An unusual outbreak of rotavirus genotype G2P[6] during the 2005-2006 epidemic season in Philadelphia

bla(OXA-23) and bla(OXA-66) were detected in 49 Acinetobacter baumannii isolates. These isolates were assigned to 7 subtypes by enterobacterial repetitive intergenic consensus polymerase chain reaction and 7 representative isolates were of ST92 or ST75. In most cases, the ISAba1-bla(OXA-23)-ATPaseΔ structure was identical to Tn2008. The 16-bp sequence at the left end of Tn2008 resembled the inverted repeat of ISAba1, suggesting that ISAba1 might have utilized an alternative boundary to mobilize bla(OXA-23).     

Prevalence and diversity of carbapenemases among imipenem-nonsusceptible Acinetobacter isolates in Korea: emergence of a novel OXA-182

Increase in multidrug-resistant Acinetobacter poses a serious problem in Korea. In this study, 190 imipenem (IPM)-nonsusceptible (NS) Acinetobacter isolates from 12 Korean hospitals in 2007 were used to determine species, prevalence, and antimicrobial susceptibility of OXA carbapenemase- and metallo-β-lactamase (MBL)-producing isolates. bla_OXA-23-like and ISAba1-asssociated bla_OXA-51-like genes were detected in 80% and 12% of 178 IPM-NS Acinetobacter baumannii isolates, respectively. A novel bla_OXA-182 was detected in 12 IPM-NS A. baumannii isolates. Twelve out of 14 MBL-producing isolates were non-baumanniiAcinetobacter. A. baumannii isolates with OXA carbapenemase were more often resistant to aminoglycosides, ciprofloxacin, and tigecycline than non-baumannii Acinetobacter isolates with MBL. Identical pulsed- field gel electrophoresis patterns were observed in 89% of A. baumannii isolates with bla_OXA-23-like gene. In conclusion, extremely rapid increase of IPM-NS A. baumannii in previous Korean studies was mainly due to clonal spread of OXA-23-producing A. baumannii isolates. A novel OXA-182 emerged in Korea.     

The route of antimicrobial resistance from the hospital effluent to the environment: focus on the occurrence of KPC-producing Aeromonas spp. and Enterobacteriaceae in sewage

We investigated the antimicrobial resistance profile and the occurrence of Klebsiella pneumoniae carbapenemase (KPC)–producing Gram-negative rods in sewage samples obtained from a Brazilian teaching hospital and from the wastewater treatment plant (WWTP) that receives it for treatment. We identified multidrug-resistant bacteria as well as KPC-2–producing Aeromonas spp. and several Enterobacteriaceae species, including Kluyvera spp., in the hospital effluent and in different sites of the WWTP. Most isolates showed the bla_KPC-2 gene harbored on a transposon that was carried by conjugative plasmids. The presence of KPC production among Aeromonas spp., Kluyvera spp., and other Enterobacteriaceae indicates the adaptability of such isolates to aquatic environments, not only in the hospital effluent but also throughout the WWTP. Although secondary treatment seems to decrease the amount of KPC producers in sewage, multidrug-resistant isolates are continually disposed in the urban river. Thus, sewage treatment regulations are urgently needed to decelerate the evolution of antimicrobial resistance beyond hospitals.     

Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010)

