Archive for June, 2010

Increase in Pneumococcus Macrolide Resistance, USA

Emerging Infectious Diseases May 2010  V.16  N.5  p.896-897


Lauri A. Hicks,  Dominique L. Monnet, and Rebecca M. Roberts

Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L.A. Hicks, R.M. Roberts); and European Centre for Disease Prevention and Control, Stockholm, Sweden (D.L. Monnet)

To the Editor: Jenkins and Farrell reported an increase in the proportion of macrolide-resistant Streptococcus pneumoniae isolates in the United States (1). They mentioned increased use and inappropriate prescription of macrolides as potential explanations for the increase in macrolide resistance and expressed doubts, stating “which (if any) of these factors might explain the trends here are not clear.” Although the spread of antimicrobial drug resistance is a complex issue with many contributing factors, we believe that the role of macrolide use should not be understated….

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June 29, 2010 at 5:46 pm Leave a comment

Multihospital Outbreak of Clostridium difficile Infection, Cleveland, Ohio, USA

Emerging Infectious Diseases May 2010  V.16  N.5  p.827-829

Robin L.P. Jump, Michelle M. Riggs, Ajay K. Sethi, Michael J. Pultz, Tracie Ellis-Reid, William Riebel, Dale N. Gerding, Robert A. Salata, and Curtis J. Donskey

University Hospitals of Cleveland, Cleveland, Ohio, USA (R.L.P. Jump, R.A. Salata); Cleveland Veterans Affairs Medical Center, Cleveland (M.M. Riggs, M.J. Pultz, T. Ellis-Reid, C.J. Donskey); Case Western Reserve University, Cleveland (A.K. Sethi); Lakewood Hospital, Lakewood, Ohio, USA (W. Riebel); Hines Veterans Affairs Hospital, Hines, Illinois, USA (D.N. Gerding); and Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA (D.N. Gerding)


To determine whether a multihospital Clostridium difficile outbreak was associated with epidemic strains and whether use of particular fluoroquinolones was associated with increased infection rates, we cultured feces from C. difficile–infected patients. Use of fluoroquionolones with enhanced antianaerobic activity was not associated with increased infection rates.

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June 29, 2010 at 5:43 pm Leave a comment

Rapid Influenza Antigen Test for Diagnosis of Pandemic (H1N1) 2009

Emerging Infectious Diseases May 2010  V.16  N.5  p.824-826

Janice K. Louie,  Hugo Guevara, Erica Boston, Melissa Dahlke, Maria Nevarez, Tong Kong, Robert Schechter, Carol A. Glaser, and David P. Schnurr

California Department of Public Health, Richmond, California, USA


We compared the QuickVue Influenza test with PCR for diagnosing pandemic (H1N1) 2009 in 404 persons with influenza-like illness. Overall sensitivity, specificity, and positive and negative predictive values were 66%, 84%, 84%, and 64%, respectively. Rapid test results should be interpreted cautiously when pandemic (H1N1) 2009 virus is suspected.

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June 29, 2010 at 5:41 pm Leave a comment

Guidelines for Using the QuantiFERON®-TB Test for Diagnosing Latent Mycobacterium tuberculosis Infection

MMWR Recommendations and Reports Jan 31, 2003  V.52  N.RR2 p.15-18

Prepared by Gerald H. Mazurek, M.D. Margarita E. Villarino, M.D. Division of Tuberculosis Elimination National Center for HIV, STD, and TB Prevention

Until 2001, the only test used to diagnose latent tuberculosis infection (LTBI) was the tuberculin skin test (TST). However, in 2001, a new test (QuantiFERON®-TB or QFT; manufactured by Cellestis Limited, Carnegie, Victoria, Australia) that measures the release of interferon-gamma in whole blood in response to stimulation by purified protein derivative was approved by the Food and Drug Administration. This statement provides interim recommendations for using and interpreting QFT. As with TST, interpretation and indicated applications of QFT differ for persons according to their risk for LTBI and for developing tuberculosis (TB). This report provides guidance for public health officials, health-care providers, and laboratorians with responsibility for TB control activities in the United States in their efforts to incorporate QFT testing for detecting and treating LTBI. Regardless of the test used to identify LTBI, testing should be primarily targeted at diagnosing infected patients who will benefit from treatment.

In 2001, the QuantiFERON®-TB test (QFT) (manufactured by Cellestis Limited, Carnegie, Victoria, Australia) was approved by the Food and Drug Administration (FDA) as an aid for detecting latent Mycobacterium tuberculosis infection (1). This test is an in vitro diagnostic aid that measures a component of cell-mediated immune reactivity to M. tuberculosis. The test is based on the quantification of interferon-gamma (IFN-gamma) released from sensitized lymphocytes in whole blood incubated overnight with purified protein derivative (PPD) from M. tuberculosis and control antigens….

