601
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Aguirre M, Collins MD. Lactic acid bacteria and human clinical infection. THE JOURNAL OF APPLIED BACTERIOLOGY 1993; 75:95-107. [PMID: 8407678 DOI: 10.1111/j.1365-2672.1993.tb02753.x] [Citation(s) in RCA: 256] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M Aguirre
- Department of Microbiology, AFRC Institute of Food Research, Reading, UK
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602
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Sanyal D, Williams AJ, Johnson AP, George RC. The emergence of vancomycin resistance in renal dialysis. J Hosp Infect 1993; 24:167-73. [PMID: 8104207 DOI: 10.1016/0195-6701(93)90046-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Intraperitoneal vancomycin is used in the treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We describe the emergence of low-level glycopeptide-resistance in five Gram-positive species over a one-year period. Isolation of these organisms was associated with vancomycin treatment failure in four patients who had had numerous episodes of peritonitis. Clinicians and microbiologists should be aware that repeated administration of glycopeptides to such patients might lead to the emergence of organisms resistant to these antibiotics.
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Affiliation(s)
- D Sanyal
- Public Health Laboratory, Northern General Hospital, Sheffield
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603
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Green M, Binczewski B, Pasculle AW, Edmund M, Barbadora K, Kusne S, Shlaes DM. Constitutively vancomycin-resistant Enterococcus faecium resistant to synergistic beta-lactam combinations. Antimicrob Agents Chemother 1993; 37:1238-42. [PMID: 8328775 PMCID: PMC187946 DOI: 10.1128/aac.37.6.1238] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Vancomycin resistance among enterococci has recently been recognized. Synergy between vancomycin and penicillin has been shown in vitro for isolates of Enterococcus faecium resistant to both of these antibiotics. We describe three isolates of vancomycin-resistant E. faecium which demonstrate unique phenotypic characteristics. The isolates exhibited high-level resistance to both vancomycin and teicoplanin, consistent with the VanA phenotype. However, resistance in these isolates could not be induced or cured, and mating experiments failed to detect a transfer of resistance. The combination of vancomycin and penicillin did not significantly change the MIC of penicillin for any of the three isolates. Immunoblotting with polyclonal anti-VanB antibody showed no reaction with the cellular proteins of these strains. Probing with a vanA oligonucleotide revealed hybridization with chromosomal but not plasmid DNA. The mechanism of constitutive resistance of those strains remains unclear. A second mutational change, perhaps involving PBP 5, may explain the presence of resistance to synergistic combination penicillin-vancomycin therapy. In vitro evaluation of penicillin-vancomycin should be carried out in all clinical cases where this therapeutic regimen is being considered.
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Affiliation(s)
- M Green
- Department of Medicine, Children's Hospital of Pittsburgh, Pennsylvania
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604
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Guiney M, Urwin G. Frequency and antimicrobial susceptibility of clinical isolates of enterococci. Eur J Clin Microbiol Infect Dis 1993; 12:362-6. [PMID: 8354304 DOI: 10.1007/bf01964435] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A study was performed to determine the frequency and antimicrobial susceptibility of Enterococcus species in clinical specimens. Of 943 aesculin-positive isolates, 873 (92%) were identified as enterococci (737 Enterococcus faecalis, 129 Enterococcus faecium and 7 other Enterococcus species). High-level resistance to gentamicin was found in 15.2% of Enterococcus faecalis, but not in Enterococcus faecium; 58% of Enterococcus faecium were resistant to gentamicin at a concentration of 64 mg/l. None of the isolates were shown to possess vancomycin resistance.
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Affiliation(s)
- M Guiney
- Department of Medical Microbiology, Royal London Hospital Trust, Whitechapel, UK
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605
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Venditti M, Tarasi A, Gelfusa V, Nicastri E, Penni A, Martino P. Antimicrobial susceptibilities of enterococci isolated from hospitalized patients. Antimicrob Agents Chemother 1993; 37:1190-2. [PMID: 8517714 PMCID: PMC187931 DOI: 10.1128/aac.37.5.1190] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
One hundred and one isolates of Enterococcus species isolated recently from hospitalized patients were evaluated in vitro for antibiotic susceptibility. Teicoplanin and mideplanin were the most active agents, followed by ramoplanin, vancomycin, ciprofloxacin, ampicillin, and imipenem. High-level resistance to gentamicin (MIC > 500 micrograms/ml) and/or streptomycin (MIC > 2,000 micrograms/ml) was found in 60 isolates. High-level resistance to ampicillin (MIC > or = 16 micrograms/ml) was found in 17 isolates. MBC studies revealed that ramoplanin possesses significant bactericidal activity.
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Affiliation(s)
- M Venditti
- Servizio Aggregato di Consulenze Infettivologiche, Policlinico Umberto I, Rome, Italy
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606
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Boyle JF, Soumakis SA, Rendo A, Herrington JA, Gianarkis DG, Thurberg BE, Painter BG. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993; 31:1280-5. [PMID: 8501230 PMCID: PMC262918 DOI: 10.1128/jcm.31.5.1280-1285.1993] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We are reporting on a nosocomial outbreak of 213 cases of vancomycin-resistant enterococcus infection involving 2,812 enterococcal isolates from patients over a period of 36 months. In 1990, the Enterococcus faecium vancomycin susceptibility rate was found to be 85.7% (36 of 42 cases), and an incidence of 10.9% (42 of 383) was noted. The 1991 data showed E. faecium with a vancomycin susceptibility rate of 61.8% (110 of 178) and an incidence of 26.0% (178 of 684). Subsequently, in 1992, the incidence of E. faecium increased to 34.0% (599 of 1,745), with a decreased vancomycin susceptibility rate of 25.8% (155 of 599). The E. faecalis vancomycin susceptibility rate remained near 97% (1,768 of 1,823) over the 36-month period. Of 115 vancomycin-resistant enterococcus (VRE) clinical isolates identified by the MicroScan MIC Combo-6 panels (Baxter Healthcare, Sacramento, Calif.), the agar dilution method indicated the resistance rate to be 92.3% (106 of 115) (high level), 3.5% (4 of 115) midlevel, and 3.5% (4 of 115) (low level). Genotypic characterization of 32 different VRE isolates by field-inversion gel electrophoresis demonstrated 19 dissimilar restriction endonuclease patterns, with 9 patterns associated with VRE quinolone resistance. Statistical analysis of case-control data for 32 patients with VRE infections indicated a positive association with intrabdominal surgical procedures (odds ratio, 24.12), multidrug therapy (odds ratio, 37.80), preexposure to vancomycin (odds ratio, 20.21), and death (odds ratio, 17.50).
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Affiliation(s)
- J F Boyle
- Division of Microbiology, Cabrini Medical Center, New York, New York 10003
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607
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Lawrence T, Rotstein C, Beam TR, Gorzynski EA, Amsterdam D. In vitro activities of ramoplanin, selected glycopeptides, fluoroquinolones, and other antibiotics against clinical bloodstream isolates of gram-positive cocci. Antimicrob Agents Chemother 1993; 37:896-900. [PMID: 8494388 PMCID: PMC187804 DOI: 10.1128/aac.37.4.896] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The susceptibilities of 316 gram-positive bacteremic isolates to ramoplanin, vancomycin, and teicoplanin and seven other antibiotics were tested. Ramoplanin demonstrated MICs of < or = 0.25 microgram/ml for at least 99% of Staphylococcus aureus isolates and 100% of coagulase-negative staphylococci tested. For both oxacillin-susceptible and oxacillin-resistant S. aureus and coagulase-negative staphylococci, the activity of ramoplanin surpassed those of both vancomycin and teicoplanin. Ramoplanin and teicoplanin had comparable activities against enterococci and Streptococcus pneumoniae and were superior to vancomycin.
