108 results on '"ENTEROCOCCUS"'
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2. Is the mazEF toxin-antitoxin system responsible for vancomycin resistance in clinical isolates of Enterococcus faecalis?
- Author
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Sadeghifard, Nourkhoda, Soheili, Sara, Sekawi, Zamberi, and Ghafourian, Sobhan
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Enterococcus ,mazEF TA system ,vancomycin ,antimicrobial target ,Medicine ,Public aspects of medicine ,RA1-1270 ,Microbiology ,QR1-502 - Abstract
[english] The current study was conducted to investigate the relationship between vancomycin-resistant (VRE) and the presence of toxin-antitoxin (TA) system, which may be useful as target for novel antimicrobial therapy concepts. The susceptibility of was determined by MIC, and the presence of the TA system was evaluated by PCR. Among 200 isolates 39.5% showed resistance to vancomycin (VRE), while 60.5% were susceptible strains (VSE). The TA system was positive in all VRE isolates (100%), but less prevalent (38/121, 31.4%) among the 121 VSE strains. In conclusion, our study demonstrated a positive relationship between the presence of vancomycin resistance and TA system. This observation may introduce therapeutic options against a novel antimicrobial target in enterococci.
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- 2014
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3. Analyse von Risikofaktoren für das Versagen von Knieprothesen nach einzeitig septischem Wechsel
- Author
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Friedenstab, Jasmin
- Subjects
610 Medizin, Gesundheit ,Knieendoprothese ,Streptococcus ,ddc:610 ,Periprothetische Infektion ,Risikofaktor ,Enterococcus - Abstract
Die Therapie bei einer periprothetischen Infektion kann sowohl ein- oder zweizeitig erfolgen, wobei der zweizeitige Wechsel einer Endoprothese derzeit als Goldstandard anzusehen ist, obwohl eine einzeitige Wechseloperation vergleichbare Ergebnisse erzielt. Das Ziel der vorliegenden Studie ist es herauszuarbeiten, aus welchen Gründen die einzeitig septischen Knieprothesenwechsel scheitern. Im Rahmen einer Fall-Kontroll Studie wurden mögliche patienten- und prozedurabhängige Risikofaktoren analysiert. Es konnten verschiedene Risikofaktoren für ein Versagen nach einem einzeitig septischen Wechsel identifiziert werden. Unter anderem sind ein vorheriger einzeitig septischer Wechsel, sowie der Nachweis von Enterokokken-Spezies oder Streptokokken-Spezies, mit einem erhöhten Risiko für ein Versagen der einzeitigen septischen Re-Revision assoziiert. Berücksichtigt man diese Risikofaktoren bei Patienten mit einer periprothetischen Infektion, könnte dies zu besseren Ergebnissen führen.
- Published
- 2021
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4. [63-year-old male with positive VRE anamnesis, elective indications for surgery and during the course VRE bacteremia : Preparation for the medical specialist examination: part 33]
- Author
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F, Schuler, S, Kampmeier, and C, Lanckohr
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Male ,Patient Isolation ,Operating Rooms ,Humans ,Bacteremia ,Hygiene ,Vancomycin Resistance ,Enterococcus ,Gram-Positive Bacterial Infections ,Perioperative Care ,Aged ,Anti-Bacterial Agents - Published
- 2019
5. Merkblatt für den Umgang mit Patienten mit multiresistenten gram-negativen Stäbchenbakterien (MRGN).
- Author
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Pitten, F.-A.
- Subjects
GRAM-negative bacteria ,METHICILLIN-resistant staphylococcus aureus ,VANCOMYCIN resistance ,DRUG resistance in bacteria ,NOSOCOMIAL infections ,ENTEROCOCCUS ,ENTEROBACTERIACEAE ,INFECTIOUS disease transmission ,DISEASE risk factors - Abstract
Copyright of Krankenhaus-Hygiene + Infektionsverhutung is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2013
- Full Text
- View/download PDF
6. Nekrotisierende Fasziitis – eine klinische Diagnose
- Author
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Scheid, C., Dudda, M., and Jäger, M.
- Published
- 2016
- Full Text
- View/download PDF
7. [Enterococci With Special Resistance Patterns - Epidemiology, Hygiene and Therapy]
- Author
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Alexander, Mischnik, Guido, Werner, Jennifer, Bender, and Nico Tom, Mutters
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Daptomycin ,Drug Resistance, Bacterial ,Linezolid ,Lipoglycopeptides ,Humans ,Tetrazoles ,Vancomycin Resistance ,Tigecycline ,Enterococcus ,Gram-Positive Bacterial Infections ,Oxazolidinones ,Anti-Bacterial Agents - Abstract
Enterococci with special resistance patterns (mainly vancomycin-resistant enterococci) play an important role in everyday clinical practice. Rising resistance rates to linezolid, daptomycin or tigecycline are also increasingly reported. Therapeutically, linezolid and daptomycin are the most important substances mainly in infections due to vancomycin-resistant enterococci. Several systematic meta-analyses of bloodstream infections showed discrepant results in the comparison of mortality of linezolid and daptomycin-treated bacteraemias. The containment of enterococci with special resistance patterns is currently receiving great attention. The key hygienic issue in all recommendations for dealing with multidrug-resistant enterococci can be summarized very simply: current scientific evidence is often inconsistent and studies that have clearly tested a single intervention for efficacy are lacking. The present work gives an insight into the current epidemiology and therapeutic strategies. Furthermore, the recently published German KRINKO recommendations are presented.
- Published
- 2019
8. Antibiotikaresistenz der Enterokokken in Deutschland.
- Author
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Wallrauch, C., Elsner, E., Milatovic, D., Cremer, J., and Braveny, I.
- Abstract
Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 1998
- Full Text
- View/download PDF
9. Antibiotikaresistenz der Enterokokken in Deutschland.
- Author
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Wallrauch, Claudia, Elsner, Elmar, Milatovic, Danica, Cremer, Josef, and Braveny, Ilja
- Abstract
Copyright of Medizinische Klinik (Urban & Vogel) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 1997
- Full Text
- View/download PDF
10. In-vitro-Suppression von Enterococcus faecalis in den Dentintubuli mit Chloramin-T
- Author
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Bräutigam, Franziska Maria
- Subjects
Chloramine ,Antimikrobieller Wirkstoff ,Backenzahn ,Wurzelkanalbehandlung ,Enterococcus - Abstract
Bei der endodontischen Behandlung soll mittels Kombination der mechanischen und chemischen Aufbereitung infizierter Wurzelkanäle eine Persistenz der endodontischen Infektion verhindert und damit ein Langzeiterfolg der Wurzelkanalbehandlung erreicht werden. Wird trotz einer lege artis durchgeführten endodontischen Therapie ein refraktärer Verlauf diagnostiziert, so ist davon auszugehen, dass der Wurzelkanal mit problematischen Mikroorganismen infiziert ist. Um die bakterielle Infektion zu behandeln, kommen verschiedene Wurzelkanalspülungen zum Einsatz. Mit den konventionellen Spülflüssigkeiten und medikamentösen Einlagen kann jedoch häufig keine vollständige Suppression der Bakterien erzielt werden. Als besonders robust gegenüber den chemo-mechanischen Therapieoptionen gilt die Spezies Enterococcus faecalis. Ein wesentlicher pathogenetischer Faktor von E. faecalis ist die Eigenschaft, die Dentintubuli besiedeln zu können. Das Ziel der vorliegenden Arbeit war es, die antimikrobielle Effektivität des Desinfiziens Chloramin-T gegen E. faecalis in den Dentintubuli in vitro zu evaluieren.
- Published
- 2018
- Full Text
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11. Untersuchungen zur antimikrobiellen Resistenz und Virulenz von Enterococcus Isolaten aus Wirtschaftsgeflügel
- Author
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Maasjost, Julia
- Subjects
resistance ,virulence traits ,embryolethality ,enterococcus ,poultry ,bacteria ,biochemical phenomena, metabolism, and nutrition - Abstract
Enterococcus Isolate aus Wirtschaftsgeflügel wurden hinsichtlich ihrer antimikrobiellen Resistenz und ihrer Virulenzfaktoren untersucht. Außerdem erfolgte die Bestimmung der Virulenz im Embryoletalitätstest. In der vorliegenden Arbeit wurden 163 klinische Enterokokkenisolate von Broilern, Legehennen und Puten aus den Jahren 2010 und 2011 bearbeitet. Zur Speziesbestimmung wurden eine genus- und speziesspezifische Multiplex-PCR und eine 16S rDNA-Genanalyse durchgeführt. Die dominierende Spezies war E. faecalis (n=127). Enterococcus faecium (n=18), E. gallinarum (n=13) und E. hirae (n=5) wurden ebenfalls nachgewiesen. Das Resistenzverhalten aller Isolate gegenüber 24 antimikrobiellen Wirkstoffen wurde mit der Mikrodilutionsmethode bestimmt. Die Auswertung der ermittelten MHK50 und MHK90 Werte erfolgte mittels CLSI-Grenzwerten. Die Resistenzraten gegenüber Lincomycin (72%-100%) und Tetrazyklin (40-100%) waren für alle Spezies hoch. Außerdem waren die meisten E. faecalis und E. faecium Isolate resistent gegen Gentamicin (89-98%) und Erythromycin (70-89%). Es wurden keine Vancomycin- resistenten Enterokokken gefunden, und die Empfindlichkeit gegenüber Ampicillin lag für E. faecalis, E. gallinarum und E. hirae bei 100%. Die MHK50 und MHK90 Werte für Beta-Laktame, Chloramphenicol und Sulfamethoxazol- Trimethoprim befanden sich im unteren Testbereich. Enterococcus faecalis Isolate von Puten zeigten die höchsten Resistenzraten für alle antimikrobiellen Wirkstoffe außer Ciprofloxacin und Sulfamethoxazol- Trimethoprim. Einundsechzig Prozent der Enterococcus Isolate waren gegen drei oder mehr Antibiotikaklassen resistent. Auch hier standen die Putenisolate mit 80% Multi-Resistenz hervor. Der häufigste Resitenzphänotyp bei den E. faecalis Isolaten von Broilern, Legehennen und Puten war Gentamicin, Lincomycin und Tetrazyklin. Achtundzwanzig ausgewählte Putenisolate (10 E. faecalis, 10 E. faecium, 8 E. gallinarum) wurden hinsichtlich fünf Virulenzfaktoren (Aggregation Substance, Cytolysin, Enterococcal Surface Protein, Gelatinase, Hyaluronidase) untersucht. Dazu erfolgte ein PCR-Nachweis der Virulenzgene asa1, cylA, cylB, cylLL, cylLS, cylM, esp, gelE und hylEfm und die Sequenzierung der nachgewiesenen Virulenzgene. Die phänotypische Ausprägung von Cytolysin, Gelatinase und Hyaluronidase wurde mit mikrobiologischen Tests untersucht. Das Gelatinase-Gen wurde bei allen drei Enterokokkenspezies, das asa1 Gen nicht bei E. gallinarum und das esp Gen nur bei E. faecium nachgewiesen. Drei E. faecalis und ein E. faecium Isolat wiesen das gesamte Cytolysin-Operon auf. Bei sechs E. faecium und zwei E. gallinarum Isolaten wurden keine Virulenzgene nachgewiesen. Sechs E. gallinarum Isolate zeigten Cytolysin-Aktivität, sieben E. faecalis Isolate verflüssigten Gelatine und sieben E. gallinarum Isolate zeigten Hyaluronidase-Aktivität. Im Embryoletalitätstest wurde anhand des Überlebensindex und der Absterberate die Virulenz der 28 Putenisolate bestimmt. Anhand des Überlebensindex wurden drei Isolate als hoch, sieben Isolate als mäßig und 18 Isolate als gering virulent eingestuft. Anhand der Absterberate wurde ein Isolat als hoch, acht Isolate als mäßig und 19 Isolate als gering virulent eingestuft., Antimicrobial resistance and virulence traits of enterococcus isolated from poultry were determined. In addition, the virulence of the isolates was assessed using the embryolethality test. Between 2010 and 2011, 163 Enterococcus isolates were collected from broilers, layers and fattening turkeys that showed various clinical signs. Genus and species identification was determined with multiplex-PCR and gene sequencing. Most of the isolates were E. faecalis (n=127), while E. faecium (n=18), E. gallinarum (n=13), and E. hirae (n=5) were found in lower numbers. Susceptibility to 24 antimicrobial substances was tested using broth microdilution test to determine minimum inhibitory concentrations (MICs). CLSI established breakpoints as well as MIC50 and MIC90 values were applied for evaluation. Resistance rates for lincomycin (72-100%) and tetracycline (40-100%) were high for all Enterococcus species. In addition, most E. faecalis and E. faecium isolates were resistant to gentamicin (89-98%) and erythromycin (70-89%). No vancomycin resistant enterococci (VRE) were found and sensitivity to ampicillin was 100% for E. faecalis, E. gallinarum, and E. hirae. MIC50 and MIC90 values for beta-lactam antibiotics, chloramphenicol and sulfamethoxazole-trimethoprim were at the lower end of the test range. Enterococcus faecalis isolated from turkeys had thehighest rates of resistances for all antimicrobial substances except ciprofloxacin and sulfamethoxazole-trimethoprim. Sixty-one percent of Enterococcus isolates were resistant to three or more antimicrobial classes. Again, isolates from turkeys stood out with 80% multi-resistance. The most frequent resistance phenotypes of E. faecalis isolated from broilers, layers and turkeys were gentamicin, lincomycin, and tetracycline. Five virulence factors (aggregation substance, cytolysin, enterococcal surface protein, gelatinase, hyaluronidase) were determined in 28 isolates from turkeys (10 E. faecalis, 10 E. faecium, 8 E. gallinarum). First, virulence genes asa1, cylA, cylB, cylLL, cylLS, cylM, esp, gelE and hylEfm were determined with multiplex- PCR. Gene-specific amplification products were confirmed by gene sequencing. All 28 Enterococcus isolates were tested for hemolytic activity, and gelatinase and hyaluronidase production. The gelE gene was found in all Enterococcus species, asa1 was not found in E. gallinarum and esp was only found in E. faecium. Three E. faecalis and one E. faecium isolate showed the whole cytolysin operon. No virulence genes were found in six E. faecium and two E. gallinarum isolates. Six E. gallinarum isolates displayed cytolysin activity, seven E. faecalis broke down gelatine and seven E. gallinarum isolates displayed hyaluronidase activity. Virulence of the 28 isolates from turkeys was determined calculating survival index and death rate. According to survival index, three isolates were found highly virulent, seven isolates were moderately virulent and 18 isolates were less virulent. According to death rate, one isolate was found highly virulent, eight isolates were moderately virulent and 19 isolates less virulent.