This study updates the frequency and resistance rates of Gram-negative bacilli isolated from Latin American medical centers enrolled in the SENTRY Antimicrobial Surveillance Program. A total of 12,811 bacterial organisms, including 5704 Gram-negative bacilli (44.5%), were consecutively collected (1 per patient) between January 2008 and December 2010 from 10 Latin American medical centers located in Argentina, Brazil, Chile, and Mexico. Antimicrobial susceptibility testing was performed and interpreted by the Clinical and Laboratory Standards Institute broth microdilution method at a central laboratory. All Gram-negative organisms with reduced susceptibility to imipenem or meropenem (MIC, ≥ 2 μg/mL) were screened for carbapenemase production by the modified Hodge test and by polymerase chain reaction. ESBL rates were 18.1%, 12.8%, 23.8%, and 48.4% among Escherichia coli and 60.4%, 49.9%, 59.2%, and 33.3% among Klebsiella spp. from Argentina, Brazil, Chile, and Mexico, respectively. Meropenem-nonsusceptible Klebsiella spp. rate was highest in Brazil (11.1%), followed by Argentina (8.2%), Chile (5.0%), and Mexico (0.8%). Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was not detected in 2008, but emerged in 2009 (10 strains) and increased significantly in 2010 (44; P < 0.0001). bla(KPC-2) was detected in 54 (65.9%) of 85 carbapenem-nonsusceptible K. pneumoniae. Meropenem-nonsusceptible P. aeruginosa was observed in 53.8%, 46.7%, 33.3%, and 28.8% of strains from Argentina, Brazil, Chile, and Mexico, respectively. Imipenem-resistant Acinetobacter spp. rates increased from 6.4%, 12.6%, and 0.0% in the 1997-1999 period to 84.9%, 71.4%, and 50.0% in 2008-2010 in Argentina, Brazil, and Chile, respectively. Oxacillinase (OXA)-producing Acinetobacter spp. was documented in Argentina (OXA-23 and -24), Brazil (OXA-23), Chile (OXA-58), and Mexico (OXA-24). Only colistin showed >77% overall coverage against the 5 most frequently isolated Gram-negative bacilli from Latin American Medical centers participating in the SENTRY Program.     

Identification of Achromobacter xylosoxidans by detection of the bla(OXA-114-like) gene intrinsic in this species

Achromobacter xylosoxidans is an emerging pathogen among patients with cystic fibrosis. Here we describe a specific PCR for identification of this organism, based on detection of bla(OXA-114-like). Comparison of isolates by pulsed-field gel electrophoresis revealed evidence of cross-infection in some cases, but most patients harbored their own strain.     

Prevalence and characteristics of aac(6′)-Ib-cr in AmpC-producing Enterobacter cloacae, Citrobacter freundii, and Serratia marcescens: a multicenter study from Korea

We investigated the prevalence of aac(6′)-Ib-cr and its association with other resistance genes in AmpC-producing Enterobacteriaceae without any selection criteria. A total of 479 clinical isolates of Enterobacter cloacae (179), Citrobacter freundii (134), and Serratia marcescens (166) from 12 laboratories between March and July 2005 were examined. We performed polymerase chain reaction for aac(6′)-Ib, bla_OXA-1, ISEcp1, and class 1 integron. The aac(6′)-Ib-cr was further identified by digestion with BstF5I and sequencing. The aac(6′)-Ib was detected in 110 (23%) of 479 isolates, and 15 isolates (3.1%) were cr variants (8 E. cloacae, 5 C. freundii, and 2 S. marcescens). The aac(6′)-Ib-cr was significantly associated with various resistance genes (bla_OXA-1, qnrS, qnrA, bla_CTX-M-3, and bla_CTX-M-14), mobile elements (ISEcp1, ISCR1, and class 1 integron), and quinolone resistance. Eleven of 15 aac(6′)-Ib-cr producers coharbored qnr genes. Although aac(6′)-Ib-cr was uncommon in Korean AmpC producers, its association with various resistance genes and mobile elements would facilitate the dissemination of this variant.     

Seroprevalence of zoonoses in a Cree community (Canada)

Cree trappers and hunters are at risk for contracting infectious diseases conveyed by wildlife. We performed a study in a Cree community (Canada) to determine the seroprevalence of 8 zoonotic infections among hunters and trappers for evidence of exposure to Trichinella sp., Toxoplasma gondii, Toxocara canis, Echinococcus granulosus, Leptospira sp., Coxiella burnetii, Francisella tularensis, and Sin Nombre virus. A total of 50 participants (28 women and 22 men) were included in this study. Results indicate no or infrequent exposure to the Sin Nombre virus (0%) and 3 of the 4 parasites investigated (0-4%). Exposure to T. gondii (10%) and some bacteria appeared to be more prevalent (range, 4-18%). Overall, seropositivity was related to fishing, hunting, and trapping activities. Physicians should be aware of these infections in this population, particularly Q fever, tularemia, and leptospirosis.     

