In vitro synergy of oxacillin and gentamicin against coagulase-negative staphylococci from blood cultures of neonates with late-onset sepsis.

Coagulase-negative staphylococci (CoNS) are the leading cause of late-onset sepsis (LOS) in neonates. Increasing resistance of CoNS to beta-lactams and aminoglycosides has led to widespread use of vancomycin, which in turn may lead to resistance to vancomycin. Thus, combination therapy of LOS has been advocated. We aimed to determine the interaction of oxacillin and gentamicin against CoNS. In 2005, 34 isolates of oxacillin- and gentamicin-resistant CoNS were obtained from blood samples of neonates with LOS. Combination effect was tested using the checkerboard method, E-test with the other antibiotic incorporated in the medium (E-test-1) and two E-test strips placed in a cross-formation (E-test-2). Of 34 isolates 61.8%, 53% and 73.5% revealed synergy or an additive effect when tested by the checkerboard method, E-test-1 and E-test-2, respectively. Results of all three tests were concordant for six (17.6%) isolates, four showing synergy, and two indifference. Our in vitro results support that combination therapy with penicillinase-resistant penicillin and aminoglycoside can be an alternative to vancomycin.

Survey of diagnostic services for genital herpes in fourteen countries in Eastern Europe.

This paper reports survey-based data on the diagnosis and management of genital herpes simplex virus (HSV) infection in 14 countries of the Eastern European Network for Sexual and Reproductive Health (EE SRH). Only 43% of the countries could provide the number of genital HSV cases recorded at national level. Eighty-six percent of countries employed syndromic management in cases of genital ulcer disease. Most countries performed type-specific and/or non-type-specific enzyme immunoassays to detect HSV antibodies. Non-type-specific serology for diagnostic purposes should be actively discouraged. Direct detection methods for HSV, such as PCR, antigen detection and culture, are available in the region, but their usage was extremely low. Their use in Eastern European countries should be actively promoted. The availability of laboratory services must be improved, and countries in the region should implement consensus recommendations for the laboratory diagnosis of genital HSV infections in order to improve clinical practice.

Inhibition of Clostridium difficile strains by intestinal Lactobacillus species.

Indigenous intestinal microflora (including lactobacilli) has an important role in protection against Clostridium difficile infection. To assess in vitro interaction between lactobacilli and C. difficile, antagonistic activity of 50 intestinal Lactobacillus spp. strains against 23 pathogenic C. difficile strains was determined. Phenotypic properties of C. difficile strains [production of short-chain fatty acids (SCFAs) and toxin A, and antimicrobial susceptibility] and lactobacilli (production of SCFAs and H(2)O(2)) were investigated. Five lactobacilli (Lactobacillus paracasei and Lactobacillus plantarum species) were antagonistic to all C. difficile strains, 18 were antagonistic to some C. difficile strains and 27 showed no antagonistic activity. This antagonistic activity was strain-specific and seemed to correlate with H(2)O(2) and lactic acid production. C. difficile strains that were more sensitive to lactobacilli (n = 9) usually produced higher toxin levels and more SCFAs, and were more resistant to antibiotics, than strains that were resistant to lactobacilli (n = 14). Compatibility of C. difficile strain properties (resistance to lactobacilli or antibiotics) with intestinal microecological conditions (e.g. presence of antagonistic lactobacilli, concentration of antibiotics) may determine expression of disease.