Disrupted tongue microbiota and detection of nonindigenous bacteria on the day of allogeneic hematopoietic stem cell transplantation.

Disruption of the intestinal microbiota caused by intensive chemotherapy, irradiation and antibiotics can result in development of severe gut graft-versus-host disease and infectious complications, leading to poorer outcomes among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Although the oral cavity is also densely colonized by indigenous microorganisms, the bacterial composition in allo-HSCT recipients remains unclear. We determined the tongue microbiota composition of 45 patients with hematological disorders on the day of transplantation and compared them to 164 community-dwelling adults. The V1-V2 regions of the 16S rRNA gene sequences demonstrated that the allo-HSCT recipients had less diverse and distinct microbiota from that of community-dwelling adults. The full-length 16S rRNA gene sequences identified 146 bacterial taxa in the microbiota of allo-HSCT recipients, of which 34 bacterial taxa did not correspond to bacteria primarily inhabiting the oral cavity deposited in the expanded Human Oral Microbiome Database. Notably, the detection of Staphylococcus haemolyticus and/or Ralstonia pickettii was significantly associated with a higher risk of mortality during the follow-up period. These results demonstrate that the oral cavity of allo-HSCT recipients is colonized by a disrupted microbiota on the day of transplantation and suggest that detection of specific nonindigenous taxa could be a predictor of transplant outcome.

Linezolid-Resistant Methicillin-Resistant Staphylococcus HemolyticusIsolated from Leukemic Patient: First Case Report from Pakistan.

Methicillin-Resistant Coagulase-Negative Staphylococcusposes a challenging situation in healthcare settings. The spread of resistance among such organisms against major drugs is alarming as it limits the treatment options for serious infections. Traditionally, Vancomycin had remained a mainstay of treatment of Methicillin-Resistant Staphylococci. Linezolid introduction into the clinical practice was a major breakthrough since it provided orally administered treatment of Methicillin-Resistant Staphylococci. Widespread use of Linezolid has gradually turned the impending fear of emergence of resistance against this novel drug into a reality. We report first case of Linezolid-Resistant Methicillin-Resistant Staphylococcushemolyticusfrom Pakistan, isolated from a leukemic patient. The organism caused a necrotic lesion on the right forearm at cannulation site of intravenous catheter. Ooze swab yielded the pure growth of Linezolid-Resistant Methicillin-Resistant Staphylococcushemolyticus.

A rare complication of tonsillitis: septic arthritis of the temporomandibular joint.

Septic arthritis of the temporomandibular joint (TMJ) is a rarely seen clinical condition. Such an infection may be encountered following infections in the head and neck region, with direct or haematogenous spread to the joint. This article presents the case of a patient with tonsillitis leading to septic arthritis of the TMJ and reports the results of a review of the literature.

Collagen Cross-linking With Photoactivated Riboflavin (PACK-CXL) for Bacterial Keratitis After Small Incision Lenticule Extraction (SMILE).

PURPOSE: To report a case of infectious keratitis after small incision lenticule extraction (SMILE) treated with collagen cross-linking with photoactivated riboflavin (PACK-CXL). METHODS: Case report and literature review. RESULTS: A patient presented with culture-proven bacterial keratitis 5 days after SMILE was treated with fortified topical antibiotics and PACK-CXL. Irrigation of the corneal cap-stromal bed interface, which can be difficult and affect visual outcomes, was not performed. Clinical improvement was seen shortly after treatment and resolution of keratitis was achieved at 2 weeks. CONCLUSIONS: This is the first reported use of PACK-CXL in the management of infectious keratitis after SMILE. PACK-CXL may help sterilize the infection and limit its spread within the interface. [J Refract Surg. 2017;33(4):278-280.].

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics

BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.

