Antibiotic-resistant Staphylococcus Research Articles

Knema retusa is antibacterial and antibiofilm against antibiotic resistant Staphylococcus aureus and S. haemolyticus isolated in bovine mastitis.

This study aimed to assess antibacterial activity of Knema retusa wood extract (KRe) against antibiotic resistant staphylococci which are causative agents of bovine mastitis. From 75 cases of intramammary infections in dairy cows, 66 staphylococcal isolates were collected, including 11 Staphylococcus aureus isolates (17%) and 55 coagulase-negative staphylococci (83%). Sixty isolates (91%) formed strong biofilms. KRe had minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC) against the isolates ranging 32-256 ug/mL and 64-512 ug/mL, respectively. Two-hour KRe exposures at 4×MIC, viabilities of S. aureus and S. haemolyticus decreased by 3 log10 compared to the control. Scanning EM (SEM) showed that KRe disrupted the bacterial cells of both species. KRe at 1/16×MIC significantly inhibited biofilm formation (P < 0.05) in both S. aureus and S. haemolyticus. At 1/2×MIC, S. aureus and S. haemolyticus biofilm inhibition ranged from 75 to 99%. Cells within established biofilms were disrupted 66-83% by KRe at 32×MIC. Moreover, 1/2×MIC KRe reduced bacterial adhesion to glass surfaces observed by SEM. According to GC-MS analysis, the major compound in KRe was endo-2-hydroxy-9,9-(ethylenedioxy)-1-carbethoxy bicyclo [3.3.1] nonane (E2N). Molecular docking analysis of E2N has a high affinity for staphylococcal accessory regulator A (SarA), binding free-energy - 6.40kcal/mol. The results suggested that KRe may have medicinal benefits by inhibiting the growth, biofilm, and adhesion of antibiotic resistant staphylococci isolated from bovine mastitis.

Whole-Genome Sequencing of Staphylococcus aureus and Staphylococcus haemolyticus Clinical Isolates from Egypt.

ABSTRACTInfections caused by antibiotic-resistant Staphylococcus are a global concern. This is true in the Middle East, where increasingly resistant Staphylococcus aureus and Staphylococcus haemolyticus strains have been detected. While extensive surveys have revealed the prevalence of infections caused by antibiotic-resistant staphylococci in Europe, Asia, and North America, the population structure of antibiotic-resistant staphylococci recovered from patients and clinical settings in Egypt remains uncharacterized. We performed whole-genome sequencing of 56 S. aureus and 10 S. haemolyticus isolates from Alexandria Main University Hospital; 46 of the S. aureus genomes and all 10 of the S. haemolyticus genomes carry mecA, which confers methicillin resistance. Supplemented with additional publicly available genomes from the other parts of the Middle East (34 S. aureus and 6 S. haemolyticus), we present the largest genomic study to date of staphylococcal isolates from the Middle East. These genomes include 20 S. aureus multilocus sequence types (MLST), including 3 new ones. They also include 9 S. haemolyticus MLSTs, including 1 new one. Phylogenomic analyses of each species’ core genome largely mirrored those of the MLSTs, irrespective of geographical origin. The hospital-acquired spa t037/ST239-SCCmec III/MLST CC8 clone represented the largest clade, comprising 22% of the S. aureus isolates. Like S. aureus genome surveys of other regions, these isolates from the Middle East have an open pangenome, a strong indicator of gene exchange of virulence factors and antibiotic resistance genes with other reservoirs. Our genome analyses will inform antibiotic stewardship and infection control plans in the Middle East.IMPORTANCE Staphylococci are understudied despite their prevalence within the Middle East. Methicillin-resistant Staphylococcus aureus (MRSA) is endemic to hospitals in Egypt, as are other antibiotic-resistant strains of S. aureus and S. haemolyticus. To provide insight into the strains circulating in Egypt, we performed whole-genome sequencing of 56 S. aureus and 10 S. haemolyticus isolates from Alexandria Main University Hospital. Through analysis of these genomes, as well as all available S. aureus and S. haemolyticus genomes from the Middle East (n = 40), we were able to produce a picture of the diversity in this region more complete than those afforded by traditional molecular typing strategies. For example, we identified 4 new MLSTs. Most strains harbored genes associated with multidrug resistance, toxin production, biofilm formation, and immune evasion. These data provide invaluable insight for future antibiotic stewardship and infection control within the Middle East.

