Hepatology, 1992 Sep, 16(3), 664 - 70 Increased spontaneous and lymphokine-conditioned IgA and IgG synthesis by B cells from alcoholic cirrhotic patients; Giron JA et al.; Immunoglobulin secretion by B lymphocytes is a complex process in which lymphokines secreted by T lymphocytes play an important regulatory role . Increased serum levels of IgA and IgG have been characteristically detected in patients with alcoholic cirrhosis . We have studied the functional alterations of T and B lymphocytes implicated in the physiopathology of this common immunoglobulin abnormality . After activation with phytohemagglutinin, purified T cells from alcoholic cirrhotic patients showed significantly enhanced secretion of B-cell differentiation factors for IgG and IgA with respect to those secreted by T cells from healthy controls (p less than 0.05) . Simultaneously, normal secretion of B-cell differentiation factor for IgM was demonstrated in T lymphocytes from these patients . The pattern of secretion of the lymphokines involved in the regulation of the B-cell differentiation pathway found in alcoholic cirrhotic patients was different from that of the primary biliary cirrhotic patients studied . Purified B cells from patients with alcoholic cirrhosis secreted significantly higher amounts of IgA and IgG than did those found in healthy controls, both spontaneously (p less than 0.05) and after sequential activation with immunoglobulin ligands (Staphylococcus aureus Cowan I) and a standard B-cell differentiation factor preparation (p less than 0.05) . By contrast, the IgM secretion and regulatory pathway were normal in alcoholic cirrhotic patients . These results support a physiopathological explanation for the characteristic hyperimmunoglobulinemia found in patients with alcoholic cirrhosis. Ann Intern Med, 1992 Sep 1, 117(5), 390 - 8 Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection; Markowitz N et al.; OBJECTIVE: To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections . DESIGN: Randomized, double-blind comparative trial . SETTING: A tertiary-care hospital . PATIENTS: One hundred and one intravenous drug users hospitalized with S . aureus infection . MEASUREMENTS: Cure and failure rates; blood and wound cultures; minimum inhibitory and bactericidal concentrations; serum inhibitory and bactericidal titers; temperature; leukocyte count; durations of treatment and hospitalization; and toxicity . RESULTS: Of 228 intravenous drug users, 101 had S . aureus infection and were included in the efficacy analysis (43 received TMP-SMZ and 58 received vancomycin) . Methicillin-resistant S . aureus (MRSA) accounted for 47% of S . aureus isolates, and 65% of patients were bacteremic . Infections were cured in 57 of 58 vancomycin recipients and in 37 of 43 TMP-SMZ recipients (P less than 0.02) . Failure occurred mostly in patients with tricuspid valve endocarditis and only in those with infection caused by methicillin-sensitive S . aureus (MSSA) . The mean duration of bacteremia was 6.7 days in TMP-SMZ recipients and 4.3 days in vancomycin recipients . Among 222 subjects hospitalized for at least 24 hours, toxicity rates were similar for TMP-SMZ (23%) and vancomycin (20%) recipients; nausea and vomiting were associated with TMP-SMZ and inflammation at the intravenous site was associated with vancomycin . Forty-four percent of TMP-SMZ recipients and 29% of vancomycin recipients experienced side effects in the efficacy cohort (P greater than 0.05) . CONCLUSIONS: Vancomycin is superior to TMP-SMZ in efficacy and safety when treating intravenous drug users who have staphylococcal infections . However, all treatment failures occurred in patients with MSSA infection at any site . Therefore, TMP-SMZ may be considered as an alternative to vancomycin in selected cases of MRSA infection. J Virol, 1992 Sep, 66(9), 5347 - 56 Proteolytic cleavage of the reovirus sigma 3 protein results in enhanced double-stranded RNA-binding activity: identification of a repeated basic amino acid motif within the C-terminal binding region; Miller JE et al.; The reovirus capsid protein sigma 3 was examined for double-stranded RNA (dsRNA)-binding activity by Northwestern (RNA-protein) blot analysis . Treatment of virion-derived sigma 3 protein with Staphylococcus aureus V8 protease led to an increase in the dsRNA-binding activity associated with the C-terminal fragment of the protein . Recombinant C-terminal fragments of the sigma 3 protein were expressed in Escherichia coli from the S4 cDNA of reovirus serotype 1 . These truncated sigma 3 proteins displayed proteolytic processing and dsRNA-binding activity similar to those observed for native, virion-derived sigma 3 protein as measured by Northwestern blot analysis . Construction of a modified pET3c vector, pET3Exo, allowed the production of 3'-terminal deletions of the S4 cDNA by using exonuclease III and rapid screening of the induced truncated sigma 3 proteins . An 85-amino-acid domain within the C-terminal portion of the sigma 3 protein which was responsible for dsRNA-binding activity was identified . The 85-amino-acid domain possessed a repeated basic amino acid motif which was conserved in all three serotypes of reovirus . Deletion of one of the basic motifs, predicted to be an amphipathic alpha-helix, destroyed dsRNA-binding activity. Kardiol Pol, 1992 Sep, 37(9), 152 - 5 {Surgical treatment of bacterial endocarditis of the tricuspid valve}; Rozycka-Chrzanowska B et al.; We present a rare case of bacterial endocarditis of tricuspid valve caused by temporary intracardiac pacing . The 48-year old male patient developed complete a-v block during the 1st day of acute inferior myocardial infarction . Intracardiac electrode was inserted for temporary pacing . After 4 days signs of bacterial endocarditis developed . Patient was markedly febrile, moderate tachycardia with gallop rhythm and systolic murmur of tricuspid valve insufficiency were present . Dullness to percussion was audible at the base of right lung . Hepato- and splenomegaly appeared during the second month of hospitalization . Laboratory tests revealed: elevated ESR, leukocytosis with a shift to the left, several blood cultures were positive to Staphylococcus aureus . On repeated chest X-ray patchy infiltrates with thin-walled translucent pools were visible . Transthoracic and transoesophageal++ echocardiography provided more precise informations . Bacterial vegetations were visualised on the tricuspid valve . Coronary angiography revealed proximal occlusion of the right coronary artery and 75-80% stenosis of the left circumflex artery . Antibacterial treatment guided by blood cultures was begun: vancomycin combined with netilmycin, then tienamycin and diflucan--after 10 weeks treatment was decided to be unsuccessful and the decision about surgical treatment was made . In extracorporeal circulation posterior left leaflet together with granular bacterial growths was excised . Septal and anterior leaflets were found normal . Cultures made of excised tissue were positive for Staphylococcus aureus and subsequent treatment with fluoroquinolones gave satisfactory result . Postoperative echocardiography revealed only small tricuspid valve insufficiency . Coronary by-pass surgery was performed later because of the high risk of simultaneous operation.(ABSTRACT TRUNCATED AT 250 WORDS) Indian J Med Res, 1992 Sep, 95, 234 - 8 Role of bacterial flora in the pathogenesis & management of atopic dermatitis; Dhar S et al.; The carriage state of Staphylococcus aureus and its role in the pathogenesis and management of atopic dermatitis were evaluated in 50 patients, aged 3 months to 12 yr . An equal number of age and sex matched controls were also studied . The positivity of Staph.aureus in patients with atopic dermatitis was 50 per cent from eczematous skin, 34 per cent from anterior nares and 26 per cent from normal skin . In controls, the comparative figures were 14 per cent from anterior nares and 10 per cent from normal skin . After institution of oral erythromycin or cloxacillin therapy (according to sensitivity), the colony counts dropped to 18 per cent from eczematous skin, 14 per cent from anterior nares and 8 per cent from normal skin after one week and to zero after 3 wk . This was associated with significant clinical improvement . The results of this study suggest that Staph . aureus aggravates the eczematous process in patients with atopic dermatitis and antibiotics decrease the severity and are useful in long term prognosis of the disease. Am J Forensic Med Pathol, 1992 Sep, 13(3), 233 - 7 Fatal hemothorax from mycotic celiac artery aneurysm; Carrel D et al.; We present two cases of ruptured mycotic aneurysms infected with Staphylococcus aureus . Each patient had hemoptysis and in each case there was hemothorax caused by a ruptured mycotic aneurysm of the celiac artery . In case 1, the pathogenesis was transient Staphylococcus aureus septicemia infecting an atherosclerotic plaque with subsequent aneurysm formation and rupture . In case 2, the septicemia arose from an infected knee . The presentation of a celiac artery aneurysm as hemoptysis and as the cause of hemothorax is rare. Nippon Geka Gakkai Zasshi, 1992 Sep, 93(9), 914 - 7 {Rapid detection of mecA gene by nested PCR for diagnosis of methicillin resistance in Staphylococcus aureus}; Kitagawa Y et al.; In recent years, the most common causative organism of hospital infections has been methicillin resistant Staphylococcus aureus (MRSA) . The major mechanism of beta-lactam resistance in MRSA is attributed to the production of a specific penicillin binding protein (PBP2'), which is a product of mecA gene, with extremely low binding affinities to beta-lactams . In the present study, we have established a rapid identification method of MRSA by sensitive detection of mecA gene using nested PCR . Nested PCR method amplifying the target DNA in two steps enhanced the efficiency of the second round amplification . By means of this method, mecA gene was successfully detected in clinical samples, such as blood, pus, sputum and feces within 3-4 hrs . Rapid diagnosis of MRSA-bacteremia is particularly important for prevention of sever systemic infection . There are some strains of S . aureus which possess mecA gene in spite of low minimal inhibitory concentration of DMPPC . In these strains expression of mecA gene is induced by contact of beta-lactams and they obtain methicillin resistance . Using nested PCR method, these latent MRSA are rapidly and certainly detectable . This method should be useful for early and effective detection of MRSA hospital infections. Nippon Geka Gakkai Zasshi, 1992 Sep, 93(9), 902 - 5 {Prevention and treatment of MRSA infection in emergency surgical ward}; Mochizuki H et al.; During two years of 1990 and 1991, methicillin-resistant Staphylococcus aureus (MRSA) strains were isolated from 121 patients who were admitted to our emergency ward with infection rate of 7% (121/1843) . The end results were miserable and the mortality rate was 28% . The infection rate was significantly higher than that of general surgical ward (2%) . Specimens of respiratory tract such as coughed-up sputum and tracheal secretion showed high rate of MRSA isolation, especially in patients who underwent tracheal intubation or tracheostomy . All of these MRSA strains were strongly resistant to antibiotics and were typed as coagulase II . MRSA strains were isolated from nostril of medical staff and in-ward patients while admission with rate of 9% and 3%, respectively . Meanwhile, the MRSA strains were also isolated from the materials surrounding the infected patients such as bed, door, gowns and hands of in-charge nurses . To prevent inter-patient transmission, the infected patients were placed in isolation room and cared with isolation technique . Handwashing with benzalkonium chloride-alcohol is strongly recommended . Intravenous injection of IPM and CEZ or VCM is indicated . Local use of MINO was reported to be useful . In conclusion, MRSA infection often occurs in the immunodepressive patients and is hard to cure. Nippon Geka Gakkai Zasshi, 1992 Sep, 93(9), 895 - 7 {Postoperative infection with methicillin-resistant Staphylococcus aureus and its control measures in patients with esophageal cancer--prediction of high risk patients}; Saito T et al.; Whether or not compromised host defense prior to surgical treatment is related to development of infection with methicillin-resistant staphylococcus aureus (MRSA) following major surgery was examined . Of 22 patients undergoing esophagectomy for cancer between 1989 and 1990, 5 were free from MRSA colonization and infection (group I) while 8 had MRSA colonization without infection (group II) and 9 had MRSA infection (group III) . Levels of neutrophil cytocidal functions, complements, immunoglobulins and cell-mediated immunity were not significantly different among these three groups . The mean of anti pneumococcal polysaccharide (PPS)-IgG was significantly lower in group III than in group I (p < 0.05) and tended to be lower than in group II (P = 0.08) . All infected patients showed a titer < 600 EU while all but one non-infected patient did so > 600 EU . Serum IgG2 levels positively correlated with anti-PSS IgG levels . Thus, we concluded that a preoperative evaluation of antibody response against polysaccharides and serum IgG2 levels can serve to predict development of MRSA-related infection following esophageal surgery. Nippon Geka Gakkai Zasshi, 1992 Sep, 93(9), 891 - 4 {Infection of methicillin resistant Staphylococcus aureus (MRSA) in patients with cardiovascular operations: four years' clinical analysis of the effect of strategy of prophylactic and treatment}; Kaneko M et al.; To evaluate the effect of strategy to reduce the rate and outcome of MRSA infection, 940 patients with cardiovascular operations from 1988 to 1991 were analyzed in aspect of the infection rate and outcome per year . Prophylactics