RESUMO
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.
Assuntos
Proteínas de Bactérias/metabolismo , Resistência a Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Adolescente , Proteínas de Bactérias/genética , Toxinas Bacterianas/metabolismo , Técnicas de Tipagem Bacteriana/métodos , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Inglaterra/epidemiologia , Exotoxinas/metabolismo , Hospitais/estatística & dados numéricos , Humanos , Lactente , Leucocidinas/metabolismo , Resistência a Meticilina/fisiologia , Testes de Sensibilidade Microbiana/métodos , Proteínas de Ligação às Penicilinas , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/genéticaRESUMO
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.
Assuntos
Surtos de Doenças , Controle de Infecções/métodos , Infecções por Serratia/epidemiologia , Serratia marcescens/genética , Células Clonais , Eletroforese em Gel de Campo Pulsado , Genótipo , Humanos , Incidência , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Técnica de Amplificação ao Acaso de DNA Polimórfico , Serratia marcescens/isolamento & purificação , Serratia marcescens/patogenicidade , Reino Unido/epidemiologia , beta-Lactamases/biossínteseRESUMO
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.
Assuntos
Antibacterianos/uso terapêutico , Farmacêuticos , Antibacterianos/administração & dosagem , Humanos , Reino UnidoAssuntos
Poluentes Atmosféricos/efeitos adversos , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/crescimento & desenvolvimento , Infecções Pneumocócicas/microbiologia , Doença Pulmonar Obstrutiva Crônica/microbiologia , Streptococcus pneumoniae/crescimento & desenvolvimento , Humanos , Tamanho da PartículaRESUMO
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.
Assuntos
Anti-Infecciosos/economia , Ciprofloxacina/economia , Serviço de Farmácia Hospitalar/organização & administração , Anti-Infecciosos/administração & dosagem , Ciprofloxacina/administração & dosagem , Redução de Custos , Uso de Medicamentos , Injeções Intravenosas , Comitê de Farmácia e Terapêutica , Reino UnidoRESUMO
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.
Assuntos
Anti-Infecciosos/farmacologia , Fluoroquinolonas , Indóis , Quinolonas , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/fisiologia , Humanos , Lactamas , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Teste Bactericida do Soro/estatística & dados numéricosRESUMO
The in vitro activity of ABT773, a ketolide antimicrobial agent, was investigated and compared with those of seven other antibiotics. Type strains and 733 Gram-positive, Gram-negative and anaerobic isolates of clinical origin and four CHLAMYDIA: isolates were used. The activity of ABT773 was very similar to that of telithromycin, the other ketolide tested. The MIC(90) was < or = 0.5 mg/L for all bacteria examined except methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Haemophilus influenzae and BACTEROIDES: spp. The antichlamydial activity of ABT773 was greater than that of telithromycin, erythromycin and ciprofloxacin. Neither an increase in the size of the inoculm nor the addition of human serum had any marked affect on the in vitro activity of ABT773.
Assuntos
Antibacterianos/farmacologia , Eritromicina/análogos & derivados , Cetolídeos , Macrolídeos , Eritromicina/farmacologia , Humanos , Resistência a Meticilina , Testes de Sensibilidade MicrobianaRESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) has spread to all parts of the world. Effective control measures are dependent on a thorough knowledge of the organism's epidemiology which requires a typing technique that can be universally applied. Many typing methods have been developed for MRSA but none has been adopted as the internationally recognized standard. This review summarizes the information available on each in order to assess their suitability as a reference procedure. The majority of phenotypic and genotypic techniques are not sufficiently discriminatory, reproducible, stable or useful in an outbreak to be acceptable. The methods which do fulfil these requirements and have a potential for standardization, such as pulsed-field gel electrophoresis, binary typing or a combination of more rapid techniques, require further systematic evaluation.
