Bacteriological findings in nasopharynx specimens from patients with a clinical diagnosis of acute sinusitis

OBJECTIVE: To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. DESIGN: Prospective study. SETTING: Patients from general practice in Vestfold county, Norway. PATIENTS: 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. MAIN OUTCOME MEASURES: Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. RESULTS: In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty-five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. CONCLUSION: Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group.     

Microbiologic findings of sinusitis by a novel method for obtaining culture

Many different methods have been described to obtain sinus culture from patients with chronic sinusitis. However, these methods presented limited information how they had prevented from the contamination with nasal flora. The purpose of this study is to demonstrate and describe a contamination-free technique to obtain culture from involved sinus during endoscopic sinus surgery (ESS). We prepared a cotton-tipped contamination-free swab. This applicator was inserted inside the sinus through ostium or inside the cavity directly established during ESS, and the swab was introduced directly into the implicated area. Thirty-five adult patients with chronic sinusitis who underwent ESS participated in the study. During ESS, the number of cultivated pathogenic microorganisms of the cultures obtained by our method was statistically significantly higher than the cultures obtained by the classic nasal cavity cultures (P = .0296). However, the number of cultivated bacteria (coagulase-negative Staphylococcus, alpha-hemolytic Streptococcus, and Corynebacterium spp.) after the contamination was lower than those of nasal cavity culture (P = .0296). During ESS, the identification of the pathogen in sinusitis with endoscopically guided narrow-bore sinus culture applicator is a reliable diagnostic method compared with the classic culture techniques.     

Efficacy of ceftriaxone in serious bacterial infections.

Ceftriaxone is a new semisynthetic cephalosporin with broad-spectrum in vitro activity and an unusually long serum half-life. The clinical efficacy of ceftriaxone was evaluated in 35 infections in 34 patients; 12 of these patients had skin and soft tissue infections, 10 had infections of the urinary tract, 8 had pneumonia, 2 had biliary tract infections, 1 had sinusitis, 1 had diverticulitis, and 1 had a retroperitoneal abscess. Of the 35 infections, 9 were bacteremic. The bacteria isolated included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus faecalis, other streptococcal species, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Haemophilus influenzae, Pseudomonas aeruginosa, Bacteroides fragilis, other Bacteroides species, and anaerobic cocci. Improvement or cure occurred in 32 episodes, for a response rate of 91%. There were three treatment failures in patients with soft tissue infections. No serious drug toxicities were observed. At a dosage regimen of 1 g every 12 h the peak and trough serum antibiotic concentrations were well above the minimal inhibitory concentrations of most pathogens. Our findings suggest that ceftriaxone is a safe and effective antibiotic for therapy of serious bacterial infections.     

The seventh nationwide surveillance of six otorhinolaryngological infectious diseases and the antimicrobial susceptibility patterns of the isolated pathogens in Japan

The Japanese Three Academic Societies Joint Antimicrobial Susceptibility Surveillance Committee conducted a nationwide surveillance on six otorhinolaryngological diseases and investigated the antimicrobial susceptibility patterns and isolation rates of the causative pathogens. The surveillance program was conducted in the otorhinolaryngological departments of 12 universities, and 36 affiliated hospitals and clinics. Patients with acute otitis media (children under six years old), chronic otitis media, acute nasal sinusitis, chronic nasal sinusitis, acute tonsillitis, and peritonsillar abscess (over 20 years old) between December 2015 and June 2017 were investigated. The collected swab or incision samples were cultivated for microbial identification, and the antimicrobial susceptibility of the detected bacteria was measured at the Kitasato University Research Center for Infections and Antimicrobials. The surveillance focused on three gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus), three gram-negative bacteria (Haemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa), and three anaerobic bacteria (anaerobic gram-positive cocci, Prevotella spp., Porphyromonas spp., and Fusobacterium spp.). Bacterial susceptibility to 40 antimicrobial agents was investigated. We were unable to completely mitigate the rise in the occurrence of resistant bacteria, such as methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, penicillin-intermediate resistant S. pneumoniae, beta-lactamase non-producing ampicillin-resistant H. influenzae, and beta-lactamase producing ampicillin-resistant H. influenzae. We suggest promoting the proper usage of antimicrobial agents to prevent the spread of these bacteria. We also suggested that immunization with pneumococcal vaccines is useful for decreasing the occurrence of otorhinolaryngological infectious diseases caused by pneumococci.     