Occurrence and Distribution of Antibiotic-Resistant Staphylococcus aureus in a Brazilian Pork Production Chain

Here we characterized the distribution and the antibiotic resistance of staphylococci from a Brazilian pork production chain. Samples (n = 1,114) from pig farms, pig lots, and slaughterhouses, located in two Brazilian states (Minas Gerais and Paraná), were subjected to coagulase-positive Staphylococcus enumeration. S. aureus isolates (n = 251) from this collection were further characterized for their resistance to oxacillin, cefoxitin, vancomycin, and tetracycline through phenotypic and molecular assays. Coagulase-positive Staphylococcus counts from pig farms were higher compared with other samples (P < 0.05). Other counts were relatively low but were present in all production stages. S. aureus isolates were commonly resistant to oxacillin and cefoxitin (54 of 73, 74.0%), qualifying them as methicillin-resistant S. aureus, but PCR assays indicated that few harbored the expected antimicrobial resistance genes (femB, mecA, and mecC). Lower frequencies of vancomycin and tetracycline resistance were found (6.8 to 37.0%). PCR sensitivity (34.5 to 86.7%) and specificity (26.6 to 85.0%) for detection of antibiotic resistance genes varied based on the assessed antibiotic. Antibiotic-resistant staphylococci are widely distributed in the Brazilian pork production chain, and methicillin-resistant S. aureus can become a potential health and economic impediment for the Brazilian pork industry.

Use of non-thermal plasma for decontamination of titanium implants

Non-thermal plasma (NTP) has a non-specific bactericidal effect as a result of the synergistic activity of biologically active components contained in the plasma torch. As part of this work, we investigated the potential of using NTP for the antibacterial treatment of titanium implants. Applying samples made of the VT6 titanium alloy used to create implants and a strain of antibiotic-resistant staphylococcus MRSA, we showed that 1) plasma pretreatment of the sample surface led to the formation of a film containing titanium oxides which have a weak bactericidal effect reducing the colonization of the surface with staphylococcus; 2) direct plasma treatment of a polished titanium disk for 120 seconds reduced the contamination of S. aureus by 563 times; 3) the relief of the titanium surface itself plays an important role in the effectiveness of decontamination: the bacteria on the rough surface were less susceptible to the effects of NTP than the bacteria on the polished surface. In total, the data obtained indicate the need to continue research aimed at increasing the effectiveness of the bactericidal activity of NTP against bacteria on the surface of titanium implants.

Occurrence of Antibiotic-Resistant Staphylococcus spp. in Orange Orchards in Thailand.

Background: The widespread indiscriminate application of antibiotics to food crops to control plant disease represents a potential human health risk. In this study, the presence of antibiotic-resistant staphylococci associated with workers and orange orchard environments was determined. A total of 20 orchards (orange and other fruits) were enrolled in the study. Trees in the orange orchards were treated with ampicillin on a pre-determined schedule. Environmental samples (n = 60) included soil, water, and oranges; 152 hand and nasal samples were collected from 76 healthy workers. Antibiotic susceptibility profiles were determined for all staphylococcal isolates. Results: This investigation revealed that of the total Staphylococcus spp. recovered from the orange orchard, 30% (3/10) were resistant to erythromycin, 20% (2/10) were resistant to ampicillin, and 20% (2/10) resistant to both erythromycin and ampicillin. Conclusion: The application of antibiotics to orange trees in open production environments to halt the spread of bacterial disease presents risks to the environment and creates health concerns for Thai farmers using those agents. ARB on crops such as oranges may enter the global food supply and adversely affect public health.

SYNTHESIS AND EVALUATION OF NEW PHENYLTHIAZOLE DERVATIVES AS ANTIMICROBIAL AGENTS

The current arsenal of antimicrobials couldn't hold back the rapid and ferocious growth of the antimicrobial resistance phenomenon. Collectively the current situation points to the pressing need to develop other effective antimicrobial agents. In the search for novel antimicrobials, phenylthiazole derivatives have recently been found to possess antibacterial activity particularly against a range of several antibiotic-resistant staphylococcus aureus strains. Modification of the nitrogenous head by incorporation the hydrolysable -HC=N- linkage within a pyrimidine ring bearing one or more hydrogen bond-promoting group led to the discovery of the second generation of phenylthiazoles, with more potent activity and longer half-lives compared to the lead compound 1a. Based on the above rationale, the objective of this study was to create a new set of structures of n-butylphenylthiazole-5-pyrimidine that contains two or more heteroatoms in their side chain and to study the relationship between the structural form of these compounds and their antimicrobial activity and spectrum against certain multi-drug resistance (MDR) strains. The new set of derivatives is designed to cover all the possibilities of side chains carbon-units distance and spatial configurations.

