[Show abstract][Hide abstract] ABSTRACT: Detection of the blaVIM-12 gene within the originally described Inh12 integron in a clinical isolate of Enterobacter cloacae is reported for the first time worldwide. Integron Inh12 was carried on a conjugative plasmid of approximately 85 kb which
also conferred resistance to aztreonam, likely due to AmpC production.
[Show abstract][Hide abstract] ABSTRACT: A total of 359 vancomycin-resistant enterococci (344 Enterococcus faecium and 15 E. faecalis) collected during 2007 from eight tertiary-care hospitals in Greece were analysed for genotypic characteristics. Four common clones, ST412, ST203, ST16 and ST17, were identified among E. faecium and one clone, ST28, among E. faecalis strains.
Full-text · Article · Dec 2009 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: A total of 10420 Gram-positive cocci (including staphylococci, enterococci and various groups of streptococci) collected from clinically significant specimens in ten Greek hospitals during 2006--2007 were tested for their susceptibility to daptomycin. The minimum inhibitory concentration (MIC) was determined by the broth microdilution method. Daptomycin demonstrated very high activity against Enterococcus faecalis (MIC at which 50% of the isolates were inhibited (MIC50) = 1mg/L and MIC at which 90% of the isolates were inhibited (MIC90) = 1.36 mg/L), Enterococcus faecium (MIC50 = 1.36 mg/L and MIC90 = 1.90 mg/L), Streptococcus pyogenes (MIC50 = 0.12 mg/L and MIC90 = 0.50mg/L), Streptococcus agalactiae (MIC50 = 0.09 mg/L and MIC90 = 0.12 mg/L), Streptococcus pneumoniae (MIC50 = 0.24 mg/L and MIC90 = 0.5 mg/L) and viridans group streptococci (MIC50 = 0.50 mg/L and MIC90 = 0.89 mg/L). Resistance to linezolid and vancomycin for enterococci and to penicillin for streptococci appears to be independent of reduced susceptibility to daptomycin. On the other hand, daptomycin was also active against meticillin-resistant Staphylococcus aureus (MIC50 = 0.44 mg/L and MIC90 = 0.78 mg/L) and meticillin-resistant coagulase-negative staphylococci (MIC50 = 0.24 mg/L and MIC90 = 0.44 mg/L); however, 0.9% of the staphylococci tested had an MIC > 1mg/L, which is the Clinical and Laboratory Standards Institute breakpoint proposed for susceptibility. For all tested organism groups, resistance to daptomycin was not associated with glycopeptide resistance.
Full-text · Article · Sep 2008 · International Journal of Antimicrobial Agents
[Show abstract][Hide abstract] ABSTRACT: Objective: To assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP). Design: Prospective ob-servational study. Setting: Multi-disciplinary intensive care unit. Pa-tients and participants: VAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bronchoalveolar lavage (BAL) and treated appropriately for all significant isolates of tracheal aspirate and BAL in 143 patients who were assigned to de-escalation therapy by BAL or tracheal aspirate. Interventions: None. Measurements and results: Antibiotic therapy was de-escalated in 58 patients (40.5%), who had decreased mortality at day 15 (5.1% vs. 31.7%) and day 28 (12% vs. 43.5%) and shorter intensive care unit (17.2 ± 1.2 vs. 22.7 ± 6.3 days) and hospital (23.7 ± 2.8 vs. 29.8 ± 11.1 days) stay (p < 0.05). Of the 81 pa-tients assigned to tracheal aspirate, the 17 (21%) who achieved de-escalation of therapy had reduced 15-day mor-tality (5.8% vs. 34.3%), reduced 28-day mortality (11.6% vs. 45.3%), and shorter intensive care unit (17.2 ± 1.6 vs. 22.4 ± 6.4 days) and hospital (23.1 ± 4.4 vs. 29.9 ± 11.1 days) stay (p < 0.05). Of the 62 patients assigned to BAL, the 41 (66.1%) who achieved de-escalation of therapy had decreased 15-day mortality (4.8% vs. 23.8%), de-creased 28-day mortality (12.1% vs. 38%), and shorter intensive care unit (17.2 ± 1.1 vs. 23.2 ± 6 days) and hospital (23.8 ± 2.4 vs. 29.8 ± 11.4 days) stay (p < 0.05). Conclusions: For patients with VAP who have had appropriate treatment and shown a fa-vorable clinical response, mortality and duration of stay can be further improved by de-escalation therapy.
Full-text · Article · Aug 2007 · Intensive Care Medicine
[Show abstract][Hide abstract] ABSTRACT: Objective: To compare the causative pathogens of early-onset and late-onset ventilator-associated pneumonia (VAP) diagnosed by bronchoalveolar lavage quantitative cultures. Most previous reports have been based on endotracheal aspirate cultures and gave uncertain findings. Design: Prospective evaluation of consecutive patients with clinical suspicion for VAP. Setting: Multi-disciplinary intensive care unit of a university hospital. Patients and participants: During a 3-year period 473 patients with clinical suspicion of VAP entered the study. Diagnosis of VAP was confirmed by cultures of bronchoalveolar lavage (>10 4 cfu/ml) specimens in 408 patients. Interven-tions: Protected bronchoalveolar la-vage samples were taken. Initial an-tibiotic therapy was modified upon bronchoalveolar lavage culture re-sults. Measurements and results: Among 408 patients 191 had early-onset (<7 days mechanical ventila-tion) and 217 late-onset (!7 days) VAP. Potentially multiresistant bac-teria, mainly Pseudomonas aerugi-nosa and methicillin-resistant Sta-phylococcus aureus (MRSA), were the most commonly isolated patho-gens in both types of VAP. No dif-ference was noted in the contribution of potentially multiresistant patho-gens (79% vs. 85%), P. aeruginosa (42% vs. 47%), or MRSA (33% vs. 30%) between early-onset and late-onset VAP. Initial antibiotic therapy was modified in 58% of early-onset VAP episodes and in 36% of late-onset VAP episodes. No difference in mortality was found between the two types of VAP. Conclusions: Both early-onset and late-onset VAP were mainly caused by potentially mul-tiresistant bacteria, most commonly P. aeruginosa and MRSA. Antimi-crobial agents against these patho-gens should be prescribed empirical-ly, at least in our institution.
Full-text · Article · Nov 2005 · Intensive Care Medicine