Antimicrobial properties of MX-2401, an expanded-spectrum lipopeptide active in the presence of lung surfactant

MX-2401 is an expanded-spectrum lipopeptide antibiotic selective for Gram-positive bacteria that is a semisynthetic analog of the naturally occurring lipopeptide amphomycin. It was active against Enterococcus spp., including vancomycin-sensitive Enterococcus (VSE), vanA-, vanB-, and vanC-positive vancomycin-resistant Enterococcus (VRE), linezolid- and quinupristin-dalfopristin-resistant isolates (MIC(90) of 4 μg/ml), methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) (MIC(90) of 2 μg/ml), coagulase-negative staphylococci, including methicillin-sensitive Staphylococcus epidermidis (MSSE) and methicillin-resistant S. epidermidis (MRSE) (MIC(90) of 2 μg/ml), and Streptococcus spp. including viridans group streptococci, and penicillin-resistant, penicillin-sensitive, penicillin-intermediate and macrolide-resistant isolates of Streptococcus pneumoniae (MIC(90) of 2 μg/ml). MX-2401 demonstrated a dose-dependent postantibiotic effect varying from 1.5 to 2.4 h. Furthermore, MX-2401 was rapidly bactericidal at 4 times the MIC against S. aureus and Enterococcus faecalis, with more than 99.9% reduction in viable bacterial attained at 4 and 24 h, respectively. The MICs of MX-2401 against MRSA, MSSA, VSE, and VRE strains serially exposed for 15 passages to sub- to supra-MICs of MX-2401 remained within three dilutions of the original MIC. In contrast to that of the lipopeptide daptomycin, the antibacterial activity of MX-2401 was not affected in vitro by the presence of lung surfactant, and MX-2401 was active in vivo in the bronchial-alveolar pneumonia mouse model, in which daptomycin failed to show any activity. Moreover, the activity of MX-2401 was not as strongly dependent on the Ca(2+) concentration as is the activity of daptomycin. In conclusion, MX-2401 is a promising new-generation lipopeptide for the treatment of serious infections with Gram-positive bacteria, including hospital-acquired pneumonia.     

手术室护士鼻、咽部机会致病菌携带状况与干预

目的 了解手术室护士鼻、咽部带菌情况,以加强对手术室护士医院感染的预防与控制.方法 采用常规方法对在手术室工作的30名护士分别进行鼻前庭或咽拭子培养和菌种鉴定及抗生素敏感度检测.结果 从15份咽拭子中分离到肺炎克雷伯菌1株,对氨苄青霉素和氧哌嗪青霉索耐药.15份鼻前庭拭子中分离到表皮葡萄球菌9株,对多种抗生素耐药,金黄色葡萄球菌1株,对红霉素耐药.结论 手术室护士鼻前庭机会致病菌携带率较高,表皮葡萄球菌对抗生素耐药率高,应建立手术室医务人员医院感染监测和预警制度.     

Bacteriological findings in nasopharynx specimens from patients with a clinical diagnosis of acute sinusitis

Objective - To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. Design - Prospective study. Setting - Patients from general practice in Vestfold county, Norway. Patients - 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. Main outcome measures - Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. Results - In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. Conclusion - Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group.     

医院婴儿室细菌污染情况调查

对重庆某医院婴儿室细菌调查表明,污染的枯草杆菌最多,硝酸盐阴性不动杆菌其次。婴儿用品、环境与工作人员手、鼻、咽均有致病菌或条件致病菌不同程度的污染。对预防医院感染提出了建议。     

Chronic sinusitis: an update.

