[Endocarditis due to Aggregatibacter (formerly: Actinobacillus) actinomycetemcomitans, a bacterium that grows in characteristic star-shaped colonies]. / Endocarditis door Aggregatibacter (voorheen: Actinobacillus) actinomycetemcomitans, een bacterie met karakteristieke stervormige kolonies.

A 72-year-old man, having had an artificial valve for almost 20 years now, presented with tiredness that had persisted for several weeks and reported weight loss of 5 kg. In more recent days he experienced fever and cold shivers, and an associated dry cough. Bearing in mind the potential for endocarditis, blood cultures were grown. In this, we identified a small, Gram-negative rod with a small, smooth, raised colony that grew slowly. We considered a micro-organism from the 'HACEK group', which is a group of micro-organisms including Haemophilus aphrophilus, Haemophilus paraphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae and Aggregatibacter (formerly: Actinobacillus) actinomycetemcomitans. More careful observation revealed that the bacteria formed star-shaped colonies, proving that A. actinomycetemcomitans was the cause of this non-acute endocarditis. The patient received antibiotic treatment. Because non-acute endocarditis is often caused by hidden abnormalities in the mouth or teeth and A. actinomycetemcomitans plays an important role in severe cases of peridontitis, a dental surgeon was consulted. The dental surgeon diagnosed multifocal peridontitis and treated the patient, who was able to leave the hospital after 6 weeks of antibiotic treatment.

Comparison of imipenem/cilastatin with the combination of aztreonam and clindamycin in the treatment of intra-abdominal infections.

The clinical safety and efficacy of imipenem/cilastatin in the treatment of intra-abdominal infections was compared with the combination of aztreonam and clindamycin in a randomized prospective trial. The severity of illness was determined by means of the Apache II score and a fixed outcome reporting scheme was used. One hundred and four patients were entered into the study, of whom 80 were evaluable. Forty-two patients were treated with imipenem/cilastatin (500 + 500 mg qds) and 38 with aztreonam (600 tds) and clindamycin (1000 mg tds). The study groups were comparable for age and sex. The imipenem/cilastatin group differed from the aztreonam and clindamycin group in having significantly more patients with the diagnosis of acute appendicitis (P < 0.01) and a significantly lower mean Apache score (P < 0.05). The predominate microorganisms isolated in both groups were Escherichia coli and Bacteroides fragilis. Treatment with imipenem/cilastatin proved successful in 71% and failed in 24%, and initial success only was seen in 5%. The numbers in the group treated with aztreonam and clindamycin were 64%, 29% and 7% respectively. Severity of illness, as measured by Apache II score, had no influence on the study outcome. Imipenem/cilastatin as well as the combination of aztreonam and clindamycin were effective in the treatment of abdominal infections and no major adverse reactions were seen.

Surveillance of the antibiotic susceptibility of non-penicillinase producing Neisseria gonorrhoeae in The Netherlands from 1983 to 1986.

From 1983 to 1986 more than 2000 non-penicillinase producing Neisseria gonorrhoeae from Amsterdam, The Hague and Rotterdam were auxotyped and screened for susceptibility to 10 antibiotics by MIC determination. By far the commonest auxotypes were N.R. (non-requiring; 40%) and Pro- (proline requiring; 30%). During that period there was a substantial shift in the ratio of both auxotypes-roughly from 1:2 to 2:1-in The Hague. Pro- isolates were generally less susceptible than N.R. isolates, and there was a strong positive correlation between the MICs of the different drugs. The prevalence of isolates with a penicillin MIC equal to or above 0.5 IU/ml amounted to 14%, while in only 1% was the MIC above 1 IU/ml. Comparing our results with an earlier study by Stolz, Zwarte & Michel (1975, British Journal of Venereal Diseases 51, 257-64), the level of resistance to penicillin among non-PPNG has not significantly increased in The Netherlands since 1972. The prevalence of isolates showing relative resistance towards tetracycline and thiamphenicol (MIC 2-4 mg/l) decreased from approximately 20% in 1983/84 to approximately 10% in 1985/86, coinciding with a drop in the prevalence of Pro- isolates. All strains were susceptible to cefuroxime and spectinomycin and highly susceptible to cefotaxime and ciprofloxacin.

Epidemic of prosthetic valve endocarditis caused by Staphylococcus epidermidis.

In an epidemic of prosthetic valve endocarditis caused by Staphylococcus epidermidis the surgeon was found to be the source of contamination. The probable route was accidental puncture of gloves during operation. During the epidemiological investigation a second cluster of patients contaminated with Staph epidermidis during open heart surgery was found also related to one surgeon. This strain caused no detectable signs or symptoms of infection. Carriage of virulent staph epidermidis has rarely been recognised as a hazard but may have serious consequences.

Evaluation of commercial test systems for the identification of nonfermenters.

Three commercially available test systems for the identification of nonfermentative gram-negative rods were compared: API 20NE, flow N/F and Minitek Nonfermenter System. Two hundred strains were identified by conventional means and by each test system. The rate of correct identification of Acinetobacter, Alcaligenes, Flavobacterium and Moraxella strains to genus level and of the other genera to species level was 92% with API 20NE, 84% with flow N/F and 75% with Minitek Nonfermenter System. The need for these kits in the diagnostic hospital laboratory is also discussed.

Brain abscess due to Streptobacillus moniliformis and Actinobacterium meyerii.

This paper deals with a case of brain abscess due to Streptobacillus moniliformis (the cause of the streptobacillary type of rat-bite fever) and Actinobacterium meyerii. Brain abscesses due to these micro-organisms are rare. The possible causative mechanisms in this particular case and the diagnostic and therapeutic management of brain abscesses in general are discussed.

Branhamella catarrhalis septicaemia in a granulocytopenic patient.

A patient with acute leukaemia developed a maxillary sinusitis and septicaemia with Branhamella catarrhalis during the period of bone marrow hypoplasia. One blood culture also grew Staphylococcus aureus. In the same period, the patient developed tender red skin lesions and disseminated intra-vascular coagulation. The patient recovered when therapy with high dosages of amoxicillin was instituted. At the same time, however, the bone marrow recovered.

Activity of cephalosporins against methicillin-resistant coagulase-negative staphylococci.

Using a dilution method (37 degrees C, 42 h), six of ten methicillin-resistant strains of coagulase-negative staphylococci were found to be resistant to cephalothin. Of 20 variations in the method for detection of resistance to methicillin and cephalothin, broth dilution tests at 30 degrees C for 42 h were the most sensitive. Differences are explained by low percentages of cephalothin-resistant clones in methicillin-resistant strains.

Nonliquid reagent for detecting nitrate reduction.

A nonliquid reagent for detecting nitrate reduction is described. The reagent contains N-(1-naphthyl)ethylenediamine dihydrochloride as a substitute for the carcinogenic alpha-naphthylamine. The reagent was tested on 135 strains and gave reliable results.