Antibiotic resistance of clinical isolates of Streptococcus pneumoniae in Greece.

The antibiotic susceptibilities of 1,002 Streptococcus pneumoniae clinical isolates from patients with community-acquired pneumonia were determined over an 18-month period. Resistance rates were 14% for penicillin, 20% for erythromycin, 26% for tetracycline, and 1% for chloramphenicol. Resistance to non-beta-lactam antibiotics was associated with penicillin resistance at statistically levels.     

Antimicrobial susceptibility testing of Streptococcus pneumoniae: quality assessment results.

Six strains of Streptococcus pneumoniae were distributed to 405 United Kingdom laboratories who were asked to test the susceptibility of the strains to penicillin, tetracycline, chloramphenicol and erythromycin and to provide details of methodology to test the standards of susceptibility testing. High error rates were seen only in failure to detect moderate resistance to penicillin (12%) and resistance to chloramphenicol (16%). Increased error rates were associated with several methods or practices. These included the use of certain culture media; failure to standardise the inoculum; inoculation by loop rather than by swab; failure to use control organisms; failure to measure zone sizes; the use of discs containing a high content of penicillin to test susceptibility to penicillin, and the use of high content discs for testing erythromycin, tetracycline, and chloramphenicol.     

Application of counterimmunoelectrophoresis in the identification of Streptococcus pneumoniae in clinical isolates.

The use of counterimmunoelectrophoresis (CIE) as a diagnostic tool in infectious diseases is becoming more widespread. This study was undertaken to determine the possible use of CIE in the more rapid identification of Streptococcus pneumoniae in clinical isolates. Typing sera were obtained from the Statens Seruminstitut, Denmark. Sixty-seven out of 68 pneumococcal isolates that were optochin sensitive and bile soluble were typed by CIE. One isolate was nontypable even after mouse passage. An additional three isolates that were optochin resistant were considered to be pneumococci on the basis of the bile solubility test and their typability by CIE. Seventy-seven alpha-streptococci were tested for the presence of cross-reacting capsular antigens. Fifty-three alpha-streptococci showed no cross-reactions using the omniserum. Precipitin bands were obtained with the omniserum with 10 of the isolates, but these did not react with type-specific antisera. However, 14 isolates did react with the type-specific pneumococcal antisera. The sensitivity of the test was increased by sonicating whole-cell suspensions before electrophoresis was carried out. Mueller-Hinton broths were inoculated with presumptive pneumococcal colonies that formed the predominant or only colony type on primary blood agar plates. These cultures required a 4-h incubation period with an initial inoculum of 10(6) viable organisms/ml before a precipitin band could be detected. Precipitin bands were observed in 54 out of 56 (97%) broth cultures of pneumococci that had been incubated for 4 h at 37 C. These data suggest that CIE could be a useful tool in the identification of S. pneumoniae isolated from clinical specimens.     

Analytic accuracy of specific immunoglobulin E antibody results determined by a blind proficiency survey

Analytic variability affects the accuracy of measurements of specific IgE antibodies, but the frequency of false results attributable to analytic variability is not well documented. We have monitored the accuracy of the results generated in our laboratory by testing aliquots of positive serum pools and a negative serum pool submitted blindly for the measurement of IgE antibodies to 16 different allergens, including foods; weed, grass, and tree pollens; mites, molds, and epithelia; and Hymenoptera venoms. Positive serum pools were prepared to contain modest amounts of IgE antibodies. Tests were performed by immunometric assays with microcrystalline cellulose allergen immunosorbents. Frank false-positive and false-negative results were very uncommon when binding levels were classified by a ratio-based reporting scheme. False-borderline results were more common. A borderline result is truly equivocal and may or may not indicate the presence of low levels of IgE antibodies. Analytic variability adds uncertainty to the measurement of small quantities of IgE antibodies regardless of the classification scheme used to report test results.     

Rhabdomyolysis as a result of Streptococcus pneumoniae: report of a case and review

We report the case of a patient who presented with RM associated with bacteremic pneumococcal pneumonia and review the literature on this condition.     

