Acinetobacter Anitratus Research Articles

Mixed Culture Optimization for Marigold Flower Ensilage via Experimental Design and Response Surface Methodology

Endogenous microorganisms isolated from the marigold flower (Tagetes erecta) were studied to understand the events taking place during its ensilage. Studies of the cellulase enzymatic activity and the ensilage process were undertaken. In both studies, the use of approximate second-order models and multiple lineal regression, within the context of an experimental mixture design using the response surface methodology as optimization strategy, determined that the microorganisms Flavobacterium IIb, Acinetobacter anitratus, and Rhizopus nigricans are the most significant in marigold flower ensilage and exhibit high cellulase activity. A mixed culture comprised of 9.8% Flavobacterium IIb, 41% A. anitratus, and 49.2% R. nigricans used during ensilage resulted in an increased yield of total xanthophylls extracted of 24.94 g/kg of dry weight compared with 12.92 for the uninoculated control ensilage.

Modeling of chlorine effect on floc forming and filamentous micro-organisms of activated sludges

Chlorination is the most economical, non-specific method to control the excessive growth of filamentous micro-organisms causing bulking in activated sludge systems in the treatment of food industrial wastewaters; it was one of the first methods used to control filamentous bulking and is still widely employed. Considering that chlorination affects both floc-forming and filamentous micro-organisms and leaves undesirable disinfection by-products, it is necessary to define the adequate doses to control bulking, minimizing the effect on floc-forming bacteria. In the present work the effect of biomass concentration and type of micro-organism on chlorine decay kinetics was evaluated; the inactivation of either a filamentous ( Sphaerotilus natans) or a floc-forming ( Acinetobacter anitratus) micro-organism due to chlorination was also analyzed. For chlorine decay assays, the samples were treated in a batch system with sodium hypochlorite ranging between 9.8 and 56.6 mg Cl 2 (gVSS) −1. Respirometric assays were used to evaluate the effect of chlorine on micro-organisms respiratory activity; in these cases, sodium hypochlorite doses ranged between 2.5 and 18 mgCl 2 (gVSS) −1. A model that allowed to predict simultaneously chlorine consumption and respiratory activity decay for both micro-organisms as a function of time was proposed. The model includes three coupled differential equations corresponding to respiratory inhibition, readily organic matter oxidation by chlorine and chlorine decay. The rate of chlorine decay depended on both, type and concentration of the micro-organisms in the system. Chlorine consumption rate due to S. natans was 2–4 times faster than A. anitratus. Using the proposed model initial critical chlorine doses (the lowest initial dose that leads to a total inhibition of the respiratory activity) were calculated for both micro-organisms and values of 11.9 mgCl 2 (gVSS) −1 for S. natans and 4.5 mgCl 2 (gVSS) −1 for A. anitratus were obtained. These critical doses indicated that in non flocculated pure cultures, floc-former bacteria A. anitratus was more susceptible to chlorine action than S. natans.

Pharmacokinetics and Pharmacodynamics of Intravenous Levofloxacin in Patients with Early-Onset Ventilator-Associated Pneumonia

To investigate the pharmacokinetics of levofloxacin and the pharmacokinetic-pharmacodynamic appropriateness of its total body exposure in patients in the intensive care unit (ICU) treated for early-onset ventilator-associated pneumonia (VAP) with intravenous levofloxacin 500mg twice daily. Prospective non-blinded pharmacokinetic-pharmacodynamic study. Ten critically ill adult patients with normal renal function. Blood and urine samples were collected at appropriate times during a 12-hour administration interval at steady state. Levofloxacin concentrations were determined by high-performance liquid chromatography. Clinical and microbiological outcomes were assessed. Levofloxacin pharmacokinetics were only partially comparable with those obtained from literature data for healthy volunteers. Area under the concentration-time curve (AUC(tau)) over the 12-hour dosage interval was about 30-40% lower than in healthy volunteers (33.90 vs 49.60 mg. h/L). The reduced exposure may be due to a greater clearance of levofloxacin (0.204 vs 0.145 L/h/kg [3.40 vs 2.42 mL/min/kg]), leading to a shorter elimination half-life (5.2 vs 7.6 hours). Cumulative urinary excretion during the 12-hour dosage interval confirmed the greater excretion of unchanged drug in these patients compared with healthy subjects (76% vs 68%). Coadministered drugs used to treat underlying diseases (dopamine, furosemide, mannitol) may at least partially account for this enhanced elimination in critically ill patients. Intravenous levofloxacin 500mg twice daily ensured a median C(max)/MIC (maximum plasma concentration/minimum inhibitory concentration) ratio of 102 and a median 24-hour AUC/MIC ratio of 930 SIT(-1). h (inverse serum inhibitory titre integrated over time) against methicillin-sensitive Staphylococcus aureus and Haemophilus influenzae. The overall success rate of the assessable cases was 75% (6/8). Bacterial eradication was obtained in all of the assessable cases (8/8), but a superinfection (Acinetobacter anitratus,Pseudomonas aeruginosa) occurred in three cases. The findings support the suitability of intravenous levofloxacin 500mg twice daily in the treatment of early-onset VAP in ICU patients with normal renal function. Levofloxacin may represent a valid alternative to non-pseudomonal beta-lactams or aminoglycosides in the empirical treatment of early-onset VAP. However, further larger studies are warranted to investigate its efficacy.

