Resistance in clinical isolates of Enterococcusfaecalis encountered at the University Hospital of the West Indies, Jamaica

Enterococcus faecalis isolates were examined by an automated identification and susceptibility system. Almost all of the 97 isolates were ampicillin susceptible (n = 86) and tetracycline resistant (n = 89). All were nitrofurantoin susceptible. About a third of isolates showed high level resistance to the aminoglycosides streptomicin and gentamicin and this was usually associated with ciprofloxacin resistance (n = 34). Seven isolates were vancomycin resistant, including one that was ampicillin resistant. Most forms of resistance described elsewhere were found

Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections

The changing pattern of antimicrobial resistance in the causative microorganisms of urinary tract infection (UTI) in childhood is a growing problem. The aims of this study were to assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of UTI. A prospective cross-sectional analysis of bacteria isolated from children with UTI was performed between January 2003 and January 2004. Resistance to antibiotics was analysed in three age groups: Group I, < or =12 months; Group II, 13-60 months; and Group III, >60 months. A total of 165 urinary pathogens were isolated from 131 patients. Mean patient age was 63.7+/-49.8 months. The most common causative agent was Escherichia coli (87% of cases) followed by Klebsiella pneumoniae (10%). Resistance to ampicillin (74.2%) and co-trimoxazole (61.3%) was significant in all isolates. Nitrofurantoin was the most active agent against E. coli (2.2% resistant isolates), followed by amikacin (4.9%), ceftriaxone (7.5%) and ciprofloxacin (12%). None of the isolates from Group I patients were resistant to ciprofloxacin and a low resistance rate (7.1%) was noted for amikacin. In Group II patients, none of the isolates were resistant to amikacin, and ceftriaxone was the second most suitable antibiotic (resistance rate 2.2%). In Group III patients, the lowest resistance rate was against nitrofurantoin (2.7%). In conclusion, we observed that the use of ampicillin and co-trimoxazole as a single agent for empirical treatment of a suspected UTI would not cover the majority of urinary pathogens in our region. Whilst amikacin, with a negligible resistance rate, was suitable in all age groups, gentamicin might still be useful as an empirical treatment of UTI in children aged >1 year. Nitrofurantoin could be included as a reasonable alternative in the empirical treatment of lower UTI in older children.

Identification of a respiratory-type nitrate reductase and its role for survival of Mycobacterium smegmatis in Wayne model

Nitrate reductase (NR) is found to be expressed in certain mycobacterium sp. whose link with the development of persistence is yet to be resolved. The present study demonstrates the action of selective inhibitors on NR as well as in the survival of Mycobacterium smegmatis using Wayne's model. During gradual shift down to anaerobic stage in Wayne's model, conversion of nitrate to nitrite became apparent in M. smegmatis. More than 97 percent inhibition was observed for the conversion of nitrate to nitrite by azide (0.05 mM) and thiocyanate (20 mM) in both whole-cell as well as its cell-free lysate, respectively. Under identical condition, chlorate (20 mM) inhibited nitrate reduction by 67 and 10 percent, respectively. At these concentrations, neither of azide, thiocyanate nor chlorate had any significant effect on cell growth under aerobic condition. In Wayne's culture model, thiocyanate and chlorate inhibited the growth of M. smegmatis by almost 2 logs at the same concentrations whereas azide inhibited by almost 1.75 log when added at the time of inoculation. Exposure of same culture at 96 h after inoculation in Wayne's model to these inhibitors showed 1.74, 1.95 and 2.37 log inhibition of viable cells with respect to azide, thiocyanate and chlorate. These findings further indicated that NR inhibitors kill the bacilli at anaerobic stage under the experimental condition mentioned. Metronidazole (MTZ) (2 mM) and Nitrofurantoin (NIT) (0.3 mM) reduced the cell number at both stages by <0.7 log. They did not have any effect on NR. Altogether, the results clearly indicate that NR-specific inhibitors could become more promising in killing the bacilli at anaerobic stage than the available conventional drugs.

Pharmacokinetic and pharmacodynamic aspects of antimicrobial agents for the treatment of uncomplicated urinary tract infections

Uncomplicated urinary tract infections (UTI) are treated with beta-lactams, co-trimoxazole, quinolones and fosfomycin tromethamine. Due to increasing resistance of causative pathogens, antibiotics should be used by considering their pharmacodynamic and pharmacokinetic characteristics. beta-lactams have time-dependent activity and should not be used once-daily. Co-trimoxazole should be restricted due to increasing chemoresistance. Fluoroquinolones play a primary role in the treatment of serious and complicated infections. Fosfomycin tromethamine is active against most urinary tract pathogens. In vitro time-kill kinetics of fosfomycin against Escherichia coli and Proteus mirabilis showed primarily concentration-dependent activity, with a prolonged post-antibiotic effect (3.4 to 4.7h). Based on these results a single 3g dose of fosfomycin guarantees optimal efficacy against common uropathogens with an AUC(urine)/MIC ratio of 500.

Salmonellae isolated from captive animals in Ibadan, Western State of Nigeria

Six serotypes of salmonellae, Salmonella offa, S. glostrup, S. wimborne, S. dublin, S. saint-paul and S. webridge were isolated from captive wild animals in Ibadan, Western State of Nigeria. S. wimborne and S. glostrup are reported for the first time in Nigeria. All strains were sensitive to nitrofurantoin (200 mcg) and chloramphenical (10 mcg) but there wasmarked resistance to sulphafurazole (100 mcg) and penicillin (1.5 units).

Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment

OBJECTIVE

To review treatment recommendations for empiric therapy of uncomplicated urinary tract infection (uUTI) in light of evolving antibiotic resistance and to consider use of guidelines to promote optimal practice.

QUALITY OF EVIDENCE

PubMed was searched and additional relevant references were identified by reviewing articles found in the search. Guidelines were identified through discussion with family practitioners. Level of evidence was assessed for recommendations.

MAIN MESSAGE

Many women have uUTIs. The treatment approach is usually empiric antimicrobial therapy without obtaining pretherapy cultures. Trimethoprim-sulfamethoxazole is standard first-line empiric treatment. While resistance to this drug is increasing, it remains only about 10% in community-acquired Escherichia coli in Canada. Concerns about increased resistance have contributed to greater use of fluoroquinolones, but widespread empiric use of this class of medications might promote resistance to fluoroquinolones. Hence, fluoroquinolones should not be considered first-line therapy. While guidelines for treatment of uUTIs have been developed, their usefulness is compromised by their conflicting recommendations.

CONCLUSION

Trimethoprim-sulfamethoxazole and nitrofurantoin remain first-choice empiric therapy for uUTIs. Development of guidelines relevant to family physicians and community education programs that incorporate local susceptibility patterns are important strategies for promoting optimal practice.

