIC) was > or =65% of the experimental time and C(max) was > or =15 times the MIC, and in the rabbit model bactericidal activity became marked when T(>MIC) was > or =35%, Cmax was > or =5 times the MIC, and the AUC at 24 h/MIC exceeded 25 . By optimization of the Cmax/MIC ratio and T(>MIC), the MIC of penicillin for pneumococci can be used to guide therapy and maximize therapeutic efficacy in nonmeningeal infections caused by PNSP. Antimicrob Agents Chemother, 2001 Apr, 45(4), 1037 - 42 Need for annual surveillance of antimicrobial resistance in Streptococcus pneumoniae in the United States: 2-year longitudinal analysis; Sahm DF et al.; Although changing patterns in antimicrobial resistance in Streptococcus pneumoniae have prompted several surveillance initiatives in recent years, the frequency with which these studies are needed has not been addressed . To approach this issue, the extent to which resistance patterns change over a 1-year period was examined . In this study we analyzed S . pneumoniae antimicrobial susceptibility results produced in our laboratory with isolates obtained over 2 consecutive years (1997-1998 and 1998-1999) from the same 96 institutions distributed throughout the United States . Comparison of results revealed increases in resistant percentages for all antimicrobial agents studied except vancomycin . For four of the agents tested (penicillin, cefuroxime, trimethoprim-sulfamethoxazole, and levofloxacin), the increases were statistically significant (P < 0.05) . Resistance to the fluoroquinolone remained low in both years (0.1 and 0.6%, respectively); in contrast, resistance to macrolides was consistently greater than 20%, and resistance to trimethoprim-sulfamethoxazole increased from 13.3 to 27.3% . Multidrug resistance, concurrent resistance to three or more antimicrobials of different chemical classes, also increased significantly between years, from 5.9 to 11% . The most prevalent phenotype was resistance to penicillin, azithromycin (representative macrolide), and trimethoprim-sulfamethoxazole . Multidrug-resistant phenotypes that included fluoroquinolone resistance were uncommon; however, two phenotypes that included fluoroquinolone resistance not found in 1997-1998 were encountered in 1998-1999 . This longitudinal surveillance study of resistance in S . pneumoniae revealed that significant changes do occur in just a single year and supports the need for surveillance at least on an annual basis, if not continuously. J Biomol NMR, 2001 Feb, 19(2), 125 - 39 Refined structure of a flexible heptasaccharide using 1H-13C and 1H-1H NMR residual dipolar couplings in concert with NOE and long range scalar coupling constants; Martin-Pastor M et al.; The heptasaccharide isolated from the cell wall polysaccharide of Streptococcus mitis J22 serves as an important model for the dynamics and conformation of complex polysaccharides, illustrating the nature of flexibility with rigid epitopes joined by flexible hinges . One-bond C-H residual dipolar couplings (1D(CH)) and long-range H-H residual dipolar couplings (nD(HH)) were measured for the heptasaccharide in a cetylpyridinium chloride/hexanol/brine lamellar liquid crystal medium . A method is proposed to determine the nD(HH) in natural abundance based on a 13C resolved 1H TOCSY pulse sequence previously published to determine the homonuclear scalar couplings . Different methods for interpretation of the 1D(CH) and the nD(HH) residual dipolar coupling data obtained were compared and combined with the NOE and long-range H,C and C,C scalar couplings available for this heptasaccharide . A flexible model of the heptasaccharide was determined in which two structurally well-defined regions involving four and two sugar residues, respectively are joined by a flexible hinge which involves two 1-->6 glycosidic linkages. Arch Inst Pasteur Alger, 1998, 62, 52 - 61 {In vitro activity of trovafloxacin (CP-99,219) against 434 bacterial strains: comparative study with other fluoroquinolones}; Tali-Maamar H et al.; We have evaluated the activity of a new fluoroquinolone, trovafloxacin (CP-99,219), against 434 strains; 24 of them are resistant to ciprofloxacin . Against gram-negative bacteria, trovafloxacin has the same activity as the others fluoroquinolones . Against gram-positive bacteria, this antibiotic agent is very active . (MIC = 0.016 to 0.5 microgram/ml); Streptococcus is the most sensitive species . The ciprofloxacin resistant strains are also resistant to trovafloxacin. Arch Inst Pasteur Alger, 1998, 62, 13 - 23 {Sensitivity to beta lactams and macrolides of Streptococcus pyogenes isolated at the services from 1994 to 1998}; Nait-Kaci S et al.; The identification and antibiotic sensibility of 188 strains of streptocoques pyogenes had been performed from 1994 to March 1998 . We were interested on active antibiotics against streptocoques pyogenes: beta lactamins (penicillin-ampicillin) and macrolids (erythromycin) . The aim of this study is to reveal resistances and calculate percentages of resistant strains to these antibiotics . The WHO recommend to treat streptococcal sore throat with penicillin, and with erythromycin when there is a proved inhibility to the penicillin . No penicillin resistant streptocoques pyogenes has been found in the world, that concords with our study: all strains (188 sp.) are penicillin sensitive . Macrolids resistant strains of streptocoques pyogenes has been described by a lot of countries with different distributions . In our study global percentage of resistant strains to erythromycin is 24% and 29% for throat specimen. Ann Intern Med, 2001 Mar 20, 134(6), 509 - 17 Principles of appropriate antibiotic use for acute pharyngitis in adults: background; Cooper RJ et al.; The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever . They do not apply during known outbreaks of group A streptococcus.1 . Group A beta-hemolytic streptococcus (GABHS) is the causal agent in approximately 10% of adult cases of pharyngitis . The large majority of adults with acute pharyngitis have a self-limited illness, for which supportive care only is needed.2 . Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection . All patients with pharyngitis should be offered appropriate doses of analgesics and antipyretics, as well as other supportive care.3 . Limit antibiotic prescriptions to patients who are most likely to have GABHS infection . Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis) . Do not test or treat patients with none or only one of these criteria, since these patients are unlikely to have GABHS infection . For patients with two or more criteria the following strategies are appropriate: a) Test patients with two, three, or four criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results; b) test patients with two or three criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results or patients with four criteria; or c) do not use any diagnostic tests, and limit antibiotic therapy to patients with three or four criteria . 4 . Throat cultures are not recommended for the routine primary evaluation of adults with pharyngitis or for confirmation of negative results on rapid antigen tests when the test sensitivity exceeds 80% . Throat cultures may be indicated as part of investigations of outbreaks of GABHS disease, for monitoring the development and spread of antibiotic resistance, or when such pathogens as gonococcus are being considered.5 . The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient. Ann Intern Med, 2001 Mar 20, 134(6), 479 - 86 Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods; Gonzales R et al.; The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneumoniae . The majority of antibiotics prescribed to adults in ambulatory practice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including the common cold) . For each of these conditions-especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routine antibiotic treatment is not recommended)-a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients . Because decreasing community use of antibiotics is an important strategy for combating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physicians representing the disciplines of internal medicine, family medicine, emergency medicine, and infectious diseases to develop a series of "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults." These principles provide evidence-based recommendations for evaluation and treatment of adults with acute respiratory illnesses.This paper describes the background and specific aims of and methods used to develop these principles . The goal of the principles is to provide clinicians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it . These principles should be used in conjunction with effective patient educational campaigns and enhancements to the health care delivery system that facilitate nonantibiotic treatment of the conditions in question. Infect Immun, 2001 Apr, 69(4), 2732 - 5 Generation and characterization of a defined mutant of Streptococcus suis lacking suilysin; Allen AG et al.; A defined allelic-replacement mutant of the sly gene, encoding a thiol-activated cytolysin, from a European isolate of Streptococcus suis serotype 2 was generated and characterized . Unlike the parental strain, it is nonhemolytic, noncytotoxic for cultured macrophage-like cells, avirulent in a mouse infection model, yet only slightly attenuated in a porcine model of systemic infection. Infect Immun, 2001 Apr, 69(4), 2477 - 86 Mosaic genes and mosaic chromosomes: intra- and interspecies genomic variation of Streptococcus pneumoniae; Hakenbeck R et al.; Streptococcus pneumoniae remains a major causative agent of serious human diseases . The worldwide increase of antibiotic resistant strains revealed the importance of horizontal gene transfer in this pathogen, a scenario that results in the modulation of the species-specific gene pool . We investigated genomic variation in 20 S . pneumoniae isolates representing major antibiotic-resistant clones and 10 different capsular serotypes . Variation was scored as decreased hybridization signals visualized on a high-density oligonucleotide array representing 1,968 genes of the type 4 reference strain KNR.7/87 . Up to 10% of the genes appeared altered between individual isolates and the reference strain; variability within clones was below 2.1% . Ten gene clusters covering 160 kb account for half of the variable genes . Most of them are associated with transposases and are assumed to be part of a flexible gene pool within the bacterial population; other variable loci include mosaic genes encoding antibiotic resistance determinants and gene clusters related to bacteriocin production . Genomic comparison between S . pneumoniae and commensal Streptococcus mitis and Streptococcus oralis strains indicates distinct antigenic profiles and suggests a smooth transition between these species, supporting the validity of the microarray system as an epidemiological and diagnostic tool. Infect Immun, 2001 Apr, 69(4), 2416 - 27 Multilocus sequence typing of Streptococcus pyogenes and the relationships between emm type and clone; Enright MC et al.; Multilocus sequence typing (MLST) is a tool that can be used to study the molecular epidemiology and population genetic structure of microorganisms . A MLST scheme was developed for Streptococcus pyogenes and the nucleotide sequences of internal fragments of seven selected housekeeping loci were obtained for 212 isolates . A total of 100 unique combinations of housekeeping alleles (allelic profiles) were identified . The MLST scheme was highly concordant with several other typing methods . The emm type, corresponding to a locus that is subject to host immune selection, was determined for each isolate; of the >150 distinct emm types identified to date, 78 are represented in this report . For a given emm type, the majority of isolates shared five or more of the seven housekeeping alleles . Stable associations between emm type and MLST were documented by comparing isolates obtained decades apart and/or from different continents . For the 33 emm types for which more than one isolate was examined, only five emm types