Molecular epidemiology of coagulase-negative bloodstream isolates: detection of Staphylococcus epidermidis ST2, ST7 and linezolid-resistant ST23

Abstract The mechanisms contributing to persistence of coagulase-negative staphylococci are diverse; to better understanding of their dynamics, the characterization of nosocomial isolates is needed. Our aim was to characterize phenotypic and molecular characteristics of Staphylococcus epidermidis and Staphylococcus haemolyticus human blood isolates from two tertiary care hospitals in Mexico, the Hospital Universitario in Monterrey and the Hospital Civil in Guadalajara. Antimicrobial susceptibility was determined. Biofilm formation was assessed by crystal violet staining. Detection of the ica operon and Staphylococcal Cassette Chromosome mec typing were performed by PCR. Clonal relatedness was determined by Pulsed-fiel gel electrophoresis and Multi locus sequence typing. Methicillin-resistance was 85.5% and 93.2% for S. epidermidis and S. haemolyticus, respectively. Both species showed resistance >70% to norfloxacin, clindamycin, levofloxacin, trimethoprim/sulfamethoxazole, and erythromycin. Three S. epidermidis and two S. haemolyticus isolates were linezolid-resistant (one isolate of each species was cfr+). Most isolates of both species were strong biofilm producers (92.8% of S. epidermidis and 72.9% of S. haemolyticus). The ica operon was amplified in 36 (43.4%) S. epidermidis isolates. SCCmec type IV was found in 47.2% of the S. epidermidis isolates and SCCmec type V in 14.5% of S. haemolyticus isolates. No clonal relatedness was found in either species. Resistance to clindamycin, levofloxacin, erythromycin, oxacillin, and cefoxitin was associated with biofilm production for both species (p < 0.05). A G2576T mutation in 23S rRNA gene was detected in an S. haemolyticus linezolid-resistant isolate. All linezolid-resistant S. epidermidis isolates belonged to ST23; isolate with SCCmec type IV belonged to ST7, and isolate with SCCmec type III belonged to ST2. This is the first report of ST7 in Mexico. There was a high genetic diversity in both species, though both species shared characteristics that may contibute to virulence.

Isolation and characterization of two novel psychrotrophic decabromodiphenyl ether-degrading bacteria from river sediments.

Decabromodiphenyl ether (BDE-209) is a brominated flame retardant and a priority contaminant. Currently, little information is available about its significance in the environment, specifically about its susceptibility to aerobic biotransformation at low temperature. In this work, five phylogenetically diverse BDE-209-degrading bacterial strains were isolated from river sediments of northern China. These strains were distributed among four different genera-Acinetobacter, Pseudomonas, Bacillus and Staphylococcus. All five isolates were capable of growing on BDE-209, among which two isolates show better growth. By detailed morphological, physiological, and biochemical characteristics and 16S rDNA sequence analysis, the two strains were identified and named as Staphylococcus haemolyticus LY1 and Bacillus pumilus LY2. The two bacteria can grow in mineral salt medium containing BDE-209 substrate across the temperatures ranging from 2.5 to 35 °C, with an optimum temperature of 25 °C which could be considered as psychrotrophs accordingly. The degradation experiment showed that more than 70.6 and 85.5 % of 0.5 mg/L BDE-209 were degraded and the highest mineralization efficiencies of 29.8 and 39.2 % were achieved for 0.5 mg/L BDE-209 by S. haemolyticus LY1 and B. pumilus LY2, respectively. To the best of our knowledge, this is the first demonstration for the biodegradation of BDE-209 by two psychrotrophic bacteria isolated from environment.

Caracterización clínica y epidemiológica de pacientes con bacteriemia en la Unidad de Cuidados Intensivos de Medicina Interna y Cirugía. Hospital Roosevelt-Guatemala / Clinical and epidemiological characterization of patients with bacteremia in the Intensive Care Unit of Internal Medicine and Surgery. Roosevelt Hospital-Guatemala

Antecedentes: La bacteriemia constituye un problema de salud prioritario debido al obstáculo que impone al proceso curativo de los pacientes, involucrando al personal y a los sistemas de salud. Objetivo: Caracterizar clínica y epidemiológicamente pacientes con bacteriemia. Materiales y Métodos: Se realizó una revisión retrospectiva de pacientes con hemocultivos positivo del año 2013, en el Intensivo médico-quirúrgico, del Hospital Roosevelt, con instrumento estandarizado, que incluyó: datos demográficos, morbilidades, comorbilidades, registro de morbilidad y mortalidad. Se calcularon intervalos de confianza al 95% y odds ratio (OR). Resultados: De 47 expedientes y 87 hemocultivos, 55% fueron femeninos, con predominio de edad de 30-49 años, en su mayoría, amas de casa. El 49%, presentó una o más condiciones médicas asociadas. La mayoría de casos de bacteriemia fueron asociados a cuidados de salud, de origen secundario. El principal foco infeccioso fue respiratorio. Los principales microorganismos aislados fueron A. baumannii, K. pneumoniae y S. haemolyticus. Los procedimientos invasivos más frecuentes fueron uso de catéter venoso central y periférico. La tasa de letalidad al día 14 fue del 30%. Conclusiones: Se observó predominio de bacteriemias secundarias, asociadas a los cuidados de la salud, cuyos principales microorganismos aislados coinciden con literatura internacional. La mayor mortalidad fue observada en el sexo femenino.(AU)