[In vitro activity of furazolidone and nitrofurantoin in Helicobacter pylori clinical isolates and study of mutation rate]

Clarithromycin, amoxicillin, tetracycline and metronidazole are the most frequently used antimicrobials for Helicobacter pylori infection treatment. While tetracycline and amoxicillin resistance are rare, clarithromycin and metronidazole resistance vary in different populations and are considered factors for treatment failure. The aim of this study was to determine the in vitro activity of furazolidone and nitrofurantoin in 164 H. pylori clinical isolates by agar dilution and to determine the spontaneous mutation rate. Metronidazole and clarithromycin resistance were 23.77% (CI95%: 18.96-29.14) and 16.78% (CI95%: 12.64-21.62), respectively; moreover, 1.4% (CI95%: 0.38-3.54) were intermediate to clarithromycin. All the isolates were susceptible to amoxicillin and tetracycline. Furazolidone and nitrofurantoin resistance rates were 1.82% (CI95%: 0.37-5.25) and 0.6% (CI95%: 0-3.35), respectively. The three furazolidone-resistant strains were nitrofurantoine-susceptible (MIC 4 mg/l for furazolidone and 2 mg/l for nitrofurantoin) and the nitrofurantoin-resistant strains were furazolidone-susceptible (MIC 4 mg/l for nitrofurantoin and 1 mg/l for furazolidone). These four strains were metronidazole-resistant (MIC 16 mg/l). Furazolidone or nitrofurantoin spontaneous mutants were not detected in the eight H. pylori strains tested. However, mutants with resistance to metronidazole were found with all the strains with a mutation rate of 7.4 x 10(-10) to 9.4 x 10(-10). Furazolidone and nitrofurantoin showed an excellent in vitro activity against the H. pylori clinical isolates included herein, supporting the usefulness of furazolidone as second-line antimicrobial after treatment failure or as first-line therapy in populations with low economical resources.

Antibiogram pattern of isolates from UTI cases in Eastern part of Nepal

The present study was conducted to study antibiogram pattern of isolates from urinary tract infection (UTI) cases at a referral hospital in Eastern Nepal. Of the total 2,799 of urine samples studied, 720 (25.7%) were positive for some kinds of bacterial agents. Escherichia coli was most predominant organism (59.0%) followed by Klebsiella sp. (12.6%), Pseudomonas aeruginosa (6.9%), Acinetobacter sp. (5.9%), Enterococcus sp. (4.2%) and others (2.6%). Antimicrobial susceptibility testing was done by Kirby-Bauer's disc diffusion method following National Committee for Clinical Laboratory Services (NCCLS) guidelines. Most strains of Esch. coli and Klebsiella sp. were resistant to Ampicillin and Ciprofloxacin. Ps. aeruginosa and Acinetobacter sp. showed relatively higher resistance to Aminoglycosides. These organisms were often multidrug resistant. Ps. aeruginosa showed 68.0% resistance to even Ceftazidime. For Enterococcus sp. Nitrofurantion and Gentamicin were the drugs of choice. Of the all antimicrobial agents tested, Ciprofloxacin showed most disappointing result.

Biochemical characterization of trinitrotoluene transforming oxygen-insensitive nitroreductases from Clostridium acetobutylicum ATCC 824

The genes that encode oxygen-insensitive nitroreductases from Clostridium acetobutylicum possessing 2,4,6-Trinitrotoluene (TNT) transformation activity were cloned, sequenced and characterized. The gene products NitA (MW 31 kDa) and NitB (MW 23 kDa) were purified to homogeneity. The NitA and NitB are oxygen-insensitive nitroreductases comprised of a single nitroreductase domain. NitA and NitB enzymes show spectral characteristics similar to flavoproteins. The biochemical characteristics of NitA and NitB are highly similar to those of NfsA, the major nitroreductase from E. coli. NitA exhibited broad specificity similar to that of E. coli NfsA and displayed no flavin reductase activity. NitB showed broad substrate specificity toward nitrocompounds in a pattern similar to NfsA and NfsB of Escherichia coli. NitB has high sequence similarity to NAD(P)H nitroreductase from Archaeoglobus fulgidus. NitA could utilize only NADH as an electron donor, whereas NitB utilized both NADH and NADPH as electron donors with a preference for NADH. The activity of both nitroreductases was high toward 2,4-Dinitrotoluene (2,4-DNT) as a substrate. Both the nitroreductases were inhibited by dicoumarol and salicyl hydroxamate. The nitroreductases showed higher relative expression on induction with TNT, nitrofurazone and nitrofurantoin compared to the uninduced control.

Differential response of iron metabolism to oxidative stress generated by antimycin A and nitrofurantoin

The close interrelationship of oxidative stress and iron is evident by the influence of intracellular reactive oxygen species on iron metabolism. Oxygen radicals can lead to release of iron from iron-sulfur proteins and ferritin, and can damage iron-containing enzymes such as mitochondrial aconitase. Treatment of HepG2 human hepatoma cells with antimycin A has two effects relating to iron depending on the concentrations of antimycin A: increase of the labile iron pool and stimulation of non-transferrin-bound iron uptake. Whereas the first could also be generated with nitrofurantoin, the stimulation of non-transferrin-bound iron uptake was only seen with antimycin A and needed considerably higher concentrations. Pretreatment of the cells with ebselen, which scavenges peroxides, reverted only the effect of nitrofurantoin on the labile iron pool. Depletion with iron chelators before or after treatment with antimycin A diminished the stimulation of non-transferrin-bound iron uptake. We conclude that the generation of oxygen radicals in the mitochondria leads to the liberation of iron from mitochondrial enzymes, which enters the labile iron pool. But high concentrations of antimycin A leading to the stimulation of non-transferrin-bound iron uptake is possibly not related to the inhibition of the respiratory chain.

Some virulence characteristics of uropathogenic Escherichia coli in different patient groups

BACKGROUND & OBJECTIVE

Uropathogenic Escherichia coli have virulence properties, that are absent in non pathogenic E. coli. The distribution of these markers can vary according to patient populations. Hence, a study was undertaken to describe the presence of virulence factors like Pfimbriae, type 1 fimbriae and haemolysin in E.coli causing urinary infections in three groups of patients. Antibiogram was also recorded to determine differences, if any, between the groups.

METHODS

E. coli isolated from three groups of subjects, in counts of >10(5) CFU/ml and in pure growth were tested for mannose resistant haemagglutination (MRHA) to indicate P fimbriae and mannose sensitive haemagglutination (MSHA) to indicate type 1 fimbriae. Haemolysin production and antimicrobial susceptibility patterns were also recorded.

RESULTS

Significantly more isolates from antenatal and postnatal women possessed P fimbriae compared to groups with urologic abnormalities (P=0.05). Haemolysin production was also significantly higher (P<0.001) in this group. Greater proportions of isolates from pregnant women were susceptible to commonly used antimicrobials. However, resistance to third generation cephalosporins was present even in these isolates from community infections.

INTERPRETATION & CONCLUSION

In patients with urological abnormality, E. coli with lower virulence can cause infections. Isolates from these patients exhibited greater drug resistance. In pregnant women and in community acquired infections, simple antimicrobial drugs like nitrofurantoin might still be useful. However, urgent and stringent policies for antimicrobial use and infection control in hospitals are required in India.