Frequency and comparison among antibiotic resistant Staphylococcus aureus strains in selected hospitals of Peshawar, Pakistan.

To assess and compare the frequency of antibiotic-resistant staphylococcus aureus strains. A retrospective study was conducted at the privately-owned Welfare Medical Laboratory, Peshawar, Pakistan, and comprised record related to the period between 07th February 2017 and 23rd March 2018 of patients referred for pus-testing from Khyber Teaching Hospital, Lady Reading Hospital and the Hayatabad Medical Complex. Pus samples were obtained from various parts of body with cotton swabs. The samples were cultured and the isolated staphylococcus aureus strains were analysed against selected antibiotics. The frequency of the isolated strains was tested and compared using Prism 7 software. Of the 6780 samples, staphylococcus aureus was found in 4315(63.64%). Wild-type staphylococcus aureus strains were 2133(31.46%), followed by 825(12.16%) methicillin resistant, 792(11.68%) vancomycin intermediate, and 565(8.33%) vancomycin-resistant staphylococcus aureus strains. The isolated strains were significant (p<0.0001) for operated wounds, and non-significant (p=0.8915) for diabetic foot cases. The frequency of antibiotic-resistant staphylococcu saureus strains was high.

Antibiotic-resistant Staphylococcus epidermidis isolated from patients and healthy students comparing with antibiotic-resistant bacteria isolated from pasteurized milk.

Antibiotic-resistant Staphylococci are a global issue affecting humans, animals, and numerous natural environments. Antibiotic-resistant Staphylococcus epidermidis is an opportunistic pathogen frequently isolated from patients and healthy individuals. This study aimed to examine the antibiotic resistance of S. epidermidis isolated from patients, healthy students and compare the results with antibiotic-resistant bacteria isolated from pasteurized milk. Clinical strain isolation was performed in several hospitals in the Riyadh. Skin swabs from 100 healthy undergraduate candidate students were obtained at King Saud University. The pasteurized milk samples were obtained from local market (company, X). After isolation, identification and susceptibility tests were performed using an automated system. A multiplex tuf gene-based PCR assay was used to confirm identification. Biofilm production and biofilm-related gene expression were studied. S. epidermidis represented 17% of clinical bacterial isolates, and 1.7% of isolates obtained from healthy students were multiantibiotic-resistant. All patient strains were teicoplanin- and vancomycin-susceptible, while all student strains were gentamicin-, levofloxacin-, moxifloxacin-, and trimethoprim/sulfamethoxazole-susceptible. All the bacteria isolated from pasteurized milk were benzylpenicillin and oxacillin-resistant strains. Of the S. epidermidis strains, 91% could produce biofilms, and mecA, icaADBR, ica-ADB, ica-AD, ica-A only, and ica-C only were expressed in 83, 17.1, 25.7, 37.1, 20, and 0% of the strains, respectively. This work demonstrates that S. epidermidis can be accurately identified using a multiplex tuf-based assay, and that multiantibiotic-resistant S. epidermidis strains are widespread amongst patients and healthy students.

Characterization of multiple antibiotic resistant clinical strains of Staphylococcus isolated from pregnant women vagina.

Vagina which is one of the important reservoirs for Staphylococcus and in pregnant women pathogenic strains may infect the child during the birth or by vertical transmission. A total of 68 presumptive Staphylococcus strains isolated from human vagina were found to be gram-positive cocci, and only 32 (47%) isolates were found beta-hemolytic. Matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) results confirmed 33 isolates belonged to Staphylococcus which consisting of 6 species, i.e., S. aureus (14), S. vitulinus (7), S. epidermidis (4), S cohnii (3), S. equorum (3), and S. succinus (2). Further, the result of antibiotic susceptibility tests showed that large proportions (76%-100%) of the isolates were resistant to multiple antibiotics and more often resistant to penicillin (100%), ampicillin (100%), oxacillin (97%), oxytetracycline (97%), vancomycin (97%), rifampin (85%), erythromycin (82%), and streptomycin (76%). In the present study, only the sec enterotoxin gene was detected in four S. aureus strains. DNA fingerprints of the 33 isolates that were generated using random amplified polymorphic DNA (RAPD) and enterobacterial repetitive intergenic consensus (ERIC) PCR analysis revealed great genetic relatedness of isolates. High prevalence of vaginal colonization with multiple antibiotic-resistant staphylococci among pregnant women was observed which were emerged from the single respective species clones that underwent evolution. The vertical transmission of these multiple antibiotic-resistant Staphylococcus species to the infant is possible; therefore, the findings of this study emphasize the need for regular surveillance of antibiotic-resistant bacterial strains in pregnant women in this area.

