Synergy of Vancomycin with Penicillins and Cephalosporins Against Pseudomonas,Klebsiella, and Serratia

A model of antibiotic synergy based on a molecular mechanism of action which blocked sequential steps in a single metabolic pathway was tested. Twenty-five strains each of Pseudomonas, Klebsiella, and Serratia were tested in vitro against three different two drug combinations of vancomycin, carbenicillin, or cephalothin. Synergy was observed when vancomycin was combined with either carbenicillin or cephalothin against isolates of Pseudomonas or Serratia, whereas the combination of carbenicillin and cephalothin did not result in significant synergy against these isolates. The presence of synergy was not related to the sensitivity or resistance of the isolates to the drugs in the combination. Synergy was also observed with all three antibiotic combinations against Klebsiella isolates which may be related to enzyme inactivation by one of the drugs in the combination. These observations support the hypothetical model of antibiotic synergy based on sequential blocking of one biochemical pathway.     

Amikacin resistance of clinical strains of Enterobacteriaceae and Pseudomonas]

Amikacin resistance was studied in 380 bacterial strains of Enterobacter, Klebsiella, Serratia, Pseudomonas and E. coli isolated in clinics of the Moscow Region. It was shown that 69 isolates were resistant to amikacin. Plasmid DNA was detected in 10 amikacin resistant isolates. Three of them belonging to Klebsiella and 3 belonging to E. coli contained plasmids controlling resistance to amikacin. The plasmids isolated from the strains of Klebsiella determined as well resistance to kanamycin and streptomycin but did not control resistance to sisomicin, tobramycin and gentamicin while the plasmids isolated from the strains of E. coli determined resistance to amikacin, kanamycin, gentamicin, tobramycin and sisomicin.     

Comparative activity of tobramycin and gentamicin against Pseudomonas,Proteus and Providencia species.

Tobramycin is a new antibiotic resembling gentamicin. We measured the minimal inhibitory concentrations of these two antibiotics against five bacterial species that cause hospital-acquired infections and are resistant to many presently available antibiotics. The organisms tested were 500 strains of Pseudomones aeruginosa, 100 strains of each of Proteus rettgeri and Pr. morganii, 50 strains of Pr. vulgaris and 250 strains of Providencia stuartii. Tobramycin was 2 to 4 times more active than gentamicin against Ps. aeruginosa; all except 6 of 70 strains resistant to 4 mug/ml of gentamicin were sensitive to 4 mug/ml of tobramycin. The two antibiotics showed a similar degree of activity against the other four species. Tobramycin promises to be of particular value in the treatment of Pseudomonas infections.     

Semisynthetic Penicillin 6-[d(—)-α-Carboxy-3-Thienylacetamido] Penicillanic Acid Active Against Pseudomonas In Vitro

The activity of 6-[d(-)-alpha-carboxy-3-thienylacetamido] penicillanic acid, BRL2288, was determined against Pseudomonas aeruginosa and various gram-negative bacilli. The majority of Pseudomonas strains (89%) were inhibited by 100 mug of the antibiotic per ml. BRL2288 is twofold more active than carbenicillin against Pseudomonas at 100 mug/ml or less. Among Enterobacteriaceae tested, 87% Enterobacter and 87% of Proteus mirabilis strains were inhibited by 25 mug/ml or less. Indole-positive Proteus were inhibited by 10 mug/ml or less. Fifty-five per cent of ampicillin-resistant Escherichia coli were inhibited by 100 mug/ml. Klebsiella were uniformly resistant. BRL2288 is not hydrolyzed by most resistant Pseudomonas, but it is destroyed by the beta-lactamases of E. coli and P. mirabilis. The antibiotic shows synergy with gentamicin but not with penicillinase-resistant penicillins such as cloxacillin. Activity of BRL2288 against gram-positive organisms is two- to eightfold less than that of ampicillin or benzylpenicillin G.     