were present on widely divergent backgrounds, differing at four or more of the housekeeping loci . The findings indicate that the majority of emm types examined define clones or clonal complexes . In addition, an MLST database is made accessible to investigators who seek to characterize other isolates of this species via the internet . Infect Immun, 2001 Apr, 69(4), 2309 - 17 Essential role for cellular phosphoglucomutase in virulence of type 3 Streptococcus pneumoniae; Hardy GG et al.; Synthesis of the Streptococcus pneumoniae type 3 capsule requires the pathway glucose-6-phosphate (Glc-6-P) --> Glc-1-P --> UDP-Glc --> UDP-glucuronic acid (UDP-GlcUA) --> (GlcUA-Glc)(n) . The UDP-Glc dehydrogenase and synthase necessary for the latter two steps, and essential for capsule production, are encoded by genes (cps3D and cps3S, respectively) located in the type 3 capsule locus . The phosphoglucomutase (PGM) and Glc-1-P uridylyltransferase activities necessary for the first two steps are derived largely through the actions of cellular enzymes . Homologues of these enzymes, encoded by cps3M and cps3U in the type 3 locus, are not required for capsule production . Here, we show that cps3M and cps3U also are not required for mouse virulence . In contrast, nonencapsulated isolates containing defined mutations in cps3D and cps3S were avirulent, as were reduced-capsule isolates containing mutations in pgm . Insertion mutants that lacked PGM activity were avirulent in both immunologically normal (BALB/cByJ) and immunodeficient (CBA/N) mice . In contrast, a mutant (JY1060) with reduced PGM activity was avirulent in the former but had only modestly reduced virulence in the latter . The high virulence in CBA/N mice was not due to the lack of antibodies to phosphocholine but reflected a growth environment distinct from that found in BALB/cByJ mice . The reduced PGM activity of JY1060 resulted in enhanced binding of complement and antibodies to surface antigens . However, decomplementation of BALB/cByJ mice did not enhance the virulence of this mutant . Suppressor mutations, only some of which resulted in increased capsule production, increased the virulence of JY1060 in BALB/cByJ mice . The results suggest that PGM plays a critical role in pneumococcal virulence by affecting multiple cellular pathways. Infect Immun, 2001 Apr, 69(4), 1994 - 2000 Streptococcus iniae virulence is associated with a distinct genetic profile; Fuller JD et al.; Streptococcus iniae causes meningoencephalitis and death in commercial fish species and has recently been identified as an emerging human pathogen producing fulminant soft tissue infection . As identified by pulsed-field gel electrophoresis (PFGE), strains causing disease in either fish or humans belong to a single clone, whereas isolates from nondiseased fish are genetically diverse . In this study, we used in vivo and in vitro models to examine the pathogenicity of disease-associated isolates . Strains with the clonal (disease-associated) PFGE profile were found to cause significant weight loss and bacteremia in a mouse model of subcutaneous infection . As little as 10(2) CFU of a disease-associated strain was sufficient to establish bacteremia, with higher inocula (10(7)) resulting in increased mortality . In contrast, non-disease-associated (commensal) strains failed to cause bacteremia and weight loss, even at inocula of 10(8) CFU . In addition, disease-associated strains were more resistant to phagocytic clearance in a human whole blood killing assay compared to commensal strains, which were almost entirely eradicated . Disease-associated strains were also cytotoxic to human endothelial cells as measured by lactate dehydrogenase release from host cells . However, both disease-associated and commensal strains adhered to and invaded cultured human epithelial and endothelial cells equally well . While cellular invasion may still contribute to the pathogenesis of invasive S . iniae disease, resistance to phagocytic clearance and direct cytotoxicity appear to be discriminating virulence attributes of the disease-associated clone. Chirurg, 2001 Feb, 72(2), 168 - 73 {Surgical concepts and results in necrotizing fasciitis}; Heitmann C et al.; INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue . The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria . Further characteristics are severe, intolerable pain and a mortality of 30-50% . PATIENTS AND METHODS: From January 1996 to January 2000 12 patients underwent treatment for NF . The patients' charts were investigated retrospectively . RESULTS: In 7 patients the bacterial cultures showed a mixed, polymicrobial infection and in 5 cases only Streptococcus pyogenes . The NF was localized at the upper extremity (2), abdomen (3), back (1), hip (2) and lower extremity (4) . The area involved was 8 (4-11)% of the total body surface . The surgical procedures in 12 patients were debridement (60x), local transposition flap (2), free muscle flaps (3), lower leg amputation (1) and split thickness skin graft (3x) . Four patients developed streptococcal toxic shock syndrome and two died . In total there were four deaths with a mortality of 33% . In the "survivor group" the time to diagnosis was 2.8 (1-7) days, the time to radical surgery 3.3 (1-9) days . In the "mortality group" it was 6.8 (3-10) days or 9.3 (6-12) days . CONCLUSION: The prognosis of NF seems to be influenced by the site of the infection, because 4 out of 6 patients with NF of the abdomen, back or hip died, but all patients with NF of the extremities survived . The age of the patient is not a key parameter, because also young and previously healthy people also die from the streptococcal toxic shock syndrome . The interval between diagnosis and radical debridement appears to be the crucial factor in terms of prognosis, since early diagnosis and prompt, radical surgery improves the survival rate. Rev Panam Salud Publica, 2001 Jan, 9(1), 30 - 4 {Effect of sodium fluoride mouth rinses containing xylitol and sorbitol on the number of Streptococcus mutans from human saliva}; Goncalves NC et al.; The objective of this study was to assess the effect of 0.05% sodium fluoride solutions containing 2.5% or 12.5% xylitol on the number of Streptococcus mutans in the human mouth . Fifty boys between 8 and 16 years of age participated in this double-blind crossover study . Of the original 50 boys, 33 finished the study . Participants were randomly divided into four groups . The following solutions were employed: placebo solution; 0.05% sodium fluoride solution; 0.05% sodium fluoride + 2.5% xylitol + 2% sorbitol; 0.05% sodium fluoride + 12.5% xylitol + 2% sorbitol . Each solution was used for a 28-day period (20 mL/day, twice a day), with a 10-day washout period between solutions . There were no significant differences (P = 0.32) between the two xylitol-containing solutions (2.5% vs . 12.5%) concerning the number of Streptococcus mutans . However, there was a significant difference between these two xylitol-containing solutions and the sodium fluoride and placebo solutions (P < 0.001) . Our results suggest that the 0.05% sodium fluoride solutions containing either 2.5% or 12.5% xylitol caused a significant reduction in the number of Streptococcus mutans. J Clin Pathol, 2001 Mar, 54(3), 214 - 8 Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed; Waghorn DJ; AIMS: Patients without spleens are at increased risk of overwhelming infection . Recently, greater efforts, including the publication of national guidelines, have been made to improve the management of asplenic individuals . In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis . In practice, such preventive measures might not be followed or may fail . A study of recent cases of overwhelming postsplenectomy infection (OPSI) was undertaken to examine specific associated factors and to determine whether currently recommended preventive measures are being followed . METHODS: Cases of OPSI were identified and reported mainly by microbiologists across the country using a specifically designed proforma . Data including the nature of the infection and vaccination/ antibiotic prophylaxis history since splenectomy were obtained . RESULTS: Seventy seven cases were reported . The age range varied from 3 months (congenital asplenia) to 87 years . In those who had undergone surgical splenectomy, the time interval between surgery and OPSI varied from 24 days to 65 years . Overall mortality reached 50%, with underlying haematological malignancy associated with the highest death rate . Streptococcus pneumoniae caused approximately 90% episodes . Only 31% individuals had received pneumococcal vaccination before OPSI . Seven of 17 pneumococcal infections in immunised cases could be considered vaccine failures . Few patients had been adequately advised on antibiotic prophylaxis or other measures . CONCLUSIONS: Currently accepted best practice for managing asplenic patients is not being followed . Some OPSI cases may still be preventable but many asplenic individuals remain unrecognised . The compilation of asplenic patient registers might help to implement agreed policies with audit necessary to evaluate compliance . More is needed to ensure optimal management for this cohort of the population. Arch Gerontol Geriatr, 2001 Feb, 32(1), 45 - 55 Prevalence of potential respiratory pathogens in the mouths of elderly patients and effects of professional oral care; Abe S et al.; To evaluate the effectiveness of professional oral health care in reducing the risk of aspiration pneumonia, we examined the prevalence of potential respiratory pathogens in gargled samples from elderly persons . Samples were obtained from 54 elderly subjects over 65 years of age who required daily nursing care, from 21 healthy elderly subjects over 65 years old, and from 22 healthy young subjects under 30 as controls . The prevalence of possible pathogens was determined by culture and the polymerase chain reaction . The percentages detected in samples of Streptococcus pneumoniae, Staphylococcus species, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans from elderly patients requiring daily nursing care were 63.0, 37.0, 14.8, 5.6 and 66.7, respectively . The numbers of C . albicans cells recovered in samples from elderly subjects were significantly higher than those recovered from the healthy young group (P<0.001) . Elderly patients needing daily care and receiving professional oral health care had lower prevalences and cell numbers of C . albicans than did the elderly patients without such oral care . This study showed that professional oral health care in elderly requiring daily nursing care reduced the cell numbers of potential respiratory pathogens. Clin Infect Dis, 2001 Mar 15, 32 Suppl 1, S39 - 46 What have we learned from pharmacokinetic and pharmacodynamic theories? Schentag JJ, Gilliland KK, Paladino JA. Pharmacokinetic characteristics and pharmacodynamic properties dictate antimicrobial response and, along with natural immune responses, clinical outcomes . As new agents are developed with long half-lives, we will lose the ability to differentiate between concentration-dependent and time-dependent properties . The area under the inhibitory concentration curve (AUIC) defines drug regimens as a ratio of drug exposure to minimum inhibitory concentration (MIC) and allows them to be compared with each other . With AUIC and agents with long half-lives, these comparisons are possible regardless of chemical classification or concentration or time-dependent activity . Historical examples of reduced drug exposure from decreased doses (i.e., cefaclor, clarithromycin, and ciprofloxacin), and thus low AUIC values, directly correlate with drug resistance . In the face of rising MICs (as is occurring worldwide with Streptococcus pneumoniae), close attention to appropriate dosing and concentration above the MIC may delay and potentially even prevent antibiotic resistance . Creating selective pressure on reliable antibiotics by inappropriately reducing their doses will undoubtedly challenge these agents and may destroy entire drug classes with similar mechanisms of action or resistance. Clin Infect Dis, 