Macrolide resistance among invasive Streptococcus pneumoniae isolates.

CONTEXT: Macrolide antibiotics, including erythromycin, clarithromycin, and azithromycin, are the mainstays of empirical pneumonia therapy. Macrolide resistance among Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, is increasing in the United States. Whether resistance is a significant problem or whether macrolides remain useful for treatment of most resistant strains is unknown. OBJECTIVE: To examine the epidemiology of macrolide-resistant pneumococci in the United States. DESIGN AND SETTING: Analysis of 15 481 invasive isolates from 1995 to 1999 collected by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance system in 8 states. MAIN OUTCOME MEASURES: Trends in macrolide use (1993-1999) and resistance and factors associated with resistance, including examination of 2 subtypes, the M phenotype, associated with moderate minimum inhibitory concentrations (MICs), and the MLS(B) phenotype, associated with high MICs and clindamycin resistance. RESULTS: From 1993 to 1999, macrolide use increased 13%; macrolide use increased 320% among children younger than 5 years. Macrolide resistance increased from 10.6% in 1995 to 20.4% in 1999. M phenotype isolates increased from 7.4% to 16.5% (P<.001), while the proportion with the MLS(B) phenotype was stable (3%-4%). The median erythromycin MIC (MIC(50)) of M phenotype isolates increased from 4 microg/mL to 8 microg/mL. In 1999, M phenotype strains were more often from children than persons 5 years or older (25.2% vs 12.6%; P<.001) and from whites than blacks (19.3% vs 11.2%; P<.001). CONCLUSIONS: In the setting of increasing macrolide use, pneumococcal resistance has become common. Most resistant strains have MICs in the range in which treatment failures have been reported. Further study and surveillance are critical to understanding the clinical implications of our findings.

Staphylococcus aureus with reduced susceptibility to vancomycin isolated from a patient with fatal bacteremia.

A Staphylococcus aureus isolate with reduced susceptibility to vancomycin was obtained from a dialysis patient with a fatal case of bacteremia. Comparison of the isolate with two methicillin-resistant S. aureus (MRSA) isolated obtained from the same patient 4 months earlier suggests that the S. aureus with reduced susceptibility to vancomycin emerged from the MRSA strain with which the patient was infected. Atypical phenotypic characteristics, including weak or negative latex-agglutination test results, weak or negative-slide coagulase test results, heterogeneous morphologic features, slow rate of growth, and vancomycin susceptibility (by disk diffusion test) were observed.

Microbiology of a major foodborne outbreak of gastroenteritis caused by Yersinia enterocolitica serogroup O:8.

Gastrointestinal disorders of varying severity were observed in 239 (53%) of 455 campers and staff members at a coed summer camp in Sullivan County, New York, during July 1981. Five of seven hospitalized patients had appendectomies before the disease was recognized as yersiniosis. Yersinia enterocolitica serogroup O:8 (American strain) was isolated from 37 (54%) of 69 persons examined, including the head cook and 3 others of the 11-person kitchen staff. Of 48 food, water, and environmental samples collected from the camp area, Y. enterocolitica isolates belonging to the same serogroup and biogroup as the human isolates were recovered from dissolved powdered milk, a milk dispenser, and turkey chow mein. This laboratory finding supported the epidemiological data indicating a correlation between consumption of these foods and illness. Y. enterocolitica isolates of the same biogroup as the O:8 isolates but belonging to serogroup O:34 were also isolated from six campers and two samples of dissolved powdered milk. Pathogenicity studies on the Yersinia isolates were performed with three in vitro tests (calcium dependency, autoagglutination, and HeLa cell infection) and one in vivo test (intraperitoneal challenge of mice). Most of the serogroup O:8 human isolates and the chow mein isolate were positive in all four tests. Milk isolates of serogroup O:8 were positive in the in vitro tests but were relatively avirulent in mice, whereas serogroup O:34 isolates, regardless of source, were negative in all four tests.

Evaluation of the API 20E system for identification of nonfermentative Gram-negative bacteria.

The API 20E system for Enterobacteriaceae, recently broadened to include identification of nonfermentative gram-negative bacteria, was evaluated and compared with the conventional method for complete identification of 221 nonfermenters, which were well distributed into 48 species or biotypes and included organisms not listed in the API 20E data base. The results of 16 tests common to both systems were in close agreement. The API 20E system correctly identified 71 (43%) of the 165 organisms included in the API 20E data base. However, almost 90% of Acinetobacter calcoaceticus, three species of Pseudomonas, and Bordetella bronchiseptica were correctly identified to species.