Trends in the susceptibility of methicillin-resistant Staphylococcus aureus to nine antimicrobial agents, including ceftobiprole, nemonoxacin, and tyrothricin: results from the Tigecycline In Vitro Surveillance in Taiwan (TIST) study, 2006-2010.

This study investigated the in vitro susceptibilities of methicillin-resistant Staphylococcus aureus (MRSA) to nine antimicrobial agents in Taiwan. A total of 1,725 isolates were obtained from 20 hospitals throughout Taiwan from 2006 to 2010. The minimum inhibitory concentrations (MICs) of the nine agents were determined by the agar dilution method. The MICs of mupirocin and tyrothricin were determined for 223 MRSA isolates collected from 2009 to 2010. For vancomycin, 99.7 % were susceptible; however, 30.0 % (n = 517) exhibited MICs of 2 µg/ml and 0.3 % (n = 6) demonstrated intermediate susceptibility (MICs of 4 µg/ml). Nearly all isolates (≥ 99.9 %) were susceptible to teicoplanin, linezolid, and daptomycin. The MIC90 values were 2 µg/ml for ceftobiprole and 1 µg/ml for nemonoxacin. The MIC90 values of mupirocin and tyrothricin were 0.12 and 4 µg/ml, respectively. MIC creep was noted for daptomycin during this period, but not for vancomycin, teicoplanin, linezolid, or tigecycline. For isolates with vancomycin MICs of 2 µg/ml, the MIC90 values were 2 µg/ml for teicoplanin, 0.5 µg/ml for daptomycin, and 0.5 µg/ml for tigecycline. Those values were four- to eight-fold higher than those among isolates with vancomycin MICs of 0.5 µg/ml (2, 0.06, and 0.12 µg/ml, respectively). Of the nine MRSA isolates exhibiting non-susceptibility to vancomycin (n = 6), teicoplanin (n = 1), daptomycin (n = 2), or tigecycline (n = 1), all had different pulsotypes, indicating the absence of intra-hospital or inter-hospital spread. The presence of a high proportion of MRSA isolates with elevated MICs (2 µg/ml) and MIC creep of daptomycin might alert clinicians on the therapy for serious MRSA infections in Taiwan.

Novel synthesis of alpha-PNA monomers by U-4CR.

A novel synthesis of alpha-PNA monomers was carried out by U-4CR, followed by photochemical cleavage of the 2-nitrobenzyl group and selective hydrolysis in the presence of 10% HCl in THF. Three of four functional components in the U-4CR were specially protected: cyclohexenyl isocyanide, Boc for protecting the amino group of glycine, and 2-nitrobenzyl group as a photocage (photoremovable protecting group) for ammonia. The amino group of aldehyde-containing adenine is too weak to interfere with the U-4CR, so that it is not necessary to be protected.

Unusual presentation of acute abdomen in scrub typhus: a report of two cases.

Two young soldiers presented with acute abdomens, then received surgical procedures under initial impression of acute cholecystitis and acute appendicitis respectively. Operative findings did not confirm the initial diagnosis, and the clinical condition did not improve after operation. Scrub typhus was suggested later by clinical manifestations of fever, chills, headache, lymphadenopathy, skin rash and presence of eschar formation; this diagnosis was finally confirmed by positive serologic results of high Weil-Felix OXK agglutination and/or Rickettsia tsutsugammushi immunoflorescence titers in paired sera. Both patients rapidly became afebrile after administration of tetracycline. This unusual presentation with acute abdomen in scrub typhus is emphasized, with caution that the possibility of scrub typhus should be taken considered, especially in patients coming from hyperendemic areas.

Hepatic dysfunction in scrub typhus.