- Published
- 2017
12. Breitsprektrum-ß-Laktamase-bildende Enterobakteriazeen am Klinikum Stuttgart: Epidemiologie, Mikrobiologie, klinische Bedeutung und Risikofaktoren
- Author
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Tran, Truong Ngoc Diem
- Subjects
Epidemiologie ,ESBL ,Enterobacteriaceae ,Extended-Spectrum Beta-Lactamase ,Escherichia coli ,ddc:610 ,DDC 610 / Medicine & health ,Breitsprektrum-ß-Laktamase ,beta-Lactamases ,Enterococcus - Abstract
Die weltweite Zunahme von Infektionen mit Enterobakteriazeen, die Extended-Spectrum-ß-Lactamase (kurz ESBL) bilden, zeigte sich auch am Klinikum Stuttgart. Es herrschen laut aktueller Studienlage unterschiedliche Ergebnisse bezüglich infektionsbegünstigender Risikofaktoren. Diese inhomogenen Angaben veranlassten uns dazu, das Patientengut mit ESBL-bildenden Escherichia coli (E. coli) speziell am Klinikum Stuttgart nach Epidemiologie, Mikrobiologie, klinischer Bedeutung und Risikofaktoren zu untersuchen. Hauptziel war es, ein Risikoprofil zu erstellen, die zum Erwerb einer Besiedlung/Infektion mit ESBL-bildenden E. coli führten. Hierzu wurde die Fallgruppe, bestanden aus 95 stationären Patienten mit ESBL-bildenden E. coli, mit einer Kontrollgruppe, bestanden aus 84 stationären Patienten mit E. coli, die keine ESBL bildeten, verglichen. Eine multivariate logistische Regressionsanalyse ermittelte uns die unabhängigen Risikofaktoren. Das Ergebnis zeigte, dass mit zunehmenden Lebensalter das Risiko für eine Besiedlung/Infektion mit ESBL-bildenden E. coli signifikant anstieg (Odds Ratio 1,031, 95% Konfidenzintervall 1,014-1,048). Darüber hinaus war das männliche Geschlecht mit einer Odds Ratio von 2,093 (95% Konfidenzintervall 1,046-4,190) einem höheren Risiko ausgesetzt. Ein weiterer unabhängiger Faktor war vergangene oder begleitende Dialysepflichtigkeit (Odds Ratio 5,14; 95% Konfidenzintervall 1,147-23,020) und sonstige infektionsbegünstigende Gründe (z. B. pAVK, Kachexie, Cortison-Behandlung, anatomisch-bedingte Nachteile wie Harnwegsobstruktionen/-reflux oder Device-Anlagen wie PEG-Sonden, ZVK, Harnwegskatheter etc.). (Odds Ratio 3,604; 95% Konfidenzintervall 1,732-7500). Die Kenntnis dieses Risikoprofils sollte bei der frühzeitigen Detektion unserer Patienten mit ESBL-Besiedlung behilflich sein. In einem ausführlichen Überblick der aktuellen klinischen Literatur wird die zunehmende klinische Bedeutung der ESBL-Bildner hinsichtlich unserer Ergebnisse diskutiert.
- Published
- 2015
13. Vergleich der Chemoresistenz verschiedener Enterokokken
- Author
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Lenhardt, Anita
- Subjects
Arzneimittelresistenz ,Enterococcus - Abstract
vorgelegt von: Anita Lenhardt Zusammenfassung in englischer Sprache Masterarbeit FH Campus Wien 2015
- Published
- 2015
14. [Infection with the capnophilic bacteria Enterococcus cecorum in broiler chickens]
- Author
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Albini, Faye, Lobsiger, Stadler-Thommen, Renggli, and Hoop
- Subjects
Male ,Behavior, Animal ,Animals ,Female ,Osteomyelitis ,Chickens ,Enterococcus ,Gram-Positive Bacterial Infections ,Poultry Diseases ,Switzerland - Published
- 2014
15. [The importance of wildlife as reservoir of antibiotic-resistant bacteria in Bavaria--first results]
- Author
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Cornelia, Meyer, Marco, Heurich, Ingrid, Huber, Gladys, Krause, Ulrike, Ullrich, and Alexandra, Fetsch
- Subjects
Staphylococcus aureus ,Deer ,Sus scrofa ,Animals, Wild ,Bacillus ,Bacterial Infections ,Anti-Bacterial Agents ,Methicillin ,Germany ,Carrier State ,Drug Resistance, Bacterial ,Animals ,Enterococcus ,Disease Reservoirs - Abstract
The use of antimicrobial agents is responsible for the emergence and spread of antibiotic resistant bacteria. Nevertheless, multiresistant bacteria have been found in animals that have never been exposed to antimicrobial agents. Wild animals that are carriers of methicillin-resistant organisms represent a hazard since they can transmit their bacteria to other animals and to humans. In the hunting season 2009/2010 nasal swabs of 98 red deer and 109 wild boars were examined for the presence of methicillin-sensitive and methicillin-resistant staphylococci. From each wild boar methicillin-susceptible staphylococci (Staphylococcus aureus in 28% and Staphylococcus spp. in 72% of the animals) were isolated. In red deer the detection rate of Staphylococcus (S.) aureus and methicillin-susceptible staphylococci was 49% and 17%, respectively. The occurrence of S. aureus was significantly higher (p0.05) in red deer than in wild boars. Methicillin-resistant staphylococci were not found. However, in one third of the red deer, methicillin-resistant bacteria of the genus Enterococcus spp. and Bacillus spp. were isolated. The results of the present study indicate that wildlife, especially red deer are an important reservoir for S. aureus and that the upper respiratory tract of red deer is regularly colonised with methicillin-resistant bacteria such as Bacillus spp. and Enterococcus spp. Primarily, commensal bacteria are harmless to human health, however, red deer may be a reservoir for antibiotic-resistant bacteria.
- Published
- 2014
16. [Multiresistant gram-negative bacteria. A bacterial challenge of the twenty-first century]
- Author
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K, Schröppel and R, Riessen
- Subjects
Methicillin-Resistant Staphylococcus aureus ,Cross Infection ,Evidence-Based Medicine ,Genotype ,Hygiene ,Vancomycin Resistance ,Microbial Sensitivity Tests ,Opportunistic Infections ,Staphylococcal Infections ,Anti-Bacterial Agents ,Disinfection ,Intensive Care Units ,Phenotype ,Drug Resistance, Multiple, Bacterial ,Germany ,Gram-Negative Bacteria ,Humans ,Gram-Negative Bacterial Infections ,Enterococcus ,Gram-Positive Bacterial Infections - Abstract
The incidence of human-pathogenic microorganisms with resistance or even complete insensitivity to broad-spectrum antibiotics is increasing. This poses a serious challenge to infection control in hospitals and to hygiene strategies in clinical areas with critically ill patients, particularly intensive care or transplant units. These microorganisms create problems that are seemingly impossible to solve at present. The management of gram-positive pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) has been facilitated by evidence-based recommendations resulting in a measurable decrease in the incidence of infection and, where treatment is concerned, in a selection of reliably effective drugs for clinicians. However, in the more frequent cases of multiresistant gram-negative (MRGN) pathogens, the only option is the use of poorly defined regimens with older drugs, which carry the risk of serious side effects and organ toxicities. This article presents a comparative analysis of hospital hygiene management for MRSA and MRGN pathogens, pointing out both similarities and features which are unique to MRGN pathogens.