and treatments which have been done during recent four years were) to use the inhalation of vancomycin for MRSA carriers, to quit the intravenous administration of prophylactic antibiotics on third postoperative day, to limit medical staffs to treat the patient with MRSA infection, to choose the most susceptible combination of two antibiotics for MRSA in each patients by periodical checking of bacterial cultures . The percentages of patients with infection to all patients detected with MRSA per year were decreased from 80% in 1988, to 66% in 1989, 31% in 1990, and 30% in 1991 . The numbers of patients who died from MRSA infection were 4 in 1988 and only one in 1989 and 1991 . MRSA infection in cardiovascular surgery could be reduced by sophisticated methods of prophylactics and treatments. Clin Rheumatol, 1992 Sep, 11(3), 424 - 6 Bacterial pyomyositis in a patient with a multiple myeloma; Prallet B et al.; Pyomyositis is relatively rare in regions with a temperate climate . The most common aetiologic agent is staphylococcus aureus . Most patients with pyomyositis from temperate regions involve immunocompromised states . Because of the rarity, it is often initially misdiagnosed . Computed tomography scan is considered the most helpful tool for the diagnosis of pyomyositis . We present a case in a patient with multiple myeloma. Clin Rheumatol, 1992 Sep, 11(3), 351 - 5 Bacterial arthritis in a district hospital; Peters RH et al.; Between 1977 and 1988 in the Enschede hospital 72 patients were seen with bacterial arthritis of one or more joints . Staphylococcus aureus was most frequently the causative agent (52%) and the knee was the most frequently infected joint (42%); the mortality rate was 11% . Complete restoration of pre-existent function was seen in 52% of the affected joints . In patients with severe deterioration of joint function after the bacterial infection, the period between the first symptoms and start of treatment (mean 30 days) was significantly longer than in patients with no or moderately deteriorated joint function (mean 10 days) . The primary focus was mostly a skin infection, predominantly localized on the lower extremities . Half of all cases of bacterial arthritis occurred in patients with rheumatoid arthritis (RA) . We therefore conclude that patients with RA and skin infections, especially if localized on legs or feet, should be treated without delay and that one should not hesitate to prescribe antibiotics . Erythrocyte sedimentation rate (ESR) was less than 20 mm after one hour in 13% and blood leucocyte count less than 10 x 10(9)/liter in 55% of all patients, showing that a normal ESR and/or blood leucocyte count do not exclude bacterial arthritis . In 4 out of 9 patients with infected prosthetic joints the infection resulted in loosening of the joint, before antibiotic treatment was started . In the other 5 patients bacterial arthritis recurred, in one patient resulting in loosening of the joint, only shortly after stopping long-term successful antibiotic treatment (6-24 months) . Thus, we feel that lifelong treatment with antibiotics is a reasonable alternative in cases, where the risk of surgery is very high. J Antimicrob Chemother, 1992 Sep, 30(3), 327 - 37 In-vitro and in-vivo evaluation of the antistaphylococcal activity of S-5556, a new 16-membered macrolide; Chuard C et al.; During recent years, a resurgence of interest in the macrolides had led to the discovery of new derivatives of erythromycin with improved antibacterial activity and pharmacokinetic properties . In this study the in-vitro and in-vivo antistaphylococcal activity of S-5556, a 16-membered macrolide, was evaluated . In vitro, S-5556 was slightly less active than erythromycin against methicillin-susceptible Staphylococcus aureus . In contrast, it had superior activity for methicillin-resistant S . aureus (MRSA); several of these strains with inducible resistance to the macrolides-lincosamides-streptogramins group were susceptible to S-5556 whereas erythromycin was inactive . The combination of S-5556 with oxacillin was synergic for most MRSA strains tested . In vivo, a single prophylactic dose of S-5556 prevented 75%-100% of the cases of acute staphylococcal subcutaneous foreign body infection in a guinea pig-model . In a rat-model of chronic implant infection due to a methicillin- and erythromycin-resistant S . aureus strain, S-5556 significantly decreased the bacterial concentration around the foreign material, however resistant mutants emerged. Mol Biother, 1992 Sep, 4(3), 151 - 4 Recombinant interleukin-2 significantly increases the survival of mice with peritonitis, but not acute Staphylococcus aureus peritoneal infection; Shadrin OV et al.; The effect of recombinant interleukin 2 (rIL-2) on survival of mice with peritonitis and acute Staphylococcus aureus strain 5/2 infection was studied . rIL-2 was ineffective in the case of acute infection when administered simultaneously with LD95 dose of bacteria . The antibiotics (gentamycin or a combination of penicillin and streptomycin) administered in the same fashion cured 100% of animals . rIL-2 proved to be a potent healing agent in the two of three models of S aureus peritonitis . In this case animals received bacteria at days 0 and 2, 4, or 6 . rIL-2 was injected at day 0 (group 1), days 0 and 2 (group 2), and days 0, 2, and 4 (group 3) . Treatment with rIL-2 was ineffective in group 1; however, in groups 2 and 3 rIL-2 increased the survival up to 90% (in comparison with 30% in the untreated animals of group 2 and 64% in group 3) . On the contrary, administration of antibiotics instead of rIL-2 in the group 3 decreased survival to 25% . The perspectives of rIL-2 use in the treatment of bacterial peritonitis, including purous ones, and the cases complicated by immunodepression, are discussed. Appl Environ Microbiol, 1992 Sep, 58(9), 2815 - 9 Quantitative spectrophotometric assay for staphylococcal lipase; Smeltzer MS et al.; We report the development of a specific spectrophotometric assay for the quantitative determination of lipase activity in Staphylococcus aureus . The assay is based on the rate of clearance of a tributyrin emulsion, and it can detect as little as 1.0 micrograms of purified Pseudomonas lipase per ml . By comparison with the reaction rates obtained with Pseudomonas lipase, we calculated that S . aureus PS54C and S6C produce approximately 15 and 60 micrograms of extracellular lipase per ml, respectively . Neither PS54, which is lysogenized with the converting bacteriophage L54a and is consequently lipase negative (Lip-), nor KS1905, a Lip- transpositional mutant of strain S6C, was positive in our spectrophotometric assay . The specificity of the spectrophotometric tributyrin assay was confirmed with a triolein plate assay; supernatants from S6C and PS54C hydrolyzed triolein, while supernatants from PS54 and KSI905 did not . In contrast to the results of the spectrophotometric tributyrin assay, all enzyme preparations tested (including commercially purified esterase) were positive when examined by a tributyrin plate assay . The lack of specificity in the tributyrin plate assay emphasizes the need to interpret the results of tributyrin lipolysis kinetically for assessing lipase activity in S . aureus. Protein Eng, 1992 Sep, 5(6), 577 - 82 pH-sensitive interactions between IgG and a mutated IgG-binding protein based upon two B domains of protein A from Staphylococcus aureus; Gore MG et al.; A fusion protein, consisting of the N-terminal 81 amino acids from an inactive bovine DNase I (Q38,E39-E38,Q39) and two sequential synthetic IgG-binding domains based upon domain B of Protein A from Staphylococcus aureus has been shown to bind to porcine IgG with a similar affinity and pH profile to Protein A . The same residue in each B domain (Tyr111 and Tyr169) has been mutated by cassette mutagenesis to Ser, Glu, His, Lys or Arg and the effect of the mutation on binding interactions with porcine IgG investigated . The evidence presented suggests that the interactions at the B domain are highly sensitive to the presence of a charged residue. JPEN J Parenter Enteral Nutr, 1992 Sep-Oct, 16(5), 455 - 9 Long-term central venous access vs other home therapies: complications in patients with acquired immunodeficiency syndrome; Mukau L et al.; One hundred and forty silicone catheters were inserted in 127 patients for long-term intravenous access with a cumulative follow-up time of 21,125 catheter-days (58 patient-years) . Fifty-six patients had acquired immunodeficiency syndrome (AIDS); 44 were not AIDS patients and were receiving ambulatory home parenteral nutrition, whereas the remaining 27 did not have AIDS and were receiving home antibiotic therapy . Patients had a mean of 1.1 catheters inserted, and the rate of Hickman catheter-related sepsis was 0.18 per 100 catheter days or 0.6 septic episodes per patient year of treatment . Catheter-related sepsis was higher in AIDS patients (p < .01) and in patients receiving parenteral nutrition (p < .05) compared with those receiving antibiotic therapy . Prior catheter infection and AIDS were the most significant predictors of catheter infection (p < .01) . Staphylococcus aureus was the most commonly isolated pathogen (61%) in AIDS patients . Fever (p < .001) and relative leukocytosis (p < .02) were the most common signs of infection . Only 14 infected catheters (37.8%) were salvaged by antibiotic therapy after the initial infection episode, and 6 of these catheters (42.9%) had recurrent multiple infections . In addition, inflammatory bowel disease was found to be a risk factor for venous thrombosis (p = .018) . We conclude that because immunocompromised patients have a high risk of infection, catheter-related sepsis in these patients should be treated by catheter removal and antibiotics. J Antibiot (Tokyo), 1992 Sep, 45(9), 1533 - 9 Studies on cephalosporin antibiotics . VI . Synthesis, antibacterial activity and oral efficacy in mice of new 7 beta-{(Z)-2-(2-aminothiazol-4-yl)-2-(hydroxyimino)-acetamido}-3- (substituted alkylthio)cephalosporins; Yokoo C et al.; A series of new 7 beta-{(Z)-2-(2-aminothiazol-4-yl)-2-(hydroxyimino)acetamido} cephalosporins (1) having various substituted alkylthio groups at the C-3 position of the cephem nucleus were prepared and evaluated for antibacterial activity and oral absorption in rats . Of these, the cephalosporin with a cyanomethylthio group (1a) showed the greatest activity against Staphylococcus aureus and Gram-negative bacteria . Its pivaloyloxymethyl ester (6a), a representative prodrug, exhibited good in vivo efficacy in mice by oral administration . The structure-activity relationships of 1 are also presented. J Dermatol Sci, 1992 Sep, 4(2), 87 - 94 Role of fibronectin in the adherence of Staphylococcus aureus to dermal tissues; Kanzaki H et al.; Staphylococcus aureus has a fibronectin receptor on its surface . Fibronectin seems to play a role in the initiation and modification of infection with S . aureus . We studied the role of fibronectin in the binding of S . aureus (clinical isolates) to dermal tissues in mice, and the relationship between the fibronectin binding ability of S . aureus and clinical features of S . aureus skin infections . Mice were inoculated with S . aureus incubated with gold-particles bound fibronectin and skin specimens were taken for electron microscopic examination . The number of gold particles surrounding the S . aureus cells decreased with time, with none detected 4 h after inoculation . At both 5 min and 1 h after inoculation, gold particles were only found on the free surface of S . aureus cells and not in the interface between S . aureus cells and fibroblasts . Fibronectin-bound gold particles were bound more extensively to S . aureus strains isolated from furunculosis or furuncle than to those from bullous impetigo . These results suggest that the matrix fibronectin on the surface of the fibroblasts of mice contributes to the adherence of S . aureus to the fibroblasts, and that the number of fibronectin binding sites on S . aureus cells is related to the degree of local invasiveness. FEMS Microbiol Immunol, 1992 Sep, 5(1-3), 5 - 12 Oligomer formation of staphylococcal alpha-toxin analyzed by electron microscopy and image processing; Hebert H et al.; The 12S oligomeric form of Staphylococcus aureus alpha-toxin has been studied with electron microscopy after incubation of the toxin with membrane preparations or liposomes . The target material originated from human platelets . Different electron microscopic preparation techniques were used including negative staining, freeze-fracture and vitrification in liquid ethane . Analysis of micrographs with image processing methods revealed two groups of ring-like structures corresponding to alpha-toxin oligomers . One form measured 75 A in diameter and had a high stain density in the central protein deficient part while the other was larger with a diameter of 100 A and less stain accumulation in the center . The conditions under which the latter were formed suggest that this corresponds to an inactive loosely-bound form of the toxin . The high stain density in the smaller particle is consistent with the presence of a penetrating pore in this structure. Am J Vet Res, 1992 Sep, 53(9), 1530 - 3 Influence of conditioned media from bovine cotyledon tissue cultures on function of bovine neutrophils; Hoedemaker M et al.; Bovine fetal placental (cotyledon) tissue obtained from pregnant cows on days 255, 265, and 275 of gestation, as well as immediately after parturition (n = 5) was incubated in media for 48 hours, and the incubation media were collected . Neutrophils from 4 ovariectomized nonpregnant cows were incubated for 2 hours with conditioned media from placental tissue cultures or medium (control) . Immediately after incubation, the neutrophils were subjected to the following leukocyte function assays: chemotaxis against zymosan-activated serum, chemotaxis