In-vitro study of photodynamic therapy of antibiotic-resistant staphylococcus from patients with chronic rhinosinusitis

To evaluate the photodynamic therapy (PDT) against multi-antibiotic-resistant Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S.epidermidis) obtained from patients with chronic rhinosinusitis (CRS). Forty-five CRS patients who had been given medical treatment but still needed endoscopic surgery were included in this study. The mucus from middle meatus was collected from these patients during surgery, followed by separation of S. aureus and S. epidermidis and drug sensitive test. The strains which could form biofilm were selected. Light emitting diode (LED) array with a major wavelength of (633±10) nm was used as light source and 5-Aminolevulinic acid (ALA) was used as photosensitizer in this PDT experiment. The safe range of LED dose and ALA concentration which were not toxic to bacteria by themselves were confirmed, and then did PDT experiment on S. aureus and S. epidermidis. The data of bacterial colony forming unit were transformed to lgCFU before statistical analysis.The Graph Pad Prism 5 software was used to analyzed the data. Thirteen S. aureus and 16 S. epidermidis were included in this experiment(from 45 patients), all of them were multi-antibiotic-resistant bacteria, and four of S. aureus and five of S. epidermidis could form biofilm in each group. In planktonic S. aureus experiment, the mean lgCFU was 8.32±0.31 in control group whereas the experiment group was 6.47±0.67 (t=9.01, P<0.01), and in planktonic S. epidermidis experiment the final data was 8.34±0.20 (control group) and 6.97±0.59 (experiment group) (t=8.84, P<0.01). In biofilm S. aureus experiment, the mean lgCFU was 8.68±0.05 (control group), 6.90±0.96(experiment group) (t=3.68, P<0.05); and in biofilm S. epidermidis experiment the data was 8.67±0.05 (control group), 7.29±0.61 (experiment group, t=5.07, P<0.01). Our results demonstrated that ALA-mediated PDT on multi-antibiotic-resistant S. aureus and S. epidermidis from CRS patients was effective in vitro. Additional work defining if the PDT treatment would damage the nasal mucosa and further checking the effectiveness of PDT in vivo is still needed.

Cytoplasmic expression, optimization and catalytic activity evaluation of recombinant mature lysostaphin as an anti-staphylococcal therapeutic in escherichia coli

Objective: Scientists are to develop novel antibacterial therapeutics in order to eliminate medically significant pathogens resistant to antibiotic. Lysostaphina zinc metalloprotease with the sub-atomic weight of 27kDa and particularly tic action against Staphylococcus aureus degrades the S. aureus by hydrolyzing the pentaglycine cross-links introduce in its cell wall. Because of such potential, lysostaphin will be a decent agent for treatment of antibiotic-resistant staphylococcal infections. Also, due to the broad needs of society to increase localization of sciences, the national production of this drug in research laboratories would be necessary. Materials and Methods: First, with the aid of articles we identified Lysostaphin sequences without signal peptide via Gene Bank data base. In order to achieve the correct protein sequence, we add the entrokinase cutting site to our sequence. To ensure the correct cloning process, the entire process of cloning and protein expression was evaluated in silico. The sequence obtained for the synthesis was sent to the Biomatik Company in Canada (BIOMATIK). After the primer design and synthesis of the DNA fragment of the gene, we amplified the gene using PCR. The mature lysostaphin gene was cloned in plasmidpET28a and expressed in E.coli with the carboxyl terminal hexa-histidine fusion tag under the transcriptional control of T7/lac promoter/operator. Result: The transformed E.coli BL2 (DE3) cells produced catalytically active recombinant lyso staphin after being induced by IPTG. Conclusion: This study shows that the E. coli expression system is suitable for expression of recombinantly so staphin and according to the conducted bioassay in this study, the expressed protein can be considered as an effective therapeutic agent against antibiotic resistant staphylococcus aureus.

