Comparative in vitro activities of teicoplanin, vancomycin, oxacillin, and other antimicrobial agents against bacteremic isolates of gram-positive cocci

The in vitro activities of teicoplanin and vancomycin were compared with those of six other antimicrobial agents against 460 bacteremic isolates of gram-positive cocci. Teicoplanin was as active as vancomycin but less active than ciprofloxacin against staphylococci. Teicoplanin was the most potent of all agents tested against enterococci and had excellent activity against pneumococci.

Comparative in vitro susceptibilities of 504 bacteremic isolates to ticarcillin plus clavulanic acid and other antimicrobial agents

A total of 504 clinical bacteremic isolates were tested for susceptibility to ticarcillin-clavulanic acid and 12 other antibiotics. Ticarcillin-clavulanic acid showed superior antibacterial activity compared to penicillin, mezlocillin, piperacillin, ticarcillin, gentamicin, and amikacin against bacteremic isolates of methicillin-susceptible Staphylococcus aureus and Staphylococcus epidermidis. However, ticarcillin-clavulanic acid's activity was inferior to that of vancomycin against methicillin-resistant isolates of S. aureus and S. epidermidis. For Escherichia coli, Klebsiella oxytoca, Proteus mirabilis, Providencia stuartii, and lactose nonfermenting aerobic gram-negative bacilli, the activity of ticarcillin-clavulanic acid surpassed that of mezlocillin, piperacillin, and ticarcillin. Of the antimicrobial agents tested, ticarcillin, piperacillin, ceftazidime, and amikacin were the most active antibiotics against Pseudomonas aeruginosa.

Neisseria meningitidis and Moraxella osloensis: dual infection in blood and peritoneal fluid

The clinical course of a malnourished alcoholic in which Neisseria meningitidis was isolated from the blood and Moraxella osloensis from the peritoneal fluid is described. Following bacteriologic diagnosis, the patient was treated and responded to a course of penicillin therapy. To our knowledge, this represents the first case of peritonitis associated with M. osloensis. Clinical reports of the isolation of this organism are rare; its pathogenicity is not clearly established, and the presence of the organism may often be unrecognized.

Long-term evaluation of the hepatitis B vaccine (Heptavax-B) in hemodialysis patients

Hemodialysis patients were screened for hepatitis B surface antibody (anti-HBs) prior to immunization at two teaching hospitals. Thirty-one of 111 patients (28%) had baseline sera positive for anti-HBs, while anti-HBs was found in 30 of 420 (7.1%) health care employees (P less than 0.001). A total of 72 hemodialysis patients (mean age, 55.7), received the hepatitis B vaccine (Heptavax-B, Merck Sharp & Dohme, West Point, PA). The responder rates (34 of 72; 47%) and nonresponder (38 of 72; 53%) rates were similar to previous reports. Neither age (P greater than 0.05) nor injection site (P greater than 0.05) appeared to influence results. Nonresponders (16 of 17; 94%) who were given a fourth vaccine dose also failed to mount an antibody response. Of the 34 responders, 18 were followed by serial anti-HBs determinations. Seven transient responders (7 of 18; 39%) were identified, and anti-HBs fell below 10 S/N (sample/control counts per minute) within 12 to 15 months of the first vaccine dose. A fourth dose was administered to this group and it extended the presence of serum anti-HBs (S/N greater than or equal to 10) in four of six patients for another 2, 8, 10, and 15 months, respectively. Antibody persisted but declined over the study period in the remainder of responders followed serially (11 of 18; 61%). When compared with those responders who lost anti-HBs, those with persistent antibody had higher anti-HBs values at 7 (P less than 0.02) and 12 months (P less than 0.005) after the first injection, and were younger (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Laboratory indices of clinical peritonitis: total leukocyte count, microscopy, and microbiologic culture of peritoneal dialysis effluent