against undiluted conditioned media (only neutrophils that were incubated in medium only), random migration, ingestion of 125I-iododeoxyuridine Staphylococcus aureus (125I-IdUR-S aureus), iodination of proteins, cytochrome C reduction, and antibody-independent and -dependent cell-mediated cytotoxicity . Conditioned media from cultured cotyledon tissue was chemoattractant for bovine neutrophils, and increased chemotactic response of neutrophils against zymosan-activated serum by 13% . The following neutrophil functions were decreased: random migration by 25%, iodination of proteins by 44%, cytochrome C reduction by 13%, and antibody-dependent cell-mediated cytotoxicity by 5% . Ingestion of 125I-IdUR-S aureus and antibody-independent cell-mediated cytotoxicity were not influenced by coincubation of neutrophils and conditioned media . Time of gestation did not alter the effects of conditioned media on neutrophil function . It was concluded that chemotactic properties of cotyledon tissue extracts, as has been reported earlier, may be attributable to substances released by fetal placental tissue . Those substances might also locally or systemically influence the oxygen-dependent antimicrobial system of neutrophils, thereby causing an increased susceptibility to bacterial infections in the peripartum period. Am J Vet Res, 1992 Sep, 53(9), 1524 - 9 Function of neutrophils and chemoattractant properties of fetal placental tissue during the last month of pregnancy in cows; Hoedemaker M et al.; Neutrophils were isolated from the blood of pregnant cows on days 255, 265, and 275 of pregnancy, and on the day of parturition (n = 5/group), and in addition, simultaneously from 4 ovariectomized healthy cows (control animals) . Neutrophils were subjected to neutrophil function assays (chemotaxis against zymosan-activated serum, random migration, ingestion of 125I-iododeoxyuridine {IdUR}-labeled Staphylococcus aureus, iodination of proteins, cytochrome C reduction, antibody-independent and antibody-dependent cell-mediated cytotoxicity) . Results were expressed as percentage of control animals . Fetal placental tissue (cotyledon), uterine wall tissue, and skeletal muscle were obtained from the principal animals on the aforementioned days via laparotomy, and tissue suspensions were prepared . Chemotaxis of neutrophils was tested against tissue supernatants . Compared with day 255, there was an increase in ingestion of 125I-IdUR-S aureus at parturition, whereas iodination of proteins and cytochrome C reduction were reduced on the day of calving . The other neutrophil functions tested did not change over time of gestation . Fetal placental and uterine wall tissue attracted neutrophils with uterine wall tissue having a tendency to be more potent than cotyledonary tissue . Skeletal muscle tissue did not attract neutrophils . There was no change in chemotaxis response of neutrophils evoked by intrauterine and uterine tissues over time of gestation . It was concluded that at parturition, neutrophil function is impaired with respect to their bactericidal effects, which may render the animal more susceptible to bacterial infections, and that the chemoattractant properties of fetal placental and uterine wall tissues are tissue-specific, at least when compared with skeletal muscle.(ABSTRACT TRUNCATED AT 250 WORDS) Vet Surg, 1992 Sep-Oct, 21(5), 367 - 73 Regional limb perfusion for antibiotic treatment of experimentally induced septic arthritis; Whithair KJ et al.; Septic arthritis was induced in one antebrachiocarpal joint of seven horses by the intra-articular injection of 1 mL Staphylococcus aureus suspension containing a mean of 10(5) colony-forming units . Twenty-four hours after inoculation, four horses were treated by regional perfusion with 1 g of gentamicin sulfate, and three horses received 2.2 mg/kg gentamicin sulfate intravenously (IV) every 6 hours . Synovial fluid was collected for culture and cytology at regular intervals, and the synovial membranes were collected for culture and histologic examination at euthanasia 24 hours after the first treatment . Gentamicin concentration in the septic synovial fluid after three successful perfusions was 221.2 +/- 71.4 (SD) micrograms/mL; after gentamicin IV, it was 7.6 +/- 1.6 (SD) micrograms/mL . The mean leukocyte count in the inoculated joints decreased significantly by hour 24 in the successfully perfused joints . Terminal bacterial cultures of synovial fluid and synovial membranes were negative in two horses with successfully perfused joints . S . aureus was isolated from the infected joints in all three horses treated with gentamicin IV. Otolaryngol Head Neck Surg, 1992 Sep, 107(3), 434 - 7 Community-acquired methicillin-resistant Staphylococcus aureus infections in otolaryngology; Gottlieb RD et al.; Soon after the introduction of methicillin, strains of Staphylococcus aureus resistant to methicillin were reported . Methicillin-resistant Staphylococcus aureus (MRSA) has become a common hospital pathogen, often resistant to multiple antibiotics, while causing significant morbidity and mortality . Community-acquired MRSA infections have been infrequently documented . Most reports have been associated with intravenous drug abuse . This report reviews 15 patients with community-acquired MRSA infections of the head and neck . None admitted to intravenous drug use . Additionally, no patient was known to be a healthcare worker . The MRSA strains showed antibiotic susceptibility and resistance profiles different from typical hospital-acquired MRSA isolates . All but one infection resolved with adequate surgical or appropriate antibiotic therapy . Clinicians should become aware of the possibility of community-acquired MRSA in the patient who has had continued infection despite antibiotic therapy. Nippon Kyobu Geka Gakkai Zasshi, 1992 Sep, 40(9), 1759 - 63 {A case of infective endocarditis with multiple embolic complications}; Sakata K et al.; A 13-year-old girl was admitted to a hospital because of fever and sore throat . Staphylococcus aureus was obtained on blood culture, and she was treated with antibiotics under the diagnosis of sepsis and DIC . Echocardiography showed huge vegetation attached to the posterior leaflet of mitral valve and severe mitral regurgitation . CT scan revealed multiple heterogeneous high density areas in her brain . She was transferred to our hospital for further examination and treatment . Large verrucae on the mitral valve, severe regurgitation and repeated embolism urged us to the emergency mitral valve replacement . Debridement of abscess on the posterior wall of the left atrium and ventricle necessitated patch plasty of those structures and mitral ring as well . Operative and postoperative examination showed mycotic aneurysm of right coronary artery, multiple brain hemorrhage, arterial obstructions of extremities and splenic infarction . Sooner she recovered except for slight macular degeneration caused by retinal embolism. J Invertebr Pathol, 1992 Sep, 60(2), 113 - 6 Processing of structural polypeptides of infectious flacherie virus of the silkworm, Bombyx mori: VP1 and VP4 are derived from VP0; Choi HK et al.; Infectious flacherie virus of the silkworm, Bombyx mori, contains five major polypeptides termed VP0, VP1, VP2, VP3, and VP4 in the order of descending molecular weight . Immunoblot analysis with specific antisera against each of these structural polypeptides showed that antisera against VP1 and VP4 unequivocally reacted with VP0 as well as their homologous structural polypeptides . Limited proteolysis of VP0 and VP1 by Staphylococcus aureus V8 protease gave several common polypeptide fragments . Amino acid sequence analysis showed that VP0 and VP4 shared a common NH2-terminal amino acid sequence . These results indicate that VP1 and VP4 are generated from VP0 and that VP4 occupies the NH2-terminal portion of VP0. J Clin Pathol, 1992 Sep, 45(9), 799 - 801 Lethal synergistic action of toxins of bacteria isolated from sudden infant death syndrome; Drucker DB et al.; AIM: To test the hypothesis that lethal toxins of bacteria associated with sudden infant death syndrome (SIDS) can act synergistically . METHODS: Bacteria occurring together in the nasopharynx of cases of cot death were studied . The lethal toxicity of crude toxin preparations was determined over a range of dilutions by injections into the chorioallantoic vein of the chick embryo . Toxin preparations of low lethality for the chick embryo SIDS model were then tested in combination . RESULTS: Staphylococcus aureus toxin preparations showed low lethality when tested alone, even at low dilution . At 1 in 100 dilution S aureus toxin was lethal to one out of 15 chick embryos . Escherichia coli toxin preparations showed high lethality except on high dilution (1 in 80) when lethality fell to two out of 15 of chick embryos . When the same toxin preparations were tested simultaneously in combination, lethality rose to 14 out of 15 . Similar findings were observed over a range of toxin dilutions . This finding was highly significant (p = 0.0012) . CONCLUSIONS: That synergy between toxins can enhance the lethality of toxins elaborated by bacteria associated with SIDS. Eur J Vasc Surg, 1992 Sep, 6(5), 494 - 8 Wound infection after arterial surgical procedures; van Himbeeck FJ et al.; During the period October 1983 to March 1987, 603 patients who underwent arterial surgical procedures were studied to determine the incidence and treatment of wound infections . Bypass procedures were performed in 395 patients (65.5%), in which autogenous vein was used for 158 grafts (26%), synthetic Dacron for 216 grafts (36%), and umbilical vein for 21 grafts (3.5%) . Thrombo-endarterectomies, embolectomies and patch-grafts were performed in 208 patients (34.5%) . An Infection Control Nurse examined and registered the wounds . The definition of wound infection used in our study is equivalent to Szilagyi grade II infection . Vascular surgery is classified as clean surgery, the clean wound infection rate being a useful measurement to evaluate preventative measures and surgical technique . Thirty-one patients (5.1%) developed a wound infection as a postoperative complication . The overall incidence of wound complications including haematoma and seroma following arterial reconstruction was 13% . The site of wound infection was predominantly the groin . The most common pathogen was Staphylococcus aureus which was found in 17 patients (2.8%) . All infections resolved without further surgical intervention . The influence of possible aetiological factors is considered and the importance of prophylactic antibiotics and good surgical technique is stressed. FEMS Microbiol Immunol, 1992 Sep, 5(1-3), 19 - 28 Structural features of the pore formed by Staphylococcus aureus alpha-toxin inferred from chemical modification and primary structure analysis; Menestrina G et al.; Staphylococcus aureus alpha-toxin makes cells and model membranes permeable to ions and uncharged molecules by opening oligomeric pores of uniform size . Its primary sequence reveals peculiar features which give some hints on the structure of the pore . A flexible region separating the toxin into two halves, several amphiphilic beta-strands and two amphiphilic alpha-helices long enough to span the hydrophobic core of the lipid bilayer are predicted . In analogy to bacterial porins, we propose that the inner walls of the pore are, at least in part, built by an amphiphilic beta-barrel . The model is consistent with circular dichroism data and with the electrophysiological properties of the pore . Functional information on this toxin were obtained by chemical modification of its four histidine residues . Specific carbethoxylation suggested they have different roles: one is required for specific receptor binding, one for oligomerisation and two for unspecific lipid binding . A tentative assignment of each histidine to its specific role is done on the basis of the structural predictions . A functionally related hemolysin, Aeromonas hydrophyla aerolysin, reveals remarkably similar features including the presence and location of histidines involved in receptor binding and oligomerisation. Immunology, 1992 Sep, 77(1), 19 - 24 Lymphokine secretion and proliferation of intraepithelial lymphocytes from murine small intestine; Viney JL et al.; Compared to other peripheral lymphocytes, intestinal intraepithelial lymphocytes (IEL) have previously been shown to have low proliferative capabilities . However, there are two main populations of IEL in the small intestine of mice . First, there is the thymus-dependent CD3+,Thy-1+ population, most of which expresses the alpha beta T-cell receptor (TcR), and second there is the thymus-independent CD3+,Thy-1- population, most of which expresses the gamma delta TcR . In this study Thy-1-enriched and Thy-1-depleted lymphocytes from murine intestinal epithelium were studied separately for their ability to proliferate and secrete lymphokines in vitro after mitogenic stimulation, after stimulation via the TcR-CD3 complex and after stimulation with the superantigen Staphylococcus aureus B (SEB) . Here we show that Thy-1-enriched IEL are not an immunocompromised population of cells but are functionally competent T cells that are capable of proliferation and lymphokine secretion after stimulation with concanavalin A (Con A), phorbol myristate acetate (PMA) and anti-CD3 monoclonal antibody (mAb) . Furthermore, Thy-1-enriched IEL proliferate and secrete lymphokines after 'superantigenic' stimulation with SEB . In contrast, the majority of Thy-1-depleted IEL do not proliferate, and secrete only minimal levels of lymphokine to any of the stimuli tested in this study. J Med Microbiol, 1992 Sep, 37(3), 187 - 91 Typing of Australian methicillin-resistant Staphylococcus aureus strains by pulsed field gel electrophoresis; Wei MQ et al.; Twenty-six clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) collected