The adherence of Escherichia coli to human uroepithelial cells obtained from midstream urine specimens of healthy women was studied. Bacteria labeled with [(3)H]uridine were used, and unattached organisms were separated from the epithelial cells by vacuum filtration with 5-mum-pore-size Nucleopore membrane filters. These techniques allowed adherence to be measured in large numbers of epithelial cells and overcame the problem of distinguishing experimental bacteria from the indigenous organisms present on uroepithelial cells. Adherence was not appreciably affected by temperature. Adherence was maximal at pH 4 to 5 and at bacterial-to-epithelial-cell ratios of 5,000 or more. The latter observation suggested that there are a limited number of receptors on the epithelial cell surface, an idea which was supported by competition experiments. Adherence occurred within 1 min and then decreased gradually or quickly, depending on the type of bacterial growth medium, to a stationary level of adherence, approximately 50% of that observed initially. The ability of epithelial cells from a single individual to bind E. coli varied in a cyclical and repetitive pattern. Adherence tended to be higher during the early phase of the menstrual cycle and diminished shortly after the time of expected ovulation; adherence frequently correlated with the value obtained on the same day of the menstrual cycle during the preceding months. Adherence was markedly enhanced by bacterial incubation in broth for 72 h and inhibited by alpha-d-mannose. These results suggest that adherence is a complex phenomenon perhaps mediated in part by bacterial pili and mannose residues on uroepithelial cells.
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To avoid the use of unnecessary broad-spectrum antibiotics, empirical therapy of bacteraemia should be adjusted according to the results of blood cultures.
To investigate whether the results of blood cultures led to changes in antibiotic use and costs in a tertiary-care university hospital in Norway.
Medical records from all patients with positive blood cultures in 2001 were analysed retrospectively. Factors predisposing to infections, results of blood cultures, antibiotic use and outcome were recorded. The influence of blood culture results on antibiotic treatment and costs were analysed.
The antibiotic use in 226 episodes of bacteraemia in 214 patients was analysed. According to the guidelines empirical antibiotic treatment should be adjusted in 166 episodes. Antibiotic use was adjusted in 146 (88%) of these 166 episodes, which led to a narrowing of therapy in 118 (80%) episodes. Compared with empirical therapy there was a 22% reduction in the number of antibiotics. Adjustment of therapy was more often performed in Gram-negative bacteraemia and polymicrobial cultures than in Gram-positive bacteraemia. In bacteraemia caused by ampicillin-resistant Escherichia coli, ampicillin was mostly replaced by ciprofloxacin. The cost for 7 days adjusted therapy in 146 episodes was euro19,800 (23%) less than for 7 days of empirical therapy.
Adjustment of antibiotic therapy according to the results of blood cultures led to a reduction in the number of antibiotics and a narrowing of antibiotic therapy. The costs for antibiotics decreased.
This report describes a study carried out to gain baseline information on the molecular characteristics of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp. in Canada. A total of 29,323 E. coli and 5,156 Klebsiella sp. isolates were screened at 12 participating sites. Of these, 505 clinically significant, nonrepeat isolates displaying reduced susceptibility to the NCCLS-recommended beta-lactams were submitted to a central laboratory over a 1-year period ending on 30 September 2000. A total of 116 isolates were confirmed to be ESBL producers. PCR and sequence analysis revealed the presence of TEM-11 (n = 1), TEM-12 (n = 1), TEM-29 (n = 1), TEM-52 (n = 4), CTX-M-13 (n = 1), CTX-M-14 (n = 15), CTX-M-15 (n = 11), SHV-2 (n = 2), SHV-2a (n = 12), SHV-5 (n = 6), SHV-12 (n = 45), and SHV-30 (n = 2). Five novel beta-lactamases were identified and designated TEM-115 (n = 2), TEM-120 (n = 1), SHV-40 (n = 2), SHV-41 (n = 4), and SHV-42 (n = 1). In addition, no molecular mechanism was identified for five isolates displaying an ESBL phenotype. Macrorestriction analysis of all ESBL isolates was conducted, as was restriction fragment length polymorphism analysis of plasmids harboring ESBLs. Although a "clonal" distribution of isolates was observed at some individual sites, there was very little evidence suggesting intrahospital spread. In addition, examples of identical or closely related plasmids that were identified at geographically distinct sites across Canada are given. However, there was considerable diversity with respect to plasmid types observed.
Escherichia coli was the most commonly isolated pathogen in the Canadian Ward Surveillance Study 2007-2009 (3789 isolates). Susceptibility to cefazolin (34.1%), trimethoprim-sulfamethoxazole (73.8%), ciprofloxacin (78.4%), and levofloxacin (78.8%) was lowest. Susceptibility was above 90% for meropenem (100%), tigecycline (99.9%), piperacillin-tazobactam (97.6%), nitrofurantoin (96.9%), ceftazidime (95.6%), amoxicillin-clavulanate (94.9%), ceftriaxone (94.1%), cefoxitin (92.3%), and gentamicin (90.8%). Over the study period, there was a significant reduction in susceptibility to amoxicillin-clavulanate and trimethoprim-sulfamethoxazole for urinary tract isolates. Inpatient status was associated with greater resistance to nearly all antimicrobials including greater multidrug resistance (MDR). Increasing age was associated with resistance to fluoroquinolones, ceftriaxone, piperacillin-tazobactam, and MDR. Female gender was associated with susceptibility to fluoroquinolones and nitrofurantoin. In conclusion, greater antimicrobial resistance and MDR in E. coli were observed in inpatients, males, and with increasing age. The deterioration of susceptibility to trimethoprim-sulfamethoxazole continues with the greatest reduction in urinary isolates. Significant regional differences in resistance rates were apparent.