An accurate history is essential to the diagnosis of chronic sinusitis. Patients classically present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, postnasal drip, ear pain or blockage, and fatigue. The headache in chronic sinusitis is usually worse in the morning and following head movement. Purulent nasal discharge, spiking fever, an elevated white blood cell count, and intense, brief headache associated with nausea and vomiting are uncommon. Palpation, transillumination of the sinuses and anterior rhinoscopy are of minimal value in making the diagnosis. Fiberoptic nasopharyngoscopy can be used to identify the source of sinus discharge and the cause of obstruction. Although plain sinus radiographs are useful in diagnosing and monitoring acute sinusitis, they are of limited value in confirming chronic sinusitis. The sinuses are better imaged with computed tomographic scanning. Prolonged antibiotic therapy, in combination with decongestants and steroids, is usually effective for chronic sinusitis. In recalcitrant cases, sinus surgery may be necessary.     

Antimicrobial resistance in the nasopharyngeal flora of children with acute maxillary sinusitis and maxillary sinusitis recurring after amoxicillin therapy

OBJECTIVE: To investigate the antimicrobial susceptibility of the organisms isolated from the nasopharynx of children who present with acute maxillary sinusitis (AMS) or maxillary sinusitis that recurred (RMS) after amoxicillin therapy. METHODS: Analysis of nasopharyngeal cultures obtained from 70 patients, 42 with AMS and 28 with RMS. RESULTS: Thirty-eight potentially pathogenic organisms were recovered in 36 (86%) of the children from the AMS group, and 40 were isolated from 26 (93%) of the children from the RMS group. The organisms isolated were Streptococcus pneumoniae (21 isolates), Haemophilus influenzae non-type b (17), Moraxella catarrhalis (15), Streptococcus pyogenes (13) and Staphylococcus aureus (12). Resistance to the eight antimicrobial agents used was found in 34 instances in the AMS group compared to 93 instances in the RMS group (P < 0.005). The difference between AMS and RMS was significant with S. pneumoniae resistance to amoxicillin (P < 0.0025), to co-amoxiclav (P < 0.0025), to trimethoprim-sulfamethoxazole (P < 0.05), to cefixime (P < 0.05), and to azithromycin (P < 0.05), and for H. influenzae to amoxicillin (P < 0.025). CONCLUSIONS: These data illustrate the higher recovery rate of antimicrobial-resistant S. pneumoniae and H. influenzae from the nasopharynx of children who had maxillary sinusitis that recurred after amoxicillin therapy than those with AMS.     

Comparative In Vitro Activity of ABT-773, a Novel Antibacterial Ketolide

The in vitro activities of ABT-773, erythromycin, clarithromycin, and azithromycin were compared. ABT-773 was the most active compound against macrolide-susceptible Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Staphylococcus epidermidis, Listeria monocytogenes, and Enterococcus spp. and multidrug-resistant Streptococcus pneumoniae. It also had good activity against gram-negative and atypical respiratory tract pathogens and Helicobacter pylori.     

规范抗菌药药敏试验合理向临床报告检测结果

本文介绍美国临床和实验室标准协会(CLSI)抗菌药药敏试验的规范操作及向临床报告注意事项.共分9部分:(1)常规工作中药敏试验应注意要点;(2)葡萄球菌;(3)肠球菌;(4)肺炎链球菌;(5)肺炎链球菌以外的其他链球菌;(6)不常见的临床分离株及苛养菌;(7)肠杆菌科菌;(8)非肠杆菌科菌菌群;(9)流感嗜血杆菌.笔者还介绍了CLSI M100-S19,2009的文件中的部分新的内容.     

ICU病房革兰阳性菌耐药性分析

目的了解ICU病房革兰阳性菌的分布和耐药情况。方法回顾性分析ICU 2008-2009年的革兰阳性菌细菌培养和药物敏感试验。结果 2008年分离出前5位的革兰阳性菌依次为：表皮葡萄球菌（9.13%）、溶血葡萄球菌（4.01%）、金黄色葡萄球菌（3.12%）、肺炎链球菌（3.34%）和粪肠球菌（1.78%）。2009年分离出前5位的革兰氏阳性菌依次为：表皮葡萄球菌（9.06%）、金黄色葡萄球菌（4.25%）、溶血葡萄球菌（3.88%）、肺炎链球菌（3.33%）和粪肠球菌（1.67%）。结论革兰阳性病原菌耐药性严重,并呈明显上升趋势,应及时监测病原菌变化及耐药趋势,以指导临床用药。     