Surveillance of methicillin-resistant Staphylococcus aureus isolated in Torino (northwest Italy)

Nosocomial infections by methicillin-resistant Staphylococcus aureus (MRSA) are an increasing cause of morbidity and mortality. Recently, a worldwide increase of community-acquired MRSA infections has also been recorded. The purpose of this study was to assess the frequency of MRSA isolation from in- and outpatients admitted to an academic teaching hospital near Torino (northwest Italy) in 1 year and to characterize 90 clinical isolates of MRSA collected in the same period. Antimicrobial susceptibility and the presence in the isolates of the Panton-Valentine leukocidin (PVL) gene were assessed. Molecular epidemiology was performed by SCCmec and capsule typing, and by pulsed-field gel electrophoresis. The global proportion of MRSA isolated was 33.1%. Characterization performed on 90 MRSA revealed a high percentage of resistance to ciprofloxacin and erythromycin, and the presence of the PVL gene in one strain only. Most of the MRSA strains circulating in the Torino district belonged to SCCmec types II and I, and the 67.6% resulted positive for the cap 5 gene. The pulsotype analysis permitted to observe a clonal heterogeneity of the isolates and a higher similarity in relation to singular mec types; only few nosocomial clones could account for a local outbreak of a sporadic isolate.     

Antimicrobial susceptibility of Pseudomonas aeruginosa isolates obtained from patients in Canadian hospitals: CANWARD 2008-2011

Broth microdilution (Clinical and Laboratory Standards Institute) was used to evaluate the antimicrobial susceptibility of 1549 Pseudomonas aeruginosa clinical isolates collected in Canada between January 2008 and October 2011. The percentage of isolates susceptible was as follows: amikacin 92.0%, ceftazidime 83.5%, ciprofloxacin 74.3%, colistin 93.4%, gentamicin 76.8%, meropenem 82.7%, and piperacillin-tazobactam 83.6%. Antimicrobial susceptibility did not change significantly between 2008 and 2011, with the exception of increasing susceptibility to gentamicin (P < 0.0001).     

Vitek2® system: a reliable tool to detect qnr determinants in Enterobacteriaceae without quinolone resistance-determining region modifications

Qnr determinants have now been found worldwide. In 2008, among 6150 Enterobacteriaceae, 12 isolates belonging to different bacterial species showing an unusual quinolone resistance pattern on Vitek2® system were investigated. Of 12, 11 harbored a qnr gene. Without QRDR modifications, qnr genes can be detected based on a Vitek2® resistance phenotype.     

Assessment of the prevalence and diversity of emergent campylobacteria in human stool samples using a combination of traditional and molecular methods

This study aims to assess the diversity of campylobacteria (Campylobacter and Arcobacter) in human fecal samples from patients with diarrhea (n = 140) and asymptomatic controls (n = 116) in Chile, using a combination of traditional culture and molecular methods. The culture methods detected campylobacteria in 10.7% of the patients with diarrhea and in 1.7% of the controls. In contrast, the molecular methods detected campylobacteria more often than the traditional culture, with a prevalence of 25.7% and 5.2%, respectively. The traditional methods only recovered the species Campylobacter jejuni, Campylobacter coli, and Arcobacter butzleri, whereas the molecular methods additionally detected the emergent species Campylobacter concisus and Campylobacter ureolyticus.     

Fungemia due to Candida guilliermondii in a pediatric and adult population during a 12-year period

Candida guilliermondii fungemia is usually described in adults with hematologic malignancies, but in children, only 2 episodes have been published. From 1995 to 2006, 7 episodes (5 in children) were detected in our hospital. Molecular typing excluded a common infection source. C. guilliermondii fungemia may occur in children with underlying conditions other than cancer.     

