- Volume 56, Issue 12, 2007

Acinetobacter baumannii is increasingly recognized as an important multidrug-resistant nosocomial pathogen. Recent work has highlighted enhanced growth and heightened virulence in the presence of ethyl alcohols. As alcohol-based hand rubs (ABHRs) are extensively used in health care settings, the authors set out to determine whether the hand rubs could also influence the growth of prevalent multidrug-resistant strains circulating in UK hospitals. A significant increase in growth was observed when minimal media were supplemented with concentrations of 1 % and lower of four commercially available hand rubs. In addition, growth in ABHR-supplemented media resulted in secretion of proteins into the culture supernatant. One of these was identified as OmpA, which is recognized as having emulsifying activity, which could potentially confer enhanced pathogenicity to A. baumannii.

Proteus mirabilis, a common cause of urinary tract infections, expresses iron-regulated outer-membrane proteins (OMPs) in response to iron restriction. It has been suggested that a 64 kDa OMP is involved in haemoprotein uptake and that this might have a role in pathogenesis. In order to confirm this hypothesis, this study generated a P. mirabilis mutant strain (P7) that did not express the 64 kDa OMP, by insertion of the TnphoA transposon. The nucleotide sequence of the interrupted gene revealed that it corresponded to a haemin receptor precursor. Moreover, in vitro growth assays showed that the mutant was unable to grow using haemoglobin and haemin as unique iron sources. The authors also carried out in vivo growth and infectivity assays and demonstrated that P7 was not able to survive in an in vivo model and was less efficient than wild-type strain Pr 6515 in colonizing the urinary tract. These results confirmed that the P. mirabilis 64 kDa iron-regulated OMP is a haem receptor that has an important role for survival and multiplication of these bacteria in the mammalian host and in the development of urinary tract infection.

An inexpensive and technically less-demanding methodology to quantify HIV-1 viral load would be of great value for resource-limited settings, where the nucleic-acid amplification technique (NAAT) is impractical and/or resource-prohibitive. In this study, an HIV-1 reverse-transcriptase enzyme-activity assay (ExaVir Load assay, version 1) was compared with the gold standard RT-PCR assay, Roche HIV-1 Amplicor Monitor, version 1.5. A total of 121 plasma specimens were used for the evaluation. ExaVir Load had a sensitivity of 97 % and a specificity of 71 % in identifying specimens with <400 copies ml−1 in the Roche RT-PCR assay as being less than the detection limit of the assay (5500 copies ml−1). The mean difference (95 % limits of agreement) between Roche RT-PCR and ExaVir Load was –0.23 (−1.59 to 1.13) log10(copies ml−1) by Bland–Altman analysis. Significant negative correlations were seen between CD4+ T-cell counts and the ExaVir Load assay (r=−0.32, P<0.05), and between CD4+ T-cell counts and the Roche RT-PCR (r=−0.38, P<0.01). The present study with HIV-1 showed a strong correlation between the ExaVir Load assay and the RT-PCR assay. Hence, the ExaVir Load assay could be considered for use in resource-limited settings as an alternative viral-load assay to the standard NAAT-based assay after further evaluation with prospective specimens.

From 1997 to 2006, in the province of Quebec, Canada, 15 isolates of Streptococcus pseudoporcinus from 1 urine and 14 vaginorectal cultures were recovered from the genitourinary tract of pregnant women. All these women originated from the Caribbean or sub-Saharan Africa (P=0.00045 compared with a suitable control group). The S. pseudoporcinus isolates were compared to eight isolates of Streptococcus porcinus identified in Quebec from 1995 to 2006, all from animals, of which five were swine. 16S rRNA gene sequencing was required to differentiate between S. pseudoporcinus and S. porcinus animal isolates.

Infection by the pandemic clone of Vibrio parahaemolyticus is prevalent in southern Thailand. This study actively surveyed the incidence of V. parahaemolyticus infection in this area. A total of 865 isolates of V. parahaemolyticus was obtained from patients at Hat Yai Hospital, the main public hospital in Songkhla Province, Thailand, from 2000 to 2005. The isolates were examined by group-specific PCR (GS-PCR) specific for the pandemic clone, and for the presence of two major virulence genes, tdh and trh, and the O : K serotype. Representative isolates were also examined by antibiogram pattern and DNA fingerprinting using an arbitrarily primed PCR method to determine the clonal relationships between isolates. The total number of isolates was less in 2000 and more in 2004 and 2005 than in the years 2001–2003. The increase in the numbers of infections in 2004 and 2005 was not due to the emergence of a particular clone having unique characteristics, but was probably due to climate change. From 2000 to 2003, the percentages of pandemic strains of V. parahaemolyticus, defined as GS-PCR-positive tdh + trh −, was stable at 64.1, 67.5, 69.7 and 67.7 % of the total isolates each year, respectively. However, in 2004 and 2005, the percentages decreased to 56.1 and 55.5 %, respectively. The O : K serotypes of the pandemic isolates remained unchanged. The proportional decrease in infections caused by the pandemic strains are probably due to the population in this area gradually developing immunity to the pandemic clone whilst continuing to be susceptible to other strains.

