Activity of telithromycin and seven other agents against 1034 pediatric Streptococcus pneumoniae isolates from ten central and eastern European centers.

OBJECTIVE: To test the activity of telithromycin against 1034 Streptococcus pneumoniae isolates from pediatric patients in ten centers from ten central and eastern European countries during 2000-2001, and to compare it with the activities of erythromycin A, azithromycin, clarithromycin, clindamycin, and quinupristin-dalfopristin. METHODS: The minimum inhibitory concentrations (MICs) of telithromycin, erythromycin A, azithromycin, clarithromycin, clindamycin, levofloxacin, quinupristin-dalfopristin and penicillin G were tested by the agar dilution method with incubation in air, and mechanisms of resistance to macrolides and quinolones were investigated. RESULTS: Strains were isolated from sputum, tracheal aspirates, ear, eye, blood, and cerebrospinal fluid. Among S. pneumoniae strains tested, 36% had raised penicillin G MICs (>/= 0.12 mg/L). Susceptibilities were as follows: telithromycin, quinupristin-dalfopristin and levofloxacin, >/= 99%; clindamycin, 83%; and erythromycin A, azithromycin and clarithromycin, 78%. Of 230 (22.3%) erythromycin A-resistant S. pneumoniae strains, 176 (79.6%) had erm(B), 38 (16.1%) had mef(A), and 10 (4.3%) had mutations in 23S ribosomal RNA or in ribosomal protein L4. The rates of drug-resistant S. pneumoniae are high in all centers except Kaunas, Riga, and Prague. CONCLUSION: Telithromycin had low MICs against all strains, irrespective of macrolide, azalide or clindamycin resistance. Ribosomal methylation was the most prevalent resistance mechanism among all resistant strains, except in Sofia, where the prevalence of the efflux mechanism was higher.

Activity of telithromycin compared with seven other agents against 1039 Streptococcus pyogenes pediatric isolates from ten centers in central and eastern Europe.

In total, 1039 pediatric Streptococcus pyogenes isolates from Bulgaria, Croatia, the Czech Republic, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia were studied. All strains were susceptible to penicillin G, levofloxacin, and quinupristin-dalfopristin, 91-100% to telithromycin, and 82-100% to erythromycin, azithromycin, and clarithromycin, and 90-100% to clindamycin. Macrolide resistance occurred mainly in Slovakia (25%), the Czech Republic (17.3%), and Croatia (15.8%). Overall, 9.7% of S. pyogenes isolates were erythromycin resistant due to erm(B)- or erm(A)-encoded methylases (72.3%) or to a mef(A)-encoded efflux pump (25.7%). One strain had alterations of both 23S rRNA (A2058G Escherichia coli numbering) and ribosomal protein L22 (G95D).

Resistance of some selected pathogens to antimicrobials in Hungary.

Bacterial resistance is an increasingly severe problem in Hungary. According to the data from Péterfy Teaching Hospital, Budapest and from the country-wide network of Public Health Laboratories, penicillin resistant pneumococci, multiresistant Enterobacteriaceae and Pseudomonas aeruginosa are of major concern. Over 30% of pneumococci are penicillin resistant. The proportion of methicillin resistant Staphylococcus aureus is relatively low nation-wide (6.2%) but at Péterfy hospital it is higher (30%). The rate of resistance of Pseudomonas aeruginosa against gentamicin, tobramycin is about 30-40%, while that against amikacin (11%) ceftazidime (11.9%) and imipenem (5%) remained low. The resistance of Pseudomonas aeruginosa against ciprofloxacin is rapidly increasing, exceeding 50% in some hospital departments. The high bacterial resistance appears to be the consequence of the unconsidered use of antibiotics and poor infection control in hospitals.

[Comparative study of meropenem and amikacin/metronidazole combination in the treatment of severe abdominal surgical infections]. / A meropenem és az amikacin/metronidazol kombináció összehasonlító vizsgálata súlyos, sebészeti hasi fertözések kezelésében.

