Turicella otitidis and Corynebacterium auris: 20 years on.

Turicella otitidis and Corynebacterium auris, described as new species 20 years ago, have been isolated mainly from the external ear canal and middle ear fluid. While their taxonomic position has been clearly established, their diagnosis in the routine laboratory is difficult. The question of their pathogenic potential in otitis is still open but might be elucidated better if corynebacteria are speciated more often.

[Quality-agreement colonoscopy: an outcome evaluation from the district of North-Württemberg, Germany, 2003 - 2007]. / Qualitätssicherungsvereinbarung Koloskopie: Eine Ergebnisevaluierung aus Nord-Württemberg 2003 - 2007.

Diverse problems with the hygienically correct reprocessing of endoscopes and resulting transmissions of pathogens over the last decades are well documented. As a consequence, the worldwide first evidence-based compulsory guidelines for all endoscopy units in clinics and practices were implemented in Germany in 2002. The presented study reports for the first time ever on a detailed outcome evaluation of these guidelines. Data of all routine and all required 1st and 2nd re-examinations of endoscopes from all units (clinics and practices) performing endoscopy in the district of Nord-Württemberg, Germany, between 2003 and 2007 were analysed. A significant (p < 0.0001) overall decrease of insufficiently sterilised endoscopes was found during the observation period. The proportion of required re-examinations in clinics was below 10 % already in 2003 and remained within single figure percentages over the following years. In doctors' practices, however, in 2003 nearly every second routine examination of endoscopes required a re-examination and a significant (p < 0.0001) decrease of these figures was only found from 2004 onwards. A significant trend (p < 0.01) of re-processing techniques away from manual techniques towards fully automated procedures could be documented. No significant changes with respect to the localisation or the spectrum of the detected pathogens during control examinations were found. The presented outcome evaluation demonstrates that the implementation of stringent compulsory guidelines in Germany (and the conditional refund from the public health system for screening procedures linked to them) resulted in a substantial and significant improvement of hygiene in the re-processing of flexible endoscopes.

Vehicle automation: a remedy for driver stress?

The present study addressed the effects of stress, vehicle automation and subjective state on driver performance and mood in a simulated driving task. A total of 168 college students participated. Participants in the stress-induction condition completed a 'winter' drive, which included periodic loss of control episodes. Participants in the no-stress-induction condition were not exposed to loss of control. An additional, independent manipulation of vehicle speed was also conducted, consisting of two control conditions requiring manual speed regulation and a third in which vehicle speed was automatically regulated by the simulation. Stress and automation both influenced subjective distress, but the two factors did not interact. Driver performance data indicated that vehicle automation impacted performance similarly in the stress and no-stress conditions. Individual differences in subjective stress response and performance were also investigated. Resource theory provides a framework that partially but not completely explains the relationship between vehicle automation and driver stress. Implications for driver workload, safety and training are discussed.

Minimal inhibitory concentrations of linezolid against clinical isolates of coryneform bacteria.

In order to evaluate the efficacy of linezolid for treating severe infections with coryneform bacteria, the activity of linezolid was tested in vitro against 425 clinically relevant isolates of coryneform bacteria and compared with the activity of penicillin and erythromycin. The minimal inhibitory concentration of linezolid did not exceed 2 microg/ml for any of the isolates tested, indicating that this agent has very good activity against coryneform bacteria. These results suggest linezolid is a possible alternative antimicrobial agent for the treatment of severe infections caused by coryneform bacteria.

Infection of the skin caused by Corynebacterium ulcerans and mimicking classical cutaneous diphtheria.

Extrapharyngeal infections caused by Corynebacterium ulcerans have rarely been reported previously, and diphtheria toxin production has usually not been addressed. This case demonstrates that strains of C. ulcerans that produce diphtheria toxin can cause infections of the skin that completely mimic typical cutaneous diphtheria, thereby potentially providing a source of bacteria capable of causing life-threatening diseases in the patient's environment. Therefore, it is recommended to screen wound swabs for coryneform bacteria, identify all isolates, carefully assess possible toxin production, and send questionable strains to a specialist or a reference laboratory.

Natural antibiotic susceptibility of recently established coryneform bacteria.