Total leukocyte count, microscopy, and conventional bacteriologic culture (10-ml sediment) of dialysis effluent were assessed for their ability to detect peritonitis in patients on peritoneal dialysis. A total of 73 patients were surveyed over a 17-month period. Laboratory findings included an examination of 1,774 dialysate samples and culture results from blood, wounds, indwelling catheters, and other specimens. Of 90 peritonitis events, 72 were culture positive. Gram-stained films were positive in no more than 14% of the dialysates collected during periods of clinical peritonitis. Factors which adversely affected the microscopic or cultural detection of microorganisms in effluent included the concentration of organisms in dialysate, antibiotic therapy, and growth medium used. Seeding of the peritoneum with organisms originating from other sites of infection or colonization was documented, although infrequent, yet bacteremia secondary to peritonitis was not seen. Because of the frequent isolation of microorganisms from dialysates in the absence of clinical peritonitis, culture-positive findings were a poor predictor of peritonitis without other evidence of infection. Detection of peritonitis by total leukocyte count (without a differential count) of dialysate specimens was adversely affected by the overlap in cell counts between dialysates collected either during or in the absence of peritonitis. This was attributed in part to nonspecific increases in dialysate cell count in the absence of peritonitis and was associated with intermittent dialysis and extraperitoneal infection.

Evaluation of HLA-DR typing by ethidium bromide fluorescence

Sixty individuals were typed for D-related human leukocyte antigens (HLA-DR) using two methods: the standard eosin exclusion method and a recently described one-color ethidium bromide technique. As a result, 88 of the 90 DR antigens detected by the standard technique were also detected by one-color fluorescence (sensitivity = 97.8 percent). However, of the 99 DR antigens identified by ethidium bromide fluorescence, 11 were left undetected by eosin exclusion (sensitivity = 88.9 percent). The one-color ethidium bromide fluorescence technique, although originally intended to conserve technical time, demonstrated an additional advantage in our laboratory. The enhanced sensitivity of the procedure may help in the identification of previously undetected DR antigens.

Septicemia due to DF-2. Cause of a false-positive cryptococcal latex agglutination result

A previously healthy 26-year-old man presented with fever, headache, skin rash, and thrombocytopenia. Cultures of blood and cerebrospinal fluid yielded a fastidious gram-negative bacillus, identified as DF-2. A unique feature of this case was the presence of a false-positive latex agglutination result for cryptococcal antigen in the cerebrospinal fluid in the absence of pleocytosis. Additional laboratory studies, which included indirect immunofluorescence and sodium dodecyl sulfate-polyacrylamide gel electrophoresis, however, failed to reveal common antigenic surface components between these organisms.

Staphylococcal peritonitis in patients on continuous peritoneal dialysis

During 1984, 35 patients undergoing continuous peritoneal dialysis experienced 77 cases of peritonitis with 55 cases (71.4%) related to staphylococci. Coagulase-negative staphylococci were isolated in 41 cases, while Staphylococcus aureus was found in 14. A coexisting tunnel infection was more often associated with S. aureus (7/14) than with coagulase-negative staphylococci (2/41) (P less than 0.01). Likewise, eradication of the infection necessitated catheter removal more frequently with S. aureus (5/14) than with coagulase-negative staphylococci (2/41) (P less than 0.01). Of the 41 coagulase-negative staphylococci, 35 were characterized as to species, adherence, and production of two exopolysaccharides. Staphylococcus epidermidis was the most frequent coagulase-negative species (29/35). Peritonitis cases caused by coagulase-negative staphylococci that lacked adherence and exopolysaccharides were more frequently associated with complications (4/6) than were those organisms with either or both properties of adherence or exopolysaccharide production (5/29). There were no appreciable differences in antibiotic susceptibilities. Staphylococcal peritonitis remains a significant cause of morbidity in continuous peritoneal dialysis patients. The incidence of complications was not directly linked to staphylococcal properties of adherence or exopolysaccharide production.

Pathophysiology of primary meningococcal pericarditis associated with Neisseria meningitidis group C. A case report and review of the literature

Pericarditis associated with Neisseria meningitidis in the absence of meningitis or meningococcemia is an extremely rare event. We report herein a case of a 59-yr-old woman with primary meningococcal pericarditis caused by Neisseria meningitidis group C. The patient responded to a course of penicillin therapy and recovery was uncomplicated. The pathophysiologic features underlying or contributing to the disease are discussed and the pertinent literature is reviewed.