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Affiliation(s)
- T Lawrence
- Department of Medical Technology, School of Medicine, State University of New York, Buffalo 14214
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608
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Eltahawy AT. In-vitro activity of ciprofloxacin and sixteen other antimicrobial agents against blood culture isolates. J Chemother 1993; 5:94-102. [PMID: 8515299 DOI: 10.1080/1120009x.1993.11739214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The in-vitro antibacterial activities of seventeen antimicrobial agents including ampicillin, amikacin, Augmentin, aztreonam, cefazolin, cefuroxime, cefotaxime, ceftizoxime, ceftriaxone, ciprofloxacin, cloxacillin, erythromycin, gentamicin, penicillin G, piperacillin and vancomycin were compared against 100 Gram-negative and Gram-positive strains isolated from blood culture specimens received at the King Abdulaziz University Hospital (KAUH), in Jeddah, Saudi Arabia. The antibacterial susceptibility was determined by the minimal inhibitory concentration (MIC), using an agar dilution method. Ciprofloxacin exhibited the greatest activity, inhibiting 90% of the tested strains (MIC90) at a concentration ranging from < 0.015-0.5 mg/L. Against cloxacillin resistant or susceptible strains of Staphylococcus aureus and coagulase-negative staphylococci, ciprofloxacin had similar activity with MIC90 of 0.2 mg/L. Salmonella typhi and salmonella species which were resistant to ampicillin and augmentin remained sensitive to ciprofloxacin (MIC90 < 0.015-0.125) mg/L.). Against gentamicin sensitive and resistant Pseudomonas aeruginosa and Pseudomonas species, ciprofloxacin MIC90 was 0.5 and 1 mg/L respectively. Aminoglycosides, third generation cephalosporins, aztreonam and antipseudomonal penicillins, on the other hand, showed high MIC90 well above the obtainable serum concentrations against Enterobacteriaceae and Pseudomonas species.
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Affiliation(s)
- A T Eltahawy
- Microbiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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609
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610
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Ena J, Houston A, Wenzel RP, Jones RN. Trends in gram-positive bloodstream organism resistance: a seven-year audit of five glycopeptides and other drugs at a large university hospital. J Chemother 1993; 5:17-21. [PMID: 8459260 DOI: 10.1080/1120009x.1993.11739203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Gram-positive pathogens (n = 525) isolated from bloodstream infections were tested by a reference broth microdilution method to establish antibiotic susceptibility trends (1985 to 1991). Cefazolin, ciprofloxacin, gentamicin, novobiocin, oxacillin, rifampin, teicoplanin, vancomycin, trimethoprim/sulfamethoxazole, daptomycin and two investigational glycopeptides (LY264826 and MDL62873) were investigated. Strains were selected without bias (first two isolates each month/species; no patient duplicates) as follows: 132 Staphylococcus aureus, 129 Staphylococcus epidermidis, 72 Staphylococcus haemolyticus, 130 Enterococcus faecalis and 62 other enterococci. All isolates were susceptible to vancomycin and teicoplanin except for Staphylococcus haemolyticus which had a resistant teicoplanin MIC90 of 64 micrograms/mL. The susceptibilities to vancomycin and teicoplanin were unchanged over the monitored period. Daptomycin, LY264826 and MDL62873 also demonstrated consistent activity; MDL62873 being superior with a MIC90 of 0.12 micrograms/mL. In 1990-1991 a significantly increased resistance to ciprofloxacin was observed among oxacillin-resistant strains of staphylococci. Our data suggest that the emergence of invasive vancomycin-resistant strains in Gram-positive isolates remains a rare phenomenon. However, we have experienced an emergence of numerous ciprofloxacin-resistant strains among staphylococci that precludes its empirical use at our institution.
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Affiliation(s)
- J Ena
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242
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611
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Rubin LG, Tucci V, Cercenado E, Eliopoulos G, Isenberg HD. Vancomycin-Resistant Enterococcus faecium in Hospitalized Children. Infect Control Hosp Epidemiol 1992. [DOI: 10.2307/30146486] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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612
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Boyce JM. Methicillin-Resistant Staphylococcus aureus in Hospitals and Long-Term Care Facilities: Microbiology, Epidemiology, and Preventive Measures. Infect Control Hosp Epidemiol 1992. [DOI: 10.2307/30146490] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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613
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Allen N, Hobbs J, Richardson J, Riggin R. Biosynthesis of modified peptidoglycan precursors by vancomycin-resistantEnterococcus faecium. FEMS Microbiol Lett 1992. [DOI: 10.1111/j.1574-6968.1992.tb05498.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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614
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Preston CA, Bruce AW, Reid G. Antibiotic resistance of urinary pathogens isolated from patients attending The Toronto Hospital between 1986 and 1990. J Hosp Infect 1992; 22:129-35. [PMID: 1358954 DOI: 10.1016/0195-6701(92)90096-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A study was carried out on 1523 urinary isolates obtained at The Toronto Hospital, Canada's largest tertiary care establishment, over three 1-month periods in 1986, 1987 and 1990. Escherichia coli was the most frequently isolated organism, with Enterococcus spp. the second most common isolate in 1986 and 1987, and Streptococcus spp. in 1990. Pseudomonas aeruginosa isolates were found to be resistant to many of the antimicrobial agents tested. Resistance patterns were found to commonly prescribed ampicillin, co-trimoxazole and, to some extent, the new fluoroquinolones, ciprofloxacin and norfloxacin. These results are relevant to the treatment and management of urinary tract infections in patients attending a tertiary care hospital.
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Affiliation(s)
- C A Preston
- Division of Urology, Toronto Hospital, Ontario, Canada
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615
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Swenson JM, Ferraro MJ, Sahm DF, Charache P, Tenover FC. New vancomycin disk diffusion breakpoints for enterococci. The National Committee for Clinical Laboratory Standards Working Group on Enterococci. J Clin Microbiol 1992; 30:2525-8. [PMID: 1400949 PMCID: PMC270472 DOI: 10.1128/jcm.30.10.2525-2528.1992] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Since 1988, when the first vancomycin-resistant enterococcus was described, several descriptions of failures of disk diffusion breakpoints to detect low-level vancomycin resistance (MICs, 8 to 32 micrograms/ml) have been published. A four-laboratory collaborative study was undertaken to establish more accurate breakpoints for the disk test. Mueller-Hinton agar was used to perform dilution testing (in three laboratories) and disk diffusion testing (in all laboratories). Results were determined at 18, 24, and 48 h, and zones of inhibition were read using both transmitted and reflected light. One hundred organisms (35 Enterococcus faecalis, 55 E. faecium, and 10 E. gallinarum or E. casseliflavus isolates) were selected to represent vancomycin-susceptible and -resistant phenotypes. Interlaboratory agreement of agar dilution MICs was better at 24 h (91 to 94% within +/- 1 dilution) than at 18 h (76% within +/- 1 dilution). Therefore, 24-h agar dilution MIC results were used as the reference. For disk diffusion, it was critical to note the presence of a haze or colonies inside the zone when interpreting the test, since this correlated better with the results of the agar dilution test. The presence of a haze or inner colonies was best detected by reading the zones with transmitted light and incubating the plates for a full 24 h. When plotted against 24-h agar dilution MICs, breakpoints of </= 14 mm (resistant), 15 to 16 mm (intermediate), and >/= 17 mm (susceptible) resulted in 58 minor errors (14.5% of total values) and 5 very major errors (2.2% of resistant values or 1.3% of total values). No major errors were seen. Results of repeat testing using a common lot of Mueller-Hinton agar showed 52 minor errors (13.3%) and 4 major errors (4.2% of susceptible values of 1.0% pf total values) but no very major errors. It is recommended that any haze or colonies within the zone be taken into account when determining zones of inhibition and that an MIC test be performed for strains with intermediate zones if vancomycin is being considered for treatment.