The natural susceptibility of 20 strains each of Brevibacterium casei (formerly CDC coryneform groups B-1 and B-3), Dermabacter hominis (formerly CDC coryneform groups 3 and 5), and Turicella otitidis (formerly coryneform group ANF-1-like) isolated from clinical specimens to 71 antibiotics was investigated. Susceptibility testing was carried out with a microdilution procedure using H medium. All three species were naturally sensitive to tetracyclines, most aminoglycosides, carbapenems, macrolides, lincosamides, glycopeptides, and rifampin. Susceptibility patterns indicating natural resistance to pipemidic acid, sulfamethoxazole, and cotrimoxazole also were found for all three species. Species-dependent discrepancies in susceptibility leading to completely different categorizations (changing from sensitive to resistant or vice versa) were found for some penicillins (e.g., oxacillin and amoxicillin), a few cephalosporins (e.g., ceftibutene), aztreonam, tobramycin, norfloxacin, fleroxacin, trimethoprim, nitrofurantoin, fosfomycin, and fusidic acid. For the majority of antibiotics, Brevibacterium casei was the least susceptible species and Turicella otitidis the most susceptible taxon. The present study describes a database on the natural susceptibility of Brevibacterium casei, Dermabacter hominis, and Turicella otitidis to a wide range of antibiotics. This database can be applied for the validation of susceptibility testing results of these recently established coryneform bacteria.

Bacteremia by Dermabacter hominis, a rare pathogen.

Dermabacter hominis is a gram-positive, catalase-positive, glucose-fermenting rod, which, as it grows forms small greyish-white colonies with a characteristic pungent odor. Previously known as coryneform Centers for Disease Control and Prevention groups 3 and 5, it was catalogued as D. hominis in 1994. Various strains isolated in blood cultures, abscesses, or wounds in the 1970s were retrospectively characterized in referral centers as D. hominis. In this report we describe two patients with severe underlying pathology who developed bacteremias by D. hominis within the context of their clinical pictures.

Noninflammatory chronic pelvic pain syndrome: immunological study in blood, ejaculate and prostate tissue.

OBJECTIVES: The aim of this prospective study was to observe immunophenotypic patterns in patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) for further description and as possible surrogate markers for diagnosis and treatment. METHODS: Eighty-eight patients with a referral diagnosis of chronic prostatitis underwent fractionated urinary cultures including expressed prostate secretion (EPS) and ejaculate analysis twice on two occasions. Monthly serum analyses included C3c, C4, IL-1alpha, sIL-2R, and IL-6. One hundred samples from healthy individuals were used as the control group for serum analysis. Monthly ejaculate testing was done for IgG, IgA, IgM, IL-1alpha, sIL-2R, and IL-6. The control group for ejaculate analysis was composed of 96 normal ejaculates (according to the WHO criteria). Immunohistochemical detection of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes) was performed in 71 biopsy cylinders of Cat IIIB CPPS patients and in 25 prostate biopsy cylinders of men without symptoms or obstruction. RESULTS: Complete sampling of urinary, serum and ejaculate specimens was achieved in 50/88 (57%) patients. Cat IIIB CPPS was observed in 44/50 (88%) patients. Intra-acinar T-lymphocytic infiltrates were dominated by T cytotoxic cells (p = 0.05). Immunohistochemical studies showed inflammatory expression in serum complement, serum interleukin, and ejaculate interleukin concentrations in relation to the presence of large numbers of T cells (all p values < or =0.01). No difference was found in the proportion of B lymphocytes in patients with Cat IIIB CPPS compared to the control group. Serum and ejaculate IL-6 and ejaculate IgA increased significantly and dropped again, correlating with a release of clinical symptoms. CONCLUSIONS: Interleukin, complement and immunoglobulin determinations in serum and ejaculate reveal an inflammatory process even in Cat IIIB CPPS. The findings of intra-acinar T-cell-rich infiltrates and the associated inflammatory reaction may be a significant advance in defining Cat IIIB CPPS caused by a possible autoimmune component. Serum and ejaculate IL-6 and ejaculate IgA are possible surrogate markers for the diagnosis and treatment of Cat IIIB CPPS.

Corynebacterium macginleyi: a conjunctiva specific pathogen.

BACKGROUND: Although non-diphtherial corynebacteria are ubiquitous in nature and commonly colonise the skin and mucous membranes of humans, they rarely account for clinical infection. METHODS AND RESULTS: 10 patients with unilateral conjunctivitis are described in which Corynebacterium macginleyi was isolated. This species has only recently been reported to be exclusively isolated form ocular surfaces. C macginleyi was uniformly susceptible to topical antibiotics commonly used in ophthalmology. CONCLUSION: Despite the fact that the pathogenicity of C macginleyi is not yet assured, this micro-organism should be recognised as a potential cause of bacterial superinfections. Appropriate antibiotic therapy leads to its elimination and resolution of the conjunctivitis.