The authors compared in a prospective, randomized study the efficacy of amikacin/metronidazole combination and meropenem monotherapy in serious, intra-abdominal infections needing surgical treatment. There were 31 evaluable patients. Fifteen patients were involved to the meropenem and 16 to the combination group. The average age were 46 years in the meropenem group and 50 in the other one, the APACHE II score was similar (12.9 and 12.5). Among the examined parameters, only the white blood cell number decrease showed significant difference between the study groups. In the meropenem group 5.05 x 10(9), while in the comparator group 3.57 x 10(9) (p < 0.01). At the end of the study period, the infection was cured in the case of 11 patients in the meropenem and 9 patients in the control-group. At the end of the treatment the average APACHE II score decreased to 7.6 and to 9.6 points respectively. Clinically both therapies proved to be effective and well tolerated but the microbiological assessment revealed that meropenem tended to cover all pathogens of the mostly polymicrobial infections (12 cases, 43%) more frequently, than amikacin/metronidazole combination (9 cases, 33%). The Gram negative bacteria showed sensitivity to both meropenem and amikacin, but their majority were inhibited by meropenem at a concentration 1 or 2 orders of magnitude lower, than by amikacin. The therapeutic dose of meropenem is not toxic; therefore, it can be safely administered in poor general condition, frequently with renal impairment. We did not observed serious adverse event during the study period.

First isolation of Clostridium difficile PCR ribotype 027 from a patient with severe persistent diarrhoea in Hungary.

A recent Supplement to Clinical Microbiology and Infection entitled 'Infection control measures to limit the spread of C. difficile' pointed out that the incidence of C. difficile-associated diarrhoea (CDAD) has been increasing worldwide, and stressed the importance of research in the fields of epidemiology and infection control [1]. Since 2003, one of the main causes of the increasing prevalence of CDAD has been claimed to be the emergence of PCR ribotype 027/NAP1, which has caused epidemics in North America, the UK, the Netherlands, Belgium and France. The presence of PCR ribotype 027 in Austria, Japan, Ireland, Germany and Switzerland has also been reported recently [2,3]. The majority of publications have emphasized that the presence of this strain is usually associated with more severe symptoms and signs than those associated with the other more common toxin-positive strains [4,5]. Whereas PCR ribotype 027 was present in the population earlier, the majority of the historic strains were fluoroquinolone sensitive [6]. The overuse of antibiotics such as fluoroquinolones may lead to the selection and emergence of resistant strains, and may contribute to the spread of PCR ribotype 027, which is usually resistant to erythromycin. Here, the Eastern European spread of C. difficile PCR ribotype 027 is reported.

Characterization of multiply resistant Proteus mirabilis isolates in Hungary.

According to a survey on tendencies of antibiotic resistance in Hungary (1974-1983), the emergence of multiresistant (MR) Proteus mirabilis isolates is a new phenomenon. A total of 60 strains resistant to 11-16 antibiotics were collected from various specimens and geographical locations. Except for cefoperazone, third generation cephalosporins, amikacin, netilmicin and ofloxacin were effective in vitro against multiply resistant P. mirabilis isolates. Out of them 62% belonged to O18, a serogroup not shown in early studies in Hungary; moreover, in serogroup-distribution the present collection differed sharply from isolates examined in 1956. All but two strains produced the same aminoglycoside-modifying enzyme ANT (2"), and all of them proved beta-lactamase positive in nitrocephin test. All multiresistant strains harboured 2-4 plasmids, whereas the sensitive isolates had no plasmids. The presence of two plasmids (62 and 22 Mdal) occurring in 85% of the isolates was a characteristic feature of the multiresistant P. mirabilis isolates. In contrast to these plasmids some other ones (17.5, 103 and 113 Mdal) could be transferred to Escherichia coli recipient. There was no relationship between plasmid profiles, serogroups and resistance patterns.

Immunoserology of Pseudomonas aeruginosa infections in man. II. effect of natural and immune anti-LPS antibodies on pseudomonas colonization and infection.