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Affiliation(s)
- J M Swenson
- Antimicrobial Resistance Section, Centers for Disease Control, Atlanta, Georgia 30333
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616
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Gordon S, Swenson JM, Hill BC, Pigott NE, Facklam RR, Cooksey RC, Thornsberry C, Jarvis WR, Tenover FC. Antimicrobial susceptibility patterns of common and unusual species of enterococci causing infections in the United States. Enterococcal Study Group. J Clin Microbiol 1992; 30:2373-8. [PMID: 1401001 PMCID: PMC265508 DOI: 10.1128/jcm.30.9.2373-2378.1992] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We collected 705 isolates of enterococci (1 per patient) from cultures of a variety of anatomic sites from patients at eight tertiary-care hospitals in six geographic regions of the United States. A total of 632 (90%) Enterococcus faecalis, 58 (8%) E. faecium, 5 E. gallinarum, 4 E. avium, 3 E. casseliflavus, 1 E. raffinosus, and 1 E. hirae isolate and 1 biochemical variant of E. faecalis were identified; 606 (86%) of these isolates were associated with clinical infections. The most common sites of isolation were the urinary tract (402 [57%]), nonsurgical wounds (94 [13%]), the bloodstream (74 [10%]), and surgical wounds (62 [9%]). High-level resistance to gentamicin or streptomycin or both was detected in 265 (38%) of the isolates. We identified two E. faecalis isolates resistant to vancomycin (MICs, 32 and 128 micrograms/ml) and 11 beta-lactamase-producing E. faecalis isolates. E. faecium isolates were significantly more resistant than E. faecalis isolates to penicillin, ampicillin, piperacillin, imipenem, and ciprofloxacin (P less than 0.001). The MICs for the 15 non-E. faecalis, non-E. faecium enterococci indicated variable resistance to ciprofloxacin and the penicillins. Antimicrobial susceptibility patterns vary among species of enterococci, and these organisms, while commonly resistant to high-level aminoglycosides, can also acquire resistance to vancomycin or the ability to produce beta-lactamase. Because of these diverse antimicrobial resistance mechanisms, successful treatment and control of enterococcal infections with current antimicrobial agents are becoming increasingly difficult.
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Affiliation(s)
- S Gordon
- Hospital Infections Program, Centers for Disease Control, Atlanta, Georgia 30333
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617
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Tomeczek L, Reid G, Cuperus PL, McGroarty JA, van der Mei HC, Bruce AW, Khoury AE, Busscher HJ. Correlation between hydrophobicity and resistance to nonoxynol-9 and vancomycin for urogenital isolates of lactobacilli. FEMS Microbiol Lett 1992; 73:101-4. [PMID: 1325935 DOI: 10.1111/j.1574-6968.1992.tb05297.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Seven clinical isolates of lactobacilli were found to be relatively hydrophobic with a mean water-contact angle of 66 +/- 15 degrees, and to be susceptible to 1% nonoxynol-9 and vancomycin. However, seven other strains were relatively hydrophilic with a mean water-contact angle of 32 +/- 13 degrees, and found to be resistant to 25% nonoxynol-9 and vancomycin. Thus, the surface properties of lactobacilli that influence susceptibility to antimicrobial agents may involve surface hydrophobicity. Possibly the penetration barrier posed by the cell surface towards these two nonionic antimicrobials is lower for hydrophobic cells than for hydrophilic cells.
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Affiliation(s)
- L Tomeczek
- Department of Microbiology, University of Toronto, Canada
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618
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Fraimow HS, Venuti E. Inconsistent bactericidal activity of triple-combination therapy with vancomycin, ampicillin, and gentamicin against vancomycin-resistant, highly ampicillin-resistant Enterococcus faecium. Antimicrob Agents Chemother 1992; 36:1563-6. [PMID: 1510455 PMCID: PMC191621 DOI: 10.1128/aac.36.7.1563] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Combination therapy with ampicillin, vancomycin, and gentamicin in vitro against several clinical isolates of vancomycin-resistant, highly ampicillin-resistant Enterococcus faecium, including VanA and VanB strains, was evaluated. The MICs of ampicillin were not significantly decreased by induction with vancomycin, and the combination of ampicillin and vancomycin was not inhibitory for any strain. Triple-combination therapy was least active against highly resistant VanA isolates, achieving a reduction of less than 1 log CFU at 24 h, but demonstrated slightly more activity against VanB strains.
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Affiliation(s)
- H S Fraimow
- Division of Infectious Disease, Jefferson Medical College, Philadelphia, Pennsylvania 19107
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619
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Shonekan D, Mildvan D, Handwerger S. Comparative in vitro activities of teicoplanin, daptomycin, ramoplanin, vancomycin, and PD127,391 against blood isolates of gram-positive cocci. Antimicrob Agents Chemother 1992; 36:1570-2. [PMID: 1324649 PMCID: PMC191623 DOI: 10.1128/aac.36.7.1570] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The in vitro activities of teicoplanin, daptomycin, ramoplanin, and PD127,391, a new quinolone, were compared with that of vancomycin. Teicoplanin showed the lowest MICs against Enterococcus faecalis. Ramoplanin was slightly more active than the other peptide antibiotics against oxacillin-resistant Staphylococcus aureus. The MICs of the four peptide antibiotics were similar for the oxacillin-susceptible S. aureus. Daptomycin had good activity against staphylococci but was the least active agent against E. faecalis. The MICs of vancomycin against all isolates were in general higher than those of the new antibiotics, with the exceptions of the MICs of daptomycin against E. faecalis and teicoplanin against oxacillin-resistant Staphylococcus epidermidis. PD127,391 was the most active agent against all staphylococcal isolates.
