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Glycopeptide resistance in coagulase-negative staphylococci isolated in blood cultures from patients with hematological malignancies during three decades. Eur J Clin Microbiol Infect Dis 2011; 30:1349-54. [PMID: 21744039 DOI: 10.1007/s10096-011-1228-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study was to determine if there was a long-term increase in glycopeptide minimum inhibitory concentration (MIC) values, MIC creep, among bloodstream isolates of Staphylococcus epidermidis and S. haemolyticus isolated from patients with hematological malignancies. We conducted a retrospective single-center study where all positive blood cultures of S. epidermidis (n = 387) and S. haemolyticus (n = 19) isolated from patients with hematological malignancies during three decades, 1980 to 2009, were re-evaluated for the presence of reduced susceptibility to vancomycin and teicoplanin. Three different methods for the detection of reduced susceptibility to glycopeptides were used; standard Etest, macromethod Etest, and glycopeptide resistance detection (GRD) Etest. The median MIC value for vancomycin was 2 mg/L. MIC values for vancomycin and teicoplanin did not show any statistically significant increase during the study period. The presence of heterogeneously glycopeptide-intermediate staphylococci (hGIS) was analyzed among 405 coagulase-negative staphylococci (CoNS) isolates. hGIS were found in 31-45% of the CoNS isolates by the macromethod Etest and in 53-67% by the GRD Etest during the three decades. In conclusion, we did not observe any long-term glycopeptide MIC creep determined by the standard Etest, although a high and increasing proportion of heterogeneous vancomycin resistance was observed.
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2
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Hussein HS, Bollinger LM. Influence of Selective Media on Successful Detection of Shiga Toxin–ProducingEscherichia coliin Food, Fecal, and Environmental Samples. Foodborne Pathog Dis 2008; 5:227-44. [DOI: 10.1089/fpd.2008.0081] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Hussein S. Hussein
- Department of Animal Biotechnology, University of Nevada—Reno, Reno, Nevada
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3
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Nakipoglu Y, Derbentli S, Cagatay AA, Katranci H. Investigation of Staphylococcus strains with heterogeneous resistance to glycopeptides in a Turkish university hospital. BMC Infect Dis 2005; 5:31. [PMID: 15871748 PMCID: PMC1156892 DOI: 10.1186/1471-2334-5-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 05/05/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hetero-glycopeptide intermediate staphylococci is considered to be the precursor of glycopeptide intermediate staphylococci especially vancomycin intermediate Staphylococcus aureus (VISA). For this purpose, we aimed to investigate the heterogeneous resistance to glycopeptide and their frequencies in 135 Staphylococcus strains. METHODS Heterogeneous resistance of Staphylococcus strains was detected by inoculating the strains onto Brain Heart Infusion agar supplemented with 4 mg/L of vancomycin (BHA-V4). Agar dilution method was used for determining MICs of glycopeptides and population analysis profile was performed for detecting frequency of heterogeneous resistance for the parents of selected strains on BHA-4. RESULTS Eight (6%) out of 135 Staphylococcus strains were exhibited heterogeneous resistance to at least one glycopeptide. One (1.2%) out of 81 S. aureus was found intermediate resistance to teicoplanin (MIC 16 mg/L). Other seven strains were Staphylococcus haemolyticus (13%) out of 54 coagulase negative staphylococci (CoNS). Six of the seven strains were detected heterogeneously reducing susceptibility to vancomycin (MICs ranged between 5-8 mg/L) and teicoplanin (MICs ranged between 32-64 mg/L), and one S. haemolyticus was found heterogeneous resistance to teicoplanin (MIC 32 mg/L). Frequencies of heterogeneous resistance were measured being one in 10(6) - 10(7) cfu/ml. MICs of vancomycin and teicoplanin for hetero-staphylococci were determined as 2-6 folds and 3-16 folds higher than their parents, respectively. These strains were isolated from six patients (7%) and two (4%) of health care workers hands. Hetero-VISA strain was not detected. CONCLUSION Heterogeneous resistance to glycopeptide in CoNS strains was observed to be significantly more emergent than those of S. aureus strains (vancomycin P 0.001, teicoplanin, P 0.007). The increase MICs of glycopeptide resistance for subpopulations of staphylococci comparing with their parents could be an important clue for recognizing the early steps in the appearance of VISA strains. We suggested to screen clinical S. aureus and CoNS strains, systematically, for the presence of heterogeneously resistance to glycopeptide.