2001 Mar 15, 32 Suppl 1, S30 - 2 Comparative in vitro activity of moxifloxacin by E-test against Streptococcus pyogenes; Amabile-Cuevas CF et al.; Macrolides are currently used to treat Streptococcus pyogenes infections where allergy or resistance prevents the use of penicillin . However, growing macrolide resistance is now seen worldwide, with rates of 5%-40% being reported . In this context it is therefore important to have other therapeutic options . The aim of this study was to ascertain the potential role of moxifloxacin, a third-generation fluoroquinolone, in the treatment of infections caused by group A S . pyogenes . The antimicrobial susceptibilities of S . pyogenes isolated from 197 adult patients with pharyngotonsillitis were analyzed by the E-test . Twelve percent of the isolates were resistant to macrolides, and 5% showed diminished susceptibility toward penicillin; none of the strains were resistant to cefotaxime or to moxifloxacin (90% minimum inhibitory concentration, 0.25 microg/mL) . Therefore, moxifloxacin may be a therapeutic option in the management of S . pyogenes infections when penicillin cannot be used or when macrolide resistance may be a local issue . Clinical studies of moxifloxacin in pharyngotonsillitis are warranted. Clin Infect Dis, 2001 Mar 15, 32 Suppl 1, S22 - 9 Penicillin-resistant streptococcus pneumoniae: review of moxifloxacin activity; Dalhoff A et al.; Streptococcus pneumoniae is a significant pathogen of respiratory tract infections such as pneumonia, sinusitis, meningitis, and acute otitis media . Rising incidences of antimicrobial resistance among pneumococcal strains reported worldwide have led to research into and development of advanced antibacterials with improved gram-positive activity . Moxifloxacin, a new 8-methoxy quinolone, has been tested against a variety of S . pneumoniae strains, including penicillin-sensitive, intermediately resistant to penicillin, and penicillin-resistant strains . We review the preclinical data corroborated by the available clinical experience to demonstrate moxifloxacin's activity against S . pneumoniae strains, irrespective of penicillin susceptibility. Curr Opin Investig Drugs, 2000 Oct, 1(2), 181 - 7 Linezolid Pharmacia Corp; Barrett JF; Linezolid is an oxazolidinone developed by Pharmacia (formerly Pharmacia & Upjohn) for the treatment of multi-resistant Gram-positive infections {187765,317456} . It binds to ribosomal 50S subunits, most likely within domain V within the 23S rRNA peptidyl transferase and a secondary interaction with the 30S subunit . This results in inhibition of the initiation of protein translation at an early point, which is probably N-formylmethionyl-tRNA {335843} . No direct action on DNA or RNA synthesis has been observed {220169} . Linezolid resistance due to a 23S rRNA mutation may emerge in Enterococci during therapy with this antimicrobial, and may be associated with clinical failure {368652} . Following FDA approval, linezolid was launched in May 2000 {368526,368652} . In April 2000, the FDA approved linezolid injection, tablets and oral suspension for the treatment of patients with infections caused by Gram-positive bacteria . It is indicated for adults in the treatment of nosocomial pneumonia, community-acquired pneumonia (CAP), complicated and uncomplicated skin and skin structure infections and vancomycin-resistant enterococcus (VRE) infections caused by methicillin-resistant Staphylococcus aureus (MRSA), VRE faecium and penicillin-susceptible Streptococcus pneumoniae {363503} . The FDA, however, did not grant Pharmacia indications for linezolid in the treatment of CAP due to either penicillin-resistant S aureus (PRSA) or MRSA . In May 2000, Merrill Lynch predicted sales for 2000 to be US $50 million, rising to US $760 million in 2004 {366910} . In February 2000, P&U predicted that peak sales of the drug had the potential to reach in excess of US $750 million {358429} . In February 1999, Morgan Stanley Dean Witter predicted sales of US $40 million in 2000 rising to US $275 million in 2005 {319855} . In December 1998, Deutsche Bank predicted sales of US $100 million in 2000 rising to US $300 million in 2002 {316769}. Cornea, 2001 Mar, 20(2), 175 - 8 Bacteriologic and clinical efficacy of ofloxacin 0.3% versus ciprofloxacin 0.3% ophthalmic solutions in the treatment of patients with culture-positive bacterial keratitis; Prajna NV et al.; PURPOSE: To compare the efficacy and safety of ofloxacin 0.3% ophthalmic solution with ciprofloxacin 0.3% ophthalmic solution in patients with culture-positive bacterial keratitis . METHODS: Patients with a microbiologic diagnosis of bacterial keratitis were included in this double-masked, parallel-group study and were randomized to treatment with either ofloxacin 0.3% or ciprofloxacin 0.3% ophthalmic solution . One drop of the study medication was instilled during the daytime according to the following schedule: every half-hour on study day 1, every hour on days 2 through 4, and every 2 hours on days 5 through 21 . Healing, the primary outcome measure, was defined as complete reepithelialization, accompanied by nonprogression of stromal infiltrate for 2 days . Secondary outcome measures included signs and symptoms of infection . Patients were monitored throughout the study period for any adverse events . RESULTS: A total of 217 patients completed the study: 112 were treated with ofloxacin and 105 were treated with ciprofloxacin . Streptococcus pneumoniae was the most commonly encountered pathogen in all patients . Complete corneal reepithelialization occurred in 85% of those treated with ofloxacin and in 77% of those treated with ciprofloxacin (p = 0.32) . The average time to corneal ulcer healing was 13.7 days in those treated with ofloxacin and 14.4 days in those treated with ciprofloxacin . Both treatments were well tolerated with no patient discontinuing the study because of side effects . CONCLUSION: Ofloxacin 0.3% and ciprofloxacin 0.3% ophthalmic solutions are effective and safe in the treatment of patients with culture-positive bacterial keratitis. FEMS Microbiol Ecol, 2001 Mar, 35(1), 49 - 56 The physiological and genetic diversity of bovine Streptococcus bovis strains(1); Jarvis GN et al.; Laboratory Streptococcus bovis strains and isolates obtained from a steer fed increasing amounts of grain had similar growth characteristics, but they differed in their sensitivity to 2-deoxyglucose (2DG), a non-metabolizable glucose analog . The addition of 2DG decreased both growth rate (0.92+/-0.34 h(-1)) and growth yield (ranging from 25 to 63%), but these differences could not be correlated with diet . However, isolates from a steer fed a 90% grain diet were more prone to 2DG-dependent lysis than those from a hay diet (P<0.001) . All S . bovis laboratory strains and isolates had an identical restriction fragment length polymorphism pattern, when their 16S rDNA was digested with HaeIII and HhaI . However, when genomic BOX elements were amplified, 5-12 bands were observed, and the S . bovis isolates and laboratory strains could be grouped into 13 different BOX types . Strains 26 and 581AXY2 had the same BOX type, but the remaining laboratory strains did not form closely related clusters . Strains JB1 and K27FF4 were most closely related to each other . Most of the fresh isolates (24 out of 30) could be grouped into a single cluster (>90% Dice similarity) . This cluster contained isolates from all three diets, but it did not have any of the laboratory strains . The majority (90%) of the isolates obtained from the hay-fed steer exhibited the same BOX type . Because more BOX types were observed if grain was added to the diet, it appears that ruminal S . bovis diversity may be a diet-dependent phenomenon. Clin Infect Dis, 2001 Mar 15, 32(6), 972 - 4 Epub 2001 Mar 09. Penicillin-resistant Streptococcus pneumoniae endocarditis: a case report and review; Siegel M et al.; Streptococcus pneumoniae has been a rare cause of endocarditis in the postantibiotic era . The emergence of antibiotic-resistant Pneumococcus species has been accompanied by isolated reports of penicillin-resistant S . pneumoniae (PRSP) endocarditis . We report a case of bivalvular PRSP endocarditis that was treated with vancomycin and trovafloxacin, and we review the literature on this topic. Eur J Clin Microbiol Infect Dis, 2001 Jan, 20(1), 61 - 4 Clonal relationships among penicillin-susceptible, multiresistant serotype 6B Streptococcus pneumoniae isolates recovered in Greece and France; Syrogiannopoulos GA et al.; In January 1996 the emergence of penicillin-susceptible, multiresistant serotype 6B Streptococcus pneumoniae isolates resistant to chloramphenicol, tetracycline, erythromycin, clindamycin and trimethoprim-sulfamethoxazole was observed in young carriers in the city of Patras, located in the southwestern region of Greece . Later, a significant spread of pneumococci with this unusual phenotype was noted in carriers living in various other areas of the country . Using restriction fragment length polymorphism of the ribosomal RNA genes, clonal relationships were found between these Greek strains and serotype 6B penicillin-susceptible, multiresistant pneumococci isolated in France between January 1992 and September 1996 . The French and Greek isolates appear to have a common ancestry. Eur J Clin Microbiol Infect Dis, 2001 Jan, 20(1), 49 - 51 Tricuspid valve endocarditis in adult patients without known predisposing factors; Shimoni Z et al.; Four patients with no known predisposing conditions developed tricuspid valve endocarditis . All patients had community-acquired infection with a rapidly progressive course that was complicated by right heart failure and respiratory insufficiency . Pulmonary involvement was prominent in all cases . The infectious process was due to Staphylococcus aureus in three patients and to Streptococcus intermedius in one patient . Three patients underwent early surgical intervention; the outcome was favourable in all cases . It is clear that tricuspid valve endocarditis can occur in the absence of known predisposing factors, and when Staphylococcus aureus is involved, the course of the disease may be acute and rapidly progressive. Chin Med J (Engl), 1998 Jul, 111(7), 615 - 8 Experimental study on distribution of serotypes and antimicrobial patterns of group B streptococcus strains; Shen A et al.; OBJECTIVE: To obtain information on the distribution of serotypes and antimicrobial agent susceptibilities to group B streptococcus (GBS) strains isolated in Beijing area from 1991 to 1996 . METHODS: Bacterial isolates of GBS were obtained from vaginal and cervical tract of pregnant and nonpregnant women in Beijing Tian Tan Hospital by culture . A total of 76 GBS strains were identified finally by coagglutination . Serotyping was determined by Standard Lancefield method . Susceptibility to test agents was assessed by determining the minimal inhibitory concentrations (MICs) with agar dilution method that was established by the National Committee for Clinical Laboratory Standards (NCCLS) . RESULTS: Seven serotypes were identified among 76 GBS strains isolates . Types II (33%), III (23%) and I a (16%) were the predominant serotypes in pregnant and nonpregnant women . MICs of penicillin G and ampicillin were < or = 0.06 microgram/ml . MICs of cephazolin, cefuroxime and cefoperozone were 0.003 microgram/ml-0.06 microgram/ml . MICs of erythromycin were 0.003 microgram/ml-0.03 microgram/ml . MICs of gentamycin were 1 microgram/ml-32 micrograms/ml . MICs of amikacin were 4 micrograms/ml- > or = 64 micrograms/ml, nearly 12.8% and 40.4% of the strains were resistant to gentamycin and amikacin, respectively . CONCLUSIONS: Our study provides useful epidemiologic data for preparation of GBS type-specific vaccines which can prevent GBS infections and antimicrobial agents susceptibility patterns in China . Routine reports on GBS susceptibilities by clinical laboratories and continuous surveillance for changes in the susceptibility are of considerable clinical importance. Presse Med, 2000 Nov 18, 29(35), 1948 - 56 {Piercing and its infectious complications . A public health issue in France}; Guiard-Schmid JB