from six Australian hospitals by a National Staphylococcal Study Group were examined by analysis of restriction fragment length polymorphisms (RFLPs) of chromosomal DNA with pulsed field gel electrophoresis . Digestion with the restriction endonuclease SmaI produced 13-17 bands of 7-700 kb . The digestion patterns were easily distinguished and isolates could be classified into 17 groups based on their RFLPs . Isolates giving a pattern associated with one group were from four hospitals in four different states . In another group, the isolates responsible were from three hospitals in two states and in a further group, the isolates were derived from two hospitals in different states . The remaining groups comprised only one member each . The method has promise for typing and studying the epidemiology of MRSA. Rev Hosp Clin Fac Med Sao Paulo, 1992 Sep-Oct, 47(5), 245 - 9 {Pyogenic arthritis: case reports and a review of the literature}; Guarniero R et al.; The authors studied septic arthritis in patients of the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo . The pathogeny, the etiology and the diagnosis with clinical and laboratory findings are discussed . Our data are in accordance with those found in the literature . The main site was the knee joint and the etiologic agent Staphylococcus aureus . The authors point to the necessity of an early diagnosis and to the fact that the treatment of septic arthritis must be started as soon as possible. Am J Vet Res, 1992 Sep, 53(9), 1534 - 9 Influence of arachidonic acid metabolites and steroids on function of bovine polymorphonuclear neutrophils; Hoedemaker M et al.; Polymorphonuclear neutrophils (PMN) from 4 ovariectomized healthy cows were incubated with 0 (control), 10(-8), 10(-7), and 10(-6) M arachidonic acid metabolites of the cyclo- and lipoxygenase pathways for 30 minutes, and with steroids for 2 hours . Immediately after incubation, PMN were subjected to the following function assays: chemotaxis against zymosan-activated serum, chemotaxis against arachidonic acid metabolite or steroid at the doses given (only control PMN were tested), random migration, ingestion of 125I-iododeoxyuridine-labeled Staphylococcus aureus (125I-IdUR-S aureus), iodination of proteins, cytochrome C reduction, antibody-independent and -dependent cell-mediated cytotoxicity (AICC and ADCC) . Prostaglandin F2 alpha was chemoattractant and stimulated ingestion of 125I-IdUR-S aureus . Prostaglandin E2 stimulated cytochrome C reduction, whereas prostacyclin inhibited iodination of proteins . Thromboxane B2 stimulated ADCC . Leukotriene B4 was chemoattractant for bovine PMN and stimulated random migration and AICC . 5-Hydroxyeicosatetraenoic acid was also chemoattractant, but inhibited ingestion of 125I-IdUR-S aureus . 15-Hydroxyeicosatetraenoic acid was chemoattractant and decreased ADCC . Lipoxin A4 stimulated random migration, whereas lipoxin B4 inhibited chemotaxis against zymosan-activated serum, but was chemoattractant and stimulated cytochrome C reduction . 12-Hydroxyhepadecatrienoic acid and 12-hydroxyeicosatetraenoic acid did not influence any of the PMN functions tested . Of the steroids tested, cortisol increased ADCC, and progesterone stimulated cytochrome C reduction, but decreased ADCC . 17 beta-Estradiol and estrone were chemoattractant and stimulated cytochrome C reduction . In addition, estrone also stimulated random migration.(ABSTRACT TRUNCATED AT 250 WORDS) Nurse Pract, 1992 Sep, 17(9), 39 - 40, 43, 46 A review of toxic shock syndrome: the need for education still exists; Colbry SL; Toxic shock syndrome is a multisystem disease that is believed to be caused by a toxin produced by Staphylococcus aureus . The syndrome can occur in persons of any gender, age or race and should be considered as a possible diagnosis in any patient displaying symptoms compatible with the illness . Most reported cases of toxic shock syndrome have occurred in young menstruating women and have been associated with the use of tampons . Toxic shock syndrome cases reported to the Centers for Disease Control have decreased substantially since May of 1980 . The decreases in diagnosis and reporting may be attributed to diminished public and professional attention to the syndrome . In addition, it is likely that cases of the syndrome that do not meet the strict Centers for Disease Control case definition are not being diagnosed . Until more is understood about toxic shock syndrome, particularly its relationship to menstruation and tampon use, patient education remains a primary key to prevention . Women should be aware of the symptoms of toxic shock syndrome and, if symptoms occur, seek medical attention immediately. Clin Exp Immunol, 1992 Sep, 89(3), 390 - 4 Regional cellular responses to intraperitoneal infection; Galandiuk S et al.; Leucocytes in different body compartments were examined in a murine intra-abdominal abscess model: (i) peripheral blood; (ii) peritoneal exudate; (iii) abscess wall; and (iv) abscess pus, with respect to their phagocytic ability, CR3 expression and Ia antigen expression (murine MHC antigen) . The ability of serum or supernatant in each compartment to opsonize Staphylococcus aureus was also determined . Mice responded to caecal ligation and puncture (CLP) with systemic monocytosis, an increased amount of opsonins in peritoneal fluid and an increased phagocytosis in pus leucocytes . This increased phagocytic ability and CR3 expression both subsequently decreased . Monocyte/macrophage Ia expression was reduced in all measured compartments over time . In contrast, sham-operated animals, without an intra-abdominal abscess, responded to operation with an even greater increase in peritoneal exudate phagocytic ability and in monocyte/macrophage Ia expression in all compartments which was sustained beyond 1 week . Decreased peritoneal exudate cell and peripheral blood Ia was still present after 28 days in CLP animals, compared with both sham and normal animals (P less than 0.05, P less than 0.02, respectively) . For all parameters, changes observed in peripheral blood did not reflect those present near the site of infection . Proper understanding of local or regional infection must take into account and ultimately alter these generally unappreciated changes in and about the actual site of infection. Zhonghua Nei Ke Za Zhi, 1992 Sep, 31(9), 556 - 8, 587 {Resistant rate to antibiotics in Tian Tan Hospital for 3 years}; Song JF et al.; The resistance to antibiotics of the 985 clinical isolates collected in Tian Tan hospital was studied . The results showed that S . aureus had a resistant rate of more than 90% to penicillin and was also highly resistant to erythromycin . Methicillin resistant Staphylococcus Aureus (MRSA) was isolated in 15.6% of all the isolates with S . aureus . The isolation rate of MRSA is lower than that in other countries or districts of West Pacific Area . K . pneumonia and other Gram negative bacilli had a resistant rate of 0.6% to amikacin and P . aeruginosa was all sensitive to Polymyxin-B. Natl Med J India, 1992 Sep-Oct, 5(5), 217 - 8 Bacterial adherence to cotton and silk sutures; Ananthakrishnan N et al.; BACKGROUND . Silk and cotton sutures are the most commonly used materials for skin closure, the choice being largely based on tradition . We undertook this study to compare the bacterial adherence in vitro to these two materials because it is well known that the physicochemical characteristics of a suture material influence its ability to attract bacteria and consequently promote wound infection . METHODS . We determined the bacterial adherence in vitro to cotton and silk for Staphylococcus aureus and Escherichia coli, common organisms found in postoperative infection at our institute, using three inoculum strengths . The sutures were incubated with the organisms and bacterial counts per suture material calculated after 20, 60, 120 and 180 hours of incubation . The bacterial counts for the sutures were then compared at these intervals . RESULTS . The bacterial adherence for both organisms at all time intervals was significantly greater to silk than to cotton, except at 60 hours for Staphylococcus aureus . The bacterial count for each suture material appeared to be an intrinsic property of the suture and did not vary with the concentration of the bacteria in the initial inoculum . The cost of an equivalent thickness of silk is 50 times that of cotton . CONCLUSION . We suggest that cotton should be the preferred suture for skin closure because bacterial adherence to it is lower and it is much cheaper than silk. Ann Acad Med Singapore, 1992 Sep, 21(5), 664 - 6 Multiple resistant Staphylococcus aureus; Pegg SP; Burn wound sepsis is still a common cause of death in burn injuries . Eighty percent of this infection is with colonisation from the patient and twenty percent as a result of cross infection . Most of the mortality is due to virulent cross infection . Pseudomonas has almost disappeared and multiple resistant staphylococcus aureus is the main pathogen today . It can cause loss of skin grafts and septicaemia, particularly due to colonisation of intravenous lines . The risk increases with the time since the burn injury . Early excision and grafting is important . With a large burn it is not possible to do this in one session and so the risk is increased with a compromised patient . Maintenance of a good diet and vitamin supplements is important, preferably orally or through a naso-gastric tube . Parenteral nutrition increases the risk of infection . Clinical infection is combated by good cleaning procedures, preferably with chlorhexidine solution and the application of a good topical agent such as Silvazine . The presence of bacteria in the wound must be monitored . Strict barrier nursing and personal hygiene, particularly hand washing, are the mainstay of cross infection prevention . Antibiotics may be required, monitored by blood cultures . Documenting MRSA is a good way to monitor the unit's infection prevention programme . The main preventive measures are early referral, early excision and grafting, good nutritional support, good topical agents and barrier nursing. J Struct Biol, 1992 Sep-Oct, 109(2), 129 - 41 The Staphylococcus aureus alpha-toxin channel complex and the effect of Ca2+ ions on its interaction with lipid layers; Ward RJ et al.; Using the techniques of two-dimensional crystallization on supported lipid bilayers together with computer image processing, two distinct two-dimensional crystal types of staphylococcal alpha-toxin complex are formed depending on the presence or absence of Ca2+ ions . Without Ca2+, these are hexagonally packed (in A, a = b = 89.5 +/- 2.5 A; theta = 119.7 degrees) With Ca2+ present, rectangular crystal packing is seen (in A, a = 114.8 +/- 1.6 A, b = 140.2 +/- 0.7 A; theta = 89.1 degrees) . A third, banded crystal type is also seen which is interpreted as a side-to-side packing of regular tubules . We use these tubular crystals for cross-correlation searches with top and side-on views of the complex from single particle reconstructions, and with the repeating units from the two-dimensional crystal types . The results lead us to propose a model in which the different two-dimensional crystal types are formed as a result of alpha-toxin hexamers packing in different orientations . In the hexagonal crystals the hexamers lie end-on with a 6-fold axis in projection . On the addition of Ca2+, the hexamers reorient to lie tilted with respect to the support, thus giving rise to a rectangular projection. Schweiz Med Wochenschr, 1992 Aug 29, 122(35), 1275 - 8 {Schoenlein-Henoch syndrome in adults and skin infection}; de Pree C et al.; Schoenlein-Henoch purpura is a rare disease in adults clinically characterized by palpable purpura, mainly on the legs, with varying degrees of gastrointestinal, articular and renal involvement . This syndrome is also characterized by IgA-vasculitis and its pathogenesis is still unclear, although it appears frequently after a viral or bacterial infection especially in the ORL sphere . We report here the cases of three adult patients who developed Schoenlein-Henoch purpura shortly after a bacterial infection of the skin, notably by Staphylococcus aureus. FEMS Microbiol Lett, 1992 Aug 15, 74(2-3), 259 - 65 Substrate specificity and energetics of antiseptic and disinfectant resistance in Staphylococcus aureus; Littlejohn TG et al.; Clinical isolates of Staphylococcus aureus carry various antiseptic and disinfectant resistance determinants (qac genes) on a variety of plasmids . The biochemistry and specificity of these resistance genes in S . aureus is the subject of this report . The qac genes were separated into two families on the basis of resistance profiles and DNA homology . Isotopic and fluorimetric assays demonstrated that the qac genes encode efflux systems that rely on proton motive force. J Am Vet Med Assoc, 1992 Aug 15, 201(4), 575 - 9 Frequency of reisolation of Staphylococcus aureus from multiple sequential milk samples; Adams DS et al.; Bacterial cultures were performed on multiple sequential composite samples of milk from 1,172 cows in 9 dairy herds . If the initial diagnosis of Staphylococcus aureus infection was based on the first positive culture, an average of 37.8% of subsequent cultures on the same cows were negative for S aureus . However, if the initial diagnosis of S aureus infection was confirmed by 2 or 2 of 3 sequential positive cultures and any conversions from S aureus positive to negative were confirmed by 2 or 2 of 3 sequential negative cultures, then only 17.0% converted to a negative diagnosis . Conversion of cows from S aureus culture-positive to -negative varied between herds; 8.1 to 69% for single cultures and 0.0 to greater than 40% for confirmed cultures. Arch Biochem Biophys, 1992 Aug 15, 297(1), 80 - 5 Purification and properties of a protamine kinase from bovine kidney microsomes; Amick GD et al.; About an eightfold increase in protamine kinase activity was detected following extraction of highly purified microsomes from bovine kidney with 1% Triton X-100 . Relative to the soluble fraction, the microsomes contained about 30% protamine kinase activity . The microsomal protamine kinase was purified to apparent homogeneity . The purified enzyme exhibited an apparent M(r) approximately 45,000 as estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and by gel permeation chromatography on Sephacryl S-200 . Relative to protamine, the purified kinase exhibited about 100% activity with the synthetic peptide RRLSSLRA and about 5, 8, and less than 0.1% activity with casein, histone H2B, and histone H1, respectively . The purified kinase phosphorylated several 40 S ribosome polypeptides . One of these polypeptides was identified as ribosomal protein S6 by N-terminal sequencing . About 2.5 mol of phosphoryl groups was incorporated per mole of ribosomal protein S6 following incubation of the 40 S ribosomes with the purified kinase . Following incubation with protein phosphatase 2A2, purified preparations of the protamine kinase were inactivated . These properties were identical to those of purified preparations of a protamine kinase from extracts of bovine kidney cytosol (Z . Damuni, G.D . Amick, and T.R . Sneed, 1989, J . Biol . Chem . 