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Affiliation(s)
- Yasar Nakipoglu
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Sengul Derbentli
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Atahan A Cagatay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Handan Katranci
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Istanbul, Istanbul, Turkey
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4
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Abstract
This review describes the use of vancomycin in neonates over the last three decades. Given the relation of late-onset neonatal septicaemia to outcome and the increase in coagulase-negative staphylococcal infection as causative organism, vancomycin remains an important antibacterial in the neonatal intensive care unit. The pharmacokinetic behaviour of vancomycin in neonates can be adequately described by a one- or two-compartment model and is mainly determined by postconceptional age and renal function. In neonates, a patent ductus arteriosus as well as treatment with indomethacin or extracorporeal membrane oxygenation (ECMO) leads to an increase in volume of distribution and a decrease in clearance. Microbiological studies in vitro have shown that an increase in vancomycin concentrations above the minimum inhibitory concentration does not result in more effective killing. The microbiological and clinical efficacy of vancomycin in neonates has only been studied explicitly in a restricted number of patients. There are no definitive data relating serum concentrations to effect in this patient group. Vancomycin-related nephrotoxicity and ototoxicity in neonates is rare, and no clear relation to serum concentrations has been demonstrated. Based on the pharmacokinetic profile of vancomycin in neonates, several administration regimens have been constructed. Recent guidelines have suggested that dosage can be independent of gestational age or postconceptional age in neonates without renal failure. In patients with renal failure, therapy can be adequately tailored by using a regimen based on serum creatinine. The usefulness of routine monitoring of peak serum concentrations is doubtful based on the current literature. Recent research demonstrates a shift towards taking only routine trough serum concentrations in order to optimise efficacy. Patients with renal failure and other special subpopulations, such as patients exposed to ECMO or indomethacin, need to be monitored more closely.
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Affiliation(s)
- Matthijs de Hoog
- Department of Pediatrics, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands.
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5
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Abstract
Vancomycin resistance has been reported in clinical isolates of both coagulase-negative staphylococci and Staphylococcus aureus. The emerging threat of widespread vancomycin resistance poses a serious public health concern given the fact that vancomycin has long been the preferred treatment of antibiotic-resistant gram-positive organisms. Though major efforts are now being focused on improving our understanding of vancomycin resistance, there is much that remains unknown at this time. This article reviews the major epidemiologic, microbiologic, and clinical characteristics of vancomycin resistance in both coagulase-negative staphylococci and S. aureus. The review begins with a discussion of issues common to both coagulase-negative staphylococci and S. aureus, such as definitions, laboratory detection of vancomycin resistance, and infection control issues related to vancomycin-resistant staphylococci. The rest of the article is then devoted to a discussion of issues unique to each organism, including epidemiology, risk factors for infection, mechanisms of resistance, and management options.
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Affiliation(s)
- Arjun Srinivasan
- Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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6
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Schulin T, Voss A. Coagulase-negative staphylococci as a cause of infections related to intravascular prosthetic devices: limitations of present therapy. Clin Microbiol Infect 2002; 7 Suppl 4:1-7. [PMID: 11688530 DOI: 10.1046/j.1469-0691.2001.00053.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coagulase-negative staphylococci (CNS) are an important cause of catheter-related bloodstream infections. This review will shed light on the pathogenesis related to biofilm formation, and will discuss antimicrobial susceptibility of CNS to older and newer antibiotics, as well as therapeutic options.
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Affiliation(s)
- T Schulin
- University Medical Center St Radboud, Department of Medical Microbiology, Nijmegen, The Netherlands.
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7
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Marsou R, Bes M, Brun Y, Boudouma M, Idrissi L, Meugnier H, Freney J, Etienne J. Molecular techniques open up new vistas for typing of coagulase-negative staphylococci. ACTA ACUST UNITED AC 2001; 49:205-15. [PMID: 11367554 DOI: 10.1016/s0369-8114(01)00130-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Several methods were used to type 64 clinical isolates of coagulase-negative staphylococci (CNS) derived from hospitals in Morocco. The clinical isolates originated principally from blood cultures and wound sources. These isolates provided the opportunity to substantially compare the proficiency of developing molecular techniques with conventional phenotypic tests for use in the identification of clinical staphylococci. The following molecular methods were examined: Utility ribotyping analysis (Ribotyping); PCR analysis performed with 16S-23S ribosomal-DNA intergenic spacer (ITS-PCR); PCR-based random amplified polymorphic DNA (RAPD). The results obtained by the molecular techniques were contrasted to those of conventional phenotypic tests. Conventional phenotypic tests allowed the outright recognition of the majority of isolates (50/64). These 50 isolates were subdivided into 33 novobiocin-susceptible and 17 novobiocin-resistant strains of CNS. However, 2 other novobiocin-susceptible and 12 other novobiocin-resistant isolates remained unclassified by these tests. There was a good agreement between the conventional phenotypic tests and RAPD for the 33 novobiocin-susceptible isolates. But, the RAPD technique permitted the assignment of the two unidentified novobiocin-susceptible isolates to the Staphylococcus hominis species. A complete correlation was obtained between the three molecular tools for recognition of the 12 novobiocin-resistant isolates that were not identified by phenotypic typing; these were in fact identified as 5 Staphylococcus cohnii and 4 Staphylococcus equorum. Three isolates remained unidentified by all three systems of molecular techniques.