Activité antibactérienne du triclocarban sur les staphylocoques, entérocoques et streptocoques résistant

Triclocarban is an antiseptic of the anilide family. Its antibacterial activity was re-assessed in vitro against various susceptible and antibiotic resistant staphylococcus, streptococcus, and enterococcus strains. The results of this study show that, in vitro, the effectiveness of triclocarban antibacterial is maintained at very low MICs ranging from 0.5 to 8mg/L for the various resistant strains studied. Triclocarban remains still very effective for the treatment of either initially bacterial skin and mucosal infections, or skin and mucosal at risk of super infection.

Editorial: Not So Nosocomial Anymore: The Growing Threat of Community-Acquired Clostridium difficile

Clostridium difficile infection is widely accepted to be the leading cause of nosocomial infection-related morbidity and mortality, outpacing both antibiotic-resistant staphylococcus and enterococcus. The existence and prevalence of community-acquired Clostridium difficile infection, on the other hand, is much less well appreciated. Growing evidence now suggests that community-acquired Clostridium difficile infection may account for more than a third of Clostridium difficile-associated diarrhea overall. Similar to nosocomial Clostridium difficile infection, community-acquired cases appear to be increasing in incidence, and although associated mortality is lower than in nosocomial cases, morbidity including hospitalization and recurrence are high. Further, traditional risk factors for Clostridium difficile infection including antibiotic exposure appear to be less important in community-acquired cases and common routes of exposure and infection in the community are yet to be elucidated. In this issue of the American Journal of Gastroenterology, Khanna et al. provide important epidemiological data on the growing threat of community-acquired Clostridium difficile infection.

The use of quaternised chitosan-loaded PMMA to inhibit biofilm formation and downregulate the virulence-associated gene expression of antibiotic-resistant staphylococcus

Biomaterial-associated infections remain a serious complication in orthopaedic surgery. Treatments, including the local use of antibiotic-loaded polymethylmethacrylate (PMMA) bone cement, are not always successful because of multiantibiotic-resistant organisms. In this study, we synthesised a new quaternised chitosan derivative (hydroxypropyltrimethyl ammonium chloride chitosan, HACC) that contains a series of substitutions of quaternary ammonium and demonstrated that HACC with a 26% degree of substitution (DS; referred to as 26%HACC) had a strong antibacterial activity and simultaneously good biocompatibility with osteogenic cells. We loaded 26%HACC at 20% by weight into PMMA bone cement to investigate whether HACC in PMMA prevents bacterial biofilm formation on the surface of bone cements. Chitosan-loaded PMMA (at the same weight ratio), gentamicin-loaded PMMA and PMMA with no antibiotic were also investigated and compared. Two clinical isolates, Staphylococcus epidermidis 389 and methicillin-resistant S. epidermidis (MRSE287), and two standard strains, S. epidermidis (ATCC35984) and methicillin-resistant Staphylococcus aureus (ATCC43300), were selected to evaluate the bacterial biofilm formation at 6, 12 and 24 h using the spread plate method, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). The results showed that 26%HACC-loaded PMMA inhibited biofilm formation on its surface, while the PMMA control and chitosan-loaded PMMA were unable to inhibit biofilm formation. The gentamicin-loaded PMMA decreased the number of viable methicillin-resistant Staphylococcus strains, but its ability to inhibit biofilm formation was lower than 26%HACC-loaded PMMA. Real-time PCR demonstrated that 26%HACC-loaded PMMA markedly downregulated the expression of icaAD, which encodes essential enzymes for polysaccharide intercellular adhesion (PIA) biosynthesis, upregulated the expression level of icaR, which negatively mediates icaAD expression, and also downregulated the expression of MecA, which encodes membrane-bound enzymes known to be penicillin-binding proteins. Our study indicates that 26%HACC-loaded PMMA prevents biofilm formation of Staphylococcus, including antibiotic-resistant strains, on the surface of bone cement, and downregulates the virulence-associated gene expression of antibiotic-resistant staphylococcus, thus providing a promising new strategy for combating implant infections and osteomyelitis.

