Streptococcus Milleri Research Articles

Surrogate analysis of vancomycin to predict susceptible categorization of dalbavancin

Dalbavancin (DAL) represents a recently approved addition for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). Newly released antimicrobial agents are rarely found on commercial susceptibility testing devices, and surrogate testing may be an option for clinical microbiology laboratories. A total of 33,688 Staphylococcus aureus, 2800 viridans group streptococci (VGS), and 5722 β-hemolytic streptococci (BHS) were included in this cross-susceptibility (DAL versus vancomycin [VAN]) analysis as well as 4576 coagulase-negative staphylococci and 6515 enterococci (nonindicated species groups). Isolates were collected as part of the SENTRY Antimicrobial Surveillance Program for the United States (USA) and Europe (2011–2013). Susceptibility testing followed CLSI (M07-A9 and M100-S24) methods. USA Food and Drug Administration (DAL) and CLSI (VAN) breakpoint criteria were used for correlations between DAL and VAN susceptibility results. A categorical agreement (CA; susceptible) rate of 99.9% was observed between DAL and VAN when testing S. aureus. Only 48 (0.14%) very major (false-susceptible) errors were noted against VAN-susceptible isolates that displayed a DAL-nonsusceptible (MIC, 0.25 or 0.5μg/mL) phenotype. When susceptible MIC correlations were analyzed against indicated BHS species (Streptococcus agalactiae and Streptococcus pyogenes), an overall CA rate of 97.7–100.0% was obtained. Complete (100.0%) CA was documented for S. pyogenes, as well as against all VGS isolates, including the indicated Streptococcus anginosus group (758 strains). In conclusion, high susceptible CA rates between DAL and VAN were observed when testing a contemporary collection of indicated clinical isolates found in ABSSSI. VAN-susceptible isolates can be inferred to be inhibited by DAL (97.7–100.0%) at the regulatory agency–approved susceptible interpretive breakpoint of ≤0.12μg/mL.

Streptococcus anginosus group - brief characterization and its contribution to the brain abscess pathogenesis

Streptococcus anginosus group - brief characterization and its contribution to the brain abscess pathogenesis

Streptococcus intermedius causing brain abscess in a child with acyanotic congenital heart defect

Streptococcus intermedius ( S. intermedius ) belongs to the Streptococcus anginosus group (SAG) along with Streptococcus anginosus ( S. anginosus ) and Streptococcus constellatus ( S. constellatus ) . Though all the members of SAG have a propensity to cause deep-seated abscesses at a wide range of sites, when it comes to brain abscesses, it is S. intermedius that is most often implicated. Paediatric population with congenital cyanotic heart disease are especially at risk for developing brain abscess. However, it is a rare occurrence in acyanotic congenital heart diseases. Here, we report a case of frontal brain abscess caused by S. intermedius in a child with a clinically silent atrial septal defect (ASD). However, an echocardiogram revealed a patent foramen ovale (PFO) accompanying the ASD. The child recovered, following burr hole aspiration and 21 days of antibiotic therapy. We report this case to highlight the importance of this pathogen in the aetiology of the brain abscess and due to the rarity of the case.

A Problem of Species Determination Using Housekeeping Genes in the Streptococcus anginosus Group

For identification of three species categorized in Streptococcus anginosus group (SAG), genotyping employing multiplex PCR for detection of species-specific genes has been widely used. We wondered whether possession of the specific genes correlated to differentiation of housekeeping genes, with an attempt to obtain more information on genetic background of clinical isolates of SAG strains and to evaluate reliability of the multiplex PCR. We therefore determined nucleotide sequences of some housekeeping genes of 52 SAG isolates from healthy volunteer to investigate whether the sequences phylogenetically corresponded to the identification by the multiplex PCR. The phylogenetic trees drawn with all of the sequences of 16S rRNA, sodA, groEL and rpoB were found to clearly correlate to species identified by the multiplex PCR. Interestingly, phylogenetic tree drawn only with single housekeeping gene often did not match with the species identified by the multiplex PCR. Our analysis implies even housekeeping genes can have their sequence varieties as independent manner from presence of species-specific genes in SAG strains, and the choice of housekeeping genes for the phylogenetic analyses may result in failure of the species identification.

Streptococcus constellatus Causing Septic Thrombophlebitis of the Right Ovarian Vein with Extension into the Inferior Vena Cava.

