No abstract

The susceptibility of 495 strains of bacteria, recently isolated in France from cows with clinical mastitis, to 10 antimicrobial agentspenicillin G, cloxacillin, oxacillin, cephalexin, cefazolin, cephapirin, cefquinome, neomycin, ampicillin and colistinwas determined by measuring their minimum inhibitory concentrations (Mics). Overall, the levels of resistance were very low except for staphylococci and penicillin G. The 167 streptococcal strains were susceptible to all of the P-lactams tested, but six (3-6 per cent) were highly resistant to neomycin. Of the 171 staphylococcal isolates, 36-2 per cent were resistant to penicillin G, one strain of Staphylococcus sciuri was classified as methicillin-resistant, but they were all susceptible to neomycin. None of the 122 strains of Escherichia col was resistant to colistin, but 12 had high MIC values for one or more of the cephalosporins.

Through a heuristic and probabilistic approach, we evaluated blood culture operating characteristics (sensitivity, specificity, and predictive values) as a function of several pretest parameters, together with their variability. On the basis of a meta-analysis of quantitative data from the literature, a model was developed and an estimation of the operating characteristics through numerical simulations (Monte Carlo method) was performed. The model evaluates the influence of ordering and drawing parameters on the ability of blood culture to distinguish bacteremic from nonbacteremic patients, regardless of the causative species. By considering the total blood volume to be cultured (six 5-10-mL bottles), results were found to confirm the current guidelines. On the basis of this hypothesis, the results, together with an analysis of the literature, failed to show any benefit of a strategy that involves obtaining multiple samples. The best strategy when performing blood culture is to obtain blood for 6 bottles (for a total volume of 35-42 mL), preferably at the same time.

The transmission dynamics of tuberculosis involves complex interactions of socio-economic and, possibly, microbiological factors. We describe an analytical framework to infer factors of epidemic success based on the joint analysis of epidemiological, clinical and pathogen genetic data. We derive isolate-specific, genetic distance-based estimates of epidemic success, and we represent success-related time-dependent concepts, namely epidemicity and endemicity, by restricting analysis to specific time scales. The method is applied to analyze a surveillance-based cohort of 1,641 tuberculosis patients with minisatellite-based isolate genotypes. Known predictors of isolate endemicity (older age, native status) and epidemicity (younger age, sputum smear positivity) were identified with high confidence (P < 0.001). Long-term epidemic success also correlated with the ability of Euro-American and Beijing MTBC lineages to cause active pulmonary infection, independent of patient age and country of origin. Our results demonstrate how important insights into the transmission dynamics of tuberculosis can be gained from active surveillance data.

The early stages of the time-killing curves of vancomycin and LY146032 have been studied, by use of short sampling intervals, for three strains of Staphylococcus aureus. Both vancomycin and LY146032 killed S. aureus, but the time-killing curves differed: the effect of vancomycin was slow, limited, and not related to the concentration of the drug, whereas that of LY146032 was rapid, extensive, and related to concentration. When strains ATCC 25923 and CIP 6525 were exposed to LY146032, the population decreased exponentially with time. The killing rate was constant and linked to the concentration by a Michaelis-Menten relationship. The maximum killing rate and the affinity constant of LY146032, estimated from the data transformed by the Lineweaver-Burk method, differed for the two strains. The concentration of the antibiotic at which killing theoretically begins (estimated by linear regression using the logarithm of the concentration) is of the same magnitude as the MIC of LY146032, which indicates the pure bactericidal mode of action of the drug. S. aureus ATCC 12600 was more resistant to the bactericidal effect of the two drugs, and its killing curve did not conform to the model described here.