- Published
- 2013
17. Induktion von Desinfektionsmittelresistenzen und Co-Induktion von Antibiotikaresistenzen bei Escherichia coli und Enterococcus spp. aus Nutztierhaltungen
- Author
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Zimmermann, Katrin
- Subjects
resistance ,drug resistance ,Escherichia coli ,Enterococcus ,antibiotics ,Disinfectants - Abstract
Im Rahmen der Infektionsprophylaxe und der Bekämpfung von Krankheitsausbrüchen werden in der Tierhaltung jährlich enorme Mengen von Desinfektionsmitteln eingesetzt. Da es nicht nur in der Humanmedizin eine wachsende Anzahl von Berichten über Desinfektionsmittelresistenzen gegen bestimmte Wirkstoffe gibt, welche zudem teilweise mit Antibiotikaresistenzen einhergehen, gilt diese Befürchtung auch für den Einsatz von Desinfektionsmitteln in der Tierhaltung. Im Fokus der durchgeführten Untersuchungen stand somit die Frage, inwieweit subinhibitorische Konzentrationen von Desinfektionsmitteln, wie sie durch zahlreiche beeinträchtigende Faktoren in der Tierhaltung entstehen können, zu einer Induktion von Resistenzen gegen diese bzw. zu einer Co-Induktion von Antibiotikaresistenzen führen können. Um dieser Frage nachzugehen, wurde die minimale Hemmkonzentration (MHK) von drei typischerweise in der Tierhaltung eingesetzten Desinfektionsmitteln (Peressigsäure, Glutaraldehyd und Ameisensäure) von Escherichia coli als gramnegative und Enterococcus spp. als grampositive, ubiquitäre Bakterien aus Nutztierhaltungen, bestimmt. Dies erfolgte im Doppelansatz nach den DVG-Richtlinien der Desinfektionsmittelprüfung sowohl bei den jeweiligen Referenzstämmen als auch bei je neun Feldisolaten aus Nutztierhaltungen jeder Gruppe. Zudem wurden ESBL-bildende und ESBL-negative E. coli im Vergleich untersucht, um die Auswirkungen bereits vorhandener Antibiotikaresistenzgene auf eine Desinfektionsmittelresistenz bei E. coli einschätzen zu können. Nachdem alle Testkeime zehnmalig subinhibitorischen Desinfektionsmittelkonzentrationen ausgesetzt wurden, wurde eine erneute MHK-Bestimmung durchgeführt um zu ermitteln, inwieweit sich diese verändert hat. Nach anschließend durchgeführten Stabilitätspassagen ohne Desinfektionsmittelzusatz wurde wieder anhand der MHK bestimmt, wie stabil die beobachteten Sensibilitätsveränderungen gegen die Desinfektionsmittel waren. Es wurden ausschließlich temporäre Toleranzerhöhungen, welche nie mehr als eine MHK- Stufe umfassten induziert, was auf ein verhältnismäßig geringes Resistenzrisiko bei dem Einsatz der untersuchten Desinfektionsmittel hindeutet. Im Gegensatz dazu konnte jedoch ein Konvergieren bzw. sogar zeitweises Überschreiten der MHK im Vergleich zu den vorgeschriebenen Gebrauchskonzentrationen bei zwei von drei getesteten Desinfektionsmitteln beobachtet werden. Im letzteren Fall kann man von der Induktion einer instabilen Resistenz sprechen, welche bei dem glutaraldehydhaltigem Desinfektionsmittel Permanent neu® bei mehreren Enterococcus-Isolaten beobachtet wurde. Durch die Erhöhung der MHK unter den idealen Bedingungen im Labor kann man darauf schließen, dass es unter den schwierigeren Gegebenheiten in der Stallumgebung vermutlich ebenfalls schnell zu einer Beeinträchtigung des Desinfektionserfolgs kommen kann. Zudem ist bemerkenswert, dass in den Versuchen mit dem glutaraldehydhaltigem Präparat die Enterococcus Feldisolate eine höhere Toleranz gegen den Wirkstoff zeigten als der entsprechende Enterococcus- Referenzstamm aus der Desinfektionsmittelprüfung. Das äquivalente Verhalten der ESBL-negativen und der ESBL-bildenden E. coli zeigt, dass zumindest das Vorhandensein dieser multiplen Resistenzen gegen ß-Laktamantibiotika bei E. coli keinen Wirkungsverlust der untersuchten Desinfektionsmittel (Peressigsäure, Glutaraldehyd und Ameisensäure) erwarten lassen. Um einen Einfluss der veränderten MHK der Desinfektionsmittel auf die Antibiotikaempfindlichkeit der Bakterien zu untersuchen, wurde vor und nach den Passagen mit subinhibitorischen Desinfektionsmittelkonzentrationen mit ausgewählten Vertretern der einzelnen Testkeimgruppen zudem ein Agardiffusionstest mit jeweils zwölf verschiedenen antibiotischen Wirkstoffen durchgeführt. Dabei konnten jedoch in keinem Fall Hinweise gefunden werden, die auf eine Korrelation zwischen den beobachteten MHK-Erhöhungen der Desinfektionsmittel und einem Sensibilitätsverlust der untersuchten Antibiotika hingedeutet hätten. Jedoch fiel auf, dass die Feldisolate der einzelnen Bakteriengruppen stets mehr Resistenzen gegen die untersuchten antibiotischen Wirkstoffe aufwiesen als die entsprechenden Referenzstämme. Da die Ausbildung von Resistenzen der einzelnen Bakterienspezies wahrscheinlich auf spezifischen statt auf generischen Resistenzmechanismen basiert, kann man aus den durchgeführten Untersuchungen lediglich schließen, dass eine Induktion stabiler oder hochgradiger Resistenzen der untersuchten Keimgruppen gegen die getesteten Desinfektionsmittel Peressigsäure, Glutaraldehyd und Ameisensäure in der Stallumgebung eher unwahrscheinlich ist. Jedoch kann dies nicht völlig ausgeschlossen werden, da es möglich ist, dass sich dies bei einem anderen Versuchsaufbau anders darstellen würde. In Anbetracht der teilweise sehr geringen Sicherheitsspannen der Präparate ist ein Versagen der Desinfektion unter den schwierigen Bedingungen in der Tierhaltung jedoch ein realistisches Szenario. Somit bleibt die Wichtigkeit eines fehlerfreien und verantwortungsbewussten Desinfektionsmitteleinsatzes hervorzuheben., For infection prophylaxis and to fight outbreaks of diseases animal husbandry utilizes enormous amounts of disinfectants each year. Not only humane medicine finds itself confronted with a growing number of reports about resistances against specific disinfectant agents, which additionally are partially accompanied by resistances against antibiotics. This apprehension is shared as well by disinfectant use in animal husbandry. Focus of this thesis was therefore to research to what extent subinhibitory concentrations of disinfectants, which are likely to be caused by numerous interfering factors in animal husbandry, will lead to the induction of resistances against those agents, or co-induction of resistances against antibiotics. To research this question the minimum inhibition concentration (MIC) of three typical disinfectants used in animal husbandry (peracetic acid, glutaraldehyde and formic acid) of Escherichia coli as gram-negative and Enterococcus spp. as gram-positive ubiquitous bacteria found in livestock husbandry was determined. Duplicate measurement following DVG guidelines for disinfectant review was employed for both the corresponding reference microbial strains and the nine field isolates from livestock husbandry of each group. Additionally, for comparison, ESBL-producing and ESBL-negative E. coli were tested to research the influence of preexisting resistance genes against antibiotics on resistances of E. coli against disinfectants. After all tested germs had been exposed ten times to subinhibitory concentrations of disinfectants a second MIC determination was conducted in order to find out how the MIC changed. After a following period of unexhibited growth the MIC was again determined in order to find out the stability of the observed change in sensibility. Only temporary changes in levels of tolerance were observed, never amounting to more than one MIC level, which suggests a relatively low risk of inducing resistances against the researched disinfectants. Contrary to that a convergence, respectively a temporary transgression of the MIC in comparison to the concentrations ready to use for two of the three disinfectants was observed. The latter case can be labeled as an induction of an instable resistance, which was observed using the glutaraldehyde based disinfectant Permanent neu® for several Enterococcus isolates. By aligning the MIC to the concentrations ready to use under ideal laboratory conditions it can be deducted that under the harsh conditions of a barn environment disinfectant effectivity will presumably quickly deteriorate. Additionally, it is alarming that in the experiments using the glutaraldehyde based disinfectant the Enterococcus field isolates showed a higher tolerance against that agent than the corresponding Enterococcus reference strain from disinfectant review. The equivalent behavior of ESBL-negative and ESBL-producing E. coli shows that at least the existence of multiresistances against ß-lactam antibiotics in E. coli will not lead to reduced sensibility against disinfectants (peracetic acid, glutaraldehyde, formic acid). To analyze the influence of the changed MIC of the disinfectants on antibiotic sensibility of the bacteria an additional agar diffusion test with twelve different antibiotic agents was made before and after each exhibition of selected test germs to subinhibitory concentrations of disinfectants. In doing so no indication of a correlation between the observed rise of the MIC of the disinfectants and a loss of sensibility against the tested antibiotics was found. Nonetheless, it was noticed that the field isolates of the different groups of bacteria always showed a higher resistance against the tested antibiotic agents than the corresponding reference strains. Since the development of resistances of the different species of bacteria is most likely based on specific rather than generic resistance mechanisms, it can only be deduced from the conducted research that an induction of stable or highly effective resistances against the disinfectants peracetic acid, glutaraldehyde and formic acid in the researched group of test germs is unlikely in a barn environment. Such a development of a resistance can still not be completely ruled out since it is deemed possible that a different setup of the experiment might lead to a different conclusion. In consideration of the partially rather small safety margins of the products used in this thesis a failure of disinfection under the difficult conditions in animal husbandry is a realistic danger. Therefore, the importance of a correct and responsible application of disinfectants should be especially noted.
- Published
- 2013
18. [Adaptation and development of German recommendations on the prevention and control of nosocomial infections due to multiresistant pathogens]
- Author
-
A, Simon and B, Christiansen
- Subjects
Methicillin-Resistant Staphylococcus aureus ,Cross Infection ,Evidence-Based Medicine ,National Health Programs ,Advisory Committees ,Academies and Institutes ,Hygiene ,Vancomycin Resistance ,Microbial Sensitivity Tests ,Staphylococcal Infections ,Cross-Sectional Studies ,Drug Resistance, Multiple, Bacterial ,Germany ,Humans ,Guideline Adherence ,Enterococcus ,Gram-Positive Bacterial Infections - Abstract
The Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute developed evidence-based recommendations for the prevention and control of nosocomial infections in Germany. Considering the growing impact of multiresistant pathogens (MRE) on morbidity and mortality related to nosocomial infections, the prevention and control of MRE is one of the most important topics on the current agenda. Currently, the German recommendations on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are being re-evaluated and a recommendation discussing options for the prevention and control of MR Gram-negative pathogens is awaited and will be published in the next months.
- Published
- 2012
19. [Antibiotic treatment of enterococcal infections in gastroenterology with daptomycin - first experiences from the EU-CORE registry study (European Cubicin® Outcomes Registry and Experience)]
- Author
-
C, Lübbert, D, Wilhelms, D, Worlitzsch, T J, Ettrich, S, Behl, and T, Seufferlein
- Subjects
Adult ,Male ,Cross Infection ,Pilot Projects ,Middle Aged ,Anti-Bacterial Agents ,Treatment Outcome ,Daptomycin ,Humans ,Female ,European Union ,Registries ,Enterococcus ,Gram-Positive Bacterial Infections ,Aged - Abstract
Enterococci are a frequent cause of nosocomial infections in gastroenterology. The increase of Enterococcus faecium infections with development of resistance to gentamicin and vancomycin as well as possible linezolid resistance require alternative antibiotic therapies. Study data show that daptomycin, a highly bactericidal antibiotic is effective in enterococcal infections. However, in Germany daptomycin is so far only approved for the treatment of complicated skin and soft tissue infections, bacteremia and infective endocarditis caused by Staphylococcus aureus. In the Department of Internal Medicine I, University Hospital Halle (Saale) from May 2 009 to April 2 010 all gastroenterological patients with evidence of invasive enterococcal infection received intravenous daptomycin treatment at inclusion in the European Cubicin® Outcomes Registry and Experience (EU-CORE). Gastroenterological diseases treated were necrotising pancreatitis, infected pancreatic pseudocysts, abscesses, obstructive cholangitis and sepsis. The clinical outcome was retrospectively detected by protocol-defined criteria. A total of 13 patients (8 male, 5 female, median age 59 years) with microbiologically assured enterococcal infections (10 × E. faecium, including 1 × VRE, 6 × E. faecalis, including double infections) were treated with intravenous daptomycin (6 mg per kg body weight). In the presence of polymicrobial infections (10 of 13 patients), an additional anti-infective therapy was initiated according to sensitivity testing. Concomitantly a direct focus approach with stenting, puncture or drainage was performed. The clinical cure rate was 92 % (12 of 13 patients). One patient died from a non-surgically uncontrollable malignancy (Klatskin tumour Bismuth IIIb). There were no adverse events. These results allow us to conclude that antibiotic therapy with daptomycin in invasive or bacteraemic enterococcal infections leads to high cure rates (up to 90 % and more) when concomitant and adequate focus relief is performed. Larger clinical studies to obtain an extended drug approval are desirable.
- Published
- 2012
20. Rare case of large double perforated anterior mitral leaflet pseudoaneurysm in a patient with aortic valve endocarditis
- Author
-
A, Matana, D, Žagar, and Z, Matana Kaštelan
- Subjects
Heart Failure ,Heart Valve Prosthesis Implantation ,Male ,Aortic Valve Insufficiency ,Mitral Valve Insufficiency ,Aortic Valve Stenosis ,Endocarditis, Bacterial ,Tricuspid Valve Insufficiency ,Anti-Bacterial Agents ,Cephalosporins ,Echocardiography, Doppler, Color ,Echocardiography ,Vancomycin ,Aortic Valve ,Humans ,Mitral Valve ,Drug Therapy, Combination ,Cefepime ,Aneurysm, False ,Echocardiography, Transesophageal ,Enterococcus ,Gram-Positive Bacterial Infections ,Aged - Published
- 2011
21. [Relevance and diagnostics of selected bacterial pathogens of poultry]
- Author
-
A, Jung, M, Ryll, and S, Rautenschlein
- Subjects
DNA, Bacterial ,Bordetella avium ,Bacterial Infections ,DNA, Ribosomal ,Ornithobacterium ,Polymerase Chain Reaction ,Poultry ,Riemerella ,Flavobacteriaceae Infections ,RNA, Ribosomal, 16S ,Animals ,Pasteurellaceae ,Pasteurellaceae Infections ,Sequence Alignment ,Enterococcus ,Gram-Positive Bacterial Infections ,Poultry Diseases ,Bordetella Infections - Abstract
This paper provides an overview of diseases caused by Bordetella avium, Gallibacterium anatis, Ornithobacterium rhinotracheale, Riemerella anatipestifer and Enterococcus cecorum in poultry flocks. These bacterial species are almost exclusively found in birds. Their identification with biochemical methods is described and alternative molecular biological methods are discussed.
