Antiseptic sensitivity of clinical strains of Pseudomonas aeruginosa

MICs, the frequency of clinical and statistic resistance and the antiseptic activity index were studied in complex on out-of-hospital and hospital ecovars of P. aeruginosa. The forms resistant to a number of antiseptics, i.e. chloramine B, chlorhexidine, decamethoxine and dioxidine whose frequency eventually increased were shown to be widely distributed. The antiseptic sensitivity spectrum was more narrow and more heterogeneous than that of other bacteria, the heterogeneity level being dependent on the antiseptic type and bacterial ecovar. The activity of pervomur, phenol, resorcin and boric acid was higher against the clinical strains of P. aeruginosa while iodopyrin, sulfacetamide sodium and dioxidine were less active. The P. aeruginosa strains had natural resistance to cetylpyridinium chloride, rokkal, ethonium, sodium laurate and laurylsulfate and rivanol. It was recommended to assay antiseptic sensitivity of agents causing purulent inflammatory infections and to control circulation of antiseptic resistant variants of bacteria in hospitals.     

Comparative study of the effect of antibiotics and antiseptics on Staphylococcus aureus

The routinely used antibiotics and antiseptics were compared with the same staphylococcal isolates by MIC ranges, the mean MIC for the strains, proportion of the variants resistant to the drugs, distribution of the strains by the resistance spectra and the number increase rate for the resistant variants in natural populations within 5-10-year periods. It was concluded that when used locally the antiseptics had some advantages over the antibiotics especially with respect to hospital strains. The authors believe that in developing new drugs, ++re-estimation of the routinely used ones, choosing the optimal drug for a particular case it is more important to consider the heterogeneity of microbial populations, the frequency of resistant variants and activity of the mechanisms of their selection under hospital conditions.     

Antiseptic susceptibility and distribution of antiseptic-resistance genes in methicillin-resistant Staphylococcus aureus

We examined the antiseptic susceptibilities and distribution of antiseptic-resistance genes qacA and smr in 98 isolates of methicillin-resistant Staphylococcus aureus obtained in 1992. Seventy-one strains were resistant to antiseptics. The qacA and smr genes were detected in 10 and 20 strains, respectively. The remaining 41 strains without qacA and smr were divided into two groups that exhibited low-level (n = 22) and high-level (n = 19) resistance to acriflavin. DNA cloning and sequencing suggested that norfloxacin-resistance gene norA was responsible for the high-level resistance to acriflavin. Our results indicated that four or more antiseptic-resistance genes exist in methicillin-resistant S. aureus and that antiseptic-resistant methicillin-resistant S. aureus strains without qacA and smr are widely spread in Japan.     

In vivo standardization of cutaneous bactericidal activity of antiseptics by using monoxenic hairless mice

This study was designed to investigate the bactericidal activities of antiseptics on the cutaneous flora of hairless mice monoxenic to Staphylococcus epidermidis, Staphylococcus aureus, or Pseudomonas aeruginosa in vivo. A standardized method for testing such antiseptics to compare their bactericidal effectiveness in humans in described. Seven antiseptics belonging to seven different chemical groups (iodine derivatives, alcohols, mercury compounds, quaternary ammonium salts, biguanides, phenols, and carbanilides) were used as recommended by the manufacturers (conditions of contact or prolonged contact time followed by washing with distilled water). Germfree hairless mice were infected with various bacterial strains by gastric intubation, producing levels of about 10(3) CFU/cm2 of skin. The antiseptic under test was placed on the right or left side of the ventral region. The contralateral side served as a control. In order to standardize the method, a number of crucial parameters were carefully controlled: the amount of antiseptic applied, the area of skin treated, the duration of treatment, and the washing procedure. Skin samples were obtained by cutaneous biopsy, which effectively removed all the bacteria along with the sample. The bacterial populations were counted before and after application of the antiseptic. Reductions of between 0.5 and 1.9 log units were obtained; these are comparable to those observed in humans. The standardization of our procedure and the use of animals with a strictly controlled flora eliminated much of the variability and sources of error inherent in human studies. This model could be of value for the study of resistant bacterial strains responsible for nosocomial infections and for investigations of damaged skin.     