et al.; CHARACTERISTIC FEATURES: Piercing, an act that modifies the body, has progressed considerably in France over the last few years . The population involved has grown and become more diversified . Performed with a solid needle or a catheter, a wide variety of anatomic localizations are concerned, particularly the nose, ears, and navel . The shape of the "rings", generally made of surgical steel, niobium or titanium, varies greatly . Wound healing by epithelialisation can take up to several months . INFECTIOUS RISK: Between 10% and 20% of all piercings lead to a local infection . The most commonly found causal agests are Staphylococcus aureus, group A Streptococcus and Pseudomonas sp . These germs can cause severe life-threatening complications even in common localizations (earlobe) . Viral transmission is another risk (hepatitis B, hepatitis C, hepatitis delta, HIV) . A few cases of fatal fulminant hepatitis have been described immediately after piercing . SAFETY MEASURES: Generally performed under less than desirable sanitary conditions, safety measures are needed for piercing . Among professional "piercers", a certain number have emphasized the need for providing their clients with safer services . The prevention of infection risk should be a priority for all . Work along this line has been done in the United States and Canada . In light of the impact on public health, it is important to rapidly develop guidelines and regulations for piercing in France . Both professional piercers and health care workers should participate in developing these safety measures in order to assure their implementation. Ophthalmic Res, 2001 Mar-Apr, 33(2), 117 - 20 In vitro susceptibilities to topical antibiotics of bacteria isolated from the surface of clinically symptomatic eyes; Egger SF et al.; BACKGROUND: The permanent change of resistance patterns of bacteria causing ocular infections makes repeat susceptibility testings against the most recent clinical isolates mandatory . The aim of the present study was to assess the in vitro susceptibility of ocular bacterial isolates of clinically symptomatic eyes admitted to the outpatient clinic of the eye department of a large central hospital to commonly used topical antibiotics . METHODS: Ocular isolates (n = 454) were tested for their susceptibility to ofloxacin, ciprofloxacin, norfloxacin, gentamicin, tobramycin, meomycin, bacitracin, erythromycin, tetracycline and chloramphenicol . RESULTS: All three tested fluoroquinolones were found to be very effective against gram-negative organisms but demonstrated some weakness against certain strains of gram-positive germs, in particular coagulase-negative staphylococci and Streptococcus viridans . These germs, however, were very susceptible to bacitracin and chloramphenicol . The relative overall in vitro efficacy was (in decreasing order): chloramphenicol, ciprofloxacin, ofloxacin, norfloxacin, bacitracin, tetracycline, neomycin, erythromycin, tobramycin and gentamicin . CONCLUSION: Chloramphenicol had the highest overall in vitro efficacy, but has potential lethal side effects . The fluoroquinolones were highly effective, especially being superior to the aminoglycosides tested, but no single antibiotic provided 100% coverage against all of the bacterial isolates that were tested . Chest, 2001 Mar, 119(3), 862 - 6 Systemic antibiotics fail to clear multidrug-resistant Klebsiella from a pediatric ICU; Petros AJ et al.; STUDY OBJECTIVEs: To determine the magnitude of infection rate and antimicrobial resistance in a pediatric ICU (PICU), and to evaluate the efficacy of using broad-spectrum antibiotics . DESIGN: A 3-month, prospective, observational cohort audit . SETTING: A 12-bed tertiary, referral PICU . PATIENTS OR PARTICIPANTS: All children admitted to the PICU for > 72 h . INTERVENTIONS: Surveillance cultures of throat and rectum on admission and once weekly thereafter . MEASUREMENTS AND RESULTS: Of the 150 admissions during the 3-month period, a total of 52 patients (24 girls and 28 boys) requiring mechanical ventilation for a minimum of 3 days were enrolled in the audit . The median age and interquartile range (IQR) was 17 months (IQR, 5.8 to 63); length of stay, 6.5 days (IQR, 4 to 13); ventilation days, 5 (IQR, 3 to 11); pediatric risk of mortality score, 14 (IQR, 9 to 19); and risk of mortality, 0.03 (IQR, 0.014 to 0.087) . Fifteen patients (29%) developed 21 infections, mainly lower-airway infections and septicemias . Of the 52 children, 7 children carried multidrug-resistant bacteria and 3 patients progressed to develop four infections with those resistant bacteria . Of the seven carriers, six patients carried gentamicin-resistant Klebsiella . Methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae and gentamicin-resistant Pseudomonas aeruginosa each were carried by one child . Six of those nine resistant isolates were present in the admission flora . Despite the potent combination of piperacillin/tazobactam and amikacin, three children acquired the multidrug-resistant Klebsiella while in the PICU and became nosocomial carriers . CONCLUSIONS: Only surveillance cultures allow the distinction between import of multidrug-resistance and resistant bacteria acquired while in PICU . In this study, two thirds of the resistant isolates were imported . The introduction of newer potent systemic antibiotic combinations failed to control the endemic reservoir of multidrug-resistant Klebsiella and suggests that such policies have little impact. Presse Med, 2001 Jan, Spec No 1, 5 - 6, 4 {Pneumococcal antibiotic resistance in 1999 . Results from 19 registries for 1999}; Chomarat M; BETA-LACTAM RESISTANCE: Among the 9956 strains of Streptococcus pneumoniae isolated in adults, 39% had some degree of penicillin resistance (reduced susceptibility), but there were relatively few strains highly resistant to penicillin: 10% . Among the 4422 strains isolated in children, the overall rate of penicillin resistance was higher (51%) with 15% highly resistant strains . For amoxicillin, the rate of reduced susceptibility was 25% while 1.4% were amoxicillin-resistant . For ceftaxime the respective figures were 21% and 0.3% OTHER ANTIBIOTIC FAMILIES: Important reduction in the susceptibility of all strains, more pronounced for peni-R strains, for macrolides, cotrimoxazole, tetracyxine and chloramphenicol . Very rare resistance to rifampicin and intact susceptibility to vancomycin . CHILDREN VERSUS ADULTS: The rate of reduced susceptibility to beta-lactams was higher in children: 31% versus 23% for amoxicillin and 21% versus 14% for cefotaxime . However there were only a few rare strains that were amoxicillin and cefotaxime resistant . Unlike what was observed in adults, there were major differences by site of sampling; strains isolated from purulent middle ear fluid exhibited the strongest resistance. Oral Microbiol Immunol, 2001 Apr, 16(2), 124 - 8 Altered antigenicity in periodontitis patients and decreased adhesion of Porphyromonas gingivalis by environmental temperature stress; Amano A et al.; Periodontopathogenic bacteria survive various environmental changes during the progression of periodontal disease . Alterations in metabolism and protein expression will have to take place to adapt their physiological functions to environmental stress . We examined the effects of an elevation of 2 degrees C in temperature on the adhesive ability and antigenicity of Porphyromonas gingivalis . Elevation of growth temperature of P . gingivalis from 37 degrees C to 39 degrees C remarkably suppressed the expression of surface filamentous structures, such as fimbriae, as well as the adhesive capacities to salivary components and Streptococcus oralis . Sera of severe periodontitis patients revealed a marked increase in serological activity with 39 degrees C cells than with 37 degrees C cells . The alteration of protein profiles of bacterial surface components by temperature elevation was demonstrated by SDS-PAGE, and their Western blot profiles were also different from those of cells grown at 37 degrees C . Although a uniform trend was not found in the altered patterns, sera from severe periodontitis patients detected more antigenic proteins in cells grown at 39 degrees C than 37 degrees C cells . These observations suggest that P . gingivalis downregulates the expression of fimbriae and alters its adhesive capacity and antigenicity by the temperature stress that could occur during the disease progression. Oral Microbiol Immunol, 2001 Apr, 16(2), 94 - 9 Inhibitory effect of sorbitol on sugar metabolism of Streptococcus mutans in vitro and on acid production in dental plaque in vivo; Takahashi-Abbe S et al.; This study was conducted to find out whether sorbitol inhibits the sugar metabolism of Streptococcus mutans in vitro and the acid production in dental plaque in vivo . S . mutans NCIB 11723 was anaerobically grown in sorbitol-containing medium . The rate of acid production from sugars was estimated with a pH stat . The rate of acid production from glucose or sucrose was not changed at various concentrations of oxygen . By the addition of sorbitol to sugar, however, the acid production was decreased with increasing levels of oxygen . Intracellular NADH/NAD+ ratio and (dihydroxyacetone-phosphate+glyceraldehyde-phosphate)/3-phosphoglycerate ratio were high whenever the acid production was inhibited by sorbitol . Sorbitol also inhibited the acid production in dental plaque in vivo . These results suggest that the increased NADH/NAD+ ratio during sorbitol metabolism through the inactivation of pyruvate formate-lyase by oxygen inhibited glyceraldehyde-phosphate dehydrogenase and then the acid production of S . mutans and the one in dental plaque. Rev Neurol (Paris), 2001 Jan, 157(1), 55 - 61 {Neurological manifestation of infectious endocarditis: 14 cases}; Pages M et al.; Fourteen cases of infective endocarditis revealed by neurological manifestations are reported: 8 strokes (one transient ischemic attack, one regressing and 6 completed strokes), 2 intracranial hematomas (one due to ruptured mycotic aneurysm), 2 toxic encephalopathies, one grand mal seizure, one suppurative meningitis . Most of them were native valve endocarditis, and streptococcus was the most frequently responsible bacteria . The outcome was characterized by a high mortality (6 cases) and morbidity (4 cases) . This emphasizes the usefulness of preventing antibiotherapy in patients with known predisposing factors and the necessity for these patients to be admitted in neurological intensive care units. Vet Microbiol, 2001 Apr 2, 79(3), 209 - 23 In vitro evidence for a bacterial pathogenesis of equine laminitis; Mungall BA et al.; Utilizing an in vitro laminitis explant model, we have investigated how bacterial broth cultures and purified bacterial proteases activate matrix metalloproteinases (MMPs) and alter structural integrity of cultured equine lamellar hoof explants . Four Gram-positive Streptococcus spp . and three Gram-negative bacteria all induced a dose-dependent activation of MMP-2 and MMP-9 and caused lamellar explants to separate . MMP activation was deemed to have occurred if a specific MMP inhibitor, batimastat, blocked MMP activity and prevented lamellar separation . Thermolysin and streptococcal pyrogenic exotoxin B (SpeB) both separated explants dose-dependently but only thermolysin was inhibitable by batimastat or induced MMP activation equivalent to that seen with bacterial broths . Additionally, thermolysin and broth MMP activation appeared to be cell dependent as MMP activation did not occur in isolation.These results suggest the rapid increase in streptococcal species in the caecum and colon observed in parallel with carbohydrate induced equine laminitis may directly cause laminitis via production of exotoxin(s) capable of activating resident MMPs within the lamellar structure . Once activated, these MMPs can degrade key components of the basement membrane (BM) hemidesmosome complex, ultimately separating the BM from the epidermal basal cells resulting in the characteristic laminitis histopathology of hoof lamellae . While many different causative agents have been evaluated in the past, the