In 39 acute patients of a respiratory unit a comparatively high Pseudomonas aeruginosa anti-lipopolysaccharide antibody level present on admission prevented colonization by the homologous pseudomonas serogroup. At lower natural antibody titres symptomless colonization occurred, and in patients with the lowest initial titres, later P. aeruginosa complications developed. A low antibody level also predisposed to pseudomonas infection in 9 chronic patients. When colonization occurred at high antibody titres, the presence of P. aeruginosa was only transient; however, the titre had no effect on the further duration of harbouring P. aeruginosa. Anti-LPS antibodies may play an important role not only in the outcome of pseudomonas infection, but also in other respects of pseudomonas-man interaction.

Immunoserology of Pseudomonas aeruginosa infections in man. I. Four types of interaction between host and bacterium.

Continuous survey of clinical symptoms, bacteriological findings and anti-LPS antibodies in 39 acute and 9 chronic patients at a respiratory department revealed four interaction-types between Pseudomonas aeruginosa and host: I, clinical complications with a serological response; II, the same without serological answer; III, rise of specific antibodies without clinical symptoms; and IV, no clinical or serological reaction despite the presence of P. aeruginosa. Exogenous factors like massiveness or mode of infection (e.g. instrumental) determined mainly the type of interaction in the absence of immune-antibodies. P. aeruginosa colonization longer than a few days turned generally into manifest or subclinical infection. The lack of antibody production in severe infection was likely a consequence of an immune-paralysis, elicited by a massive infection. Antibody production was lower in subclinical than in manifest infection, yet IgG-type antibodies increased not only in the latter, but always in the former, too.

Immunoserology of Pseudomonas aeruginosa infections in man. III. Site of infection, duration of the presence of Pseudomonas aeruginosa and antibody response.

In 39 patients of a respiratory intensive care unit the intensity of the serological response to the purified LPS of the causative Pseudomonas aeruginosa was found to change according to the site of infection. The highest titres were found in septic cases, when the antigenic assault reached all the immune-competent cells in the body. Short presence (only one positive bacteriological culture) of P. aeruginosa at the site of inflammation resulted in a low or moderate rise in antibody titre. Ten days were enough for the development of a maximum total antibody (approximately IgM) response, while IgG type antibodies moderately grew further when the presence of P. aeruginosa lasted more than 10 days. Only a 16-fold increase in total antibodies per se or a 4-fold rise in both total (approximately IgM) and IgG antibodies confirmed the pseudomonas infection.

Is seminal fluid a suitable specimen for detecting chlamydial infection in men?

As genital chlamydia infection is considered the most prevalent sexually transmitted bacterial disease worldwide, its correct diagnosis has a great clinical and epidemiological importance. Urethra is the recommended site for collecting specimen for detection of Chlamydia trachomatis in men, but urethral swabbing is very inconvenient for the patients. Testing of seminal fluid has two advantages: taking the sample is more convenient for the patient, and the ejaculate would provide more information on the possible infection of the upper genital tract. Three non-culture methods-enzyme immunoassay (EIA), DNA hybridization, and polymerase chain reaction (PCR)-were used for evaluation of suitability of seminal fluid as a sample for detection of Chlamydia in 4 patient groups comprising 259 symptomatic and asymptomatic, urology and andrology patients. The seminal fluids were tested parallel with the urethral samples. In one group of patients with typical prostatic complaints expressed prostatic secretion was examined parallel with urethral swab. C. trachomatis positivity rates were much higher in symptomatic (49.1%) than in asymptomatic patients (12.3%) in all kinds of sample. Seminal fluid was somewhat more frequently positive (7.9%) than urethral sample (6.2%). Simultaneous positivity was relatively rare (3.3%), it occurred most frequently in samples of patients with possible accessory gland infection tested by EIA. In a group of 17 patients with typical prostatic complaints the expressed prostatic secretion alone was positive in 7 cases, whereas only other two of the parallel urethral samples proved positive by PCR, simultaneous positivity occurred in one case. These findings suggest that testing of the ejaculate and/or the prostatic secretion parallel with the urethral sample would improve the sensitivity of detection of chlamydial infections.