Competitive growth kinetics of Sphaerotilus natans and Acinetobacter anitratus

Growth kinetics of Sphaerotilus natans and Acinetobacter anitratus (strain E932) in pure and mixed cultures were analysed. In order to determine mixed cultures biomass composition, a quantitative image analysis technique was developed. Pure culture studies showed that for dilution rates less than 0.188 h(-1), the filamentous micro-organism will predominate leading to bulking phenomena. By using the developed technique to determine biomass composition, mixed culture experiments showed that changes in the dilution rate modify the microbial composition of the biomass determining which micro-organism predominate. The stated equations that predict the predominance of S. natans at low dilution rates agree satisfactorily with the obtained results.

Emergence of multi-drug-resistant Acinetobacter anitratus species in neonatal and paediatric intensive care units in a developing country: concern about antimicrobial policies.

Antimicrobial abuse is a serious risk factor for the emergence of multi-drug-resistant (MDR) pathogens. We report on the emergence of multi-drug-resistant Acinetobacter anitratus species over two 8-week periods in 1999 in the neonatal and paediatric intensive care units (NICU and PICU) of King Edward VII Hospital, Durban, South Africa. The source, transmission dynamics, microbiological evaluations, antibiotic utilization patterns and outcome were evaluated. MDR Acinetobacter anitratus was isolated from different body sites in 23 infants less than 2 months of age, 18 in the PICU and five in the NICU. The mortality was 56.5% and two survivors required re-admission. Ten of the 23 cases had entered the ICU with MDR Acinetobacter anitratus. Eleven of the study infants had received broad-spectrum antimicrobial agents before entering the ICU, while all infants with nosocomially acquired MDR Acinetobacter anitratus had received broad-spectrum antimicrobial agents. All the surgical cases with MDR Acinetobacter anitratus died. Microbiological data from both ICUs for 1999 indicated that gram-negative bacteria accounted for two-thirds of isolates, Acinetobacter anitratus and Klebsiella pneumoniae accounting for 33% and 27% of the isolates, respectively. Only 53% and 57% of all Acinetobacter spp isolates were susceptible to piperacillin/tazobactam and carbepenems, respectively. MDR Acinetobacter anitratus is an emerging problem to which antimicrobial abuse contributes.

Comparison of the efficacy and safety of isepamicin plus metronidazole and amikacin plus metronidazole in intra-abdominal infections