Background: Bacteremia known as a major public health problem, because of the limitation it causes to the healing process among patients, involving both health care workers, and health system.Objectives: Characterize the clinical and epidemiological profile among patients with bacteremia.Materials and methods: A retrospective review was made, including positive blood culture patients, admitted to the medical and surgical Intensive Care Unit during 2013, with a standardized instrument which included: demographical data, morbidities and co-morbidities, including a morbidity and morta-lity. The statistics included 95% confidence intervals and odds ratio (OR).Results: Of 47 clinical files, 87 blood cultures, 55% were females. The mostly affected age group was the one within 30-49 years, mainly housewives. 49% presented one or more than one associated con-dition. Most cases of bacteremia were secondary, nosocomial and health care associated. The main origin was the respiratory tract. Main microorganisms isolated were A. baumannii, K. pneumoniae and S. haemolyticus. The most frequent invasive dispositive was central and peripheral venous catheteri-zation. The mortality rate at day 14 was 30%.Conclusions: A predominance of secondary bacteremia, health care associated was observed, who-se main isolated microorganisms agree with international literature. The highest mortality rate was observed in the female sex (AU)

Characterization of mannitol-fermenting methicillin-resistant staphylococci isolated from pigs in Nigeria

This study was conducted to determine the species distribution, antimicrobial resistance pheno- and genotypes and virulence traits of mannitol-positive methicillin-resistant staphylococci (MRS) isolated from pigs in Nsukka agricultural zone, Nigeria. Twenty mannitol-positive methicillin-resistant coagulase-negative staphylococcal (MRCoNS) strains harboring the mecA gene were detected among the 64 Staphylococcus isolates from 291 pigs. A total of 4 species were identified among the MRCoNS isolates, namely, Staphylococcus sciuri (10 strains), Staphylococcus lentus (6 strains), Staphylococcus cohnii (3 strains) and Staphylococcus haemolyticus (one strain). All MRCoNS isolates were multidrug-resistant. In addition to β-lactams, the strains were resistant to fusidic acid (85%), tetracycline (75%), streptomycin (65%), ciprofloxacin (65%), and trimethoprim/sulphamethoxazole (60%). In addition to the mecA and blaZ genes, other antimicrobial resistance genes detected were tet(K), tet(M), tet(L), erm(B), erm(C), aacA-aphD, aphA3, str, dfrK, dfrG, cat_pC221, and cat_pC223. Thirteen isolates were found to be ciprofloxacin-resistant, and all harbored a Ser84Leu mutation within the QRDR of the GyrA protein, with 3 isolates showing 2 extra substitutions, Ser98Ile and Arg100Lys (one strain) and Glu88Asp and Asp96Thr (2 strains). A phylogenetic tree of the QRDR nucleotide sequences in the gyrA gene revealed a high nucleotide diversity, with several major clusters not associated with the bacterial species. Our study highlights the possibility of transfer of mecA ...

[Sternal wound complications after cardiac surgery--a case report]. / Powiklania w gojeniu rany mostka po operacji kardiochirurgicznej--opis przypadku.

The authors presents case report of a 59-years-old man with triple vessel coronary artery disease, hypertension after myocardial infarction of the inferior wall with sternal wound complcations after coronary bypass grafting (CABG). On the fourth postoperative day the patient developed sternal dehiscence with wound infection. Infection was caused by Staphylococcus haemolyticus--coagulase-negative methicillin-resistant strain, MRCNS. An antimicrobial therapy and negative pressure wound therapy were used for complete wound healing.

[Acetazolamide in the resolution of cerebrospinal fluid cutaneous fistula after peridural analgesia: case report]. / Acetazolamida en el manejo de la fístula de líquido cefalorraquídeo posterior a analgesia peridural: reporte de caso.