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Affiliation(s)
- D Shonekan
- Department of Medicine, Beth Israel Medical Center, New York, New York 10003
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620
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Vincent S, Minkler P, Bincziewski B, Etter L, Shlaes DM. Vancomycin resistance in Enterococcus gallinarum. Antimicrob Agents Chemother 1992; 36:1392-9. [PMID: 1510433 PMCID: PMC191592 DOI: 10.1128/aac.36.7.1392] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The vancomycin resistance expressed by several strains of Enterococcus gallinarum was studied. Resistance was expressed constitutively, as demonstrated by analysis of growth and inhibition of peptidoglycan synthesis. E. gallinarum strains were moderately resistant to vancomycin (MIC, 16 micrograms/ml) but were as susceptible as vancomycin-susceptible enterococci to the glycopeptides, teicoplanin, A35512B, A47934, A4103A, and A41030E and the glycopeptide actaplanins A1, B2, and C1. Vancomycin resistance in E. gallinarum was inhibited by beta-lactam antibiotics at concentrations that saturated penicillin-binding protein 6 (PBP 6), as demonstrated by binding competition experiments. Spontaneous mutants (frequency, 10(-8)) were two- to fourfold more resistant to beta-lactam inhibition of vancomycin resistance than the parent strain. PBP binding competition experiments suggested that PBP 6 in the mutants bound less cefotaxime, while binding of penicillin and cefoxitin was unaffected. Both a bioassay method and high-performance liquid chromatography showed that E. gallinarum membranes have enzymatic activity which modifies a model pentapeptide yielding a product that is thought to be a tetrapeptide. This activity could be a D,D-carboxypeptidase. In both the parent E. gallinarum strain and its derivatives that were resistant to the synergistic drug combination, the activity was inhibited by beta-lactams at concentrations which correlated with those that inhibit vancomycin resistance and those that saturate PBP 6. These results suggest the possibility that PBP 6 may be involved in the vancomycin resistance of E. gallinarum and that the putative D,D-carboxypeptidase activity seen in E. gallinarum membranes may be attributable to PBP 6.
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Affiliation(s)
- S Vincent
- Research Service, Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio 44106
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621
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Boyce JM, Opal SM, Potter-Bynoe G, LaForge RG, Zervos MJ, Furtado G, Victor G, Medeiros AA. Emergence and nosocomial transmission of ampicillin-resistant enterococci. Antimicrob Agents Chemother 1992; 36:1032-9. [PMID: 1510390 PMCID: PMC188831 DOI: 10.1128/aac.36.5.1032] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Between 1986 and 1988, the incidence of ampicillin-resistant enterococci increased sevenfold at a university-affiliated hospital. Forty-three patients acquired nosocomial infections with ampicillin-resistant enterococci, most of which were also resistant to mezlocillin, piperacillin, and imipenem. An analysis of plasmid and chromosomal DNAs of isolates revealed that the increase was due to an epidemic of 19 nosocomial infections that yielded closely related strains of Enterococcus faecium and to a significant increase in the incidence of nonepidemic, largely unrelated strains of ampicillin-resistant enterococci. The nonepidemic strains were identified as E. faecium, E. raffinosus, E. durans, and E. gallinarum. A logistic regression analysis revealed that patients with nonepidemic resistant strains were 16 times more likely than controls to have received preceding therapy with imipenem. In our institution, the increase in the incidence of ampicillin-resistant enterococci appears to be due to the selection of various strains of resistant enterococci by the use of imipenem and to the nosocomial transmission of E. faecium and E. raffinosus.
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Affiliation(s)
- J M Boyce
- Department of Medicine, Miriam Hospital, Providence, Rhode Island 02906
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622
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Davis TE, Fuller DD, Aeschleman EC. Rapid, direct identification of Staphylococcus aureus and Streptococcus pneumoniae from blood cultures using commercial immunologic kits and modified conventional tests. Diagn Microbiol Infect Dis 1992; 15:295-300. [PMID: 1611845 DOI: 10.1016/0732-8893(92)90014-k] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To develop safe and rapid methods for identification of Staphylococcus aureus and Streptococcus pneumoniae directly from positive blood culture bottles (BCB) (BACTEC, Johnston Laboratories), several commercial biochemical and immunological tests as well as modified conventional tests were evaluated. Preliminary studies demonstrated that both S. aureus and St. pneumoniae could be identified directly using only a small aliquot (100 microliters) of the blood culture broth obtained via vent without need for centrifugation or other separation steps. A simple tube coagulase exhibited 98% sensitivity and 100% specificity for 32 S. aureus isolates and 157 blood cultures positive for coagulase-negative staphylococci when read at 2 hr. All systems employed for direct identification of St. pneumoniae exhibited excellent sensitivity and specificity using aliquots from blood culture broths, but Pneumoslide (BBL Microbiology Systems, Cockeysville, MD) was easiest to perform and interpret. The results of this study show that S. aureus and St. pneumoniae can be identified directly from blood culture broth aliquots using rapid methods that eliminate the need for centrifugation or use of needles and syringes.
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Affiliation(s)
- T E Davis
- Wishard Memorial Hospital-Indiana University Medical Center, Indianapolis
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623
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Handwerger S, Discotto L, Thanassi J, Pucci MJ. Insertional inactivation of a gene which controls expression of vancomycin resistance on plasmid pHKK100. FEMS Microbiol Lett 1992. [DOI: 10.1111/j.1574-6968.1992.tb05226.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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624
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Zarlenga LJ, Gilmore MS, Sahm DF. Effects of amino acids on expression of enterococcal vancomycin resistance. Antimicrob Agents Chemother 1992; 36:902-5. [PMID: 1503457 PMCID: PMC189485 DOI: 10.1128/aac.36.4.902] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The effects of various amino acids on vancomycin MICs obtained with resistant enterococci was investigated by using broth dilution testing. For both the type A (i.e., possessing transferable resistance to teicoplanin and vancomycin) and the type B (i.e., possessing teicoplanin susceptibility and nontransferable vancomycin resistance) resistant strains, vancomycin MICs in the presence of glycine were substantially lower than those in unsupplemented broth (range of MIC decrease, 8- to 128-fold). No such effect was seen with Enterococcus gallinarum AIB-39 or with the susceptible control Enterococcus faecalis ATCC 29212. Further testing of two type B strains (E. faecalis V583 and V583-2) showed that certain other amino acids (i.e., D-methionine, D-serine, D-alanine, and D-phenylalanine) had effects similar to that of glycine. Results of sodium dodecyl sulfate-polyacrylamide gel electrophoresis with membrane preparations from these strains revealed the production of vancomycin-inducible proteins of sizes comparable to those describe for other enterococcal isolates that exhibit acquired vancomycin resistance. Even in the presence of 0.2 M glycine, the inducible proteins were produced. These results indicate that certain amino acids specifically interfere with the mechanism(s) of acquired vancomycin resistance in enterococci and that the nature of interference probably involves inhibition or circumvention of the inducible proteins' functions.
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Affiliation(s)
- L J Zarlenga
- Department of Pathology, University of Chicago Medical Center, Illinois 60637
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625
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Aubert G, Jehl F, El Fassi M. La teicoplanine : réflexion après 3 années d'utilisation. Med Mal Infect 1992. [DOI: 10.1016/s0399-077x(05)80954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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626
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Karanfil LV, Murphy M, Josephson A, Gaynes R, Mandel L, Hill BC, Swenson JM. A Cluster of Vancomycin-Resistant Enterococcus faecium in an Intensive Care Unit. Infect Control Hosp Epidemiol 1992. [DOI: 10.2307/30147097] [Citation(s) in RCA: 133] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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627
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Dutka-Malen S, Molinas C, Arthur M, Courvalin P. Sequence of the vanC gene of Enterococcus gallinarum BM4174 encoding a D-alanine:D-alanine ligase-related protein necessary for vancomycin resistance. Gene 1992; 112:53-8. [PMID: 1551598 DOI: 10.1016/0378-1119(92)90302-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The amplification product obtained with DNA from vancomycin-resistant (VmR) Enterococcus gallinarum BM4174 and a pair of degenerate oligodeoxyribonucleotides that correspond to conserved amino acid (aa) motifs in Escherichia coli D-alanine (D-Ala):D-Ala ligases and in En. faecium VmR protein (VanA) was used as a probe to clone the vanC gene of that strain. The vanC product, with a calculated Mr of 37,504, exhibits 29 to 38% aa identity with VanA and E. coli ligases. Insertional inactivation of vanC led to Vm sensitivity of BM4174 suggesting that the gene may encode a D-Ala:D-Ala ligase of altered specificity.