Scrub typhus is an acute febrile illness that generally causes non-specific symptoms and signs of which fever is the most common. It is one of the causes of "fevers of unknown origin" in the Asia-Pacific region. The relationship between hepatic dysfunction and scrub typhus has been given little attention in the literature. From 1982 to 1993, 47 patients diagnosed with scrub typhus at Tri-Service General Hospital, Taipei, were studied, with attention being given to hepatic dysfunction. The medical records of these patients were reviewed thoroughly. Hepatic dysfunction occurred in 77% (36/47) of patients. Among the liver function parameters, the percentage of abnormality was 74.5% for aspartate aminotransferase, 74.5% for alanine aminotransferase, 57.4% for alkaline phosphatase, 44.7% for lactate dehydrogenase and 44.7% for serum bilirubin. Six patients presented with a picture of true hepatitis similar to acute viral hepatitis. The results indicate that hepatocellular damage does occur in scrub typhus, and is perhaps, more common than previously realized. We recommend that the differential diagnosis of patients from high-risk groups and endemic areas who present with hepatitis-like symptoms should include examination for scrub typhus.

Neurological complications of varicella: a report of two cases.

Varicella (chickenpox) is the primary infection of Varicella-Zoster virus, characterized by generalized vesicular eruption, fever and mild constitutional symptoms. Chiefly infecting children of 1 to 14 years of age, the disease has been almost neglected because of its inevitable and benign outcome. Adults are rarely infected with an incidence of less than 20%. These two cases are presented of normal adults with marked neurological complications 10 and 14 days, respectively, following typical skin eruption of varicella. The first case developed transverse myelitis and the second, an encephalomyelitis. Neurological complications are very rare post-varicella infection. Although prognosis is good and complete recovery is the rule, still some morbidity with neurological sequelae and mortality have been reported. The present cases had extensive neurological deficit, despite aggressive treatment, making a high index of suspicion for differential diagnosis in patients who present with encephalitis. Especially following the typical exanthema of varicella, this possibility is emphasized and the literature is reviewed.

Septicemia caused by Vibrio parahemolyticus: a case report.

Vibrio parahemolyticus is a halophilic marine vibrio commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of septicemia. A few reports suggest that patients with chronic liver disease and leukemia are more susceptible. A case of liver cirrhosis with septicemia caused by this organism is discussed. The patient's condition rapidly deteriorated, and he died 12 hours after admission.

Serodiagnosis of tuberculosis using the A60 IgG ELISA.

The serodiagnosis of tuberculosis (TB) by using an enzyme-linked immunosorbent assay (ELISA) to detect IgG against mycobacterial antigen 60 (A60) was evaluated. Forty-three controls (10 healthy adults, 19 patients with non-tuberculous pulmonary diseases and 14 patients with non-pulmonary infectious diseases) and 63 patients with TB in different disease activity (50 patients with active TB and 13 patients with old pulmonary TB) were studied. When a cut-off value of 200 units was selected, the results obtained with controls were: 100% negative in IgG titers in healthy adults and patients with non-pulmonary infectious diseases, 89% negative in IgG titers in patients with non-tuberculous pulmonary diseases. The overall "false positive" rate was 5% in the control groups. The percentage of serologically positive cases of active TB was: 82% in smear-positive, 67% in smear-negative/culture-positive and 38% in culture-negative. Of the 13 patients with calcified pulmonary TB, four had a positive serological response (31%). Four out of eight patients with active TB showed an elevation in IgG titer 1 to 3 months after diagnosis and anti-TB chemotherapy. The positive and negative predictive values of the test may provide valuable information according to the prevalence of TB in different populations. When the TB prevalence is high, a positive IgG ELISA test may support the diagnosis of active TB.

[Infected common iliac aneurysm due to Salmonella: a case report].

A 62-year-old male, presenting with chills and fever and RLQ abdominal pain, was found to have an infected aneurysm of the right common iliac artery infected by Salmonella group C1. CT scan of abdomen and arteriography definitely identified the lesions. Antibiotic treatment and surgical intervention with aneurysmectomy and suprapubic crossover femoro-femoral artery graft resulted in a good recovery and outcome.

Acute renal failure associated with scrub typhus: report of a case.