In vitro activity of cefodizime (HR-221)

The in vitro activity of cefodizime (HR-221), a new cephalosporin antibiotic, was compared with the activities of selected antimicrobial agents against a broad spectrum of aerobic bacteria. Cefodizime concentrations of 2 micrograms/ml inhibited about 90% of Enterobacteriaceae studied. Serratia marcescens required 8 micrograms/ml to inhibit 90% of strains. Among gram-positive cocci, 50% of strains were inhibited by 2 micrograms/ml of cefodizime (including methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, and penicillin-resistant Streptococcus pneumoniae). Pseudomonas aeruginosa was less susceptible to cefodizime. Cefotaxime, an antibiotic closely related to cefodizime structurally, was about fourfold more active.     

2005—2007年山西省儿童医院儿童细菌性肺炎病原菌分布及耐药性变迁分析

目的了解太原地区儿童细菌性肺炎病原菌的分布情况、抗菌药物的耐药情况以及近三年的变化趋势，为临床经验性治疗提供借鉴。方法对山西省儿童医院呼吸科2005年1月至2007年12月因肺炎住院治疗患儿的合格痰标本进行细菌学培养，用TDR200B细菌鉴定及药敏诊断系统进行菌株的鉴定与药物敏感性检测。结果共分离出致病菌1674株，革兰阳性菌1312株，革兰阴性菌362株。革兰阳性菌居前五位的依次是：草绿色链球菌、肺炎链球菌、C群链球菌、肠球菌属、耐甲氧西林表皮葡萄球菌；革兰阴性菌居前五位的依次是：产ESBLs大肠埃希菌、铜绿假单孢菌、嗜麦芽寡养单孢菌、大肠埃希菌、鲍氏不动杆菌。草绿色链球菌、C群链球菌、铜绿假单孢菌检出率的增长有统计学意义（P〈0．001）；常见耐药表型ESBLs阳性菌株的检出率的增长有统计学意义（P〈0．001）。对革兰阳性菌中的草绿色链球菌和肺炎链球菌，哌拉西林、头孢曲松敏感性最好。万古霉素对全部革兰阳性菌均敏感。对革兰阴性菌中产ESBLs大肠埃希菌和不产ESBLs大肠埃希菌，亚胺培南西司他丁全部敏感，其次是头孢哌酮舒巴坦；对铜绿假单孢菌，头孢哌酮舒巴坦敏感性最好。结论不同地区的儿童细菌性肺炎流行菌株及其药物敏感性可能不同，临床应根据本地区的病原菌流行特点、耐药规律及其动态制定最佳的治疗方案。     

In vitro antibacterial activity of men 10700, a new penem antibiotic

We report here the antibacterial activity of the new penem antibiotic Men 10700 against a total of 740 gram-positive and gram-negative clinical isolates, in comparison to imipenem, meropenem, cefotaxime, ceftriaxone, ciprofloxacin and gentamicin. Men 10700 has shown a wide spectrum of antibacterial activity, with a potent activity both against gram-positive species (with the exception of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis) as indicated by minimal inhibitory concentration (MIC(90)) values < or =0.5 mg/l, and gram-negative species, with MIC(90) values generally < or =2 mg/l. Men 10700 was the most potent antibiotic against methicillin-susceptible S. aureus and S. epidermidis, while the overall spectrum of activity resembled that of imipenem; meropenem was more active against most gram-negative species. In comparison with third-generation cephalosporins, Men 10700 demonstrated superior activity against methicillin-susceptible S. aureus and S. epidermidis and some gram-negative species such as Morganella morganii, Serratia spp. and Enterobacter cloacae; moreover, in contrast to third-generation cephalosporins, Men 10700 showed moderate activity against Enterococcus spp. The activity of Men 10700 against penicillin-resistant Streptococcus pneumoniae (10 strains) and some gram-negative strains selected for their resistance to cefotaxime (20 strains) was particularly interesting. Copyright Copyright 1999 S. Karger AG, Basel.     