Infection-Related Glomerulonephritis: Understanding Mechanisms

The epidemiology of infection-related glomerulonephritis is undergoing striking changes, particularly in developed countries. The incidence of acute poststreptococcal glomerulonephritis (PSAGN) is decreasing because of the successful treatment of streptococcal infections. In contrast, because of the emergence of antibiotic-resistant staphylococcus strains, such as methicillin-resistant Staphylococcus aureus (MRSA), the incidence of Staphylococcus aureus infection-associated glomerulonephritis (SAAGN) is on the rise. In this review, we focus on the pathogenesis of PSAGN and SAAGN, but also emphasize the clinical importance of differentiating between two major forms of infection-related glomerulonephritis: postinfectious glomerulonephritis (such as PSAGN) and glomerulonephritis associated with active infection (such as SAAGN).

Combined Antibiotic Treatment

The May 2006 issue of Microbe contained a letter from John S. Hibbard in which he presented a cogent case stating that “….all infectious diseases should be treated with a combination of two antibiotics with different mechanisms of action…” His premise is a good one, but is 46 years too late. It's been done! I refer him to: (i) W. E. Herrell, A. Balows, and J. Becker. Erythrocillin: a new approach to the problem of antibiotic resistant staphylococcus. J. Antibiot. Med. Clin. Ther. 7:637–640,1960; (ii) W. E. Herrell, A. Balows, and J. Becker. Alpha phenoxypropyl penicillin & propionyl erythromycin against resistant staphylococci, Antimicrob. Agents Chemother. 1961:723–733, 1962; (iii) W. E. Herrell, A. Balows, and J. Becker. Bacterial effect of the combination of Cephalothin & Streptomycin against Strep. viridans. Antimicrob. Agents Chemother. 1964:350–354, 1965. In each of the above publications we provided data to show that the effect of the combined antibiotics in serum attainable levels was bactericidal as opposed to the ineffectiveness of the maximum dosage of each antibiotic when given singly.

Infection control at autopsy: a guide for pathologists and autopsy personnel

The emergence of acquired immunodeficiency syndrome (AIDS), Hepatitis C, Creutzfeldt–Jacob Disease and antibiotic resistant tuberculosis, staphylococcus and enterococcus have increasingly focused attention on infectious hazards in healthcare occupations. Relatively few publications have dealt with hazards to, and infection control methods for, autopsy pathologists and technicians. It is important that those performing and in charge of autopsy services reacquaint themselves with the risks, routes of infection, and safe and sane control methods for performing autopsies. This review is a guide to autopsy infection control procedures and equipment for hepatitis, tuberculosis, human immunodeficiency virus (HIV) and prion associated diseases (Creutzfeldt-Jacob disease [CJD] and variants). Tuberculosis is re-emerging as a hazard deserving particular attention by pathologists, because it is still too often unanticipated.

Long-term tetracycline treatment of chronic bronchitis.

Cultures from patients with chronic bronchitis frequently grow hemophilus or pneumococcus. Thirty-two patients with well established chronic bronchitis were treated for 3 months at a time with 1.0 gm. daily of tetracycline, alternated with 3 months of indistinguishable placebos in a double blind study. About onethird as many exacerbations occurred during tetracycline treatment as during placebo treatment. In some patients, daily cough, sputum volume, and dyspnea were somewhat improved during tetracycline treatment. In individual patients there was a good correlation between eradication of pneumococcus and hemophilus and reduction of acute exacerbations. One patient had a fatal acute bronchitis due to an antibioticresistant staphylococcus during tetracycline therapy; otherwise, there was no evidence of replacement of normal flora during tetracycline treatment.

Progressive bacterial synergistic symbiotic gangrene: A complication of cesarean section

A case of progressive synergistic symbiotic bacterial gangrene has been presented as a complication of a cesarean section. The history, etiology, and therapy have been discussed. This has been presented to show that even with antibiotics, wound infection can still be a serious condition. With the frequently present microaerophilic streptococcus and the antibiotic resistant staphylococcus, wounds are vulnerable to infection of this type if the guards of asepsis are let down.

Staphylococcal endocarditis after mitral valvulotomy; report of three cases.

BACTERIAL endocarditis after cardiac surgery has been previously reported in 6 patients.1 2 3 4 5 Four had undergone mitral valvulotomy, the fifth had a transventricular commissurotomy for aortic stenosis, and the sixth had been operated on for pulmonic stenosis. In 2 of these cases, the organism proved to be an antibiotic-resistant staphylococcus, and the patients succumbed to the infection.1 , 2 In a third patient, whose blood culture had yielded a staphylococcus, large doses of penicillin, sulfisoxazole and chloramphenicol resulted in recovery.3 Pseudomonas aeruginosa was recovered from the blood and from the vegetations on the heart valves in the fourth case, reported in England by . . .