Assuntos
Guias como Assunto , Resistência a Meticilina , Sorotipagem/métodos , Sorotipagem/normas , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Tipagem de Bacteriófagos/métodos , Southern Blotting/métodos , DNA Bacteriano/genética , Análise Discriminante , Surtos de Doenças/estatística & dados numéricos , Eletroforese/métodos , Genótipo , Humanos , Immunoblotting/métodos , Cooperação Internacional , Fenótipo , Reação em Cadeia da Polimerase/métodos , Reprodutibilidade dos Testes , Mapeamento por Restrição/métodos , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/genéticaRESUMO
The presence and sequences of genes that regulate the expression of methicillin resistance was investigated in 42 isolates of Staphylococcus aureus and 102 isolates of coagulase-negative staphylococci (CNS). PCR was used to detect mecA and the regulatory genes mecR1 and mecI. In a selected group of isolates, the sequences of mecI and the mec promoter region were also determined and compared with the sequences obtained from pre-MRSA strain N315. The genetic diversity of the collection was assessed by pulsed-field gel electrophoresis (PFGE). mecA was present in 21 S. aureus and 44 CNS. mecR1 was associated with mecA in all S. aureus and in all CNS, except two isolates of Staphylococcus haemolyticus. mecI was present in 48% of mecA-positive S. aureus and 50% of mecA-positive CNS. In six S. aureus isolates, mecI contained a termination codon at nucleotide 202 which would truncate the MecI protein. No mutation was found in the mecI gene of the four other S. aureus and 15 CNS sequenced. Seven isolates of Staphylococcus simulans had a single nucleotide substitution in the mec promoter region. Expression of methicillin resistance could be explained for all mecA-positive staphylococci with mutations within mecI or in the mec promoter region or in which mecI was deleted. However, the 'wild type' sequences observed in four S. aureus and eight CNS suggest that there is another mechanism for overcoming the repression of resistance caused by mecI.
Assuntos
Proteínas de Bactérias/genética , Resistência a Meticilina/genética , Proteínas Repressoras/genética , Staphylococcus/genética , Sequência de Bases , Coagulase/metabolismo , Eletroforese em Gel de Campo Pulsado , Frequência do Gene , Meticilina/farmacologia , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Mutação , Regiões Promotoras Genéticas , Análise de Sequência de DNA , Staphylococcus/efeitos dos fármacosRESUMO
An outbreak of multiresistant Klebsiella pneumoniae has continued in the Grampian Region of Scotland since 1992. The organism, which generally produces an extended-spectrum beta-lactamase (ESBL), has spread to several hospitals and nursing homes. DNA from 80 possible outbreak isolates was digested with the restriction endonucleases XbaI and SpeI, and the patterns obtained by pulsed-field gel electrophoresis were compared. Restriction patterns of 79 of the isolates were found to be highly similar with both restriction enzymes, whereas one isolate was unrelated. The outbreak isolates were divided into six subtypes with SpeI and 16 subtypes with XbaI. These subtypes were independent of antibiotic susceptibility pattern, date of isolation and ward of origin, but the XbaI subtype did correlate with the SpeI subtype. It was concluded that the Klebsiella isolates of this outbreak were clonally related.
Assuntos
DNA Bacteriano/análise , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae , Antibacterianos/farmacologia , Cápsulas Bacterianas/análise , Surtos de Doenças , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Eletroforese em Gel de Campo Pulsado , Hospitais , Humanos , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Casas de Saúde , Polimorfismo de Fragmento de Restrição , Escócia/epidemiologiaRESUMO
The susceptibility to methicillin of 44 Staphylococcus aureus and 120 coagulase-negative staphylococci (CNS) was determined by Etest, agar dilution and presence of the mecA gene. There was agreement between the results of all methods when testing S. aureus. However, discrepancies occurred with CNS when cultural methods were compared with presence of the mecA gene. mecA-positive isolates tested as resistant more often with agar dilution on Columbia agar plus 5% NaCl than by Etest.