264, 6412-6418) . Near identical peptide patterns were obtained following incubation of purified preparations of the microsomal and cytosolic protamine kinases with Staphylococcus aureus V8 proteinase . The results indicate that a form of the cytosolic protamine kinase is present in microsomes. Gene, 1992 Aug 1, 117(1), 45 - 51 Sequence of a staphylococcal plasmid gene, vga, encoding a putative ATP-binding protein involved in resistance to virginiamycin A-like antibiotics; Allignet J et al.; The Staphylococcus aureus plasmid gene, vga, conferring resistance to A compounds of virginiamycin-like antibiotics (streptogramin A, pristinamycin II, virginiamycin M), and to synergistic mixtures of the A and B compounds of these antibiotics, was cloned and sequenced . This gene potentially encodes a 522-amino acid protein, VgA, of 60,115 Da which exhibits significant homology with the ATP-binding domains of numerous proteins . VgA has two ATP-binding domains, containing each the A and the B motifs, but does not contain long hydrophobic stretches that might represent potential membrane-spanning domains . Resistance to A compounds of virginiamycin-like antibiotics conferred to S . aureus by gene vga was not conferred to Escherichia coli, although a protein having an M(r) similar to that encoded by this gene was detected in E . coli minicells. Chest, 1992 Aug, 102(2), 525 - 9 Nosocomial respiratory tract infections in multiple trauma patients . Influence of level of consciousness with implications for therapy; Rello J et al.; A prospective study of 161 multiple trauma patients was carried out to determine the incidence, the causative agents, and the outcome of nosocomial respiratory tract infections in this highly selected population . Thirty-eight (23.6 percent) patients developed a nosocomial pneumonia (NP) . In addition, there were four superinfections in three patients, representing an incidence of 26 percent (42 of 161) . Incidence of NP was significantly greater among comatose patients (42.2 vs 13.3 percent, p less than 0.05) . Furthermore, purulent tracheobronchitis was diagnosed in six patients . The causative agent of NP was identified in 36 (85.7 percent) episodes by means of fiberoptic bronchoscopies with protected specimen brush sampling . Staphylococcus aureus (55.8 percent) was the predominant pathogen isolated in multiple trauma patients in coma (Glasgow coma score {GCS} below 9 during a period greater than 24 h), while aerobic Gram-negative bacilli were responsible for the majority of cases in the remaining population studied . The overall mortality rate was 19.8 percent, but only five deaths were related to NP . We conclude that nosocomial respiratory tract infections are a frequent problem in multiple trauma patients, especially in those with GCS below 9, although this complication is associated with a relatively low mortality . Among patients with GCS below 9, S aureus was a frequent finding; consequently, antimicrobial therapy in this population needs to be different than that for the remaining multiple trauma patients with NP. Infect Immun, 1992 Aug, 60(8), 3381 - 8 Glucose and nonmaintained pH decrease expression of the accessory gene regulator (agr) in Staphylococcus aureus; Regassa LB et al.; The effect of glucose on accessory gene regulator (agr) expression in Staphylococcus aureus was examined . agr is a global regulator that affects the expression of numerous genes, including those for some factors implicated in virulence, such as toxic shock syndrome toxin 1, alpha-hemolysin, and protein A . The agr locus determines two divergent transcripts, designated RNAII and RNAIII . RNAII contains four open reading frames (agrABCD), and RNAIII encodes delta-hemolysin . The mechanisms responsible for agr-mediated regulation are not well understood, but it appears that the RNAIII transcript plays a central role in the regulation of a number of target genes, including those for alpha-hemolysin (hla), beta-hemolysin (hlb), protein A (spa), and staphylococcal enterotoxin B (seb+) . In this study, S . aureus cultures were grown either in a shake flask system with a complex medium or in a fermentor system with a completely defined medium in which the pH and glucose concentration were maintained . Northern (RNA) blot analysis revealed that a dramatic reduction in agr expression was apparent only when the cultures contained glucose and when the pH was 5.5 or was not maintained . The effect of glucose on two agr target genes, sec+ and hla, was also studied . Glucose-containing cultures produced less sec+ and hla mRNAs at maintained pH (6.5) . In addition, the glucose effect on sec+ and hla was enhanced under conditions that inhibited agr expression (i.e., pH 5.5 or a nonmaintained pH). Hepatology, 1992 Aug, 16(2), 358 - 64 Immunomodulatory effects of ursodeoxycholic acid on immune responses; Yoshikawa M et al.; Ursodeoxycholic acid was recently recognized as an effective agent in the treatment of primary biliary cirrhosis . Experimental evidence supporting the usefulness of ursodeoxycholic acid as a potentially beneficial therapeutic agent for primary biliary cirrhosis has been reported from the biochemical and physiological aspects . In this study, we investigated the direct effects of ursodeoxycholic acid on immunoglobulin and cytokine production in vitro using plaque-forming cell assay and enzyme-linked immunosorbent assay . It was demonstrated that ursodeoxycholic acid suppressed the production of IgM, IgG and IgA induced by Staphylococcus aureus Cowan I in peripheral blood mononuclear cells derived from healthy subjects and patients with primary biliary cirrhosis and also in human B lymphoma cell lines . Furthermore, ursodeoxycholic acid suppressed interleukin-2 and interleukin-4 production induced by concanavalin A and interferon-gamma production induced by polyinosinic-polycytidylic acid, but it did not affect interleukin-1 and interleukin-6 production induced by lipopolysaccharide in peripheral blood mononuclear cells . In addition, ursodeoxycholic acid suppressed the concanavalin A-induced thymocyte proliferation mediated by interleukin-1 . Cytotoxicity against lymphocytes was not observed at the concentrations of ursodeoxycholic acid used . These results suggest that the beneficial effect of ursodeoxycholic acid in primary biliary cirrhosis is mediated in part by immunosuppression. Eur J Immunol, 1992 Aug, 22(8), 2003 - 8 Glycosidase inhibitors (castanospermine and swainsonine) and neuraminidase inhibit pokeweed mitogen-induced B cell maturation; Karasuno T et al.; Castanospermine (CSP), an inhibitor of alpha-glucosidase, enhanced immunoglobulin (Ig) release in a Staphylococcus aureus Cowan I (SAC)-induced lymphocyte culture (Scand . J . Immunol . 1990 . 32: 529) . In a pokeweed mitogen (PWM)-human lymphocyte culture, unlike the SAC-stimulated system, CSP strongly decreased the number of IgG-, IgA- and IgM-secreting cells as well as that of Ig-bearing cells . Peripheral blood lymphocytes treated with swainsonine, a mannosidase II inhibitor, or with neuraminidase also showed a reduced response to PWM . In cross-culture experiments, only a mixture of B cells pretreated with either agent and untreated T cells showed such a suppressive effect . Adhesion was decreased between B cells treated with either agent and untreated T cells, but not between treated T cells and untreated B cells . These results demonstrate that a certain alteration in B cell membrane oligosaccharides inhibited the T cell-B cell adhesion in the PWM culture, leading to an arrest of B cell maturation . Considering that these inhibitors eventually prevent terminal sialic acid addition, the present study provides evidence that sialic acids on B cell surface oligosaccharides play a biological role in the T cell-B cell interaction. Clin Exp Immunol, 1992 Aug, 89(2), 204 - 10 Possible role of IL-2 deficiency for hypogammaglobulinaemia in patients with common variable immunodeficiency; Rump JA et al.; Common variable immunodeficiency (CVID) patients are unable to produce specific immunoglobulins after antigen contact in vivo . The aim of this study was to investigate whether in some cases of CVID a decreased de novo synthesis of IL-2 might be the cause of immunodeficiency and whether this deficiency can be corrected by IL-2 supplementation in vitro . Mononuclear cells from 17 CVID patients and from 10 healthy controls were cultured with monoclonal anti-CD3 antibody OKT3, pokeweed mitogen (PWM) or tetanus toxoid (TT) to stimulate IL-2 synthesis . In parallel, in vitro IgG and IgM synthesis was stimulated with Staphylococcus aureus Cowan I (SAC), PWM or TT in the presence or absence of IL-2 . While lymphocytes of 11 out of 17 patients produced low to normal amounts of IL-2 upon stimulation with anti-CD3, only three patients showed low IL-2 production in response to PWM and five in response to TT . Regarding immunoglobulin synthesis in vitro, five patients completely failed to produce IgM or IgG upon stimulation with PWM, SAC or TT irrespective of the addition of IL-2 . By contrast, four patients did not show any defect in vitro and synthesized normal amounts of IgM and IgG with any of the three stimuli . Finally, eight patients could be reconstituted for PWM-, SAC- and TT-induced IgM and/or IgG synthesis in vitro, by adding IL-2 to the culture system . This enhancing effect of IL-2 could be blocked by adding anti-IL-2 receptor antibodies to the cultures . Our findings indicate that a defective IL-2 synthesis after antigen stimulation may be one reason for the impaired immunoglobulin production in some cases of CVID. J Infect Dis, 1992 Aug, 166(2), 400 - 4 Comparison of in vitro adherence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus to human nasal epithelial cells; Ward TT; Reported nasal carriage rates of personnel caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) range from 1% to 6% in contrast to nasal carriage rates of 45%-65% for methicillin-sensitive S . aureus (MSSA) in health care personnel under nonepidemic conditions . One proposed explanation for these conflicting observations was examined, namely that MSSA and MRSA differ in their ability to adhere to nasal epithelial cells . The adherence of 6 genotypically distinct strains of MSSA and MRSA to nasal epithelial cells from 5 healthy donors was compared using a radioisotope assay system (coefficient of variation, 26%) . The effect of pretreating epithelial cells with S . aureus-derived ribitol teichoic acid, a known adhesin of S . aureus for epithelial cells, was also examined . The mean (+/- SE) adherence of MRSA compared with MSSA in 108 assays was 125 +/- 11.9 versus 129 +/- 8.3 viable bacteria per cell (P = .67) . Dose-dependent competitive inhibition by ribitol teichoic acid was linear and equivalent for MRSA and MSSA (r, .949, P less than .001) . As these in vitro results correlate to adherence in vivo, it would be anticipated that MRSA and MSSA would have an equal likelihood of nasal carriage . A critical review of published epidemiologic studies comparing MRSA and MSSA carriage rates also supports this hypothesis. J Bacteriol, 1992 Aug, 174(15), 5095 - 100 Alkaline pH decreases expression of the accessory gene regulator (agr) in Staphylococcus aureus; Regassa LB et al.; The effect of alkaline pH on expression of the accessory gene regulator (agr) in Staphylococcus aureus was examined . agr, a global regulator, affects the expression of numerous exoproteins, including alpha-hemolysin, toxic shock syndrome toxin 1, protein A, and staphylococcal enterotoxins types B, C, and D . agr contains two major, divergent transcripts, designated RNAII and RNAIII . In this study, the level of RNAIII was used to monitor agr expression because this transcript and/or its protein product(s) appears to be responsible for altering target gene expression . S . aureus FRI1230 and its Agr- derivative were examined in a fermentor system which allowed batch cultures to be maintained at a constant pH . FRI1230 cultures were grown at pH 6.5, 7.0, 7.5, and 8.0 . Northern (RNA blot) analysis of samples revealed that maximal agr expression occurred at pH 7.0, with virtually no RNAIII observed at pH 8.0 . The effect of alkaline pH on an agr target gene, sec, was also evaluated . sec expression was reduced at alkaline pH in strain FRI1230 (Agr+) but not in its Agr- derivative, indicating that an intact agr allele is required for the pH effect on sec . Examination of batch cultures under conditions of nonmaintained pH gave results that were also consistent with a role for alkaline pH in repressing agr expression. J Trop Pediatr, 1992 Aug, 38(4), 173 - 5 Septicaemia among neonates with tetanus; Antia-Obong OE et al.; In a study of 149 cases of neonatal tetanus (NNT) admitted into the University of Calabar Teaching Hospital, 49 (33 per cent) were also found to have septicaemia . The dominant organisms were coliforms and Staphylococcus aureus . A comparison of the clinical features of the septicaemic and non-septicaemic neonates showed umbilical cord infection to be an indicator of septicaemia . There was no significant difference in the case fatality rates of the two groups of patients and the overall case fatality was low (37 per cent) . This is attributable to early diagnosis and treatment of the septicaemia cases . It is suggested that paediatricians should have a high index of suspicion of septicaemia among cases of NNT as a means of reducing case fatality. Oral Surg Oral Med Oral Pathol, 1992 Aug, 74(2), 216 - 20 Antimicrobial activity of seven root canal sealers . Results of agar diffusion and agar dilution tests; Pumarola J et al.; A comparative study of the antimicrobial action of seven root canal sealers: Traitement Spad, Endomethasone, N2 Universal, Diaket-A, AH26 with silver, Tubli Seal, and Sealapex was done with 120 strains of Staphylococcus aureus . Two antimicrobial susceptibility tests were used: the agar dilution test and the agar diffusion test . The Diaket-A and Traitement Spad sealer cements showed the highest efficiency in the dilution test, whereas Diaket-A was in fourth place in the diffusion test, only better than the antimicrobial activity of the Tubli Seal and Sealapex sealers. Ophthalmic Surg, 1992 Aug, 23(8), 560 - 1 Bilateral dacryocystitis after punctal occlusion with thermal cautery; Marx JL et al.; A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca . The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy . Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause . In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion. J Trauma, 1992 Aug, 33(2), 171 - 8 Induced immunoglobulin secretion by T-cell-replacing products from blunt trauma patients; Teodorczyk-Injeyan JA et al.; The capacity to induce immunoglobulin (Ig) secretion by soluble T-cell-replacing (TCR) factors derived from alloantigen-stimulated T lymphocytes of blunt trauma patients (n = 15, mean ISS = 24) was examined in Staphylococcus aureus (SAC)-activated normal B-cell cultures . The majority of the patients studied demonstrated a profound suppression of the T-cell-dependent, pokeweed-mitogen-induced Ig production . However, the activity to induce Ig secretion associated with TCRs from the same patients was not reduced compared with that of TCRs from normal subjects . IgM synthesis was normal and IgG secretion induced by TCRs was within the control range (in 6 of 15 patients) or significantly higher (p less than 0.05) than that in the remaining patients . Both patient-derived and control TCRs failed to induce Ig synthesis in cultures of resting B cells and had comparable mitogenic effects on normal SAC-activated and phytohemagglutinin A-activated B and T lymphocytes, respectively . Thus, the intrinsic ability of T lymphocytes to produce B-cell helper factors appears to be unaffected following blunt trauma . Suppression of the T-cell-regulated Ig secretion in traumatized patients may therefore reflect an altered B lymphocyte response to such factors. J Clin Microbiol, 1992 Aug, 30(8), 2071 - 6 Rapid whole-blood microassay using flow cytometry for measuring neutrophil phagocytosis; White-Owen C et al.; A simple flow cytometric method (FCM) for measuring phagocytosis of Staphylococcus aureus by human neutrophils (polymorphonuclear leukocytes {PMNs}) is described . This assay utilizes 100 microliters of EDTA-anticoagulated whole blood and a simplified method of fluorescently labeling bacteria . A commercially available whole-blood lysing reagent allows for the removal of erythrocytes and the exclusion of external free or adherent bacteria . Phagocytized bacteria are unaffected by this reagent, so PMNs containing internalized bacteria can be easily identified by FCM . Advantages of this method include the following: (i) small sample size, (ii) no requirement for PMN separation, (iii) rapid reliable method of labeling the bacteria, (iv) ability to distinguish between adherent bacteria and those which are actually internalized, (v) avoidance of vital dyes as quenching agents, and (vi) ability to fix cells and store for future FCM analysis. J Clin Microbiol, 1992 Aug, 30(8), 2058 - 63 Clonal analysis of methicillin-resistant Staphylococcus aureus strains from intercontinental sources: association of the mec gene with divergent phylogenetic lineages implies dissemination by horizontal transfer and recombination; Musser JM et al.; Genetic relationships among 254 isolates of Staphylococcus aureus resistant to methicillin recovered between 1961 and 1992 from nine countries on four continents were determined by analyzing electrophoretically demonstrable allelic variation at 15 chromosomal enzyme loci . Fifteen distinctive electrophoretic types, marking clones, were identified . The mec gene is harbored by many divergent phylogenetic lineages representing a large portion of the breadth of chromosomal diversity in the species, a result that is interpreted as evidence that multiple episodes of horizontal transfer and recombination have contributed to the spread of this resistance determinant in natural populations . Isolates recovered in the United Kingdom, Denmark, Switzerland, Egypt, and Uganda in the 1960s are of a single multilocus enzyme genotype and probably are progeny of an ancestral methicillin-resistant clone . There is geographic variation in the frequency of recovery of the common methicillin-resistant clones, an observation that may in part explain reported regional differences in natural history correlates of resistant organisms. J Clin Microbiol, 1992 Aug, 30(8), 1985 - 8 Evaluation of commercial and standard methodology for determination of oxacillin susceptibility in Staphylococcus aureus; Skulnick M et al.; Agar dilution with and without 4% NaCl, broth microdilution with 2% NaCl, the dried MicroScan Rapid Positive MIC 1 panel (Baxter Health Care Corp., West Sacramento, Calif.), the Vitek GPS-SA card (Vitek Systems, Hazelwood, Mo.), and the oxacillin agar screen plate were compared with a DNA probe encoding the mec gene for their abilities to detect oxacillin resistance in 506 clinical isolates of Staphylococcus aureus . The results of testing for the mec gene showed that there were 254 oxacillin-resistant and 252 oxacillin-susceptible isolates of S . aureus . There were 14.2% very major errors with Vitek (a resistant isolate was interpreted as susceptible) and 6.7% very major errors with MicroScan . Fewer major errors were seen: 0.8% with MicroScan (a susceptible isolate was interpreted as resistant) and 0.4% with Vitek . No very major errors but 2.4% major errors occurred by agar dilution with 4% NaCl supplementation, whereas there were 0.8% very major and 0.4% major errors without 4% NaCl supplementation . By broth microdilution there were 2.0% very major and 0.8% major errors . The results of the oxacillin agar screen plate method were 100% concordant with those of the mec gene probe method. Epidemiol Infect, 1992 Aug, 109(1), 87 - 96 A study into the mechanism of the Crystal Violet reaction in Staphylococcus aureus; Barer MR et al.; The mechanism of the Crystal Violet (CV) reaction, a trait which has been related to biotype, source and pathogenicity in Staphylococcus aureus, was investigated in agar and broth studies . White reactions could be converted to purple and vice versa by altering the incubation conditions on agar . Broth reactions examined macroscopically and by spectrophotometry revealed that both white and purple human biotype strains take up CV but the former then progressively modify the dye more quickly than the latter . A cell-associated product of CV was detected in white and purple strains by reverse-phase thin-layer chromatography of methanol extracts . White strains appear to produce a second additional product from CV . The white reaction was not inhibited by chloramphenicol or azide but did depend on viable cells with a nutrient source . CV MICs and MBCs for 10 white and 10 purple reactors showed no gross differences in susceptibility, while a standardized assay for the rate of CV modifying activity (52 strains) demonstrated that the two categories comprise discrete populations which alter CV at different rates . Although most white strains belong to either or both of phage-typing groups V and II, purple strains with this pattern of susceptibility and white strains without it both occur . The capacity to modify CV slowly or rapidly appears to subdivide human biotype strains independently of their phage group and is associated in the former case with their capacity to produce hospital-acquired and invasive infections. Clin Orthop, 1992 Aug, (281), 123 - 32 Acute septic arthritis of the hip joint in infancy and childhood; Bennett OM et al.; Forty-three children with 45 hip joint infections were admitted to the hospital between 1983 and 1988 . The duration of symptoms was the single most important prognostic feature . Almost all children who were treated within four days of symptoms had a satisfactory outcome . Concomitant osteomyelitis of the proximal femur produced by far a worse prognosis than if the infection was confined to the synovium of the hip joint . In addition, patients whose hips were infected with Staphylococcus aureus bacteria were more likely to have a poor prognosis than those whose hips were infected with non-S . aureus bacteria. J Thorac Cardiovasc Surg, 1992 Aug, 104(2), 511 - 20 Aortic valve infection . Risk factors for death and recurrent endocarditis after aortic valve replacement; McGiffin DC et al.; Patients (n = 195) undergoing aortic valve replacement (n = 209) for native or prosthetic valve endocarditis were studied to determine risk factors for death and recurrent endocarditis and also to determine the valve type least likely to be associated with recurrent endocarditis . Ten-year survival was 60%, the highest risk of dying occurring within the first 3 postoperative months . Risk factors for death in this early phase included increased urea concentration, higher New York Heart Association functional class, prosthetic valve endocarditis, infection status (lower in patients with healed endocarditis), longer duration of cardiopulmonary bypass, and nonuse of an allograft valve . In the late phase (beyond 3 months), risk factors included age at operation and Staphylococcus aureus infection (only in New York Heart Association functional class V) . Ten years after aortic valve replacement, 79% of valves were free of recurrent endocarditis . The highest risk of recurrence was in the first 4 months . Longer duration of cardiopulmonary bypass was a weak risk factor for recurrent endocarditis in the early phase, and in the late phase risk factors were S . aureus infection (only in New York Heart Association functional classes III, IV, and V) and the use of now discontinued biologic valves . Allograft aortic valve replacement was shown to be associated with a low and constant risk of recurrent endocarditis, whereas other valve types were associated with a high early risk . The allograft valve should be the preferred replacement device for aortic root infection. J Vasc Surg, 1992 Aug, 16(2), 293 - 6 Septic emboli from a radial artery catheter with local manifestations of subacute bacterial endocarditis; Shinfeld A et al.; Septic emboli, giving rise to physical signs similar to those of subacute bacterial endocarditis, are extremely rare complications of radial artery catheterization . A case is reported with splinter hemorrhages and Janeway lesions, resulting from an infected radial artery catheter . Five other cases with these signs are collected from among 21 patients with localized septic complications described in the literature . The duration of radial artery catheterization was 4 days or longer in all cases, and Staphylococcus aureus was the offending agent in all . We conclude that arterial lines should be removed as early as possible, and in any case they should be pulled out at the earliest sign of a local complication . In the presence of signs of local infection, antistaphylococcal treatment should be given until results of cultures are available. Postgrad Med J, 1992 Aug, 68(802), 629 - 33 Cardiovascular complications of parenteral nutrition; Naidoo DP et al.; During a 3 year period, 1987-1989, we encountered three major complications associated with parenteral nutrition leading to congestive cardiac failure--acute beriberi, right atrial and superior vena caval thrombosis, and fungal endocarditis . Unrecognized, these are invariably fatal . Persistent vomiting from intestinal obstruction led to the development of thiamine deficiency in the patient with beriberi . Recurrent catheter tip sepsis probably accounted for thrombosis and endocarditis in the second and third cases, respectively . These conditions are preventable with careful attention to nutritional replenishment and aseptic technique . In patients with catheter-related sepsis early, repeated blood culture is of diagnostic value . Patients with Staphylococcus aureus catheter-associated bacteraemia require at least 4 weeks of appropriate antibiotic therapy . Recurrent sepsis, especially when associated with pulmonary embolic phenomena, is an indication for echocardiography. Allergy, 1992 Aug, 47(4 Pt 1), 265 - 9 Atopic eczema: role of microorganisms on the skin surface; Ring J et al.; The pathophysiology of atopic eczema (AE) is still poorly understood . One possible concept favors IgE-mediated reactivity towards allergens that enter the skin from the outside or through the blood . Microorganisms of the cutaneous flora also might represent a