Emerging linezolid-resistant Enterococcus faecalis and Enterococcus faecium isolated from two Austrian patients in the same intensive care unit.

Of two patients in the same intensive care unit who were treated with linezolid, one yielded linezolid-resistant Enterococcus faecalis, whereas the other yielded linezolid-resistant Enterococcus faecium. In each case, molecular typing indicated that the resistant isolates were related to linezolid-susceptible isolates from the same patient, but differed from them by the same G2576U ribosomal RNA mutation. This is the first clinical case report of emerging resistance to linezolid among Enterococcus faecalis and also the first report of resistance involving vancomycin-susceptible rather than vancomycin-resistant enterococci. The linezolid-resistant isolates showed cross-resistance to the experimental oxazolidinone AZD2563, suggesting that oxazolidinone resistance might be a class effect.

Renal oncocytoma with prominent intracytoplasmic vacuoles of mitochondrial origin.

AIMS: We observed two oncocytomas with prominent intracytoplasmatic vacuoles. To investigate if this previously undescribed finding is a diagnostic feature and compatible with the diagnosis of oncocytoma, we characterized these vacuoles by electron microscopy and immunohistochemistry. METHODS AND RESULTS: The tumours were analysed by transmission electron microscopy. Immunohistochemistry was performed with antimitochondrial antibody, anti-Golgi-zone antibody, anti-lysozyme antibody and anti-human-trans-Golgi-network antibody. By electron microscopy, the vacuoles were found to be double-membrane-bounded, and some contained fragmented christae. Immunohistochemistry showed a positive reaction of the vacuoles with anti-mitochondrial antibody. Staining with anti-Golgi-zone antibody, anti-lysozyme antibody and anti-human-trans-Golgi-network antibody was negative. CONCLUSION: Both tumours are benign oncocytomas. The phenomena of cells with prominent intracytoplasmatic vacuoles is not inconsistent with the diagnosis of oncocytoma. The vacuoles are of mitochondrial origin and may develop, by balloon degeneration, as a mechanism of mitochondrial involution and elimination.

Group B streptococci during pregnancy: a comparison of two screening and treatment protocols.

OBJECTIVE: The objective was to evaluate whether the rate of neonatal group B streptococcal infection could be reduced by screening for group B streptococci during the third trimester of pregnancy. STUDY DESIGN: Two periods in which different screening and treatment protocols were applied were compared. In period A all mothers showing high-risk factors were given peripartal antibiotic coverage. In period B vaginal and rectal smears were routinely obtained in gestational week 34 and cultured for group B streptococci. If culture results were positive, the woman received peripartal antibiotics. The incidence of group B streptococcal infections and the number of peripartal antibiotic doses were established by comparing 3700 neonates (3623 mothers) in period A with 3648 neonates (3569 mothers) in period B. RESULTS: In period A, 20 group B streptococcal infections were recorded. Of these, 5 were severe to life-threatening. In period B, 4 group B streptococcal infections were observed. Two were severe and occurred in neonates born before the mothers could be screened. Another 2 were mild and occurred in neonates whose mothers had negative screening test results. The reduction was significant by the chi2 test (chi2 = 9.19, Yates' corrected P = .0024). The rates of peripartal antibiotic treatment were 11.9% in period A and 14.5% in period B. CONCLUSION: Although no neonate died of group B streptococcal sepsis in either of the 2 periods, the protocol used in period B clearly reduced the incidence of group B streptococcal infection. The number of peripartal antibiotic doses required was not much higher than in period A. Screening for group B streptococci in week 34 seems to be a valuable contribution to further improvement of neonatal outcome.

[A rare malformation of the liver in adults]. / Uber eine seltene Missbildung der Leber beim Erwachsenen.

The described malformation of the liver can be divided into several different findings: the deficiency of the left part of the lig. triangulare, a shift of the enlarged left liver lobe to ventral right into the right hypochondrium with a bending of the liver, hypoplasia of the right liver lobe with a field of connective tissue in the bending angle of the liver and concomitant torsion of the lig. hepatoduodenale. The deficiency of the left part of the lig. triangulare hepatis is considered the pathogenetic origin of the malformation. The development of all the other malformations is discussed according to ontogenetic considerations.