Introduction. Streptococcus constellatus collectively with Streptococcus anginosus and Streptococcus intermedius constitute the Streptococcus anginosus (formerly Streptococcus milleri) group. Though they are commonly associated with abscesses, bacteremia with subsequent septic thrombophlebitis is extremely rare, and resulting mortality is infrequent. Case Presentation. We report a case of a previously healthy 60-year-old African American female who presented with Streptococcus constellatus bacteremia associated with septic thrombophlebitis to the right ovarian vein extending into the inferior vena cava. She was urgently treated with antibiotics and anticoagulation. Conclusion. Septic thrombophlebitis has a clinical presentation that is often misleading. Therefore, a high clinical index of suspicion and the use of appropriate imaging modalities (computed tomography) are essential in recognizing and confirming this diagnosis. Prompt treatment is warranted. Surgical thrombectomies have been successfully replaced by a combination of antibiotics and anticoagulation therapy.

Effects of gatifloxaine content in gatifloxacine-loaded PLGA and β-tricalcium phosphate composites on efficacy in treating osteomyelitis.

Composites of gatifloxacin (GFLX)-loaded poly (lactic-co-glycolic) acid (PLGA) and β-tricalcium phosphate (βTCP) containing 0, 1, and 10 wt % GFLX (0, 1, and 10 wt % GFLX composites), and GFLX-loaded PLGA containing 1, 5, and 10 wt % GFLX (1, 5, and 10wt % GFLX-PLGA) as controls were fabricated and characterized in vitro and in vivo. On in vitro evaluation, the 10 wt % GFLX composite released GFLX over at least 28 days in Hanks' balanced solution and exhibited clinically sufficient bactericidal activities against Streptococcus milleri and Bacteroides fragilis from 1 h to 10 days. The 0, 1, and 10 wt % GFLX composites and 10 wt % GFLX-PLGA were implanted in bone defects created by debridement of osteomyelitis lesions induced by S. milleri and B. fragilis in the mandible of rabbits (n = 5). Four weeks after implantation of the 10 wt % GFLX composite, inflammation in the debrided area disappeared in all the rabbits, while inflammation remained in all the rabbits after implantation of the 0 wt % GFLX composite and 10 wt % GFLX-PLGA, and in three rabbits after implantation of the 1 wt % GFLX composite. Bone formation appears to be less intense for the 10 wt % GFLX composite than for the 1 wt % GFLX composite probably owing to the rapid degradation of the 10 wt % GFLX composite. These findings show that the GFLX composite is effective for the local treatment of osteomyelitis.

Bacterial pathogens associated with hidradenitis suppurativa, France.

Hidradenitis suppurativa (HS) is a skin disease characterized by recurrent nodules or abscesses and chronic suppurating lesions. In the absence of clear pathophysiology, HS is considered to be an inflammatory disease and has no satisfactory medical treatment. Recently, prolonged antimicrobial treatments were shown to improve or resolve HS lesions. We prospectively studied the microbiology of 102 HS lesions sampled from 82 patients using prolonged bacterial cultures and bacterial metagenomics on 6 samples. Staphylococcus lugdunensis was cultured as a unique or predominant isolate from 58% of HS nodules and abscesses, and a polymicrobial anaerobic microflora comprising strict anaerobes, milleri group streptococci, and actinomycetes was found in 24% of abscesses or nodules and in 87% of chronic suppurating lesions. These data show that bacteria known to cause soft tissue and skin infections are associated with HS lesions. Whether these pathogens are the cause of the lesions or are secondary infectious agents, these findings support targeted antimicrobial treatment of HS.

Dalbavancin, tedizolid phosphate, oritavancin diphosphate, and vedolizumab

Antibacterial agents Skin and skin structure infections are most often caused by Grampositive bacteria such as streptococci and staphylococci. The number of these infections that are caused by methicillin-resistant Staphylococcus aureus (MRSA) has rapidly increased in recent years in both the community and hospital settings. MRSA skin infections experienced in the community can usually be effectively treated with the oral use of trimethoprim-sulfamethoxazole, clindamycin, or doxycycline. Hospitalized patients with skin and skin structure infections (e.g., cellulitis, major abscess, wound infection) caused by MRSA usually require, at least initially, intravenous treatment with an antibiotic. Vancomycin continues to be highly effective for the treatment of most patients with these infections, but a number of options are available including linezolid (Zyvox), daptomycin (Cubicin), telavancin (Vibativ), and ceftaroline (Teflaro). Linezolid is available in formulations that may be administered intravenously or orally. In 2014, three new antibiotics— dalbavancin (Dalvance—Durata), tedizolid phosphate (Sivextro— Cubist), and oritavancin diphosphate (Orbactiv—The Medicines Company)—have been approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible microorganisms. Based on the provisions of the Generating Antibiotic Incentives Now (GAIN) title of the Food and Drug Administration (FDA) Safety and Innovation Act, each of these antibiotics has been designated as a Qualified Infectious Disease Product (QIDP) because it is intended to treat a serious or life-threatening infection. Drugs receiving the QIDP designation are provided an expedited review of their application and qualify for an additional 5 years of marketing exclusivity. Dalbavancin, tedizolid, and oritavancin are considered on an individual basis in the following discussions. Dalbavancin (Dalvance—Durata) is a lipoglycopeptide that is a mixture of five closely related active homologs. It interferes with bacterial cell wall synthesis and exhibits a bactericidal action; and its properties are most similar to those of telavancin. Dalbavancin is administered by intravenous infusion and is specifically indicated for the treatment of adult patients with ABSSSI caused by susceptible isolates of the Gram-positive microorganisms Staphylococcus aureus (S. aureus) (including methicillin-susceptible and methicillin-resistant strains), Streptococcus pyogenes (S. pyogenes), Streptococcus agalactiae (S. agalactiae), and Streptococcus anginosus (S. anginosus) group (including S. anginosus, S. intermedius, and S. constellatus). It should only be used to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. The results of in vitro studies suggest that dalbavancin is also active against vancomycin-susceptible Enterococcus faecium and Enterococcus faecalis (E. faecalis), as well as vancomycin-intermediate S. aureus. Dalbavancin, tedizolid phosphate, oritavancin diphosphate, and vedolizumab