We report on a 25-year-old man who had scrub typhus with the unusual complication of acute renal failure. The clinical features of fever, headache, high Weil-Felix OX-K agglutination and Rickettsia tsutsugamushi immunofluorescence titers confirmed the diagnosis of scrub typhus. Acute renal failure was proven by oliguria, urinary diagnostic indices and renal biopsy. The patient had a complete recovery after adequate medical treatment.

Gram-negative bacillary meningitis in adults.

To evaluate the clinical aspects of gram-negative bacillary meningitis (GNBM), we reviewed 41 adult patients with bacteriologically proven gram-negative bacillary meningitis, seen from 1985 to 1990. Thirty-two patients had post-neurosurgical GNBM and nine patients had spontaneous GNBM. Spontaneous GNBM appeared to have a sudden onset, a relatively fulminant course, and was caused most often by Escherichia coli. Post-neurosurgical GNBM, however, had a more insidious onset, a more protracted course, and was more often caused by nosocomial organisms which were resistant to multiple antibiotics. The overall mortality was 39%. Patients treated with combined aminoglycoside therapy had a lower mortality rate than those treated with intravenous aminoglycoside (17% vs 48%). The use of third-generation cephalosporins has made a significant therapeutic advance in the treatment of GNBM, with a lower mortality of 21%. We recommend treatment of GNBM with third-generation cephalosporins and aminoglycosides. If aminoglycosides are to be employed, it is suggested that they be administered both intravenously and directly into the central nervous system.

[Staphylococcal colonization rate on neonatal nares and umbilical cord in a newborn nursery].

Staphylococcus aureus and Staphylococcus epidermidis were the most important gram positive pathogens found in a five-year study (1985-1989) of nosocomial infection in this hospital. They caused 56.2% of all nosocomial infections in this newborn nursery, particularly skin infections. To determine the reasons, and to decrease effectively the neonatal staphylococcal colonization rate, three different disinfection methods were selected for management of neonatal umbilical cords. A total of 1578 swabs from neonatal nares and umbilical cords were collected. During the first period no disinfectant was applied to the cord after bathing the baby. Beta-iodine in alcohol and bacitracin ointment were used for the second and the third periods, respectively. The result showed a significant difference (P less than 0.05) in staphylococcal colonization rate on neonatal umbilical cord using different disinfectants even after the first day. The same result for neonatal nares was also found, after infants had been in the nursery for two days. During the third period, no case of skin infection was found. Most Staphylococcus aureus isolated were resistant to ampicillin, erythromycin, tetracycline and penicillin. The percentage of this antibiogram found in neonatal nares and umbilical cords was 44% and 56% respectively. Besides nosocomial infection control and surveillance of medical personnel, environment, materials, instruments and isolation techniques, it is really necessary to choose an effective disinfectant (bacitracin ointment is recommended) to reduce the staphylococcal colonization in newborn nurseries.

[Investigation on the relation between hepatitis B virus knowledge and needle-stick injury of hospital personnel].

The purposes of this study are: (1) to understand the knowledge of Hepatitis B virus known by hospital personnel. (2) to investigate the injury caused by accidental needle stick and its frequency. (3) to identify those personnel and job activities at high risk of needlestick injuries, to assess current medical management of these injuries in our hospital, and also to develop rational guidelines for prevention, based on the findings. 510 effective questionnaires were collected and analyzed by SPSS analytical system. The result of the present study showed that 77.1% hospital personnel had been experienced by needlestick injury. Most injuries occurred during recapping the needle after use and disposal of used needle. 92.7% hospital personnel felt that hospital should provide all the expense needed for Hepatitis B virus immunoglobulin while needle-stick injuries happened within the hospital. 86.3% of them felt that hospital should establish a special committee to evaluate and manage all the needle-stick injuries events. This study also showed that hospital personnel who have been working less than five years and their age between 21-30 can pay more attention to this kind of event. Dietitian and doctor got higher score in this study. Hospital personnel who were infected by Hepatitis B virus scored higher than uninfected one. In conclusion, we recommend not recapping used needles and making widely available and promoting use of an efficient needle disposal system. And we hope that those who have never been infected by Hepatitis B virus should accept vaccination as soon as possible.