BACKGROUND: Cerebrospinal fluid cutaneous fistula following spinal anesthesia is a serious and rare complication which mandates prompt diagnosis, although the treatment modalities are not well codified. CLINICAL CASE: Female aged 50 with a stage IIB cervical carcinoma; a peridural catheter was passed at lumbar level; three days after surgery, refers severe headache and to corroborate leakage cerebrospinal fluid through the puncture. The prescription was antibiotics and acetazolamide 250mg every 8hours for five days with favorable evolution. CONCLUSION: In this case, management with acetazolamide and suture of the fistula inhibits cerebrospinal fluid leakage without blood patch.

Endophthalmitis caused by Staphylococcus hominis and two different colonies of Staphylococcus haemolyticus after cataract surgery.

PURPOSE: To describe a case of endophthalmitis after cataract surgery caused by Staphylococcus hominis and two separate colony types of Staphylococcus haemolyticus. METHODS: Retrospective chart review including ophthalmic examination, intraocular biopsy and cultures, and anterior segment photography. RESULTS: A patient presented with endophthalmitis 1 month after cataract surgery. The patient underwent pars plana vitrectomy with vitreous fluid, aqueous fluid, and lens capsule biopsy with injection of intravitreal antimicrobials with full resolution of the infection. Cultures isolated grew S. hominis and two different colonies of S. haemolyticus, all sensitive to vancomycin. CONCLUSION: To the best of the authors' knowledge, this is the first case of endophthalmitis due to lens capsule seeding from three different types of bacteria, S. hominis and two different colony types of S. haemolyticus. Prompt diagnosis and treatment can be associated with good visual outcomes.

Virulence and the presence of aminoglycoside resistance genes of Staphylococcus haemolyticus strains isolated from clinical specimens.

We examined thirty methicillin-resistant Staphylococcus haemolyticus isolates cultured from clinical specimens for antibiotic resistance, various important interactions of the bacteria with epithelial cells and putative virulence determinants. All strains were resistant to oxacillin and carried the mecA gene. Aminocyclitol-3'-phosphotransferase (aph(3')-IIIa) gene encoding nucleotidyltransferases was detected in 43 %, aminocyclitol-6'-acetyltransferase-aminocyclitol-2″-phosphotransferase (aac(6')/aph(2″)) gene encoding bifunctional acetyltransferases/phosphotransferases in 33 %, aminocyclitol-4'-adenylyltransferase (ant(4')-Ia) gene encoding phosphotransferases in 20 %. The coexistence of resistance to methicillin and aminoglycosides was investigated in multi-resistant strains. Coexisting (aac(6')/aph(2″)) and (aph(3')-IIIa) genes were detected in 33 % of isolates, whereas 63 % of isolates had at least one of these genes. All strains revealed adherence ability and most of them (63 %) were invasive to epithelial cells. Electron microscopy revealed that the bacteria were found in vacuoles inside the cells. We observed that the contact of the bacteria with host epithelial cells is a prerequisite to their cytotoxicity at 5 h-incubation. Culture supernatant of the strains induced a low effect of cytotoxicity at the same time of incubation. Cell-free supernatant of all isolates expressed cytotoxic activity which caused destruction of HEp-2 cells at 24 h. None of the strains was cytotonic towards CHO cells. Among thirty strains, 27 % revealed lipolytic activity, 43 % produced lecithinase and 20 % were positive for proteinase activity. Analyses of cellular morphology and DNA fragmentation exhibited typical characteristic features of those undergoing apoptosis. The Pearson linear test revealed positive correlations between the apoptotic index at 24 h and percentage of cytotoxicity. Our results provided new insights into the mechanisms contributing to the development of S. haemolyticus-associated infections. The bacteria adhered and invaded to non-professional phagocytes. The invasion of epithelial cells by S. haemolyticus could be similar to phagocytosis that requires polymerization of the actin cytoskeleton. The process is inhibited by cytochalasin D. Moreover, they survived within the cells by residing in membrane bound compartments and induced apoptotic cell death.

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model.

OBJECTIVE: This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation. METHODS: Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85%) of all 20 animals. The positive rate for bacteria presence was 45% by culture and 80% by pyrosequencing method. RESULTS: Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culture-positive animals. CONCLUSION: Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the "culprit" for the persistence or recurrence of infection.

Management of pleural empyema with a vacuum-assisted closure device and reconstruction of open thoracic window in a patient with liver cirrhosis.

