Diabetic foot infections. Bacteriology and activity of 10 oral antimicrobial agents against bacteria isolated from consecutive cases.

Objective: To study the relative frequency of bacterial isolates cultured from community-acquired foot infections and assess their comparative in vitro susceptibility to sparfloxacin, levofloxacin, and eight other commonly used oral antimicrobial agents.

Research Design And Methods: This is a prospective study in which the infected wounds of 25 consecutive diabetic patients seen by one of the authors were cultured as they entered the hospital. Isolates were stored and tested for susceptibility to 10 oral antimicrobial agents using the agar dilution method.

United States National Hospital Survey of anaerobic culture and susceptibility methods, II.

To assess the status of clinical anaerobic bacteriology in the United States, we surveyed (by means of a questionnaire) 120 hospitals selected at random with bed capacities of 200-1000, and we received responses from 78 (65%), all of which performed some degree of clinical anaerobic microbiology. Separate anaerobic blood culture bottles were used by 73 labs (94%) (median, 450 specimens/mo): 56% used Bactec 7, 27 or 37; 15% used 'BacT-Alert'; 11% used Columbia broth; 5% used thioglycolate and 'lytic'; 3% each used, Dupont Isolator, Supplemented peptone or other media. Selective media was used for primary anaerobe isolation by 89% labs which included: LKV, 76%; PEA, 53%; BBE, 31%; CNA, 28%; 'CDC', 12%.

Identification and antimicrobial resistance patterns of clinical isolates of Clostridium clostridioforme, Clostridium innocuum, and Clostridium ramosum compared with those of clinical isolates of Clostridium perfringens.

Clostridium ramosum, C. innocuum, and C. clostridioforme are frequently isolated from clinical specimens including blood.

Outcome of therapy for sexually abused children: a repeated measures study.

The outcome of abuse-focused treatment was examined in a sample of 105 sexually abused children, 71 of whom completed 3 months of treatment or longer. Symptom change was measured with the Trauma Symptom Checklist for Children (TSCC; Briere, in press) and the Children's Depression Inventory (CDI; Kovacs, 1983, 1992), administered at 3 month intervals. The CDI and all TSCC scales but Sexual Concerns decreased after 3 months of therapy, and of these, all but Dissociation continued to decline at one or more assessment periods thereafter.

Survival of anaerobic bacteria in various thioglycolate and chopped meat broth formulations.

Three commercially available formulations of thioglycolate broth and of chopped meat broth were evaluated for their abilities to maintain the viabilities of 32 strains of anaerobic bacteria during a period of 8 weeks. While thioglycolate broth supported the initial (48-h) growth of all strains tested, approximately half of the strains died off within 4 weeks. Chopped meat broths maintained the viabilities of almost all cultures during the test period.

Activity of ampicillin/sulbactam, ticarcillin/clavulanate, clarithromycin, and eleven other antimicrobial agents against anaerobic bacteria isolated from infections in children.

The activity of 14 antimicrobial agents against 253 clinical isolates of anaerobic bacteria from pediatric infections was assessed by the agar dilution method. Fifty-eight percent of the isolates were from intraabdominal sites. The drugs tested were ampicillin/sulbactam, ticarcillin/clavulanate, ampicillin, sulbactam, piperacillin, cefoxitin, cefotaxime, cefoperazone/sulbactam, clarithromycin, azithromycin, erythromycin, clindamycin, metronidazole, and chloramphenicol.

Anaerobes under assault: from cottage industry to industrialization of medicine and microbiology.

More than 100 years have elapsed since the initial discovery of anaerobiosis, the first anaerobic microbiological isolation, and the first clinical descriptions of human anaerobic infection. New species are still being discovered, the important role of anaerobes as normal flora and in the maintenance of health is becoming increasingly appreciated, and the development of resistance by anaerobes to virtually all antimicrobials has recently accelerated. Anaerobes and their products have been employed widely and at times have been associated with political evolution, such as the establishment of the state of Israel.

Simian bites and bacterial infection.

Three patients with simian bites and resultant infection are described. The bacteriology of the wounds was diverse and included alpha-hemolytic streptococci and other streptococci in all wounds, enterococci, Staphylococcus epidermidis, and Enterobacteriaceae. A literature review revealed brief mentions of 132 cases of simian bites in some of which Bacteroides species, Fusobacterium species, and Eikenella corrodens were isolated.

Comparative in vitro activities of azithromycin, Bay y 3118, levofloxacin, sparfloxacin, and 11 other oral antimicrobial agents against 194 aerobic and anaerobic bite wound isolates.

The activities of sparfloxacin, levofloxacin, Bay y 3118, azithromycin, cefprozil, loracarbef, and nine other oral antimicrobial agents against 194 aerobic and anaerobic clinical bite wound isolates were determined by the agar dilution method. Sparfloxacin, levofloxacin, and Bay y 3118 were active against all aerobic isolates (MICs at which 90% of the isolates are inhibited [MIC90], < or = 1.0 microgram/ml for sparfloxacin and levofloxacin and 0.

Fatal sepsis due to a beta-lactamase-producing strain of Fusobacterium nucleatum subspecies polymorphum.

A patient with Waldenström's macroglobulinemia was treated empirically with imipenem for sepsis related to oropharyngeal infection and responded within 24 hours. When blood cultures yielded Streptococcus agalactiae, the regimen was changed to ampicillin and gentamicin. The patient's condition rapidly deteriorated, and she died 3 days later.