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Affiliation(s)
- R Marsou
- Centre national de référence de toxémies à staphylocoques, EA 1655, faculté de médecine RTH Laennec, rue Guillaume Paradin, 69372 Lyon, France
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8
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Biavasco F, Vignaroli C, Lazzarini R, Varaldo PE. Glycopeptide susceptibility profiles of Staphylococcus haemolyticus bloodstream isolates. Antimicrob Agents Chemother 2000; 44:3122-6. [PMID: 11036034 PMCID: PMC101614 DOI: 10.1128/aac.44.11.3122-3126.2000] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Twelve clinical strains of Staphylococcus haemolyticus (eight methicillin resistant and three methicillin susceptible), isolated from blood cultures between 1982 and 1997, were investigated for teicoplanin and vancomycin susceptibility profiles. On the basis of conventional MIC tests and breakpoints, four isolates were susceptible (MICs, 1 to 8 microgram/ml) and eight were resistant (MICs, 32 to 64 microgram/ml) to teicoplanin while all were susceptible to vancomycin (MICs, 1 to 2 microgram/ml). All four strains for which the conventional teicoplanin MICs were within the range of susceptibility expressed heterogeneous resistance to teicoplanin and homogeneous vancomycin susceptibility. Of the eight strains for which the conventional teicoplanin MICs were within the range of resistance, six expressed heterogeneous and two expressed homogeneous teicoplanin resistance while seven showed heterogeneous vancomycin resistance profiles (with subpopulations growing on 8 microgram of the drug per ml at frequencies of >/=10(-6) for six strains and 10(-7) for one) and one demonstrated homogeneous vancomycin susceptibility. Of six bloodstream isolates of other staphylococcal species (S. aureus, S. epidermidis, and S. simulans), for all of which the conventional teicoplanin MICs were >/=4 microgram/ml and the vancomycin MICs were </=2 microgram/ml, none exhibited heterogeneous susceptibility profiles for teicoplanin while three showed homogeneous and three showed heterogeneous susceptibility profiles for vancomycin (with subpopulations growing on 8 microgram of the drug per ml found for only one strain). The results of this study indicate that a heterogeneous response to glycopeptides is a common feature of S. haemolyticus isolates and suggest that susceptibility to glycopeptides as determined by conventional MIC tests may not be predictive of the outcome of glycopeptide therapy.
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Affiliation(s)
- F Biavasco
- Institute of Microbiology, University of Ancona, 60131 Ancona, Italy.
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9
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Domaracki BE, Evans AM, Venezia RA. Vancomycin and oxacillin synergy for methicillin-resistant staphylococci. Antimicrob Agents Chemother 2000; 44:1394-6. [PMID: 10770789 PMCID: PMC89882 DOI: 10.1128/aac.44.5.1394-1396.2000] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An increase in oxacillin activity was observed against methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) in the presence of a sub-MIC of vancomycin. Vancomycin and oxacillin were synergistic against 14 of 21 strains of MRCNS and MRSA. A pattern of enhanced killing was also supported by time-kill studies. These results suggest that combinations of sub-MICs of vancomycin and oxacillin may have therapeutic benefits against methicillin-resistant staphylococci.
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Affiliation(s)
- B E Domaracki
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York 12208, USA
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10
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Aeschlimann JR, Hershberger E, Rybak MJ. Activities of trovafloxacin and ampicillin-sulbactam alone or in combination versus three strains of vancomycin- intermediate Staphylococcus aureus in an in vitro pharmacodynamic infection model. Antimicrob Agents Chemother 2000; 44:1153-8. [PMID: 10770744 PMCID: PMC89837 DOI: 10.1128/aac.44.5.1153-1158.2000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The recent isolation of clinical strains of methicillin-resistant Staphylococcus aureus (MRSA) with intermediate susceptibility (MICs, 8 microg/ml) to vancomycin (vancomycin-intermediate S. aureus [VISA]) emphasizes the importance of developing novel antimicrobial regimens and/or agents for future treatment. We studied the activities of ampicillin-sulbactam and trovafloxacin alone or in combination against three unique strains of VISA in an in vitro infection model. Two VISA strains were trovafloxacin susceptible (MICs, < or =2 microg/ml); one VISA strain was trovafloxacin resistant (MIC, 4 microg/ml). Trovafloxacin was administered to simulate a dose of 200 or 400 mg every 24 h. Ampicillin-sulbactam was administered to simulate a dose of 3 g every 6 h. Samples were removed from the infection models over 48 h, and reductions in colony counts were compared between regimens. Trovafloxacin (200 mg) produced rapid killing of a control MRSA strain over the 48-h experiment but produced only slight killing of all three VISA strains. The higher dose of trovafloxacin improved killing but did not produce bactericidal activity at 48 h. Ampicillin-sulbactam produced rapid bactericidal activity against all four strains tested, and colony counts at 8 h were at the limits of detection. However, regrowth occurred by 48 h for each strain. The combination of ampicillin-sulbactam and trovafloxacin provided additive activity against two of the three VISA strains. In conclusion, trovafloxacin or ampicillin-sulbactam alone did not provide adequate activity against the VISA strains for the 48-h evaluation period, but the combination could help improve activity against some strains of VISA.
