Escherichia coli is a widespread bacterium encompassing a variety of strains, ranging from highly pathogenic strains, causing worldwide outbreaks of severe diseases to avirulent, well characterized safe laboratory strains. This study evaluated the prevalence and antibiogram profiles of E. coli pathotypes isolated from the Kat River and Fort Beaufort abstraction water. A total of 171 out of 278 confirmed E. coli isolates were positive for at least one pathogenic determinant and these included enteropathogenic E. coli (6%), enterotoxigenic E. coli (47%), uropathogenic E. coli (2%), neonatal meningitis E. coli (5%), diffusely adherent E. coli (1%) and enterohaemorrhagic E. coli (1%). Interestingly, enteroinvasive and enteroaggregative E. coli were not detected. The phenotypic antibiogram profiles of the isolates revealed that all were resistant to penicillin G, while 98% and 38% of the pathotypes were resistant to ampicillin and trimethoprim-sulphamethoxazole, respectively. About 8% of the isolates were resistant to streptomycin. More than half of the isolates exhibited multiple antibiotic resistance with 44% being resistant to three antibiotics and 8% resistant to four antibiotics. We conclude that the Kat River is a reservoir of potentially virulent antibiotic resistant E. coli strains that can cause serious health risks to humans who drink raw water from this river, or in the case that consumption of treated drinking water coincides with failed drinking water processes.

SUMMARY Two infants with nephrotic syndrome who developed penicillin resistant pneumococcal peritonitis while receiving penicillin chemoprophylaxis are reported and the problems associated with prophylaxis against pneumococcal infection discussed. It is suggested that penicillin prophylaxis may be hazardous in an environment in which penicillin resistant pneumococci are prevalent.Children with nephrotic syndrome are at an increased risk of developing peritonitis due to Streptococcus pneumoniae. The depressed immune state caused by the nephrotic syndrome is due to decreased serum concentrations of immunoglobulins' and impaired opsonisation,2 cellular immunity,3 and granulocyte chemotaxis.2 Prophylaxis against pneumococcal infection may be attempted with pneumococcal polysaccharide vaccine or with oral penicillin. We report two children with nephrotic syndrome who developed penicillin resistant pneumococcal peritonitis while receiving prophylaxis with oral penicillin. S penumoniae was identified as an a-haemolytic streptococcus sensitive to optochin. Antibiotic sensitivity testing of this organism was performed on 5% sheep blood agar by the Kirby-Bauer disc diffusion method. Penicillin resistance was defined by a zone of inhibition smaller than 20 mm around a 5 ,tg methicillin disc. Case reports CASE 1A 2 month old black boy with histologically confirmed Finnish type congenital nephrotic syndrome was given oral prophylaxis with phenoxymethyl penicillin (62.5 mg twice daily) and co-trimoxazole (2 mg/kg daily of trimethoprim). One week after discharge he was readmitted with vomiting and abdominal distension. Examination showed that his systolic blood pressure was 40 mm Hg and pulse rate was 120/minute. He had poor peripheral perfusion and generalised oedema. Abdominal examination showed ascites, and the liver and spleen edges were palpable 2-5 cm and 1 cm, respectively, below the right and left costal margins. The heart was normal and the lung fields were dull to percussion at both bases. There was neck retraction, a bulging anterior fontanelle, and hypertonia.

Background:Many disease conditions including Staphylococcal infections are becoming increasingly difficult to treat in South Africa due to the surge of vancomycin-oxacillin resistant strains. How widespread this phenomenon is in commensal isolates in the Nkonkobe municipality in the Eastern Cape Province of South Africa is not known, and considering the high level of immunocompromised individuals in the province, this study couldn’t have come at a better time.Objectives:The objective of this study is to evaluate the prevalence of vancomycin and oxacillin co-resistance in methicillin-resistant commensal staphylococci in Nkonkobe municipality, South Africa as part of our larger study on the surveillance of reservoirs of antibiotic resistance in South Africa.Materials and Methods:Staphylococcus species were isolated from domestic animals of Nkonkobe municipality, in the Eastern Cape Province of South Africa. The isolates were evaluated for antibiotic susceptibility against a panel of several relevant antibiotics. Specific primer sets were also used for the polymerase chain reaction assay to detect the presence of mecA gene as well as vanA and vanB genes in the genome of resistant Staphylococcus species.Results:A total of 120 Staphylococcus isolates were screened, out of which, 32 (26%) were susceptible to both methicillin and vancomycin, while 12 (10%) had co-resistance to the antibiotics, which is still on the high side, both clinically and epidemiologically. Gentamicin (an aminoglycoside) had a relatively high potency against the isolates with 107 (89.17%) of the bacteria being susceptible to it, while 10 (8.33%) were resistant. On the other hand, erythromycin (a macrolide) was active against 72 (60%) of the isolates, while 5 (4.17%) and 74 (61.67%) of them yielded intermediate and resistant responses, respectively. Similarly, 51 (42.5%) of the isolates were susceptible to rifampicin, while 1 (0.83%) and 17 (14.17%) were intermediate and resistant, respectively.Conclusions:Ten percent of the isolates were positive for mecA gene among the vancomycin-oxacillin resistant strains, while van gene was not detected in any of the isolates. The data obtained would be useful in clinical control of resistant staphylococcal strains.