results of this study provide a unifying aetiological mechanism for the development of carbohydrate induced equine laminitis. J Dent, 2001 Feb, 29(2), 119 - 22 Inhibition of bacterial and glucan adherence to various light-cured fluoride-releasing restorative materials; Kawai K et al.; OBJECTIVES: This study investigated the potential plaque adhesion properties of various light-cured fluoride-releasing restorative materials by measuring the amount of adhering radiolabeled bacteria and glucan . METHODS: Three resin-modified glass ionomer cements (RMGI) and two polyacid-modified resin composites (compomer) were used in this study . As a control, one light-cured resin composite was added . Disk-shaped specimens were made following the manufacturers' recommendations and the respective surfaces were finished with a 600-grit abrasive paper . Streptococcus sobrinus B13 was selected as a cariogenic bacterial strain . The amount of bacteria and glucan adhered to these specimens were measured after 3, 8 and 24h incubations with radiolabeled cariogenic bacteria and sucrose . RESULTS: After 3 and 8h incubations, the amount of adhered bacteria and glucan was small and there were no significant differences among the restorative materials except in the resin composite . Although after 24h incubation the amounts of adhered bacteria and glucan, significantly increased on the RMGIs and compomers, these were still significantly less than the resin composite except one compomer . Although at 3h no good correlation was found between the contact angles and the amount of bacteria and glucans, the correlation coefficients were high at 8 or 24h . In addition, the coefficients for bacteria were always higher than those for glucan irrespective of the incubation times . CONCLUSIONS: After 24h resin-modified glass ionomer cements and compomers showed significantly smaller amounts of adhered bacteria and glucans compared to resin composite with an exception of glucan adherence on one compomer. Microbiology, 2001 Mar, 147(Pt 3), 653 - 62 Characterization of a copper-transport operon, copYAZ, from Streptococcus mutans; Vats N et al.; A copper-transport (copYAZ) operon was cloned from the oral bacterium Streptococcus mutans JH1005 . DNA sequencing showed that the operon contained three genes (copY, copA and copZ), which were flanked by a single promoter and a factor-independent terminator . copY encoded a small protein of 147 aa with a heavy-metal-binding motif (CXCX(4)CXC) at the C-terminus . CopY shared extensive homology with other bacterial negative transcriptional regulators . copA encoded a 742 aa protein that shared extensive homology with P-type ATPases . copZ encoded a 67 aa protein that also contained a heavy-metal-binding motif (CXXC) at the N-terminus . Northern blotting showed that a 3.2 kb transcript was produced by Cu2+-induced Strep . mutans cells, suggesting that the genes were synthesized as a polycistronic message . The transcriptional start site of the cop operon was mapped and shown to lie within the inverted repeats of the promoter-operator region . Strep . mutans wild-type cells were resistant to 800 microM Cu2+, whereas cells of a cop knock-out mutant were killed by 200 microM Cu2+ . Complementation of the cop knock-out mutant with the cop operon restored Cu2+ resistance to wild-type level . The wild-type and the mutant did not show any differences in susceptibility to other heavy metals, suggesting that the operon was specific for copper . By using a chloramphenicol acetyltransferase reporter gene fusion, the cop operon was shown to be negatively regulated by CopY and could be derepressed by Cu2+. J Immunol, 2001 Mar 15, 166(6), 4059 - 64 Mice lacking the multidrug resistance protein 1 are resistant to Streptococcus pneumoniae-induced pneumonia; Schultz MJ et al.; Leukotrienes (LTs) are considered important for antibacterial defense in the lung . Multidrug resistance protein 1 (mrp1) is a transmembrane protein responsible for the cellular extrusion of LTC(4) . To determine the role of mrp1 in host defense against pneumonia, mrp1(-/-) and wild-type mice were intranasally inoculated with Streptococcus pneumoniae . mrp1(-/-) mice displayed a diminished outgrowth of pneumococci in lungs and a strongly reduced mortality . These findings were related to an effect of mrp1 on LT metabolism, because survival was similar in mrp1(-/-) and wild-type mice treated with the 5-lipoxygenase-activating protein inhibitor MK-886 . Although LTC(4) levels remained low in the bronchoalveolar lavage fluid of mrp1(-/-) mice, LTB(4) concentrations were higher than in wild-type mice . These elevated LTB(4) concentrations were important for the relative protection of mrp1(-/-) mice, because the LTB(4) antagonist LTB(4)-dimethyl amide abolished their survival advantage . In vitro experiments suggested that the intracellullar accumulation of LTC(4) in mrp1(-/-) mice results in product inhibition of LTC(4)-synthase, diminishing substrate competition between LTA(4)-hydrolase (which yields LTB(4)) and LTC(4)-synthase for the available LTA(4) . We conclude that mrp1(-/-) mice are resistant against pneumococcal pneumonia by a mechanism that involves increased release of LTB(4) . These results identify mrp1 as a novel target for adjunctive therapy in pneumonia. Clin Diagn Lab Immunol, 2001 Mar, 8(2), 441 - 5 Human T-cell responses to the glucosyltransferases of Streptococcus mutans; Chia JS et al.; We previously reported differential humoral responses to glucosyltransferases (GTFs), with significantly higher saliva and serum antibody levels to GtfD than to GtfB or GtfC . To test the hypothesis that cellular immune responses to these molecules also may differ, peripheral blood mononuclear cell (PBMC) and T-cell proliferative responses in young adults and children with distinct genetic backgrounds were determined using purified recombinant GtfC and GtfD . PBMCs from all of the volunteers responded to GtfC and -D, but responses were directed predominantly towards GtfD and were major histocompatibility class II antigen dependent . A predominant T-cell response to GtfD, over GtfC, was detectable at various antigen concentrations ranging from 1 to 20 microg/ml and correlated with the differential serum immunoglobulin G (IgG) and salivary IgA antibody responses to the GTFs . Therefore, in naturally sensitized humans, Streptococcus mutans GTFs stimulate differential humoral and cellular immune responses, with the secreted form of GtfD eliciting a stronger response than the cell wall-associated form of GtfC. Clin Diagn Lab Immunol, 2001 Mar, 8(2), 363 - 9 Are the opsonophagocytic activities of antibodies in infant sera measured by different pneumococcal phagocytosis assays comparable? Vakevainen M, Jansen W, Saeland E, Jonsdottir I, Snippe H, Verheul A, Kayhty H. Host protection against Streptococcus pneumoniae is mainly mediated by opsonin-dependent phagocytosis . Several techniques for measuring opsonophagocytic activity (OPA) of antibodies to S . pneumoniae have been standardized and used . These include the viable cell-assay, flow-cytometric assays, and an assay utilizing radiolabeled bacteria . Using these different methods, we measured the OPA of antibodies to S . pneumoniae types 6B and 19F from the sera of infants immunized with a pneumococcal conjugate vaccine, PncCRM . Generally, the results obtained by the various techniques correlated well, although serotype-specific differences were found (6B, r = 0.78 to 0.95, P < 0.001; 19F, r = 0.50 to 0.84, P < 0.001) . The same serotype-specific differences were observed for the relationship between the concentrations of specific immunoglobulin G antibodies measured by enzyme immunoassay and the OPA . Since the sensitivities of the OPA assays differed, the most prominent discrepancies between the techniques were found at low antibody concentrations. Clin Diagn Lab Immunol, 2001 Mar, 8(2), 251 - 7 Cloning and characterization of the gene encoding the glutamate dehydrogenase of Streptococcus suis serotype 2; Okwumabua O et al.; Given the lack of effective vaccines to control Streptococcus suis infection and the lack of a rapid and reliable molecular diagnostic assay to detect its infection, a polyclonal antibody was raised against the whole-cell protein of S . suis type 2 and used to screen an S . suis gene library in an effort to identify protective antigen(s) and antigens of diagnostic importance . A clone that produced a 45-kDa S . suis-specific protein was identified by Western blotting . Restriction analysis showed that the gene encoding the 45-kDa protein was present on a 1.6-kb pair DraI region on the cloned chromosomal fragment . The nucleotide sequence contained an open reading frame that encoded a polypeptide of 448 amino acid residues with a calculated molecular mass of 48.8 kDa, in close agreement with the size observed on Western blots . A GenBank database search revealed that the derived amino acid sequence is homologous to the sequence of glutamate dehydrogenase (GDH) protein isolated from various sources, including conserved motifs and functional domains typical of the family 1-type hexameric GDH proteins, thus placing it in that family . Because of these similarities, the protein was designated the GDH of S . suis . Hybridization studies showed that the gene is conserved among the S . suis type 2 strains tested . Antiserum raised against the purified recombinant protein was reactive with a protein of the same molecular size as the recombinant protein in S . suis strains, suggesting expression of the gene in all of the isolates and antigenic conservation of the protein . The recombinant protein was reactive with serum from pigs experimentally infected with a virulent strain of S . suis type 2, suggesting that the protein might serve as an antigen of diagnostic importance to detect S . suis infection . Activity staining showed that the S . suis GDH activity is NAD(P)H dependent but, unlike the NAD(P)H-dependent GDH from various other sources, that of S . suis utilizes L-glutamate rather than alpha-ketoglutarate as the substrate . Highly virulent strains of S . suis type 2 could be distinguished from moderately virulent and avirulent strains on the basis of their GDH protein profile following activity staining on a nondenaturing gel . We examined the cellular location of the protein using a whole-cell enzyme-linked immunosorbent assay and an immunogold-labeling technique . Results showed that the S . suis GDH protein is exposed at the surface of intact cells. Clin Diagn Lab Immunol, 2001 Mar, 8(2), 245 - 50 Comparison of a classical phagocytosis assay and a flow cytometry assay for assessment of the phagocytic capacity of sera from adults vaccinated with a pneumococcal conjugate vaccine; Jansen WT et al.; Antibody- and complement-mediated phagocytosis is the main defense mechanism against Streptococcus pneumoniae . A standardized, easy to perform phagocytosis assay for pneumococci would be a great asset for the evaluation of the potential efficacy of (experimental) pneumococcal vaccines . Such an assay could replace the laborious phagocytosis assay of viable pneumococci (classical killing assay) . Therefore, a newly developed phagocytosis assay based on flow cytometry (flow assay) was compared with the conventional killing assay and enzyme-linked immunosorbent assay (ELISA), using sera obtained from adults pre- and postvaccination with either a bivalent conjugate, a tetravalent conjugate, or the 23-valent polysaccharide vaccine . Highly significant correlations were observed between flow assay phagocytosis titers, killing assay phagocytosis titers, and ELISA antibody titers for serotype 6B and 23F as well . For serotype 19F, strong correlations were only observed between killing assay and ELISA titers . A potential drawback of the flow assay might be the low sensitivity compared with that of the killing assay . The choice of what assay to use, however, will depend on the objectives of the assay . When speed, easy performance, sample throughput, improved worker safety, absence of influence of antibiotics, and absence of false positives are the major criteria, the flow assay is the method of choice . When higher