In vivo standardization of cutaneous bactericidal activity of antiseptics by using monoxenic hairless mice.

This study was designed to investigate the bactericidal activities of antiseptics on the cutaneous flora of hairless mice monoxenic to Staphylococcus epidermidis, Staphylococcus aureus, or Pseudomonas aeruginosa in vivo. A standardized method for testing such antiseptics to compare their bactericidal effectiveness in humans in described. Seven antiseptics belonging to seven different chemical groups (iodine derivatives, alcohols, mercury compounds, quaternary ammonium salts, biguanides, phenols, and carbanilides) were used as recommended by the manufacturers (conditions of contact or prolonged contact time followed by washing with distilled water). Germfree hairless mice were infected with various bacterial strains by gastric intubation, producing levels of about 10(3) CFU/cm2 of skin. The antiseptic under test was placed on the right or left side of the ventral region. The contralateral side served as a control. In order to standardize the method, a number of crucial parameters were carefully controlled: the amount of antiseptic applied, the area of skin treated, the duration of treatment, and the washing procedure. Skin samples were obtained by cutaneous biopsy, which effectively removed all the bacteria along with the sample. The bacterial populations were counted before and after application of the antiseptic. Reductions of between 0.5 and 1.9 log units were obtained; these are comparable to those observed in humans. The standardization of our procedure and the use of animals with a strictly controlled flora eliminated much of the variability and sources of error inherent in human studies. This model could be of value for the study of resistant bacterial strains responsible for nosocomial infections and for investigations of damaged skin.     

An evaluation of the suitability of the European suspension test to reflect in vitro activity of antiseptics against clinically significant organisms

The effectiveness of four antiseptics representing soluble phenolics (Dettol), Quaternary Ammonium Compounds (QAC) (Dettol Hospital Concentrate: DHC), mixed QAC/chlorhexidine (Hibicet Hospital Concentrate: HHC) and povidone iodine (Betadine) was assessed using the proposed phase 2 step 1 European Suspension test. The in vitro activity of the antiseptics against two of the proposed challenge strains, i.e. Staphylococcus aureus and Pseudomonas aeruginosa, was compared with that of 14 problematic clinical isolates of bacteria from a range of genera, including some multiple antibiotic resistant strains, and a clinical isolate of Candida albicans. In addition to the 5 min contact time recommended in the European test, a 1 min time was included. All four products, at their recommended use dilutions and a contact time of 5 min, achieved a Microbicidal Effect (ME) log reduction of at least 5 against the majority of organisms. Differences in activity between products were more pronounced and therefore the tests more discriminatory, when the contact time was reduced to 1 min. The clinical strains were not overtly more resistant to antiseptics than the standard test strains, suggesting that the CEN test strains mimic the antiseptic susceptibility of clinical isolates.     

Resistance to antibiotics and heavy metal salts of coagulase-positive staphylococci belonging to different biological types (ecovars)

A total of 189 strains of S. aureus isolated from cows, sheep, swines, poultry, monkeys, rabbits, foxes, and humans and 23 strains of S. intermedius isolated from minks and sables were studied. The staphylococci belonged to different biological types (according to the Hajek-Marsalek's scheme) and ecovars (according to the Meyer-Witte's scheme). The strains were studied with respect to their resistance to 10 antibiotics (benzylpenicillin, streptomycin, tetracycline, levomycetin, erythromycin, oleandomycin, neomycin, kanamycin, monomycin, and novobiocin), mercuric chloride and cadmium sulfate. As a whole the frequency of resistance to the above preparations among the staphylococci of the animal origin was not high. Differences in the frequency and range of the resistance between strains belonging to different biological types (ecovars) were shown. The highest number of the resistant cultures was detected among the strains of the biological type E (ecovar canis) and atypical strains of S. intermedius isolated from the minks. The least number of the resistant cultures was detected among the strains of the biological type C1 (ecovar bovis) isolated from the cows. It was found that almost all strains of S. intermedius were resistant to cadmium sulfate. This may be used as an additional characteristic of the species.     