Activity of oritavancin against Gram-positive clinical isolates responsible for documented skin and soft-tissue infections in European and US hospitals (2010-13).

To assess oritavancin activity in vitro against clinically relevant Gram-positive pathogens causing skin and soft-tissue infections (SSTIs) in European and US hospitals. 13 262 consecutive and unique isolates deemed to be responsible for SSTIs were included. Isolates originated from 36 and 27 institutions in Europe (Israel included) and the USA, respectively, between 2010 and 2013. Oritavancin (98.8% susceptible) showed modal MIC, MIC50 and MIC90 results of 0.03, 0.03 and 0.06 mg/L, respectively, for Staphylococcus aureus. CoNS from the USA (MIC50, 0.015 mg/L) demonstrated an MIC50 value of oritavancin slightly lower than those from Europe (MIC50, 0.03 mg/L). Overall, vancomycin-resistant (VanA-phenotype) Enterococcus faecalis had oritavancin MICs (MIC50/90, 0.25/0.5 mg/L) that were 16-fold higher than those obtained for vancomycin-susceptible isolates (MIC50/90, 0.015/0.03 mg/L; 99.2%-99.8% susceptible); nevertheless, oritavancin inhibited all VanA E. faecalis at ≤0.5 mg/L. Equivalent oritavancin MICs (MIC50/90, 0.004/0.008 mg/L) were noted for all VanB and vancomycin-susceptible Enterococcus faecium, while higher MICs (MIC50/90, 0.03/0.12 mg/L) were obtained for VanA strains. Oritavancin had low MICs against the overall populations of Streptococcus pyogenes (MIC50/90, 0.03/0.12 mg/L; 98.4%-98.6% susceptible), Streptococcus agalactiae (MIC50/90, 0.03/0.06 mg/L; 97.9%-98.0% susceptible) and the Streptococcus anginosus group (MIC50/90, 0.008/0.015 mg/L; 100.0% susceptible), with slightly higher MICs for Streptococcus dysgalactiae (MIC50/90, 0.06/0.25 mg/L; ≥98.3% susceptible). Oritavancin had potent activity in vitro against this contemporary collection of European and US isolates causing SSTIs. These results describe oritavancin activity against Gram-positive pathogens collected shortly prior to its regulatory approval in the USA.

Subperiosteal Abscess of the Orbit: Evolving Pathogens and the Therapeutic Protocol

Because of widespread antibiotic use, immunization against selective species, and the emergence of hypervirulent organisms, we sought to determine changes over time in the bacteriology of sinusitis-related subperiosteal abscess (SPA) of the orbit and their impact on patient outcomes under a uniform management protocol. Comparative case series. Patients≤18 years of age with sinusitis-related SPA treated from 2002 to 2012; comparable cohorts from earlier time frames. We analyzed culture results and outcomes in surgical cases, compared overall and age-specific results with those in a 1977 through 1992 patient series, and compared the proportion of patients<9 years old requiring surgery among 1988 through 1998, 1999 through 2008, and current cohorts. Patients requiring surgery; prevalence of pathogens; criteria prompting surgery; visual and systemic outcomes. Ninety-four patients met inclusion criteria: 53 (56%) recovered with medical therapy alone and 41 (44%) underwent surgical drainage. Compared with the 1977 through 1992 cohort, there was increased representation of Streptococcus anginosus group, S aureus, and group A β-streptococci. Methicillin-resistant S aureus (MRSA) accounted for 4 of 7 S aureus isolates. Of 94 patients, 74 (79%) were <9 years of age: 53 (72%) recovered without surgery and 21 (28%) underwent drainage. Comparable figures were 67.5% versus 32.5% and 85% versus 15% in 1988 through 1998 and 1999 through 2008 cohorts, respectively. Whereas patients≥9 years old in the 1977 through 1992 cohort had a higher proportion of positive cultures and more varied pathogens than younger patients, in the current series both groups had similar culture yields and aerobic constituencies. Anaerobes were isolated from only patients≥9 years old in both series. In cases positive for MRSA and other aggressive aerobes, initial findings prompted early drainage; outcomes were not compromised by adherence to the treatment protocol. The proportion of children<9 years requiring surgery for sinusitis-related SPA has remained a minority (15%-32.5%), without a clear upward trend over 25 years. Anaerobes continue not to factor in the younger subgroup, but more aggressive aerobic pathogens, including MRSA, have emerged. In such cases, surgical criteria that supersede age are triggered under the current treatment algorithm, and modification is not recommended.

