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Ulger Toprak N, Duman N, Sacak B, Ozkan MC, Sayın E, Mulazimoglu L, Soyletir G. Alloprevotella rava isolated from a mixed infection of an elderly patient with chronic mandibular osteomyelitis mimicking oral squamous cell carcinoma. New Microbes New Infect 2021; 42:100880. [PMID: 34136264 PMCID: PMC8176353 DOI: 10.1016/j.nmni.2021.100880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
The anaerobic, Gram-negative bacillus Alloprevotella rava has recently been described in the human oral cavity. To our knowledge, this species has not been isolated from chronic osteomyleitis samples. We present the first case of A. rava infection in a 92-year-old woman with polymicrobial chronic mandibular osteomyelitis, mimicking oral squamous cell carcinoma.
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Affiliation(s)
- N Ulger Toprak
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - N Duman
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - B Sacak
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - M C Ozkan
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - E Sayın
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - L Mulazimoglu
- Department of Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey
| | - G Soyletir
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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2
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Ergönül Ö, Aydin M, Azap A, Başaran S, Tekin S, Kaya Ş, Gülsün S, Yörük G, Kurşun E, Yeşilkaya A, Şimşek F, Yılmaz E, Bilgin H, Hatipoğlu Ç, Cabadak H, Tezer Y, Togan T, Karaoğlan I, İnan A, Engin A, Alışkan HE, Yavuz SŞ, Erdinç Ş, Mulazimoglu L, Azap Ö, Can F, Akalın H, Timurkaynak F. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality. J Hosp Infect 2016; 94:381-385. [PMID: 27717604 DOI: 10.1016/j.jhin.2016.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/02/2016] [Indexed: 12/28/2022]
Abstract
This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.
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Affiliation(s)
- Ö Ergönül
- Koç University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey.
| | - M Aydin
- Başkent University School of Medicine, Istanbul Hospital, Infectious Diseases and Clinical Microbiology Department, Turkey
| | - A Azap
- Ankara University Medical Faculty, Infectious Diseases and Clinical Microbiology Department, Turkey
| | - S Başaran
- Istanbul University Istanbul Medical School, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - S Tekin
- Koç University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ş Kaya
- Diyarbakır Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Diyarbakır, Turkey
| | - S Gülsün
- Diyarbakır Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Diyarbakır, Turkey
| | - G Yörük
- Istanbul Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - E Kurşun
- Başkent University School of Medicine, Adana Hospital, Infectious Diseases and Clinical Microbiology Department, Adana, Turkey
| | - A Yeşilkaya
- Başkent University School of Medicine, Ankara Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - F Şimşek
- Okmeydanı Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - E Yılmaz
- Uludağ University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Bursa, Turkey
| | - H Bilgin
- Marmara University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ç Hatipoğlu
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - H Cabadak
- Ankara Specialty Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - Y Tezer
- Ankara Specialty Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - T Togan
- Başkent University School of Medicine, Konya Hospital, Infectious Diseases and Clinical Microbiology Department, Konya, Turkey
| | - I Karaoğlan
- Gaziantep University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Gaziantep, Turkey
| | - A İnan
- Haydarpaşa Numune Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - A Engin
- Cumhuriyet University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Sivas, Turkey
| | - H E Alışkan
- Başkent University School of Medicine, Adana Hospital, Infectious Diseases and Clinical Microbiology Department, Adana, Turkey
| | - S Ş Yavuz
- Istanbul University Istanbul Medical School, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ş Erdinç
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - L Mulazimoglu
- Marmara University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ö Azap
- Başkent University School of Medicine, Ankara Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - F Can
- Koç University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - H Akalın
- Uludağ University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Bursa, Turkey
| | - F Timurkaynak
- Başkent University School of Medicine, Istanbul Hospital, Infectious Diseases and Clinical Microbiology Department, Turkey
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3
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Saltoglu N, Yemisen M, Ergonul O, Kadanali A, Karagoz G, Batirel A, Ak O, Eraksoy H, Cagatay A, Vatan A, Sengoz G, Pehlivanoglu F, Aslan T, Akkoyunlu Y, Engin D, Ceran N, Erturk B, Mulazimoglu L, Oncul O, Ay H, Sargin F, Ozgunes N, Simsek F, Yildirmak T, Tuna N, Karabay O, Yasar K, Uzun N, Kucukardali Y, Sonmezoglu M, Yilmaz F, Tozalgan U, Ozer S, Ozyazar M. Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey. Clin Microbiol Infect 2015; 21:659-64. [PMID: 25861844 DOI: 10.1016/j.cmi.2015.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 03/08/2015] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
Abstract
We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum β-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.