- Published
- 2011
22. [Necrotising inflammations of the lower extremities due to gastrointestinal perforations]
- Author
-
M, Schmelzle, G, Peterschulte, H, Matthaei, J, Schulte Am Esch, M, Peiper, A, Rehders, C F, Eisenberger, and W T, Knoefel
- Subjects
Adult ,Male ,Leg ,Sigmoid Diseases ,Middle Aged ,Diverticulitis, Colonic ,Sigmoid Neoplasms ,Debridement ,Intestinal Perforation ,Humans ,Psoas Abscess ,Female ,Fasciitis, Necrotizing ,Tomography, X-Ray Computed ,Enterococcus ,Escherichia coli Infections ,Gram-Positive Bacterial Infections - Published
- 2011
23. Untersuchungen zum Vorkommen von Methicillin-resistenten Staphylokokken (MRS) und Vancomycin-resistenten Enterokokken (VRE) in Putenmastbetrieben
- Author
-
Richter, Agnes
- Subjects
Staphylococcus ,turkey ,methicillin-resistant Staphylococcus aureus ,vancomycin-resistant enterococci ,Enterococcus ,antibiotics - Abstract
Ziel der vorliegenden Arbeit war es, das Vorkommen von Methicillin-resistenten Staphylokokken (MRS) und Vancomycin-resistenten Enterokokken (VRE) in Mastputenbeständen sowie bei Personen dieser Betriebe zu ermitteln. MRSA Für den Nachweis von Methicillin-resistenten Staphylokokken (MRS) wurden Kloaken- und Trachealtupferproben von insgesamt 200 Mastputen und Staubproben aus 20 Putenställen sowie Nasentupferproben von 59 Personen dieser Betriebe entnommen. Die Untersuchungen wurden gemäß den Vorgaben des Bundesinstituts für Risikobewertung (BfR) auf der Grundlage der Entscheidung der Kommission 2008/55/EG mit Hilfe einer Kombination aus nicht selektiver Voranreicherung, selektiver Anreicherung und anschließender Kultivierung auf einer selektiven, chromogenen Agarplatte durchgeführt (Anon, 2008a; BfR, 2009). Die Identifizierung von Gattung und Spezies wurde mittels Fourier-Transformations- Infrarotspektroskopie (FT-IR) und der Nachweis des mecA-Gens mittels Real-Time PCR durchgeführt. Anschließend wurden die mecA-Gen tragenden Isolate molekularbiologisch mittels spa- und SCCmec-Typisierung charakterisiert. Bei je einem Isolat jedes identifizierten spa-Typs wurde zusätzlich der MLST-Typ bestimmt. Nachgewiesen werden konnte MRSA bei 71,5% (143 von 200) der untersuchten Puten in insgesamt 90% (18 von 20) der Betriebe. Bei allen 18 positiven Betrieben ergab auch stets die Staubtupferprobe ein MRSA-positives Ergebnis. Somit kann eine Vereinfachung des Nachweises von MRSA-Keimen in Beständen bei Puten durch die Entnahme von Staubtupferproben mit ausreichender Sicherheit erreicht werden. Von den MRSA-positiven Tieren konnten 90,2% über eine alleinige Trachealtupferprobenentnahme als MRSA-positiv identifiziert werden. Dies ermöglicht beim Einzeltier den Nachweis von MRSA durch die ausschließliche Untersuchung einer Trachealtupferprobe. Zusätzlich zu MRSA- Keimen traten in elf Betrieben auch MRSASA (Methicillin-resistente Staphylokokken, ausgenommen S. aureus) auf. Diese Ergebnisse zeigen, dass die untersuchten Mastputen nicht nur erheblich mit MRSA, sondern auch - wenn auch deutlich geringer - mit MRSASA-Keimen belastet waren. Von den 59 mittels Nasentupferproben untersuchten Personen erwiesen sich 22 (37,3%) als Träger von MRSA und acht Personen (13,5%) als Träger von MRSASA. Betrachtet man den Nachweis von MRSA unter Berücksichtigung der Frequenz des Aufenthaltes in den Putenstallungen so war die Chance der Besiedlung mit MRSA bei Personen, die sich regelmäßig in Putenställen aufhielten, im Vergleich zu Personen, die sich nur selten oder nie in Putenställen aufheilten, deutlich erhöht (OR = 3,43). Bei den beprobten Personen konnten ausschließlich und bei den beprobten Puten überwiegend MRSA-Isolate isoliert werden, die dem Sequenztyp ST398 und damit den livestock-associated MRSA (laMRSA) zugeordnet werden. VRE Für den Nachweis von VRE-Keimen wurden Kloakentupferproben von 200 lebenden Puten und Staubtupferproben aus 20 Mastputenställen sowie von 59 Personen dieser Betriebe Nasentupferproben in diese Studie einbezogen. Der Nachweis der VRE- Keime wurde nach der von Ellerbroek et al. (2004) beschriebenen Methode durchgeführt, die ein Anreicherungsverfahren mittels Chromocult-Enterokokken- Bouillon mit anschließender Kultivierung auf einem mit Vancomycin supplementierten Selektivagar kombiniert. Die Identifizierung der Enterokokken erfolgte mit Hilfe biochemischer Parameter nach Angaben von Ruoff et al. (2003) und der Nachweis der vanA-, vanB1/2/3-, vanC1- und vanC2/3- Resistenzgene mittels Real-Time PCR. VRE-Keime konnten bei 27% (54 von 200) der untersuchten Puten in insgesamt 75% (15 von 20) der untersuchten Mastbetriebe nachgewiesen werden. Bei 93,3% der positiven Betriebe ergab die gepoolte Staubtupferprobe ein VRE-positives Ergebnis. Das Spektrum nachgewiesener VRE-Resistenzgene beschränkt sich in der vorliegenden Studie ausschließlich auf das vanA-Gen (17,6%, 12 von 68) und das vanC1-Gen (82,4%, 56 von 68). Nicht nachgewiesen werden konnten die in die Untersuchungen einbezogenen Resistenzgene vanB1/2/3 und vanC2/3. Obwohl zu einem hohen Anteil VRE-Keime in den Staubproben nachweisbar waren, konnten bei keiner der 59 beprobten Personen VRE-Keime in Nasentupferproben isoliert werden., The objective of the work presented here is to investigate presence of methicillin-resistant staphylococci (MRS) and vancomycin-resistant enterococci (VRE) in turkey flocks and personnel on the respective farms. MRSA For evidence of methicillin-resistant staphylococci (MRS), cloaca and trachea swab samples were taken from a total of 200 turkeys and dust samples from 20 turkey houses as well as swab samples from the noses of 59 personnel on the respective farms. The investigations were conducted according to Federal Institute for Risk Assessment (BfR) guidelines based on Commission Decision 2008/55/EG using a combination of non-selective pre-enrichment, selective enrichment and subsequent cultivation on a selective, chromogenic agar plate (Anon, 2008a; BfR, 2009). The identification of genus and species was by Fourier transformation infrared spectroscopy (FT-IR) and mecA gene detection via real-time PCR. In conclusion, the isolate carrying the mecA gene was molecularbiologically characterised via spa and SCCmec typing. In each isolate of every identified spa type the MLST type was additionally determined. MRSA could be detected in 71.5% (143 from 200) of the examined turkeys in a total of 90%(18 from 20) of the farms. In all 18 of the positive farms the dust swab samples always tested positive for MRSA. In this way testing for MRSA bacteria presence in turkey flocks can be simplified with sufficient reliability through collecting dust swab samples. 90.2% of the MRSApositive birds could be identified through a trachea swab sample alone. This enables identification of MRSA presence with individual birds through testing the trachea sample only. In addition to MRSA bacteria, MRS/SA (methicillin-resistant staphylococci, with exception of S. aureus) bacteria were also present on 11 of the farms. These results showed that the examined turkeys were not only substantially infected with MRSA bacteria but also – although to a clearly lesser extent – with MRS/SA bacteria. From the 59 personnel examined via nose swab sampling, 22 of them (37.3%) were shown to be MRSA carriers and eight (13.5%) to be carriers of MRS/SA. Looking at the detection of MRSA in the light of the frequency of stay in the turkey stables so was the chance of colonization with MRSA in people who were regularly in turkey stables clearly increased, compared to people, who were rarely or never in turkey stables (OR = 3.43). MRSA isolates belonging to the sequence type ST398 and, with that, the livestock-associated MRSA (laMRSA), were always isolated from the tested people and isolated in the majority of the cases from the tested turkeys. VRE For detecting VRE bacteria in this study, cloaca swab samples were taken from 200 living turkeys and dust swab samples from 20 turkey houses as well as nose swab samples from 59 humans. The detection of VRE bacteria was carried out using the method described by Ellerbroek et al. (2004). This combines an enrichment procedure using Chromocult® enteroccoci broth with subsequent cultivation of a selective agar supplemented with vancomycin. The identification of the enterococci took place with the help of biochemical parameters according to Ruoff et al. (2003) and real-time PCR was applied for identifying the vanA, vanB1/2/3 and vanC2/3 resistance genes. VRE bacteria could be identified in 27% (54 from 200) of the examined turkeys in total 75% (15 from 20) of the examined feeding farms. At 93.3% of the positive flocks was the pooled swab dust sample VRE-positive. The spectrum of detected VRE resistance genes was limited in the study presented here to only the vanA gene (17.6%, 12 from 68) and the vanC1 gene (82.4%, 56 from 68). The resistance genes vanB1/2/3 and vanC2/3 which were also tested for, could not be detected in the investigations. Although VRE bacteria could be detected in a high proportion of dust samples, VRE bacteria were not isolated from the nose swab samples from any of the 59 persons sampled.
- Published
- 2011
24. [Effectiveness and risks of isolation precautions in patients with MRSA and other multidrug-resistant bacteria]
- Author
-
M, Dettenkofer, S, Utzolino, D, Luft, and S, Lemmen
- Subjects
Methicillin-Resistant Staphylococcus aureus ,Critical Care ,Guidelines as Topic ,Vancomycin Resistance ,Staphylococcal Infections ,Universal Precautions ,beta-Lactam Resistance ,Patient Isolation ,Risk Factors ,Drug Resistance, Multiple, Bacterial ,Patients' Rooms ,Humans ,Mass Screening ,Contact Tracing ,Gram-Negative Bacterial Infections ,Enterococcus ,Gram-Positive Bacterial Infections ,Hand Disinfection - Abstract
The transmission of multidrug-resistant organisms (MRSA, VRE and ESBL producing bacteria) occurs predominantly if health-care workers are not compliant with hand hygiene procedures. The impact of single-room isolation in transmission prevention is often overestimated. As long as hand disinfection is not performed before and after patient contact and gloves are not removed, a single room will not prevent transmission by -itself. Understaffing is additionally worsening the situation. There is no consistent evidence sup-port-ing strict single-room isolation even though data show supportive tendencies. Social isolation is one of the risks that should be considered as well as the economic impact of using shared rooms as a single room. Up-to-date, evidence-based standard operating procedures and individual infection control recommendations should take these considerations into account. In general, contact precautions including isolation in a single room are performed in MRSA and VRE-positive patients. If a single room cannot be provided in a given case (a common problem in intensive care units), contact precautions can be performed in a shared room as an alternative. The problem of establishing an optimal compliance with standard precautions (especially hand hygiene) throughout all professional groups should be addressed. Additional precautions, including single-room isolation, should be implemented critically if indicated.
- Published
- 2010
25. [Infectious endocarditis]
- Author
-
D, Elsner and M, Doering
- Subjects
Cross Infection ,Pacemaker, Artificial ,Prosthesis-Related Infections ,Bacteremia ,Endocarditis, Bacterial ,Staphylococcal Infections ,Anti-Bacterial Agents ,Defibrillators, Implantable ,Survival Rate ,Echocardiography ,Drug Resistance, Multiple, Bacterial ,Heart Valve Prosthesis ,Streptococcal Infections ,Humans ,Device Removal ,Enterococcus - Published
- 2010
26. A case of enterococcal sepsis
- Author
-
P T, ECONOMOU
- Subjects
Bacteria ,Sepsis ,Humans ,Enterococcus - Published
- 2010
27. [Collateral damage of cephalosporins and quinolones and possibilities for control]
- Author
-
Fuat H, Saner, Ali, Canbay, Guido, Gerken, and Christoph E, Broelsch
- Subjects
Methicillin-Resistant Staphylococcus aureus ,Acinetobacter ,Clostridioides difficile ,Drug Resistance, Microbial ,Vancomycin Resistance ,Bacterial Infections ,Quinolones ,beta-Lactam Resistance ,beta-Lactamases ,Cephalosporins ,Klebsiella pneumoniae ,Delayed-Action Preparations ,Drug Resistance, Multiple, Bacterial ,Gram-Negative Bacteria ,Pseudomonas aeruginosa ,Humans ,Enterococcus - Abstract
The occurrence of multidrug-resistant microorganisms is associated with an extended and long-term use of broad-spectrum antibiotics. Indeed, this may lead to a colonization and even to an infection of the patient, which is called collateral damage. Moreover, the risk for collateral damage can be assessed for different antibiotic classes. OCCURRENCE OF MULTIDRUG-RESISTANT MICROORGANISMS: The use of cephalosporins may induce a subsequent infection with vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, beta-lactam-resistant Acinetobacter species, and Clostridium difficile. Quinolones are associated with a subsequent infection with methicillin-resistant Staphylococcus aureus and with increasing resistance in gram-negative bacilli, such as Pseudomonas aeruginosa.To avoid the occurrence of multidrug-resistant microorganisms, a strict indication and time-limited use (e.g., 1 week) of antibiotics are required, as already established in the guidelines for infection.
