Antimicrobial resistance of invasive pneumococci in Finland in 1999-2000

The resistance patterns and macrolide resistance mechanisms of 910 Finnish invasive pneumococci isolated during 1999 and 2000 were studied. Macrolide resistance was detected in 6.9% of isolates. Penicillin resistance was detected in 1.5% of isolates, and penicillin intermediate resistance was detected in 4.0% of isolates. Active macrolide efflux, mediated by the mef(A) gene, was the most common macrolide resistance mechanism. Four macrolide-resistant isolates had mutations in rRNA or ribosomal protein L22.     

Antimicrobial resistance of Streptococcus pneumoniae isolates of outpatients in Germany, 1999-2000

BACKGROUND: The aim of the study was to determine the prevalence of antimicrobial resistance among clinical isolates of Streptococcus pneumoniae during the winter of 1999-2000 in Germany. METHODS: Pneumococcal isolates were prospectively collected by 14 different clinical microbiology laboratories. Minimal inhibitory concentrations of penicillin G, erythromycin A, clarithromycin, roxithromycin, azithromycin, clindamycin, levofloxacin and telithromycin were determined by the broth microdilution method. RESULTS: Among 328 strains 4.6% were nonsusceptible to penicillin G (intermediate and resistant strains) and 9.5% were resistant to erythromycin A. Analysis of erythromycin-resistant strains for the underlying resistance determinants revealed that 12 (38.7%) belonged to the erm(B) and 19 (61.3%) to the mef(E) type of resistance. Among the macrolide-resistant strains, serotypes 19F (n = 9) and 14 (n = 8) were the predominant types. CONCLUSIONS: Macrolide resistance in Germany is of growing concern and mainly due to the high prevalence of pneumococci expressing the mef(E) type of resistance.     

Calman-Hine reassessed: a survey of cancer network development in England, 1999-2000

Rationale, aims and objectives The paper assesses preliminary national data on the development of cancer care networks in England. Methods In January 2000, a national postal survey was sent to lead clinicians at 36 cancer centres and associate centres. Respondents were asked to provide basic numerical data on the design of the network (i.e. its configuration), detailing how many units it encompassed, and whether the centre was a multiple or a single entity. Results The survey highlighted national variations in the size and configuration of networks. The survey also highlighted tentative signs of shifts in clinical practice. The results showed that consultants at cancer centres and units were engaging in two forms of collaboration across centre–unit boundaries. Type 1 involved routine multidisciplinary team (MDT) outreach from centres to units, incorporating joint planning between clinicians at cancer centres and cancer units. Type 2 collaboration involved joint planning but also promoted joint centre and unit training and continuing professional development (CPD) programmes. Conclusions In our estimation, both forms of collaboration represented early evidence of qualitative changes in medical working practices. Organizational changes within cancer services have moved swiftly since initial soundings were taken in 2000 and we update our initial commentary in the light of recent empirical data. The findings may be of wider significance to managers and health practitioners who are working towards the implementation of delivery network elsewhere in the UK National Health Service.     

Antimicrobial resistance of Streptococcus pneumoniae isolates in 1999 and 2000 in Madrid, Spain: a multicentre surveillance study

Resistance to first-line antimicrobial agents in Streptococcus pneumoniae is increasing worldwide and the new fluoroquinolones may provide a good alternative. The antimicrobial susceptibility to levofloxacin and 13 other antibiotics of 300 isolates of S. pneumoniae, isolated in the Madrid community in 1999 and 2000, was determined. A total of 65.6% of isolates were penicillin intermediate or resistant strains. A high percentage of resistance to macrolides, clindamycin, tetracycline and chloramphenicol was also observed, mainly in penicillin-resistant strains. All but one strain was susceptible to levofloxacin.     

Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in the United States during 1999--2000, including a comparison of resistance rates since 1994--1995

A total of 1,531 recent clinical isolates of Streptococcus pneumoniae were collected from 33 medical centers nationwide during the winter of 1999--2000 and characterized at a central laboratory. Of these isolates, 34.2% were penicillin nonsusceptible (MIC > or = 0.12 microg/ml) and 21.5% were high-level resistant (MIC > or = 2 microg/ml). MICs to all beta-lactam antimicrobials increased as penicillin MICs increased. Resistance rates among non-beta-lactam agents were the following: macrolides, 25.2 to 25.7%; clindamycin, 8.9%; tetracycline, 16.3%; chloramphenicol, 8.3%; and trimethoprim-sulfamethoxazole (TMP-SMX), 30.3%. Resistance to non-beta-lactam agents was higher among penicillin-resistant strains than penicillin-susceptible strains; 22.4% of S. pneumoniae were multiresistant. Resistance to vancomycin and quinupristin-dalfopristin was not detected. Resistance to rifampin was 0.1%. Testing of seven fluoroquinolones resulted in the following rank order of in vitro activity: gemifloxacin > sitafloxacin > moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin > ofloxacin. For 1.4% of strains, ciprofloxacin MICs were > or = 4 microg/ml. The MIC(90)s (MICs at which 90% of isolates were inhibited) of two ketolides were 0.06 microg/ml (ABT773) and 0.12 microg/ml (telithromycin). The MIC(90) of linezolid was 2 microg/ml. Overall, antimicrobial resistance was highest among middle ear fluid and sinus isolates of S. pneumoniae; lowest resistance rates were noted with isolates from cerebrospinal fluid and blood. Resistant isolates were most often recovered from children 0 to 5 years of age and from patients in the southeastern United States. This study represents a continuation of two previous national studies, one in 1994--1995 and the other in 1997--1998. Resistance rates with S. pneumoniae have increased markedly in the United States during the past 5 years. Increases in resistance from 1994--1995 to 1999--2000 for selected antimicrobial agents were as follows: penicillin, 10.6%; erythromycin, 16.1%; tetracycline, 9.0%; TMP-SMX, 9.1%; and chloramphenicol, 4.0%, the increase in multiresistance was 13.3%. Despite awareness and prevention efforts, antimicrobial resistance with S. pneumoniae continues to increase in the United States.     

Fluoroquinolone consumption and resistance in haematology-oncology patients: ecological analysis in two university hospitals 1999-2002

OBJECTIVES: To compare rates of in vitro fluoroquinolone resistance of bacterial isolates obtained from inpatients of two haematology-oncology services with high and low fluoroquinolone consumption. METHODS: Two hospitals with consistently high (A) and low (B) fluoroquinolone use in their haematology-oncology services between the years 1999 and 2002 were identified in a hospital antibiotic use surveillance project. Rates of in vitro resistance to fluoroquinolones in inpatients of the services were determined for Escherichia coli and coagulase-negative staphylococcal bloodstream isolates, and also for Pseudomonas aeruginosa and Staphylococcus aureus isolates from any site. RESULTS: Fluoroquinolone resistance of E. coli was significantly higher in hospital A than in hospital B, but there was no such correlation between fluoroquinolone use and resistance rates for P. aeruginosa and staphylococci. CONCLUSION: The impact of antibiotic consumption on the prevalence of resistance may differ widely between different pathogens. Interventions using ecological analyses of the relationship between hospital antibiotic use and resistance need to consider pathogen-specific dynamics in the emergence and control of bacterial resistance.     

Antimicrobial use in Finnish acute care hospitals: data from national prevalence survey, 2005

OBJECTIVES: In Finland, use of antimicrobials in ambulatory care is moderate, but some reports suggest that hospital use is higher than in other European countries. We evaluated the amount and type of antimicrobials administered in Finnish acute care hospitals. PATIENTS AND METHODS: We analysed data collected in the national prevalence survey of nosocomial infections (NIs) during February-March 2005 in all tertiary care, all secondary care and 25% of other acute care hospitals. All inpatients present on the study day in acute care wards for adults were included (n=8234). The names and use-days of antimicrobials in Anatomical Therapeutic Class groups J01-J05 were collected on the study day and retrospectively for the previous 6 days. RESULTS: On the study day, 39% of patients had received at least one, 14% at least two and 3% at least three antimicrobials; patients with NI represented 21%, 29% and 45% of these groups, respectively. The prevalence of patients receiving any antimicrobial was 53% in intensive care patients and varied in other specialties from 0% in ophthalmology to 63% in dental and oral surgery. Within a 7 day period, the total use of antibacterial agents (J01) was 64 use-days per 100 patient-days. Cephalosporins were the most frequently used antimicrobials, followed by quinolones and metronidazole. CONCLUSIONS: The prevalence and spectrum of antimicrobial use in Finnish acute care hospitals were high. NI patients contributed markedly to the total usage. The NI survey with a 7 day data collection period provided insights into the use-density of antimicrobials.     