Five-year report of national surveillance of antimicrobial resistance in Pseudomonas aeruginosa isolated from non-tertiary care hospitals in Korea (2002-2006)

A nationwide surveillance of the antimicrobial resistance of Pseudomonas aeruginosa isolates from non-tertiary care hospitals was conducted in Korea from 2002 to 2006. Resistance to almost all antimicrobial agents decreased significantly from 2003 (P < 0.01). Resistance rates to the major antipseudomonal agents, ceftazidime, imipenem, meropenem, and aztreonam, were 18.8%, 20.5%, 18.7%, and 19.7%, respectively, in 2003. However, they had all decreased to below 10% in 2006. The proportion of multidrug-resistant isolates that were resistant to at least 3 of 5 major antipseudomonal agent decreased from 33.5% in 2003 to 23.1% in 2006 (P < 0.05). In this study, we found a decreasing trend in resistance rates and low resistance rates in P. aeruginosa from non-tertiary care hospitals compared with those from general hospitals, including tertiary care hospitals, in Korea. Our data provide valuable information for the selection of reliable empiric therapies for P. aeruginosa infections in non-tertiary care hospital patients, including outpatients.     

Telavancin activity tested against a contemporary collection of Gram-positive pathogens from USA Hospitals (2007-2009)

This study updates the activity of telavancin against Gram-positive pathogens collected from USA hospitals (2007-2009). Telavancin (MIC_50/90, 0.12/0.25 μg/mL) was active against coagulase-negative staphylococci and methicillin-resistant Staphylococcus aureus (100% susceptible), for which only daptomycin (MIC_50/90, 0.25/0.5 μg/mL; 99% susceptible) and quinupristin/dalfopristin (MIC_50/90, ≤0.25-0.5/0.5 μg/mL; 99% susceptible) exhibited similar activity. Telavancin (MIC_50/90, 0.25/0.5 μg/mL) inhibited 96.5% of Enterococcus faecalis at the Food and Drug Administration breakpoint (MIC, ≤1 μg/mL), where ampicillin (99.9% susceptible), daptomycin (99.9% susceptible), and linezolid (100% susceptible) also demonstrated high-level coverage. Telavancin inhibited, respectively, 100.0% and 91.7% of VanB-phenotype E. faecalis and E. faecium at ≤1 μg/mL, whereas it was less active against VanA strains. Telavancin was uniformly active against Streptococcus pneumoniae and resistant subsets, and demonstrated good potency (MIC₉₀, 0.06-0.12 μg/mL) against other streptococci, regardless of resistance to other drugs. This assessment reveals potent activity of telavancin against Gram-positive isolates collected from USA hospitals with no evidence of emergence of resistance.     

Validation of the EntericBio Panel II® multiplex polymerase chain reaction system for detection of Campylobacter spp., Salmonella spp., Shigella spp., and verotoxigenic E. coli for use in a clinical diagnostic setting

A total of 717 faeces samples were tested prospectively using the EntericBio Panel II® detection system (Serosep, Limerick, Ireland), in parallel with routine laboratory testing, which combines the EntericBio® system with retrospective culture of each specimen where a target is detected. Discrepancy analysis was conducted using molecular methods. The EntericBio Panel II® assay produced 585 negative and 132 positive results, namely, Campylobacter spp. (n = 66); SLT 1 and/or SLT 2 (n = 64); Salmonella spp. (n = 5); and Shigella spp. (n = 0). Three samples were positive for more than 1 target. Of these results, 4 Campylobacter spp. detections and 4 SLT 1/ SLT 2 detections remained unconfirmed, and the system failed to detect 2 Campylobacter spp. targets detected by routine laboratory detection. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were calculated to be 98.4%, 98.7%, 93.9%, 99.7%, and 98.6%, respectively.     