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June 29, 2010 at 5:40 pm Leave a comment

Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase — United States, 2010

MMWR JUNE 2010 V.59  N.24  p.750

During January–June 2010, three Enterobacteriaceae isolates carrying a newly described resistance mechanism, the New Delhi metallo-beta-lactamase (NDM-1) (1), were identified from three U.S. states at the CDC antimicrobial susceptibility laboratory. This is the first report of NDM-1 in the United States, and the first report of metallo-beta-lactamase carriage among Enterobacteriaceae in the United States. These isolates, which include an Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, carry blaNDM-1, which confers resistance to all beta-lactam agents except aztreonam (a monobactam antimicrobial) (1); all three isolates were aztreonam resistant, presumably by a different mechanism. In the United Kingdom, where these organisms are increasingly common, carriage of Enterobacteriaceae containing blaNDM-1 has been closely linked to receipt of medical care in India and Pakistan (2). All three U.S. isolates were from patients who received recent medical care in India…

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June 27, 2010 at 8:35 pm Leave a comment

Susceptibility of Gram-Negative Pathogens Isolated from Patients with Complicated Intra-Abdominal Infections in the United States, 2007-2008: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART)

Antimicrob. Agents Chemother. 1 July 2010  V.54  N.7  p.3031-3034

Daryl J. Hoban,1* Samuel K. Bouchillon,1 Stephen P. Hawser,2 Robert E. Badal,1 Vincent J. LaBombardi,3 and Joseph DiPersio4

International Health Management Associates, Inc., Schaumburg, Illinois,1 IHMA Europe Sàrl, 1066 Epalinges, Switzerland,2 Mount Sinai Medical Center, New York, New York,3 Akron City Hospital, Akron, Ohio4

During 2007-2008, 1,036 Gram-negative bacilli were isolated from patients with complicated intra-abdominal infections in the United States. Against members of the family Enterobacteriaceae, the most active agents in vitro were ertapenem, imipenem, and amikacin, while the least active agent was ampicillin-sulbactam. Ertapenem and imipenem were active against all extended-spectrum-beta-lactamase (ESBL)-positive Escherichia coli. Antimicrobial resistance in Gram-negative bacilli isolated from patients with complicated intra-abdominal infections in the United States continues to increase.


June 27, 2010 at 8:33 pm Leave a comment

Antimicrobial Resistance among Respiratory Pathogens in Spain: Latest Data and Changes over 11 Years (1996-1997 to 2006-2007)

Antimicrob. Agents Chemother. 1 July 2010  V.54  N.7  p.2953-2959

Emilio Pérez-Trallero,1 Jose E. Martín-Herrero,2 Ana Mazón,3 Celia García-Delafuente,4 Purificación Robles,5 Victor Iriarte,2* Rafael Dal-Ré,2 Juan García-de-Lomas,6 the Spanish Surveillance Group for Respiratory Pathogens

Department of Microbiology and CIBERES, Hospital Donostia, San Sebastián, Gipuzkoa, Spain,1 Medical Department, GlaxoSmithKline S.A., Tres Cantos, Madrid, Spain,2 Department of Microbiology, Centro San Martin, Pamplona, Spain,3 Department of Microbiology, Hospital Marqués de Valdecilla, Santander, Spain,4 Department of Microbiology, Hospital General Universitario, Albacete, Spain,5 Department of Microbiology, Hospital Universitario, School of Medicine and Valencian Institute for Microbiology, Valencia, Spain6

A nationwide multicenter susceptibility surveillance study (Susceptibility to the Antimicrobials Used in the Community in España [SAUCE] project), SAUCE-4, including 2,559 Streptococcus pneumoniae, 2,287 Streptococcus pyogenes, and 2,736 Haemophilus influenzae isolates was carried out from May 2006 to June 2007 in 34 Spanish hospitals. Then, the results from SAUCE-4 were compared to those from all three previous SAUCE studies carried out in 1996-1997, 1998-1999, and 2001-2002 to assess the temporal trends in resistance and the phenotypes of resistance over the 11-year period. In SAUCE-4, on the basis of the CLSI breakpoints, penicillin (parenteral, nonmeningitis breakpoint) and cefotaxime were the antimicrobials that were the most active against S. pneumoniae (99.8% and 99.6%, respectively). Only 0.9% of isolates had a penicillin MIC of 2 µg/ml. In S. pyogenes, nonsusceptibility to erythromycin was observed in 19.4% of isolates. Among the H. influenzae isolates, a β-lactamase-positive prevalence of 15.7% was found. A statistically significant temporal decreasing trend over the 11-year period was observed for nonsusceptibility (from 60.0% to 22.9%) and resistance (from 36.5% to 0.9%) to penicillin and for the proportion of erythromycin-resistant isolates of S. pneumoniae of the macrolide-lincosamide-streptogramin B (MLSB) phenotype (from 98.4% to 81.3%). A similar trend was observed for the prevalence of ampicillin resistance (from 37.6% to 16.1%), β-lactamase production (from 25.7% to 15.7%), and β-lactamase-negative ampicillin resistance (BLNAR) in H. influenzae (from 13.5% to 0.7%). Among erythromycin-resistant isolates of S. pyogenes, a significant increasing trend in the prevalence of MLSB was observed (from 7.0% to 35.5%). SAUCE-4 confirms a generalized decline in the resistance of the main respiratory pathogens to the antimicrobials as well as a shift in their resistance phenotypes.


June 27, 2010 at 8:31 pm Leave a comment

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