Localized Mycobacterium avium-intracellulare mastitis in an immunocompetent woman with silicone breast implants.

While M. avium-intracellulare has received increasing recognition due to its association with AIDS, silicone breast implants have come under increased FDA scrutiny, requiring new safety and efficacy protocols. We report a case of localized M.

Selected nonsurgical anaerobic infections: therapeutic choices and the effective armamentarium.

Anaerobic bacteria play an important role in diverse clinical infections. In this review the historical role and prevalence of anaerobes and their potential impact on the management of patients are discussed in terms of pleuropulmonary infections, animal and human bite-wound infections, diabetic foot infections, bacteremia, tetanus, diarrhea due to Anaerobiospirillum succiniciproducens, and diarrhea due to toxigenic Bacteroides fragilis.

How far should a clinical laboratory go in identifying anaerobic isolates, and who should pay?

Identification of anaerobic bacteria in specimens from sites of infection due to mixed organisms can be time-consuming and expensive. Laboratories should limit anaerobic workups by testing only those specimens that have been properly collected and transported to the laboratory. Use of selective and differential media for initial processing can provide rapid and relevant information to the clinician.

Patterns of susceptibility to fluoroquinolones among anaerobic bacterial isolates in the United States.

The activity of the fluoroquinolone antibiotics against anaerobic bacteria has generally been moderate to poor. Nalidixic acid and cinoxacin show poor activity against almost all anaerobes. Norfloxacin and enoxacin exhibit poor anaerobic activity (MIC90, 8- > 256 micrograms/mL) except against Clostridium perfringens, Bacteroides ureolyticus, and some eubacteria.

Empyema due to Bacteroides gracilis: case report and in vitro susceptibilities to eight antimicrobial agents.

We describe a patient with empyema due to Bacteroides gracilis and a viridans streptococcus. Therapy with both cefoxitin and imipenem failed, and the patient remained symptomatic even after thoracotomy was performed. Clinical response occurred after initiation of clindamycin therapy.

Comparative susceptibilities of 173 aerobic and anaerobic bite wound isolates to sparfloxacin, temafloxacin, clarithromycin, and older agents.

The in vitro activities of sparfloxacin, temafloxacin, ciprofloxacin, ofloxacin, clarithromycin, erythromycin, tetracycline, cephalothin, penicillin G, and amoxicillin-clavulanic acid against 173 recent clinical bite wound isolates were determined by agar dilution. Sparfloxacin was active against all strains (MIC for 90% of strains tested, < or = 1 micrograms/ml) except for most fusobacteria and one-third of the Prevotella spp. The other fluoroquinolones had similar activities but higher MICs, especially for streptococci.

Comparative susceptibility of the Bacteroides fragilis group species and other anaerobic bacteria to meropenem, imipenem, piperacillin, cefoxitin, ampicillin/sulbactam, clindamycin and metronidazole.

The in-vitro activity of meropenem, imipenem, piperacillin, cefoxitin, ampicillin/sulbactam, clindamycin and metronidazole was determined against 395 strains of strict and facultative anaerobes, including Gardnerella vaginalis, Lactobacillus spp. and Mobiluncus spp. The activities of meropenem and imipenem were within one dilution of their MIC50 and MIC90 values.

National hospital survey of anaerobic culture and susceptibility testing methods: results and recommendations for improvement.

The methods for performing anaerobic bacterial isolation and identification continue to change and improve. Anaerobic susceptibility testing has become controversial, and method-dependent variability has been noted. To assess the status of clinical anaerobic bacteriology in the United States, we surveyed, by means of a questionnaire, 120 hospitals, selected at random, with bed capacities of 200 to 1,000, and we received responses from 88 (73%).

Sertoli-Leydig cell tumor of the ovary: a rare cause of amenorrhea.

A 15-year-old girl presented to a primary care clinic with secondary amenorrhea, masculinization, and rapidly increasing abdominal girth. Evaluation revealed a large pelvic mass, which was found at laparotomy to be a bilateral Sertoli-Leydig cell tumor producing androgens and high levels of alpha-fetoprotein (AFP). The patient underwent bilateral salpingo-oophorectomy.

Comparative activity of ciprofloxacin, ofloxacin, sparfloxacin, temafloxacin, CI-960, CI-990, and WIN 57273 against anaerobic bacteria.

The in vitro activities of seven fluoroquinolones against 290 anaerobes were determined by agar dilution. CI-960 and WIN 57273 inhibited greater than 95% of the strains at less than or equal to 2 micrograms/ml. CI-990 required less than or equal to 16 micrograms/ml.

Bite wounds and infection.

One of every two Americans will be bitten by an animal or by another person at some point. Bites account for approximately 1% of all visits to emergency rooms; injuries inflicted by dogs are most common. The bacteria involved in infection of bite wounds include Pasteurella multocida, Staphylococcus aureus, Staphylococcus intermedius, alpha-hemolytic streptococci, Capnocytophaga canimorsus, and other members of the oral flora.

Susceptibility of anaerobic bacteria isolated from intra-abdominal infections to ofloxacin and interaction of ofloxacin with metronidazole.

The in vitro activities of ofloxacin alone and in combination with metronidazole against 177 anaerobic bacteria isolated from intra-abdominal infections, as determined by broth microdilution, showed that some Bacteroides fragilis strains were susceptible and that most other B. fragilis group species strains were resistant to ofloxacin. Isolates of other anaerobic species and genera, including those causing female genital tract disease, were generally susceptible to ofloxacin.