Intra-abdominal infections due to penetrating wound through the abdominal wall or rupture of the gastrointestinal tract are acute conditions requiring prompt surgical intervention and the use of appropriate antimicrobial agents. Isepamicin is an effective aminoglycoside against various Gram-negative pathogens causing intra-abdominal infections. The objective of the present study is to compare the efficacy and safety of isepamicin (15 mg/kgBW IV o.d.) with amikacin (7.5 mg/kgBB b.i.d.), in conjunction with metronidazole for both drugs. An open, randomized, parallel design was applied in this trial. The subject allocation ratio for isepamicin: amikacin is 2:1. Out of 50 patients enrolled in this study, 27 fuffilled the criteria for safety and efficacy population, and 46 for intent-to-treat population. In the safety and efficacy population, the clinical success rare for isepamicin and amikacin group did not differ significantly (i.e., 95% and 100%, respectively). In the intent-to-treat population, the clinical success rates for isepamicin and amikacin group were also insignifficantly different (i.e., 97% and 100%, respectively). The rates of bacteriological elimination for isepamicin and amikacin, were 95% and 100%, respectively in the efficacy and safety population, and 90% and 93%, respectively in the intent-to-treat population. Streptococci and staphylococci were the most frequent (40%) pathogens isolated from pus, and Acinetobacter anitratus (55%) was the most common one isolated from blood. In the efficacy and safety population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.7 ± 3.9 and 11.1 ± 3.8 days, respectively, while in the intent-to-treat population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.1 ± 3.4 and 10.5 ± 3 days, respectively. In the present study, both aminoglycosides were well tolerated and there was no patient withdrawal associated with side effect. It is concluded that for intra-abdominal infections, intravenous isepamicin given once daily is as effective as intravenous amikacin given twice daily in combination with metronidazole. (Med J Indones 2001; 10: 88-94) Keywords : Isepamicin, amikacin, inta-abdominal infections

Bactericidal and bacteriostatic activity of gemifloxacin against Acinetobacter spp. in vitro.

This study compared the in vitro bacteriostatic activity of gemifloxacin (SB-265805) and a panel of test antimicrobial agents against 100 clinical isolates of Acinetobacter spp. (47 Acinetobacter baumannii, 18 Acinetobacter anitratus, 18 Acinetobacter lwoffii, 13 Acinetobacter calcoaceticus and four other Acinetobacter spp.). Gemifloxacin (MIC(50/90) 0.06/16 mg/L) was more than eight-fold more potent than ciprofloxacin (0.5/>128 mg/L), two- to eight-fold more potent than grepafloxacin, moxifloxacin, levofloxacin, ofloxacin and gatifloxacin, and of similar potency to trovafloxacin and sparfloxacin. Cross-resistance was seen only within the quinolone group and did not extend to non-quinolone antimicrobials. The bactericidal activities of gemifloxacin and the six comparator quinolones were investigated by dose-response and time-kill studies against A. baumannii ATCC 19606 at their optimum bactericidal concentration (OBC) and at 4 x MIC. At the OBC there was no significant difference between the quinolones, but at 4 x MIC gemifloxacin showed superior activity, reducing the viable count by almost 2 log(10) in 30 min compared with a 1 log(10) reduction seen with the other drugs. This enhanced killing extended over 24 h, reducing cell numbers by >4 log(10). These data suggest that gemifloxacin has the potential to be of therapeutic value in the treatment of infection by Acinetobacter spp.

Impact of use of multiple antimicrobials on changes in susceptibility of gram-negative aerobes.

Evaluation of antimicrobial usage vs. susceptibility relationships typically involves single agents. However, susceptibility profiles may be affected by multiple drugs. From 1992 through 1996, we studied relationships between drug usage and the susceptibility (only susceptibility rates of > or = 70%) of Acinetobacter anitratus (baumannii), Enterobacter aerogenes, Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, and Serratia marcescens to 22 agents. Linear regression was used to assess usage of each agent vs. susceptibility to it and to all agents. Only relationships with a coefficient of determination of > or = 0.5 and a negative slope were evaluated and classified as increasing drug use and decreasing susceptibility (increasing D, decreasing %S) or decreasing drug use and increasing susceptibility (decreasing D, increasing %S). The mean numbers (range) of drugs associated with a change in susceptibility were 1.7 (0-14) and 0.6 (0-7), respectively, for increasing D, decreasing %S and decreasing D, increasing %S relationships. Multiple antimicrobials are associated with susceptibility to other drugs; thus, surveillance of these relationships should not be limited to single drugs.