Antimicrobial susceptibility of community-acquired respiratory tract pathogens in North America in 1999-2000: findings of the PROTEKT surveillance study

The PROTEKT surveillance study commenced in 1999 to examine the antimicrobial susceptibility of community-acquired respiratory pathogens. We report here the results from 2371 isolates collected during 2000 by North American centers (Canada, n = 7; USA, n = 8). Overall, 21.3% of pneumococci (n = 687) were penicillin G-resistant (Canada, 10.3%; USA, 32.6%). Corresponding rates of erythromycin resistance were 16.3% and 31.5%. Telithromycin inhibited all penicillin- and erythromycin-resistant isolates at < or =1 microg/ml. Among 612 Hemophilus influenzae isolates, 22.4% were beta-lactamase-positive. Antimicrobial susceptibility of H. influenzae varied between 82.4% (clarithromycin) and 100% (cefpodoxime, levofloxacin). Importantly, one isolate was found to be resistant to both moxifloxacin and ciprofloxacin. Most Moraxella catarrhalis isolates were highly susceptible to the antimicrobials tested, except ampicillin. All Streptococcus pyogenes isolates (n = 382) were penicillin-susceptible and 5.2% were non-susceptible to erythromycin. S. pyogenes showed cross-resistance to other macrolides yet remained inhibited by telithromycin at < or =0.5 microg/ml. Methicillin resistance among Staphylococcus aureus was common (19.9%), particularly in the USA. The PROTEKT study confirms the widespread prevalence of antimicrobial resistance among common respiratory pathogens in North America, and hence the need for continued surveillance to guide optimal empiric therapy for community-acquired respiratory tract infections.     

2000-2003年北京地区1 542株腹泻病原药敏试验结果分析

目的监测北京地区2000-2003年与腹泻有关的肠道致病菌的组成及耐药状况,为本地区的流行病学研究、疫苗的制备及临床合理用药提供依据.方法通过常规大便培养,筛出致病菌后经生化及血清学进一步鉴定到种、群或血清型,并以纸片扩散法测定了抗菌药物的敏感性.结果肠道病原菌1 542株,以男性为主,儿童和青年发病为多,7～9月为腹泻发病高峰.病原以志贺菌属居首位占65.1%,其次是弧菌属占23.4%,而单胞菌属、沙门菌属及大肠杆菌分别占5.7%、4.4%及1.5%.各菌属对抗菌药物的敏感率有差异,福氏志贺菌和沙门菌属多重耐药较多,而宋内志贺菌和弧菌属对多种抗菌药物敏感.结论北京地区感染性腹泻的病原种类多,有性别、年龄、季节的分布特点,耐药性不同,应重视监测.     

Antimicrobial resistance trends in medical centers using carbapenems: report of 1999 and 2000 results from the MYSTIC program (USA).

