Catheter-related Staphylococcus aureus infections.

Among 3394 patients with Staphylococcus aureus bacteraemia from the years 1986-89, 88 patients were found whose intravenous catheter and blood grew organisms of the same phage type. Strains of phage type 95 were more frequent among the patients with confirmed catheter-related bacteraemia than among other bacteraemia cases. Strains with particular phage-type patterns occurring with increasing frequency in Denmark during recent years also occurred with significantly higher frequencies among the confirmed catheter-related bacteraemias. No major differences in antibiotic resistance were observed. Patients with catheter-related bacteraemia had, in spite of a higher frequency of underlying diseases, a lower mortality compared with other bacteraemia patients, and endocarditis occurred less frequently (2% vs. 6%). Among 201 S. aureus isolates from catheters in 1988 only strains of group I occurred with increased frequency. The possible role of catheters as selection pressure on the S. aureus population is discussed.

Evolution of Staphylococcus aureus resistance to erythromycin in Denmark, 1959 to 1988: comparison with erythromycin-susceptible strains.

Between 1959 and 1988, all Staphylococcus aureus strains (15 168 patients) isolated from blood in Denmark have been collected, investigated and stored, and clinical data has been obtained. Erythromycin resistance was found in 4.9% of these strains. The frequency of erythromycin resistance peaked at 25% in 1966, due to the spread in hospitals of multiresistant strains of the 83A complex. When these strains dominated, an increased mortality rate was seen in patients infected with erythromycin-resistant S. aureus. In contrast to most countries, erythromycin resistance in S. aureus declined to less than 5% in 1971, continued to fall to 1.3% in 1983, and has increased slowly to 2.4% in 1988. The decline was only due to a decrease of multiresistant strains. Erythromycin-resistant strains isolated in recent years are predominantly resistant only to penicillin and erythromycin and belong to many different phage type patterns. In Denmark, inducible resistance has occurred at a stable high frequency of approximately 90% of the erythromycin-resistant strains during the last 30 years. Erythromycin-resistant strains isolated today, however, have higher minimum inhibitory concentrations, and are rarely resistant to spectinomycin, in contrast to the strains isolated in the first half of the observation period.

Evolution of Staphylococcus aureus resistance to erythromycin in Denmark, 1959 to 1988: correlations between characteristics of erythromycin-resistant bacteraemia strains.

In an attempt to characterize erythromycin-resistant Staphylococcus aureus we present the intricate relationships between the following factors: phage type, period of isolation, antibiogram, minimum inhibitory concentration (MIC) to erythromycin, inducible or constitutive resistance, spectinomycin susceptibility, hospital- or community-acquired infection, and mortality rate. We studied 718 cases of bacteraemia with erythromycin-resistant S. aureus, occurring between 1959 and 1988. Central factors were phage type pattern, period of isolation, and antibiogram. Between 1959 and 1973 the majority of the erythromycin-resistant strains were multiresistant and belonged to the 83A complex and the related group III. They were mainly inducibly resistant, spectinomycin resistant, and had intermediate MICs (1-4 mg l-1) to erythromycin. The majority of these strains came from hospital-acquired infections and still exist today, although in decreased numbers. By contrast, erythromycin-resistant S. aureus isolated in recent years are usually co-resistant only to penicillin and more rarely also to tetracycline. These strains have inducible resistance, are spectinomycin susceptible, and have a high erythromycin MIC. They are isolated both from hospital- and community-acquired infections. Strains with constitutive resistance to macrolides occurred at a stable low level (13%) during the whole observation period and always had high MICs to erythromycin. The mortality rate among patients with S. aureus bacteraemia due to an erythromycin-resistant strain was only associated with the year of infection and decreased from 61% in the first 15-year period to 40% in the subsequent 15 years.

The decline of methicillin resistance among Danish Staphylococcus aureus strains.

OBJECTIVE: To describe the occurrence and decline of methicillin-resistant Staphylococcus aureus in Denmark from 1966 to 1986, and to illustrate why it has been possible to retain a frequency of only 0.2% MRSA since 1984. DESIGN: A study of antibiotic susceptibility and phage-type of 522,978 S aureus strains isolated from hospitalized patients in Denmark during the years 1960 to 1988 combined with clinical information on patients with methicillin-resistant strains during the years 1986 through 1988. SETTING: All strains and information were collected at the centralized, national laboratory for S aureus phage-typing. PATIENTS: Hospitalized patients with S aureus isolates, and especially patients with methicillin-resistant strains. INTERVENTION: Antibiotic treatment. RESULTS: The frequency of MRSA rose to 15% in the years 1967 through 1971 but decreased to 0.2% in 1984, and has remained so ever since. The increase was due mainly to the spread of a single or a few clones of the phage-type complex 83A. Occurrence of strains of these phage-types declined from 18% in 1969 to 0.6% in 1989. In 1986 through 1988, at least 48% of the MRSA strains were imported by patients from abroad. Cross-infection occurred only in two cases. High awareness and special precautions were taken when MRSA was detected. CONCLUSIONS: MRSA of a single or a few clones spread in Danish hospitals in the years 1967 through 1971. Since 1984, only 0.2% of the Danish S aureus population has been MRSA, and imported MRSA strains have been prevented from spreading.

beta-lactamase production in coagulase-negative micrococcaceae.

A total of 8 penicillin-susceptible and 55 penicillin-resistant coagulase-negative Micrococcaceae were investigated for their beta-lactamase production by one quantitative and three qualitative methods. Seven of the 8 penicillin-susceptible strains had no beta-lactamase production; one had a very low production. Among the 55 penicillin-resistant strains, 54 produced beta-lactamase (mean 63 units/mg bacteria). Methicillin/gentamicin-resistant strains produced less enzyme than strains susceptible to these antibiotics. The percentage extracellularity (mean 18%) was lower than in Staphylococcus aureus, whereas the induction ratio (mean 56) was higher. No significant difference between the different species could be observed, but 70% of the strains were Staphylococcus epidermidis. Among the 55 beta-lactamase producing strains, the microbiological clover-leaf method detected 51, the iodometric method 40 and the chromogenic cephalosporin method 38. None of the three qualitative methods gave any false positive reactions.

Evaluation of two methods of scoring denture plaque.

In a previously published study on the effect of an alcalase on development of denture plaque, two different methods were used to quantify plaque on the fitting surface of maxillary dentures. Both methods were based on scoring of photographs at X 10 magnification. In one of the methods the percentage area was estimated with 10% intervals from 0% to 100%. By the other method dentures were ranked according to cleanliness based on area and on degree of staining of plaque. The number of dentures in each of the 14 treatment periods was 14 or 15. The present study was conducted to determine the reliability of the two methods. Reliability of the two methods was determined by using Pearson's correlation coefficient and Kendall's tau. Both intra- and inter-examiner reliability was high. A high correlation between the two methods was also demonstrated.