A comparative analysis of the antibacterial activity of antiseptics and antibiotics on samples of Pseudomonas aeruginosa

Antibiotic and antiseptic preparations, currently used in medical practice, have been tested on the same P. aeruginosa samples and compared by the amplitude of their minimal inhibiting concentration (MIC) values, determined as the average MIC values for the samples under test, by the proportion of variants resistant to the tested preparations, by the distribution of strains in the resistance spectrum, and by the pace of the increase of resistant variants under natural conditions in 5-10 years. On the basis of the results obtained in this study a conclusion has been made that in some cases of local application antiseptic preparations have advantages over antibiotics, especially in controlling hospital strains of microorganisms. The authors believe that the heterogeneity of microbial populations, as well as the frequency of the appearance of resistant variants and the activity of the mechanisms of their selection in hospitals, is of great importance in the development of new preparations, in the re-evaluation of currently used preparations and in the choice of the optimum preparation in concrete situations.     

Plants as a Source of Bacterial Resistance Modulators and Anti-Infective Agents

The spread of multidrug-resistant (MDR) strains of bacteria necessitates the discovery of new classes of antibacterials and compounds that inhibit these resistance mechanisms. At present, there are no single chemical entity plant-derived antibacterials used clinically, and this chemically diverse group deserves consideration as a source for two major reasons. First, plants have exceptional ability to produce cytotoxic agents and second there is an ecological rationale that antimicrobial natural products should be present or synthesised de novo in plants following microbial attack to protect the producer from pathogenic microbes in its environment. We have been characterising plant-derived products that are either antibacterial in their own right, or modulators of resistance in bacterial strains possessing multidrug efflux mechanisms. These efflux transporters are responsible for resistance to certain antibiotics and antiseptics and occur in strains of methicillin-resistant Staphylococcus aureus (MRSA), a major clinical problem at present. We are also investigating plant sources for compounds with activity against mycobacteria with a view to discovering drug leads with potential activity toward tuberculosis (TB) producing species. This paper will briefly review the literature on plant derived bacterial resistance modifying agents and antibacterials. Examples in this area from our own work will be given. The activities of plant-derived antibacterials show that there are many potential new classes of antibacterial agents which should undergo further cytotoxicity, microbial specificity and preclinical studies.     

On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community

The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typically increases with population size: In small hospitals chance effects cause large fluctuations in pathogen population size or even extinctions, both of which impede the acquisition and spread of drug resistance. Finally, we show that indirect transmission via environmental reservoirs can reduce the effect of hospital size because the slow turnover in the environment can prevent extinction of resistant strains. This implies that reducing environmental transmission is especially important in small hospitals, because such a reduction not only reduces overall transmission but might also facilitate the extinction of resistant strains. Overall, our study shows that the distribution of hospital sizes is a crucial factor for the spread of drug resistance.     

The role of mechanically purified city sewers in the spread of antibiotic-resistant bacteria of the Enterobacteriaceae family

The aim of this study was to evaluate a degree of contribution of mechanically cleansed municipal sewage in a spread in on environment of bacteria of Enterobacteriaceae family with special regard to antibiotic resistant strains. High number of bacteria of Enterobacteriaceae family was found in 1 ml of sewage and the number of antibiotic-resistant bacteria was 0.5-50 X 10(3)/ml. Among the strains tested the resistance to more than one antibiotics was encountered. 78.3% of strains transferred antibiotic resistance to E. coli recipient strain, what indicate a participation of potentially pathogenic bacteria from Enterobacteriaceae family in a spread of antibiotic resistance in a environment.     

Molecular epidemiology of infections caused by methicillin-resistant staphylococci

The review deals with the periodicity of the spread of methicillin-resistant S. aureus (MRSA) strains during the last 40 years, the mechanism of their resistance to methicillin and other beta-lactamic antibiotics, the genetic control of methicillin resistance, the genome organization of mec DNA and its possible cause, as well as the organization of epidemiological surveillance on MSRA in hospitals. The problem of changes in the epidemiology of staphylococcal infections due to the appearance of MRSA in the absence of contacts with carriers, treatment with antibiotics or stay in a hospital is discussed. The concern of public health authorities in connection with the emergence of MRSA strains, moderately resistant or resistant to vancomycin, is also discussed. The most promising programs of the MRSA study, as well as the optimum programs introduced in economically developed counties for the control of hospital infections caused by MRSA, are considered.     