Bacillus subtilis paraquat resistance is directed by sigmaM, an extracytoplasmic function sigma factor, and is conferred by YqjL and BcrC

A Bacillus subtilis sigM null mutant, lacking the extracytoplasmic function sigma(M) protein, was sensitive to paraquat (PQ), a superoxide-generating reagent, but not to the redox stress-inducing compounds hydrogen peroxide, cumene hydroperoxide, t-butyl hydroperoxide, or diamide. Surprisingly, a sigM mutant was only sensitive to superoxide-generating compounds with a dipyridyl ring such as PQ, ethyl viologen, benzyl viologen, and diquat but not to menadione, plumbagin, pyrogallol, or nitrofurantoin. Mutational analysis of candidate sigma(M)-regulated genes revealed that both YqjL, a putative hydrolase, and BcrC, a bacitracin resistance protein, were involved in PQ resistance. Expression of yqjL, but not bcrC, from a xylose-inducible promoter restored PQ resistance to the sigM mutant.

Sex-dependent expression and activity of the ATP-binding cassette transporter breast cancer resistance protein (BCRP/ABCG2) in liver

The breast cancer resistance protein (BCRP/ABCG2) is an ATP-binding cassette drug efflux transporter present in the liver and other tissues that affects the pharmacological behavior of many compounds. To assess the possible role of BCRP in sex-dependent pharmacokinetics, we studied the in vivo disposition of several murine Bcrp1 substrates in male and female wild-type and Bcrp1 knockout mice. After oral administration of the antibiotic nitrofurantoin, the area under the plasma concentration-time curve in wild-type female mice was approximately 2-fold higher than in wild-type male mice. Moreover, after i.v. administration of nitrofurantoin, the antiulcerative cimetidine, the anticancer drug topotecan, and the carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), the plasma levels in wild-type female mice were all significantly higher than those in wild-type male mice. Analysis of the expression of murine Bcrp1 in several pharmacokinetically important tissues showed that only the hepatic Bcrp1 expression was higher in male mice compared with female mice. In line with this difference, the hepatobiliary excretion for nitrofurantoin and PhIP was, respectively, 9-fold higher and approximately 2-fold higher in male compared with female wild-type mice. No significant sex differences were observed in plasma levels or hepatobiliary excretion for any of the tested compounds in Bcrp1-/- mice, indicating that Bcrp1 was the main cause of the sex difference in wild-type mice. Analysis of hepatic expression of human BCRP also indicated a higher expression in men compared with women. In conclusion, sex-dependent expression of BCRP/Bcrp1 in the liver may be a cause of sex-specific variability in the pharmacokinetics of BCRP substrates, with potential impact on the clinical-therapeutic applications and toxicity risks of drugs.

In-vitro activity of nitrofurantoin in enterococcus urinary tract infection

OBJECTIVE

To compare in-vitro antimicrobial susceptibility of nitrofurantoin against commonly used antimicrobials for the treatment of urinary tract infection caused by enterococci.

METHODS

A total of 144 enterococci (Enterococcus faecalis, n=130, Enterococcus faecium, n=14) isolated and confirmed by biochemical tests at the department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, for a period of three years were included in the study. The antimicrobial susceptibility tests of isolated organisms were performed by standard disc diffusion method as recommended by NCCLS. In addition to nitrofurantoin (NIT), doxycycline (DOX), co-trimoxazole (COT), ampicillin (AMP), imipenem (IPM) and vancomycin (VAN) were used for antimicrobial susceptibility testing.

RESULTS

One hundred and twenty seven (88%) isolates of Enterococci were susceptible to NIT while 72% (n = 103) to AMP, 13% to COT, 11% to DOX, 91% to IPM and 99% to VAN. Among the strains resistant to AMP, COT, DOX, IPM and VAN, 50-88% were susceptible to NIT.

CONCLUSION

Nitrofurantoin is an effective antimicrobial in vitro and can be used for treatment of Enterococcus urinary tract infections.

In vitro activity of nitrofuran derivatives on growth and morphology of Salmonella enterica serotype Enteritidis

AIMS

To evaluate the effect of nitrofuran derivatives furazolidone (Fz) and nitrofurantoin (Nf) on Salmonella enterica serovar Enteritidis PT4 in vitro, with regard to cell growth, morphology and ultrastructure.

METHODS AND RESULTS

The effects of Fz on the growth rates of Fz resistant (FzR) and sensitive (FzS) strains were assessed by viable counts. Over 24 h incubation, concentrations of <1 microg ml(-1) of Fz were bacteriostatic to the FzS strain. The FzR strain tolerated concentrations up to 16 microg ml(-1) before cell numbers diminished over the same time period. The effect on the growth rate of the FzS strain after 1 h exposure to supra-inhibitory concentrations of Fz, gave a maximum response at 32X minimum inhibitory concentration (MIC) of 4.5 h. Effects on the ultrastructure of bacterial cells by scanning electron and transmission microscopy, and DNA-specific staining with DAPI of the FzS strain exposed to nitrofurans were studied. Abnormalities such as extensive filamentation with sparse, sporadic nucleotide distribution and evidence of extrusions in the cell envelope in the form of blebs were evident.

CONCLUSIONS

Nitrofurans exert their bactericidal effect on Salmonella by inducing extensive structural alteration after exposure at sub- or suprainhibitory concentrations, involving inhibition of cell division because of the activated drug causing an intercalating type of binding in DNA.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results demonstrate the in vitro activity of the nitrofuran derivatives, furazolidone and nitrofurantoin on Salmonella, defining the pharmacodynamics and physical nature of their action as therapeutic agents.

Urinary tract infections in South Croatia: aetiology and antimicrobial resistance

The aim of this study was to determine the distribution of uropathogens isolated from outpatients living in South Croatia and the in vitro susceptibility of these organisms to antimicrobial agents. Of 5080 enrolled uropathogen isolates, 82.28% isolates were Gram-negative, the most frequent isolates being Escherichia coli (62.62%), enterococci (10.18%), Proteus mirabilis (5.31%), Streptococcus agalactiae (3.84%), Staphylococcus spp. (3.70%), Pseudomonas spp. (3.46%), Klebsiella spp. (2.38%). The E. coli resistance rate was 42.17% to amoxycillin, 20.59% to trimethoprim-sulphamethoxazole and 6.09% to norfloxacin. Almost all Klebsiella spp. isolates were resistant to amoxycillin and the resistance rate to trimethoprim-sulphamethoxazole was over 20%, and 14.15% to the fluoroquinolones. A high methicillin-resistance rate was found among S. aureus (61.22%) and coagulase negative staphylococci (41.48).