Antibiotic susceptibility and molecular mechanisms of cephalosporins resistance in Klebsiella isolates from patients with hospital-acquired infections]

Antibiotic susceptibility of nosocomial Klebsiella isolates from inpatients of 30 medical centres in 15 various regions of Russia was studied. In total 212 strains were tested. The Klebsiella genus was represented by the following species: Klebsiella pmeumoniae ss. pneumoniae (182 isolates, 85.8%), Klebsiella pneumonia ss. ozaenae (1 isolate, 0.5%), Klebsiella oxytoca (29 isolates, 13.7%). The susceptibility was determined by the broth microdilution method. Carbapenems (imipenem and meropenem) remained to be the most active antibacterial agents. However, 1 imipenem resistant strain and 2 meropenem resistant strains were isolated. As for the 3rd generation cephalosporins, the lowest MICs were observed with the use of the inhibitor-protected agents, such as ceftazidime/clavulanic acid (MIC50 0.25 mcg/ml, MIC90 64 mcg/ml). 48.8%, 16.9%, 29.7% and only 10.5% of the isolates was susceptible to cefepime, cefotaxime, ceftazidime and cefoperazone respectively. Detecting of the beta-lactamase genes (TEM, SHV and CTX) was performed by PCR in 42 strains of Klebsiella pneumoniae ss. pneumoniae. Alone or in various combination the TEM type beta-lactamases were detected in 16 (38.1%) isolates. SHV and CTX were detected in 29 (69%) and 27 (64.3%) isolates respectively. Combinations of 2 and 3 different determinants of resistance to beta-lactams were revealed in 23.8% and 26.2% of the isolates respectively. No isolates producing class B MBL among the carbapenem resistant nosocomial Klebsiella strains were detected.     

Resistance to antibiotics, metals, hydrophobicity and klebocinogeny of Klebsiella pneumoniae isolated from foods.

Milk samples and milk products (69 in toto) were screened for the presence of Klebsiella pneumoniae (52%), and maximum isolations (77%) were from ice cream samples (13). The isolates were hydrophobic, non-haemolytic and possessed both mannose resistant (MR) and mannose sensitive (MS) pili or only MR pili when tested with human or sheep blood, respectively. All isolates were resistant to one metal at least whereas about 98% exhibited resistance to two or more metal ions. The resistance frequency of 93%, 90% and 66.7% was observed against silver (20 micrograms/ml), cadmium (20 micrograms/ml) and mercuric ions (20 micrograms/ml), respectively. Multiple drug resistance (MDR) was observed in 10% of the isolates only. A direct correlation between the metal ion and antibiotic resistance was found in MDR strains. The klebocin typeability of 53% and 61% was observed with 153-158 and 153-156, U-5 and U-6 groups, respectively. The most common typing patterns involved strains 424 (21%) and 442 (31.8%). Only 61% of the isolates showed enterotoxigenicity by the coagglutination test.     

In vitro antibacterial activity of a new 1-oxa cephalosporin compound

The in vitro activity of a unique new 1-oxa cephalosporin beta-lactam antibiotic (LY 127935) was tested against clinical isolates of gram-positive and gram-negative bacteria and compared with the activities of cefoxitin, cefamandole, cephalothin, clindamycin, amikacin, tobramycin, gentamicin, ticarcillin, and carbenicillin. The new compound was observed to have a broad spectrum of antibacterial activity which far exceeded the activity of older cephalosporins against aerobic gram-negative enteric bacilli. This new compound was the most active drug tested against Klebsiella, Serratia, Enterobacter, indole-negative and positive Proteus species, and E. coli. Against clinical isolates of Pseudomonas species the new compound was more active than cefoxitin, cefamandole, cephalothin, and clindamycin, comparable to ticarcillin and carbenicillin, and less active than gentamicin, tobramycin, and amikacin. Yet, most of the Pseudomonas isolates were inhibited by 16 micrograms/ml of the new compound. Against both beta-lactamase and non beta-lactamase producing Staphylococcus aureus isolates, the new 1-oxa compound was less active than the older cephalosporins of which cephalothin and cefamandole were the most effective. The 1-oxa compound had no appreciable activity against isolates of Streptococcus faecalis. Activity of all four cephalosporins studied was decreased in the presence of an increased inoculum of Enterobacteriaceae in trypticase soy and Mueller-Hinton broth. The activity of the new compound against Pseudomonas species was also decreased by an increased inoculum in Mueller-Hinton but not in trypticase soy broth. These results indicate that this new 1-oxa compound may have great promise as a broad spectrum antibiotic and may warrant controlled clinical trials in man.     