Candida species are the fourth most common cause of bloodstream infection (BSI) in the hospitalized patient. Candida glabrata is the most common non-Candida albicans Candida species in England and Wales with an attributed mortality of 48 %. C. glabrata is known to demonstrate reduced susceptibility to fluconazole, resulting in treatment failures when employing this agent for empirical treatment of Candida BSI. The first part of this study demonstrated a technique utilizing a blood culture system commonly used by many laboratories (BACTEC 9240 automated detection system) that reduced the time to identification of this potentially resistant organism by up to 72 h. A presumptive identification was achieved by observing a difference in the duration of incubation required before growth was detected automatically between Lytic Anaerobic and Plus Aerobic culture bottles. Secondly, experiments exploring the growth characteristics of C. glabrata in BACTEC blood culture bottles containing various media were carried out to explore possible reasons underpinning this clinical observation. The detection of yeast in the anaerobic bottle of a blood culture pair consisting of Lytic Anaerobic and Plus Aerobic in a BACTEC 9240 system was found to be highly predictive of the isolation of C. glabrata (positive predictive value 93.3 %, negative predictive value 98.3 %). The reason for this appeared to be a component of the Lytic Anaerobic blood culture medium enhancing the growth of C. glabrata in that medium.

Vibrio cholerae O1 serotype Ogawa and serotype Inaba isolates from the cholera epidemic that occurred in 2001 and 2002 in South Africa were compared with isolates of V. cholerae O1 serotype Inaba from the epidemic that occurred between 1980 and 1987. PFGE using NotI digestion was used to compare stored isolates received during the 1980s epidemic with those received during the epidemic in 2001/2002. A selected number of these isolates were then sequenced to compare the sequence of the wbeT gene in the V. cholerae O1 Ogawa strains of 2001/2002 with that in the V. cholerae O1 Inaba strains of the 1980s and 2001/2002. Isolates from the recent epidemic were shown to be related, irrespective of serotype, and had comparable banding patterns on PFGE, using NotI. They were distinctly different from those from the previous epidemic. Sequencing of the wbeT gene showed that the gene was highly conserved between the two epidemics. A single deletional mutation of an adenine residue was observed in the V. cholerae serotype Inaba isolates from the 2001/2002 epidemic, resulting in the serotype switch between the V. cholerae O1 strains from the recent epidemic. The distinct differences in PFGE patterns among isolates from the first and second epidemics exclude the possibility that the Inaba strain from the 1980s became dormant in the environment and mutated to serotype Ogawa, causing the 2001/2002 epidemic, despite the apparent consistency in the site of mutation in the Inaba serotypes between the two epidemics.

A previous study using bacterial 16S rRNA gene-based clone libraries revealed that the microbiota in healthy human skin included uncultured micro-organisms, although the micro-organisms in skin exposed to disease conditions remain to be examined. To compare the profiles of skin microbiota in 13 patients with atopic dermatitis (AD) and 10 healthy controls, terminal RFLP analysis of bacterial 16S rRNA genes was applied to 23 swab-scrubbed samples from facial skin. This culture-independent analysis successfully revealed the complex bacterial members of the microbiota as peak patterns following capillary electrophoresis of terminal restriction fragments (T-RFs). Each T-RF peak reflected a micro-organism, and the micro-organism to which each peak was assigned could be identified by computer simulation of T-RF length using the nucleotide sequence data of bacterial species residing in the skin. Among 18 species detected in the study, Stenotrophomonas maltophilia was detected significantly more commonly in AD patients (5/13 for AD patients vs 0/10 for controls), whilst Dietzia maris was detected significantly more commonly in normal controls (8/10 for controls vs 2/13 for AD patients). Moreover, Streptococcus species, which are considered to be uncommon in uninfected skin, were detected in seven patients and eight normal controls. Although further studies should be undertaken to investigate the roles of these micro-organisms in AD, the microbiota were presumed to include hitherto uninvestigated bacterial species in the major population of patients with AD and of healthy controls.

A cornyeform bacterium was isolated from a blood culture from a 24-year-old man with familial hypertrophic non-obstructive cardiomyopathy, chronic abuse of anabolic steroids and prior admission to hospital because of clinical signs of sepsis. 16S rRNA gene analysis unambiguously identified Gordonia terrae.

As the usual pathogen spectrum of a late-onset (>12 month post-operatively) prosthetic valve endocarditis is similar to normal valve endocarditis, with the exception of coagulase-negative staphylococcus, a prosthetic valve endocarditis caused by unusual bacterial pathogens represents a therapeutic and diagnostic dilemma. The lack of well established criteria or clinical experience for the management of such infections makes therapy and prognosis difficult to determine. A case of successfully treated Gemella morbillorum prosthetic valve endocarditis and a review of the relevant literature are presented.

A case of osteomyelitis caused by multidrug-resistant Pseudomonas aeruginosa is reported in a patient who underwent allogeneic bone marrow transplantation for acute lymphoblastic leukaemia. The patient was successfully treated by prolonged administration of a full dose of colistin and tigecycline, and surgical curettage with the positioning of resorbable calcium sulfate pellets loaded with colistin.