An electronic surveillance network for monitoring antibiotic resistance in The Netherlands has been in operation since 1989. Seven public health laboratories participate and the system covers about 25% of all bacteriological determinations in The Netherlands. This paper reports the results of staphylococci isolated in the period 1989-1995. About 0.3% of the Staphylococcus aureus isolates in the study period were resistant to methicillin. This low percentage may be due to the restrictive use of antibiotics and to strict isolation measures aimed at eradicating methicillin-resistant S. aureus. Low frequencies of resistance among methicillin-resistant S. aureus were found for vancomycin (0%), chloramphenicol (11%), cotrimoxazole (11%), mupirocin (3% low-level resistance) and fusidic acid (7%). Twenty-one percent of the coagulase-negative staphylococci were resistant to methicillin. Low frequencies of resistance among these methicillin-resistant coagulase-negative staphylococci were those to vancomycin (0.4%), nitrofurantoin (2%), doxycycline (20%) and amikacin (20%). Coagulase-negative staphylococci from cerebrospinal fluid, blood and skin were less often resistant to quinolones than isolates from respiratory tract, faeces and urine. A significant increase in resistance of coagulase-negative staphylococci to methicillin, erythromycin, gentamicin and ciprofloxacin was observed in the investigated period but the resistance to doxycycline and co-trimoxazole decreased in the last few years. To confirm the determination of methicillin resistance and coagulase production, a PCR method was developed which detects both the mecA and the coagulase gene. The results of the PCR method correlated well with the methicillin MIC as determined by an agar-dilution method.

In conclusion, preservation of skin in 85% glycerol reduces the risk of bacterial transfer to the recipient and allows an increase in yield of cadaver skin of approximately 10%.

The efficacies and safeties of a three-dose regimen of azithromycin (500 mg once daily for 3 days) and a 15-dose regimen of amoxicillin (500 mg three times daily for 5 days) were compared in a double-blind manner in patients with an acute exacerbation of chronic bronchitis. Azithromycin is a new azalide antibiotic (12) that differs from erythromycin by a methyl-substituted nitrogen at position 9a within the macrocyclic ring. This modification has resulted in improved stability at low pH and improved potency against Haemophilus influenzae and Moraxella (Branhamella) catarrhalis (10, 12). Although serum levels remain low after oral administration, the levels achieved in sputum, bronchial mucosa, and alveolar macrophages are sustained for 4 days well above the MICs for many respiratory pathogens (4). Moreover, azithromycin proved to be superior to erythromycin in a mouse pneumococcal pneumonia model, probably because of these improved pharmacokinetic parameters (2). Since the drug concentrates in macrophages as well, it is potentially active against intracellular pathogens such as Legionella pneumophila (4, 10). These properties suggested that a very short course (3 days) of treatment with once-daily administration of azithromycin could be useful in the treatment of respiratory infections. This paper reports the results of a double-blind comparison with a 5-day course of amoxicillin in patients with acute exacerbations of chronic bronchitis.

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Several reports have been published to show the in vitro susceptibility of Campylobacter pylori to different classes of antibiotics, including fluoroquinolones. The purpose of this study was to describe the clinical effect of norfloxacin on eradication of C. pylori in patients with gastritis. Endoscopy was performed in 38 patients with symptoms of nonulcerative dyspepsia. Of these, 20 patients had a C. pylori-positive culture. From this group, 17 patients were treated with norfloxacin for 1 month. After therapy, 15 patients still had positive cultures, and in 9 cases the strain was resistant to norfloxacin. These data, which confirm previous studies, support the concept that the in vitro activity of norfloxacin against C. pylori cannot be transposed to an in vivo effect.