A fatal case of necrotizing fasciitis due to bacterial translocation of Klebsiella oxytoca.

We report a 73-year-old man with hepatocellular cell carcinoma who had eruptions on and severe pain in the lower leg. Within several hours, the patient's skin lesions had progressed markedly. Magnetic resonance imaging findings were consistent with necrotizing fasciitis. Klebsiella oxytoca was isolated from cultures of biopsy samples taken from the leg. The resulting DNA fingerprint pattern revealed that the enteric bacterium was the same as that obtained from the biopsy samples taken from the leg. Furthermore, a dendrogram showed that genetic proximity between samples was extremely high. These results confirmed that translocation of Klebsiella oxytoca as an enteric pathogen caused the necrotizing fasciitis in this patient.

[Molecular epidemiologic analysis of nosocomocal infection due to TEIC resistant MRSA strains].

We performed epidemiologic study of 109 strains of methicillin resistant Staphylococcus aureus (MRSA) which were detected in our hospital. Of these strains, 6 strains showed resistant to Teicoplanin (TEIC) which MIC level were between 4 to 8microg/mL. All of them showed some phenotype, such as type II of coagulase, type A of enterotoxin, and were producing TSST-1. Genotype analysis by PFGE also showed that those strains ware identical. From analyzing the spreading rout of these TEIC resistant MRSA, we speculate that they first were in ICU ward, then spread all over the hospital carried by the stuff cross-working ICU and other units of hospital.

[The isolation frequency and antimicrobial susceptibility of Haemophilus influenzae isolated in Saga University Hospital].

Isolation frequency and antimicrobial susceptibility of Haemophilus influenzae isolated in Saga University hospital from October 2002 to September 2003 were investigated. Out of 155 H. influenzae strains subjected 77 were isolated from pediatrics specimens. beta-Lactamase negative ampicillin (ABPC)-resistant H. influenzae (BLNAR), against which MICs of ABPC were higher than 4 microg/mL, were 32 strains (20.6%), and it became 63 strains (41.3%) when Low-BLNAR, against which MICs of ABPC were higher than 2 microg/mL, were included. beta-Lactamase positive ABPC-resistant H. influenzae (BLPAR) were 8 strains (5.2%). Although those BLNAR were also resistant to variety of beta-lactams, fluoroquinolones and other antibiotics were not affected by the level of ABPC-resistance. Resistant strains of BLPAR against SBT/ABPC, a combination of a beta-lactamase inhibitor, were detected but all of them were sensitive to TAZ/PIPC, an another combination. Those strains were able to be considered as beta-lactamase positive amoxicillin-clavulanate resistant H. influenzae (BLPACR). PIPC, TAZ/PIPC, CTRX, CDTR, MEPM, LVFX and CPFX showed good activity among tested antibiotics.

[Antibacterial activity of oral Cephems against various clinically isolated strains].

We determined the antibacterial activities of oral Cephems against isolated from the patients with the respiratory infections, the urinary tract infections, and infections in the obstetrics field of an adult and a child, during the period from 2002 to 2003; Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, Klebsiella pneumoniae and Escherichia coli of 40 strains of each, and Peptostreptococcus spp. 22 strains. S. pneumoniae and H. influenzae strains that resistant is regarded were collected mainly, penicillin-intermediate S. pneumoniae (PISP), penicillin-resistant S. pneumoniae (PRSP) and beta-lactamase negative ampicillin-resistant H. influenzae (BLNAR) strains. The MICs of Cephems except cefaclor (CCL) were < or = 0.03 microgram/mL against all strains of S. pyogenes. The MICs of cefteram (CFTM) and cefditoren (CDTR) were < or = 0.0125 microgram/mL activity against 7 strains penicillin-susceptible S. pneumoniae (PSSP). However the MIC90s of cefditoren (CDTR) was 1 microgram/mL, cefteram (CFTM), and cefcapene (CFPN) were 2 micrograms/mL against PISP and PRSP, were higher than those of other drugs, but showed slightly higher than PSSP. The MIC90s of Cephems. were 0.5-4 micrograms/mL against strains of E. coli. The MIC90s of CFTM was 0.5 microgram/mL, and CDTR, CFPN were 1 microgram/mL against E. coli were higher than those of other drugs. The four strains of E. coli however were highly-resistant which MIC90s of CCL were more than 32 micrograms/mL were obtains. Furthermore it is necessary to pay much attention to the trend of resistant such as E. coli of Cephems. Although all strains showed resistant to AMPC, MIC90 of Cephems were 0.25-1 microgram/mL, good activities against K. pneumoniae. Against beta-lactamase negative ampicillin-susceptible H. influenzae (BLNAS) 23 strains the MIC90s of CCL and other Cephems were 64 micrograms/mL and 0.25-8 micrograms/mL. The MIC90s of CDTR and CFTM were < or = 1 microgram/mL of BLNAR (15 strains). However there of CFDN and CPDX were 8 micrograms/mL and CCL were > or = 16 micrograms/mL. Two strains which were produced beta-lactamase were highly--ABPC resistant. Although B. catarrhalis all strains were produced beta-lactamase and Cephems except for CCL showed better susceptibility than AMPC. The MIC90s of Cephems were 0.25-2 micrograms/mL against Peptostreptococcus spp.