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Affiliation(s)
- S Dutka-Malen
- Unité des Agents Antibactériens, Institut Pasteur, Paris, France
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628
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Recent trends in the college of American pathologists proficiency results for antimicrobial susceptibility testing: Preparing for CLIA '88. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/0196-4399(92)90033-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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629
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Biavasco F, Lupidi R, Varaldo PE. In vitro activities of three semisynthetic amide derivatives of teicoplanin, MDL 62208, MDL 62211, and MDL 62873. Antimicrob Agents Chemother 1992; 36:331-8. [PMID: 1534977 PMCID: PMC188437 DOI: 10.1128/aac.36.2.331] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
MDL 62208, MDL 62211, and MDL 62873 are three semisynthetic amide derivatives of teicoplanin (MDL 62208 is an amide of teicoplanin aglycone, MDL 62211 is an amide of the teicoplanin A2 complex, and MDL 62873 is the corresponding derivative of peak A2-2 of the complex). The three semisynthetic glycopeptides were evaluated for in vitro antibacterial activity in comparison with the parent drug (teicoplanin) and vancomycin. A variety of gram-positive bacteria of clinical origin, whose species were carefully determined and that included 428 staphylococci (207 methicillin susceptible and 221 methicillin resistant), 41 streptococci, 82 enterococci, 43 strains of Listeria monocytogenes, 10 JK coryneform bacteria, and 67 anaerobes belonging to the genera Clostridium, Propionibacterium, Peptostreptococcus, and Eubacterium, were tested. The only resistances to MDL 62208, MDL 62211, and MDL 62873 were encountered with vancomycin- and teicoplanin-resistant enterococci. All of the other test strains, including some teicoplanin-resistant coagulase-negative staphylococci of the species Staphylococcus haemolyticus and Staphylococcus epidermidis, were highly susceptible to the three teicoplanin amides. Only minor differences in activity were observed among MDL 62208, MDL 62211, and MDL 62873, whereas the three experimental compounds were usually found to be more potent than teicoplanin or vancomycin (especially against staphylococci, with differences mostly ranging from 2- to 16-fold). The MBC-to-MIC ratios varied depending on the organisms, with the highest ratios usually observed for enterococci and listeriae. Overall, the MBC-to-MIC ratios yielded by the teicoplanin analogs were slightly greater than those yielded by teicoplanin or vancomycin.
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Affiliation(s)
- F Biavasco
- Institute of Microbiology, University of Ancona Medical School, Italy
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630
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Berti M, Candiani G, Borgonovi M, Landini P, Ripamonti F, Scotti R, Cavenaghi L, Denaro M, Goldstein BP. Antimicrobial activity of MDL 62,873, a semisynthetic derivative of teicoplanin, in vitro and in experimental infections. Antimicrob Agents Chemother 1992; 36:446-52. [PMID: 1534978 PMCID: PMC188455 DOI: 10.1128/aac.36.2.446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
MDL 62,873 is an amide derivative of teicoplanin A2-2. Like those of natural glycopeptides, its antibacterial activity is mediated by inhibition of cell wall peptidoglycan synthesis. Against streptococci and enterococci, the in vitro activity of MDL 62,873 was similar to that of teicoplanin and greater than that of vancomycin. Against staphylococci, it has activity similar to that of vancomycin, and it was significantly more active than teicoplanin against coagulase-negative isolates. Like teicoplanin and vancomycin, MDL 62,873 had slow but significant bactericidal activity (99 to 99.9% killing in 24 h) against staphylococci at concentrations near the MIC. In murine septicemia studies with Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae, the 50% effective doses were lower than those of vancomycin. In staphylococcal endocarditis in rats, MDL 62,873 at 20 mg/kg of body weight and vancomycin at 40 mg/kg, both doses given intravenously twice daily, had similar efficacies in reducing the heart bacterial load. These results probably reflect the longer half-life of MDL 62,873, which has a pharmacokinetic profile in rats similar to that of teicoplanin.
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Affiliation(s)
- M Berti
- Lepetit Research Center, Marion Merrell Dow Research Institute, Gerenzano (Varese), Italy
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631
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Hodges TL, Zighelboim-Daum S, Eliopoulos GM, Wennersten C, Moellering RC. Antimicrobial susceptibility changes in Enterococcus faecalis following various penicillin exposure regimens. Antimicrob Agents Chemother 1992; 36:121-5. [PMID: 1590676 PMCID: PMC189238 DOI: 10.1128/aac.36.1.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Penicillin-"virgin" strains of Enterococcus faecalis collected from a population of individuals with no previous antibiotic exposure were subjected in vitro to penicillin delivered as repeated pulses, stepwise increasing concentrations, or sustained levels of a single concentration. Changes in resistance to penicillin were assessed by determination of MICs, and time-kill studies were performed to evaluate changes in tolerance to the bactericidal effects of penicillin. Isogenic clones, derived from various exposure regimens, which exhibited changes in either resistance or tolerance were further examined for changes in penicillin-binding proteins. Exposure to repeated pulses of penicillin resulted in the development of tolerance to penicillin without changes in the level of resistance. Clones derived from a regimen of stepwise increases in the penicillin concentration acquired both increased penicillin resistance and tolerance. Clones selected after prolonged continuous exposure to a fixed concentration of penicillin displayed minimally increased resistance to penicillin, but they retained the lytic, nontolerant response to the bactericidal effect of penicillin. Clones which acquired tolerance to the bactericidal effect of penicillin without changes in penicillin resistance exhibited a penicillin-binding protein pattern identical to that of the parental strain. Increased labeling of several penicillin-binding proteins accompanied the development of increased penicillin resistance in both penicillin-tolerant and nontolerant strains. Exposure of E. faecalis to penicillin in repeated pulses of brief duration, for prolonged periods at a constant concentration, or in stepwise graded concentrations can result in the selection of clones with increased resistance to the inhibitory or bactericidal effects of penicillin, or both. These observations may be relevant to the selection of dosing regimes for penicillin in the treatment of enterococcal infections, when bactericidal synergism cannot be achieved with penicillin-aminoglycoside combinations.
