To determine the incidence rate of complications associated with vascular catheters in intensive care unit patients and to analyze risk factors for a positive vascular culture, we performed a multicenter study of intensive care unit patients at eight French hospitals. During the study period, 865 intravenous catheters were inserted in 566 patients; 362 (41.8%) were peripheral catheters, and 503 (58.2%) were central catheters. Local complications (i.e., infiltration) occurred significantly more often with peripheral than with central catheters (P < 0.001); in contrast, fever and bacteremia were significantly more often associated with central than with peripheral catheters (P < 0.01 and P < 0.05, respectively). The culture of the vascular-catheter tip was positive for 24% of central catheters (32 of 1,000 catheters days) and for 9% of peripheral catheters (21 of 1,000 catheters days). Staphylococcus epidermidis was the most common microorganism isolated from both peripheral and central catheters, followed by Staphylococcus aureus and Pseudomonas aeruginosa. No significant risk factor associated with positive cultures for peripheral catheters was found by univariate analysis. In contrast, the purpose of the cannula (nutrition and monitoring of central venous pressure), the insertion site (jugular), the dressing type (semipermeable transparent dressing), the antiseptic used to prepare the insertion site (povidone iodine), and routine changing of the intravenous administration set were significantly associated with positive cultures of central catheters. Three factors, duration of catheterization, use of a semipermeable transparent dressing, and the jugular insertion site, were found to be independently associated with positive cultures of central catheters by multivariate analysis.

A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period.

The antimicrobial resistance of Streptococcus pneumoniae was surveyed in 1970-1990 at Saint Joseph and Broussais hospitals in Paris (3,279 isolates) and in 1984-1990 at the National Reference Center for Pneumococci (NRCP) in Créteil (8,128 isolates). All isolates were tested for susceptibility and serotyped. At St. Joseph and Broussais hospitals, the rate of resistance to tetracycline increased from 14% in 1970 to 46.5% in 1978 and then decreased to approximately 20% in 1988-1990. Resistance to chloramphenicol appeared in 1972; its frequency remained at less than 10% until 1990. Resistance to macrolides was first detected in 1976, increased to 20% in 1984, and reached 29% in 1990. Among strains submitted to the NRCP, resistance to penicillin (MIC, greater than or equal to 0.1 mg/L) remained infrequent (less than or equal to 1.1%) between 1984 and 1986 but then increased steadily, reaching 12% in 1990. The frequency of high-level resistance to penicillin (MIC, greater than 1 mg/L) among penicillin-resistant pneumococci increased from 13% in 1988 to 48% in 1990. Compared with other serotypes, the penicillin-resistant serotype isolated most frequently (23F, 49.3%) was more often highly resistant to penicillin and was more often multiresistant.

Two strains of gram-positive cocci highly resistant to vancomycin (MICs of 512 and 1,024 ,ug/mI) were isolated from blood cultures in two compromised patients. These organisms were identified as Leuconostoc spp. Leuconostoc spp. are gram-positive cocci found in vegetables and dairy products; they had not been isolated previously from clinical specimens. The susceptibility of eight Leuconostoc spp. strains, including the two clinical isolates, to 23 antimicrobial agents was determined.Vancomycin is a glycopeptide antibiotic that is highly potent against gram-positive bacteria. In addition to its role in the therapy of serious gram-positive infections in penicillin-sensitive patients, the use of vancomycin has been recently extended for treatment of enterocolitis associated with Clostridium difficile as well as for infections caused by methicillin-resistant Staphylococcus aureus (10, 18). Resistance to vancomycin among gram-positive cocci has rarely been encountered (7); although this resistance has not yet been observed in S. aureus, several vancomycin-resistant strains of Streptococcus mutans, Streptococcus bovis, and enterococci have been described (1,2,12,16,18 Thornsberry and Facklam (17) have recently reported that a number of other purported vancomycin-resistant streptococci were identified by the Centers for Disease Control as Lactobacillus spp. rather than streptococci. In this study, we described the isolation of two strains of gram-positive cocci highly resistant to vancomycin (MICs of 512 and 1,024 ,ug/ml) from blood cultures in two compromised patients. These strains were first misidentified as streptococci by conventional tests and by the Analytab Products API Strep System (5, 8, 13). These organisms were further examined and identified as Leuconostoc spp.Leuconostoc spp. are gram-positive cocci belonging to the genus II of the family Streptococcaccae (9). These organisms are found on herbage, vegetables, dairy products, wine, and sugar solutions; they are of importance in the dairy, wine, and sugar industries (9). This is the first report of Leuconostoc spp. isolated from clinical specimens.Case Strains 9276 and 9735 displayed the following characteristics. Gram stain of blood culture or broth subcultures showed round or slightly elongated gram-positive cocci, mostly in pairs but also in chains of 4 to 10 cells. After 24 h of incubation on horse blood agar, these organisms produced small, alpha-hemolytic colonies that did not produce catalase. By conventional tests with the classification of Facklam (8, 13), strains 9276 and 9735 were identified as S. sanguis II. They did not produce acid from mannitol, sorbitol, or inulin, but they did form acid from lactose, raffinose, and sucrose. Strain 9276 produced dextran on sucrose agar.Identification was also performed with the API 20 Strep System (5). Strain 9276 was identified as S. sanguis II with "very good identification," and strain 9735 was identified as Streptococcus salivarius with "acceptable identification." However, when these strains were re...