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We investigated transfer of antibiotic resistance from 51 multiply resistant strains of Pseudomonas aeruginosa isolated from seriously ill patients in the Frankfurt University Clinics. Nine isolates directly transferred resistance to three recipient strains used. Ticarcillin and cephalothin resistance determinants were accepted from eight isolates, and in one case a kanamycin resistance determinant was transferred. The total spectrum of resistance transferred demonstrated that several donor strains transferred a different set of resistance determinants to all three recipient strains. Two P. aeruginosa isolates transferred spectrum of seven resistance determinants including ceftazidime, cefepime and aztreonam, three isolates transferred five determinants and four isolates transferred four resistance determinants. The fact that identical spectra of multiple drug resistance were transferred to recipient strains belonging to three different species (Escherichia coli, Proteus mirabilis and P. aeruginosa), indicates a broad host range in all three transferable genetic elements not observed in previous transfers from P. aeruginosa strains.

Sixty-seven multiresistant nosocomial Acinetobacter baumannii isolates from patients hospitalized mostly in intensive care units of seven clinics in Slovak and Czech Republic were tested to determine their ability to transfer antibiotic resistance. All isolates were resistant to kanamycin, ticarcillin, cephalothin, cefotaxime, ceftazidime, aztreonam and susceptible to carbapenems, sulbactam and ampicillin/sulbactam. Sixty-five out of 67 strains transferred resistance determinants to Escherichia coli K-12 and Proteus mirabilis P-38 recipients. Analysis of selected transconjugants by an indirect selection method showed a more variable pattern of transferred resistance determinants. The clonal spread of strains transferring resistance seems to be an additional risk for occurrence of strains resistant to ceftazidime and aztreonam.

One hundred and one cases of nosocomial meningitis in children from a national survey over 8 years have been analyzed for risk factors and outcome. From 101 cases, 115 organisms were isolated. Seventy six were Gram-positive bacteria, 29 were Gram-negative and there were ten fungal isolates. Major risk factors for acquisition of nosocomial meningitis were neurosurgery (70.2%), ventriculoperitoneal shunt (42.9%), prior therapy with broad spectrum antibiotics (64.1%), central venous catheter (94.5%), premature neonates with very low birth weight (32.8%) and total parenteral nutrition (68.8%). Overall attributable mortality was 14. 9%; in bacterial infection it was 13.2% and in fungal nosocomial meningitis, 30.0%. Higher mortality was significantly related to perinatal pathology with CNS abnormality, prematurity polymicrobial infection with Enterobacteriaceae and concomitant bacteraemia. Prematurity in neonates, very low birth weight and infection with Enterobacteriaceae were significantly associated with a worse outcome.

Twelve cases of neonatal and infant nosocomial meningitis treated with intravenous ciprofloxacin in doses of 10 to 60 mg/kg/day are described. Four neonates were 21 to 28 days old and eight infants were 2 to 6 months old. Six presented with Gram-negative meningitis: Escherichia coli (2), Salmonella enteritidis (1), Acinetobacter calcoaceticus (1), two with two organisms, and (H. influenzae plus Staphylococcus epidermidis, Acinetobacter spp. plus S. epidermidis), and six were attributable to Gram-positive cocci (four S. aureus and two Enterococcus faecalis). Ten cases were cured. In two cases, reversible hydrocephalus appeared that responded to intraventricular punctures. In seven children, no neurologic sequellae appeared after a 2- to 4-year follow-up. One neonate had relapse of meningitis 3 months later and was ultimately cured, but developed a sequellae of psychomotoric retardation. Follow-up varied from 27 months to 10 years. Current published case reports from Medline on quinolone use in meningitis in neonates and infants are reviewed.

Background: Data on the incidence of multiresistant nosocomial bacterial strains of Xanthomonas (Stenotrophomonas) maltophilia, producing in addition to metallo-beta-lactamases also new types of broad spectrum beta-lactamases (ESBL) called for analyses of the production of different types of enzymes., Methods and Results: Nosocomial multiresistant strains of Xanthomonas (Stenotrophomonas) maltophilia isolated from patients in 1996 were tested for the production of ESBL by a double diffusion disc test. The production of different types of ESBL was revealed, in particular production of ESBL specific for inactivation of aztreonam which is reversible by the action of clavulanate. The test of ESBL production, proved suitable also for orientation as regards selection of a suitable antibiotic in the treatment of infections caused by multiresistant or naturally resistant bacteria, possibly also the possible synergic action of antibiotics may be detected. The effect of mutual action of different antibiotics with a different inhibitory action of beta-lactamase inhibitors is illustrated when the test of ESBL production is used, where the effect of aztreonam on the inhibition of growth of ofloxacin resistant colonies was proved., Conclusions: The double diffusion test of production of new beta-lactamases (EBL) in multiresistant Gram-negative nosocomial strains made it possible to detect the possible synergic action of antibiotics in combination with the action of beta-lactamase inhibitors.