The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation.

Successful non-surgical treatment of endocarditis caused by Staphylococcus haemolyticus following transcatheter aortic valve implantation (TAVI).

We describe a case of a 79-year-old male patient with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) at our institution. He presented at the emergency department with dyspnea and fatigue 7 months after implantation. The diagnosis of early prosthetic valve endocarditis (PVE) caused by Staphylococcus haemolyticus was made by transesophageal echocardiography (TEE) and multiple positive blood cultures. Since our patient was considered inoperable due to a history of coronary artery bypass graft (CABG) surgery with patent bypasses, high peri-operative mortality including renal failure and a poor general prognosis, surgical removal of the valve was not an option. The patient was successfully treated with antibiotic therapy.

Conduta em infecções relacionadas a cateter venoso central em um hospital de referência / Care conduct for central venous catheter-related infectionsat an excellence hospital

Objetivos: avaliar a adesão às recomendações para diagnóstico de sepse relacionada a cateter (SRC), verificando a realização simultânea cultura de ponta de cateter (CPC) e hemocultura de sangue periférico (HP), em um hospital de referência. Métodos: trata-se de estudo transversal, realizado no Hospital das Cínicas da Universidade Federal de Minas Gerais, no período de janeiro de 2007 a outubro de 2009. Os dados foram coletados por profissionais especializados da Comissão de Controle de Infecção Hospitalar. Os critérios de base basearam-se nos critérios de notificação do National Healthcare Safety Network e diretrizes da Infectious Diseases Society of America (IDSA). Os dados foram digitados e analisados pelo Statistical Package for the Social Sciences (SPSS) versão 14.0. Resultados: de 683 CPC com crescimento de microrganismos, apenas 220 (32,2%) apresentaram isolamento de microrganismo em HP concomitante. Desses 220 casos, 74,1% apresentaram crescimento do mesmo microrganismo, com mesmo perfil fenotípico, em ambas as amostras. Nos casos de HP com resultado negativo e casos em que a HP não foi realizada, antimicrobianos foram prescritos em 25,7 e 31,5% dos casos, respectivamente, embora não tenha havido critérios para definição de SRC. Conclusão: apenas da recomendação de realização de CPC pareada com HP, este estudo reflete a prática de realização de CPC isolada e pode estar relacionada ao uso inapropriado de antimicrobianos, aumentando custos da assistência e favorecendo a seleção de resistência bacteriana. O diagnóstico e tratamento da SRC devem ser melhorados e os profissionais devem ser conscientizados das práticas adequadas de manejo de cateter venoso central...

Objectives: This study aims to assess compliance with recommendations for the diagnosis of catheter-related bloodstream infection (CRBSI) at an excellence hospital by verifying simultaneous performance of catheter tip culture (CTC) and peripheral blood culture (PBC). Methods: This is a cross-sectional study conducted at UFMG University Hospital from January 2007 through October 2009. Data were collected by specialized professionals of the Hospital Infection Control Committee. The notification criteria followed those prescribed by the National Healthcare Safety Network and the Infectious Diseases Society of America (IDSA). Database and statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 14.0. Results: Concurrent peripheral blood culture was performed for only 220 (32.2%) of the 683 CTC samples presenting microorganism growth. This points to low compliance with the existing guidelines. Out of the 220 positive CTC paired with PBC results, 74.1% presented the same microorganism, with the same phenotypic profile in both samples. As for negative PBC results and no blood culture testing, antibiotics were prescribed in 25.7 and 31.5% of the cases respectively, despite the inexistence of criteria to determine CRBSI. Conclusions: Despite recommendations for pairing CTC and PBC results, this study points to the common practice of performing isolated CTC tests. This may lead to inappropriate use of antimicrobials, increasing health care costs and selection of resistant bacteria. CRBSI diagnosis and treatment should be improved, and professionals should be aware of adequate practices and management of central venous catheter...

Activity of vancomycin, ciprofloxacin, daptomycin, and linezolid against coagulase-negative staphylococci bacteremia.