Incidence of decreased penicillin sensitivity of Streptococcus pneumoniae from clinical isolates.

One hundred isolates of Streptococcus pneumoniae isolated from clinical specimens over nine months were examined for sensitivity to penicillin using disc tests and minimum inhibitory concentration (MIC) studies. Four per cent of the isolates were found to have reduced sensitivity to penicillin. Penicillin and methicillin discs with 1 unit and 5 micrograms antibiotic, respectively, were inferior to discs with 1 microgram oxacillin, which gave results comparable with those of MIC studies.     

Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.     

Emergence of a Streptococcus pneumoniae clinical isolate highly resistant to telithromycin and fluoroquinolones

Streptococcus pneumoniae is a major pathogen causing community-acquired pneumonia and acute bronchitis. Macrolides, fluoroquinolones (FQs), and, recently, telithromycin (TEL) constitute primary therapeutic options, and rare cases of resistance have been reported. In this report, we describe the emergence of an S. pneumoniae clinical isolate with high-level TEL resistance (MIC, 256 microg/ml) and simultaneous resistance to FQs. Ongoing studies are oriented to elucidate the precise mechanism of resistance to TEL.     

Use of proficiency test performance to determine clinical laboratory director qualifications

Many activities and policies influence laboratory test quality. Proficiency test results are one measure of laboratory quality, and during the past 25 years, five studies have examined the relationship of laboratory director educational requirements to proficiency test results. Data from three studies support the association between director qualifications and quality as measured by proficiency test performance, whereas no relationship was found in the other two studies. Possible reasons for conflicting results include differences in database size and demographics; in addition, proficiency test results may be inappropriate, although widely used, as the sole measure of laboratory director performance.     

Identification of Streptococcus pneumoniae with a DNA probe.

The Accuprobe Streptococcus pneumoniae Culture Identification Test (Gen-Probe, Inc.) was evaluated with 172 isolates of S. pneumoniae and 204 nonpneumococcal isolates. The sensitivity and specificity of the Accuprobe test were 100%. Optimum results were obtained when four or more discrete colonies were selected for testing. The Accuprobe test was determined to be an accurate and rapid method for identification of S. pneumoniae.     

Detection of tetracycline resistance in Streptococcus pneumoniae.

Bacteriological details are given of a patient with chronic purulent bronchitis, who was being followed up during a survey of relapse in chronic bronchitis. A strain of Streptococcus pneumoniae, serotype 10, was isolated from the sputum over a period of six months, followed by a type 47A strain and later a type 28 strain. The patient was receiving prophylactic treatment with tetracycline throughout. The type 10 strain was sensitive to tetracycline in vitro by both the disc diffusion and doubling dilution sensitivity tests and mice infected with this strain were protected by tetracycline. In contrast, both the type 47A and type 28 strains were sensitive by the disc diffusion technique, but showed a low degree of tetracycline resistance by the doubling dilution method; mice infected with both these strains were not protected by tetracycline.     

Antimicrobial resistance in Streptococcus pneumoniae: a growing universal concern.

Streptococcus pneumoniae is the most common cause of bacterial pneumonia, otitis media, bacteremia, and meningitis in infants, children, and immunocompromised and splenectomized patients. After the introduction of penicillin in 1940, pneumococci were regarded as uniformly sensitive to minimal inhibitory concentrations (less than or equal to 0.05 microgram/mL). This idea persisted until 1967, when the first strain showing increased resistance to penicillin was isolated. Pneumococci with intermediate penicillin resistance recovered from different geographic areas have minimum inhibitory concentrations of 0.1 to 1.0 microgram/mL. In 1977, however, resistant strains were isolated with minimum inhibitory concentrations of 2 to 10 micrograms/mL; subsequently, strains resistant to other antibiotics including tetracycline, sulfonamides, erythromycin, lincomycin, chloramphenicol, clindamycin, streptomycin, and rifampin have also been reported. The authors emphasize the need for continued surveillance of pneumococcal isolates and recommend sensitivity testing of all isolates to penicillin.