An in vivo method for assessing the antimicrobial properties of topical antiseptics using artifically contaminated skin

A method is described for assessing the antimicrobial activity of topical antiseptics on human skin. The test, carried out on the forearms of volunteers, uses an inoculum of Stuphylococcus aureus . Up to four preparations may be tested at one time plus a placebo and untreated control site. The method has been used to compare four proprietary antiseptics and to evaluate their activity for up to one hour and has demonstrated a chloroxylenol, triclosan, EDTA combination product to be the most effective. The method is highly adaptable and may be used to evaluate activity versus other organisms and to examine other factors affecting antiseptic efficacy     

Susceptibility of antibiotic-resistant gram-negative bacteria to biocides: a perspective from the study of catheter biofilms

Bacteria resistant to both the agents deployed to prevent infections and those used to treat infections would be formidable nosocomial pathogens. The aim of this paper is to review the evidence that gram-negative bacteria resistant to antibiotics and biocides have emerged and been responsible for catheter-associated urinary tract infection. A study of patients undergoing intermittent bladder catheterization revealed that the frequent application of the antiseptic chlorhexidine to the perineal skin prior to the insertion of the catheter was effective against the normal gram-positive skin flora but not against the gram-negative organisms that subsequently colonized this site. Organisms such as Providencia stuartii, Pseudomonas aeruginosa and Proteus mirabilis were repeatedly isolated from the skin of these patients and inevitably went on to cause urinary infections. The minimum inhibitory concentration (MIC) of chlorhexidine for many of these strains proved to be 200-800 microg ml(-1) compared with the 10-50 microg ml(-1) recorded for reference strains of gram-negative species. A subsequent survey of over 800 gram-negative isolates from urinary tract infections in patients from both hospitals and the community revealed that chlorhexidine resistance was not a widespread phenomenon, but was restricted to these species and to units where the care of catheterized patients involved the extensive use of chlorhexidine. Analysis of the antibiotic resistance patterns revealed that the chlorhexidine-resistant strains were also multidrug resistant. Other clinical studies also reported catheter-associated infections with chlorhexidine- and multidrug-resistant strains of Pr. mirabilis when chlorhexidine was being used extensively. This species poses particular problems to the catheterized patient. Chlorhexidine thus proved counterproductive in the care of catheters and its use in this context has been largely abandoned. Suggestions of reintroducing this agent in the form of biocide-impregnated catheters should be resisted.     

Isolation of strains of a new ecological variant of Staphylococcus aureus from asses

47 coagulase-positive staphylococcal strains were isolated from the nasal smears of 175 healthy donkeys. In accordance with the schemes of Akatov--Devriese and Mayer-Witte--Akatov, 10.6% of the cultures were classified with the coagulase-positive species S. hyicus and 89.3%, with the species S. aureus. Out of S. aureus strains, 11.9% were found to have the characteristics of ecovar hominis, while 16.2% of the cultures could not be classified with definite ecovars. Most of the strains (71.4%) were found to differ from the known ecovars of S. aureus in their biological properties. For this reason, the above strains were classified with the new ecovar asinae. The authors propose to make the existing S. aureus identification scheme (the scheme of Mayer-Witte--Akatov) more complete by adding the tests for hyaluronidase and phosphatase.     

2013年医院住院患者院内感染调查与分析

目的了解大连大学附属新华医院各主要科室院内感染发生情况及其致病菌的分布及耐药性情况,为临床制定医院感染控制措施提供参考依据。方法对2013年该院住院患者院内感染发生情况、感染病原菌分布及耐药性情况进行回顾性分析。结果全年合计住院10 985例,发生医院感染368例,医院感染发生率为3.35%。医院感染病例中60岁占3.86%。感染部位以呼吸道为主,占73.10%;ICU病房院内感染发生率最高,占15.30%。全年检测标本10 205份,检出致病菌421株,其中多重耐药菌79株,占致病菌总数的18.76%。分离多重耐药菌主要种类依次为产ESBLs大肠埃希菌、耐甲氧西林金黄色葡萄球菌、产ESBLs肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌。结论大连大学院附属新华医院院内感染率低于国内综合性医院,病原菌耐药现状不容乐观;应加强临床抗菌药物管理和细菌耐药性监测,减少耐药菌株的产生及扩散。     