Diagnosis and treatment of sinusitis

Maxillary and ethmoid sinusitis may occur at any age. Frontal sinus infections first appear in adolescence. The bacteria that cause sinusitis are similar to those associated with otitis media. Streptococcus pneumoniae and Hemophilus influenzae are recovered from 50 to 70 percent of isolates. Anaerobes are also important pathogens in adults. Fungal sinusitis usually occurs only in diabetics or immunosuppressed individuals.     

Bronchial hyperresponsiveness and bacterial respiratory infections.

Some studies suggest a potential role for bacterial respiratory tract infections in the development of bronchospasm and the progression of chronic obstructive pulmonary disease (COPD). Patients with bronchiectasis or cystic fibrosis have exaggerated airway reactivity; croup in children can also cause exaggerated upper and lower airway responsiveness. Bronchial obstruction after inhalation of Haemophilus influenzae and other bacteria has been reported. Between January 1989 and June 1990 we and two other centers studied 193 patients suffering from acute exacerbation of asthma. Fifty-two (27%) of these patients had bacteria in their sputum. Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis, and H influenzae were the most commonly isolated bacterial species. Antibiotics may be of value in the treatment of infective lung disease, not only by killing bacteria but also by preventing increases in bacterial histamine levels within the lung airways. Moreover, an antibiotic of proven efficacy can reduce airway reactivity in patients with bacterial exacerbations of COPD or bronchial asthma. In 12 patients with acute bacterial exacerbation of asthma and high airway reactivity to methacholine, a ten-day course of treatment with cefaclor and existing bronchodilators induced microbiologic cure and a slight but nonsignificant change in airway reactivity in nine patients. Antibiotic therapy has a minor but clear role in the control of acquired bronchial hyperreactivity during bacterial respiratory infections in asthmatic patients; however, because of airway inflammation, an antibiotic's efficacy is evident only when the inflammatory process subsides. Approaches designed to minimize airway reactivity may contribute to the prevention or reversal of respiratory failure during exacerbation of COPD and bronchial asthma.     

感染性心内膜炎血培养病原菌的分布及耐药性分析

目的 对感染性心内膜炎患者血培养分离菌的分布及对常用抗菌药物的耐药性进行分析,为临床合理选用抗菌药物提供依据.方法 采用VITEK-2-Compact系统鉴定细菌,药敏试验采用纸片扩散法,万古霉素对葡萄球菌的药敏试验采用E-Test方法,数据分析应用WHONET 5.6 软件.结果 共分离141株病原菌,草绿色链球菌、凝固酶阴性葡萄球菌和金黄色葡萄球菌为最常见病原菌,分别为53株、34株和18株.草绿色链球菌对红霉素、克林霉素的耐药率均为50%,对青霉素、头孢曲松、头孢噻肟和左氧氟沙星的耐药率均低于10%.凝固酶阴性葡萄球菌对青霉素类、头孢菌素类及红霉素的耐药率均大于80%.金黄色葡萄球菌对青霉素的耐药率最高为94.4%,对左氧氟沙星和红霉素的耐药率分别为27.8%和22.2%,对其他抗菌药物的耐药率均小于20%.耐甲氧西林的凝固酶阴性葡萄球菌和耐甲氧西林的金黄色葡萄球菌的发生率分别为85.3%和11.1%.结论 临床医生要密切关注分离菌的变迁及耐药性情况,合理使用抗菌药物.     

表皮葡萄球菌败血症96例临床分析

目的：探讨表皮葡萄球菌（表葡菌）败血症的临床特点和防治方法。方法：对９６例表葡菌败血症的临床资料进行分析。结果：表葡菌败血症多见地婴幼儿，部分还有基础疾病及并发症。原发病灶以呼吸道和皮肤粘膜为多，表葡菌时多种抗生素对耐药，结论：环丙沙星是治疗表葡菌败血症较敏感药物，可选用环丙沙星及阿米卡星，庆大霉素等联合进行初步治疗，然后根据药敏结果及时调整。