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Affiliation(s)
- J R Aeschlimann
- The Anti-Infective Research Laboratory, Department of Pharmacy Services, Detroit Receiving Hospital and University Health Center, Wayne State University, Detroit, Michigan 48201, USA
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11
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Giovanetti E, Biavasco F, Pugnaloni A, Lupidi R, Biagini G, Varaldo PE. An electron microscopic study of clinical and laboratory-derived strains of teicoplanin-resistant Staphylococcus haemolyticus. Microb Drug Resist 2000; 2:239-43. [PMID: 9158766 DOI: 10.1089/mdr.1996.2.239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Staphylococcal resistance to glycopeptides (which involves more teicoplanin than vancomycin) is uncommon and largely confined to Staphylococcus haemolyticus, an emerging nosocomial pathogen with a tendency to develop antibiotic resistance. In this study, six S. haemolyticus strains, including two isogenic pairs of teicoplanin-susceptible/-resistant strains and two resistant clinical isolates, were used in a morphologic and morphometric electron microscope investigation. Cells from both clinical and laboratory-derived teicoplanin-resistant strains exhibited abnormally roughened, irregular outlines when observed by transmission electron microscopy. However, no significant differences in cell wall thickness resulted from morphometric analysis when the susceptible/resistant cells of the two isogenic pairs were compared. By scanning electron microscopy, an abnormally roughened, blistered surface was associated with teicoplanin-resistant cocci. A certain variability was noted between strains, not clearly related to the resistance level. In freeze-fracture investigations, a higher number per square micrometer of intramembrane particles, more significant in the E than in the P membrane fracture face, was observed in the laboratory-derived resistant clones as compared to susceptible parent strains. Further studies are needed to understand the cause-effect relation between these ultrastructural alterations and staphylococcal resistance to teicoplanin (but not to vancomycin).
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Affiliation(s)
- E Giovanetti
- Institute of Microbiology, University of Ancona Medical School, Italy
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12
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De Giusti M, Pacifico L, Tufi D, Panero A, Boccia A, Chiesa C. Phenotypic detection of nosocomial mecA-positive coagulase-negative staphylococci from neonates. J Antimicrob Chemother 1999; 44:351-8. [PMID: 10511402 DOI: 10.1093/jac/44.3.351] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over a 3-year period, we screened antimicrobial resistance genotype (mecA-positive or -negative) in clinically significant coagulase-negative staphylococci isolated from patients residing in our neonatal intensive care unit. For the 152 study strains, the accuracy of standard methods (agar dilution MIC, disc diffusion and agar screen tests) in detecting oxacillin resistance during 48 h of incubation was evaluated. Using mecA gene PCR and Southern blot hybridization as the gold standard, the differential in MICs of additional antibiotics selected for their relevant clinical use in our setting was also compared with mecA status of the isolates. The frequency of mecA was 48.6% among study strains. When applying the previous (1998) and most current (1999) NCCLS interpretive criteria, the specificities of oxacillin agar dilution MICs in detecting the 78 mecA-negative isolates were 100 and 89.7%, respectively, at 24 h, and 100 and 80.7%, respectively, at 48 h. In this respect, the sensitivities of oxacillin agar dilution MICs in detecting the 74 mecA-positive strains were 75.6 and 97.2%, respectively, at 24 h, and 86.4 and 100%, respectively, at 48 h. When applying the previous and most current NCCLS zone size interpretive criteria, oxacillin zone diameters were in false-susceptible error for 13.5 and 8.1%, respectively, of the 74 mecA-positive strains tested at 24 h, and for 6.7 and 2.7%, respectively, at 48 h. Accordingly, when the 78 mecA-negative strains were considered, oxacillin zone diameters were in false-resistant error for 2.5 and 8.9%, respectively, at 24 h, and for 8.9 and 15.3%, respectively, at 48 h. The oxacillin salt agar screen assay accurately identified all mecA-negative strains at both 24 and 48 h. However, 26 (35.1%) and 7 (9.4%) of the mecA-positive strains were misinterpreted as susceptible by the agar screen test at 24 and 48 h, respectively. Using the presence of mecA as the reference standard for interpreting oxacillin susceptibility results, strains lacking mecA were more likely to be susceptible to ampicillin, ceftazidime, gentamicin, netilmicin and rifampicin than were mecA-positive strains. Vancomycin was the only antibiotic tested for which all strains, regardless of mecA status, remained susceptible.
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Affiliation(s)
- M De Giusti
- Department of Experimental Medicine, La Sapienza University of Rome, Italy
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13
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Abstract
Recognized since 1883 as a common cause of infection, Staphylococcus aureus' preantimicrobial-era bacteremia mortality rate was 82%. The mortality of that era threatens to return as evidence of growing vancomycin resistance undermines the utility of vancomycin therapy. Successful treatment of S. aureus infections requires knowledge of its antimicrobial resistance capacity.