Susceptibility of Corneal and Conjunctival Pathogens to Ciprofloxacin

Ciprofloxacin 0.3% ophthalmic solution has been shown to be effective in the treatment of bacterial keratitis and conjunctivitis, and many physicians use ciprofloxacin as sole therapy in these conditions. In this retrospective study, we found seven of 84 isolates from corneal and conjunctival cultures that were resistant to ciprofloxacin. All of the resistant organisms were gram positive. Six of the isolates (Staphylococcus aureus, Staphylococcus hominis, and four isolates of the Streptococcus viridans group) were from corneal cultures, and one (Staphylococcus aureus) was from a conjunctival culture. Yearly records of systemic isolates from 1988 to 1993 (n = 35,308) demonstrated a statistically significant decrease in susceptibility for several organisms that are common pathogens in the conjunctiva and cornea: Pseudomonas aeruginosa (95-90%, p = 0.001); Staphylococcus aureus (96-87%, p < 0.0001); Staphylococcus spp., coagulase negative (97-81%, p < 0.0001); Enterococcus spp. (92-79%, p < 0.0001); Acinetobacter anitratus (97-77%, p = 0.0006); and Enterobacter cloacae (100-96%, p = 0.03). Although the susceptibility of corneal and conjunctival isolates in this series remained relatively high (91.7%), a much larger series of systemic isolates that are common ocular pathogens revealed a statistically significant increase in resistance to ciprofloxacin over the preceding 5 years.

Investigation of the epidemiology of hospital isolates of Acinetobacter anitratus by two molecular methods

Two hundred and two isolates of Acinetobacter anitratus from 126 patients in 36 wards belonging to 11 specialties of a university teaching hospital were compared by ribotyping and restriction enzyme digest analysis (REA) of total DNA. Forty-six groups were defined by both techniques and there was 96·5% agreement between the methods for the designation of isolates into groups. Only two groups were endemic and circulating in the whole hospital while others were less common. Burns and intensive therapy units had the highest number of isolates and these were mainly of the two endemic groups while renal dialysis and neonatal units had isolates belonging to the less common groups. Of the 32 patients with multiple isolates, 17 were infected or colonized at different sites by two and up to four groups of A. anitratus. Both ribotyping and REA of total DNA are discriminatory methods for typing A. anitratus, however, the latter is a simpler and more rapid method and it can be used in a routine clinical laboratory.

Antibacterial Activity of Several Organic Acids Commonly Used as Food Additives

Among 9 organic acids commonly used as food additives in Japan, fumaric acid (FA) exhibited the strongest growth-inhibiting (GI) action on 20 Gram-negative bacterial strains tested. Growth of these 20 strains, including 3 Salmonella serovars, Escherichia coli, E. cloacae, Klebsiella oxytoca, K. pneumoniae, Acinetobacter anitratus, Proteus mirabilis, or Pseudomonas aeruginosa, was inhibited within 160 seconds of contact with 0.3w/v% solution of FA, although strains of S. Typhimurium exhibited lower susceptibility than the others. Both Bacillus cereus and Staphylococcus aureus were resistant to the GI action of FA and other organic acids. The GI action of FA was remarkably improved by the addition of 0.3-0.1% ascorbic acid, malic acid, tartaric acid or citric acid monohydrate.

Bacteremia with Acinetobacter species--clinicopathological characteristics of 27 cases

Acinetobacter spp. are non-fermented gram-negative rods that are widespread in the environment and colonize in the human skin. They are known to be a nosocomial pathogen causing, pneumonia, meningitis and bacteremia. Recently, they have been found increasingly in catheter-related infections (CRI). Thirty-seven cases of bacteremia were developed in our hospital during the past five years. Of these 27 cases were chosen out of the medical records for discussion in this paper. Twenty-three cases are blood positive for Acinetobacter anitratus and 4 cases for A. lwoffii. Most cases have an underlying disease like hematological malignancy, solid tumor and infantile congenital abnormality. There were also some clinical signs; high fever, hypotension, tachycardia, tachypnea, peripheral cyanosis. A central venus catheter was inserted in 22 cases, and in 13 of these, the catheter was removed after the bacteremic episode. Nine cases became afebrile after the removal of the catheter and A. anitratus was isolated from the catheter tip in four cases. Heparin was administered through the catheter in 7 cases. Formerly Acinetobacter spp. were not recognized as a major pathogen, but recently found increasingly in CRI. We also found 9 cases which were definitely diagnosed or suspected as CRI, and were successfully treated by removal of the central venus catheter. Association between administration of heparin and bacteremia of Acinetobacter spp. was reported, we actually detected such association in 7 cases, but the potential role of heparin has not been clarified yet. Compared with A. lwoffii, A. anitratus were resistant to many drugs, but had good susceptibility to imipenem, minocycline, aminoglycoside, and fluoroquinolone.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibiotic-resistant Acinetobacter meningitis in neurosurgical patients.

