SUMMARYLivestock-associated methicillin-resistantStaphylococcus aureus(LA-MRSA) have been isolated from a number of livestock species and persons involved in animal production. We investigated the prevalence of LA-MRSA in fattening turkeys and people living on farms that house fattening turkeys. Eighteen (90%) of 20 investigated flocks were positive for MRSA, and on 12 of the farms 22 (37·3%) of 59 persons sampled were positive for MRSA. People with frequent access to the stables were more likely to be positive for MRSA. In most flocks MRSA that could be assigned to clonal complex (CC) 398 were detected. In five flocks MRSA ofspa-type t002 that is not related to CC398 were identified. Moreover, other methicillin-resistantStaphylococcusspp. were detected on 11 farms and in eight people working on the farms.

In the present study, the prevalence of vancomycin-resistant enterococci (VRE) in turkeys in the southwest of Germany was investigated. For this purpose, 200 cloacal swab samples and 5 environmental dust samples (tested as a pooled sample) of each of the 20 flocks (10 female and 10 male flocks) included in this study were examined. The VRE could be isolated by means of a procedure combining bacterial cultivation in an enrichment broth and on a selective solid media. Enterococci were identified biochemically and subsequently tested on the presence of the vancomycin resistance genes vanA, vanB (B1/B2/B3), and vanC (C1/C2/C3) using real-time PCR assays. In 54 (27%) turkeys originating from 11 (55%) flocks and in 14 (70%) of the dust samples, exclusively vanA and vanC1 genes could be detected. Of the turkeys examined, 46 were colonized with VRE bearing the resistance gene vanC1 and 8 vanA, originating from 9 and 2 flocks, respectively. None of the birds carried vanB, vanC2, or vanC3 positive VRE. The results obtained from the birds are largely confirmed by the dust samples originating from 4 vanA and 10 vanC1 positive flocks. However, one flock housing animals colonized with vanC1 positive VRE could not be confirmed by the dust samples that revealed vanA bearing VRE. However, in one case vanA and in 3 cases vanC1 carrying VRE could be detected in dust samples of the turkey houses, but not in the turkeys of the associated flock. In 5 flocks the turkeys as well as the dust samples were free of VRE.

We investigated the antibacterial activity of clindamycin and lincomycin at 1/4 X minimum inhibitory concentration (MIC), 1 X MIC and 4 X MIC against a serum-resistant Staphylococcus aureus and a serum-resistant Staphylococcus epidermidis strain in broth, in serum with and without the presence of leukocytes and in Hank's medium in combination with leukocytes alone. Against both test strains, lincomycin in broth and serum was similarly effective, whereas against S. aureus clindamycin in broth was somewhat more active. In the combined test mixture of serum with leukocytes, even a 1/4 X MIC of clindamycin or lincomycin markedly improved leukocyte killing of S. aureus, whereas both compounds could not further enhance the marked leukocyte killing of S. epidermidis, even at inhibitory concentrations. In Hank's medium with leukocytes alone, clindamycin and lincomycin had at the most only a bacteriostatic effect against both test strains.

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VLBW-infants below 1500 g of birth weight have a quite high risk to acquire a nosocomial sepsis. 20-40% of all infants exhibit signs of nosocomial infection once during neonatal intensive care. The rate of infection is related to technique and amount of used invasive devices as to gestational age. Coagulase-negative staphylococci (CONS) and gram-negative organisms contribute most to these cases of sepsis. In a three phase study we tried to demonstrate the efficacy of different mechanisms to change the rate of nosocomial sepsis. During the first phase a strict hygienical protocol was enforced as isolation, care with sterile gloves and aseptic techniques in introducing and maintaining i.v. lines. In a second phase we started a randomized controlled study of prophylactic vancomycin (10 mg/kg/day in two doses). In a third phase we added an oral antibiotic regime with cefixime for all patients with positive cultures for gramnegative organisms under the hypothesis of translocation from the gut as the way of infection. During the first phase 23.7% of 76 patients enrolled acquired CONS-sepsis, 0.52% gramnegative sepsis. During the second phase (41 patients) 6 patients in the control group acquired CONS-sepsis, none in the vancomycin-group. The rate of gramnegative infections was not different (4 and 3 cases). During the third phase (vancomycin plus cefixime eventually in cases of positive stool cultures) no case of nosocomial sepsis occurred (35 patients, 11 positive cultures). The management used in phase 3 reduced the rate of nosocomial infections in VLBW-infants drastically.