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Affiliation(s)
- T L Smith
- Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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14
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Domaracki BE, Evans A, Preston KE, Fraimow H, Venezia RA. Increased oxacillin activity associated with glycopeptides in coagulase-negative staphylococci. Eur J Clin Microbiol Infect Dis 1998; 17:143-50. [PMID: 9665294 DOI: 10.1007/bf01691109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Vancomycin resistance in methicillin-resistant staphylococci presents a potential therapeutic problem. In order to understand the impact of low-level vancomycin resistance in coagulase-negative staphylococci, stepwise selection of vancomycin resistance was accomplished by growing Staphylococcus haemolyticus in culture media with increasing concentrations of vancomycin. A >40-fold increase in susceptibility to beta-lactam antibiotics was observed. No obvious alterations in the growth curve, the presence of the mecA gene, total DNA restriction fragment length polymorphism (RFLP), beta-lactamase production, or the crude protein fraction were detected in the Staphylococcus haemolyticus-derived clones when compared to the original isolate. The proportion of the oxacillin-heteroresistant population also remained similar. A comparable phenomenon occurred with the selection of Staphylococcus epidermidis exhibiting low-level resistance to vancomycin. Additionally, it was observed that clinical isolates of coagulase-negative staphylococci grown in the presence of sub-minimum inhibitory concentrations of either vancomycin or teicoplanin lost their high-level resistance to oxacillin. Checkerboard tests showed that the combination of vancomycin and oxacillin was synergistic for two isolates of Staphylococcus haemolyticus, two of four isolates of Staphylococcus epidermidis, and one isolate of Staphylococcus hominis.
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Affiliation(s)
- B E Domaracki
- Department of Pathology and Laboratory Medicine, Albany Medical Center, New York 12208, USA
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15
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Hiramatsu K. Vancomycin resistance in staphylococci. Drug Resist Updat 1998; 1:135-50. [PMID: 16904400 DOI: 10.1016/s1368-7646(98)80029-0] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/1997] [Revised: 02/24/1998] [Accepted: 02/28/1998] [Indexed: 10/25/2022]
Abstract
Recent emergence of vancomycin resistance in methicillin-resistant Staphylococcus aureus (VRSA) has posed a new threat to hospital infection control and antibiotic chemotherapy. Relatively low-level resistance of VRSA compared to that of vancomycin-resistant enterococci (VRE), and prevalence of S. aureus clinical strains heterogeneously resistant to vancomycin (hetero-VRSA), challenge the value of routine antibiotic susceptibility tests as a tool for the prediction of clinical efficacy of vancomycin therapy. This review summarizes the history of emergence of glycopeptide resistance in staphylococci and considers the mechanism of resistance in these organisms.
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Affiliation(s)
- K Hiramatsu
- Department of Bacteriology, Juntendo University, Tokyo, Japan.
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16
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Boyle-Vavra S, de Jonge BL, Ebert CC, Daum RS. Cloning of the Staphylococcus aureus ddh gene encoding NAD+-dependent D-lactate dehydrogenase and insertional inactivation in a glycopeptide-resistant isolate. J Bacteriol 1997; 179:6756-63. [PMID: 9352927 PMCID: PMC179606 DOI: 10.1128/jb.179.21.6756-6763.1997] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The mechanism of low-level glycopeptide resistance among staphylococci is not known. A cytoplasmic protein, provisionally called Ddh (W. M. Milewski, S. Boyle-Vavra, B. Moreira, C. C. Ebert, and R. S. Daum, Antimicrob. Agents Chemother. 40:166-172, 1996), and the RNA transcript that contains the ddh gene, which encodes Ddh, are present in increased amounts in a vancomycin-resistant isolate, 523k, compared with the susceptible parent isolate, 523. Sequence analysis had previously revealed that Ddh is related to NAD+-dependent D-lactate dehydrogenase (D-nLDH) and VanH. This latter protein is essential for high-level glycopeptide resistance in Enterococcus faecium and Enterococcus faecalis by synthesizing the D-lactate needed for biosynthesis of D-lactate-terminating peptidoglycan precursors with low affinity for vancomycin. We now provide the direct evidence that the ddh gene product is Staphylococcus aureus D-nLDH and hereafter refer to the protein as D-nLDH. However, overproduction of this protein in isolate 523k did not result in production of D-lactate-containing peptidoglycan precursors, and susceptibility testing of ddh mutants of 523k demonstrated that S. aureus D-nLDH is not necessary for glycopeptide resistance in this isolate. We conclude that the mechanism of glycopeptide resistance in this isolate is distinct from that in enterococci.
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Affiliation(s)
- S Boyle-Vavra
- Department of Pediatrics, University of Chicago, Illinois 60637, USA.