OBJECTIVE: Multiresistant coagulase-negative staphylococci (CNS) infections are mainly increased in hospitalized patients. We have studied the activity of vancomycin, ciprofloxacin, daptomycin and linezolid in methicillin-resistant CNS strains, isolated from true blood cultures. METHODS: We collected 87 strains of different CNS species from positive blood cultures. Staphylococci were identified by MicroScan Walkaway (Dade Behring, Siemens) and with the Api ID 32 Staph (BioMerieux, France). The susceptibility to oxacillin, vancomycin and ciprofloxacin was performed by automatic microdilution plate as cited above. The susceptibility to daptomycin and linezolid was performed by Etest (AB BioMerieux, Solna, Sweden). Interpretative criteria were done following the CLSI guidelines. RESULTS: Eighty-seven CNS strains were studied: 55 (63%) were S. epidermidis, 15 (17%) S. haemolyticus, 10 (12%) S. hominis, and 7 (8%) other species. Fifty-three (61%) strains showed loss of susceptibility to vancomycin, MIC = 2 mg/L. Ciprofloxacin resistance, MIC > 2 mg/L, was observed in 56 (64%) strains. Daptomycin resistance was not observed, with a susceptibility range between 0.032-1 mg/L and modal value of 0.25 mg/L. Ten strains (11.5%) resistant to linezolid were observed. Nine patients were in ICU, where the average length of stay was 38 days (range 16-58 days) and one belonged to Hepato-Pancreatic Surgery, where he stayed for 64 days. CONCLUSIONS: Low susceptibility to vancomycin is frequent in the CNS strains studied in our hospital. Daptomycin shows a high efficacy against CNS, and it could be useful for the treatment of primary bacteremia or catheter associated bacteremia. The massive and continuous use of linezolid has led to the appearance of resistance.

Calcific myonecrosis of the leg: report of three patients presenting with infection.

BACKGROUND: Calcific myonecrosis is a rare late complication of trauma, affecting almost exclusively the lower limb. Its radiologic appearance is characteristic. Superimposed infection usually is a sequela of biopsy. CASE REPORT: We present three patients, one with bilateral involvement, who presented with calcific myonecrosis and spontaneous infection. Three infections were attributable to a single microorganism: Enterobacter cloacae, Staphylococcus hominis, and S. haemolyticus were recovered. Multiple microorganisms were responsible in the other case. Treatment consisted of radical surgical debridement and antibiotics. The incision was closed over a suction drain, where possible, or left open to close by secondary intention. CONCLUSIONS: Calcific myonecrosis may present as infection without any obvious precipitating factor, and it should be included in the differential diagnosis in cases of soft tissue infection of the leg.

Antibiotic resistance and molecular characterization of clinical isolates of methicillin-resistant coagulase-negative staphylococci isolated from bacteremic patients in oncohematology.

Polymerase chain reaction (PCR) amplification of antibiotic resistance genes as well as staphylococcal cassette chromosome mec (SCCmec) typing and pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments of genomic DNA were used to characterize 45 methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolates responsible of bacteremia recovered in patients at the Bone Marrow Transplant Centre of Tunisia in 1998-2007. Among the 45 MRCoNS isolates, Staphylococcus epidermidis was the most prevalent species (75.6%) followed by Staphylococcus haemolyticus (22.2%) and Staphylococcus hominis (2.2%). Extended susceptibility profiles were generated for MRCoNS against 16 antimicrobial agents. Out of 45 mecA-positive strains, 43 (95.6%) were phenotypically methicillin-resistant and two (4.4%) were methicillin-susceptible. The msr(A) was the most prevalent gene (13 isolates; 48.1%) among erythromycin-resistant isolates. The erm(C) was found alone in seven (25.9%) or in combination with both erm(A) and erm(B) in two (7.4%) isolates. The aac(6')-Ie-aph(2″)-Ia was the most prevalent gene among aminoglycoside-resistant isolates, detected alone in 14 isolates (33.3%) isolates, in combination with ant(4')-Ia in 18 (42.8%) isolates, in combination with aph(3')-IIIa in four (9.5%) or with both ant(4')-Ia and aph(3')-IIIa in two (4.7%) isolates. The ant(4')-Ia was detected in three (7.1%) isolates and the aph(3')-IIIa in one (2.4%) isolate. Among tetracycline-resistant isolates, six (85.7%) strains harbored the tet(K) gene and one (14.3%) strain carried tet(K) and tet(M) genes. SCCmec types IV (31%) and III (24.5%), the most prevalent types detected, were found to be more resistant to non-ß-lactam antibiotics. A wide diversity of isolates was observed by PFGE among MRCoNS.