Urinary tract infections caused by anaerobic bacteria. Utility of anaerobic urine culture.

Urinary tract infections (UTIs) caused by anaerobic bacteria have scarcely been reported. Since anaerobic bacteria are commensals of the genitourinary tract, their presence in a urine sample adds ambiguity in making a definitive diagnosis of anaerobic UTI. It is well known that standard urine culture is the gold standard method for the detection, identification, and antimicrobial susceptibility testing of uropathogens. Nonetheless, both the difficulties in establishing them as pathogens and the scarcity of reported anaerobic UTI cases led to the discontinuation of routine urine culture under an anaerobic atmosphere (UCAA). On the other hand, it is important to emphasize that culture-independent methods, such as proteomics and molecular technics, may detect anaerobes directly on a urine sample. Anaerobes are not included in guidelines for the diagnosis and management of UTIs. At the same time, as fastidious uropathogens and antibiotic resistance become more common, accurate pathogen identification becomes even more important for effective UTI treatment. As a result, we conducted a review of the clinical context, pathogen antimicrobial susceptibility, and treatment of patients with anaerobic UTIs. Because UCAA is a contentious topic, we narrowed our search to cases with both negative standard urine culture and positive UCAA.

Peptostreptococcus anaerobius: Pathogenicity, identification, and antimicrobial susceptibility. Review of monobacterial infections and addition of a case of urinary tract infection directly identified from a urine sample by MALDI-TOF MS.

Peptostreptococcus anaerobius is a gram-positive anaerobic coccus (GPAC) found in the gastrointestinal and vaginal microbiota. The organism is mainly found in polymicrobial and scarcely in monobacterial infections such as prosthetic and native endocarditis. Anaerobic bacteria have rarely been reported as the cause of urinary tract infection (UTI). Although GPAC are susceptible to most antimicrobials used against anaerobic infections, P. anaerobius has shown to be more resistant. Herein, we report a case of UTI caused by P. anaerobius from a 62-year-old man with a history of urological disease. Surprisingly, the microorganism was directly identified by Matrix-Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) from the urine sample. The isolate was successfully identified by phenotypic methods, MALDI-TOF MS, and 16S rRNA gene sequencing. P. anaerobius showed no ß-lactamase-producing activity, was resistant to penicillin, ampicillin, ciprofloxacin and levofloxacin, and displayed intermediate susceptibility to ampicillin-sulbactam and amoxicillin-clavulanic acid. Successful treatment was achieved with oral amoxicillin-clavulanic acid. Antimicrobial susceptibility testing (AST) should be performed on P. anaerobius isolates due to their unpredictable AST patterns and because empirically administered antimicrobial agents may not be active. This report shows that MALDI-TOF MS, directly used in urine specimens, may be a quick option to diagnose UTI caused by P. anaerobius or other anaerobic bacteria. This review is a compilation of monobacterial infections caused by P. anaerobius published in the literature, their pathogenicity, identification, and data about the antimicrobial susceptibility of P. anaerobius.

Intra-peritoneal abscess after an abdominal hysterectomy involving Cutibacterium avidum (former Propionibacterium avidum) highly resistant to clindamycin.

Cutibacterium avidum is a gram-positive anaerobic rod belonging to the cutaneous group of human bacteria with preferential colonization of sweat glands in moist areas. The microorganism rarely cause disease, generally delayed prosthetic joint infections (PJIs). We describe the second case of intraperitoneal abscess by C. avidum after an abdominal surgery in an obese female patient and the first case after a non-prosthetic abdominal surgery due to a highly clindamycin resistant strain in a patient with underling conditions. The patient was successfully treated with surgical drainage and beta-lactam antibiotics. Although rare and apparently non-pathogenic, C. avidum may be involved in infections, especially in some high-risk patients with obesity who have undergone surgical incision involving deep folder of the skin. The microorganism was identified by phenotypic methods, MALDI-TOF MS and 16S rRNA gene sequencing. Susceptibility test should be performed in C. avidum because high level resistance to clindamycin could be present. We present a literature review of C. avidum infections.