- Published
- 2007
28. [Implementation of the new EU Bathing Water Directive in Germany]
- Author
-
R, Szewzyk and A, Knobling
- Subjects
Europe ,Feces ,Water Supply ,Germany ,Escherichia coli ,Humans ,Guidelines as Topic ,European Union ,Public Health ,Reference Standards ,Water Microbiology ,Bathing Beaches ,Enterococcus - Abstract
A revised version of the Bathing Water Directive 76/160/EWG has been elaborated to include scientific progress in risk assessment of bathing-related illness. The new Bathing Water Directive 2006/7/EC came into force on March 24, 2006, and will have to be implemented in the federal states within two years. The new bathing water directive contains several positive innovations which will improve a protection of the bathers namely i) health related indicators, ii) uniform detection methods, iii) requirements for active bathing water management, and iv) stricter standards for coastal waters. In Germany, the 16 federal states of the Federal Republic of Germany - the Länder - are responsible for monitoring bathing waters and for implementing the new bathing water directive into national law. A common master directive is being written by a joint working-group to ensure comparable implementation in all parts of Germany. An immediate application of the new directive is not possible since the parameter "intestinal enterococci" is currently not routinely monitored. It was decided to start monitoring according to the new directive in Germany in 2008. This will allow the first classification of bathing waters according to the new directive in 2011.
- Published
- 2007
29. [Microbiological detection procedures according to Water Supply V 2001. List of alternative procedures according to 15 Abs. 1 Water Supply V 2001 --1. Notification of change: Notification of the Federal Environmental Department ]
- Subjects
Agar ,Bacteriological Techniques ,Bacteria ,Reference Values ,Water Supply ,Germany ,Humans ,Water Microbiology ,Environmental Health ,Enterococcus ,Culture Media - Published
- 2006
30. [V.A.C.-instill therapy in periprosthetic infection of hip and knee arthroplasty]
- Author
-
B, Lehner and L, Bernd
- Subjects
Male ,Postoperative Care ,Prosthesis-Related Infections ,Vacuum ,Occlusive Dressings ,Middle Aged ,Staphylococcal Infections ,Combined Modality Therapy ,Anti-Bacterial Agents ,Instillation, Drug ,Debridement ,Humans ,Female ,Hip Prosthesis ,Knee Prosthesis ,Therapeutic Irrigation ,Enterococcus ,Gram-Positive Bacterial Infections ,Aged - Abstract
Periprosthetic infection represents a main complication of arthroplasty. In case of an early infection the implant often can be left in place. Whether instillation of antiseptic solution using a reticulated sponge in combination with negative pressure wound therapy (V.A.C.-Instill) can be useful was the aim of our investigation. Up to now the instillation of Lavasept in combination with negative pressure wound therapy could be performed in three patients. In two cases an early infection of a hip prosthesis and one infected knee implant had to be treated. Following surgical debridement V.A.C.-Instill therapy was performed for 4-7 days followed by closure of the wound or a repeated application. Lavasept was used for irrigation. In all three cases retention of the primary implant could be achieved. The follow up now is 8 to 22 weeks. No recurrence of the infection occurred. After salvage of the prosthesis the joint allowed full load bearing and painfree mobilisation. The V.A.C.-Instill system proved to be easy to use. With this system early periprosthetic infection with antiseptic irrigation in combination with negative pressure wound therapy decreasing the bacterial burden, salvage of prosthesis seems to be possible. The therapy is applicable in hip and knee prosthesis. Final conclusions about this therapy however can be done only after a larger series of patients.
- Published
- 2006
31. [Multiplex PCR in the framework of an enterococci monitoring project]
- Author
-
Kiem, Mac and Lüppo, Ellerbroek
- Subjects
Base Sequence ,Magnesium Chloride ,Temperature ,Vancomycin Resistance ,Polymerase Chain Reaction ,Sensitivity and Specificity ,Bacterial Proteins ,Species Specificity ,Drug Resistance, Bacterial ,Humans ,False Positive Reactions ,Carbon-Oxygen Ligases ,False Negative Reactions ,Enterococcus ,Phylogeny ,DNA Primers - Abstract
A multiplex-PCR (MPCR) assay was optimised in the framework of an enterococci monitoring project in order to accelerate the previous time-consuming biochemical testing of enterococcal strains isolated from animal materials and food. The MPCR was optimised by variation of annealing temperature, MgCl2-concentration but more over by primer combinations and primer concentrations. Reference strains were used during the optimization. Afterwards 522 enterococcal field strains were examined by the MPCR. Ambiguous results occurred for 20 strains (17 with false-positive and 3 with false-negative results) which could be explained by the minor specificity ("EM"-primers) and sensitivity (ddlE.faecium-primers) respectively. Differences also existed between the genus-specific primers "E" and "Ent". The first mentioned primers showed weaknesses for the identification of enterococci whereas the use of the "Ent" primers inhibited other primers in the MPCR. However, the majority of the examined strains could be detected unambiguously, so that a differentiation of enterococcal isolates can be recommended by MPCR in contrast to the high time-, material- and work-consumption of conventional biochemical testings.
- Published
- 2003
32. [Infectious endocarditis]
- Author
-
B, Pilz, R, von Harsdorf, R, Dietz, and K J, Osterziel
- Subjects
Heart Valve Prosthesis Implantation ,Staphylococcus aureus ,Time Factors ,Substance-Related Disorders ,Streptococcus ,Endocarditis, Bacterial ,Prognosis ,Immunocompromised Host ,Blood ,Anti-Infective Agents ,Echocardiography ,Risk Factors ,Gram-Negative Bacteria ,Humans ,Drug Therapy, Combination ,Enterococcus ,Aged - Published
- 2003
33. [MRSA/MRSE-VISA/GISA/VRSA-PRP-VRE: current gram positive problem bacteria and mechanism of resistance, prevalence and clinical consequences]
- Author
-
Petra, Apfalter
- Subjects
Cross-Cultural Comparison ,Europe ,Staphylococcus aureus ,Streptococcus pneumoniae ,Gene Expression Regulation ,Penicillin Resistance ,Humans ,Methicillin Resistance ,Vancomycin Resistance ,Drug Resistance, Multiple ,Enterococcus - Abstract
The raising frequency of occurrence of multi-resistant Gram-positive pathogens has led to difficult to treat infections not only in hospitals but also in outpatient settings. Methicillin-resistant Staphylococcus aureus, the glycopeptide-susceptibility of which one cannot be sure of any more, vancomycin-resistant enterococci and penicillin-resistant pneumococci are on the top of the list of Gram-positive problem organisms nowadays. Clinical microbiology laboratories are faced with the challenge of accurately detecting emerging antibiotic resistance, which might be difficult and purpose of reporting data should be twofold: First to report adequately identified, relevant organisms as well as their susceptibility profiles to clinicians in context with adequate patient management and secondly to report continuously epidemiological data in form of statistics to the community in general and within a given setting as could be a specified hospital in particular. For reliable detection, laboratories may need to employ special screening- and susceptibility testing methods. Certain of these tests are highly specific, while others may require additional confirmatory testing for definite results. This article reports on current resistance mechanisms of gram-positive pathogens and subsequently resulting consequences for clinicians. Moreover, the frequency of occurrence in Austria in general as well as at the Vienna General Hospital in particular will be referred to.
- Published
- 2003
34. Antibiotikaresistenz von Enterokokken aus landwirtschaftlichen Nutztieren und Lebensmitteln tierischer Herkunft
- Author
-
Peters, Jan
- Subjects
Antibiotics ,Vancomycin ,Avoparcin ,Growth Promoters ,Antibacterial Agents ,Drug Resistance ,biochemical phenomena, metabolism, and nutrition ,Teicoplanin ,Virginiamycin ,Enterococcus - Abstract
Innerhalb der letzten Jahre ist eine Zunahme der Infektionen mit Enterococcus spp., insbesondere E. faecalis und E. faecium, in der Humanmedizin zu beobachten. Gleichzeitig kommen Resistenzen gegen wichtige Antibiotika bei dieser Bakteriengattung mit steigender Häufigkeit vor. Ein Zusammenhang mit dem Einsatz von Antibiotika in der Haltung landwirtschaftlicher Nutztiere wird diskutiert. Vor diesem Hintergrund sollte in dieser Dissertation das Resistenzverhalten von Enterokokkenstämmen untersucht werden, die von Rind und Schwein sowie aus von diesen Tierarten gewonnenen Lebensmitteln isoliert wurden. Als Lebensmittel wurden für die Untersuchung insbesondere Hackfleisch, Rohwurst, Schinken und Weichkäse ausgewählt, da in diesen ein Vorkommen von Enterokokken tierischen Ursprungs theoretisch möglich ist und diese zum Rohverzehr bestimmt sind. Bundesweit wurden 60 Rinderherden (Jungbullen und Kälber), 97 Schweineherden sowie 166 Lebensmittelproben untersucht. Daraus wurden 1257 Enterokokkenstämme isoliert und deren Spezies bestimmt. Zur Gattungsdiagnose wurden die Katalase- und Pyrrolidonylarylamidase-Aktivität sowie die Fähigkeit zum Wachstum in Gegenwart von 6,5% NaCl überprüft. Die Speziesdiagnose erfolgte anhand des Hämolyseverhaltens, der Pigmentproduktion, der Beweglichkeit, Fähigkeit zur Tetrazoliumreduktion, Vorhandensein der Arginindihydrolase und einer Reihe von Kohlenhydratspaltungstests. Von 569 ausgewählten Isolaten wurde das Resistenzverhalten gegenüber Penicillin, Ampicillin, Amoxicillin/Clavulansäure, Gentamicin, Tetrazyklin, Erythromycin, Tylosin, Vancomycin, Teicoplanin, Enrofloxacin, Quinupristin/Dalfopristin, Chloramphenicol, Bacitracin, Flavomycin und Avilamycin im Mikrodilutionsverfahren überprüft. Bei Stämmen mit einer MHK gegenüber Gentamicin von größer oder gleich 256 mg/l wurde im Etest-Verfahren das Vorkommen der Hochresistenz überprüft. Glykopeptidresistente Stämme wurden mit Hilfe der Polymerasekettenreaktion auf das Vorkommen der Resistenzgene vanA, vanB, vanC1 und vanC2 untersucht. Penicillinresistenz trat bei 11%, 31% und 4% der E. faecium-Isolate vom Rind, Schwein und aus Lebensmitteln auf. Ampicillin- und Amoxicillin/Clavulansäureresistenz kam bei 3% der E. faecium-Isolate vom Schwein vor. Mit Ausnahme eines E. durans/hirae-Stammes verhielten sich alle anderen Isolate gegenüber diesen ß-Laktam-Antibiotika sensibel. Gegenüber Gentamicin verhielten sich 2% der E. faecalis-Isolate vom Schwein und 1% der E. faecalis-Isolate aus Lebensmitteln hochresistent, darüber hinaus trat diese Resistenzform bei E. faecalis und E. faecium nicht auf. vanA-vermittelte Glykopeptidhochresistenz wurde bei 3 E. faecium Isolaten vom Schwein festgestellt, andere Stämme zeigten diese Resistenzform nicht. Quinupristin/Dalfopristin-Resistenz kam bei 56%, 57% und 23% der E. faecium- Isolate jeweils vom Rind, Schwein und Lebensmittel vor. Gegenüber Tetrazyklin lagen die Resistenzraten von E. faecalis und E. faecium zwischen 16% (E. faecalis vom Rind) und 37% (E. faecalis vom Schwein), gegenüber Erythromycin zwischen 6% (E. faecalis vom Rind) und 49% (E. faecium vom Schwein) und gegenüber Chloramphenicol zwischen 4% (E. faecium aus Lebensmitteln) und 22% (E. faecium vom Rind). Gegenüber Enrofloxacin verhielt sich E. faecalis (33% sensible Isolate beim Rind) empfindlicher als E. faecium (0% sensible Isolate beim Rind). Gegenüber den Leistungsförderern bewegten sich die Resistenzen zwischen 0% (E. faecium vom Rind gegen Tylosin) und 100% (E. faecium aus Lebensmitteln gegen Flavomycin). Rinder- und Schweinebestände scheinen als Reservoir für Enterokokken mit Resistenzen gegen die humanmedizinisch bei Enterokokkeninfektionen in erster Linie eingesetzten Antibiotika (Ampicillin, Gentamicin und die Glykopeptide) nur eine sehr untergeordnete Rolle zu spielen. Auch scheint die Gefahr für den Verbraucher, solcherart resistente Enterokokken über Lebensmittel aufzunehmen, gering. Demgegenüber sind die Resistenzraten gegenüber dem neuzugelassenen humanmedizinischen Therapeutikum Quinupristin/Dalfopristin sowohl in Rinder- und Schweinebeständen als auch in den Lebensmitteln bedenklich hoch, wobei die wahrscheinliche Ursache dafür durch das Verbot des Einsatzes von Virginiamycin beseitigt worden sein dürfte. Resistenzen gegenüber human- und veterinärmedizinisch wichtigen Antibiotika, die bei Enterokokkeninfektionen nicht das Mittel der ersten Wahl darstellen, wie beispielsweise Tetrazyklin und Erythromycin, traten zum Teil relativ häufig auf. Hier ist nicht auszuschließen, daß eine Übertragung auf andere Bakteriengattungen stattfinden kann. Darin liegt zwar möglicherweise eine Gefahr für den Verbraucher, andererseits erscheint der Einsatz einer gewissen Zahl wirksamer Antibiotika zu therapeutischen Zwecken auch bei lebensmittelliefernden Tieren unverzichtbar. Insgesamt kann das Risiko für den Verbraucher, über Lebensmittel Enterokokken aufzunehmen, die gegen die bei Enterokokkeninfektionen in erster Linie eingesetzten Antibiotika resistent sind, als gering eingeschätzt werden., The quantity of infections caused by enterococci, in particular E. faecalis and E. faecium, has been increasing in the field of human medicine within the last years. Resistances to important antimicrobial agents have been increasing in this genus simultaneously. A connection with the application of antimicrobial agents in livestock farming is supposed. The target of this study was to determine the resistance behaviour of strains of enterococci isolated from cattle, pigs and food made of these animal species. Minced meat, raw sausages, ham and soft cheese were chosen for the analysis in particular since these could contain enterococci of animal origin and are intended to be consumed uncooked. Sixty herds of cattle (young bulls and calves), ninety seven herds of pigs and one hundred and sixty-six food samples from different regions of Germany were investigated. 