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Affiliation(s)
- N Saltoglu
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
| | - M Yemisen
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O Ergonul
- Koc University, School of Medicine, Infectious Diseases, Istanbul, Turkey
| | - A Kadanali
- Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - G Karagoz
- Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A Batirel
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O Ak
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Eraksoy
- Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A Cagatay
- Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - A Vatan
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - G Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Pehlivanoglu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Aslan
- Bezmialem University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Y Akkoyunlu
- Bezmialem University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - D Engin
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Ceran
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Erturk
- Marmara University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - L Mulazimoglu
- Marmara University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - O Oncul
- Gulhane Military Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Ay
- Gulhane Military Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Sargin
- Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Ozgunes
- Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Simsek
- Okmeydani Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Yildirmak
- Okmeydani Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Tuna
- Sakarya University Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - O Karabay
- Sakarya University Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - K Yasar
- Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Uzun
- Sisli Etfal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Y Kucukardali
- Yeditepe University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - M Sonmezoglu
- Yeditepe University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Yilmaz
- Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - U Tozalgan
- Samatya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S Ozer
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - M Ozyazar
- Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Kaygusuz I, Mulazimoglu L, Cerikcioglu N, Toprak A, Oktay A, Korten V. An unusual native tricuspid valve endocarditis caused by Candida colliculosa. Clin Microbiol Infect 2003; 9:319-22. [PMID: 12667244 DOI: 10.1046/j.1469-0691.2003.00511.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unknown origin that had lasted for 7 months, in conjunction with transthoracic echocardiography, demonstrating a 20-mm vegetation, superior to the tricuspid valve, herniating into the right atrial cavity. The finding led to the diagnosis of fungal endocarditis. Fluconazole, 600 mg daily, was commenced for 8 days; followed by amphotericin B, 1 mg/kg daily. On the fourth day of the amphotericin B treatment, the patient underwent replacement of the infected tricuspid valve. Even though the initial postoperative period was relatively uncomplicated, the patient died after a gross aspiration on the 67th day of his hospital stay, despite aggressive cardiovascular support and antimicrobial therapy. This is the first report of a native tricuspid valve fungal endocarditis due to C. colliculosa or Torulaspora delbrueckii, which is not known to be a human pathogen.
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Affiliation(s)
- I Kaygusuz
- Department of Medicine, Marmara University School of Medicine and Marmara Universitesi Hastanesi, Infeksiyon Hastaliklari ABD, 81090 Altunizade, Istanbul, Turkey
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Abstract
Community-acquired pneumonia (CAP) can be life-threatening. The prognosis is generally poorest in elderly patients and/or those with underlying chronic conditions, but fatalities can occur in all age groups. Current challenges in the clinical management of CAP are discussed, and the criteria for identifying those patients who should be treated in hospital with initial intravenous therapy are considered. Rapid initiation of therapy is important, using an agent that provides coverage against the most likely pathogens--Streptococcus pneumoniae and the atypical organisms. There is an increasing tendency to minimise the duration of intravenous therapy, with an early transition to oral therapy and the rapid return of the patient to the community. The efficacy of oral macrolides in the treatment of CAP is well established. Evidence for the use of intravenous azithromycin to provide effective and well-tolerated, first-line intervention in the hospitalized CAP patient is summarised.
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Affiliation(s)
- L Mulazimoglu
- Section of Infectious Diseases, Department of Medicine, Medical School, Marmara University, Altunizade, Istanbul, Turkey.
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Paterson DL, Ko WC, Von Gottberg A, Casellas JM, Mulazimoglu L, Klugman KP, Bonomo RA, Rice LB, McCormack JG, Yu VL. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001; 39:2206-12. [PMID: 11376058 PMCID: PMC88112 DOI: 10.1128/jcm.39.6.2206-2212.2001] [Citation(s) in RCA: 378] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although extended-spectrum beta-lactamases (ESBLs) hydrolyze cephalosporin antibiotics, some ESBL-producing organisms are not resistant to all cephalosporins when tested in vitro. Some authors have suggested that screening klebsiellae or Escherichia coli for ESBL production is not clinically necessary, and when most recently surveyed the majority of American clinical microbiology laboratories did not make efforts to detect ESBLs. We performed a prospective, multinational study of Klebsiella pneumoniae bacteremia and identified 10 patients who were treated for ESBL-producing K. pneumoniae bacteremia with cephalosporins and whose infecting organisms were not resistant in vitro to the utilized cephalosporin. In addition, we reviewed 26 similar cases of severe infections which had previously been reported. Of these 36 patients, 4 had to be excluded from analysis. Of the remaining 32 patients, 100% (4 of 4) patients experienced clinical failure when MICs of the cephalosporin used for treatment were in the intermediate range and 54% (15 of 28) experienced failure when MICs of the cephalosporin used for treatment were in the susceptible range. Thus, it is clinically important to detect ESBL production by klebsiellae or E. coli even when cephalosporin MICs are in the susceptible range (<or = 8 microg/ml) and to report ESBL-producing organisms as resistant to aztreonam and all cephalosporins (with the exception of cephamycins).