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Billot-Klein D, Shlaes D, Bryant D, Bell D, Legrand R, Gutmann L, van Heijenoort J. Presence of UDP-N-acetylmuramyl-hexapeptides and -heptapeptides in enterococci and staphylococci after treatment with ramoplanin, tunicamycin, or vancomycin. J Bacteriol 1997; 179:4684-8. [PMID: 9244253 PMCID: PMC179312 DOI: 10.1128/jb.179.15.4684-4688.1997] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Analyses of the peptidoglycan nucleotide precursor contents of enterococci and staphylococci treated with ramoplanin, tunicamycin, or vancomycin were carried out by high-pressure liquid chromatography coupled with mass spectrometry (MS). In all cases, a sharp increase in the UDP-N-actetylmuramoyl-pentapeptide or -pentadepsipeptide pool was observed. Concomitantly, new peptidoglycan nucleotide peptides of higher molecular masses with hexa- or heptapeptide moieties were identified: UDP-MurNAc-pentapeptide-Asp or pentadepsipeptide-Asp in enterococci and UDP-MurNAc-pentapeptide-Gly or -Ala and UDP-MurNAc-pentapeptide-Gly-Gly or -Ala-Gly in staphylococci. These new compounds are derivatives of normal UDP-MurNAc-pentapeptide or -pentadepsipeptide precursors with the extra amino acid(s) linked to the lysine epsilon-amino group as established by various analytical procedures (MS, MS-MS fragmentation, chemical analysis, and digestion with R39 D,D carboxypeptidase). Except for tunicamycin-treated cells, it was not possible to ascertain whether these unusual nucleotides were formed by direct addition of the amino acids to UDP-MurNAc-pentapeptide (or -pentadepsipeptide) or whether they arose by reverse reactions from lipid I intermediates to which the amino acids had been added.
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18
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Sieradzki K, Tomasz A. Inhibition of cell wall turnover and autolysis by vancomycin in a highly vancomycin-resistant mutant of Staphylococcus aureus. J Bacteriol 1997; 179:2557-66. [PMID: 9098053 PMCID: PMC179004 DOI: 10.1128/jb.179.8.2557-2566.1997] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A highly vancomycin-resistant mutant (MIC = 100 microg/ml) of Staphylococcus aureus, mutant VM, which was isolated in the laboratory by a step-pressure procedure, continued to grow and synthesize peptidoglycan in the presence of vancomycin (50 microg/ml) in the medium, but the antibiotic completely inhibited cell wall turnover and autolysis, resulting in the accumulation of cell wall material at the cell surface and inhibition of daughter cell separation. Cultures of mutant VM removed vancomycin from the growth medium through binding the antibiotic to the cell walls, from which the antibiotic could be quantitatively recovered in biologically active form. Vancomycin blocked the in vitro hydrolysis of cell walls by autolytic enzyme extracts, lysostaphin and mutanolysin. Analysis of UDP-linked peptidoglycan precursors showed no evidence for the presence of D-lactate-terminating muropeptides. While there was no significant difference in the composition of muropeptide units of mutant and parental cell walls, the peptidoglycan of VM had a significantly lower degree of cross-linkage. These observations and the results of vancomycin-binding studies suggest alterations in the structural organization of the mutant cell walls such that access of the vancomycin molecules to the sites of wall biosynthesis is blocked.
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Affiliation(s)
- K Sieradzki
- The Rockefeller University, New York, New York 10021, USA
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19
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Barriga FJ, Varas M, Potin M, Sapunar F, Rojo H, Martinez A, Capdeville V, Becker A, Vial PA. Efficacy of a vancomycin solution to prevent bacteremia associated with an indwelling central venous catheter in neutropenic and non-neutropenic cancer patients. MEDICAL AND PEDIATRIC ONCOLOGY 1997; 28:196-200. [PMID: 9024516 DOI: 10.1002/(sici)1096-911x(199703)28:3<196::aid-mpo8>3.0.co;2-e] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated the efficacy of a vancomycin solution in the prevention of bacteremia caused by vancomycin-sensitive organisms (VSO) in cancer patients with a tunneled central venous catheter (CVC). Eighty-three patients who had a single lumen CVC were randomized to use a heparin solution (25 U/ml) for daily catheter flush with (HepVan) or without (Hep) vancomycin, 25 mcg/ml. Febrile episodes were recorded, and central and peripheral blood cultures were drawn before beginning antibiotic therapy. Patients participated in follow-up to 16,677 catheter days (8,666 Hep and 8,011 HepVan), and 143 febrile episodes were recorded (82 Hep and 61 HepVan). Forty-four episodes of bacteremia occurred, 23 of them due to VSO (16 occurred in the Hep group and 7 in the HepVan group (P = 0.19). VSO bacteremia occurred in 14 neutropenic (absolute neutrophil count < 500 x 10(9)/l) episodes (7 Hep vs. 7 HepVan) and in 9 non-neutropenic episodes (9 Hep vs. O HepVan; P = 0.013). Vancomycin effectively prevented bacteremia by VSO in non-neutropenic patients, supporting the idea that intraluminal colonization of indwelling CVCs contributes to bacteremia only in these patients.