1257 strains of enterococci were isolated out of them and identified to the species level. The genus Enterococcus was confirmed using the catalase test, pyrrolidonylarylamidase test and testing for growth in BHI broth with 6.5% NaCl. The species was diagnosed by examining haemolysis behaviour, pigment production, motility, the ability to reduce tetrazolium, the presence of arginine dihydrolase and a series of hydrocarbonate splitting tests. The resistance of five hundred and sixty-nine selected strains was determined to penicillin, ampicillin, amoxicillin/clavulanic acid, gentamicin, tetracycline, erythromycin, tylosin, vancomycin, teicoplanin, enrofloxacin, quinupristin/dalfopristin, chloramphenicol, bacitracin, flavomycin and avilamycin using the microbroth dilution method. Strains possessing a mimimal inhibitory concentration (MIC) to gentamicin higher than or equal to 256 mg/l were checked for high-level resistance with the Etest method. Glycopeptide- resistant strains were tested for the resistance genes vanA, vanB, vanC1 and vanC2 using the polymerase chain reaction (PCR). Resistance to penicillin occured in 11%, 31% and 4% of the E. faecium strains isolated from cattle, pigs and food, respectively. Resistance to ampicillin and amoxicillin/clavulanic acid was found in 3% of the E. faecium isolates from pigs. The remaining strains (with the exception of one E. durans/hirae isolate) were susceptible to these beta-lactam antibiotics. High-level resistance to gentamicin was restricted to 2% of the E. faecalis strains isolated from pigs and 1% of the E. faecalis strains isolated from food. VanA- mediated high level resistance to glycopeptide antibiotics was found exclusively in three E. faecium strains isolated from pigs. Resistance to quinupristin/dalfopristin was observed in 56%, 57% and 23% of the E. faecium strains isolated from cattle, pigs and food, respectively. The resistance rates of E. faecalis and E. faecium to tetracycline ranged between 16% (E. faecalis isolated from cattle) and 37% (E. faecalis isolated from pigs), to erythromycin between 6% (E. faecalis isolated from cattle) and 49% (E. faecium isolated from pigs) and to chloramphenicol between 4% (E. faecium isolated from food) and 22% (E. faecium isolated from cattle). E. faecalis (33% susceptible strains isolated from cattle) was more susceptible to enrofloxacin than E. faecium (0% susceptible strains isolated from cattle). The resistances to the antimicrobial growth promoters ranged from 0% (E. faecium isolated from cattle to tylosin) to 100% (E. faecium isolated from food to flavomycin). Cattle and pigs seem to have only little importance as a reservoir of enterococci with resistances to ampicillin, gentamicin and the glycopepetide antibiotics, which are the agents of choice for the treatment of enterococcal infections in human medicine. The risk for the consumers to acquire such resistant enterococci via the food chain seems to be very small. Compared with this the resistance rate to the recently approved antimicrobial agent quinupristin/dalfopristin is rather high in E. faecium isolated from cattle, pigs and food. This problem is probably caused by the former use of the antimicrobial growth promoter virginiamycin in conventional animal fattening. Virginiamycin causes cross-resistances to quinupristin/dalfopristin in enterococci and has been banned in the EU since 1999. This ban is probably followed by a decrease of resistances to quinupristin/dalfopristin. Resistances to antimicrobial agents, which have importance in veterinary and human medicine but only a low significance in the treatment of enterococcal infections, e.g. tetracycline or erythromycin, were partly found quite frequently. A transfer of resistance genes to other genera of bacteria cannot be ruled out. This may imply a risk for the consumers, on the other hand the use of a certain quantity of antimicrobial active agents for the treatment of bacterial infections in farm animals seems to be indispensible. The risk for the consumers to acquire enterococci, which are resistant to the agents of choice for the treatment of enterococcal infections, via the food chain seems to be very small.
- Published
- 2003
35. Zum Vorkommen und zur Bedeutung antibiotikaresistenter Enterokokken im Bereich der Fleischgewinnung bei landwirtschaftlichen Nutztieren
- Author
-
Hultqvist, Linda
- Subjects
enterococcus ,drug resistance ,vancomycin ,virginiamycin ,growth promotors ,enterococcus faecium ,antibiotics - Abstract
Enterokokken erregten als Bakterien mit Multiantibiotikaresistenzen, speziell auch der Glykopeptidresistenz, in letzter Zeit Aufmerksamkeit und wurden als Indikatorkeime für Antibiotikaresistenzen eingestuft. Zur Zeit werden diese Eigenschaften in verschiedenen nationalen Resistenzmonitorings und Studien untersucht und überwacht. In dem Zeitraum von November 1998 bis Juli 1999 wurden insgesamt 81 Nutztiere (Masthähnchen, Mastschwein und Jungrinder) aus jeweils unterschiedlichen Beständen aus verschiedenen Gegenden Deutschlands untersucht. Aus den Darm- und Hautproben wurden insgesamt 499 Enterokokken isoliert. Diese wurden nach kulturmorphologischen, biochemischen und physikalischen Kriterien den verschiedenen Enterokokkenspezies zugeordnet. 463 Stýmme gehörten zu den mit der Studie zu erfassenden Spezies E. faecium, E. faecalis, E. hirae, E. durans, E. casseliflavus und E. gallinarum. Mittels der vorliegenden Studie konnte erstmals die Speziesverteilung der Enterokokken bei den verschiedenen Nutztierarten festgestellt werden: E. faecalis war bei Masthähnchen und Mastschwein die vorherrschende Enterokokkenspezies gefolgt von E. faecium. Bei Jungrindern stellte sich E. casseliflavus als vorherrschende Enterokokkenspezies heraus. Die isolierten Stýmme wurden auf ihr Resistenzverhalten gegenüber 23 verschiedenen Antibiotika überprüft. Diese untersuchten Substanzen besitzen ein gram-positives Wirkungsspektrum, werden oral angewandt und sind Testsubstanzen für Antibiotikaklassen. Es waren zum einen Antibiotika mit therapeutischer Bedeutung für die Veterinär- sowie Humanmedizin und zum anderen Antibiotika, die als Leistungsförderer in der Tiermast Bedeutung besitzen, in die Erhebung einbezogen. Die vorliegenden Untersuchungen lieferten neue oder genauere Erkenntnisse über das natürliche und erworbene Antibiotikaresistenzverhalten der einzelnen Enterokokkenspezies. So erwiesen sich die Enterokokken als natürlich tiamulinresistent. Für Avilamycin existieren bei den Enterokokken erworbene Resistenzen. Eine erworbene high- level Resistenz für Aminoglykoside liess sich bei den untersuchten Enterokokken nicht feststellen. Die E. hirae- und E. durans-Stämme zeigten sich als nicht natürlich monensinresistent, und die E. gallinarum- und E. casseliflavus-Stämme verhielten sich low-level natürlich virginiamycinresistent. Des weiteren wurde ein Überblick des Antibiotikaresistenzstatus für Enterokokken aus deutschen Nutztierbeständen gewonnen. Das Profil konnte aufgrund der gleichen angewandten Methodik mit vielen anderen Resistenzmonitorings verglichen werden und eignet sich für ein deutsches Monitoring als Grundlage. Einige E. faecium-Stämme besassen erhebliche Multiresistenzen, von den 23 untersuchten Antibiotika war bei einem Stamm nur noch eines wirksam. Das Vorkommen glykopeptidresistenter Enterokokken in der vorliegenden Studie liess sich mit früheren Resultaten der Studie von RICHTER (1999) vergleichen, wobei eine markante Abnahme des Vorkommens resistenter Keime nach dem Verbot des Glykopeptidleistungsförderers Avoparcin eintrat. Für die glykopeptidresistenten E. faecium- und E. durans-Stämme wurde ihr Verwandtschaftsgrad mittels Pulsfeldgelelektrophorese untersucht. Als verwandte Stämme erwiesen sich lediglich Stämme, die vom selben Tier isoliert wurden. Bisher konnten enge Verwandtschaften von Enterokokken mit Glykopeptidresistenz nur in Krankenhäusern nachgewiesen werden. Das Ziel der vorliegenden Studie bildete die Beantwortung der Frage, ob in gesunden deutschen Nutztieren, die zur Schlachtung gelangen, Enterokokken mit Antibiotikaresistenzen vorkommen. Diese Kontamination konnte leider eindeutig festgestellt werden., Lately enterococci have achieved a lot of attention as multi-antibiotic resistant bacteria - especially their glycopeptide-resistance - and have therefore been levelled as an indicating bacteria for determination of antibiotic-resistance. These characteristics are presently being researched and surveyed in different national resistance-monitorings and studies. During the time between November 98 and July 99 totally 81 domestic animals (broilers, pigs and calves) from different livestocks from numerous areas of Germany were researched. Totally 499 enterococci were isolated from intestinal and skin samples. These were levelled in accordance to the culturemorphologicigal, biochemical and physical criteria of the different species of enterocci. 463 strains belonged to one of the species E. faecium, E. faecalis,E. hirae, E. durans, E. casseliflavus and E. gallinarum which were all aimed in the study. The existing study determines the division of the different species of enterococci by the different domestic animals for the first time: E. faecalis was the dominant species of enterococci, followed by E. faecium. In regard to calves the E. casseliflavus turned out to be the dominant species of enterococci. The resistance of the isolated strains were researched against 23 different types of antibiotics. These researched substances have a gram- positive spectrum of influence, are orally applied and also test-substances for classes of antibiotics. It were on one hand antibiotics with therapeutical importance as well for the veterinary as for the human medicine, and on other hand antibiotics with importance as growth-promotors in animal breeding, which were included in the research. The present study delivered new and more accurate detections about the natural and obtained conduct of antibiotic-resistance of the single species of enterococci. Thus the enterococci shows to be naturally tiamulin-resistant. For avilamycin it exists obtained resistance among the enterococci. An obtained high-level resistance against aminoglycosides is not possible to determine among the monitored enterococci. The E. hirae- and E. durans-strains showed a non natural monensin-resistance and the E. gallinarum- and E. casseliflavus-strains behaved as low-level natural virginiamycin-resistant. Furthermore an overview over the status of antibiotic-resistance against enterococci by german livestock of domestic animals was obtained. Because the same applied method was used, the profile could be compared with many other resistance-monitorings and is suitable as a basis for a german monitoring. Some E. faecium-strain showed some significant multi-resistances; in one of the strains, only one out of the 23 monitored antibiotics were effective. The occurrence of glycopeptide-resistant enterococci in the existing study could well be compared with the earlier results of RICHTERs study (1999), were there was a significant decrease of the occurrence of resistant bacterias after the ban of the glycopeptide-growth-promotor avoparcin. The relationship between the glycopeptide-resistant E. faecium- and E. duransýstrains were researched with pulsfieldgelelectrophoresis. Only strains who were isolated from the same animals showed relationship between each other. Close relationship between enterococci with glycopeptide-resistance could so far only be determined in hospitals. The purpose with the present study established the answer of the question if there is any existence of enterococci with antibiotic-resistance in healthy german domestic animals send to slaughter. This contamination could unfortunately be univocally determined.