Antitumor activity of common antibiotics against superficial bladder cancer

OBJECTIVES

The recurrence rate for superficial bladder tumors treated with complete resection averages 88%. Intravesical chemotherapy decreases the recurrence rate by only 14%; thus, new chemotherapeutic agents are needed. Antibiotics are often used to prevent infections after transurethral resection of bladder tumors. Oral intake of antibiotics results in significantly greater concentrations in the urine than in the serum. Our objective was to evaluate four commonly used urinary antibiotics for their cytotoxic activity against bladder cancer cells at clinically relevant concentrations.

METHODS

Three human transitional cell carcinoma lines--HTB9 (grade 2), T24 (grade 3), and TccSup (grade 4)--were exposed to ciprofloxacin, trimethoprim-sulfamethoxazole, cefazolin, or nitrofurantoin at concentrations from 0 (control) to 1000, 1000, 5000, and 2000 microg/mL, respectively, for 96 hours. Cytotoxicity was evaluated using the MTT colorimetric assay. Six replicates were used for each data point, and the results are reported as the mean +/- standard deviation.

RESULTS

Significant cytotoxicity (P <0.001) was seen, starting at 12.5 microg/mL (HTB9, TccSup) and 50 microg/mL (T24) for ciprofloxacin, 31.25 microg/mL (HTB9, TccSup) and 62.5 microg/mL (T24) for trimethoprim-sulfamethoxazole, 19.5 microg/mL (HTB9) and 156.3 microg/mL (T24, TccSup) for cefazolin, and 7.8 microg/mL (HTB9, T24, TccSup) for nitrofurantoin. Cytotoxicity was dose dependent for all four antibiotics, and the maximal effect did not differ among antibiotics.

CONCLUSIONS

Commonly used antibiotics exhibit significant dose-dependent cytotoxicity against bladder cancer cells at concentrations achievable in the urine after oral administration. The administration of antibiotics after transurethral resection of bladder tumors might prevent seeding of cancer cells and thereby decrease the recurrence rate. Preclinical data such as these must be considered in the design of clinical trials addressing recurrence after transurethral resection of bladder tumors.

Piperitone fromMentha longifolia var.chorodictya Rech F. reduces the nitrofurantoin resistance of strains of enterobacteriaceae

The diluted essential oil of Mentha longifolia (L.) var. chlorodictya Rech F. foliage enhanced the bactericidal activity of nitrofurantoin decreasing the minimum inhibitory concentration (MIC) of nitrofurantoin for nitrofurantoin-resistant strains of Enterobacteriaceae. Thin-layer chromatography (TLC) analysis of the essential oil detected a fraction (R(f) = 0.35, UV lambda(max) of 232.5), which was the most effective in enhancement of nitrofurantoin activity. Using gas liquid chromatography and known standards, the active fraction was identified as piperitone. 1 microl of the piperitone fraction decreased the MIC of nitrofurantoin 3-20 fold for the different strains of Enterobacteriaceae tested.

[Antibiotic susceptibility analysis of Enterococcus spp. isolated from urine]

Recently increase of enterococcal infections has been observed. These bacteria, mainly Enterococcus faecalis and Enterococcus faecium are members of the normal flora of gastrointestinal tract but also are typical opportunistic pathogens. Enterococci are characterized by natural resistance to numerous antibiotics (among them cephalosporins), and also by easy acquired resistance to antibiotics. Infections caused by multiresistant strains are difficult in treatment, chronic, recurrent and sometimes fatal are described. Enterococcal infections are caused often by E. faecalis, rarely by E. faecium. In the last years other species of enterococci have been isolated from different clinical materials (E. casseliflavus, E. avium, E. durans, E. gallinarum). The aim of this study was to analyze the antibiotics susceptibility of Enterococcus spp. isolated from urine of children with urinary tract infection (UTI), hospitalized in the Upper Silesian Health Center of Child and Mother or treated ambulatory. Susceptibility of the 130 strains of E. faecalis and 41 E. faecium to: penicillin, tetracycline, high level of aminoglycoside (gentamycin 120 microg and streptomycin 300 microg), glycopeptides (vancomycin and teicoplanin), ciprofloxacin and nitrofurantoin was estimated. All isolated strains of E. faecalis (100%) were sensitive to glycopeptides (vancomycin and teicoplanin) and to nitrofurantoin, 96% strains were sensitive to penicillin, 43% to ciprofloxacin and 28% to tetracycline. All strains of E. faecium were sensitive to glycopeptides (vancomycin and teicoplanin), 32% strains were sensitive to penicillin, 19% to tetracycline 14% to ciprofloxacin and 50% to nitrofurantoin. Twenty two strains of E. faecalis (17%) and twelve strains of E. faecium (29%) were demonstrated high level resistance to aminoglycosides (HLAR). Among HLAR strains of enterococci, were observed strains of high level resistance only to streptomycin, high level resistance only to gentamycin and high level resistance to both aminoglycosides. The HLAR strains of E. faecalis and E. faecium were also resistant to other antibiotics: penicillin, tetracycline and ciprofloxacin. The most frequent cause of child urinary tract infection was E. faecalis, with high sensitivity to penicillins, glycopeptides and nitrofurantoin. The increased role of E. faecium and other strains of enterococci also has been shown. These species demonstrated sensitivity to glycopeptides, but resistance to other antibiotics, routinely used for treatment of UTI as well as to nitrofurantoin.

In vitro evaluation of a new treatment for urinary tract infections caused by nitrate-reducing bacteria

Dietary and endogenous nitrates are excreted in urine, and during infection with nitrate-reducing bacteria they are reduced to nitrite. At a low pH nitrite is converted to a variety of nitrogen oxides that are toxic to bacteria. We hypothesized that acidification of nitrite-rich infected urine would result in the killing of the nitrate-reducing bacteria. An Escherichia coli control strain and a mutant lacking nitrate reductase activity were preincubated in urine supplemented with sodium nitrate (0 to 10 mM) at pH 7.0. Then, the nitrite-containing bacterial culture was transferred (and diluted 1/10) to slightly acidic urine (pH 5 and 5.5) containing ascorbic acid (10 mM) and growth was monitored. The control strain produced nitrite in amounts related to the amount of nitrate added. This strain was killed when the culture was transferred to acidic urine. In contrast, the mutant that did not produce nitrite retained full viability. When control bacteria were grown in acidic urine with nitrate and ascorbic acid present from the start of the experiment, no inhibition of growth was noted. The MICs and minimal bactericidal concentrations of sodium nitrite-ascorbic acid in acidic urine were comparable to those of conventional antibiotics. Preincubation of nitrate-reducing E. coli in nitrate-rich urine leads to the accumulation of nitrite. Subsequent acidification of the urine results in generation of nitrogen oxides that are bactericidal. Killing, however, requires a sequential procedure in which the bacteria are first allowed to grow in a nitrate-rich neutral environment, later followed by acidification. We speculate that ingestion of nitrate followed some hours later by acidification of urine could be a new therapeutic strategy for the treatment of urinary tract infections.