Trends in susceptibility to antimicrobials were assessed from United States participants using 4488 isolates in the MYSTIC Program, 1999 (10 centers) through 2000 (15 centers). Diverse types of hospitals (general service, university, cancer, federal, pediatric, cystic fibrosis) were enrolled from 13 states. In 2000, oxacillin-susceptible staphylococci were 100% susceptible to meropenem, imipenem, and cefepime; but only 88% of strains were susceptible to ceftazidime. Among Enterobacteriaceae, > or = 96% of Enterobacter spp., Citrobacter spp., and Serratia spp. were susceptible to meropenem, imipenem, and cefepime; but ceftazidime, ceftriaxone, and piperacillin/tazobactam had 5-20% resistance rates. Extended-spectrum beta-lactamase resistance rates in Klebsiella spp. and Escherichia coli (6-7% and 3-5%, respectively) were stable over 2 years. Acinetobacter spp. were 78-81% susceptible to carbapenems but only 63-72% susceptible to ciprofloxacin. Meropenem, tobramycin, and piperacillin/tazobactam were the most active against Pseudomonas aeruginosa, but ciprofloxacin inhibited only 74% in 2000. Overall, meropenem remained the most potent agent, especially against ceftazidime- or piperacillin/tazobactam-resistant strains.     

Antibiotic resistance in 3113 blood isolates of Staphylococcus aureus in 40 Spanish hospitals participating in the European Antimicrobial Resistance Surveillance System (2000-2002)

OBJECTIVES: Since 1998 the European Commission has funded EARSS. We present the antibiotic susceptibility results of invasive Staphylococcus aureus obtained in Spain (2000-2002). MATERIAL AND METHODS: Forty hospitals participated in this study, covering nearly 30% of the Spanish population. All blood isolates of S. aureus were included. Laboratories used their usual methods to perform microbiological studies. Annual external quality controls were carried out. A questionnaire with hospital, patient and specimen data was completed for each isolate. Results were included in a database and analysed with WHONET 5 software. RESULTS: Invasive S. aureus was isolated in 3113 patients. Resistance was 24.5% to oxacillin, 25.4% to ciprofloxacin, 25.2% to erythromycin and 12.1% to gentamicin. Gentamicin resistance decreased from 16.6% (2000) to 9.7% (2002). Multiresistance was observed in 68.1% of oxacillin-resistant isolates. More prevalent multiresistance profiles consisted of oxacillin-ciprofloxacin-erythromycin-gentamicin (7.4%) and oxacillin-ciprofloxacin-erythromycin (7.1%). Oxacillin resistance was significantly higher in nosocomial isolates than in those implicated in community-onset infections (26.7% versus 14.2%), in isolates from adults than in those from children (27.3% versus 4.7%), in hospitals with >500 beds than in those with <500 beds (31.1% versus 18.3%) and in isolates from Intensive Care Units than in those from other departments (39.3% versus 24%). Decreased susceptibility to vancomycin was not detected. CONCLUSIONS: In Spain, S. aureus blood isolates present a high prevalence of resistance to oxacillin, ciprofloxacin and erythromycin, as well as a high prevalence of multiresistance. Oxacillin resistance remains stable but varies in relation to hospital size, patient age, hospital department and place of infection acquisition.     

Antimicrobial susceptibility of anaerobic bacteria in New Zealand: 1999-2003

OBJECTIVES: Routine susceptibility testing of all anaerobic organisms is not advocated, but it is useful for laboratories to test periodically for anaerobic organisms and provide local susceptibility data to guide therapy. This study reports the national trend of antibiotic susceptibility of clinically significant anaerobes in New Zealand. METHODS: Clinical isolates were tested using standardized methods against a range of antibiotics commonly used to treat anaerobic infections. Susceptibility was determined using NCCLS criteria. The change in susceptibility trends between this study and earlier studies was measured by comparing the geometric mean of the MIC. RESULTS: A total of 364 anaerobes were tested. Penicillin had poor activity against Bacteroides spp., Prevotella spp., Eubacterium spp., Clostridium tertium and Veillonella spp. In general, Fusobacterium spp., Bacteroides ureolyticus, Propionibacterium spp., Clostridium perfringens and anaerobic streptococci isolates, with the exception of Peptostreptococcus anaerobius, were penicillin susceptible. Amoxicillin/clavulanate showed good activity against most anaerobes, but resistance was seen with Bacteroides fragilis group and P. anaerobius isolates. Cefoxitin was more active than cefotetan, particularly against non-B. fragilis species, Eubacterium spp. and P. anaerobius. Meropenem and imipenem showed good activity against all anaerobes, with only 2 and 4% of Bacteroides spp., respectively, showing resistance. With the exception of Propionibacterium acnes isolates, which are predictably resistant, metronidazole was active against all anaerobes tested. There has been little change in susceptibility since 1997. CONCLUSIONS: Metronidazole, cefoxitin, piperacillin/tazobactam and amoxicillin/clavulanate remain good empirical choices when anaerobes are expected in our setting. No clinically relevant changes in susceptibility over time were found.     