Acinetobacter anitratus has emerged as one of the common pathogens responsible for postneurosurgical meningitis at the authors' institution. Seven patients with Acinetobacter meningitis were identified during the 4-year period of this study, five of whom acquired organisms susceptible only to imipenem and amikacin. Acinetobacter bacteremia occurred concomitantly in five patients. Despite late institution of therapy as a result either of organism misidentification on Gram stain or of unexpected acquisition of a highly resistant organism, the patients' outcome was favorable after the initiation of appropriate antibiotic therapy. Imipenem and amikacin, with or without intrathecal aminoglycosides, were effective in patients with resistant strains of Acinetobacter.

Studies on the microbiological flora of caprine mastitis and antibiotic inhibitory concentrations in Nigeria

The prevalence of bacterial species in each of 103 clinically unaffected and affected caprine udders in the Sahel zone of Nigeria was investigated. A total of 11 genera of bacteria were isolated from unaffected and affected udders. Of the 39 bacterial species isolated from the udders, Acinetobacter anitratus, Bacillus subtilis, Escherichia coli, Pasteurella haemolytica and Staphylococcus aureus occurred significantly (P<0.05) more often than other species in affected compared with unaffected udders. Minimum inhibitory concentrations (MICs) of six antibiotics tested against the significant isolated showed that tylosin had the lowest inhibitory concentrations ranging from 0.10–0.39 μg/ml. Streptomycin and methicillin with MICs of 0.10–0.65 μ/ml and 0.13–1.04 μg/mg, respectively, were lower than bacitracin oxytetracycline and cloxacillin. The need to ascertain antibiotic inhibitory concentrations against significant isolates from different geographical locations for effective chemotherapy and control of caprine mastitis are indicated.

Studies on the influence of ozone on complement-mediated killing of bacteria.

The role of ozone in the susceptibility of clinical isolates of Acinetobacter anitratus and Pseudomonas aeruginosa to serum was investigated. It was found that ozone-treated cells were more susceptible to complement-mediated killing serum. These results suggest that ozone damage or change of cell membrane leads to a more rapid penetration of the membrane attack complex of complement.

Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome.

To investigate the conditions that have developed in the treatment of posttraumatic meningitis with the use of new antibiotics, the authors studied cases with this infection retrospectively for a period of 68 months. Among 860 patients with moderate to severe head injuries, 12 (1.39%) sustained this complication. Of these, nine patients (75%) had a demonstrable basilar skull fracture and seven (58.3%) presented obvious rhinorrhea. Of these seven, four (57.1%) were treated conservatively and three (42.8%) finally underwent surgery for dural repair. The infecting agents were Gram-positive cocci (Staphylococcus haemolyticus, Staphylococcus warneri, Staphylococcus cohnii, Staphylococcus epidermidis, and Streptococcus pneumoniae) in five patients and Gram-negative bacilli in six patients (Escherichia coli in two, Klebsiella pneumoniae in two, and Acinetobacter anitratus in two). In one patient, the culture results were negative. All Gram-negative strains appeared resistant to ampicillin and third-generation cephalosporins, but sensitive to imipenem and to the quinolone ciprofloxacin. Gram-positive strains were sensitive to vancomycin. Hydrocephalus finally developed in the two patients who had received intrathecal infusions of amikacin. No other report of the relation of intrathecal infusion of antibiotics and the development of hydrocephalus was found. All patients survived, indicating that, for the present, posttraumatic meningitis is a nonfatal complication of head injury.

Posttraumatic Meningitis

TO INVESTIGATE THE conditions that have developed in the treatment of posttraumatic meningitis with the use of new antibiotics, the authors studied cases with this infection retrospectively for a period of 68 months. Among 860 patients with moderate to severe head injuries, 12 (1.39%) sustained this complication. Of these, nine patients (75%) had a demonstrable basilar skull fracture and seven (58.3%) presented obvious rhinorrhea. Of these seven, four (57.1%) were treated conservatively and three (42.8%) finally underwent surgery for dural repair. The infecting agents were Gram-positive cocci (Staphylococcus haemolyticus, Staphylococcus warneri, Staphylococcus cohnii, Staphylococcus epidermidis, and Streptococcus pneumoniae) in five patients and Gram-negative bacilli in six patients (Escherichia coli in two, Klebsiella pneumoniae in two, and Acinetobacter anitratus in two). In one patient, the culture results were negative. All Gram-negative strains appeared resistant to ampicillin and third-generation cephalosporins, but sensitive to imipenem and to the quinolone ciprofloxacin. Gram-positive strains were sensitive to vancomycin. Hydrocephalus finally developed in the two patients who had received intrathecal infusions of amikacin. No other report of the relation of intrathecal infusion of antibiotics and the development of hydrocephalus was found. All patients survived, indicating that, for the present, posttraumatic meningitis is a nonfatal complication of head injury.