Clostridium ramosum rapidly identified by MALDI-TOF MS. A rare gram-variable agent of bacteraemia.

Clostridium ramosum is an enteric anaerobic, endospore-forming, gram-positive rod with a low GC content that is rarely associated with disease in humans. We present a case of C. ramosum bacteraemia. To the best of our knowledge, this is the second case of C. ramosum bacteraemia in an elderly patient presenting with fever, abdominal pain and bilious emesis. We highlight the Gram stain variability, the lack of visualization of spores and the atypical morphology of the colonies that showed C. ramosum in a polymicrobial presentation that initially appeared to show monomicrobial bacteraemia. The microorganism was rapidly identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We present a comprehensive literature review of 32 cases of clinical infections by C. ramosum in which we describe, if available, sex, age, clinical symptoms, predisposing conditions, other organisms present in the blood culture, other samples with C. ramosum , identification methodology, treatment and outcome.

[Evaluation of API Coryne System, version 2.0, for diphteroid gram-positive rods identification with clinical relevance]. / Evaluación del sistema API coryne, versión 2.0, para la identificación de bacilos gram-positivos difteroides de importancia clínica.

The ability of the API Coryne system, version 2.0, to identify 178 strains of gram-positive rods was evaluated. Seventy eight isolates belonged to genus Corynebacterium and one hundred to related genera, all strains were isolated from clinical samples at the Laboratory of Bacteriology, Hospital de Clínicas José de San Martin (UBA) between 1995 and 2004. The isolates were identified according to von Graevenitz and Funke's scheme. One hundred and sixty two out of 178 strains (91%) were correctly identified at genus and species level (IC95 = 85.6-94.6), in 44 of them (24.7%) additional tests were needed to final identification. Sixteen strains (9%) were not correctly identified (IC95 = 5.4-14.4); none of the 178 strains remained unidentified. The API Coryne system, version 2.0, is useful to identify the majority of Cory-nebacterium species with clinical relevance: Corynebacterium jeikeium, Corynebacterium urealyticum, Corynebacterium striatum, Corynebacterium pseudodiphtheriticum, Corynebacterium amycolatum and related species such as Arcanobacterium haemolyticum, Dermabacter hominis, Listeria monocytogenes, among others. Nevertheless for yellow-pigmented diphteroid gram-positive rods (Aureobacterium spp., Leifsonia aquatica, Microbacterium spp. and Cellulomonas spp.) and for acid fast gram-positive rods (Rhodococcus, Gordonia, Tsukamurella and Nocardia) the identification usefulness the system is limited.

[Comparison of different methods in order to identify Proteus spp]. / Comparación de diferentes métodos para identificar las especies del género Proteus.

Comparison of different methods in order to identify Proteus spp. The objectives were: (a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clinicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

[Prevalence of vaginal candidiasis in pregnant women. Identification of yeasts and susceptibility to antifungal agents]. / Prevalencia de candidiasis vaginal en embarazadas. identificación de levaduras y sensibilidad a los antifúngicos.

Pregnant women are more susceptible to both vaginal colonization and infection by yeast. Our objectives were to determine the prevalence in pregnant women of yeasts isolated from vaginal exudates and their susceptibility to current antifungal drugs. A total of 493 patients was studied between December 1998 and February 2000. The prevalence of Candida spp. was 28% (Candida albicans 90.4%; Candida glabrata 6.3%; Candida parapsilosis 1.1%, Candida kefyr 1.1 %; unidentified species 1.1 %). The diffusion test in Shadomy agar was employed to determine the susceptibility to fluconazole, ketoconazole, itraconazole and nistatine. All C. albicans, C. kefyr and C. parapsilosis isolates were susceptible in vitro to the antifungal agents tested, while 1 in 6 C. glabrata isolates showed resistance to azole drugs; all strains were susceptible to nistatine. In pregnant women, C. albicans was the yeast most frequently isolated from vaginal exudates; it continues to be highly susceptible to antifungal drugs. Azole resistance was detected only among C. glabrata isolates. Identification to the species level is recommended, specially in cases of treatment failure and recurrent or chronic infection.