Mardi Gras eye injury survey, 1998-1999

BACKGROUND: We studied the nature of associated ocular trauma during the 1998 and 1999 New Orleans parade seasons and whether trends were observable from previous surveys. METHODS: A prospective survey and retrospective analysis included 18 emergency rooms (ERs) in the New Orleans area. RESULTS: Sixteen surveys representing eight ERs were completed between February 19 and 24, 1998, and 32 surveys representing five ERs were completed between February 5 and 17, 1999. In both years, the most common ocular complaints were pain, blur, foreign body sensation, tearing, and photophobia. The most common slit lamp findings in 1998 were within normal limits, corneal abrasion, and conjunctival hyperemia. In 1999, the most common findings were subconjunctival hemorrhage, corneal abrasion, cell and flare, and lid laceration. CONCLUSIONS: Projectile injuries of the eyes are common during Mardi Gras due to the nature of interaction between paradegoers and float riders. We found no identifiable trend in the number or type of injuries reported in 1986, 1987, and 1998 Mardi Gras surveys.     

Antimicrobial therapy,resistance, and appropriateness in healthcare-associated and community-associated infections; a point prevalence survey

BackgroundData examining differences in antimicrobial therapy and its appropriateness between healthcare-associated infections (HAIs) and community-associated infections (CAIs) are limited. The objective was to compare antimicrobial therapy, resistance, and appropriateness between CAIs and HAIs.MethodsOne-day point prevalence survey targeting admitted patients with active infections was conducted in six tertiary care hospitals. Antimicrobial appropriateness was decided based on hospital antimicrobial guidelines, clinical assessment, culture results, and other relevant investigations.ResultsOut of 1666 patient records reviewed, 240 (14.4%) infection events were identified. Prevalence of infections treated with antimicrobials were 6.5% for HAIs and 7.1% for CAIs. The most commonly prescribed antimicrobials were carbapenems (19.6%), cephalosporins (14.8%), and vancomycin (13.2%), with some differences between HAIs and CAIs. The overall contribution of MDR pathogens to both HAIs and CAIs was similar (34.0% versus 34.3%, p = 0.969). ESBL was significantly associated with CAIs while other gram-negative MDR pathogens significantly associated with HAIs. Overall appropriateness of antimicrobial therapy was similar in HAI and CAI events (64.2% versus 64.7%, p = 0.934). However, it was highest in aminoglycosides (78.6%) and lowest in vancomycin (40.8%). It was lowest in bloodstream infections than other infections (48.5% versus 61% to 78%, p = 0.044).ConclusionAlthough the overall burden of MDR pathogens and appropriateness of antimicrobial therapy were similar in HAI and CAI events, there were some differences related to the type of MDR, type of antimicrobials, and type of infection. The current finding can guide training and educational activities of local antimicrobial stewardship initiatives aiming to improve antimicrobial therapy in hospital setting.     

Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals

OBJECTIVE: To describe and evaluate empiric antimicrobial regimens chosen for hospitalized patients with presumed community-acquired pneumonia (CAP) in US hospitals, including compliance with the American Thoracic Society (ATS) guidelines. Secondary outcomes included length of stay (LOS) and mortality associated with the choice of therapy. METHODS: A nonrandomized, prospective, observational study was performed in 72 nonteaching hospitals affiliated with a national group purchasing organization. Patients with an admission diagnosis of physician-presumed CAP and an X-ray taken within 72 hours of admission were eligible for the study. Demographic, antibiotic selection, and outcomes data were collected prospectively from patient charts. RESULTS: 3035 patients were enrolled; 2963 were eligible for analysis. Compliance with the ATS guidelines was 81% in patients with nonsevere CAP. The most common antibiotic regimen used for empiric treatment was ceftriaxone alone or in combination with a macrolide (42%). The overall mortality rate was 5.5%. The addition of a macrolide to either a second- or third-generation cephalosporin or a beta-lactam/beta-lactamase inhibitor was associated with decreased mortality and reduced LOS. CONCLUSIONS: Most hospitalized patients with CAP receive antimicrobial therapy consistent with the ATS guidelines. The addition of a macrolide may be associated with improved patient outcomes.     