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Affiliation(s)
- T L Hodges
- Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts
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632
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Louie M, Simor AE, Szeto S, Patel M, Kreiswirth B, Low DE. Susceptibility testing of clinical isolates of Enterococcus faecium and Enterococcus faecalis. J Clin Microbiol 1992; 30:41-5. [PMID: 1310332 PMCID: PMC264993 DOI: 10.1128/jcm.30.1.41-45.1992] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We collected 103 clinical Enterococcus faecium isolates from across Canada, performed standard broth microdilution susceptibility testing, and compared these results with results from the MicroScan Pos MIC Type 6 panel (Baxter Health Care Corp., West Sacramento, Calif.) and the AMS-Vitek Gram-Positive Susceptibility card (Vitek Inc., St. Louis, Mo.). High-level aminoglycoside resistance to gentamicin and streptomycin was detected by a single-concentration agar method with 1,000 micrograms of each aminoglycoside per ml. In addition, we tested the effect of the lower calcium content in broth media as recommended in National Committee for Clinical Laboratory Standards (NCCLS) guideline M7-A2 on the activity of the highly calcium-dependent agent daptomycin. Of the 103 E. faecium isolates, there were 4 and 30 isolates with high-level gentamicin resistance (HLGR) and high-level streptomycin resistance (HLSR), respectively. An additional 39 (37 with HLGR and 36 with HLSR) E. faecium isolates were tested by both the MicroScan and the AMS-Vitek systems. The AMS-Vitek card demonstrated sensitivities of 95 and 82% for detecting HLGR strains and HLSR strains, respectively. The MicroScan panel demonstrated improved sensitivities for detecting HLGR (42 to 97%) and HLSR (64 to 84%) when readings were performed manually instead of being generated automatically. Ampicillin resistance (MIC, greater than or equal to 16 micrograms/ml) was detected in 23 of the 103 E. faecium isolates. Only 14 and 20 of these were detected by the MicroScan panels and AMS-Vitek cards, respectively. beta-Lactamase activity was not detected in any isolates. The lower calcium content in broth media recommended by NCCLS guideline M7-A2 markedly reduced the in vitro activity of daptomycin against Enterococcus spp.
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Affiliation(s)
- M Louie
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
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633
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Abstract
Vancomycin is a glycopeptide antibiotic that is active against staphylococci, streptococci, and other gram-positive bacteria. It is the drug of choice for the treatment of infections due to methicillin-resistant staphylococci, Corynebacterium jeikeium, and multiply resistant strains of Streptococcus pneumoniae. Vancomycin is an alternative treatment for serious staphylococcal and streptococcal infections, including endocarditis, when allergy precludes the use of penicillins and cephalosporins. Vancomycin is bactericidal against most strains of staphylococci and nonenterococcal streptococci. Although rare strains of staphylococci and enterococci that are resistant to vancomycin have been reported, bacterial resistance has thus far not emerged as a major clinical problem despite widespread use of vancomycin. When therapy is monitored by periodic determinations of serum concentrations of the drug and rapid infusion rates are avoided, vancomycin is rarely associated with serious toxicity.
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Affiliation(s)
- M P Wilhelm
- Division of Infectious Diseases and Internal Medicine, Mayo, Clinic, Rochester, MN 55905
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634
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Wenzel RP, Nettleman MD, Jones RN, Pfaller MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991; 91:221S-227S. [PMID: 1928168 DOI: 10.1016/0002-9343(91)90372-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Data from around the world verify the escalating incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Since MRSA are spread primarily on the hands of health care workers, rates of infection are a function of infection control activities within institutions. Moreover, infections with MRSA are serious and often life-threatening. Thus, there are compelling medical and ethical reasons to invest in control measures. Currently available data suggest the efficacy of three measures: (a) identification of the entire patient reservoir (cases and carriers) for purposes of isolation; (b) strict handwashing between patients to prevent transmission; and (c) treatment of the carrier state in health care workers and patients during periods of high infection rates with safe and effective topical agents such as mupirocin.
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Affiliation(s)
- R P Wenzel
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242
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635
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Abstract
Glycopeptide resistance is recent in enterococci and its expression is inducible by glycopeptides. Two phenotypes can be distinguished: (a) resistance to high levels of vancomycin and teicoplanin, and (b) resistance to low levels of vancomycin only. There is no cross-resistance between glycopeptides, glycolipodepsipeptides (ramoplanin), and lipopeptides (daptomycin). The determinants conferring low-level resistance are nontransferable and presumably chromosomal. High-level resistance is plasmid-mediated and the plasmids range from 34 to 40 kb, are self-transferable, and encode various resistance combinations. All plasmids share the same glycopeptide resistance determinant, which is distinct from that conferring low-level resistance. Induction of resistance is associated with induction of about a 40 kDa protein. We have determined the sequence of the vanA gene encoding one such resistance protein designated VANA. Amino acid sequence similarity was detected between VANA and D-Ala: D-Ala ligases from Enterobacteriaceae. Complementation analysis in Escherichia coli indicated that VANA possesses D-Ala: D-Ala ligase activity and is therefore related to enzymes that catalyze synthesis of glycopeptide target, i.e., terminal D-Ala-D-Ala of peptidoglycan precursors. The contribution of VANA to synthesis of peptidoglycan in the presence of glycopeptides is unknown: VANA could bind to D-Ala-D-Ala, preventing the binding of the drugs; could modify the target of the drug; and could be a ligase with novel specificity.
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Affiliation(s)
- E Derlot
- Unité des Agents Antibactériens, Institut Pasteur, Paris, France
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636
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Corcoran GD, Gibbons N, Mulvihill TE. Septicaemia caused by Pediococcus pentosaceus: a new opportunistic pathogen. J Infect 1991; 23:179-82. [PMID: 1753117 DOI: 10.1016/0163-4453(91)92190-g] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case of septicaemia caused by Pediococcus pentosaceus is described. The role played by pediococci, and other vancomycin-resistant Gram-positive cocci, in disease states is examined. We suggest that in immunocompromised patients these organisms act as opportunist pathogens. This would appear to be the first reported case of P. pentosaceus septicaemia.
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Affiliation(s)
- G D Corcoran
- Department of Microbiology, St James's Hospital, Dublin, Republic of Ireland
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637
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Fantin B, Leclercq R, Arthur M, Duval J, Carbon C. Influence of low-level resistance to vancomycin on efficacy of teicoplanin and vancomycin for treatment of experimental endocarditis due to Enterococcus faecium. Antimicrob Agents Chemother 1991; 35:1570-5. [PMID: 1834013 PMCID: PMC245220 DOI: 10.1128/aac.35.8.1570] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Emergence of vancomycin-resistant strains among enterococci raises a new clinical challenge. Rabbits with aortic endocarditis were infected with Enterococcus faecium BM4172, a clinical strain resistant to low levels of vancomycin (MIC, 16 micrograms/ml) and susceptible to teicoplanin (MIC, 1 micrograms/ml), and against its susceptible variant E. faecium BM4172S obtained in vitro by insertional mutagenesis (MICs, 2 and 0.5 micrograms/ml, respectively). Control animals retained 8 to 10.5 log10 CFU/g of vegetation. We evaluated in this model the efficacy of vancomycin (30 mg/kg of body weight; mean peak and trough serum levels, 27 and 5 micrograms/ml, respectively), teicoplanin (standard dose, 10 mg/kg; mean peak and trough levels, 23 and 9 micrograms/ml, respectively; and high dose, 20 mg/kg; mean peak and trough levels, 63 and 25 micrograms/ml, respectively), gentamicin (6 mg/kg; mean peak and trough levels, 8.6 and less than 0.1 micrograms/ml, respectively), alone or in combination, given every 12 h intramuscularly for 5 days. Teicoplanin standard dose was as active as vancomycin against both strains. Vancomycin was not effective against E. faecium BM4172 but was highly effective against E. faecium BM4172S (7.5 +/- 1.1 log10 CFU/g of vegetation versus 4.9 +/- 1.0 log10 CFU/g of vegetation for vancomycin against E. faecium BM4172 and E. faecium BM4172S, respectively; P = 0.0012). A high dose of teicoplanin was more effective than vancomycin against E. faecium BM4172 (4.4 +/- 1.8 log10 CFU/g of vegetation versus 7.5 +/- 1.1 log10 CFU/g of vegetation for teicoplanin high dose and vancomycin, respectively; P less than 0.05). Against E. faecium BM4172 glycopeptide-gentamicin combinations were the most effective regimens in vitro and in vivo (2.8 +/- 0.7 and 3.5 +/- 1.3 log10 CFU/g of vegetation for vancomycin plus gentamicin and teicoplanin standard dose plus gentamicin, respectively; P < 0.05 versus single-drug regimens). We concluded that high-dose teicoplanin or the combination of a glycopeptide antibiotic plus gentamicin was effective against experimental infection due to E. faecium with low-level resistance to vancomycin.
