Evaluation of the BinaxNOW Staphylococcus aureus test for rapid identification of Gram-positive cocci from VersaTREK blood culture bottles.

The ability of the rapid BinaxNOW Staphylococcus aureus (BNSA) immunochromatographic test (Alere Scarborough, Inc., ME) to accurately differentiate S. aureus from coagulase-negative staphylococci (CoNS) and other Gram-positive cocci (GPC) directly from VersaTREK blood culture bottles was evaluated. A total of 319 positive patient blood culture bottles with GPC seen in clusters with Gram staining were tested using the BNSA test and a direct tube coagulase test (DTCT). The BNSA test was accurate for the detection and differentiation of S. aureus from CoNS and other GPC within 30 min from the time of blood culture positivity and demonstrated a test sensitivity and specificity of 95.8% and 99.6%, respectively. BNSA test results were faxed to the antimicrobial stewardship pharmacist by noon each day in order to evaluate empirical antimicrobial therapy and facilitate more rapid changes or modifications if necessary. Same-day reporting of BNSA test results in conjunction with an antimicrobial stewardship program was more impactful in improving treatment for inpatients with documented S. aureus bacteremia than in reducing empirical vancomycin use in inpatients with CoNS during the first 24 h following reporting.

Identification and characterization of plasmid-borne erm(T) macrolide resistance in group B and group A Streptococcus.

One hundred and seven group B Streptococcus (GBS) isolates and 344 group A Streptococcus (GAS) isolates were collected between 2005 and 2009 from 2 area hospitals and studied for resistance to erythromycin (ERY) and clindamycin (CLI) and the presence of the erm(T) macrolide resistance gene. The erm(T) gene was found in 5 (8%) of 61 erythromycin nonsusceptible GBS isolates and in 22 (55%) of 40 erythromycin nonsusceptible GAS isolates. The erm(T) gene in all 27 GBS/GAS erm(T) gene-positive isolates was located on a plasmid. Three erm(T) gene-positive plasmids were DNA sequenced. Two plasmids (1 each from GBS and GAS isolates) were both 4967 bp in size, contained the erm(T) gene, and differed by only 2 base pairs, suggesting interspecies horizontal transfer of the erm(T) gene containing plasmid. The third (GBS) plasmid was 6825 bp in size and contained GBSi1, a group II bacterial intron, as well as the erm(T) gene. Pulsed-field gel electrophoresis of all 27 erm(T) gene containing isolates and a selection of erm(T) gene-negative isolates indicated possible clonal expansion among erm(T) gene containing GAS isolates, but not among the 5 erm(T) gene-positive GBS isolates.

Prevalence of the erm(T) gene in clinical isolates of erythromycin-resistant group D Streptococcus and Enterococcus.

Among 48 erythromycin-resistant group D streptococci (GDS), 36 had the erm(T) resistance gene. erm(T) was also found in 4 of 31 erythromycin-resistant Enterococcus faecium isolates. This is the first report of the erm(T) gene in U.S. GDS isolates and the first report of the erm(T) gene in enterococci.

Stealth dendrimers for drug delivery: correlation between PEGylation, cytocompatibility, and drug payload.

It is advantageous to utilize low generation polyamidoamine (PAMAM) dendrimers for drug delivery because low generations (generation 4.0 or below) have more biologically favorable properties as compared to high generations. Nevertheless, modification of low generation dendrimers with PEG to create stealth dendrimers is still necessary to avoid potential side effects by long term accumulation. However, low generation dendrimers have much fewer surface sites for drug loading as compared to higher generations. To efficiently utilize low generation dendrimer-based stealth dendrimers for drug loading, PEGylation needs to be optimized. In this study, we synthesized a series of stealth dendrimers based on low generation Starburst PAMAM dendrimers (i.e., G2.5, G3.0, G3.5, and G4.0) and quantitatively assessed PEGylation efficacy in modulating cytocompatibility of low generation PAMAM dendrimers. Cytocompatibility of stealth dendrimers was examined using endothelial cells. The results showed that PEGylation degree on low generation dendrimers could be dramatically reduced to leave as many unoccupied surface groups as possible for drug loading, while maintaining the drug carrier cytocompatibility. 3PEGs-G3.0 and 10PEGs-G4.0 were considered initially optimized stealth dendrimers that would be further modified to deliver drugs of interest. Correlation of PEGylation, cytocompatibility, and drug payload allowed us to optimize low generation dendrimer-based stealth dendrimers for drug delivery and advance the understanding of structure-property relationship of stealth dendrimers.

Identification of an erm(T) gene in strains of inducibly clindamycin-resistant group B Streptococcus.

Five inducibly clindamycin (CLI)-resistant group B Streptococcus (GBS) isolates, all negative for erm(A) and erm(B) genes, were found to contain erm(T), a gene previously reported in erythromycin-resistant animal isolates of Lactobacillus spp. and human isolates of Streptococcus bovis. One additional GBS isolate, constitutively resistant to CLI, was also positive for the erm(T) gene in addition to erm(B). To our knowledge, this is the 1st report of erm(T) in GBS, the 2nd bacterial species from humans in which the erm(T) gene has been identified, and the 3rd erm gene to be found in GBS.

Rise of Streptococcus pneumoniae isolates containing both erm(B) and mef(E) genes from an adult tertiary care community hospital system.

The emergence of macrolide- and lincosamide-resistant Streptococcus pneumoniae is a worldwide concern. Of particular interest is the increasing prevalence of erythromycin and clindamycin-resistant isolates containing both erm(B) and mef genes. This study determined the prevalence of erythromycin and clindamycin resistance in 596 clinical S. pneumoniae isolates from 2 adult tertiary care hospitals over a 4-year period (2001-2004). Erythromycin resistance increased from 24% to 34%, but S. pneumoniae isolates resistant to clindamycin as well as to erythromycin increased from 3% in 2001 to 15.5% in 2004 (5-fold increase). Among erythromycin-resistant isolates, those also resistant to clindamycin (MLS(B) phenotype) increased 3-fold (12.8-45%). Of forty-one erythromycin/clindamycin-resistant S. pneumoniae isolates tested, 29 (71%) contained both erm(B) and mef(E) genes. Pulsed-field gel electrophoresis performed on 28 erm(B) + mef(E) positive isolates identified 2 predominant and possibly related clones, which made up 64% of the isolates.

High rates of erythromycin and clindamycin resistance among OBGYN isolates of group B Streptococcus.

In vitro susceptibility testing on 200 Streptococcus agalactiae strains isolated during a 4-year period from vaginal/rectal specimens demonstrated a very high resistance rate for both erythromycin (54%) and clindamycin (33%). Methylase genes erm(B) and erm(TR) and efflux genes mef(E) and mef(A) were detected. Pulsed-field gel electrophoresis showed evidence of both clonal spread and multiclonal dissemination of resistant strains. All but 3 of 200 isolates were susceptible to telithromycin.