北京4家医院临床分离的肠球菌株的耐药性分析

目的：深入分析北京地区分离的肠球菌的耐药表型，为临床合理选药提供客观实验依据。方法：按照美国临床实验室标准化委员会（NCCLS）推荐的方法和判断标准进行纸片扩散法药敏试验，并用WHONET5专用软件进行分析。结果：临床分离的肠球菌中，粪肠球菌和尿肠球菌分别占80．7％和17．1％；居前四位分离出肠球菌的标本是尿液（33．8％）、痰液（23．5％）、脓性分泌物（9．8％）和血液（4．4％）。粪肠球菌、尿肠球菌对万古霉素、替考拉宁、呋喃妥因、氯霉素、氨苄西林；高浓度庆大霉素的耐药率分别是2．0％、1．5％、1．4％、2．6％；11．7％、15．5％；44．3％、23．5％；17．7％、64．2％；47．4％、64．9％。结论：泌尿系统肠球菌感染最常见。粪肠球菌和尿肠球菌对万古霉素、替考拉宁的耐药率低，治疗重症感染可优先选药；对呋喃妥因有较好的敏感性；对高浓度庆大霉素和链霉素的耐药率较高。     

Patent review: therapeutic applications for antisense oligonucleotides 1999-2000

Over 200 patents disclosing antisense sequences have been published in the last year. 30 Of these, in which a therapeutic application is claimed, have been reviewed in this article. We have classified these under the headings of antibacterial, antiviral, inflammation, cardiovascular, apoptosis and anticancer. Although not exhaustive or covering all diseases, major areas of antisense research have been addressed.     

Epidemiological and virological characteristics of symptomatic acute hepatitis E in Greater Cairo, Egypt

Clin Microbiol Infect 2012; 18: 982-988 ABSTRACT: The aim of the study was to describe the characteristics of acute hepatitis E in Greater Cairo. Patients with acute hepatitis E were identified through a surveillance of acute hepatitis using the following definition: recent (<3?weeks) onset of fever or jaundice, alanine aminotransferase at least three times the upper limit of normal (uln), negative markers for other causes of viral hepatitis and detectable hepatitis E virus (HEV) RNA. Comparison of the liver tests between acute hepatitis E and hepatitis A virus (HAV), case-control analysis (four sex-matched and age-matched (±1?year) HAV controls per case) to explore risk factors and phylogenetic analyses were performed. Of the 17 acute HEV patients identified between 2002 and 2007, 14 were male. Median age was 16?years (interquartile range 13-22). Compared with HAV (n?=?68 sex-matched and ±1?year age-matched), HEV patients had higher bilirubin (mean (SD) 10.9 (5.7) uln versus 7.5 (4.4) uln, p?0.05) and aspartate aminotransferase levels (38.6 (27.1) uln versus 18.3 (18.1) uln, p?0.02). Co-infection (hepatitis C virus RNA or hepatitis B surface (HBs) -antigen positive/IgM anti-hepatitis B core (HBc) anitgen negative) was diagnosed in four patients. In univariate matched analysis (17 cases, 68 matched controls), HEV cases were more likely to live in a rural area than HAV controls (matched OR 7.9; 95% CI 2.0-30.4). Of the 16 isolates confirmed as genotype 1, 15 belonged to the same cluster with 94-98.5% identity in the open-reading frame 2 region. Our findings documented the sporadic nature of HEV in Greater Cairo, characterized a large number of Egyptian HEV genotype 1 strains and identified living in a rural area as a potential risk factor for infection.