MRSA in children presenting to hospitals in Birmingham, UK

Meticillin-resistant Staphylococcus aureus (MRSA) isolates from children presenting to Birmingham hospitals were characterized using molecular methods. The study was performed on MRSA isolates from children aged </=16 years, identified between March 2004 and December 2004, from three hospitals offering general paediatric services. Fifty isolates were classified as either community-acquired (CA-MRSA) or hospital-acquired MRSA (HA-MRSA) according to Centers for Disease Control and Prevention (CDC) criteria. They underwent susceptibility testing and pulsed-field gel electrophoresis (PFGE) analyses. Polymerase chain reaction (PCR) methodology was used to determine the type of staphylococcal chromosome cassette (SCCmec) and the presence or absence of genes encoding Panton-Valentine leucocidin (PVL). Overall, 31 (62%) MRSA were defined as CA-MRSA. PFGE band pattern and SCCmec analysis were similar to EMRSA 15 for 72% of isolates. Over 80% of isolates contained SCCmec type IV; one isolate was untypable. Genes encoding PVL were not detected. MRSA in children presenting to Birmingham hospitals classified as CA-MRSA are most likely to resemble the usual hospital epidemic strains. None of the isolates fulfilled the criteria for de-novo CA-MRSA based on PFGE, PVL production and SCCmec analysis.

An outbreak of Serratia marcescens on the neonatal unit: a tale of two clones

Serratia spp. are an important cause of hospital-acquired infections and outbreaks in high-risk settings. Twenty-one patients were infected or colonized over a nine-month period during 2001-2002 on a neonatal unit. Twenty-two isolates collected were examined for antibiotic susceptibility, beta-lactamase production and genotype. Random-amplified polymorphic DNA polymerase chain reaction and pulsed-field gel electrophoresis revealed that two clones were present. The first clone caused invasive clinical infection in four babies, and was subsequently replaced by a non-invasive clone that affected 14 babies. Phenotypically, the two strains also differed in their prodigiosin production; the first strain was non-pigmented whereas the second strain displayed pink-red pigmentation. Clinical features suggested a difference in their pathogenicity. No environmental source was found. The outbreak terminated following enhanced compliance with infection control measures and a change of antibiotic policy. Although S. marcescens continued to be isolated occasionally for another five months of follow-up, these were sporadic isolates with distinct molecular typing patterns.

The expanding role of the antibiotic pharmacist

Widespread inappropriate prescribing of antibiotics in UK hospitals has led to the introduction of specialist antibiotic pharmacists. Their role is to monitor antibiotic use, advise clinicians, educate all grades of healthcare workers and help to develop policy. Antibiotic pharmacists have been shown to be effective in many situations. As these practitioners become more accomplished it will be possible to expand their role to include direct intervention in patient treatment. Simple measures, such as modification of intravenous treatment to oral and automatic stop orders, could greatly enhance patient care.

The successful introduction of a programme to reduce the use of i.v. ciprofloxacin in hospital

The effectiveness of a programme to reduce the use of i.v. ciprofloxacin was assessed. i.v. ciprofloxacin was removed from ward stock and discussion occurred regarding appropriate use of the drug. Six months later, a factsheet containing recommendations was distributed to all medical staff and a requirement for justification before prescription was introduced. The programme reduced expenditure on i.v. ciprofloxacin to 34% of original levels. Savings of > 36,000 pounds sterling were made for two consecutive years. A sustained reduction in the use of i.v. ciprofloxacin was obtained by a combination of education and restriction.

The in vitro activity of BMS-284756, a new des-fluorinated quinolone

The in vitro activity of BMS-284756 (previously T-3811ME), a des-fluoro(6) quinolone, was investigated and compared with those of six other antimicrobial agents. Susceptibility tests were performed on 919 Gram-positive, Gram-negative (including nine quinolone-resistant Escherichia coli) and anaerobic bacteria, three Chlamydia isolates and four Mycobacteria spp. BMS-284756 was marginally less active against the Enterobacteriaceae, but was the most active quinolone against staphylococci, enterococci and peptostreptococci. Against Streptococcus pneumoniae, BMS-284756 and gemifloxacin were more active than other quinolones. The MIC(90) of BMS-284756 was > or = 2 mg/L for the following bacteria: E. coli (MIC(90) 16 mg/L), Acinetobacter spp. (8 mg/L), Pseudomonas aeruginosa (64 mg/L) and Enterococcus faecium (4 mg/L). The MIC of BMS-284756 for Mycobacterium spp. was within one dilution of the MIC of ciprofloxacin. BMS-284756 was markedly more active than ciprofloxacin against the Chlamydia isolates tested.