Fluoroquinolones and resistance in the treatment of uncomplicated urinary tract infection

Acute uncomplicated cystitis is one of the most common problems for which young women seek medical attention. Most of these infections are caused by Escherichia coli which are susceptible to many oral antimicrobials, although resistance is increasing to some of the commonly used agents, especially trimethoprim/sulphamethoxazole (TMP/SMX). In women with risk factors for infection with resistant bacteria, or in the setting of a high prevalence of TMP/SMX resistance, a fluoroquinolone or nitrofurantoin should be considered for empirical treatment. Use of nitrofurantoin does not share cross-resistance with more commonly prescribed antimicrobials and its more widespread use is justified from a public health perspective as a fluoroquinolone-sparing agent. beta-lactams and fosfomycin should be considered second-line agents for empirical treatment of cystitis. For acute uncomplicated pyelonephritis, fluoroquinolones are superior to TMP/SMX for empirical therapy due to the relatively high prevalence of TMP/SMX resistance among uropathogens causing pyelonephritis. TMP/SMX, effective for patients with mild to moderate disease, is an appropriate drug if the uropathogen is known to be susceptible. It is reasonable to use a 7-10 day oral fluoroquinolone regimen for outpatient management of mild to moderate pyelonephritis in the setting of a susceptible causative pathogen and rapid clinical response to therapy. Most women with acute uncomplicated pyelonephritis are now managed safely and effectively as outpatients.

Increasing prevalence of antibiotic resistance and multi drug resistance among uropathogens

A study was conducted to examine the prevalence of antibiotic resistance in the strains of bacteria isolated from patients with suspected urinary tract infection. A total of 348 bacterial isolates were grown from semi quantitative urine culture and were of significant bacteriuria. The antibiotic susceptibility testing was performed on Muller-Hinton agar by disc diffusion method according to the standard criteria of the National Committee for Clinical Laboratory Standards, Antibiotic susceptibility testing revealed a high prevalence of resistance to ampicillin (55.4%) followed by nitrofurantoin (45.4%), gentamicin (45.1%), amikacin (41.4%) and co-trimoxazole (30.5%). E. coli and Klebsiella pneumonia showed 78.8 % and 75.3 % resistance to three or more drugs respectively. Cefotaxime (87.1%) appeared to be the most active antibiotic against the majority of isolates, followed by Norfloxacin (83.3%).

Proteomic approach to understanding antibiotic action

We have used proteomic technology to elucidate the complex cellular responses of Bacillus subtilis to antimicrobial compounds belonging to classical and emerging antibiotic classes. We established on two-dimensional gels a comprehensive database of cytoplasmic proteins with pIs covering a range of 4 to 7 that were synthesized during treatment with antibiotics or agents known to cause generalized cell damage. Although each antibiotic showed an individual protein expression profile, overlaps in the expression of marker proteins reflected similarities in molecular drug mechanisms, suggesting that novel compounds with unknown mechanisms of action may be classified. Indeed, one such substance, a structurally novel protein synthesis inhibitor (BAY 50-2369), could be classified as a peptidyltransferase inhibitor. These results suggest that this technique gives new insights into the bacterial response toward classical antibiotics and hints at modes of action of novel compounds. Such a method should prove useful in the process of antibiotic drug discovery.

Susceptibility of antimicrobial-resistant urinary Escherichia coli isolates to fluoroquinolones and nitrofurantoin

In vitro surveillance data from across the United States indicate that approximately 10%-20% of urinary Escherichia coli isolates from female outpatients are resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Alternative therapies for uncomplicated urinary tract infections in women include fluoroquinolones and nitrofurantoin, but the activities of these agents against TMP-SMX-resistant isolates are rarely reported. Among TMP-SMX-resistant urinary E. coli isolates tested in US laboratories from 1998 through 2001, 9.5% (5767 of 60,414) were resistant to ciprofloxacin and 1.9% (1214 of 63,817) were resistant to nitrofurantoin; 10.4% of ciprofloxacin-resistant isolates (683 of 6560) were resistant to nitrofurantoin. An association between resistance to fluoroquinolones and nitrofurantoin in E. coli has not been previously reported and warrants further study.

Prooxidant effects of nitrofurantoin

We studied the possibility of using prooxidant effects of nitrofurantoin (furadonin) for stimulation of the natural antioxidant systems for preventing myocardial damage after coronary occlusion. A pronounced cardioprotective effect of the drug was observed.

Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States

The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing > or =100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

Lysosomal oxidative stress cytotoxicity induced by nitrofurantoin redox cycling in hepatocytes

1. The enzymes responsible for the reductive activation of NFT are not known. We have now shown that under aerobic conditions, inhibitors of cytochrome P450 or P450 reductase but not DT diaphorase prevented NFT induced cytotoxicity and reactive oxygen species ("ROS") formation. This suggests that NFT was reductively activated by reduced cytochrome P450 and/or P450 reductase. 2. The subcellular organelle oxidative stress effects leading to cytotoxicity are not known. Hepatocyte mitochondrial membrane potential was only slightly decreased by NFT before cytotoxicity ensued. However NFT induced lysosomal damage and hepatocyte protease activation. Endocytosis inhibitors, lysosomotropic agents or lysosomal protease inhibitors also prevented NFT induced cytotoxicity. 3. Lipid peroxidation also preceded cytotoxicity. Furthermore desferoxamine (a ferric chelator), antioxidants or ROS scavengers (catalase, mannitol, TEMPOL or dimethylsulfoxide) prevented NFT cytotoxicity. 4. It is concluded that H2O2 reacts with lysosomal Fe(+2) to form "ROS" which causes lysosomal lipid peroxidation, membrane disruption, protease release and cell death.

Antimicrobial susceptibility of Gram-negative uropathogens isolated from obstetric patients

OBJECTIVE

To evaluate the antimicrobial susceptibility of Gram-negative uropathogens isolated from pregnant women.

METHODS

We performed a snapshot cohort study of women receiving care in the University of Florida prenatal clinics during March 2000. Subjects with asymptomatic bacteriuria or cystitis were identified and the antimicrobial susceptibility of each pathogen was recorded. Data were analyzed using chi-square, Fisher's exact test and ninety-five percent confidence intervals, as appropriate.

RESULTS

Ninety-five positive cultures were identified. Isolates were more often susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) (87%) and nitrofurantoin (89%) than to ampicillin (72%) (p < 0.03). Escherichia coli accounted for 71 (75%) cases and was more often susceptible to nitrofurantoin (100%) than to TMP-SMX (87%) (p < 0.01). Proteus isolates were all susceptible to TMP-SMX and resistant to nitrofurantoin (p < 0.01).

CONCLUSIONS

Both TMP-SMX and nitrofurantoin are superior to ampicillin for empiric treatment of lower urinary tract infection in pregnant women. Nitrofurantoin is superior to TMP-SMX for treatment of infections caused by E. coli. For suspected or confirmed cases caused by Proteus organisms, TMP-SMX is the preferred agent.