- Published
- 2003
36. [HYGEA (Hygiene in gastroenterology--endoscope reprocessing): Study on quality of reprocessing flexible endoscopes in hospitals and in the practice setting]
- Author
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L, Bader, G, Blumenstock, B, Birkner, O, Leiss, J, Heesemann, J F, Riemann, and H-K, Selbmann
- Subjects
Disinfection ,Endoscopes, Gastrointestinal ,Cross Infection ,Feces ,Enterobacteriaceae ,Quality Assurance, Health Care ,Germany ,Pseudomonas aeruginosa ,Colony Count, Microbial ,Escherichia coli ,Equipment Contamination ,Humans ,Enterococcus - Abstract
The quality of reprocessing gastroscopes, colonoscopes and duodenoscopes in daily routine of 25 endoscopy departments in hospitals and 30 doctors with their own practices was evaluated by microbiological testing in the HYGEA interventional study. In 2 test periods, endoscopes ready for use in patients were found contaminated at high rates (period 1: 49 % of 152 endoscopes; period 2: 39 % of 154 endoscopes). Culture of bacterial fecal flora (E. coli, coliform enterobacteriaceae, enterococci) was interpreted indicating failure of cleaning procedure and disinfection of endoscopes. Detection of Pseudomonas spp. (especially P. aeruginosa) and other non-fermenting rods - indicating microbially insufficient final rinsing and incomplete drying of the endoscope or a contaminated flushing equipment for the air/water-channel - pointed out endoscope recontamination during reprocessing or afterwards. Cause for complaint was found in more than 50 % of endoscopy facilities tested (period 2: 5 in hospitals, 25 practices). Reprocessing endoscopes in fully automatic chemo-thermally decontaminating washer-disinfectors with disinfection of final rinsing water led to much better results than manual or semi-automatic procedures (failure rate of endoscopy facilities in period 2 : 3 of 28 with fully automatic, 8 of 12 with manual, 9 of 15 with semi-automatic reprocessing). The study results give evidence for the following recommendations: 1. Manual brushing of all accessible endoscope channels has to be performed even before further automatic reprocessing; 2. For final endoscope rinsing, water or aqua dest. should only be used disinfected or sterile-filtered; 3. Endoscopes have to be dried thoroughly using compressed air prior to storage; 4. Bottle and tube for air/water-channel flushing have to be reprocessed daily by disinfection or sterilization, and in use, the bottle have to be filled exclusively with sterile water. The HYGEA study shows that microbiological testing of endoscopes is useful for detection of insufficient reprocessing and should be performed for quality assurance in doctors' practices, too. The study put recommendations for reprocessing procedures in more concrete terms.
- Published
- 2002
37. Phenylethylaminbildung durch Enterokokken isoliert aus Lebensmitteln tierischer Herkunft
- Author
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Walter, Doreen
- Subjects
Food Hygiene ,Biogenic Amines ,600 Technik, Medizin, angewandte Wissenschaften::630 Landwirtschaft::630 Landwirtschaft und verwandte Bereiche ,Phenethylamine ,Tyramine ,Enterococcus - Abstract
Titelblatt, Inhaltsverzeichnis, Lebenslauf 1\. Einleitung 2\. Literaturýbersicht 3\. Eigene Untersuchungen 4\. Diskussion und Schlussfolgerung 5\. Zusammenfassung / Summary 6\. Anhang Literaturverzeichnis, In dieser Dissertation wurde die Phenylethylaminbildung durch Enterokokken, isoliert aus Lebensmitteln untersucht., In this thesis I am talking about the phenethylamine formation by enterococci from food of animal origin.
- Published
- 2002
38. [Meaningful and meaningless hygienic measures in internal medicine]
- Author
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T, Hauer, G, Dziekan, H, Rüden, H E, Blum, and F, Daschner
- Subjects
Cross Infection ,Infection Control ,Legionellosis ,Drug Resistance, Microbial ,Hygiene ,Staphylococcal Infections ,Drug Resistance, Multiple ,Disinfection ,Immunocompromised Host ,Protective Clothing ,Internal Medicine ,Humans ,Tuberculosis ,Gloves, Protective ,Enterococcus ,Gram-Positive Bacterial Infections ,Hand Disinfection - Published
- 2001
39. [Food as a potential vector for antibiotic resistances. 2: Relevance of lactic acid bacteria]
- Author
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G, Klein
- Subjects
Lactobacillus ,Meat ,Food Microbiology ,Animals ,Humans ,Drug Resistance, Microbial ,Enterococcus - Abstract
Transfer of antibiotic resistances via the food chain is possible through the ingestion of resistant parts of the original food microflora. Lactic acid bacteria (especially glycopeptide resistant enterococci) are considered as important vectors because of their ability to transfer resistances by genetic mechanisms. Therefore a literature review and own investigations concerning the incidence and the resistance profile of enterococci from fresh meat were performed. The isolates harboured in part resistances relevant for human medicine. However, they could be isolated only sporadically and could not be demonstrated quantitatively in most cases. The resistance profile differed from those of human clinical origin. These results were confirmed by other authors. Additionally other investigators could prove molecular differences compared to clinical strains. Therefore food can only be considered as a vector if resistance transfer from food isolates to pathogenic microorganisms is possible. Such a transfer could be shown only in very low frequencies. In conclusion so far lactic acid bacteria cannot be considered as the main source for the incidence of antibiotic resistances in man.
- Published
- 2000
40. [Cryopreserved arterial homografts. A treatment alternative for infected vascular reconstructions]
- Author
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P U, Reber, E, Stauffer, B, Kipfer, and H W, Kniemeyer
- Subjects
Cryopreservation ,Male ,Prosthesis-Related Infections ,Angioplasty ,Arteries ,Staphylococcal Infections ,Humans ,Transplantation, Homologous ,Female ,Vascular Diseases ,Vascular Surgical Procedures ,Enterococcus ,Escherichia coli Infections ,Aged - Abstract
Deep wound infection or prosthetic vascular graft infection is one of the most challenging complications in vascular surgery with a substantial early and late morbidity and mortality. Surgical treatment usually consists of complete removal of infected vessels or prosthetic vascular grafts followed by extraanatomic bypass procedures. However, this method is associated with significant mortality and amputation rates. Herein, we report two patients with deep wound and prosthetic vascular graft infection who underwent successful in situ reconstruction with cryopreserved arterial homografts. Although the long-term results are missing, this approach may offer a possible treatment alternative for this potentially life-threatening complication.
- Published
- 1999
41. Isolation und Identifikation glykopeptidresistenter Enterokokkenspezies aus Mastgeflügel
- Author
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Richter, Petra
- Subjects
drug-resistance ,poultry ,glycopeptides ,Enterococcus - Abstract
In den letzten Jahren gewinnen einige Stämme der Gattung Enterococcus als fakultativ patho-gene Erreger in der Humanmedizin an Bedeutung. Während noch vor 10 Jahren Enterokokken nicht zu den nosokomialen Sepsiserregern zählten, werden sie heute bereits für ca. ein Fünftel der septischen Allgemeininfektionen verantwortlich gemacht. Dieser Anstieg begründet sich vor allem auf ihrer besonderen Fähigkeit, Resistenzen gegenüber antimikrobiell wirksame Substanzen auszubilden. Entsprechende Untersuchungen ergaben natürliche Resistenzen gegen Cephalosporine, Aminoglykoside, Polymyxine und Makrolidantibiotika sowie erworbene Empfindlichkeiten gegenüber Tetracyclinen, Chloramphenicol sowie Glykopeptiden und Chinolonen, wobei letztere nur mäßig ausgeprägt ist. Mit diesem Phänomen verbindet sich das aktuelle Versagen von Reserveantibiotika wie Vancomycin und Teicoplanin in der Intensiv-medizin. Die hohe Glykopeptidunempfindlichkeit wird durch die Präsenz des high-level Resistenzgens VanA gekennzeichnet. Diese high-level Resistenz wird mittels Transposonen übertragen. Sie äußert sich in einer durch Vancomycin und Teicoplanin induzierbaren Unempfindlichkeit mit einer MHK von >256 µg/ml. Ziel der Studie war es, Vorkommen und Empfindlichkeit Vancomycin-resistenter Entero-kokken (VRE) zu erfassen sowie Zusammenhänge zwischen Glykopeptidresistenzen und dem Einsatz von Avoparcin in der Tierproduktion aufzuzeigen. Das Glykopeptid Avoparcin wurde in der Tiermast als Leistungsförderer eingesetzt und weist eine dem Teicoplanin und Vancomycin ähnliche Struktur auf. Allerdings ist seit Januar 1996 diese Applikation gesetzlich unterbunden worden, da man die Entwicklung von Kreuzresistenzen und Resistenzpools fürchtete. Die untersuchten Proben stammten aus Geflügelmastbetrieben. Zur Klärung möglicher Zu-sammenhänge zwischen Avoparcinverfütterung und Resistenzverhalten wurden Betriebe zweier unterschiedlicher Haltungsformen ausgewählt: Einerseits konventionell, also potentiell mit dem Einsatz von Avoparcin (bis zu dessen Verbot) als Futtermittelzusatz arbeitende Großbetriebe und andererseits ökologisch, also unter dem Verzicht von Fütterungsarznei-mitteln produzierende Kleinbetriebe. Um ein möglichst breites Spektrum der Infektionskreise zu erfassen, wurden die Proben aus den Bereichen Stall, Schlachthof und Lebensmittelendprodukt gezogen. Es wurden insgesamt 223 Proben entnommen und 281 VRE-Stämme isoliert. Zunächst wurde von allen VRE-Stämmen nach kulturmorphologischen, biochemischen und serologischen Kriterien die Artzugehörigkeit bestimmt. Anschließend wurde die Glykopeptidempfindlichkeit im Mikrodilutionsverfahren geprüft. Bei 48, auf grund von Herkunft, Haltungsform und Resistenzverhalten ausgewählten Isolaten, wurde mittels PCR das VanA-Gen nachgewiesen. Von diesen Isolaten wurde eine horizontale Polyacrylamidgelelektrophorese durchgeführt, und die Gele durch eine Clusteranalyse mit dem Programm Gelcompar 3.1 ausgewertet. 60,1% der Gesamtproben erwiesen sich bei Anzüchtung auf einem mit 50 mg Vancomycin/l supplementierten CATC-Agar als VRE positiv. Bei den Proben kleinbäuerlicher Haltung fielen 30,5% VRE-positiv aus, hingegen 87,8% der Proben konventioneller Großbetriebe. Bei den VRE-Isolaten handelte es sich ausschließlich um E. faecium-Stämme mit einem high-level Resistenzverhalten. Das VanA-Gen wurde bei allen ausgewählten Isolaten nachgewiesen. Die Clusteranalyse zeigte eine Übereinstimmung der Proteinmuster von mehr als 90% und weist damit einen hohen verwandtschaftlichen Grad nach., In the field of human medicine in recent years, several strains of the enterococcus species have been gaining significance as facultative pathogenic agents. While as recently as 10 years ago enterococci did not figure as nosocomial septic agents, today they are held responsible for some fifth of all general septic infections. This rise is attributable above all to the special capability of these agents to develop resistance to substances with anti-microbial effects. Studies of these agents describe their natural powers of resistance to cephalosporins, aminoglycosides, polymyxins and macrolidantibiotics, acquired powers of resistance to tetracyclines, chloramphenicol and glycopeptides, and merely moderate sensitivity to chinolones. An associated effect in intensive medicine is the current failure of reserve antibiotics such as vancomycin and teicoplanin. This high degree of insensitivity to glycopeptides is characterized by the presence of the high-level resistance gene VanA. With transposones, this high- level resistance demonstrates a transferrable resistance with an MHK of more than 256 µg/ml; the same level of inducible resistance is achieved with vancomycin and teicoplanin. The target of the study was to demonstrate the incidence and resistance behaviour of vanycomycin-resistant enterococci (VRE), as well as the connections between powers of resistance to glycopeptide and the deployment of Avoparcin in livestock production. Avoparcin is likewise a glycopeptide; it was used in livestock breeding as performance booster and has a structural formula similar to that of Teicoplanine and Vancomycin. Since January 1996, however, the usage of Avoparcin has been outlawed due to the fact that it must be assumed that cross-over resistances can develop and lead to the creation of a resistance pool. The samples examined are derived from poultry-breeding operations. In order to investigate the potential links described above, enterprises with different operating forms were chosen. These were conventional poultry farms, on the one hand, i.e. large-scale operations which potentially deployed Avoparcin (until its prohibition) as feed additive, and on the other hand ecological operations, i.e. small-scale farms raising livestock without medicinal additives to fodder. To collect data on as wide a spectrum as possible, samples were taken from the following areas: poultry house, slaughterhouse, and carcass. 223 samples were taken from the various areas, and 281 VRE strains were isolated. Initially, the species was identified in line with culture- morphological, biochemical and serological criteria. Once this was done, the glycopeptide sensitivity was tested by means of the microdilution method. The VanA gene of selected isolates (n=48) was proven by means of PCR. The selection criteria were origin, form of livestock holding, and resistance behaviour. A horizontal polyacrylamide-gel electrophoresis was conducted on the basis of these isolates. The gels were analyzed with a cluster analysis furnished by the software progam Gelcompar 3.1. 60.1% of all samples proved to be VRE positive. Of this total, 87.8% of the samples originated from conventional large-scale operations, and 30.5% from small-scale farms. In the case of the VRE isolates, these were exclusively E.faecium strains with high-level resistance behaviour. The VanA gene was detected in all selected isolates. The cluster analysis showed an agreement of more than 90% in the protein samples, and thus proves a high degree of relationship.