Certain pheno- and genotype properties of S. typhimurium and some other representatives of Enterobacteriaceae resistant to antimicrobial drugs were studied. The strains were isolated from children with salmonellosis within 4 months when an infection hospital was subjected to microbiological observation. It was shown that by their antibiotic resistance, phagovars and molecular weights of the plasmid DNas, the strains S. typhimurium were similar to those isolated during hospital infections. The conjugative plasmids responsible for antibiotic resistance in some strains did not differ in their molecular weights and antibiotic resistance markers. The strains S. typhimurium similar in their pheno- and genotype properties were isolated only from 2 patients which allowed one to consider it possible that the patients were infected by the strains of common genesis. Analysis of nonpathogenic representatives of Enterobacteriaceae isolated from the patients along with the S. typhimurium strains confirmed the fact that the patients were infected with the same pathogenic strain.
The antimicrobial properties of three glycols, - propylene glycol, hexylene glycol, and 1,3-butylene glycol - against Candida albicans, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes A, Streptococcus mitis, and E. coli were studied in vitro. Within 20 h, 10% and 30% hexylene glycol in fresh tryptic soy broth were able to kill all the micro-organisms listed above. Five percent hexylene glycol showed some antimicrobial properties but the 1% agent had no effect. Thirty percent 1,3-butylene glycol and 30% propylene glycol were approximately as effective as 10% HG. The results speak in favour of using hexylene glycol in cosmetic and dermatological vehicles instead of propylene glycol and 1,3-butylene glycol.
Antibacterial Susceptibilities of Escherichia coli from Community-Acquired Urinary Tract Infections in the Faroe Islands, Associations with Antibacterial Sales, and Comparison with Iceland and Denmark.
Currently, data on Escherichia coli antibacterial susceptibilities in the Faroe Islands are lacking. The aim was to investigate the antibacterial susceptibilities of E. coli from patients with community-acquired urinary tract infections in the Faroe Islands, correlate with antibacterial sales, and compare with Iceland and Denmark. From 2009 to 2010 and in 2012, 12 general practitioners from the Faroe Islands were recruited to provide urine samples from patients. Antibacterial susceptibilities were determined by disc diffusion testing according to the Clinical and Laboratory Standards Institute methods and criteria. Logistic regression (quasibinomial) of the antibacterial resistance proportions versus mean sales during the period of 2008-2011 was used to determine association. Nonsusceptibility to at least 1 of the 14 antibacterial drugs investigated was found in 54% of the E. coli isolates and was most common to ampicillin (46%), followed by sulfamethoxazole (39%), trimethoprim (27%), trimethoprim/sulfamethoxazole (27%), and
E. coli strains isolated from 5-day-old and 30-day-old healthy calves were tested for antibiotic resistance and H-factor mediated antibiotic resistance. An average of 1.6 antibiotic-resistant strains and 1.1 strains with transferable antibiotic resistance were isolated from each of the investigated calves. In comparison with the 30-day-old calves, the 5-day-old calves had significantly more strains with transferable antibiotic resistance (95.8 percent as against 63.4 percent). The R+ strains isolated from the younger calves transferred significantly more en bloc (43.5 percent as against 10.0 percent) and double plus multiple resistance (5292 percent as against 24.4 percent) than did those isolated from the older calves. The most common resistance was to sulphonamide and tetracycline and the most common transferred resistance was to sulphonamide.
We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.
We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.
Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases. Escherichia coli accounted for 82.3% of all UTIs, whereas Staphylococcus saprophyticus accounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16-9.62) and TMP-SMX (OR 4.02, 95% CI 1.48-10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.
E. coli was the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.
All episodes of bacteraemia during a 15-year period (1981-1995) in the County of Northern Jutland, Denmark, were analysed with regard to antibiotic resistance. A total of 8840 isolates from 7938 episodes of bacteraemia was identified. Over time, no changes in bacterial aetiology were noted. Three isolates of Staphylococcus aureus were methicillin resistant (0.2%) and six were gentamicin resistant (0.4%). Among coagulase-negative staphylococci a 14% increase in resistance to penicillin was observed (95% confidence intervals, CI: 2-26%). Likewise, the frequency of resistance to methicillin, gentamicin and erythromycin increased, the corresponding figures being 38% (CI: 26-50%), 26% (CI: 14-38%) and 32% (CI: 16-50%), respectively, whereas a 14% decrease in resistance to streptomycin was recorded (CI: 4-24%). A 20% (CI: 2-37%) increase of coagulase-negative staphylococci resistant to three or more antibiotics was observed. The frequency of ampicillin resistance increased by 9% among Escherichia coli (CI: 4-13%) and by 10% (CI: 6-14%) in all Enterobacteriaceae. Among Enterobacteriaceae the level of resistance to third-generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones remained low (