Stenotrophomonas maltophilia (298/85) was isolated from the extensively inflamed conjunctiva of a neonate in a regional hospital in Ostrava, Czech Republic. It was resistant to all available antibiotics except cefepime and trimethoprim. The donor S. maltophilia strain 298/85 transferred carbenicillin and cephaloridine resistance determinants to recipient strains of Escherichia coli K-12 3110 rif+ and Proteus mirabilis P-38 rif+. All transconjugant colonies were co-resistant also to kanamycin, cefotaxime, and aztreonam. Active hydrolysis of imipenem in the original strain was inhibited by ethylene diamine tetra-acetic acid, and hydrolysis of cefotaxime and aztreonam in the original strain and in the E. coli K-12 transconjugant was inhibited by clavulanate. In contrast, ceftazidime was hydrolyzed by the original strain and was not inhibited by clavulanate, indicating a different character of the resistance to cefotaxime or aztreonam and ceftazidime.

Background: In the last decade were in SR documented new problems in resistance to the newer antibiotics that with regard to their structure and antibacterial properties resisted to the known mechanism of bacterial resistance. The emergence of multiple drug resistance to the new betalactams is connected both with frequent application of these drugs in the hospitals and transfer of R plasmids., Methods and Results: We studied composition and transferability of resistance to newer betalactam antibiotics in strains of Acinetobacter sp., Enterobacter sp, and Citrobacter sp. isolated during one month in patients from two teaching University Hospitals. All strains studied were resistant to cefotaxime (CTX), ceftazidime (CAZ) and aztreonam (ATM) but Acinetobacter strains, although resistant also to CAZ and ATM transferred the resistance to CTX only. Thus, resistance to CAZ and ATM has a chromosomal origin in these strains. A strain of Citrobacter sp., resistant to CTX, CAZ and ATM, produced a ESBL betalactamase detectable in a double-disk diffusion method (Fig. 1). An Enterobacter cloacae strain transfers directly the resistance to all new betalactams indicated. Their hydrolysis by these strains points to their production of new types of extended-spectrum beta-lactamases ESBL)., Conclusions: We strongly recommend to be strictly rational in the use of new betalactams of CTX, CZA or ATM type because it is suspected that, especially in so-called empirical prophylaxis or treatment, they exert a strong selective pressure toward the prevalence of mutants with transferable ESBL-producing nosocomial bacteria resistant to these drugs.

Transferable resistance to cefotaxime was demonstrated in 21 nosocomial strains of Klebsiella pneumoniae and Escherichia coli subsequently isolated from patients in two large University clinics. Using the double-disk diffusion test, we could detect, in each such strain, as well as in E. coli 3110 K-12 transconjugants after the transfer, the production of an Extended Spectrum Beta-Lactamase (ESBL). Ceftibuten was demonstrated to be effective against the majority of strains studied.

The results of antibiotic treatment administered to 78 patients within one year are reported. Due to the nosocomial nature of the infections, the serious overall condition of the patients and the associated diseases, the prognosis remained unfavourable despite adequate antibiotic treatment. In the group of patients on dialysis ofloxacin and ciprofloxacin proved effective. Patients with exacerbation of chronic bronchitis responded well to doxycycline. In the treatment of infections of the urinary tract, the known favourable effect of cotrimoxazol was confirmed. Of the group of 78 patients with transitory or permanent cardiostimulation, 18 received antibiotic treatment. In 6 of them with transitory cardiostimulation antibiotics were given as a prophylactic measure, 4 patients developed febrile conditions after implantation of the cardiostimulator and 8 patients received antibiotics due to infections of the respiratory and urinary tract. After implantation of the cardiostimulator 60 patients (77%) did not require antibacterial treatment. (Ref. 5.)

R plasmids have been demonstrated in several group of strains of enterobacteriaceae from hospital environment. R + enteropathogenic strains of Escherichia coli were isolated from several items of baby-care as well as from the pre-prepared baby food in a newborn unit. Strains from environmental samples are thought to be identical with those causing nosocomial gastroenteritis of babies. From hospital waste waters of another larger country hospital we could isolate R + strains of Salmonella typhimurium and R + protei, both associated with occurence of gastrointestinal or urological hospital infections. R-factor-carrying strains of E. coli have been isolated also from surface water samples from the area surrounding the hospital monitored.

From incubators and children in a premature-born unit, a number of red-pigmented Ps. aeruginosa strains, resistant to kanamycin, streptomycin and lividomycin and producing haemolytic toxin II, were isolated and investigated for transfer of resistance in mixed cultures. Streptomycin, kanamycin and lividomycin resistance was co-transferred, from some strains, together with the ability of toxin production. Transfer ability was also co-transferred which might have genetic as well as epidemiological significance. Strains do produce "Autoplaques" and transferability of this property as well as of lysogeny is under investition.