Cytogenetic analysis of peripheral blood lymphocytes of children treated with nitrofurantoin for recurrent urinary tract infection

The objective of this study was to determine whether nitrofurantoin, used for long-term antimicrobial prophylaxis of urinary tract infection, may induce chromosome aberrations (CAs) and sister chromatid exchanges (SCEs) in lymphocytes of treated children. Ninety-nine blood samples were taken from 69 children aged from 0.2 to 13 years and suffering from urinary tract infection. The treatment consisted of oral administration of nitrofurantoin at doses of 5-8 mg/kg/day for the first 7 days and at doses of 1-2 mg/kg/day for the rest of the treatment period. Blood was sampled before the start of the nitrofurantoin therapy and after 1, 3, 6 and 12 months of the therapy. Analysis of variance showed no statistically significant increase in CA and SCE frequencies in lymphocytes of children treated with nitrofurantoin for 1-12 months. However, a significant increase in SCE rates was determined in lymphocytes of those patients whose blood samples were available both before and after treatment with nitrofurantoin (6.21 +/- 0.28 and 7.30 +/- 0.39 SCE/cell, respectively, P = 0.0315, Student's paired t-test). Moreover, there was a statistically significant correlation (r = 0.6603, P = 0.0270) between cumulative dose of nitrofurantoin and SCE frequency in lymphocytes of children after 1 month of the therapy. Also, in vitro experiments indicated that nitrofurantoin was able to induce both CAs and SCEs in human lymphocytes. Positive findings with chromosome aberrations and SCEs in vitro and suggestive results with SCEs in vivo indicate that further, much larger follow-up studies are needed to elucidate the genetic safety of the therapeutic use of nitrofurantoin.

An update on the role of nitrofurans in the management of urinary tract infections

There have been few recent reviews of the nitrofurans in the literature, and none include recently available data on the use of nitrofurazone (nitrofural) in the prevention of catheter-associated urinary tract infection (CAUTI). Nitrofurazone and nitrofurantoin are the only nitrofurans that have become established in clinical use in the 20th century. These 2 nitrofurans have remained clinically useful against a wide spectrum of gram-positive and gram-negative bacteria, including many strains of common urinary tract pathogens. Today, the primary use of nitrofurantoin is as an oral antibacterial treatment for genitourinary infections. Nitrofurazone is primarily used as a topical antibacterial agent in burns and skin grafts and recently was approved for the prophylaxis of CAUTI. The recent development of a nitrofurazone-impregnated catheter as a novel modality in the prevention of CAUTI reflects a renewed interest in the effectiveness of nitrofurans. In an era when concern about bacterial resistance to many anti-infective agents is growing, the nitrofurans have continued to be active against organisms that have developed resistance to antibacterials. The presence of multiple mechanisms of action for the nitrofurans might be expected to reduce the ability of bacteria to develop resistance. Considering that an emergence of resistance to the nitrofurans has not appreciably occurred after several decades of clinical use, the nitrofurans may be unique among common antibacterial agents in this regard.

[The Dutch College of General Practitioners' guideline on urinary tract infections: response from the viewpoint of internal medicine]

In 1999 the Dutch College of General Practitioners (NHG) and the Dutch Institute for Healthcare Improvement (CBO) published revisions of their guidelines on urinary tract infections. Contrary to previous editions, the revised guidelines agree on most points, but not all. To diagnose a urinary tract infection in non-pregnant women with dysuria, the NHG guideline advises a nitrite test and a dip-slide culture if the nitrite test is negative. Although the dip-slide improves the diagnostic accuracy, a considerable number of patients have to wait at least 24 hours before therapy is given. The diagnostic approach of the CBO guideline uses only rapidly available test results, with the consequence that some women are treated despite not having an infection. The NHG guideline advocates the use of amoxicillin or nitrofurantoin for pregnant women. Amoxicillin is a questionable choice given that about 30% of isolates are resistant to it. Nitrofurantoin is in theory a correct choice. However, it is not registered for the treatment of complicated urinary tract infections. In the CBO guideline amoxicillin-clavulanic acid is considered to be sufficiently safe for the treatment of pregnant women because most urinary tract infections occur after the first trimester.

The establishment of conditions to efficiently screen photosynthesis-deficient mutants of Synechocystis sp. PCC 6803 by nitrofurantoin treatment

A method based on the susceptibility of photosynthetic organisms to nitrofurantoin under illumination was established to screen mutants of Synechocystis sp. PCC 6803 deficient in the function of photosystem II, which were created by random PCR mutagenesis targeted to the psbAII gene coding for the D1 protein of the photosystem II reaction center. In this method, cyanobacterial colonies on a nitrocellulose membrane on a BG11 agar plate were treated with nitrofurantoin at 1.0 mM under white light at 40 microE x m(-2 ) x s(-1) for 2 h, and then kept under normal conditions without nitrofurantoin so that surviving cells could grow. This method was also shown to be useful for screening mutants deficient in the function of photosystem I.

Nitrofurantoin quadruple therapy for Helicobacter pylori infection: effect of metronidazole resistance

BACKGROUND

Antibiotic resistance has increasingly been recognized as the major cause of treatment failure for Helicobacter pylori infection. New therapies for patients with metronidazole- or clarithromycin-resistant H. pylori are needed.

AIM

To investigate the role of nitrofurantoin quadruple therapy for the treatment of H. pylori.

METHODS

Patients with confirmed H. pylori infection received nitrofurantoin (100 mg t.d.s.), omeprazole (20 mg b.d.), Pepto-Bismol (two tablets t.d.s.), and tetracycline (500 mg t.d.s.) for 14 days. Four or more weeks after the end of therapy, outcome was assessed by repeat endoscopy with histology and culture or urea breath testing.

RESULTS

Thirty patients were entered, including 25 men and five women; the mean age was 54.9 years. The most common diagnoses were duodenal ulcer (23%) and GERD (18%). The intention-to-treat cure rate was 70% (95% CI: 50.6-85%). Nitrofurantoin quadruple therapy was more effective with metronidazole-sensitive strains (88%; 15 out of 17) than with metronidazole-resistant strains (33%; three out of nine; P=0.008). Two of the treatment failures had pre-treatment isolates susceptible to metronidazole, which were resistant after therapy.

CONCLUSIONS

Because nitrofurantoin quadruple therapy performed inadequately in the presence of metronidazole resistance, we conclude that nitrofurantoin is unlikely to find clinical utility for the eradication of H. pylori.

Furazolidone- and nitrofurantoin-resistant Helicobacter pylori: prevalence and role of genes involved in metronidazole resistance

The prevalence of furazolidone, nitrofurantoin, and metronidazole resistance among Helicobacter pylori strains was assessed with 431 clinical isolates. Fifty-two percent were metronidazole resistant, compared to 2% (7 of 431) with resistance to furazolidone and nitrofurantoin. All seven furazolidone- and nitrofurantoin-resistant isolates were also metronidazole resistant. rdxA, frxA, and fdxB knockouts did not result in furazolidone or nitrofurantoin resistance. These data suggest that furazolidone and nitrofurantoin may be good alternatives to metronidazole for treating H. pylori infection.