Chemical composition and antimicrobial activity of Satureja hortensis L. essential oil

Essential oil of Satureja hortensis L. was analyzed by GC and GC/MS and tested by a broth micro-well dilution method for activity against multiresistant clinical isolates of pathogenic bacteria from 10 different genera: Klebsiella, Escherichia, Proteus, Staphylococcus, Streptococcus, Pseudomonas, Enterococcus, Enterobacter, Citrobacter and Acinetobacter. The main compounds in the oil were carvacrol (67%), γ-terpinene (15.3%) and p-cymene (6.73%). The oil showed activity against all tested strains. MIC/MBC values were in the range of 0.78-25 μl/ml, with the exception of the strain P. aeruginosa. Microbicidal concentration for this particular strain (50 μl/ml) was the highest tested concentration. The oil showed inhibitory and bactericidal effect at the same concentration (MIC=MBC) for all but three strains.     

Cephapirin: In Vitro Antibacterial Spectrum

Cephapirin, a new semisynthetic cephalosporin derivative, was found to have an antibacterial spectrum similar to that of cephalothin. Staphylococcus aureus was inhibited by cephapirin concentrations of 0.09 to 12.5 mug/ml. S. epidermidis, S. viridans, S. pyogenes, and Diplococcus pneumonia isolates were inhibited by less than 1 mug/ml. The Enterococcus required a concentration of 25 mug of antibiotic per ml for inhibition. Approximately 65% of Escherichia coli, and all Klebsiella, indole-negative Proteus, and Salmonella strains tested were inhibited by the drug. Serratia, Pseudomonas, indole-positive Proteus, and Erwinia strains were highly resistant. Inoculum size was not an important factor in determining the level of sensitivity of S. aureus to cephapirin. The antibiotic does not appear to be significantly bound to serum protein. In vitro development of resistance to the drug was demonstrated with two isolates of S. aureus.     

Antibiotic synergy against biofilm-forming <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis>

Eight antibiotics (aztreonam, ceftazidim, cefoperazon, cefepim, netilmicin, amikacin, ofloxacin and ciprofloxacin) exhibited antimicrobial activity individually and/or in combinations against 20 wild-type biofilm-forming strains of Pseudomonas aeruginosa. The strains were less susceptible in biofilm; in 10 strains antibiotic synergy was observed for the combination of aztreonam and ciprofloxacin. Synergy was also demonstrated in the case of β-lactams and aminoglycosides, β-lactams and fluoroquinolones, aminoglycosides and fluoroquinolones, and for monobactams and β-lactams although the strains were resistant to the individual antibiotics. Synergism or partial synergism was found with one or more antibiotic combinations against 32.4% of isolates.     

临床分离肺炎克雷伯菌Ⅰ整合子分布及其与qnr基因关系研究

目的 了解临床分离肺炎克雷伯菌中qnr基因和Ⅰ类整合子基因的分布及其耐药特征.方法 采用PCR法对45株耐环丙沙星肺炎克雷伯菌进行qnrA、qnrB、qnrS基因筛查并测序,用PCR法检测qnr阳性菌株Ⅰ类整合子基因,并采用SPSS 13.0和Whonet 5.4软件分析药敏结果及比较.结果 45株肺炎克雷伯菌中,24株(51.1％)细菌检出qnrS基因,未检出qnrA和qnrB基因.20株qnr阳性菌株同时携带Ⅰ类整合子基因.qnr阳性菌株Ⅰ类整合子基因携带率显著高于阴性菌株,qnr阳性菌株对阿米卡星、妥布霉素、亚胺培南、哌拉西林/他唑巴坦及头孢哌酮舒巴坦的敏感性较高.结论 肺炎克雷伯菌对氟喹诺酮类抗菌药物耐药主要由qnrS引起,qnr阳性株同时携带Ⅰ类整合子,导致呈现多重耐药性,加强临床耐药监测对控制多重耐药传播有着重要的意义.     