['In vitro' activity of different antimicrobial agents on Gram-negative nonfermentative bacilli, excluding Pseudomonas aeruginosa and Acinetobacter spp]. / Actividad "in vitro" de diferentes antibacterianos sobre bacilos gram-negativos no fermentadores, excluidos Pseudomonas aeruginosa y Acinetobacter spp.

Gram-negative nonfermentative bacilli (NFB) are widely spread in the environment. Besides of difficulties for identification, they often have a marked multiresistance to antimicrobial agents, including those active against Pseudomonas aeruginosa. The objective of this study was to evaluate the 'in vitro' activity of different antimicrobial agents on 177 gram-negative nonfermentative bacilli isolates (excluding Pseudomonas aeruginosa and Acinetobacter spp.) isolated from clinical specimens. Minimum inhibitory concentrations (MIC) were determined according to the Mueller Hinton agar dilution method against the following antibacterial agents: ampicillin, piperacillin, piperacillin-tazobactam, sulbactam, cefoperazone, cefoperazone-sulbactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, colistin, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, rifampin, norfloxacin, ciprofloxacin and minocycline. Seven isolates: Sphingobacterium multivorum (2), Sphingobacteriumspiritivorum (1), Empedobacterbrevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) and Oligella urethralis (1), were tested for amoxicillin-clavulanic acid and ampicillin-sulbactam susceptibility, and susceptibility to cefoperazone or sulbactam was not determined. Multiresistance was generally found in Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans, and Ochrobactrum anthropi isolates. On the other hand, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, and Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa and Oligella urethralis were widely susceptible to the antibacterial agents tested. As a result of the wide variation in antimicrobial susceptibility shown by different species, a test on susceptibility to different antibacterial agents is essential in order to select an adequate therapy. The marked multiresistance evidenced by some species, prompts the need to develop new antimicrobial agents active against this group of bacteria and to search for synergistic combinations.

[Group B Streptococcus carriers among pregnant women]. / Portación de estreptococo grupo B en mujeres embarazadas.

Streptococcus agalactiae--group B streptococci (GBS)--is a main cause of severe neonatal infections with a high mortality rate. The detection of pregnant GBS carriers (5-35%) allows intrapartum administration of antibiotic prophylaxis to these women and prevents perinatal infection. We studied the prevalence of GBS in 259 patients between 28 and 37 weeks gestation from April 2000 to March 2002. The anorectum (AR) and vaginal introitus swabs (VI) were cultured in selective Todd-Hewitt broth containing colistin (10 micrograms/ml) and nalidixic acid (15 micrograms/ml) while vaginal swabs (VFS) were cultured following conventional methods. A total of 47 strains of EGB were isolated from 259 patients (18.15%). The prevalence in different samples were: 5.40% in VFS, 13.51% in VI, 11.58% in AR and 17.76% in VI + AR (reference method). The isolates were tested against penicillin, ceftriaxone, erythromycin, clindamycin, vancomycin, gentamicin and streptomycin to determine the minimum inhibitory concentration. The resistance phenotypes of erythromycin-resistant GBS were determined by the double-disk test. All strains were susceptible to penicillin, ceftriaxone and vancomycin, only one strain was erythromycin and clindamycin resistant by IMLSB mechanism. None of the isolated strains had a high resistant level to aminoglycosides. The sensitivity of cultures increased when selective broths were used as the primary detection method.

Accuracy of cefoxitin disk testing for characterization of oxacillin resistance mediated by penicillin-binding protein 2a in coagulase-negative staphylococci.