stimulus for allergic skin reactions . Abnormal bacterial skin colonization is a characteristic feature of AE . Staphylococcus aureus (S . aureus) is the most common pathogen . Binding to host cells involves special receptors, such as fibronectin or laminin . Specific IgE antibodies to S . aureus can be detected in the blood . Whereas the clinical relevance of anti-staphylococcal antibodies is still controversial, specific IgE antibodies to Pityrosporum species as well as positive type I prick test reactions to these yeasts seem to correlate with the intensity of eczematous lesions in the head and neck regions of patients with AE . Both antimicrobial and antifungal treatment has been shown helpful in some cases of AE. Jpn J Antibiot, 1992 Aug, 45(8), 943 - 8 Cross-resistance of clinical isolates of methicillin-resistant Staphylococcus aureus to aminoglycosides and fluoroquinolones; Uete T et al.; Susceptibilities of 117 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) to aminoglycosides and fluoroquinolones were investigated during 1987 and 1990 . Gentamicin, tobramycin, sisomicin, micronomicin, and astromicin showed the bimodal antimicrobial activity pattern against MRSA, revealing cross-resistance to these antibiotics . However, amikacin, netilmicin, isepamicin and arbekacin (ABK) exhibited the monomodal antimicrobial activity pattern, suggesting the presence of less resistant strains . All 117 MRSA strains were susceptible to ABK with MICs less than 3 micrograms/ml . MRSA also showed the bimodal antimicrobial susceptibility pattern to fluoroquinolones such as ofloxacin (OFLX), ciprofloxacin (CPFX) and tosufloxacin (TFLX) . Frequencies of TFLX susceptible MRSA isolates decreased progressively from 1987 to 1989 when this drug was not even in general clinical use . The cross-resistance of MRSA between TFLX and OFLX or CPFX persisted . Cross-resistance between aminoglycosides and fluoroquinolones, however, was less frequently observed. Eur J Clin Microbiol Infect Dis, 1992 Aug, 11(8), 675 - 82 Serious complications of vascular catheter-related Staphylococcus aureus bacteremia in cancer patients; Raad I et al.; Over the period 1986 to 1989, 53 cancer patients were identified with catheter-related Staphylococcus aureus bacteremia at the University of Texas M.D . Anderson Cancer Center . Septic thrombosis was diagnosed in 12 (23%) patients and was suspected in another 3 (6%) . Of the 12 patients, five developed deep-seated infections (septic emboli, endocarditis, meningitis, abscess), compared with 2 of the 38 other patients with no septic thrombosis (p < 0.01) . Fever persisted for more than three days after antibiotic initiation in 52% of the patients with complications (septic thrombosis and/or deep-seated infections), compared with 19% of those without complications (p < 0.02) . Of the three patients with complications who were treated for 14 days with intravenous antistaphylococcal antibiotics, two relapsed; in contrast, all of the nine patients with complications who were treated for more than 14 days (mean 4 weeks) were cured, and none relapsed (p < 0.05) . Of the nine patients with complications who were treated with a long course of therapy, only one required surgery . The possibility of septic thrombosis and/or deep-seated infections should be considered in all cancer patients with catheter-related Staphylococcus aureus bacteremia, and if present, the condition should be treated with appropriate intravenous antibiotics for at least four weeks. Antimicrob Agents Chemother, 1992 Aug, 36(8), 1766 - 9 Analysis of vancomycin time-kill studies with Staphylococcus species by using a curve stripping program to describe the relationship between concentration and pharmacodynamic response; Ackerman BH et al.; Mono- and biexponential killing curves for vancomycin over a 2- to 50-micrograms/ml concentration range were generated for 11 Staphylococcus aureus isolates and 12 coagulase-negative Staphylococcus species in the logarithmic phase of growth . Nonlinear least-squares regression of the initial growth rate and disappearance were not significantly different for lower or higher concentrations of vancomycin in broth. Antimicrob Agents Chemother, 1992 Aug, 36(8), 1665 - 70 Platelet microbicidal protein enhances antibiotic-induced killing of and postantibiotic effect in Staphylococcus aureus; Yeaman MR et al.; The interaction of bacteria with platelets at the cardiac valve surface represents a critical event in the induction of infective endocarditis . Platelets are thought to modulate induction or propagation of endocarditis via secretion of alpha-granule-derived platelet microbicidal protein (PMP) (a low-molecular-mass, cationic, heat-stable protein distinct from lysozyme) . We studied representative PMP-susceptible and PMP-resistant Staphylococcus aureus isolates to determine their in vitro bacteriostatic and bactericidal susceptibilities to combinations of PMP plus antistaphylococcal antibiotics . PMP plus oxacillin exerted a synergistic bactericidal effect, in contrast to either agent alone, regardless of the intrinsic PMP susceptibility of the isolate tested . Exposure of S . aureus to PMP alone resulted in residual postexposure growth-inhibitory effects lasting from 0.9 to 1.8 h . Sequential exposure of S . aureus isolates to PMP for 30 min followed by exposure to either oxacillin or vancomycin (each at 10x the MIC for 120 min) resulted in a significant extension of the postantibiotic-effect duration compared with antibiotic exposure alone (P less than or equal to 0.05) . Collectively, these findings indicate that PMP both enhances antibiotic-induced killing of S . aureus and increases the postantibiotic-effect duration in S . aureus. J Pharm Sci, 1992 Aug, 81(8), 845 - 8 Lipidic peptides . V: Penicillin and cephalosporin acid conjugates with increased lipophilic character; Hughes RA et al.; Lipophilic, double-ester derivatives of beta-lactam antibiotics with methylene, ethylene, and propylene spacers were prepared by crown-ether-assisted coupling of halogenoalkyl esters of 2-(tert-butoxycarbonylamino)decanoic acid to either penicillin G or cefuroxime . The hydroxyethyl ester of penicillin G and the tert-butoxypropyl ester of cefuroxime were also prepared . The lipophilic, double-ester conjugates, the hydroxyethyl ester of penicillin G, and the tert-butoxypropyl ester of cefuroxime showed weak or no antibiotic activity in vitro, as expected . The lipophilic penicillin G conjugates and the tert-butoxypropyl ester of cefuroxime were active in vivo against a nonpenicillinase-producing strain of Staphylococcus aureus after subcutaneous administration . The penicillin G double ester with propylene spacer and the tert-butoxypropyl ester of cefuroxime were inactive in vitro, a fact indicating that both compounds were hydrolyzed in vivo, as desired . After oral administration, the lipophilic, double-ester conjugate of penicillin G with methylene spacer and the tert-butoxypropyl ester of cefuroxime were active. J Pediatr Surg, 1992 Aug, 27(8), 1054 - 9; discussion 1059-60 Mycotic thromboaneurysmal disease of the abdominal aorta in preterm infants: its natural history and its management; Lobe TE et al.; Five infants with mycotic complications of umbilical artery catheterization were evaluated with abdominal ultrasound and followed serially to document their natural history . Methicillin-resistant Staphylococcus aureus was always the infecting organism . There were one female and four male infants and they weighed between 900 and 1,200 g at birth . While two of the catheters were positioned in the abdominal aorta, three were located above the diaphragm . The predominate signs and symptoms included: thrombocytopenia, unexplained anemia, renal failure, hypertension, and embolic phenomena to the toes . Real-time ultrasound always proved sufficient for diagnosis . Serial studies detected the initial aortic thrombosis in three patients and accurately documented its progression to aneurysmal disease over 10 days in one patient and 17 days in another . Three of the infants were diagnosed with aneurysms at their initial examination . Of the five patients, three were treated nonoperatively and died of complications of their aortic disease . One patient was discovered at operation to have necrotic ischemic intestine . Aortic repair was postponed and he died of septic complications . The remaining patient underwent a PTFE interposition graft and survived for 6 months, dying of pulmonary failure with autopsy confirmed graft patency. J Antimicrob Chemother, 1992 Aug, 30(2), 215 - 20 An open, comparative trial of aztreonam with vancomycin and gentamicin with piperacillin in patients with fulminant hepatic failure; Rolando N et al.; Fifty patients admitted with fulminant hepatic failure and clinically suspected infection were allocated to receive either aztreonam and vancomycin or piperacillin and gentamicin as first line treatment . Fourteen patients died within 48 h of admission and were excluded from the analysis . Of the remaining 36 patients, 16 received aztreonam/vancomycin and 20 piperacillin/gentamicin . There were 18 episodes of infection in the aztreonam/vancomycin group and 24 in the piperacillin/gentamicin group (P = not significant) . The most frequent bacterial pathogen was Staphylococcus aureus . Fungal infection developed in 13 patients (nine in the aztreonam/vancomycin group and four in the piperacillin/gentamicin group; P = not significant) . Death attributed to infection occurred in 4 (25%) of 16 patients receiving aztreonam/vancomycin and 4 (20%) of 20 receiving piperacillin/gentamicin (P = not significant) . Thirteen patients (three in the aztreonam/vancomycin group and ten in the piperacillin/gentamicin group) had clinical and microbiological improvement without addition or substitution of other antibiotics . No side-effects attributed to the study drugs were recorded. Clin Ter, 1992 Aug, 141(8), 135 - 8 {The prevalence of rhinopharyngeal staphylococcal carriers among those employed in the communal food services of the province of Rome}; Caruso E et al.; Microbial food contamination is at present less frequent than in the past . Nevertheless, Staphylococcus aureus food poisoning is still among the most frequent ones in Italy . The authors screened nasal swabs of 112 person working in five communal feeding services in Rome province; of these, 53 were found to be positive . This percentage (48.3%) does not differ substantially from those found by other researchers in various Italian cites. FEMS Microbiol Immunol, 1992 Aug, 4(6), 305 - 15 Interaction of fibronectin and fibronectin binding protein (FnBP) of Staphylococcus aureus with murine phagocytes and lymphocytes; Rozalska B et al.; In the present study we examined the in vitro and in vivo interactions of a cloned staphylococcal fibronectin binding protein (FnBP) and plasma fibronectin (Fn) with polymorphonuclear cells (PMNs) and macrophages, and how antibodies against FnBP affect the phagocytosis process in vitro . Moreover, the interaction of FnBP and Fn coupled on latex beads as 'artificial bacteria' and 'artificially opsonized bacteria' with murine spleen cells and peritoneal macrophages was tested . The major finding of the present study is that antibodies against the FnBP of Staphylococcus aureus (S . aureus) and low concentration of antibodies recognized two IgG-binding domains of protein A (SpA) are effective in the promotion of phagocytosis in vitro . It was also observed that FnBP has a chemoattractant activity and causes accumulation of PMNs and macrophages in the mouse peritoneal cavity when injected 24 h before irritation of peritoneal exudate . It seems likely that this activity is connected with binding to Fn molecules since formalin inactivation of FnBP (60%) abolished it . In the in vitro phagocytosis assay in the presence of FnBP (in a medium supplemented with serum depleted of Fn), ingestion of bacteria by phagocytes was identical to assay carried out in the presence of BSA . However, addition of plasma fibronectin caused an increased uptake of bacteria by macrophages and to a lesser degree by PMNs . We observed that in a population of normal splenocytes, those cells that effectively bound FnBP- and Fn-coated latex beads were mostly those cells exhibiting macrophage and dendritic morphology . In populations of spleen cells of animal infected with S . aureus, T lymphocytes were also found to bind FnBP- and Fn-coated latex beads . These data suggest that FnBP may have the ability to promote aggregation of immune cells, either directly or by interaction with plasma Fn, which can be helpful in certain cell-cell interactions taking place at the initial stages of specific immune response. Clin Infect Dis, 1992 Aug, 15(2), 285 - 9 Evaluation of intraventricular teicoplanin for the treatment of neurosurgical shunt infections; Cruciani M et al.; Seven patients with staphylococcal neurosurgical shunt infections were treated with intraventricular teicoplanin . Two infants received 5 mg/d, three patients received 20 mg/d, and two patients received 20 mg every other day . Six of these patients also received intravenous antibiotics . Three patients had infections caused by methicillin-susceptible Staphylococcus epidermidis, and one patient had an infection caused by methicillin-resistant S . epidermidis . Three patients were infected with Staphylococcus aureus (one with a methicillin-resistant strain and two with methicillin-susceptible strains) . The mean duration of intraventricular therapy was 16 days . Sterilization of cerebrospinal fluid (CSF) was obtained after an average of 4.4 days . All patients were cured both clinically and microbiologically . No significant adverse effects were observed in any patients . Penetration of teicoplanin into the CSF after intravenous administration was poor . However, after intraventricular administration, high and prolonged peak and trough levels of teicoplanin