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Affiliation(s)
- B Fantin
- Service de Médecine Interne, Hôpital Bichat, Université Paris VII, France
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638
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Grayson ML, Eliopoulos GM, Wennersten CB, Ruoff KL, Klimm K, Sapico FL, Bayer AS, Moellering RC. Comparison of Enterococcus raffinosus with Enterococcus avium on the basis of penicillin susceptibility, penicillin-binding protein analysis, and high-level aminoglycoside resistance. Antimicrob Agents Chemother 1991; 35:1408-12. [PMID: 1929301 PMCID: PMC245181 DOI: 10.1128/aac.35.7.1408] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We reidentified our laboratories' collections of 57 enterococcal isolates previously classified as Enterococcus avium by the API Rapid Strep identification system (Analytab Products, Plainview, N.Y.) with the identification criteria recommended by Facklam and Collins (R. R. Facklam and M. D. Collins, J. Clin. Microbiol. 27: 731-734, 1989). Thirty isolates were identified as true E. avium, 25 isolates were identified as E. raffinosus, and 2 isolates were identified as E. pseudoavium. E. raffinosus could be differentiated from E. avium on the basis of penicillin susceptibility, as follows: MIC for 50% of E. raffinosus isolates tested (MIC50), 32 micrograms/ml; MIC90, 64 micrograms/ml (range, 4 to 64 micrograms/ml); E. avium MIC50, 1 microgram/ml; MIC90, 2 micrograms/ml (range, 0.5 to 2 micrograms/ml). No strains produced detectable beta-lactamase. Penicillin-binding protein (PBP) analysis of all E. raffinosus isolates demonstrated the unique pattern reported previously (M. D. Collins, R. R. Facklam, J. A. E. Farrow, and R. Williamson, FEMS Microbiol. Lett. 57:283-288, 1989); however, a number of newly identified PBPs were noted. Of 25 isolates, 13 had an additional PBP of 77 kDa (designated PBP 6*), while all isolates possessed a 52-kDa PBP (PBP 7) and a 46-kDa PBP (PBP 8). The presence or absence of PBP 6* did not correlate with penicillin susceptibility; however, PBP 7 demonstrated many features suggestive of low penicillin-binding affinity and may represent a possible mechanism for the relative resistance of this species to penicillin, although this hypothesis remains speculative since attempts to develop a penicillin-hypersusceptible E. raffinosus mutant were unsuccessful. E. raffinosus isolates were significantly more likely to exhibit high-level resistance to kanamycin than E. avium strains were (P < 0.001; chi-square); however, no strains demonstrated high-level resistance to gentamicin. No trend toward increasing penicillin resistance was noted among this collection of E. avium and E. raffinosus isolates collected over the past 35 and 14 years, respectively. Relative resistance to penicillin may be a helpful differentiating feature between E. avium and E. raffinosus when assessment of raffinose metabolism is not possible or is indeterminant.
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Affiliation(s)
- M L Grayson
- Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215
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639
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Yamane N, Jones RN. In vitro activity of 43 antimicrobial agents tested against ampicillin-resistant enterococci and gram-positive species resistant to vancomycin. Diagn Microbiol Infect Dis 1991; 14:337-45. [PMID: 1889183 DOI: 10.1016/0732-8893(91)90025-b] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A total of 57 strains of ampicillin-resistant and -susceptible enterococci representing 10 species and 23 strains of vancomycin-resistant Gram-positive bacteria (Leuconostoc and Pediococcus) were tested to determine their susceptibility to 43 antimicrobial agents by the reference broth microdilution method. The drug MICs for the ampicillin-resistant enterococci were generally similar to those of ampicillin-susceptible strains, that is, highly resistant to cephalosporins, moderately susceptible or resistant to quinolones, and susceptible to "glycopeptides." Some investigational quinolones (PD127391, sparfloxacin, WIN57273), minocycline, and rifampin were highly active. Vancomycin-resistant strains were usually resistant to other "glycopeptides," for which correlation coefficients of MICs ranged from 0.881 to 0.978, except ramoplanin (MICs, 0.008-0.5 micrograms/ml). Most isolates resistant to vancomycin were susceptible to the newer quinolones, penicillins, aminoglycosides, clindamycin, and erythromycin, but highly resistant to cephalosporins. Discrepancies between the MICs and MBCs for glycopeptides were noted (greater than or equal to 8-fold, MBC50/MIC50), but not for ramoplanin. The vancomycin disk test was in 96.1% absolute agreement by identifying resistant strains without contributing false-susceptible, very major error.
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Affiliation(s)
- N Yamane
- Department of Pathology, University of Iowa College of Medicine, Iowa City
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640
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Wade JJ, Desai N, Casewell MW. Hygienic hand disinfection for the removal of epidemic vancomycin-resistant Enterococcus faecium and gentamicin-resistant Enterobacter cloacae. J Hosp Infect 1991; 18:211-8. [PMID: 1680903 DOI: 10.1016/0195-6701(91)90145-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An outbreak strain of Enterococcus faecium, bearing plasmid-mediated vancomycin resistance, and an epidemic gentamicin-resistant, multiply-resistant strain of Enterobacter cloacae, both survived well on fingertips of three volunteers for up to 30 minutes after inoculation. Hand disinfection of inoculated fingers with 60% isopropyl alcohol, or with alcoholic chlorhexidine, reliably gave a 4 log10 reduction of both test organisms. Enterobacter cloacae could not be detected in any finger washings, even by enrichment culture. Chlorhexidine digluconate and povidone-iodine were also effective against E. faecium and Ent. cloacae, giving 4 log10 reductions, but finger washings taken after disinfection yielded low counts of the test strains, e.g. less than 45 recoverable colony forming units (cfu) per finger. Handwashing with soap and water was the least reliable method. The epidemicity, serious antimicrobial multiple resistance and survival on finger-tips of these two strains justifies the use of handwashing agents which have maximum effect. The rapid bactericidal (and residual) activity of alcoholic chlorhexidine suggests that, on the basis of present evidence, it is the preferred agent for hygienic hand disinfection against such strains.