The Clinical and Laboratory Standards Institute (CLSI) proposed, beginning in 2004, the use of cefoxitin disks to predict resistance mediated by the mecA gene in all species of coagulase-negative staphylococci (CoNS). The aim of this work was to evaluate the efficiency of the cefoxitin disk and of oxacillin-salt agar screening (MHOX) to characterize the oxacillin resistance mediated by the mecA gene in CoNS. One hundred seven CoNS isolates from different clinical samples were studied. Detection of the mecA gene by PCR was considered the "gold standard." The susceptibility to oxacillin and cefoxitin was detected by the disk diffusion and agar dilution tests, as described by the CLSI. MHOX was also performed with 6 microg/ml of oxacillin and 4% NaCl. The sensitivities of the oxacillin and cefoxitin disks for all CoNS species were 88% and 80%, respectively, whereas the specificities were 63% and 100%, respectively. The sensitivities of the agar dilution test for oxacillin and cefoxitin (for proposed breakpoints of > or =4 microg/ml for resistance and < or =2 microg/ml for susceptibility) were 90% and 85%, respectively, whereas the specificities were 76% and 98%, respectively. MHOX showed a sensitivity of 90% and a specificity of 95% for all CoNS species. Both the MHOX and the cefoxitin disk results indicate that these are appropriate methods for the evaluation of oxacillin resistance mediated by the mecA gene in all CoNS species.

Diagnostic value of the papanicolaou smear in lower genital tract infections during pregnancy.

OBJECTIVES: To evaluate the diagnostic value of the Pap smear in lower genital tract infections during pregnancy. MATERIALS AND METHODS: A total of 190 pregnant women were examined in the Lower Genital Tract and Colposcopy clinics of the Obstetrics Division at the University Hospital de Clínicas "José de San Martín" of University of Buenos Aires from April to August 1997. Samples were taken from the vaginal fornix for microbiologic study and from the exocervix for Pap smear. Both the sensitivity and specificity test of the Pap smear for diagnosing lower genital tract infections were calculated considering the microbiologic study as the reference standard. RESULTS: The sensitivity of the Pap smear for Candida spp., bacterial vaginosis and Trichomonas vaginalis compared with microbiologic study was 50, 81, and 78, respectively. The specificity for the same study was 96%, 93%, and 100%, respectively. CONCLUSIONS: Pap smear for diagnosing lower genital tract infections is useful when positive results are found for these infections because of its high specificity.

Prevalencia de candidiasis vaginal en embarazadas: Identificación de levaduras y sensibilidad a los antifúngicos / Prevalence of vaginal candidiasis in pregnant women: Identification of yeasts and susceptibility to antifungal agents

La mujer embarazada es más susceptible tanto a la colonización como a la infección vaginal por levaduras. El objetivo de este trabajo fue determinar la prevalencia de levaduras aisladas de exudados vaginales de mujeres embarazadas y evaluar la sensibilidad a los antifúngicos de uso frecuente. Se estudiaron 493 pacientes en el período comprendido desde diciembre de 1998 hasta febrero de 2000. La prevalencia de Candida spp. fue 28% (Candida albicans 90,4%, Candida glabrata 6,3%, Candida parapsilosis 1,1%, Candida kefyr 1,1%, especies no identificadas 1,1%). Se determinó la sensibilidad a fluconazol, ketoconazol, itraconazol y nistatina por el método de difusión en agar Shadomy. Todos los aislamientos de C. albicans, C. kefyr y C. parapsilosis fueron sensibles in vitro a los antifúngicos probados, mientras que 1 de 6 aislamientos de C. glabrata presentó resistencia extendida a todos los azoles, pero sensibilidad a nistatina. En mujeres embarazadas C. albicans fue la levadura más frecuentemente aislada de exudados vaginales y continúa siendo ampliamente sensible a los antifúngicos; sólo en C. glabrata se observó resistencia a los azoles. Se recomienda la identificación de la levadura a nivel de especie particularmente en el caso de falla terapéutica y en infecciones recidivantes o crónicas.