were detected in the CSF . Bactericidal activity of the CSF was remarkable, exceeding the 1:8 dilution in the majority of the cases . The alternate-day schedule of intraventricular administration of teicoplanin was as effective as the once-daily regimen. Immunology, 1992 Aug, 76(4), 610 - 5 Functional localization of an exocytosis-triggering G-protein in human cytotoxic T lymphocytes; Mittrucker HW et al.; Human cloned CD8+ cytotoxic T lymphocytes permeabilized with alpha-toxin of Staphylococcus aureus can be triggered by the guanosine triphosphate (GTP) analogue GTP gamma S to release the contents of their granula by exocytosis . To localize the guanosine nucleotide-binding protein (G-protein) activated by GTP gamma S in the sequence of events after T-lymphocyte triggering we have used several inhibitors of T-cell activation that inhibit early stages in T-cell triggering . The protein kinase C-inhibitor staurosporine, the immunosuppressants cyclosporin A and FK-506 and genistein, an inhibitor of tyrosine kinases, all inhibited esterase release triggered in intact cells by anti-T-cell receptor antibodies but not GTP gamma S-induced release from permeabilized cells . Cyclosporin A, FK-506 and genistein also blocked exocytosis triggered in intact cells by a combination of phorbolester and the calcium ionophore A23187 . In addition, cytochalasin B, an inhibitor of actin polymerization, inhibited exocytosis in intact cells but enhanced exocytosis from permeabilized cells . These data show that the G-protein effecting exocytosis is localized distally in the cascade of events after T-cell activation. Clin Exp Immunol, 1992 Aug, 89(2), 223 - 9 IL-4 down-regulates the surface expression of CD5 on B cells and inhibits spontaneous immunoglobulin and IgM-rheumatoid factor production in patients with rheumatoid arthritis; Hidaka T et al.; There is evidence to suggest that CD5+ B cells may be associated with autoimmunity, e.g . they are increased in patients with rheumatoid arthritis (RA) . In this study, we found that the expression of CD5 on RA B cells increased spontaneously, following culture for up to 4 days in vitro in the absence of T cells, supporting the idea that the CD5+ B cell possesses distinctive features . The spontaneous increase of CD5 expression was down-regulated by recombinant IL-4 (rIL-4) . Other cytokines studied (rIL-1 alpha, rIL-2, rIL-5, rIL-6) did not alter CD5 expression . Studies of antibody production showed that rIL-4 could reduce spontaneous production of total IgG and IgM in non-stimulated RA T plus B cell cultures . Spontaneous production of IgM rheumatoid factor (IgM-RF), measured by a newly developed avidin-biotin complex ELISA, was also reduced by rIL-4 . Furthermore, rIL-4 reduced the increase in IgM-RF production observed on stimulation with Staphylococcus aureus Cowan I (SAC) or pokeweed mitogen (PWM) . Thus, IL-4 might act as a regulator of the development of abnormal B cell differentiation in patients with RA. Appl Microbiol Biotechnol, 1992 Aug, 37(5), 685 - 90 Use of the polymerase chain reaction for specific detection of type A, D and E enterotoxigenic Staphylococcus aureus in foods; Tsen HY et al.; By comparison with the DNA sequences coding for Staphylococcus aureus enterotoxins (ents) A, B, C, D and E, oligonucleotides unique to the entA, entD and entE genes were synthesized and used as polymerase-chain-reaction (PCR) primers for the specific detection of type A, D or E enterotoxigenic S . aureus . The relative molecular weights of the PCR products amplified with these primers were 210, 333 and 456 bp, respectively . Despite the high relatedness among these S . aureus enterotoxin genes, each primer pair allows specific detection with total discrimination from other types of enterotoxigenic S . aureus . DNA from non-enterotoxigenic S . aureus or from non-S . aureus would not interfere with the PCR results either . Primers designed for entE detection allow the discrimination of entE strains that when assayed by a serological method might be classified as entA-producing strains . Study of the detection sensitivity showed that by using these primers, DNA from 10(0) cells of enterotoxigenic S . aureus could be detected unambiguously . When these oligonucleotide primers were used for the detection of S . aureus in foods, 10(0)-10(1) cells per gram of food could be detected and the naturally contaminating microflora in the food sample did not interfere with the detection. J Hosp Infect, 1992 Aug, 21(4), 291 - 9 In-vitro evaluation of povidone-iodine and chlorhexidine against methicillin-resistant Staphylococcus aureus; McLure AR et al.; The in-vitro activity of povidone-iodine (PVP-I) and chlorhexidine (CHX) against 33 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) was evaluated by a quantitative suspension test method . Bactericidal potency was measured by the logarithmic reduction factors (LRFs) achieved with each strain, tested at dilutions 25-800 over exposure times 30-300 s using a challenge of approximately 10(7) colony forming units (cfu) ml-1 . The mean LRFs achieved over all dilutions, times and strains were significantly higher for PVP-I than CHX . PVP-I exhibited a superior killing effect whether measured by rate of kill or final LRF achieved . This difference was highly significant as judged by analysis of variance (P less than 0.001) . Full efficacy of an antiseptic has been defined as a safe LRF greater than five . Over the dilution range 25-200 this was achieved by CHX with only three of 33 strains . In contrast, PVP-I achieved full efficacy with all 33 strains. J Clin Microbiol, 1992 Aug, 30(8), 2092 - 6 DNA polymorphisms in methicillin-susceptible and methicillin-resistant strains of Staphylococcus aureus; Carles-Nurit MJ et al.; Restriction fragment length polymorphisms in methicillin-susceptible and methicillin-resistant (MRSA) strains of Staphylococcus aureus isolated in the same hospital over a 4-month period were studied by using SmaI and ApaI digestion of genomic DNA and pulsed-field gel electrophoresis . Each of the 20 methicillin-susceptible strains had a unique SmaI pattern, but the 27 MRSA strains showed only seven SmaI patterns . More than half of the SmaI fragments in all of these seven patterns were identical, as were those in the patterns from two unrelated MRSA strains . Digestion with ApaI, which cuts staphylococcus DNA into at least twice as many fragments, confirmed the results obtained with SmaI . Lastly, the plasmid contents of MRSA strains showing identical SmaI and ApaI electrophoretic patterns were not identical . These results are interpreted as supporting the hypothesis that all MRSA strains arose from a single clone and emphasize the need to use several methods in epidemiological investigations of MRSA outbreaks. Zhonghua Yi Xue Za Zhi, 1992 Aug, 72(8), 465 - 7, 509 {Nosocomial infections of methicillin-resistant Staphylococcus aureus and their detection}; Dai L et al.; In 142 strains of Staphylococcus aureus randomly isolated from clinical samples in a year, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 79.6% (113/142) . MRSA in the samples from the respiratory, burning and hematological departments came to 92.0% (23/25), 84.6% (11/13) and 83.3% (30/36) in proportion respectively . 79.6% of MRSA strains were isolated from the patients in whom the infections were confirmed to be hospital-acquired . All the strains of Staphylococcus aureus examined were resistant to penicillin G and ampicillin, but sensitive to vancomycin . Twenty hospital-acquired strains of MRSA showed a resistance to all detected antibiotics (multi-drug resistance, MDR), but vancomycin; strains of methicillin-sensitive ones, however, showed on MDR . In 45 strains of Staphylococcus aureus isolated from swabs of fingers of 62 medical workers, 31 (68.9%) were methicillin-resistant . The resistant similarity of shares of strains between medical staff and patients indicated a potential role that medical workers play in spread of nosocomial infections. Diagn Microbiol Infect Dis, 1992 Aug, 15(6), 517 - 21 In vitro activity of various antimicrobial agents against Staphylococcus aureus isolates including fluoroquinolone- and oxacillin-resistant strains; Aldridge KE et al.; To determine susceptibility to 31 old and new antimicrobials, 44 strains of Staphylococcus aureus, most resistant to oxacillin and ciprofloxacin and isolated in a community hospital, were tested in vitro . For the peptide/peptide-derivative compounds, with the exception of mersacidin, all strains were inhibited by less than or equal to 2 micrograms/ml . Minimum inhibitory concentration (MIC)90 values indicated mupirocin, teicoplanin, and MDL 62211 to be fourfold more active than vancomycin, ramoplanin, and decaplanin . For fluoroquinolones, ciprofloxacin-resistant S . aureus exhibited high-level cross-resistance to ofloxacin, norfloxacin, fleroxacin, enoxacin, and Ro 23-9424 . WIN 57253, a new fluorinated naphthyridine, showed good activity against these strains . Among the beta-lactams, the penem-derivative compounds (imipenem, meropenem, FCE 22101, and HRE 664) had the greatest activity, although resistance to each compound was detected among oxacillin-resistant S . aureus . The presence of tazobactam reduced the piperacillin MIC90 fourfold . Oxacillin-susceptible strains were susceptible to cephalosporins/cephamycins, whereas most oxacillin-resistant strains exhibited resistance . This study has shown that certain old and new quinolones and peptide-derivative compounds have good in vitro activity against multiply resistant strains of S . aureus. Mol Microbiol, 1992 Aug, 6(15), 2147 - 57 Molecular cloning and characterization of two lincomycin-resistance genes, lmrA and lmrB, from Streptomyces lincolnensis 78-11; Zhang HZ et al.; Two different lincomycin-resistance determinants (lmrA and lmrB) from Streptomyces lincolnensis 78-11 were cloned in Streptomyces lividans 66 TK23 . The gene lmrA was localized on a 2.16 kb fragment, the determined nucleotide sequence of which encoded a single open reading frame 1446 bp long . Analysis of the deduced amino acid sequence suggested the presence of 12 membrane-spanning domains and showed significant similarities to the methylenomycin-resistance protein (Mmr) from Streptomyces coelicolor, the QacA protein from Staphylococcus aureus, and several tetracycline-resistance proteins from both Gram-positive and Gram-negative bacteria, as well as to some sugar-transport proteins from Escherichia coli . The lmrB gene was actively expressed from a 2.7 kb fragment . An open reading frame of 837 bp could be localized which encoded a protein that was significantly similar to 23S rRNA adenine(2058)-N-methyltransferases conferring macrolide-lincosamide-streptogramin resistance . LmrB also had putative rRNA methyltransferase activity since lincomycin resistance of ribosomes was induced in lmrB-containing strains . Surprisingly, both enzymes, LmrA and LmrB, had a substrate specificity restricted to lincomycin and did not cause resistance to other lincosamides such as celesticetin and clindamycin, or to macrolides. Infect Control Hosp Epidemiol, 1992 Aug, 13(8), 472 - 6 Investigation of an outbreak of methicillin-resistant Staphylococcus aureus in patients with skin disease using DNA restriction patterns; Venezia RA et al.; OBJECTIVE: To investigate an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) among patients using chromosomal typing of the isolates . DESIGN: Comparison of epidemiological and clinical data to endonuclease restriction fragmentation analysis (RFA) of the MRSA isolates associated with an outbreak . Total DNA from the MRSA isolates was restricted with HINDIII and HAEIII for typing . SETTING: Tertiary care academic medical center . METHODS: An epidemiological investigation of an outbreak of MRSA among patients in private rooms was evaluated by routine infection control methods . The MRSA isolates from blood cultures of 7 patients and the nares of a nurse were collected during the outbreak . MRSA isolates from 23 patients not associated with the outbreak also were collected . The total DNA of the MRSA isolates were restricted with HINDIII and HAEIII and electrophoresed on 0.6% agarose gels . RESULTS: MRSA from 4 of the 7 bacteremic patients and the nurse on the outbreak unit had the same endonuclease restriction pattern . The patients were linked in that they were compromised by severe psoriasis or skin ulcers, were on the unit during the same period, and had oatmeal baths in a common bathtub . Of 50 staff members screened, the nurse was the only person detected as colonized by the strain . The other 3 patients on the unit as well as the 23 patients in other locations not associated with the outbreak had MRSA isolates with different RFA patterns . The use of the bathtub was discontinued and further transmission of MRSA was stopped . CONCLUSIONS: A comparison of the relatedness of MRSA by RFA demonstrated the uniqueness of the epidemiologically linked isolates and the utility of the RFA technique in the performance of routine infection control investigations. J Clin Invest, 1992 Aug, 90(2), 382 - 8 Suppression of metalloproteinase biosynthesis in human alveolar macrophages by interleukin-4; Lacraz S et al.; To study the interaction of lymphocytes and macrophages in the control of extracellular matrix turnover, we determined the effects of several soluble T cell products on mononuclear phagocyte production of metalloproteinases . Cytokines including IL-2, IL-4, IL-6, tumor necrosis factor alpha (TNF alpha), GM-CSF, and IFN-gamma were each tested for capacity to modulate macrophage metalloproteinase and tissue inhibitor of metalloproteinases (TIMP) expression . The addition of IL-4 to cells cultured under basal conditions caused a dose-dependent suppression in the release of 92-kD type IV collagenase without affecting TIMP production . 92-kD enzyme secretion was inhibited by 50% with 1-2 ng/ml of IL-4