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Affiliation(s)
- F J Barriga
- Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
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20
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Billot-Klein D, Gutmann L, Bryant D, Bell D, Van Heijenoort J, Grewal J, Shlaes DM. Peptidoglycan synthesis and structure in Staphylococcus haemolyticus expressing increasing levels of resistance to glycopeptide antibiotics. J Bacteriol 1996; 178:4696-703. [PMID: 8755902 PMCID: PMC178241 DOI: 10.1128/jb.178.15.4696-4703.1996] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The structures of cytoplasmic peptidoglycan precursor and mature peptidoglycan of an isogenic series of Staphylococcus haemolyticus strains expressing increasing levels of resistance to the glycopeptide antibiotics teicoplanin and vancomycin (MICs, 8 to 32 and 4 to 16 microg/ml, respectively) were determined. High-performance liquid chromatography, mass spectrometry, amino acid analysis, digestion by R39 D,D-carboxypeptidase, and N-terminal amino acid sequencing were utilized. UDP-muramyl-tetrapeptide-D-lactate constituted 1.7% of total cytoplasmic peptidoglycan precursors in the most resistant strain. It is not clear if this amount of depsipeptide precursor can account for the levels of resistance achieved by this strain. Detailed structural analysis of mature peptidoglycan, examined for the first time for this species, revealed that the peptidoglycan of these strains, like that of other staphylococci, is highly cross-linked and is composed of a lysine muropeptide acceptor containing a substitution at its epsilon-amino position of a glycine-containing cross bridge to the D-Ala 4 of the donor, with disaccharide-pentapeptide frequently serving as an acceptor for transpeptidation. The predominant cross bridges were found to be COOH-Gly-Gly-Ser-Gly-Gly-NH2 and COOH-Ala-Gly-Ser-Gly-Gly-NH2. Liquid chromatography-mass spectrometry analysis of the peptidoglycan of resistant strains revealed polymeric muropeptides bearing cross bridges containing an additional serine in place of glycine (probable structures, COOH-Gly-Ser-Ser-Gly-Gly-NH2 and COOH-Ala-Gly-Ser-Ser-Gly-NH2). Muropeptides bearing an additional serine in their cross bridges are estimated to account for 13.6% of peptidoglycan analyzed from resistant strains of S. haemolyticus. A soluble glycopeptide target (L-Ala-gamma-D-iso-glutamyl-L-Lys-D-Ala-D-Ala) was able to more effectively compete for vancomycin when assayed in the presence of resistant cells than when assayed in the presence of susceptible cells, suggesting that some of the resistance was directed towards the cooperativity of glycopeptide binding to its target. These results are consistent with a hypothesis that alterations at the level of the cross bridge might interfere with the binding of glycopeptide dimers and therefore with the cooperative binding of the antibiotic to its target in situ. Glycopeptide resistance in S. haemolyticus may be multifactorial.
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Affiliation(s)
- D Billot-Klein
- L.R.M.A., Unité de Recherche Associée 1131 du Centre National de la Recherche Scientifique, Biochimie Moléculaire et Cellulaire, Paris, France
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21
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Christensen KJ, Gubbins PO. Treatment of vancomycin-resistant staphylococcal infections. Ann Pharmacother 1996; 30:288-90. [PMID: 8833565 DOI: 10.1177/106002809603000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The reports of vancomycin resistance, though sparse, cannot be ignored. They document evidence of emerging vancomycin resistance. Because of the absence of suitable alternatives and a poor current understanding of the mechanisms involved, much work is needed to prevent such resistance from becoming widespread. Only by understanding the mechanism(s) of resistance involved can we develop strategies to combat resistant strains.
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Affiliation(s)
- K J Christensen
- Department of Pharmacy, University Hospital of Arkansas, Little Rock, USA
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22
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Woodford N, Johnson AP, Morrison D, Speller DC. Current perspectives on glycopeptide resistance. Clin Microbiol Rev 1995; 8:585-615. [PMID: 8665471 PMCID: PMC172877 DOI: 10.1128/cmr.8.4.585] [Citation(s) in RCA: 215] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In the last 5 years, clinical isolates of gram-positive bacteria with intrinsic or acquired resistance to glycopeptide antibiotics have been encountered increasingly. In many of these isolates, resistance arises from an alteration of the antibiotic target site, with the terminal D-alanyl-D-alanine moiety of peptidoglycan precursors being replaced by groups that do not bind glycopeptides. Although the criteria for defining resistance have been revised frequently, the reliable detection of low-level glycopeptide resistance remains problematic and is influenced by the method chosen. Glycopeptide-resistant enterococci have emerged as a particular problem in hospitals, where in addition to sporadic cases, clusters of infections with evidence of interpatient spread have occurred. Studies using molecular typing methods have implicated colonization of patients, staff carriage, and environmental contamination in the dissemination of these bacteria. Choice of antimicrobial therapy for infections caused by glycopeptide-resistant bacteria may be complicated by resistance to other antibiotics. Severe therapeutic difficulties are being encountered among patients infected with enterococci, with some infections being untreatable with currently available antibiotics.