The Mechanism of Heterogeneous Beta-Lactam Resistance in MRSA: Key Role of the Stringent Stress Response

All methicillin resistant S. aureus (MRSA) strains carry an acquired genetic determinant – mecA or mecC - which encode for a low affinity penicillin binding protein –PBP2A or PBP2A′ – that can continue the catalysis of peptidoglycan transpeptidation in the presence of high concentrations of beta-lactam antibiotics which would inhibit the native PBPs normally involved with the synthesis of staphylococcal cell wall peptidoglycan. In contrast to this common genetic and biochemical mechanism carried by all MRSA strains, the level of beta-lactam antibiotic resistance shows a very wide strain to strain variation, the mechanism of which has remained poorly understood. The overwhelming majority of MRSA strains produce a unique – heterogeneous – phenotype in which the great majority of the bacteria exhibit very poor resistance often close to the MIC value of susceptible S. aureus strains. However, cultures of such heterogeneously resistant MRSA strains also contain subpopulations of bacteria with extremely high beta-lactam MIC values and the resistance level and frequency of the highly resistant cells in such strain is a characteristic of the particular MRSA clone. In the study described in this communication, we used a variety of experimental models to understand the mechanism of heterogeneous beta-lactam resistance. Methicillin-susceptible S. aureus (MSSA) that received the mecA determinant in the laboratory either on a plasmid or in the form of a chromosomal SCCmec cassette, generated heterogeneously resistant cultures and the highly resistant subpopulations that emerged in these models had increased levels of PBP2A and were composed of bacteria in which the stringent stress response was induced. Each of the major heterogeneously resistant clones of MRSA clinical isolates could be converted to express high level and homogeneous resistance if the growth medium contained an inducer of the stringent stress response.     

Phagocytosis of chloramine B sensitive and resistant staphylococci isolated from healthy persons and patients

Phagocytic reaction with respect to antibiotic and chloramine B sensitive and resistant staphylococci isolated from healthy persons and patients, air and stock of medical institutions was studied on albino mice. It was shown that the staphylococcal isolates included strains simultaneously sensitive to antibiotics and chloramine, sensitive to antibiotics and resistant to chloramine, resistant to antibiotics and sensitive to chloramine and simultaneously resistant to antibiotics and chloramine. Activity, intensity and completeness of phagocytosis by leucocytes from mouse abdominal cavity exudates with respect to the staphylococcal strains sensitive to antibiotics and resistant to chloramine, resistant to antibiotics and sensitive to chloramine and simultaneously resistant to antibiotics and chloramine were lower than the values of the phagocytic reaction with respect to the isolates simultaneously sensitive to antibiotics and chloramine. This suggested that not only antibiotic resistance of microbes but also their resistance to disinfectants could be referred to complicating factors of hospital infections.     

Chlorhexidine resistance and the lipids of Providencia stuartii

The lipid composition of Providencia stuartii has been shown to resemble closely that of Proteus mirabilis. The ability of some Pv, stuartii strains to survive exposure to high concentrations of the antiseptic chlorhexidine could not be explained in terms of differences in lipid content between sensitive and resistant strains. In addition, resistance could not be attributed to either reduced adsorption of the antiseptic or to its gross enzymic degradation.     

Streptococcus group A resistance to tetracycline: its spread and transduction]

The study on antibiotics resistance of group A streptococci isolated in 1977 showed that the number of the antibiotic resistant strains had significantly increased as compared to the data of 1960. High percentage (53%) of the cultures with multiple resistance was noted. It was observed that the number of the streptococcal cultures resistant to erythromycin and chloramphenicol decreased while the number of the strains resistant to tetracyclines increased. The level of resistance to tetracycline increased more than 2 times from 1960 and in some cases reached 125 and 250 gamma/ml. The wide spread of tetracycline resistance was evident of the presence of the mechanism of the marker transduction. Possible transduction of this feature was studied. Microbe-free phagolysates obtained by induction with UV-light from the strains with multiple antibiotic resistance were used as the donor material in the experiment on transduction. Principal possibility of transducing resistance to tetracycline from 2 donors to 4 recipients at a frequency of 10(-6) was shown.