Pregnant women are more susceptible to both vaginal colonization and infection by yeast. Our objectives were to determine the prevalence in pregnant women of yeasts isolated from vaginal exudates and their susceptibility to current antifungal drugs. A total of 493 patients was studied between December 1998 and February 2000. The prevalence of Candida spp. was 28% (Candida albicans 90.4%; Candida glabrata 6.3%; Candida parapsilosis 1.1%, Candida kefyr 1.1%; unidentified species 1.1%). The diffusion test in Shadomy agar was employed to determine the susceptibility to fluconazole, ketoconazole, itraconazole and nistatine. All C. albicans, C. kefyr and C. parapsilosis isolates were susceptible in vitro to the antifungal agents tested, while 1 in 6 C. glabrata isolates showed resistance to azole drugs; all strains were susceptible to nistatine. In pregnant women, C. albicans was the yeast most frequently isolated from vaginal exudates; it continues to be highly susceptible to antifungal drugs. Azole resistance was detected only among C. glabrata isolates. Identification to the species level is recommended, specially in cases of treatment failure and recurrent or chronic infection.

Comparación de diferentes métodos para identificar las especies del género Proteus / Comparison of different methods in order to identify Proteus spp

Los objetivos de este trabajo fueron: a) identificar a nivel de especie aislamientos de Proteus siguiendo la combinación de los esquemas de Farmer y O'Hara; b) determinar la utilidad del sistema comercial API 20E y de un esquema reducido de pruebas (agar TSI y agar MIO: movilidad, indol y ornitina), comparar estos procedimientos con la metodología convencional y evaluar su sensibilidad y especificidad, y c) evaluar la utilidad del perfil proteico en la identificación de las distintas especies. Se estudiaron 205 aislamientos de Proteus spp. aislados en el período comprendido entre enero de 1998 y setiembre de 2004, recuperados de distintos materiales clínicos correspondientes a pacientes hospitalizados y ambulatorios atendidos en el Hospital de Clínicas. Los organismos fueron identificados mediante la metodología convencional, por el sistema API 20E y con un esquema reducido de pruebas; 48 de ellos fueron sometidos a un SDS-PAGE. API 20E identificó 79 de 87 aislamientos de P. mirabilis (90,8%), 103/103 del complejo P. vulgaris y 15/15 de P. penneri. Ocho aislamientos identificados como Proteus spp. resultaron ser P. mirabilis, al incluir una prueba adicional (maltosa). En la identificación, el esquema reducido coincidió en un 100% con la metodología convencional. A diferencia del sistema API 20E, el esquema reducido alcanza la correcta identificación de todas las especies en laboratorios de baja complejidad, sin la necesidad de pruebas adicionales. El perfil proteico permitió la correcta diferenciación de las tres especies, independientemente de las diferentes atipias de P. mirabilis.

The objectives were: a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clínicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

Actividad "in vitro" de diferentes antibacterianos sobre bacilos gram-negativos no fermentadores, excluidos Pseudomonas aeruginosa y Acinetobacter spp / ‘In vitro' activity of different antimicrobial agents on gram-negative nonfermentative bacilli, excluding Pseudomonas aeruginosa and Acinetobacter spp

Los bacilos gram-negativos no fermentadores se encuentran ampliamente distribuidos en el medio ambiente. Además de causar dificultades en la identificación, a menudo presentan una marcada multirresistencia a los antimicrobianos incluyendo aquellos activos frente a Pseudomonas aeruginosa. El objetivo de este trabajo fue evaluar la actividad "in vitro" de diferentes antimicrobianos sobre 177 aislamientos de bacilos gram-negativos no fermentadores (excluidos Pseudomonas aeruginosa y Acinetobacter spp.) provenientes de especimenes clínicos. Las concentraciones inhibitorias mínimas (CIM) se determinaron por el método de dilución en agar Mueller Hinton frente a los siguientes antibacterianos: ampicilina, piperacilina, piperacilina-tazobactama, sulbactama, cefoperazona, cefoperazona-sulbactama, ceftazidima, cefepima, aztreonam, imipenem, meropenem, colistina, gentamicina, amicacina, trimetoprima-sulfametoxazol (TMS), cloranfenicol, eritromicina, rifampicina, norfloxacina, ciprofloxacina y minociclina. Sobre siete aislamientos: Sphingobacterium multivorum (2), Sphingobacterium spiritivorum (1), Empedobacter brevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) y Oligella urethralis (1) se ensayó la sensibilidad a amoxicilina-ácido clavulánico y ampicilina-sulbactama y no se determinó la actividad de cefoperazona ni de sulbactama. La multirresistencia fue comúnmente observada en los aislamientos de Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans y Ochrobactrum anthropi. En cambio, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa y Oligella urethralis, fueron ampliamente sensibles a los antibacterianos ensayados. Debido a la gran variabilidad observada en la sensibilidad a los antimicrobianos en las distintas especies, se hace imprescindible realizar la prueba de sensibilidad a los antibacterianos a fin de abordar la elección correcta del mismo. Debido a la marcada multirresistencia de algunas especies, surge la necesidad del desarrollo de nuevos agentes antimicrobianos que posean actividad sobre este grupo de bacterias, así como tambien la búsqueda de combinaciones sinérgicas.