Cloning and sequencing of the class A beta-lactamase gene (blaTEM-15) located on a chromosomal Tn801 transposon

Escherichia coli CA0210 was identified in a stool culture of a 03-month-neonate in Tunisia. This strain was resistant to beta-lactams, including ureidopenicillins, ticarcillin-clavulanic acid, cefpirome, ceftazidime, and cefotaxime, but it remained susceptible to imipenem and cefoxitin. The beta-lactam-hydrolyzing beta-lactamase gene of E. coli CA0210 and the upstream and downstream regions were cloned, sequenced, and expressed in E. coli DH5alpha. These resistances were carried by a 1080-bp chromosomal gene that encoded a beta-lactamase with a pI of 6.3. Cloning and sequencing experiments showed that the corresponding blaTEM-15 gene was part of a chromosomally located Tn801 transposon.     

Molecular characterization of Neisseria meningitidis B:NT:P1.14/162 clonal complex responsible of invasive meningococcal disease in the north of Italy

The molecular characteristics of 14 B:NT:P1.14 Neisseria meningitidis isolates, collected from 2007 through 2010 in Italy, have been investigated. The B:NT:P1.14 phenotype has only more recently been identified in our country, mainly associated with clonal complex CC162, which is rare in Italy.     

Effects of D-004, a lipid extract of the fruit of the Cuban royal palm (Roystonea regia) or the lipidosterolic extract of saw palmetto (Serenoa repens) on the sexual activity in male rats: A controlled, experimental study

Background: The etiology of benign prostatic hyperplasia (BPH) is not completely understood, but hormonal changes in aging men seem to be pivotal. Dihydrotestosterone, a potent, active metabolite of testosterone, is formed by the enzymatic action of prostate 5α-reductase and causes cell growth and hyperplasia. Consistent with this action, male sexual dysfunction has been clinically documented to be among the drug-related adverse events associated with 5α-reductase inhibitors. The lipidosterolic extract of saw palmetto (LESP) fruit (Serenoa repens) has been used to treat BPH. D-004, a lipid extract of Roystonea regia Royal palm fruit, has been found to prevent prostatic hyperplasia induced by testoste-rone in rodents and to competitively inhibit prostate 5α-reductase activity in vitro.Objective: The purpose of this study was to assess the effects of D-004 and LESP, administered as single or repeated doses, on the sexual activity in male rats.Methods: This controlled, experimental study was conducted at the Pharmacology Department, Centre of Natural Products, National Centre for Scientific Research, Havana City, Cuba. Adult male Wistar rats weighing 250 to 300 g were randomized into 5 groups: 2 groups treated orally with D-004 (400 and 800 mg/kg); 2 groups treated orally with LESP (400 and 800 mg/kg); and 1 control group orally administered a water vehicle. Sexual activity behavior (the number of mounts and intromissions, mount latency, and intromission latency) was assessed during 2 observation periods: 90 minutes after the initial dose and at the end of the 30-day treatment. Latency was defined as time elapsed between the first mount and intromission.Results: A total of 50 rats (mean [SD] age, 10 [3] weeks; mean [SD] weight, 295 [10] g) were included in the experiment. There were no significant difterences in the mean number of mounts, intromissions, mount latency, or intromission latency in the groups treated with single or repeated doses of D-004 or LESP (400 and 800 mg/kg) compared with the controls. There was also no between-group difterence in mating behavior among the active treatment groups. All rats survived up to study completion, with normal behavior (weight gain, food intake, daily observations, without any sign of toxicity). There were no observable adverse events during the study.Conclusions: D-004 and LESP administered as a single dose or repeated doses for 30 days did not significantly affect male rat sexual activity behavior compared with a vehicle control group.     

Evaluation of the in vitro activity of daptomycin against 19615 clinical isolates of Gram-positive cocci collected in North American hospitals (2002-2005)

We evaluated the antimicrobial activity of daptomycin against 19,615 clinical strains consecutively collected by numerous centers located across the United States and Canada (2002-2005). Daptomycin was very active against all indicated species (>99% susceptible), with the highest MIC results being 2, 8, 0.5, and 1 microg/mL for staphylococci, enterococci, beta-hemolytic streptococci, and viridans group streptococci, respectively, and no significant loss in potency was observed over the period studied.