Addi-Chek filtration, BACTEC, and 10-ml culture methods for recovery of microorganisms from dialysis effluent during episodes of peritonitis

The Addi-Chek (filtration; Millipore Corp., Bedford, Mass.) and BACTEC (radiometric detection of growth in culture media; Johnston Laboratories, Inc., Towson, Md.) systems were compared with the 10-ml culture (centrifugation) method for the recovery of microorganisms from peritoneal dialysate collected from patients with clinical evidence of peritonitis and containing greater than or equal to 200 leukocytes per mm3. Both alternate methods were comparable, and results were not significantly different from those of the conventional 10-ml culture method. All systems were adversely affected in their capacity to recover organisms when dialysates had been collected during periods of antimicrobial therapy.

Application of bioluminescent urine screens in a tertiary care facility

Two adenosine triphosphate (ATP)-detection systems for quantitating bacteriuria, the LUMAC (noncentrifugation method) and MONOLIGHT (centrifugation method) urine screens, were separately evaluated for their capacity to detect bacteriuria in specimens from patients at a tertiary care teaching hospital. Results of each study were compared with the findings of conventional culture. Indices of test efficacy, sensitivity/predictive value for a negative test, were as follows: at greater than or equal to 10(4) CFU/ml--LUMAC 88%/93% and MONOLIGHT 82%/88%; and at greater than or equal to 10(5) CFU/ml--LUMAC 99%/99% and MONOLIGHT 97%/99%. Both systems were satisfactory urine screens for catheterized and midstream urine specimens when used at the traditional level of significance (greater than or equal to 10(5) CFU/ml). An assessment of the MONOLIGHT noncentrifugation protocol demonstrated efficacy of the system to detect significant bacteriuria at greater than or equal to 10(5) CFU/ml. Decreased numbers of false-positive results compared to the centrifugation method were obtained with this assay. False-positive and false-negative results were attributable to threshold sensitivity of the instruments. The presence of somatic cells and yeasts were associated with false-positive results. False-positive results might stem from the inability of conventional culture to recover selected microorganisms. Time and cost analyses of the LUMAC system indicated that significant savings over conventional methodology were not effected.

Leukocyte esterase-nitrite and bioluminescence assays as urine screens

The 1-min leukocyte esterase (LE)-nitrite test (Chemstrip 9; Biodynamics, Division of Boehringer Mannheim Biochemicals, Indianapolis, Ind.) and a bioluminescence assay (Monolight centrifugation method; Analytical Luminescence Laboratory, Inc., San Diego, Calif.) were tested for their efficacy as urine screens among 453 patients at a tertiary-care teaching hospital. Both methods had the capacity to exclude significant bacteriuria (greater than or equal to 10(5) CFU/ml) when compared with the results of conventional culture methods, with predictive values of 99 and 93%, respectively, for a negative test. Bioluminescence was the more accurate nonculture method used. Sensitivity and specificity values were 97 and 71%, respectively, for bioluminescence, 82 and 60%, respectively, for LE with nitrite, and 72 and 64%, respectively, for LE without nitrite. At reduced levels of bacteriuria less than 10(5) CFU/ml), the sensitivities of LE-nitrite and bioluminescence were decreased but comparable. The addition of protein and blood test results in the Chemstrip 9, along with LE-nitrite as bacteriuria indicators, were unsatisfactory because of the large numbers of false-positive results attributed to protein and blood determinations. LE activity as detected by the LE test was a poor predictor of significant bacteriuria in both male and female patients. The sensitivity (71%) and specificity (57%) of the LE test in male patients were significantly lower than those previously reported and varied with the patient population studied.

Staphylococcus simulans septicemia in a patient with chronic osteomyelitis and pyarthrosis

Staphylococcus simulans was identified as the etiological agent of osteomyelitis and septic arthritis in an adult male who had sustained a fracture of the fibula and syndesmosis separation which required the installation of orthopedic hardware. Identifying characteristics and antibiograms for this organism, recovered from blood, wound exudate, and deep tissue samples, were determined. Recent evidence has linked slime production (adherence to smooth surfaces) by coagulase-negative staphylococci to infections by these organisms at sites where foreign bodies had been inserted. Tests for adherence showed this S. simulans strain to be a strong slime producer. This is the first reported case of osteomyelitis and septicemia due to S. simulans.