Tobramycin (Nebramycin Factor 6): In Vitro Activity Against Pseudomonas aeruginosa

Tobramycin (factor 6 of the nebramycin complex) is a new aminoglycoside antibiotic isolated from Streptomyces tenebrarius which is active against S. aureus, Enterobacteriaceae, and Pseudomonas aeruginosa. Susceptibility to tobramycin of 96 strains of P. aeruginosa, including 45 recent isolates from blood, was studied by using agar and broth dilution methods. The minimum inhibitory concentration (MIC) for 83 of 96 strains was 3.12 mug/ml or lower in Mueller Hinton agar; MIC values were two to eight times lower in Mueller Hinton broth tests. Agar dilution MIC values were generally lower than those obtained in parallel tests with gentamicin. Killing curves obtained from serial sampling of broth cultures showed a 100- to 10,000-fold decline in viability of log-phase organisms within 30 min of exposure to the drug. Two-dimensional agar dilution tests with carbenicillin and tobramycin with 79 strains showed additive or synergistic effects; no antagonism was documented. Seventy-eight of 79 strains were inhibited by a combination of 50 mug of carbenicillin per ml and 1.56 mug of tobramycin per ml, blood levels which seem attainable in man. Tobramycin appears to be a potent, rapidly bactericidal antibiotic against P. aeruginosa and merits clinical evaluation.     

In Vitro Activity of Carbenicillin Against Gram-negative Bacilli

The activity of a new semisynthetic penicillin, carbenicillin, was determined against 241 strains of gram-negative bacilli with the tube-dilution technique. Of 143 strains of Pseudomonas sp., 99 had a minimal inhibitory concentration of 200 to 300 mug/ml. The majority of strains of Escherichia coli and Proteus spp. were sensitive to this antibiotic, with minimal inhibitory concentrations of 25 mug/ml or less. Strains of Klebsiella sp. were quite resistant to carbenicillin. The size of inoculum had no significant effect on the minimal inhibitory concentration for Pseudomonas sp.     

临床分离肺炎克雷伯菌耐药性监测

目的了解临床分离肺炎克雷伯菌的耐药性,为临床合理应用抗菌药物提供实验室依据。方法采用微量稀释法对392例临床分离肺炎克雷伯菌进行药物敏感性测定;超广谱β-内酰胺酶(Extendedspectrumbeta-lactamases,ESBLs)检测用微量稀释法初筛,纸片法做确证试验。结果肺炎克雷伯菌对18种抗菌药物的药敏结果中,耐药率大于30%的抗菌药物多达11种;其中氨苄西林-舒巴坦、氨苄西林、头孢噻吩、哌拉西林、复方新诺明和头孢唑啉的耐药率高达20%以上。耐药率低于10%的抗菌药物仅有4种,分别为头孢曲松(7.7%)、头孢噻肟(7.4%)、氨曲南(6.9%)和亚胺培南(3.1%)。其它抗菌药物的耐药率都高于10%。产ESBLs菌株的发生率为32.9%～45.8%,平均为39.8%;产ESBLs菌株对多种抗菌药物的耐药率显著高于非产ESBLs菌株(P<0.05)。结论临床分离肺炎克雷伯菌对多种抗菌药物的耐药率较高,尤其是产ESBLs菌株的高耐药率及多重耐药性更为明显。临床应加强对肺炎克雷伯菌耐药性的监测并预防耐药菌株的传播流行。     

Time-kill study and synergistic activity of cell-wall inhibitor antibiotics in combination with gentamicin against Enterococcus faecalis and Enterococcus faecium

The synergy between gentamicin and vancomycin, teicoplanin, ampicillin and linezolid was studied by time-kill method. Two clinical vancomycin resistant enterococci (VRE) and two vancomycin susceptible enterococci (VSE) isolates were used. Different concentrations of antibiotics were combined. Two VSE strains and the control strain exhibited synergism with the combination of gentamicin, vancomycin, teicoplanin, ampicillin and linezolid. Two VRE strains exhibited synergism with the combination of gentamicin and ampicillin. Synergy between gentamicin and vancomycin, teicoplanin and linezolid was not observed against these isolates. The VRE isolates were positive for vanA, aac (6')-Ie aph (2") and aph (3')-IIIa genes and their vancomycin, teicoplanin and gentamicin MICs were 512 μg/ml, 512 μg/ml and >4000 μg/ml, respectively. In order to treat serious enterococcal infections, further clinical evaluation is needed to examine the in vitro combined effects of gentamicin and vancomycin, teicoplanin and linezolid.     