Nitrofurantoin is active against vancomycin-resistant enterococci

The activity of nitrofurantoin was tested against 300 isolates of Enterococcus faecium, Enterococcus faecalis, and Enterococcus gallinarum. No isolates tested were resistant to nitrofurantoin (MIC, >/=128 microg/ml), including vancomycin-resistant E. faecium isolates with vanA- and vanB-positive genotypes and vancomycin-resistant E. gallinarum isolates. We conclude that nitrofurantoin may provide effective treatment of urinary tract infections caused by vancomycin-resistant enterococci.

Bactericidal activity of nitrofurans against growing and dormant Mycobacterium bovis BCG

Depletion of oxygen triggers the shift-down of Mycobacterium bovis BCG to a state of dormancy. Bacilli in their dormant state are resistant to standard anti-mycobacterials. The nitroimidazole metronidazole was the first compound identified to show bactericidal activity against dormant tubercle bacilli. In contrast to metronidazole's selective toxicity for dormant bacilli, we report here that the nitrofurans nitrofurantoin, furaltadone and nitrofurazone showed bactericidal activity against dormant and growing bacteria. Importantly, the bactericidal effect of nitrofurans on dormant bacilli was 35- to 250-fold higher compared with metronidazole.

Increasing resistance to fluoroquinolones in escherichia coli from urinary tract infections in the netherlands

In continuous surveillance of routine samples from five Dutch laboratories, we studied resistance to the antibiotics most commonly prescribed for urinary tract infections (UTI) in The Netherlands, namely norfloxacin, amoxycillin, trimethoprim and nitrofurantoin, from 1989 to 1998 in >90000 Escherichia coli isolates. Resistance to norfloxacin increased from 1.3% in 1989 to 5.8% in 1998. Multiresistance, defined as resistance to norfloxacin and at least two of the other three antibiotics, increased from 0.5% in 1989 to 4. 0% in 1998. Multivariate analysis of the norfloxacin resistance demonstrated that this yearly increase (the odds ratio was 1.0 in 1989, 1.6 in 1992, 2.9 in 1995 and 6.1 in 1998) was independent of other determinants of resistance to norfloxacin, such as age, gender and origin of the isolate. Analysis of strata, classified by year, age and gender, demonstrated an association between prescription of fluoroquinolones (defined daily doses per case of UTI) and resistance to norfloxacin in E. coli (P < 0.001). There was no significant association with the prescription of nitrofuran derivatives (nitrofurantoin) and trimethoprim with or without sulphamethoxazole. The yearly increase of resistance to fluoroquinolones in E. coli from UTI may stem from increased prescription of fluoroquinolones for UTI. Resistance of E. coli to these agents is likely to increase further as fluoroquinolone use increases in future.

[Nitrofurans: a modern treatment for uncomplicated urinary infections?]

From January 1995 to December 1998, 2,912 strains of enteric bacilli were isolated from the urinary tract. Increasing antibiotic resistance in Enterobacteriaceae as a cause of urinary tract infection (UTI) led us to reevaluate first- and second-line therapies. We studied antimicrobial susceptibilities of these strains to norfloxacin (NOR), nalidixic acid (NAL), trimethoprim sulfamethoxazole (TS) and nitrofurantoin (FT) using the disk diffusion method. These results show no significant superiority of the activity of nitrofurantoin against Enterobacteriaceae compared with the other antibiotics with sustained concentration in urine. However, if we consider only multiresistant Enterobacteriaceae (cefotaxime resistant), this molecule appears to be very active. These results show a significant superiority of nitrofurantoin in vitro against these multiresistant Enterobacteriaceae. Thus, this molecule could once again become a good choice for the treatment of uncomplicated UTI.

A novel NADPH:diamide oxidoreductase activity in arabidopsis thaliana P1 zeta-crystallin

The zeta-crystallin (ZCr) gene P1 of Arabidopsis thaliana, known to confer tolerance toward the oxidizing drug 1,1'-azobis(N, N-dimethylformamide) (diamide) to yeast [Babiychuk, E., Kushnir, S., Belles-Boix, E., Van Montagu, M. & Inzé, D. (1995) J. Biol. Chem. 270, 26224], was expressed in Escherichia coli to characterize biochemical properties of the P1-zeta-crystallin (P1-ZCr). Recombinant P1-ZCr, a noncovalent dimer, showed NADPH:quinone oxidoreductase activity with specificity to quinones similar to that of guinea-pig ZCr. P1-ZCr also catalyzed the divalent reduction of diamide to 1,2-bis(N,N-dimethylcarbamoyl)hydrazine, with a kcat comparable with that for quinones. Two other azodicarbonyl compounds also served as substrates of P1-ZCr. Guinea-pig ZCr, however, did not catalyze the azodicarbonyl reduction. Hence, plant ZCr is distinct from mammalian ZCr, and can be referred to as NADPH:azodicarbonyl/quinone reductase. The quinone-reducing reaction was accompanied by radical chain reactions to produce superoxide radicals, while the azodicarbonyl-reducing reaction was not. Specificity to NADPH, as judged by kcat/Km, was > 1000-fold higher than that to NADH both for quinones and diamide. N-Ethylmaleimide and p-chloromercuribenzoic acid inhibited both quinone-reducing and diamide-reducing activities. Both NADPH and NADP+ suppressed the inhibition, but NADH did not, suggesting that sulfhydryl groups reside in the binding site for the phosphate group on the adenosine moiety of NADPH. The diamide-reducing activity of P1-ZCr accounts for the tolerance of P1-overexpressing yeast to diamide. Other possible physiological functions of P1-ZCr in plants are discussed.

Statistical modeling and analyses of a base-specific Salmonella mutagenicity assay

Statistical features of a base-specific Salmonella mutagenicity assay are considered in detail, following up on a previous report comparing responses of base-specific Salmonella (Ames II) strains with those of traditional tester strains. In addition to using different Salmonella strains, the new procedure also differs in that it is performed as a microwell fluctuation test, as opposed to the standard plate or preincubation test. This report describes the statistical modeling of data obtained from the use of these new strains in the microwell test procedure. We emphasize how to assess any significant interactions between replicate cultures and exposure doses, and how to identify a significant increase in the mutagenic response to a series of concentrations of a test substance.

A Canadian national surveillance study of urinary tract isolates from outpatients: comparison of the activities of trimethoprim-sulfamethoxazole, ampicillin, mecillinam, nitrofurantoin, and ciprofloxacin. The Canadian Urinary Isolate Study Group

Ampicillin, trimethoprim-sulfamethoxazole, mecillinam, nitrofurantoin, and ciprofloxacin mean resistance rates for 2,000 urinary tract isolates collected from outpatients across Canada in 1998 were 41.1, 19.2, 14.7, 5.0, and 1.8%, respectively. For Escherichia coli isolates alone (n = 1,681) comparable rates were 41. 0, 18.9, 7.4, 0.1, and 1.2%, respectively. The majority of E. coli isolates resistant to ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin were susceptible (MIC, <16 microg/ml) to mecillinam.