Natural antibiotic susceptibility of Listeria species: L. grayi, L. innocua, L. ivanovii, L. monocytogenes, L. seeligeri and L. welshimeri strains.

OBJECTIVE: To investigate the natural susceptibility to 71 antimicrobial agents of 103 Listeria strains belonging to all known Listeria species (L. monocytogenes (N = 21), L. innocua (N = 21), L. seeligeri (N = 21), L. ivanovii (N = 19), L. welshimeri (N = 11), and L. grayi (N = 10)). METHODS: MICs were determined using a microdilution procedure in H-Medium. RESULTS: All listeriae were naturally sensitive or intermediate to tetracyclines, aminoglycosides, penicillins (except oxacillin), loracarbef, cefazoline, cefaclor, cefotiam, cefoperazone, carbapenems, macrolides, lincosamides, glycopeptides, dalfopristin/quinupristin, chloramphenicol and rifampicin (probably except L. grayi). Listeria spp. were naturally resistant or intermediate to most 'modern' cephalosporins (cefetamet, cefixime, ceftibuten, ceftazidime, cefdinir, cefpodoxime, cefotaxime, ceftriaxone, cefuroxime), aztreonam, pipemidic acid, dalfopristin quinupristin and sulfamethoxazole. Significant differences in natural susceptibility among the species were seen with the quinolones, trimethoprim, co-trimoxazole, rifampicin, fosfomycin and fusidic acid. It seems likely that L. grayi is naturally resistant to all antifolates; the species was least susceptible to rifampicin and most susceptible to quinolones, whereas L. ivanovii was naturally resistant to most quinolones. L. ivanovii was naturally sensitive to fosfomycin, whereas L. innocua and L. monocytogenes were naturally resistant. L. ivanovii was also the most susceptible species to fusidic acid. CONCLUSIONS: The present study describes a database on the natural susceptibility of Listeria spp. to a wide range of antibiotics, which can be used to validate susceptibility testing results of these microorganisms.

rRNA gene RFLP as an identification tool for Corynebacterium species.

The value of rRNA gene RFLP analysis (ribotyping) as a tool for Corynebacterium and Turicella species identification was evaluated. Seventy-four strains representing 26 different species or subspecies were analysed by BstEII, SmaI and SphI ribotyping. Numerical analysis of the resulting rDNA banding patterns was performed by Dice coefficient correlation in order to establish a database for species identification. In general, most of the strains belonging to the same species clustered together. Interestingly, BstEII clustering of many species followed known phylogenetic lineages. This was not evident with the more heterogeneous SmaI and SphI patterns. The SmaI patterns contained a 1800 bp band in the digests of all species studied with the exception of Corynebacterium urealyticum. SphI digestion resulted in the most heterogeneous patterns. The information provided by all three enzymes was considered essential for the reliable linking of strains of unknown identity with defined species in the database. It is concluded that ribotyping provides an useful tool for screening and characterization of potentially new Corynebacterium species.

Emergence of related nontoxigenic Corynebacterium diphtheriae biotype mitis strains in Western Europe.

We report on 17 isolates of Corynebacterium diphtheriae biotype mitis with related ribotypes from Switzerland, Germany, and France. Isolates came from skin and subcutaneous infections of injecting drug users, homeless persons, prisoners, and elderly orthopedic patients with joint prostheses or primary joint infections. Such isolates had only been observed in Switzerland.

Streptococcal toxic shock syndrome in two patients infected by a colonized surgeon.

The incidence of severe invasive infections caused by Streptococcus pyogenes, a group A streptococcus (GAS), has increased in the past 10 years. Most cases occur outside of the hospital setting. We report on two patients with nosocomial streptococcal toxic shock syndrome (StrepTSS). In patient 1 the syndrome was associated with the development of necrotizing fasciitis following inguinal hernia repair. Patient 2 suffered from StrepTSS shortly after receiving a tetanus vaccine in her left deltoid. Epidemiologic investigations of these cases, which were noted within 48 hours of each other, showed that the same surgeon performed the vaccination on patient 2 after assisting a colleague during the hernia repair procedure on patient 1. He was found to be a nasal carrier of GAS. All GAS isolates from the patients and the surgeon were indistinguishable by pulsed field gel electrophoresis. PCR analysis demonstrated the presence of streptococcal pyogenic exotoxins A and F. All strains were of the T-1 serotype and possessed the gene for M-protein 1. This report demonstrates that a virulent strain of GAS may be spread by asymptomatically colonized medical personnel via the air route.

