Direct detection of methicillin resistance in Staphylococcus aureus in blood culture broth by use of a penicillin binding protein 2a latex agglutination test.

We studied the utility of performing a penicillin binding protein 2a latex agglutination (PBP-LA) assay directly on Bactec blood culture broth samples containing Staphylococcus aureus to rapidly detect methicillin resistance. The sensitivity, specificity, positive predictive value, and negative predictive value of this method were 94.1%, 97.5%, 98%, and 92.9%, respectively.

Outbreak of CTX-M-3-type extended-spectrum beta-lactamase-producing Enterobacter cloacae in a pediatric ward.

A first resistant strain of Enterobacter cloacae was isolated from a blood specimen in a pediatric patient with immature teratoma-developed sepsis after combination chemotherapy. The strain produced extended-spectrum beta-lactamase (ESBL), and the same ESBL-producing strains were detected in urine samples from other patients in the pediatric ward. All strains harbored genes for bla (CTX-M-3) by polymerase chain reaction (PCR) and sequencing analysis. Analysis of pulsed-field gel electrophoresis revealed that all strains were the same clonal type. These results suggest that ESBL-producing strains might be transmitted in the ward via contact among patients or medical staff.

[A case of Mycobacterium goodii infection wifh isolation from blood and a pacemaker lead].

We report a case of blood stream infection due to Mycobacterium goodii in a patient who had an implanting pacemaker. The patient injured left thorax where the pacemaker was implanted several days before septicemia. The microorganism was isolated from both blood cultures and leads of the pacemaker. The serial isolates were identified as M. goodii by conventional biochemical methods, tobramycin susceptibility test and 16Sr-RNA sequencing. This is the first reported case of M. goodii septicemia in Japan. M. goodii is regarded as an environmental bacterium and its pathogenicity has been recognized recently. The present case suggests that its ability as a primary invader should not be underestimated, especially in a patient with indwelling devices.

[Norwalk virus and Noro virus].

Norwalk virus and Noro virus are members of the Caliciviridae. These viruses are morphological similarity in each other and shows small round structure. These viruses also are well known as main pathogens of acute infectious gastroenteritis. Clinical features include an incubation period of 24 of 48 hours and illness period of 18 to 72 hours with vomiting and diarrhea in most patients and high secondary attack rates. Oral transmitted infection occurs contaminated water and foods. In our country, outbreak of Noro virus-related gastroenteritis are reported sometimes in hospital and nursing home from winter to early spring seasons. This article are described to the morphlogy, physical characteristics, epidemiology, and clinical manifestation relating to Norwalk virus and Noro virus.

[Mycoses].

Antifungal susceptibility testing has developed rapidly during the last decade. Through the intensive collaborative work, the National Committee for Clinical Laboratory Standards (NCCLS) has published a standardized antifungal susceptibility method M27-A which included interpretive guidelines for 3 antifungal agents. Meaningful large-scale, longitudinal studies of antifungal susceptibility and resistance, based on standardized methodology and interpretive guidelines, have been published and serve as the basis for analysis of resistance trends. Resistant isolates have been further characterized using molecular biological techniques. Candida albicans and related species become resistant to antifungal agents, in particular triazoles, by expression of efflux pomps that reduce drug accumulation, alteration of the structure or concentration of antifungal target enzymes, and alteration of membrane sterol composition. On the other hand, there are several ongoing problems in antifungal susceptibility testing such as trailing phenomenon, ability to detect amphotericin B resistance, and application for other fungal pathogens. In this paper, we review studies which focused on the reliability of antifungal susceptibility testing, epidemiology of resistant isolates, and resistant mechanisms. Furthermore, we provide several recommendations for antifungal susceptibility testing in the clinical laboratory.

[Diagnosed tuberculosis using specific DNA probe hybridization methods].

In Japan, reported cases of tuberculosis had declined nearly every year until 1995. However, in 1997 newly recorded cases began increasing for the first time in more than 38 years. Recent studies using DNA fingerprinting show that person- to person transmission may account for as many as one-third of new cases of tuberculosis in citizen populations. Nucleic acid hybridization methods using specific DNA probes can specifically identify M. tuberculosis and other mycobacterial species. Rapid nucleic acid amplification techniques such as polymerase chain reaction methods allow direct identification of M. tuberculosis in clinical specimens. Is 6110 has been exploited extensively as a clonal marker in molecular epidemiology studies of tuberculosis. The emergence of resistance to antituberculosis drugs is a relevant matter worldwide. A recent genotypic method allows earlier detection of RFP-resistant and INH-resistant stains using probes for mutation in rpoB and in katG.