sensitivity is the major requirement, the classical killing assay should be used. J Infect Dis, 2001 Apr 1, 183(7), 1143 - 6 Epub 2001 Mar 01. Experimental pneumococcal meningitis in mice: a model of intranasal infection; Zwijnenburg PJ et al.; Effective laboratory animal models of bacterial meningitis are needed to unravel the pathophysiology of this disease . Previous models have failed to simulate human meningitis by using a directly intracerebral route of infection . Hyaluronidase is a virulence factor of Streptococcus pneumoniae . In this study, a novel model of murine meningitis is described . Intranasal administration of S . pneumoniae with hyaluronidase induced meningitis in 50% of inoculated mice, as defined by a positive cerebrospinal fluid (CSF) culture and an inflammatory infiltrate in the meninges . None of the mice inoculated without hyaluronidase developed meningitis . Hyaluronidase was found to facilitate pneumococcal invasion of the bloodstream after colonization of the upper respiratory tract . Meningitis was characterized by pleocytosis of CSF and the induction of proinflammatory cytokines and CXC chemokines in brain tissue . These results indicate that this murine model mimics important features of human disease and allow for the use of this model for studying issues related to the pathophysiology and the treatment of pneumococcal meningitis. J Infect Dis, 2001 Apr 1, 183(7), 1138 - 42 Epub 2001 Mar 01. Invasive group B streptococcal disease in Maryland nursing home residents; Henning KJ et al.; Between 1991 and 1995, among 999 nonpregnant adult Maryland residents with group B Streptococcus (GBS) isolated from a normally sterile site, 84 resided in nursing homes (NHs) . The age-adjusted annual incidence of GBS infection (per 100,000 population) among those > or = 65 years old was 72.3 for NH residents and 17.5 for community residents (relative risk, 4.1; P < 0.001) . Thirty-four case patients resided in 11 NHs with > or = 2 cases; 1 NH had 8 case patients within 22 months . Six of 8 case patients from 3 NHs had serotype V GBS . Molecular subtyping of several isolates identified 2 case patients in 1 NH with identical subtype patterns . NH residents have a markedly higher incidence of invasive GBS than do community residents > or = 65 years old and may serve as a target group for immunization when GBS vaccines become available . Further evaluation of intra-NH transmission of GBS is warranted. J Infect Dis, 2001 Apr 1, 183(7), 1043 - 54 Epub 2001 Mar 01. Spontaneous mutations in the CsrRS two-component regulatory system of Streptococcus pyogenes result in enhanced virulence in a murine model of skin and soft tissue infection; Engleberg NC et al.; CsrS/CsrR is a 2-component system in Streptococcus pyogenes that negatively regulates hyaluronic capsule and several exotoxins . To detect spontaneous mutations in csrRS, mucoid and large colony variants of M1 strain MGAS166 were isolated from experimental murine skin infections . By use of complementation with a csrRS(+) plasmid, relevant mutations were also detected in 7 of 12 human clinical isolates . The presence of spontaneous mutants in mouse infection was associated with larger, more necrotic lesions . Most spontaneous changes in CsrR resulted from single amino acid substitutions, whereas most csrS mutations were frameshift or nonsense mutations . In 2 instances, IS1548 insertions were found in csrS . Experimental inoculation of mixtures of wild-type (wt) and csrRS(-) bacteria yielded larger, more necrotic lesions than did either strain at twice the inoculum, which suggests that these variants may exhibit pathogenic synergy . Spontaneous emergence of csrRS(-) mutants in vivo enhances the virulence of wt bacteria and increases severity of murine skin infection. J Infect Dis, 2001 Mar 15, 183(6), 887 - 96 Epub 2001 Feb 21. Pneumococcal carriage and otitis media induce salivary antibodies to pneumococcal surface adhesin a, pneumolysin, and pneumococcal surface protein a in children; Simell B et al.; Local antibodies probably contribute to defense against Streptococcus pneumoniae . This study examined whether pneumococcal carriage and acute otitis media (AOM) induce mucosal antibodies to potential vaccine candidates pneumococcal surface adhesin A (PsaA), pneumolysin (Ply), and pneumococcal surface protein A (PspA) . IgA to all 3 proteins was detected by EIA in saliva of 329 children at ages 6, 12, 18, and 24 months and of 17 adults . A higher proportion of IgA-positive samples and higher antibody concentrations were seen in children with pneumococci-positive cultures of nasopharyngeal samples or middle ear fluid than in children with all cultures negative for pneumococci . The strong correlation between IgA and the presence of the secretory component suggests that the IgA was secretory . The findings indicate that pneumococcal carriage and AOM induce local production of anti-PsaA, anti-Ply, and anti-PspA antibodies early in life. Biochem Biophys Res Commun, 2001 Mar 9, 281(4), 957 - 61 Streptococcus mutans lipoteichoic acid-induced apoptosis in cultured dental pulp cells from human deciduous teeth; Wang PL et al.; Herein, we suggest that Streptococcus mutans lipoteichoic acid-induced death of dental pulp cells on human deciduous teeth is caused by apoptosis . We provide evidence for the causal role of apoptosis in this process by demonstrating an increase in the proportion of fragmented DNA in such dental pulp cells, which results in a ladder pattern of DNA fragmentation . Additionally, Streptococcus mutans lipoteichoic acid-induced apoptotic cell death is suppressed by caspase inhibitor . Collectively, these findings suggest that Streptococcus mutans lipoteichoic acids may cause apoptosis in human dental pulp cells, and serve as an important factor in pulpitis . Paediatr Perinat Epidemiol, 2001 Jan, 15(1), 54 - 60 Fetal and neonatal death from maternally acquired infection; Embleton ND; Northern Region's Perinatal Mortality Survey; Infection is a potentially preventable cause of perinatal mortality but there is only limited epidemiological information on which to develop prophylactic guidelines . The aim of this study was to determine the population incidence of perinatal death from maternally acquired infection and to describe the responsible organisms and antibiotic sensitivities, and also the associated risk factors . Fetal and neonatal deaths from perinatal infection in the former Northern Health Region, United Kingdom, were identified for the years 1981-96 using data held by the Perinatal Mortality Survey, and the obstetric, paediatric and pathology case notes were reviewed . Maternally acquired bacterial infection of the baby was identified as responsible for 60 pre-delivery deaths and 142 post-delivery deaths among babies of 24 or more weeks gestation at birth between 1981 and 1996 . There were 630,206 livebirths and 3,591 registered stillbirths in the survey area during this time . Bacterial infection was also considered the primary cause of death in 64 fetuses where delivery occurred at 20-23 weeks gestation between 1989 and 1996 . Although group B streptococcus was the commonest single organism it was only responsible for 30% of all infectious deaths from 24 weeks gestation onwards . Ampicillin resistance was more common in the second half of the study . Infection remains an important cause of perinatal mortality but responsible organisms and antibiotic sensitivities have changed significantly over time . Although 80% of the post-delivery deaths would have received intrapartum antibiotics if current guidelines had been in place, the choice of antibiotics and identification of risk groups requires careful consideration. S D J Med, 2001 Feb, 54(2), 65 - 9 Antimicrobial resistance: steps to reduce the problem with emphasis on antibiotic utilization the Rapid City experience; Keegan JM; In summary, as the SHEA/IDSA Joint Committee on Prevention of Antimicrobial Resistance suggested, it should be easier to prevent the acquisition of resistance than to respond after the problem is extensive . We have taken that approach in the measures undertaken and outlined above . Our lower rates of resistant microorganisms are, in part, due to this, but also due to the diligent use of antibiotics by the medical staff-largely in avoiding empiric broad-spectrum antibiotic therapy when not needed . Our formulary is not restrictive but new antibiotics are not added unless there is a proven niche . The most appropriate and effective antibiotic at our hospital for Streptococcus pneumoniae is penicillin, for Streptococcus pyogenes, penicillin, for Staphylococcus aureus, nafcillin, for a severe Escherichia Coli infection, gentamicin, and for Pseudomonas aeurginosa, gentamicin and ceftazidime . Our efforts are to maintain this favorable situation for our patients and clinicians . Additionally, we will continue to explore and implement new avenues of prevention, with an emphasis on optimal antibiotic utilization, toward the goal of protecting our patients and health care workers from resistant bacteria. Scand J Infect Dis, 2001, 33(1), 41 - 6 Group A streptococcus clones causing repeated epidemics and endemic disease in intravenous drug users; Lechot P et al.; Clones of Group A streptococcus (GAS) may spread epidemically and may be associated with enhanced virulence . Sociodemographic and clinical characteristics, together with bacterial isolates, of 79 patients with GAS infection in the Berne region between January 1993 and February 1997 were analysed retrospectively . Using pulsed-field gel electrophoresis, most strains (71%) were found to belong to one of 12 clones . Clonal strains caused significantly more frequent skin abscesses and more severe invasive disease than non-clonal strains . The largest clone (M serotype 1) occurred endemically in non-IVDU patients and caused severe disease in most . Three clones occurred almost exclusively among IVDUs: an M serotype 11 was associated with severe, endemic disease; the other 2 clones, both of M serotype 25, caused epidemics of needle abscesses . Epidemic and endemic spread of GAS clones among IVDUs may be more frequent than previously assumed. Ther Umsch, 2001 Feb, 58(2), 87 - 93 {Clinical presentation, diagnosis and management of inflammatory heart diseases in childhood}; Jaeggi ET et al.; Inflammatory disorders which may affect the heart muscle, the endocardium, the pericardium and/or the coronary arteries are rare, but potentially devastating diseases . As the incidence of rheumatic heart disease has decreased, children with congenital heart disease now constitute the primary patient population at risk of infective endocarditis . Streptococcus viridans and Staphylococcus aureus are still the most frequently observed organisms . The majority of children with infective endocarditis can be cured today, but good results depend on early diagnosis and accurate treatment . Myocarditis occurs when the heart muscle is involved in an inflammatory process . Causes are numerous, but most common in children are infections with cocksackie viruses . Approximately two-thirds of children with symptomatic acute myocarditis show complete recovery of impaired ventricular function, 10-20% progress of dilatative cardiomyopathy and about 10% die or require heart transplantation . Kawasaki disease is the most prevalent inflammatory coronary artery disease and the leading cause of acquired heart disease in children . The origin of this acute systemic vasculitis remains unknown . Visible coronary arterial abnormalities develop in approximately 20% of children with untreated Kawasaki syndrome . A single dose of gamma-globulin (2 g/kg over 12 h) given within the first 10 days of onset of illness as early as possible, in addition to aspirin has been shown to reduce the duration of fever, which may reflect the severity of ongoing vasculitis, and to reduce the prevalence of coronary artery anomalies. Swiss Surg, 2001, 7(1), 25 - 7 Streptococcal toxic shock syndrome revealed by a peritonitis . Case report and review of the literature; Vuilleumier H et al.; Group A streptococcus (GAS) or Streptococcus pyogenes cause a variety of life-threatening infectious