- Published
- 1999
42. [Development of antibiotic resistance]
- Author
-
B, Bornkessel
- Subjects
Streptococcus pneumoniae ,Vancomycin ,Penicillin Resistance ,Gram-Negative Bacteria ,Humans ,Drug Resistance, Microbial ,Bacterial Infections ,Enterococcus ,beta-Lactam Resistance - Published
- 1998
43. [How great is the potential danger from vancomycin-resistant enterococci?]
- Author
-
W, Witte
- Subjects
Vancomycin ,Humans ,Drug Resistance, Microbial ,Enterococcus ,Gram-Positive Bacterial Infections ,Anti-Bacterial Agents - Published
- 1998
44. [Bacterial endocarditis and prevention of endocarditis. 1: Bacterial endocarditis]
- Author
-
M, Markreiter and R, von Essen
- Subjects
Streptococcal Infections ,Humans ,Endocarditis, Bacterial ,Staphylococcal Infections ,Heart Valves ,Enterococcus ,Gram-Positive Bacterial Infections - Published
- 1997
45. [Vancomycin resistant enterococci in Austria]
- Author
-
Franz Allerberger, Lass-Flörl C, Mp, Dierich, Am, Hirschl, Presterl E, Haas G, Klare I, and Witte W
- Subjects
Adult ,Male ,Cross Infection ,Adolescent ,Genotype ,Enterococcus faecium ,Administration, Oral ,Drug Resistance, Microbial ,Microbial Sensitivity Tests ,Antibiotic Prophylaxis ,Middle Aged ,Polymerase Chain Reaction ,Anti-Bacterial Agents ,Intensive Care Units ,Phenotype ,Vancomycin ,Austria ,Child, Preschool ,Enterococcus faecalis ,Humans ,Female ,Child ,Enterococcus ,Gram-Positive Bacterial Infections ,Aged - Abstract
This study reports pheno- and genotypical analysis of 9 isolates of vancomycin-resistant enterococci (VRE) and 5 vancomycin-sensitive enterococci (VSE) in Austria: 5 E, faecium isolates of 4 patients (the sole patients demonstrating VRE at the University Hospital of Innsbruck in 1994 and 1995), 3 glycopeptide-sensitive isolates collected in Innsbruck in February 1996 for epidemiological analysis, and 6 enterococcus isolates from the University Hospitals of Vienna and Graz. The pheno- and genotypical analyses of all glycopeptide highly resistant E. faecium and E. faecalis isolates indicated the presence of VanA type resistance. One E. casseliflavus strain with intrinsic VanC-1 resistance showed a characteristic constitutive low-level resistance to vancomycin and susceptibility to teicoplanin. Genotyping with macro-restriction analysis demonstrated that 3 VRE isolates of the 5 E. faecium specimens were identical; the same applied to 2 VSE isolates. The two patients with VRE had been cared for at the same time in a surgical ICU and likewise, the two patients with VSE were simultaneously treated at a neurological ICU. The genotyping of E. faecalis strains showed that two strains of the three VRE isolates exhibited identical patterns. Epidemiological investigation did not reveal a mode of transmission for this cluster. Two of the 8 patients with VRE died within 60 days after isolation of the bacteria; the doctors in charge did not consider that the enterococci had been the cause of death. The results of our study indicate that oral vancomycin administration to humans is a primary cause of VRE in Austrian hospitals. In Austria approximately 66 kg vancomycin, 20% of it given orally, are administered to patients per year. Approx. 18-20 tons Avotan (active ingredient Avoparcin-10%)/year were used in Austria; as of April 1, 1997 the use of this animal foodstuff supplement is prohibited by the European Commission.
- Published
- 1997
46. [Federal investigations on the distribution and in vitro resistance of udder pathogenic bacteria in the milk of cows with subclinical mastitis]
- Author
-
A, Sobiraj, A, Kron, U, Schollmeyer, and K, Failing
- Subjects
Staphylococcus aureus ,Mammary Glands, Animal ,Milk ,Bacteria ,Geography ,Germany ,Animals ,Streptococcus ,Cattle ,Female ,Microbial Sensitivity Tests ,Mastitis, Bovine ,Enterococcus - Abstract
1644 quarter milk samples of 948 dairy cows with subclinical mastitis, collected from 63 veterinary practices all over Germany origined by 262 livestocks with problems in udder health were examined semiquantitatively by "Aulendorfer Mastitistest" for cell count and additionally bacteriologically. Potentially udder pathogenic bacteria were tested for in vitro-sensitivity to penicillin G, ampicillin, oxacillin, cefacetril, tylosin, neomycin, gentamicin, polymyxin B and enrofloxacin. 24.5% of all tested milk samples were bacteriologically negative. In 35.3% of the bacteriological positive milk samples Staphylococcus (S) aureus was detected. Enterococci, Streptococcus (Sc.) uberis, Sc. dysgalactiae and Sc. agalactiae were found in 8.9%, 8.2%, 8.1% and 4.9% of all positive milk samples, respectively. G-streptococci were found only occasionally. Apathogenic bacteria like coagulase-negative staphylococci, micrococci, aerobic bacilli and coryneforms were detected in 45.0% of all positive milk samples. Enterobacteriaceae (E. coli, klebsiella spp., proteus spp. and other coliforms) were isolated in 3.3% of all cases and should be considered as insignificant for the subclinical mastitis of dairy cows in Germany. Against S. aureus cefacetril and oxacillin were mostly effective in vitro, whereas penicillin G was ineffective because 40% of these bacteria are penicillinase-positive. Streptococci and enterococci were mostly sensitive to cefacetril, oxacillin, penicillin G and ampicillin. Concerning the distribution of bacteria regional differences were recognized. Regional differences concerning in vitro-sensitivity were negligible. The results are discussed.
- Published
- 1997
47. [Aminoglycosides in the treatment of infectious endocarditis]
- Author
-
R, Malinverni
- Subjects
Aminoglycosides ,Heart Valve Prosthesis ,Penicillin Resistance ,Streptococcal Infections ,Humans ,Streptococcus ,Drug Therapy, Combination ,Penicillin G ,Endocarditis, Bacterial ,Penicillins ,Staphylococcal Infections ,Enterococcus ,Anti-Bacterial Agents - Abstract
The role of aminoglycosides in the treatment of infective endocarditis is well established. The combination of a beta-lactam with an aminoglycoside shortens the treatment of endocarditis due to penicillin-sensitive streptococci (MICor = 0.1 micrograms/mL) when compared to beta-lactams alone. Patients at higher risk (e.g. with prosthetic valves, clinical duration of symptoms3 months) should be treated with penicillin for 4 weeks in combination with an aminoglycoside for 2 weeks. Once-daily dosing (ODD) of aminoglycosides can be recommended in penicillin-sensitive streptococcal endocarditis. The treatment of endocarditis due to streptococci relatively and/or highly resistant to penicillin requires combined treatment with penicillin plus an aminoglycoside for a longer duration. At present ODD of aminoglycosides cannot be recommended. Enterococcal endocarditis requires combined treatment for 4 to 6 weeks. Based upon experimental data, ODD of aminoglycosides appears to be markedly inferior to q 8 h dosing. Enterococcal isolates should be screened for high-level resistance to streptomycin and gentamicin. Gentamicin is the preferred agent if susceptibility testing is not performed. Aminoglycosides are administered during the initial 3 to 5 days of treatment for staphylococcal endocarditis on native valves in order to shorten the duration of bacteremia. For staphylococcal prosthetic valve endocarditis, aminoglycosides are administered for the initial 2 weeks of treatment. However, there are no reliable clinical data for methicillin-susceptible isolates to support this recommendation. In prosthetic valve endocarditis due to coagulase-negative staphylococci combination with an aminoglycoside appears to suppress the emergence of rifampin-resistant variants during treatment. There are no data on ODD of aminoglycosides in staphylococcal endocarditis. Right-sided staphylococcal endocarditis due to methicillin-susceptible staphylococci is adequately treated with a two-week course of a beta-lactam plus an aminoglycoside. This short regimen can be recommended for low risk patients, e.g. those without significant heart failure and vegetations2 cm3 and with an aminoglycoside-susceptible isolate.
- Published
- 1996
48. [Microbial sensitivity spectrum of framycetin. Comparison with the 1972 to 1993 resistance status]
- Author
-
H, Knothe and W, Hauke
- Subjects
Cross Infection ,Dose-Response Relationship, Drug ,Staphylococcus ,Pseudomonas aeruginosa ,Humans ,Streptococcus ,Bacterial Infections ,Microbial Sensitivity Tests ,Enterococcus ,Framycetin - Abstract
Framycetin was tested against a variety of isolates of grampositive and gramnegative bacteria. The in-vitro activity of Framycetin against Staphylococcus aureus, Enterobacteriaceae, Pseudomonas aeruginosa as well as Pseudomonas fluorescens is today still favourable.
- Published
- 1995
49. [The peripartum disease complex of the sow in industrial swine breeds. 1. Peripartum course of bacteriuria of sows with vaginal-vulvar discharge in a modern swine breeding facility]
- Author
-
G, Bilkei, A, Bölcskei, E, Clavadetscher, T, Goos, C, Hofmann, H, Bilkei, and O, Szenci
- Subjects
Swine Diseases ,Bacteriuria ,Pregnancy ,Swine ,Animals ,Puerperal Infection ,Female ,Pregnancy Complications, Infectious ,Enterococcus ,Escherichia coli Infections ,Gram-Positive Bacterial Infections - Abstract
In an industrial pig production unit ten sows were selected at random. All the sows had puerperal disease in their anamnesis and all of them revealed at the time of selection--during their late pregnancy--Urinary Tract Infection (UT)I and vaginal-vulvar discharge (VD). Mid-stream early morning urine samples were collected during four days ante partum and during four days post partum. The samples were semiquantitatively examined for E. coli and gram positive cocci. Three sows showed ante partum non significant bacteriuria which turned into significant bacteriuria post partum. The majority of the reminding sows revealed a significant bacteriuria during the whole period of examination.
- Published
- 1994
50. [Antibiotic therapy of infectious endocarditis (when, with what drug, how long?]
- Author
-
G, Schuler
- Subjects
Postoperative Complications ,Dose-Response Relationship, Drug ,Heart Valve Prosthesis ,Streptococcal Infections ,Humans ,Endocarditis, Bacterial ,Microbial Sensitivity Tests ,Staphylococcal Infections ,Drug Administration Schedule ,Enterococcus ,Gram-Positive Bacterial Infections ,Anti-Bacterial Agents - Abstract
The aim of antibiotic therapy in bacterial endocarditis is to sterilize infected cardiac structures and vegetations. Pathogenic organisms are present in great numbers within vegetations and abscess-formations. They exist in a state of reduced metabolic activity so that they are able to tolerate even therapeutic levels of bactericidal antibiotic concentrations. Because vegetations are normally devoid of blood vessels, impregnation with antibiotic agents is poor. Effective therapy is greatly improved by identification of the pathogenic organism involved. With very few exceptions isolation is possible prior to initiation of antibiotic therapy. In acute cases with signs of septicemia, however, therapy cannot await results of bacterial testing. In these patients selection of antibiotic agents is based on associated evidence such as the presence of a prosthetic heart valve or intravenous drug addiction. Once the pathogen has been identified antibacterial therapy should be tailored according to the test results. Bactericidal antibiotics should always be preferred over bacteriostatic agents; in many cases adequate bactericidal levels can only be achieved by combining various agents, such as ampicillin and gentamycin for treatment of enterococcal endocarditis. Dosing intervals must take into account the resulting trough levels, which should always exceed the minimal inhibitory concentrations for a specific bacterial strain. In cases with inadequate control of infection, congestive heart failure resulting from valve dysfunction, and abscess formation, surgery as the only means of eradicating the infection and restoring cardiac performance should not be delayed.
- Published
- 1994
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