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Affiliation(s)
- J J Wade
- Department of Medical Microbiology, King's College School of Medicine & Dentistry, London
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641
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Nagarajan R. Antibacterial activities and modes of action of vancomycin and related glycopeptides. Antimicrob Agents Chemother 1991; 35:605-9. [PMID: 2069366 PMCID: PMC245066 DOI: 10.1128/aac.35.4.605] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- R Nagarajan
- Lilly Research Laboratories, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana 46285
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642
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Barnass S, Holland K, Tabaqchali S. Vancomycin-resistant Corynebacterium species causing prosthetic valve endocarditis successfully treated with imipenem and ciprofloxacin. J Infect 1991; 22:161-9. [PMID: 2026890 DOI: 10.1016/0163-4453(91)91591-k] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Endocarditis caused by a Corynebacterium sp. resistant to vancomycin, penicillin G, erythromycin, gentamicin and rifampicin arose in a 44-year-old woman 4 months after replacement of the mitral valve with a prosthesis. She was successfully treated with a 79-day course of intravenous imipenem and ciprofloxacin and replacement of the prosthesis 48 days after treatment began.
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Affiliation(s)
- S Barnass
- Department of Medical Microbiology, St Bartholomew's Hospital, West Smithfield, London, U.K
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643
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Chin NX, Neu HC. In vitro activity of LY264826 compared to other glycopeptides and daptomycin. Diagn Microbiol Infect Dis 1991; 14:181-4. [PMID: 1651826 DOI: 10.1016/0732-8893(91)90056-l] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LY264826 a new naturally occurring glycopeptide inhibited 90% of methicillin-susceptible and -resistant Staphylococcus aureus at 1 micrograms/ml. LY264826 had similar activity against methicillin-susceptible and -resistant coagulase-negative staphylococci. The LY264826 MIC90 for Streptococcus pyogenes was 0.25 microgram/ml, twofold more active than vancomycin and twofold less active than teicoplanin. LY264826 was eightfold more active than vancomycin and twofold more active than teicoplanin against enterococci. LY264826 inhibited Streptococcus pneumoniae at 0.25 microgram/ml and Listeria monocytogenes at 0.5 microgram/ml. Clostridium were inhibited by less than or equal to 0.25 microgram/ml of LY264826 and peptococci, peptostreptococci, and Fusobacterium were inhibited by less than 0.5 microgram/ml. Bacteroides species were LY284826 -resistant as were all Enterobacteriaceae, Flavobacterium, and Neisseria spp. Minimum bactericidal and inhibitory concentrations (MBCs and MICs) were within a dilution for S. aureus, S. pyogenes, and S. pneumoniae, but greater than or equal to 32-fold greater for enterococci.
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Affiliation(s)
- N X Chin
- Department of Medicine, College of Physicians and Surgeons, New York, New York
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644
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Affiliation(s)
- G A Jacoby
- Infectious Disease Unit, Massachusetts General Hospital, Boston 02114
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645
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Heisig P, Wiedemann B. [Evaluation of the development of resistance as a factor for the limitation of therapeutic possibilities]. Infection 1991; 19 Suppl 1:S47-51. [PMID: 1901050 DOI: 10.1007/bf01644735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
From the microbiological point of view a variety of highly active compounds has contributed to improved efficacy of antibacterial chemotherapy during the last few decades. In some cases, however, resistance has increased due to different molecular mechanisms. Resistance to the new generation of broad-spectrum beta-lactams is in the cases of TEM and SHV enzymes based upon the stepwise acquisition of point mutations within the structural gene. Multiresistance to aminoglycosides is caused by a combination of different genes coding for aminoglycoside modifying enzymes on transferable plasmids. Resistance to glycopeptides has recently been detected in enterococci and is due to a new mechanism of resistance. These substances have so far had unlimited activity against methicillin-resistant Staphylococcus aureus and have been widely used for treatment of pseudomembranous colitis. While all the three mechanisms of resistance mentioned above are transferable among different strains, no evidence exists so far for transferable resistance to 4-quinolones. However, for S. aureus and Pseudomonas aeruginosa an increase of resistance has been reported. The underlying mechanisms seem to be unchanged. The detection of global changes in the development of resistance and the discrimination of these changes from local events requires recording of statistically significant data obtained with approved methods and evaluation of the data with standardized international breakpoints. Consequently, the use of new agents should be controlled efficiently.
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Affiliation(s)
- P Heisig
- Institut für Medizinische Mikrobiologie der Universität, Bonn, Germany
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646
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Affiliation(s)
- D J Herman
- Department of Medicine, Veterans Affairs Medical Center, Minneapolis, Minnesota
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647
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Biavasco F, Manso E, Varaldo PE. In vitro activities of ramoplanin and four glycopeptide antibiotics against clinical isolates of Clostridium difficile. Antimicrob Agents Chemother 1991; 35:195-7. [PMID: 1826593 PMCID: PMC244968 DOI: 10.1128/aac.35.1.195] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Seventy strains of Clostridium difficile, all isolated from symptomatic patients, were found to be uniformly susceptible to ramoplanin, a new glycolipodepsipeptide antibiotic, and to four glycopeptides (vancomycin, teicoplanin, and two semisynthetic teicoplanin derivatives). Ramoplanin is recommended for further evaluation in the treatment of C. difficile-associated disease.
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Affiliation(s)
- F Biavasco
- Institute of Microbiology, University of Ancona Medical School, Italy
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648
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Peetermans WE, Sebens FW, Guiot HF. Vancomycin-resistant Enterococcus faecalis in a bone-marrow transplant recipient. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1991; 23:105-9. [PMID: 1902979 DOI: 10.3109/00365549109023382] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Since 1988 a number of reports on the emergence of vancomycin-resistant enterococci have been published. We describe an additional case of colonization of and subsequent infection with a vancomycin-resistant Enterococcus faecalis in a bone-marrow transplant recipient, who had never before received vancomycin therapy. The strain was resistant to most antibiotics tested, including low-level resistance to gentamicin and cross-resistance to teicoplanin. It was sensitive to amoxicillin and the lipopeptide antibiotic daptomycin. The origin, the mode of acquisition and the incidence of vancomycin-resistant enterococci are still unknown. The clinical and bacteriological features of the cases reported thus far and the genetic and biochemical basis of vancomycin resistance are discussed.
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Affiliation(s)
- W E Peetermans
- Department of Infectious Diseases, University Hospital Leiden, The Netherlands
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649
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Boyce JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991; 12:46-54. [PMID: 1999643 DOI: 10.1086/646237] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review practices currently used to control transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, determine the frequency of their use, and discuss the indications for implementing such measures. DESIGN A questionnaire survey to determine how commonly selected control practices are used, and a literature review of the efficacy of control practices. PARTICIPANTS Two hundred fifty-six of 360 hospital-based members fo the Society for Hospital Epidemiology of America, Inc. (SHEA) completed the survey questionnaire. RESULTS Many different combinations of surveillance and control measures are used by hospitals with MRSA. Nine percent of hospitals stated that no special measures were used to control MRSA. The efficacy of commonly used control measures has not been established by controlled trials. CONCLUSIONS Implementing control measures is warranted when MRSA causes a high incidence of serious nosocomial infections, and is desirable when MRSA has been newly introduced into a hospital or into an intensive care unit, or when MRSA accounts for more than 10% of nosocomial staphylococcal isolates. While the value of some practices is well established, measures such as routinely attempting to eradicate carriage of MRSA by colonized patients and personnel require further evaluation.
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Affiliation(s)
- J M Boyce
- Department of Medicine, Miriam Hospital and Brown University, Providence, Rhode Island 02906
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650
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Affiliation(s)
- P Courvalin
- Center for Molecular Genetics, University of California, San Diego, La Jolla 92093
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