phenylephrine-hydrochloride and Endocarditis--Bacterial

Topics: Acne Vulgaris; Animals; Bacteria; Celiac Disease; Cholic Acids; Colonic Neoplasms; Dental Caries; Digestive System; Endocarditis, Bacterial; Humans; Immunity; Mouth; Nose; Pharynx; Propionibacterium acnes; Skin; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus

Most Staphylococcus aureus small-colony variants (SCVs) are auxotrophs for menadione, hemin, or thymidine but rarely for CO(2). We conducted a prospective investigation of all clinical cases of CO(2)-dependent S. aureus during a 3-year period. We found 14 CO(2)-dependent isolates of S. aureus from 14 patients that fulfilled all requirements to be considered SCVs, 9 of which were methicillin resistant. The clinical presentations included four cases of catheter-related bacteremia, one complicated by endocarditis; two deep infections (mediastinitis and spondylodiscitis); four wound infections; two respiratory infections; and two cases of nasal colonization. Pulsed-field gel electrophoresis typing showed that the 14 isolates were distributed into 4 types corresponding to sequence types ST125-agr group II (agrII), ST30-agrIII, ST34-agrIII, and ST45-agrI. An array hybridization technique performed on the 14 CO(2)-dependent isolates and 20 S. aureus isolates with normal phenotype and representing the same sequence types showed that all possessed the enterotoxin gene cluster egc, as well as the genes for alpha-hemolysin and delta-hemolysin; biofilm genes icaA, icaC, and icaD; several microbial surface components recognizing adhesive matrix molecules (MSCRAMM) genes (clfA, clfB, ebh, eno, fib, ebpS, sdrC, and vw); and the isaB gene. Our study confirms the importance of CO(2)-dependent SCVs of S. aureus as significant pathogens. Clinical microbiologists should be aware of this kind of auxotrophy because recovery and identification are challenging and not routine. Further studies are necessary to determine the incidence of CO(2) auxotrophs of S. aureus, the factors that select these strains in the host, and the genetic basis of this type of auxotrophy.

Topics: Aged; Bacteremia; Bacterial Typing Techniques; Carbon Dioxide; Carrier State; Catheter-Related Infections; Discitis; DNA Fingerprinting; Electrophoresis, Gel, Pulsed-Field; Endocarditis, Bacterial; Genotype; Humans; Male; Mediastinitis; Microarray Analysis; Middle Aged; Nose; Respiratory Tract Infections; Staphylococcal Infections; Staphylococcus aureus; Virulence Factors; Wound Infection

We have developed a multiplex PCR procedure to determine the distribution of nine adhesin genes in Staphylococcus aureus isolates. Only genes encoding bone sialoprotein binding protein and fibronectin binding protein B were significantly associated with hematogenous osteomyelitis/arthritis and native-valve endocarditis, respectively, suggesting their involvement in hematogenous tissue infections.

Topics: Adhesins, Bacterial; Arthritis, Infectious; Bacterial Proteins; Carrier Proteins; Coagulase; Endocarditis, Bacterial; Humans; Nose; Osteomyelitis; Polymerase Chain Reaction; Sensitivity and Specificity

Topics: Adolescent; Endocarditis, Bacterial; Female; Humans; Nose; Staphylococcal Infections

In vitro collagen binding of 216 Staphylococcus aureus isolates from patients with various diagnoses was studied. Polymerase chain reaction was used to examine these isolates regarding the existence of the corresponding cna gene. Distribution of capsular polysaccharide (CP) types was examined. Fifty-six (57%) of 99 S. aureus isolates from patients with endocarditis or bacteremic bone or joint infection were cna-positive compared with 65 (56%) of 117 isolates from bacteremic patients without signs of bone or joint infection (P = .99). There was a good correlation between in vitro collagen binding and presence of the cna gene. These data suggest that collagen binding is not a prerequisite for the development of endocarditis, osteomyelitis, or septic arthritis. There was no significant difference in the distribution of CP types among various patient groups, although there was a strong association between CP type 8 and the existence of the cna gene.

Topics: Antibodies, Bacterial; Antigens, Bacterial; Bacteremia; Bone Diseases, Infectious; Carrier Proteins; Carrier State; Collagen; Endocarditis, Bacterial; Gene Expression; Genes, Bacterial; Humans; Joint Diseases; Nose; Polymerase Chain Reaction; Polysaccharides, Bacterial; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

To determine the prevalence and clonality of non-toxigenic Corynebacterium diphtheriae biovar gravis in a community with two cases of endocarditis caused by this organism.. A Koorie (Aboriginal) community in Gippsland, eastern Victoria, in 1994.. Nose and throat swabs were collected from 359 community contacts of the cases and cultured for C. diphtheriae. Strains isolated from the contacts were compared by pulsed-field gel electrophoresis (after digestion with Sma1, Not1 and Sfi1) with those from the invasive cases in the same community, another invasive case in Victoria, a cluster of invasive cases in New South Wales (NSW) (1990-1991), and other stored strains isolated from skin ulcers and sore throats.. Non-toxigenic strains of C. diphtheriae biovar gravis were isolated from throat swabs of five of the case contacts. Uniform DNA patterns were found for the two community cases, the other Victorian case, nine of ten isolates from NSW, and the five throat isolates from case contacts.. An invasive clone of C. diphtheriae biovar gravis appears to have been responsible for the three Victorian cases of endocarditis. It was also present among case contacts and responsible for previous invasive cases in NSW. Prophylactic treatment should be considered for clearly defined contacts in all instances where C. diphtheriae is isolated from a normally sterile site, regardless of the toxigenic nature of the strain.

Topics: Adult; Arthritis, Infectious; Australia; Carrier State; Child; Chronic Disease; Corynebacterium diphtheriae; Corynebacterium Infections; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Nose; Pharynx; Prevalence; Skin Ulcer

Cultures of nasal or presternal swabs form part of the routine preoperative screening of patients on the cardiac surgical ward. During a trial of antibiotic prophylaxis in 314 patients, preoperative isolates of Staphylococcus aureus and coagulase-negative staphylococci were compared with strains associated with postoperative sternal wound breakdown (24 patients) and prosthetic valve endocarditis (3 patients). Morphology, antibiotic sensitivity pattern, plasmid analysis and phage typing were used to differentiate strains. In only three cases of wound infection and one of prosthetic valve endocarditis were pathogenic staphylococci not distinguishable from preoperative isolates. The collection of superficial swabs for this purpose before cardiac surgery is therefore unlikely to be cost effective.

Topics: Cardiac Surgical Procedures; Endocarditis, Bacterial; Humans; Nose; Postoperative Complications; Premedication; Preoperative Care; Skin; Staphylococcal Infections; Staphylococcus; Sternum; Surgical Wound Infection

Topics: Bacteria; Drainage; Endocarditis, Bacterial; Humans; Nasal Mucosa; Nasopharynx; Nose; Prospective Studies; Sepsis; Time Factors; Trachea