Comparative crossover assessment of serum bactericidal activity and pharmacokinetics of ciprofloxacin and ofloxacin

The study compared the pharmacokinetics and pharmacodynamics of ciprofloxacin and ofloxacin in 12 healthy male volunteers with normal renal function. Each volunteer received oral ciprofloxacin 500 mg, intravenous (i.v.) ciprofloxacin 400 mg, oral ofloxacin 400 mg, or i.v. ofloxacin 400 mg in a randomized, double-blind, crossover design with a one-week 'washout' period between doses. Mean peak serum concentrations were 4.48 and 5.44 mg/L for i.v. ciprofloxacin and ofloxacin, respectively. For the oral regimens, mean peak serum concentrations were 2.45 mg/L for ciprofloxacin and 4.44 mg/L for ofloxacin. Minimum bactericidal concentrations (MBC) and serum bactericidal activity (SBA) for each drug were measured against five strains of each of the following species: Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Pseudomonas aeruginosa, Acinetobacter anitratus, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae, using the microdilution method of the National Committee for Clinical Laboratory Standards (NCCLS). Ciprofloxacin was more active in vitro than ofloxacin against the tested species of Enterobacteriaceae and P. aeruginosa, while ofloxacin was slightly more active against A. anitratus. MBCs for the two drugs were similar for H. influenzae and S. aureus. Oral and i.v. ciprofloxacin in the doses given resulted in nearly equivalent SBA. Similarly, oral and i.v. ofloxacin had nearly equivalent SBA. For the i.v. and oral regimens of both agents, peak SBA was > or = 2 throughout the 12-hour test period against the Enterobacteriaceae and H. influenzae. At peak concentrations, both drugs had modest SBA against P. aeruginosa, A. anitratus, and S. aureus but little or no activity 8 and 12 h after dosing.(ABSTRACT TRUNCATED AT 250 WORDS)

In-vitro activities of cefepime against Enterobacter cloacae, Serratia marcescens, Pseudomonas aeruginosa and other aerobic Gram-negative bacilli

Infections caused by resistant bacterial pathogens such as Citrobacter freundii, Enterobacter cloacae, Serratia marcescens and Pseudomonas aeruginosa have become an increasing problem with respect to therapy in large medical centres in Korea. The MICs of cefepime for aerobic Gram-negative bacilli isolated during 1991, mostly from in-patients in a hospital in Seoul, were determined by the agar dilution method and compared with those of several other antimicrobials. Of the agents tested, cefepime had the lowest MIC90s for C. freundii and E. cloacae (0.12 and 8 mg/L, respectively). The MIC90s of cefepime and amikacin (both 8 mg/L) were the lowest for S. marcescens. The MIC90s of cefepime, ceftazidime and doxycycline (all 32 mg/L) were the lowest for Acinetobacter anitratus. For P. aeruginosa, the MIC90 was relatively high (32 mg/L) but still the lowest of the antimicrobials tested. Of the cefotaxime-resistant E. cloacae isolates studied, only 7% were resistant to cefepime, while 100%, 96% and 89% were resistant to ceftazidime, ceftizoxime and cefuzonam, respectively. Similarly, only 6% of gentamicin-resistant isolates were resistant to cefepime, compared with 91%, 72%, 69% and 63% to ceftazidime, ceftizoxime, cefuzonam and cefotaxime, respectively. In conclusion, isolates from Korean patients are often resistant to several antimicrobial agents. However, based on the results of this study, cefepime may be very useful as treatment for patients with nosocomial infections caused by aerobic Gram-negative bacilli, including those which are resistant to most of the third-generation cephalosporins and gentamicin.

Acinetobacter anitratus pneumonia outbreak in the intensive care unit (ICU) traced to a manual weaning criteria machine

Acinetobacter anitratus pneumonia outbreak in the intensive care unit (ICU) traced to a manual weaning criteria machine