Corynebacterium confusum sp. nov., isolated from human clinical specimens.

Three strains of a previously unknown coryneform bacterium were isolated from two patients with foot infections and from a blood culture of a third patient. The three non-lipophilic strains exhibited very slow fermentative acid production from glucose but not from maltose or sucrose, nitrate reductase activity, no tyrosinase activity and the presence of small amounts of tuberculostearic acid as the most significant phenotypic features. Differentiation of these strains from all other presently defined coryneform bacteria was readily achieved. Chemotaxonomic investigations revealed that the three strains unambiguously belonged to the genus Corynebacterium. Comparative 16S rRNA gene sequence analysis demonstrated that the isolates were almost identical and represented a new subline within the genus Corynebacterium, for which the designation Corynebacterium confusum sp. nov. is proposed. The type strain of Corynebacterium confusum is CCUG 38267T.

Corynebacterium macginleyi has to date been isolated exclusively from conjunctival swabs.

Fifteen strains of Corynebacterium macginleyi were exclusively isolated from conjunctival swabs of patients with either conjunctivitis or corneal ulcers. Up to now, only three C. macginleyi strains had been described in the literature. The characteristics of the 15 patients from whom C. macginleyi was isolated are outlined, characteristics useful for the identification of C. macginleyi are described, and the antimicrobial susceptibility pattern of the species is provided. C. macginleyi is uniformly susceptible to penicillins, quinolones, and aminoglycosides. Although considered to be of rather low pathogenicity C. macginleyi seems to have the potential to cause superinfections in selected patients with ocular surface problems.

Corynebacterium thomssenii sp. nov., a Corynebacterium with N-acetyl-beta-glucosaminidase activity from human clinical specimens.

A strain of a previously undescribed non-lipophilic coryneform bacterium was isolated from pleural fluids of a patient with chronic renal failure, stroke and pneumonia. Slow fermentative acid production from glucose, maltose and sucrose, and strong N-acetyl-beta-glucosaminidase activity were the most characteristic features of the bacterium. Chemotaxonomic characterization unambiguously indicated that the organism belonged to the genus Corynebacterium. The results of comparative 16S rRNA gene sequence analysis revealed that the isolate represented a new species within the genus, for which the name Corynebacterium thomssenii sp. nov. is proposed. The type strain is DSM 44276.

Evaluation of the RapID CB plus system for identification of coryneform bacteria and Listeria spp.

In a stress test, the recently introduced RapID CB Plus system (Remel Inc. [formerly Innovative Diagnostic Systems], Norcross, Ga.) was challenged with a diverse set of gram-positive rods comprising 345 strains of coryneform bacteria and 33 strains of Listeria spp. representing a total of 49 different taxa. Overall, within 4 h, the system correctly identified 80.9% of the strains on the species level and 12.2% of the strains on the genus level. Only 3.7% strains were misidentified, and for 3.2% of the strains no identification was provided. Difficulties with the system were mainly due to occasional uncertainties in reading reactions for acid production from carbohydrates and, to a lesser extent, aminopeptidase reactions. It is concluded that the system may also perform well under the conditions of a routine clinical laboratory.

Evaluation of the VITEK 2 system for rapid identification of medically relevant gram-negative rods.

The new VITEK 2 system (bioMérieux) was evaluated at two independent sites with the identification card for gram-negative bacilli (ID-GNB card). Of the 845 strains tested, which represented 70 different taxa belonging to either the family Enterobacteriaceae or the nonenteric bacilli, 716 (84.7%) were correctly identified at the species level. Thirty-two (3.8%) additional strains were identified to the species level after the performance of simple, rapid manual tests (oxidase, hemolysis, indole reaction, motility, and pigmentation). For 80 (9.5%) strains, these additional tests did not lead to an identification at the species level but the correct species identification was given among the organisms listed. Only 7 (0.8%) strains were misidentified, and 10 (1.2%) were not identified. Mistakes were randomly distributed over different taxa. Due to the new, more sensitive fluorescence-based technology of the VITEK 2 system, final results were available after 3 h. Since our evaluation was mainly a stress test, it is predicted that the VITEK 2 system in conjunction with the ID-GNB card would perform well under conditions of a routine clinical laboratory in identifying members of the family Enterobacteriaceae and selected species of nonenteric bacteria. This system is a promising, highly automated new tool for the rapid identification of gram-negative bacilli from human clinical specimens.