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Affiliation(s)
- D L Paterson
- Infectious Disease Division, University of Pittsburgh VA Medical Center, University Dr. C, Pittsburgh, PA 15240, USA
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Paterson DL, Mulazimoglu L, Casellas JM, Ko WC, Goossens H, Von Gottberg A, Mohapatra S, Trenholme GM, Klugman KP, McCormack JG, Yu VL. Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia. Clin Infect Dis 2000; 30:473-8. [PMID: 10722430 DOI: 10.1086/313719] [Citation(s) in RCA: 244] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum beta-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P=.0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P=.0065) and an ESBL-producing strain (P=.012). In all, 18% of ESBL-producing isolates were also ciprofloxacin-resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid-mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.
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Affiliation(s)
- D L Paterson
- Infectious Disease Section, Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA
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Mulazimoglu L, Drenning SD, Yu VL. In vitro activities of two novel oxazolidinones (U100592 and U100766), a new fluoroquinolone (trovafloxacin), and dalfopristin-quinupristin against Staphylococcus aureus and Staphylococcus epidermidis. Antimicrob Agents Chemother 1996; 40:2428-30. [PMID: 8891159 PMCID: PMC163549 DOI: 10.1128/aac.40.10.2428] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Two oxazolidinones (U100592 and U100766), trovafloxacin, and a streptogramin combination (dalfopristin-quinupristin) were highly active in vitro against Staphylococcus aureus and Staphylococcus epidermidis, including methicillin-resistant strains. Trovafloxacin was more active than ciprofloxacin. Time-kill synergy studies demonstrated indifference for the oxazolidinones combined with vancomycin and rifampin against methicillin-resistant staphylococci. Spontaneous resistance was observed with all agents.
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Affiliation(s)
- L Mulazimoglu
- Section of Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey
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Mulazimoglu L, Drenning SD, Muder RR. Vancomycin-gentamicin synergism revisited: effect of gentamicin susceptibility of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1996; 40:1534-5. [PMID: 8726033 PMCID: PMC163363 DOI: 10.1128/aac.40.6.1534] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Vancomycin monotherapy of deep-seated staphylococcal infection may be associated with poor bacteriological response. We evaluated 24 unique patient isolates of methicillin-resistant Staphylococcus aureus (MRSA) for vancomycin-gentamicin synergism by determining time-kill curves for vancomycin at 10 micrograms/ml and gentamicin at 1 microgram/ml. Nine MRSA strains showed high-level gentamicin resistance (HLGR) (MIC, > 500 micrograms/ml), and 15 did not. Vancomycin-gentamicin demonstrated synergism against none of the HLGR strains. For the non-HLGR strains, gentamicin agar dilution MICs ranged from 0.5 to > 128 micrograms/ml. Vancomycin-gentamicin demonstrated synergism against six of these strains and indifference against nine of them. There was no relationship between the agar dilution MIC of gentamicin and the occurrence of synergism against non-HLGR strains. We conclude that a gentamicin MIC of > 500 micrograms/ml predicts a lack of vancomycin-gentamicin synergism for strains of MRSA. For non-HLGR strains, synergism is not predictable from the gentamicin MIC.
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Vahaboglu H, Hall LM, Mulazimoglu L, Dodanli S, Yildirim I, Livermore DM. Resistance to extended-spectrum cephalosporins, caused by PER-1 beta-lactamase, in Salmonella typhimurium from Istanbul, Turkey. J Med Microbiol 1995; 43:294-9. [PMID: 7562992 DOI: 10.1099/00222615-43-4-294] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Two Salmonella typhimurium isolates were studied, one as a representative from a series of neonatal meningitis cases treated at an Istanbul teaching hospital, the other from a gastro-enteritis case seen at a different Istanbul hospital. Both isolates were resistant to extended-spectrum cephalosporins, as well as penicillins, aminoglycosides and chloramphenicol. Cephalosporin resistance depended on production of PER-1 beta-lactamase, which is an extended-spectrum class A enzyme that is only distantly related to TEM and SHV enzymes, and which was previously known only from Pseudomonas aeruginosa isolates. The PER-1 gene was carried by an 81-MDa plasmid, which also determined resistance to aminoglycosides and chloramphenicol. Although it was not self-transmissible to Escherichia coli, this element did transfer if mobilised with plasmid pUZ8. The two S. typhimurium isolates gave indistinguishable DNA restriction patterns and, in addition to their 81-MDa plasmid, also contained 52- and 2.8-MDa plasmids, the last of these encoded TEM-1 enzyme. The two isolates were identical in serotype, antibiogram and plasmid-profile but nevertheless differed in phage type, and, therefore, represented distinct strains. The emergence of cefotaxime and ceftriaxone resistance in salmonellae is disturbing, since these agents are preferred therapy for neonatal meningitis caused by members of the genus.
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Affiliation(s)
- H Vahaboglu
- Department of Medical Microbiology, London Hospital Medical College
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