Gram-negative nonfermentative bacilli (NFB) are widely spread in the environment. Besides of difficulties for identification, they often have a marked multiresistance to antimicrobial agents, including those active against Pseudomonas aeruginosa. The objective of this study was to evaluate the ‘in vitro' activity of different antimicrobial agents on 177 gram-negative nonfermentative bacilli isolates (excluding Pseudomonas aeruginosa and Acinetobacter spp.) isolated from clinical specimens. Minimum inhibitory concentrations (MIC) were determined according to the Mueller Hinton agar dilution method against the following antibacterial agents: ampicillin, piperacillin, piperacillin-tazobactam, sulbactam, cefoperazone, cefoperazone-sulbactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, colistin, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, rifampin, norfloxacin, ciprofloxacin and minocycline. Seven isolates: Sphingobacterium multivorum (2 ), Sphingobacterium spiritivorum (1), Empedobacter brevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) and Oligella urethralis (1), were tested for amoxicillin-clavulanic acid and ampicillin-sulbactam susceptibility, and susceptibility to cefoperazone or sulbactam was not determined. Multiresistance was generally found in Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans, and Ochrobactrum anthropi isolates. On the other hand, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, and Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa and Oligella urethralis were widely susceptible to the antibacterial agents tested. As a result of the wide variation in antimicrobial susceptibility shown by different species, a test on susceptibility to different antibacterial agents is essential in order to select an adequate therapy. The marked multiresistance evidenced by some species, prompts the need to develop new antimicrobial agents active against this group of bacteria and to search for synergistic combinations.

Portación de estreptococo grupo B en mujeres embarazadas / [Group B Streptococcus carriers among pregnant women]

Streptococcus agalactiae--group B streptococci (GBS)--is a main cause of severe neonatal infections with a high mortality rate. The detection of pregnant GBS carriers (5-35

) allows intrapartum administration of antibiotic prophylaxis to these women and prevents perinatal infection. We studied the prevalence of GBS in 259 patients between 28 and 37 weeks gestation from April 2000 to March 2002. The anorectum (AR) and vaginal introitus swabs (VI) were cultured in selective Todd-Hewitt broth containing colistin (10 micrograms/ml) and nalidixic acid (15 micrograms/ml) while vaginal swabs (VFS) were cultured following conventional methods. A total of 47 strains of EGB were isolated from 259 patients (18.15

). The prevalence in different samples were: 5.40

in AR and 17.76

in VI + AR (reference method). The isolates were tested against penicillin, ceftriaxone, erythromycin, clindamycin, vancomycin, gentamicin and streptomycin to determine the minimum inhibitory concentration. The resistance phenotypes of erythromycin-resistant GBS were determined by the double-disk test. All strains were susceptible to penicillin, ceftriaxone and vancomycin, only one strain was erythromycin and clindamycin resistant by IMLSB mechanism. None of the isolated strains had a high resistant level to aminoglycosides. The sensitivity of cultures increased when selective broths were used as the primary detection method.