complications including necrotizing fasciitis, purpura fulminans and streptococcal toxic shock syndrome (STSS) . Exotoxins that act as superantigens are felt to be responsible for STSS . These exotoxins are highly destructive to skin, muscle and soft tissue . This syndrome has a rapid and fulminant course with frequently fatal outcome . GAS remains sensitive to penicillin but in serious infection a combination of clindamycin and ceftriaxone or meropenemum is recommended . Several studies have shown that mortality was dramatically reduced in STSS patients treated with immunoglobulin G given intravenously (IVIG) . Early recognition of this most rapidly progressive infection and prompt operative debridement are required for successful management . This report presents a female patient at two month post-partum with a peritonitis and multi-organ failure. Jpn J Antibiot, 2000 Dec, 53(12), 652 - 9 {The frequency of Streptococcus pneumoniae strains and sensitivity surveillance for several antibiotics in Gifu Prefecture}; Ishigo S et al.; The frequency and the antibacterial sensitivity of Streptococcus pneumoniae strains isolated from 6 key hospitals (in 5 areas) and 1 otorhinolaryngology clinic in Gifu Prefecture from February to March, 1999, were investigated with several antibiotics . A total of 128 strains of Streptococcus pneumoniae were isolated throughout the study: 47 strains (36.7%) of penicillin-susceptible S . pneumoniae (PSSP), 51 strains (39.8%) of penicillin-intermediate S . pneumoniae (PISP), and 30 strains (23.4%) of penicillin-resistant S . pneumoniae (PRSP); the resistant bacteria being relatively prominent . In these hospitals, PSSP was isolated by 38.8% in all the key hospitals and by 30% in the otolaryngology clinic with almost no discernible difference . PISP was isolated by 63.3%, higher in the otolaryngology clinic and PRSP by 28.6%, higher in the key hospitals conversely . The MIC90s in PISP and PRSP were determined with the antibiotics . In result, only cefditoren (CDTR) showed favorable antibacterial activities with the MIC90 of 0.78 microgram/ml among penicillins or oral cephems . The MIC90s of carbapenems such as imipenem (IPM), meropenem (MEPM), and panipenem (PAPM) were less than 0.39 microgram/ml; particularly, PAPM showed the highest antibacterial activities . Among new quinolones such as tosufloxacin (TFLX), levofloxacin (LVFX), sparfloxacin (SPFX), and ciprofloxacin (CPFX), TFLX showed the highest antibacterial activities with the MIC90 of 0.39 microgram/ml . Other agents showed very low antibacterial activities as the MIC90s were 25 micrograms/ml in minocycline (MINO) and more than 100 micrograms/ml in clarithromycin (CAM) and clindamycin (CLDM). Acta Microbiol Immunol Hung, 2001, 48(2), 147 - 50 Group-F streptococcal pleuro-pericarditis in a mesothelioma patient after dental surgery (case report); Berek Z et al.; A 71-year-old mesothelioma patient developed pleuro-pericarditis and pleural empyema . Bacteriological examinations and serological identification proved group F Streptococcus in the pleural fluid . Anamnestic data suggested that the source of infection might have been the oral cavity after dental surgery. Cardiol Young, 2001 Jan, 11(1), 91 - 3 Replacement of the mitral valve in an infant with group B streptococcal endocarditis; Walker TA et al.; Endocarditis due to group B streptococcus is very rare in infants, and may be associated with significant morbidity and mortality . Review of the literature reveals only a single reported case of an infant with this type of streptococcal endocarditis involving the mitral valve . This infant had underlying congenital heart disease, and died shortly after catheterization . We now report group B streptococcal endocarditis occurring in an infant with a structurally normal heart who was treated successfully by replacement of the mitral valve. Drugs Aging, 2001, 18(1), 1 - 11 Acute exacerbations of chronic bronchitis: what role for the new fluoroquinolones? Obaji A, Sethi S. Acute exacerbations of chronic bronchitis (AECB) are a major cause of morbidity and mortality . Bacterial pathogens are implicated in about half the episodes of AECB . Empirical antibacterials have a significant benefit in AECB; however, several recent developments have considerably complicated antibacterial choice for this condition . New fluoroquinolone antibacterials introduced in the last decade are theoretically well suited for the treatment of AECB, as the in vitro antimicrobial spectrum of these drugs includes all the major pathogens involved . The pharmacokinetic and pharmacodynamic properties of the new fluoroquinolones are superior to many other antibacterials used to treat AECB . In trials, clinical success with the new fluoroquinolones was equivalent and bacteriological success was occasionally superior to nonfluoroquinolone comparators . However, these clinical trials did not assess several potentially important end-points for which the theoretical superiority of the fluoroquinolones may translate into differences in outcome . Rare but serious adverse effects with some of the new fluoroquinolones have shaken the confidence of prescribing physicians in this class of drugs . Emergence of the resistance of Streptococcus pneumoniae to fluoroquinolones has raised concerns about indiscriminate and widespread use of the new agents for trivial infections . Patients with AECB are a heterogeneous population who should be stratified in order to appropriately choose empirical antibacterial therapy . Highly efficacious antibacterial therapy, such as the new fluoroquinolones, is appropriate as a first-line choice for patients who have risk factors for a poor outcome or are in intensive care units . Such selected use of the new fluoroquinolones balances individual benefit with societal concerns of the use of these agents for AECB. Int J Infect Dis, 2000, 4(4), 214 - 8 Trends in antimicrobial resistance and serotype distribution of blood and cerebrospinal fluid isolates of Streptococcus pneumoniae in South Africa, 1991-1998; Huebner RE et al.; OBJECTIVE: Since 1979, the South African Institute for Medical Research (SAIMR) has served as the national reference center for pneumococcal serotyping and monitoring of antibiotic resistance trends . This study documents trends in antimicrobial resistance in pneumococci isolated from blood or cerebrospinal fluid (CSF) between 1991 and 1998 in South Africa . METHODS: Pneumococcal isolates (n = 7406) from either blood or CSF were sent to the SAIMR reference laboratory for serotyping . The isolates were evaluated for resistance to penicillin, chloramphenicol, tetracycline, erythromycin, clindamycin, and rifampicin . RESULTS: Resistance to one or more antibiotics increased significantly from 19% in 1991 to 1994 to 25% in 1995 to 1998 in all ages, and in children from 32% to 38% (P < 10{-6}) . Although penicillin resistance did not increase in children (28.1% vs . 28.9%), penicillin resistance in all ages increased from 9.6% to 18.0% . Significant increases in resistance to chloramphenicol, tetracycline, erythromycin, and rifampicin also were seen in both groups . Multiple resistance increased significantly, from 2.2% to 3.8% . The proportion of isolates with intermediate or high-level penicillin resistance remained constant during the surveillance period . Erythromycin resistance, predominantly expressed as simultaneous resistance to erythromycin and clindamycin, increased from 1.6% to 2.6% . The percentage of erythromycin-resistant isolates that were resistance to erythromycin alone increased from 10.6% to 28.7%, suggesting the emergence of mefE-mediated resistance . In children 2 years of age and younger, although serogroup 6 remained the most common, there were significant increases in serogroups 19, 18, and 13 . The percentage of the total invasive pneumococcal disease in this population that is caused by serogroups found in the nonavalent pneumococcal conjugate vaccine (serogroups 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F) increased from 72% to 91% . CONCLUSIONS: Antibiotic resistance in the pneumococcus is increasing in South Africa, although the proportion of strains with high-level penicillin resistance has not increased . New conjugate vaccines may not only decrease the burden of all pneumococcal disease but, in addition, lower the incidence of antibiotic-resistant disease in South Africa. J Clin Microbiol, 2001 Mar, 39(3), 1187 - 9 Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients with respiratory tract infections in Germany from 1998 to 1999: results of a national surveillance study; Reinert RR et al.; Clinically significant pneumococcal isolates were prospectively collected from outpatients with respiratory tract infections by 19 different clinical microbiology laboratories in Germany . Resistance rates in a total of 961 isolates were as follows: penicillin, 6.6%; clarithromycin, 10.6%; tetracycline, 13.9%; and levofloxacin, 0.1% . Among 324 isolates from children, pneumococcal serotypes 19F (17.0%), 23F (13.0%), and 6B (11.7%) were the predominant types. J Clin Microbiol, 2001 Mar, 39(3), 1144 - 7 Novel penicillin-, cephalosporin-, and macrolide-resistant clones of Streptococcus pneumoniae serotypes 23F and 19F in Taiwan which differ from international epidemic clones; Chiou CC et al.; A cluster (14 of 18) of Streptococcus pneumoniae serotype 23F isolates that were resistant to penicillin (PEN), cephalosporin, and macrolide was found in one day care center in Kaohsiung, Taiwan . We analyzed the 18 isolates by pulsed field gel electrophoresis (PFGE) . All but one serotype 23F isolate demonstrated identical PFGE patterns, which were different from the established pattern of the internationally spread Spanish 23F clone . The three strains of serotype 19F also showed a uniform pattern . These data strongly suggest that two novel clones of PEN-, cephalosporin-, and macrolide-resistant S . pneumoniae serotypes 23F and 19F are present in Taiwan. J Clin Microbiol, 2001 Mar, 39(3), 1021 - 4 Evaluation of a medium (STGG) for transport and optimal recovery of Streptococcus pneumoniae from nasopharyngeal secretions collected during field studies; O'Brien KL et al.; Field studies of Streptococcus pneumoniae (pneumococci) nasopharyngeal (NP) colonization are hampered by the need to directly plate specimens in order to ensure isolate viability . A medium containing skim milk, tryptone, glucose, and glycerin (STGG) has been used to transport and store NP material, but its ability to preserve pneumococci has not been evaluated . Our objective was to qualitatively and semiquantitatively evaluate the ability of STGG to preserve pneumococci in NP secretions . Entwined duplicate calcium alginate NP swab samples were obtained from children . One swab was plated directly onto a gentamicin blood agar plate; the other was placed in STGG . Growth from the directly plated specimen was compared with growth from an STGG aliquot immediately cultured or stored at -70 degrees C for 9 weeks, -20 degrees C for 9 weeks, or 4 degrees C for 5 days . Of 186 specimens, 96 (52%) were positive for pneumococci from the direct plating; 94 (98%) of these were positive from the fresh STGG specimen . Pneumococci were recovered from all 38 positive specimens frozen at -70 degrees C, all 18 positive specimens frozen at -20 degrees C, and 18 of 20 positive specimens stored at 4 degrees C . Recovery of pneumococci after storage of NP material in STGG medium at -70 degrees C is at least as good as that from direct plating . Storage at -20 degrees C is also acceptable . Storage at 4 degrees C for 5 days is not ideal. Clin Infect Dis, 2001 Mar 1, 32(5), 701 - 7 Epub 2001 Feb 28. Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study; Ho PL et al.; A case-control study was conducted to identify the risk factors associated with levofloxacin-resistant Streptococcus pneumoniae (LRSP) colonization or infection . Twenty-seven case patients (patients with LRSP) were compared with 54 controls (patients with levofloxacin-susceptible S . pneumoniae) . Risk factors that were significantly associated with LRSP colonization or infection, according to univariate analysis, included an older age (median age, 75 years for case patients versus 72.5 years for controls), residence in a nursing home (odds ratio {OR}, 7.2), history of recent (OR, 4.6) and multiple (OR, 4.4) hospitalizations, prior exposure to fluoroquinolones (OR, 10.6) and beta-lactams (OR, 8.6), presence of chronic obstructive pulmonary disease (COPD; OR, 5.9), and nosocomial origin of the bacteria (OR, 5.7) . Multivariate analysis showed that presence of COPD (OR, 10.3), nosocomial origin of the bacteria (OR, 16.2), residence in a nursing home (OR, 7.4), and exposure to fluoroquinolones (OR, 10.7) were independently associated with LRSP colonization or infection . Thus, a distinct group of patients with COPD is the reservoir of LRSP. Vaccine, 2001 Feb 28, 19(15-16), 1931 - 9 Immunization with recombinant Streptococcus gordonii expressing tetanus toxin fragment C confers protection from lethal challenge in mice; Medaglini D et al.; Tetanus toxin fragment C (TTFC) was expressed on the surface of the vaccine vector Streptococcus gordonii, a Gram-positive commensal bacterium of the human oral cavity . The immunogenicity of recombinant S . gordonii expressing TTFC was assayed in mice immunized by the parenteral and mucosal routes . High serum TTFC-specific IgG responses were induced in both BALB/c and C57BL/6 mice immunized subcutaneously . A total of 82% of vaccinated BALB/c mice were protected from the lethal challenge with 50 LD(50) of tetanus toxin (TT) and a direct correlation between the serum TTFC-specific IgG concentration and survival time of unprotected animals was observed . Intranasal immunization of BALB/c mice was also effective in inducing TTFC-specific serum IgG and local IgA in lung washes . Furthermore, 38% of animals immunized intranasally were protected from the lethal challenge with 10 LD(50) of TT while all control animals died within 24 h . Analysis of the serum IgG subclasses showed that the IgG1 subclass was predominant after parenteral immunization in BALB/c mice (IgG1/IgG2a ratio congruent with6) while following mucosal immunization a mixed IgG1 and IgG2a pattern (IgG1/IgG2a ratio congruent with1) was observed . These data show that TTFC expressed on the surface of S . gordonii is immunogenic by the subcutaneous and mucosal routes and the immune response induced is capable of conferring protection from the lethal challenge with TT. Dis Colon Rectum, 2001 Feb, 44(2), 291 - 4 Thoracic empyema associated with recurrent colon cancer: report of a case and review of the literature; Osada T et al.; Many types of infections associated with colorectal cancer have been reported . Here, we describe a rare case of thoracic empyema that was observed during immunotherapy for recurrent colon cancer . Culture of the pleural fluid yielded Streptococcus bovis, which is known to be associated with gastrointestinal lesions, especially colorectal malignancies . The possible correlation between these two clinical entities-empyema and colon cancer-is discussed. J Burn Care Rehabil, 2001 Jan-Feb, 22(1), 35 - 40 The use of 5% mafenide acetate solution in the postgraft treatment of necrotizing fasciitis; Heinle EC et al.; Twenty-nine patients with necrotizing fasciitis who were treated with 5% mafenide acetate solution (MAS) as an adjunct after grafting were compared with 45 patients treated without MAS . Statistical analysis of differences was obtained through P values by chi2 testing . The MAS+ (M) and MAS- (C) groups were similar in percent skin deficit (M = 7.5%; C = 9.8%), with the extremity being the most common area of infection . Streptococcus was the most common single organism but polymicrobial infections were the most prevalent (M = 48%; C = 58%) . Patients with necrotizing fasciitis treated with MAS had fewer debridements per patient (M = 3.7; C = 5.4), fewer closure procedures (average per patient: M = 1.2; C = 1.73) and a higher percent of first-time closures (83 vs 59%; chi2 = 4.26; P = 0.039) . There is a trend toward a lower mortality rate (3.4 vs 13%; chi2 = 2.00; P = 0.158) . We conclude that MAS is a useful adjunct in necrotizing fasciitis wound care protocols. Tijdschr Diergeneeskd, 2001 Feb 1, 126(3), 66 - 71 {Streptococcus gallolyticus infections in racing pigeons, a literature review}; van der Toorn F et al.; S . gallolyticus, formerly known as S . bovis is known since 1988 as a facultative pathogen of racing pigeons . Important clinical signs include acute mortality, inability to fly, lameness, weight loss and slimy green diarrhea . A pathognomonic sign at post mortem examination is the presence of well circumscribed areas of necrosis in the pectoral muscle . Furthermore tenosynovitis of the supracoracoid muscle and arthritis of the knee, shoulder and hock can be observed . In one study S . gallolyticus septicaemia was diagnosed in 10% of necropsied pigeons . Since S . gallolyticus was also isolated from nearly 40% of clinical healthy pigeons it is regarded as a facultative pathogen . Various biotypes, serotypes and culture supernatant phenotypes can be distinguished . Supernatant phenotypes are identified on the basis of the presence of either a T1, T2 or T3 protein triplet and the presence or absence of an extracellular A protein . S . gallolyticus strains with A protein are highly virulent, while strains with only T3 or T2 protein are of moderately or low virulence respectively . Fimbriae are only seen in highly virulent and some of the moderately virulent strains . Possible virulence factors include survival in macrophages, adhesion to cells and toxin production . Infection with serotype 1 and 2 induces some degree of protection against re-infection with serotype 1, which offers perspectives for the development of a vaccine . Experimentally ampicillin, doxycycline and erythromycin have shown therapeutic effects . For the treatment of clinical cases the use of ampicillin is advocated, together with hygienic measures, such as the use of grid floors and avoiding overcrowding. Can J Vet Res, 2001 Jan, 65(1), 68 - 72 Specific detection by PCR of Streptococcus agalactiae in milk; Martinez G et al.; The aim of this study was to develop a simple and specific method for direct detection of Streptococcus agalactiae from cow's milk . The method was based on polymerase chain reaction (PCR) using species-specific and universal primers derived from the 16S rRNA gene . The amplification product was verified by restriction endonuclease digest and sequencing . Specific identification was proven on a collection of 147 S . agalactiae isolates of bovine and human origin . In addition, 17 strains belonging to different bacterial species that potentially can be found in milk samples also tested negative . The PCR developed was used for direct detection of S . agalactiae in milk, using for the first time with gram-positive bacteria the nucleic acid-binding properties of diatomaceous earth . The test, which has high specificity, high sensitivity (100 cfu/mL), and can be carried out in less than 24 h, represents an innovative diagnostic tool for the detection of S . agalactiae in milk. Nippon Rinsho, 2000 Nov, 58(11), 2249 - 54 {Pneumonia and influenza}; Kawakami K et al.; Pneumonia is more frequent in the elderly and results in higher mortality . Primary viral pneumonia is not so common but important in severe cases . Chest X-ray shows grand-glass appearance or linear shadow in pure viral pneumonia cases . That is sometimes specific and clearly different from consolidation or infiltration with bacterial pneumonia . We can try to decrease pneumonia and influenza mortality, if we prevent influenza infections by vaccination and treat by anti-influenza drugs . Secondary bacterial pneumonias are more common, caused by such as Streptococcus pneumonia, Hemophilus influenzae, Branhamella catarrhalis . Gram staining and the culture of purulent sputum was useful for treatment by antibiotics. Int J Clin Pract, 2000 Nov, 54(9), 585 - 8 Oral antimicrobial susceptibilities of Streptococcus pyogenes recently isolated in five countries; Bandak SI et al.; Between July 1998 and July 1999 1050 clinical isolates of Streptococcus pyogenes were collected from 11 study centres in five countries . Isolates were shipped to a co-ordinating laboratory for NCCLS specified broth microdilution susceptibility testing for penicillin, cefaclor, azithromycin, clarithromycin, erythromycin and roxithromycin . All 1050 isolates of S . pyogenes tested were susceptible to penicillin (MIC < or = 0.12 microgram/ml) and cefaclor (MIC < or = 0.25 microgram/ml) . Azithromycin, clarithromycin and erythromycin resistance rates were 15.9%, 15.4% and 15.8%, respectively . MIC90S for penicillin, cefaclor, azithromycin, clarithromycin, erythromycin, and roxithromycin were 0.015, 0.12, > 4, 8, > 1 and 16 micrograms/ml, respectively . Macrolide (erythromycin) resistance rates were highest in study centres in Italy (31.0%) and Spain (26.6%) . Lower macrolide resistance rates were identified in study centres in Turkey (4.8%), France (3.8%), and Sweden (3.7%) . In conclusion, the isolates of S . pyogenes tested were universally susceptible to beta-lactam antibiotics such as penicillin and cefaclor, while resistance to macrolides was significant and ranged from 3.2% to 31%. Infect Dis Obstet Gynecol, 2000, 8(5-6), 220 - 7 Intrauterine infection and spontaneous midgestation abortion: is the spectrum of microorganisms similar to that in preterm labor? McDonald HM, Chambers HM. OBJECTIVE: To determine whether microorganisms associated with intrauterine infection and preterm labor play a contributing role in midgestation abortion . METHODS: A 4 year retrospective review of spontaneous midgestation abortions for which autopsy and microbiological cultures of placental and fetal tissue were performed was conducted for a tertiary obstetrics hospital, which included a regional referral service for perinatal and fetal pathology . One hundred twenty-nine spontaneously delivered, nonmacerated, midgestation fetuses or stillbirths (of between 16 and 26 weeks' gestation) and placentas were examined and cultured for aerobic and anaerobic bacteria, yeasts, and genital mycoplasmas . RESULTS: Microorganisms were recovered in 85 (66%) cases (57% placentas, 49% fetuses) . Among the culture positive cases, 81% had histological chorioamnionitis, 28% fetal pneumonitis, 38% clinical signs of infection, and 62% ruptured membranes at the time of miscarriage . These differed significantly from culture-negative cases (44%, 5%, 13%, and 34%, respectively) . Group B streptococcus (GBS) was the most significant pathogen, recovered in 21 cases, 13 as the sole isolate, 94% with chorioamnionitis, and 47% in women with intact membranes . Escherichia coli and Ureaplasma urealyticum (22 and 24 cases, respectively) occurred mostly as mixed infections, with ruptured membranes . GBS, MU urealyticum, and Streptococcus anginosus group were individually associated with chorioamnionitis, Bacteroides/Prevotella and S . anginosus with fetal pneumonitis . The spectrum of microorganisms was similar to that in preterm labor at later gestations; however, GBS appeared to be the most significant pathogen in midgestation miscarriage, especially with intact membranes . CONCLUSIONS: Unsuspected intrauterine infection underlies many spontaneous midgestation abortions . GBS is a key pathogen in this setting. Pediatr Infect Dis J, 2001 Feb, 20(2), 218 - 9 Dichloroacetate treatment for severe refractory metabolic acidosis during neonatal sepsis; Arnon S et al.; We describe a preterm neonate with documented group B Streptococcus sepsis and associated metabolic acidosis whose lactic acidemia was refractory to conventional sodium bicarbonate therapy but responded well to dichloroacetate treatment. Epidemiol Infect, 2000 Dec, 125(3), 573 - 81 The prevalence and clonal diversity of penicillin-resistant Streptococcus pneumoniae in Kuwait; Ahmed K et al.; Penicillin-resistant Streptococcus pneumoniae (PRSP) is widespread all over the world, including countries previously free of PRSP . This study was undertaken to determine the prevalence, the common serotypes and the clonality of PRSP isolated over a period of 1 year, from various clinical samp