Modified enzyme immunoassay for detecting Neisseria gonorrhoeae antigens

A commercial modification of an enzyme immunoassay (EIA) (Gonozyme; Abbott Laboratories, North Chicago, Ill.) for detection of Neisseria gonorrhoeae antigens was compared with conventional culturing. Specimens from males and females were collected at a sexually transmitted disease clinic; additional female specimens were collected at an obstetrics and gynecology clinic. EIA sensitivity and specificity for males were 100 and 98.6%, respectively (68 negative, 34 positive, 1 false-positive, and 0 false-negative). EIA sensitivity and specificity for female sexually transmitted disease clinic patients were 74.4 and 95.7%, respectively (66 negative, 29 positive, 3 false-positive, and 10 false-negative) EIA sensitivity and specificity for obstetrics and gynecology clinic patients were 100 and 99.2%, respectively (6 positive, 119 negative, 1 false-positive, and 0 false-negative). In female patients from whom multiple swab specimens were collected, the sequence of specimen collection and subsequent EIA analysis affected sensitivity.

Recovery of Salmonella group B from blood and Salmonella group C2 from feces and serological evidence of dual infection in one patient

A patient with a dual Salmonella infection is described. Salmonella group B was recovered from three blood culture sets but was not detected in seven stool cultures. Salmonella group C2 was isolated from three of seven stool cultures but was not recovered from blood cultures. Specific, non-cross-reactive antibodies to Salmonella groups B and C2 were detected in the sera of the patient by passive hemagglutination assays.

Validity of an enzyme immunoassay for detection of Neisseria gonorrhoeae antigens

An enzyme immunoassay (EIA; Gonozyme, Abbott Laboratories) for the antigenic detection of Neisseria gonorrhoeae in endocervical or urethral specimens was evaluated. EIA results were compared with results of conventional culture tests for N. gonorrhoeae. Specimens from 208 males (113 culture positive) and 252 females (72 culture positive) were tested. The sensitivity and specificity of EIA for specimens from males were 97.3 and 95.8%, respectively. The sensitivity and specificity of EIA for specimens from females were 79.2 and 87.2%, respectively.

Superiority of hypertonic culture medium for detection of Haemophilus influenzae by the BACTEC procedure

A comparison of hypertonic (sucrose), aerobic, and anaerobic media for the detection of eight recent clinical isolates of Haemophilus influenzae type b by the BACTEC procedure revealed that the hypertonic medium, without exception, yielded diagnostic growth index values of 30 or above from 4 to 24 h earlier than did the other media. This culture medium was also superior when an increase in growth index units of 10, before a value of 30 was reached, was taken as a criterion. The number of colony-forming units increased more rapidly in the hypertonic medium as compared with the other media. These results, together with limited observations on blood cultures from patients, suggest that the sucrose medium may permit earlier detection of H. influenzae bacteremia than the aerobic medium, particularly since a growth index of 20 rather than 30 is used for the indication of bacterial growth.

The effect of Pseudomonas aeruginosa on the immunogenicity of enterobacterial common antigen

Pseudomonas aeruginosa produces a factor (PF) which alters the enterobacterial common antigen (ECA). Its effect on the immunogenicity of two types of immunogenic ECA, namely, the ethanol-soluble preparation freed of lipopolysaccharide and the LPS-coupled form from the R-mutant E. coli 014 was investigated. The antibody response following intravenous immunization was determined by means of the hemagglutination test. It is shown that PF abolishes the immunogenicity of the former but not of the latter. PF obtained from a strain of P. maltophilia yielded the same results. Antiserum against Pseudomonas aeruginosa of types 1 and 6 neutralizes PF produced by either type. These results suggest that PF alters the lipid part and not the haptenic determinant of ECA and that this activity is neutralized by P. aeruginosa antiserum of either type 1 or type 6. This interpretation is compatible with the identification of PF as a lipase.