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Affiliation(s)
- N Woodford
- Antibiotic Reference Unit, Central Public Health Laboratory, London, England
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23
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Archer GL, Climo MW. Antimicrobial susceptibility of coagulase-negative staphylococci. Antimicrob Agents Chemother 1994; 38:2231-7. [PMID: 7840550 PMCID: PMC284723 DOI: 10.1128/aac.38.10.2231] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- G L Archer
- Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0049
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24
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Wilson A, Grüneberg R, Neu H. A critical review of the dosage of teicoplanin in Europe and the USA. Int J Antimicrob Agents 1994; 4 Suppl 1:1-30. [DOI: 10.1016/0924-8579(94)90049-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/1993] [Indexed: 10/27/2022]
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25
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Kloos WE, Bannerman TL. Update on clinical significance of coagulase-negative staphylococci. Clin Microbiol Rev 1994; 7:117-40. [PMID: 8118787 PMCID: PMC358308 DOI: 10.1128/cmr.7.1.117] [Citation(s) in RCA: 501] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The clinical significance of coagulase-negative Staphylococcus species (CNS) continues to increase as strategies in medical practice lead to more invasive procedures. Hospitalized patients that are immunocompromised and/or suffering from chronic diseases are the most vulnerable to infection. Since CNS are widespread on the human body and are capable of producing very large populations, distinguishing the etiologic agent(s) from contaminating flora is a serious challenge. For this reason, culture identification should proceed to the species and strain levels. A much stronger case can be made for the identification of a CNS etiologic agent if the same strain is repeatedly isolated from a series of specimens as opposed to the isolation of different strains of one or more species. Strain identity initially can be based on colony morphology, and then one or more molecular approaches can be used to gain information on the genotype. Many of the CNS species are commonly resistant to antibiotics that are being indicated for staphylococcal infections, with the exception of vancomycin. The widespread use of antibiotics in hospitals has provided a reservoir of antibiotic-resistant genes. The main focus on mechanisms of pathogenesis has been with foreign body infections and the role of specific adhesins and slime produced by Staphylococcus epidermidis. Slime can reduce the immune response and opsonophagocytosis, thereby interfering with host defense mechanisms. As we become more aware of the various strategies used by CNS, we will be in a better position to compromise their defense mechanisms and improve treatment.
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Affiliation(s)
- W E Kloos
- Department of Genetics, North Carolina State University, Raleigh 27695-7614
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26
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Pallares R, Dick R, Wenzel RP, Adams JR, Nettleman MD. Trends in Antimicrobial Utilization at a Tertiary Teaching Hospital during a 15-Year Period (1978-1992). Infect Control Hosp Epidemiol 1993. [DOI: 10.2307/30148319] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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27
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Pallares R, Dick R, Wenzel RP, Adams JR, Nettleman MD. Trends in antimicrobial utilization at a tertiary teaching hospital during a 15-year period (1978-1992). Infect Control Hosp Epidemiol 1993; 14:376-82. [PMID: 8354868 DOI: 10.1086/646765] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Antimicrobials are a major part of hospital pharmacy budgets and must be considered in resource planning and spending projections. Logically, trends in antimicrobial usage should be linked to trends in resistant pathogens. OBJECTIVE To examine long-term trends in antimicrobial use over a 15-year period (1978 to 1992) and contrast them with changes in pathogens causing nosocomial bacteremia. SETTING A 900-bed, tertiary care teaching hospital. METHODS Pharmacy records were reviewed to identify parenteral antimicrobial agents administered to adult inpatients. Results were expressed in average daily adult doses per 1,000 patient days. RESULTS Chloramphenicol use decreased, while use of penicillin G, antistaphylococcal penicillins, first-generation cephalosporins, and aminoglycosides remained relatively stable. In contrast, there was a sharp increase in the use of second- and third-generation cephalosporins (7-fold and 6.5-fold increase, respectively), vancomycin (161-fold increase), metronidazole (32-fold increase) and amphotericin B (35-fold increase). The proportion of nosocomial bacteremias due to methicillin-resistant gram-positive bacteria rose, but gentamicin resistance in gram-negatives remained at low levels. During the past 14 years, the percentage of patients receiving at least one parenteral antimicrobial rose from 23% to 44%. Among patients receiving antimicrobials, the average number of different agents used per patient increased from 1.8 to 2.1. CONCLUSIONS If newer agents were available, use of older agents usually declined. If newer alternatives were not available, use of older agents rose sharply. The increased use of antimicrobials in adults was related to the expanded proportion of patients receiving these agents.
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Affiliation(s)
- R Pallares
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242
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28
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Sanyal D, Williams AJ, Johnson AP, George RC. The emergence of vancomycin resistance in renal dialysis. J Hosp Infect 1993; 24:167-73. [PMID: 8104207 DOI: 10.1016/0195-6701(93)90046-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Intraperitoneal vancomycin is used in the treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We describe the emergence of low-level glycopeptide-resistance in five Gram-positive species over a one-year period. Isolation of these organisms was associated with vancomycin treatment failure in four patients who had had numerous episodes of peritonitis. Clinicians and microbiologists should be aware that repeated administration of glycopeptides to such patients might lead to the emergence of organisms resistant to these antibiotics.
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Affiliation(s)
- D Sanyal
- Public Health Laboratory, Northern General Hospital, Sheffield
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