大肠埃希菌对22种抗生素耐药性分析

目的 :研究大肠埃希菌 (EC)对多种抗生素的耐药性。方法 :用 AMS法检测 173株 EC临床菌株的耐药性。结果 :EC对亚胺培南、头孢他啶、头胞噻肟、丁胺卡那霉素的耐药率为 1.2 %～ 3.5 % ,对氨曲南、头孢西丁、呋喃妥因的耐药率为 8.1%～ 10 .4% ,对头孢呋辛钠、头孢呋辛脂、妥布霉素、头孢噻吩的耐药率为 11.6 %～ 19.6 % ,对头孢唑啉、替卡西林 /克拉维酸、环丙沙星、头孢噻吩、庆大霉素、替卡西林和美洛西林的耐药率为 2 7.7%～ 5 9.0 % ,对哌拉西林、四环素、氨苄西林、羧苄西林的耐药率为 6 1.3%～ 76 .9%。在五类标本中 ,不同标本分离的 EC对 1～ 13种抗生素的耐药性差异有显著性 ,P<(0 .0 5 0～ 0 .0 0 5 )。在 2 2种抗生素中 ,15种抗生素对 2～ 6组配对标本分离 EC的敏感性差异有显著性 ,(P<(0 .0 5 0～ 0 .0 0 5 )。结论 :EC对亚胺培南、头孢他啶、头孢噻肟、丁氨卡那霉素的耐药率低 ,对羧苄西林、氨苄西林、四环素、哌拉西林的耐药率高 ,不同标本分离 EC对多种抗生素的耐药性差异有显著性。     

Aminoglycosides resistance in clinical isolates of Staphylococcus aureus from a University Hospital in Bialystok, Poland

Staphylococcus aureus obtained from a University Hospital in Poland were characterized in relation to resistance to aminoglycoside antibiotics and the distribution of the genes encoding the most clinically relevant aminoglycoside modifying enzymes (AMEs). Of a total of 118 S. aureus, 45 (38.1%) isolates were found to be resistant to at least one of the tested antibiotics. All aminoglycoside resistant isolates except one 44 (97.8%) were resistant to kanamycin. The majority of strains 37 (82.2%) and 32 (71.1%) expressed resistance to neomycin and tobramycin, respectively. Eleven strains (24.4%) were resistant to gentamicin or amikacin. All S. aureus strains were sensitive to netilmicin. The most prevalent resistance gene was aac(6')-Ie+aph(2') found in 13 (28.9%) strains and 12 (26.7%) isolates carried ant(4')-Ia gene, whilst aph(3')-IIIa gene was detected in only 7 (15.6%) isolates. Additionally, the ant(6)-Ia and str genes were detected in 14 (31.1%) and 2 (4.4%) strains, respectively. Ten (22.2%) strains resistant to amikacin, tobramycin, kanamycin or neomycin did not harbor any of the above-noted genes.     