Antimicrobial resistance patterns in urinary isolates from nursing home residents. Fifteen years of data reviewed

The antibiotic resistance patterns of gram-negative bacteria isolated from nursing home patients between 1983 and 1997 were analysed. Escherichia coli was the most prevalent isolate (48%) followed by Proteus spp. (26%) and other Enterobacteriaceae (20%). During the study period, the susceptibility of E. coli decreased for co-trimoxazole (79% to 62%), increased for nitrofurantoin (79% to 91%) and remained unchanged for amoxycillin (41%). Susceptibility to norfloxacin, available from 1990, decreased from 87% to 71%. Similar trends were observed when the susceptibilities of all gram-negative urinary pathogens were combined. The changes in susceptibility can probably be attributed to the empirical prescribing practices in the nursing homes studied.

Mechanisms of resistance to ampicillin, chloramphenicol and quinolones in multiresistant Salmonella typhimurium strains isolated from fish

Mechanisms of antibiotic resistance and epidemiological relationships were investigated for five multiresistant strains of Salmonella typhimurium isolated from fish in India. Four strains showed resistance to nalidixic acid, chloramphenicol, tetracycline, co-trimoxazole, gentamicin and beta-lactam antibiotics. The remaining strain was susceptible to all beta-lactam antibiotics tested and to co-trimoxazole but resistant to the other antibiotics tested. Epidemiological analysis performed by REP-PCR showed that the five isolates belonged to the same clone. Resistance to nalidixic acid was related to a single mutation in the gyrA gene. Chloramphenicol resistance was related to the production of chloramphenicol acetyl-transferase. An OXA-1 beta-lactamase, located in an integron, was responsible for resistance to ampicillin. These results indicate the health hazard posed by the fact that S. typhimurium may acquire or develop several mechanisms of resistance to a variety of antibiotics, including quinolones, and can thus cause disease in humans which may be difficult to treat.

In-vitro evaluation of nitrofurantoin as an alternative agent for metronidazole in combination antimicrobial therapy against Helicobacter pylori

Increasing metronidazole resistance suggests the need for alternative antibiotics for combination therapy of Helicobacter pylori infections. We evaluated a metronidazole-resistant and a clarithromycin-resistant strain of H. pylori under stationary growth phase conditions that favoured physiological conditions in order to determine if nitrofurantoin might be a suitable alternative for metronidazole in combination therapy. The results demonstrated that the triple combination of bismuth, tetracycline and nitrofurantoin achieved greater bactericidal activity against these two strains than did the combination of bismuth, tetracycline and metronidazole. These results suggest that further evaluation is warranted.

Mecillinam activity compared to ampicillin, trimethoprim/sulfamethoxazole, ciprofloxacin and nitrofurantoin against urinary tract isolates of gram-negative bacilli

Recent Canadian, American and European studies have reported increased ampicillin and trimethoprim/sulfamethoxazole resistance among urinary tract isolates of Escherichia coli. This trend suggests that a reevaluation of first- and second-line therapies for the treatment of community-acquired urinary tract infections is necessary. Mecillinam, a beta-lactam with preferential activity against gram-negative penicillin binding protein 2 (unlike other beta-lactams which preferentially bind gram-negative penicillin binding proteins 1a, 1b or 3), may offer clinically significant activity against ampicillin-resistant and trimethoprim/sulfamethoxazole-resistant E. coli. To test this assertion, the activity of mecillinam was compared with ampicillin, trimethoprim/sulfamethoxazole, nitrofurantoin and ciprofloxacin against 258 consecutive gram-negative urinary tract isolates collected at a Canadian tertiary care hospital. Mecillinam demonstrated significantly better activity than ampicillin and trimethoprim/sulfamethoxazole and significantly less activity than ciprofloxacin and nitrofurantoin against the 258 isolates tested. Against E. coli isolates specifically, mecillinam was significantly more active than ampicillin and trimethoprim/sulfamethoxazole (p < 0. 001) and as active as ciprofloxacin and nitrofurantoin. Mecillinam was active against 91.9% of ampicillin-resistant E. coli and 95.9% of trimethoprim/sulfamethoxazole-resistant E. coli. We conclude that mecillinam should be reevaluated for potential use in the treatment of community-acquired urinary tract infections.

A novel, selective synthetic acetamide containing culture medium for isolating Pseudomonas aeruginosa from milk

A selective synthetic medium has been developed both in liquid (Z-broth) and solid (Z-agar) forms for selective isolation of Pseudomonas aeruginosa from foods. The simple, easy to prepare peptone-free synthetic medium contained acetamide that is metabolized to ammonia and acetic acid providing nitrogen and carbon supply. The medium contained no inhibitors. Selectivity of the liquid medium was tested by inoculation of pure cultures of different bacteria belonging to the groups Bacillus, Pseudomonas, Enterobacteriaceae and Staphylococcus. It was found that the selectivity of the medium was complete for the examined range of bacteria. However, a similar result was obtained when nitrofurantoin broth was used. Applicability of the synthetic agar medium was also tested by a nation-wide inter-laboratory test using two milk samples containing 10(3)/ml (sample I) and 10(5)/ml (sample II) Pseudomonas aeruginosa. According to this test, no microbiologically relevant differences were found between the results obtained by Z-agar and cetrimide-agar a frequently used selective agar in case of sample II. However, a relevant and statistically significant difference was found in the results of sample I in favour of the Z-agar, that could indicate the presence of a low number of bacteria. Concerning repeatability and reproducibility, Z-agar proved to be superior to cetrimide agar.

Asymptomatic bacteriuria in pregnancy: epidemiological, clinical and microbiological approach

Asymptomatic urinary tract infection is a risk factor for fetal and maternal morbidity including development of pyelonephritis, premature labor and impaired intra-uterine development. In this study, 326 pregnant and 100 non-pregnant control women were screened for significant asymptomatic bacteriuria from April 8 to July 25, 1997 to gain insight into the prevalence rate, clinical characteristics of the disease and microbiological assessments of the causative agents. All the subjects were clinically identified to have no signs and symptoms of urinary tract infection (UTI). The age ranges of the study and control groups were between 15-40 years for both groups with mean of 25.1 and 25.3 years, respectively. Bacteriological screening of mid-stream urine (MSU) revealed that 24/326 (7%) and 3/100 (3%) were positive for asymptomatic bacteriuria in the study group and controls, respectively (P < 0.05). Further biochemical species identification showed that Escherichia coli was found in 11/24 (46%) followed by coagulase-negative staphylococci (CNS) in 8/24 (33%) and Citrobacter freundii in 2/24 (8%). Others found in smaller number included Staphylococcus aureus, Enterobacter cloacae and Proteus rettgeri in 1/24 (4%) each. Antimicrobial susceptibility test revealed that 10/11 (91%) of the E. coli isolates were resistant to ampicillin and amoxicillin and 10/11 (91%) of them sensitive to nitrofurantoin.