In vitro Activity of Gatifloxacin Against 238 Strains of Anaerobic Bacteria

The activity of gatifloxacin, a new 8-methoxy-fluoroquinolone, was tested against 208 pulmonary pathogens and against an additional 30 isolates of the Bacteroides fragilis group. Pulmonary isolates were from patients with documented anaerobic pleuropulmonary infections and were obtained by appropriate sampling methods. MICs were determined using the NCCLS-approved Wadsworth brucella laked blood agar method and compared to those of clindamycin, imipenem, metronidazole and trovafloxacin. Breakpoints used to define susceptible and [resistant] categories were (in μg/ml): Clindamycin-2, imipenem-4, metronidazole 8 and trovafloxacin. No breakpoint has been defined for gatifloxacin. Gatifloxacin inhibited 99% of all anaerobes tested at 4 μg/ml and 97% of all strains at 2 μg/ml. One strain of B. fragilis was resistant to gatifloxacin at 4 μg/ml; all strains of other B. fragilis group species were susceptible. One strain of Peptostreptococcus sp. was resistant to both gatifloxacin and trovafloxacin (MIC >4 μg/ml). All other strains were susceptible to all agents at ≤μg/ml. All of the non-sporeforming Gram-positive rods were susceptible to gatifloxacin at ≤μg/ml (three strains had an MIC of 4 μg/ml). Trovafloxacin had MICs of 4 μg/ml for two strains, and an MIC of 8 μg/ml for one strain. Five percent of B. fragilis, 21% of other B. fragilis group species and 20% of Clostridium species (other than C. difficile, C. perfringens or C. ramosum) were resistant to clindamycin. No imipenem resistant isolates were found in this study. Gatifloxacin appears to have excellentin vitro activity against pulmonary isolates of anaerobes and very good activity against strains of the B. fragilis group.     

Coastal Seawater Bacteria Harbor a Large Reservoir of Plasmid-Mediated Quinolone Resistance Determinants in Jiaozhou Bay, China

Diversity and prevalence of plasmid-mediated quinolone resistance determinants were investigated in environmental bacteria isolated from surface seawater of Jiaozhou Bay, China. Five qnr gene alleles were identified in 34 isolates by PCR amplification, including qnrA3 gene in a Shewanella algae isolate, qnrB9 gene in a Citrobacter freundii isolate, qnrD gene in 22 Proteus vulgaris isolates, qnrS1 gene in 1 Enterobacter sp. and 4 Klebsiella spp. isolates, and qnrS2 gene in 1 Pseudomonas sp. and 4 Pseudoalteromonas sp. isolates. The qnrC, aac(6')-Ib-cr, and qepA genes could not be detected in this study. The 22 qnrD-positive Proteus vulgaris isolates could be differentiated into four genotypes based on ERIC-PCR assay. The qnrS1 and qnrD genes could be transferred to Escherichia coli J53 Azi(R) or E. coli TOP10 recipient strains using conjugation or transformation methods. Among the 34 qnr-positive isolates, 30 had a single point mutation in the QRDRs of GyrA protein (Ala67Ser, Ser83Ile, or Ser83Thr), indicating that cooperation of chromosome- and plasmid-mediated resistance contributed to the spread and evolution of quinolone resistance in this coastal bay. Eighty-five percent of the isolates were also found to be resistant to ampicillin, and bla(CMY), bla(OXY), bla(SHV), and bla(TEM) genes were detected in five isolates that also harbored the qnrB9 or qnrS1 gene. Our current study is the first identification of qnrS2 gene in Pseudoalteromonas and Pseudomonas strains, and qnrD gene in Proteus vulgaris strains. High prevalence of diverse qnr genes in Jiaozhou Bay indicates that coastal seawater may serve as an important reservoir, natural source, and dissemination vehicle of quinolone resistance determinants.     

A note on antibiotic resistance in the bacterial flora of raw sewage and sewage-polluted River Tigris in Mosul, Iraq

Polluted water samples collected from the River Tigris in the vicinity of a raw sewage outfall were examined for the incidence of antibiotic resistance among coliform bacteria on three occasions during 1983. Eighty percent or more of the coliform bacteria were resistant to one or more antibiotics. At the same time, raw sewage samples were examined for the incidence of antibiotic-resistant bacteria, and Escherichia coli, Pseudomonas spp. and Staphylococcus spp. were selected for sensitivity testing. Collectively, more than 90% of the 480 strains of the three organisms were resistant to one or more antibiotics. The minimal inhibitory concentration (MIC) of ampicillin for twenty-nine strains including coliforms, E. coli, Klebsiella sp., Serratia sp., Ps. aeruginosa, Pseudomonas sp., Micrococcus sp., Staph. aureus, Streptococcus faecalis and Bacillus sp. from raw sewage and polluted River Tigris water was determined and that for Ps. aeruginosa was 250 micrograms/ml. The high incidence of antibiotic-resistant bacteria in natural waters could be related to the widespread use of antibiotics in this locality.