Performance of Canadian clinical laboratories processing throat culture proficiency testing surveys

Proficiency testing results obtained from simulated throat swab cultures sent between 1999 and 2013 were analyzed to evaluate the ability of participants to process, analyze, and properly report results for these cultures. Eight percent of all pathogen-positive samples were reported as false negatives, and 11 % of the pathogen-negative ones were reported as false positives. More than 90 % of the participants achieved acceptable grades in each of the proficiency testing samples containing Streptococcus pyogenes. Laboratories were less successful in reporting other significant pathogens including group C and G streptococcus and Arcanobacterium haemolyticum, although an overall increase in performance was observed for each subsequent survey. Most laboratories recognized other respiratory pathogens as not being agents of pharyngitis; a common issue with these specimens was the suggestion of the organism’s clinical significance when their presence was reported. The presence of small colony-forming β-hemolytic streptococcus (Streptococcus anginosus group) proved to be challenging for many laboratories as 66 % of all unacceptable grades for pathogen-negative throat swabs occurred in these PT samples. Moreover, performance in this group did not improve with subsequent surveys. Results obtained in this study support the added value of clinical relevancy challenges for proficiency testing as laboratories that may not have problems with the analytical aspect of the testing process struggle with the appropriate interpretation of results.

Microbial Flora and Antibiotic Resistance in Odontogenic Oral Abscesses in Upstate New York

Objectives: (1) Identify the most common bacteria in odontogenic oral abscesses over the past decade. (2) Identify the prevalence of antibiotic resistance of pathogens responsible for odontogenic oral abscesses to guide initial antibiotic treatment. Methods: This is a retrospective chart review conducted at a single tertiary academic medical center of adult and pediatric patients who underwent drainage of oral abscesses caused by odontogenic sources (n = 129), during which cultures of the abscess were obtained. The cultures were analyzed for type of pathogen and antibiotic sensitivities. Medical comorbidities and drainage techniques were reviewed. Results: Multiple bacteria species were identified in 59.69% of odontogenic abscesses and single bacteria species in 34.11%. The most common bacteria were alpha hemolytic streptococci (34.11%), streptococcus milleri (32.56%), prevotella strains (19.38%), and coagulase negative staphylococcus (14.73%). Clindamycin resistance was identified in stomatococcus (50%), lactobacillus (33.33%), streptococcus milleri (33.33%), staphylococcus (10%), corynebacterium (8.33%), and alpha hemolytic streptococcus (2.27%). Penicillin resistance was identified in stomatococcus (50%) and lactobacillus (33.33%). Methicillin resistance was identified in staphylococcus (10%). Erythromycin resistance was identified in streptococcus milleri (35.71%), staphylococcus (10%), corynebacterium (8.33%), and alpha hemolytic streptococcus (2.27%). Strepto-coccus milleri was also resistant to tetracycline (2.38%), and morganella morganii was resistant to ampicillin (100%) and cefazolin (100%). Conclusions: Most oral odontogenic abscesses were polymicrobial, with the most common pathogens being alpha hemolytic streptococcus, streptococcus milleri, prevotella, and coagulase negative staphylococcus. The most common antibiotic resistances were to clindamycin and erythromycin, which should be considered when deciding initial antibiotic therapy.

Microbial Flora and Antibiotic Resistance in Peritonsillar Abscesses in Upstate New York

Objectives: (1) Identify the most common bacteria in peritonsillar abscesses over the past decade. (2) Identify the prevalence of antibiotic resistance of pathogens responsible for peritonsillar abscesses to guide initial antibiotic treatment. Methods: This is a retrospective chart review looking at adult and pediatric patients who presented to a single tertiary academic center in upstate New York from 2002 through 2012 and underwent either incision and drainage or quincy tonsillectomy for a peritonsillar abscess (n = 69), during which cultures of the abscess were obtained. Cultures from the abscess were reviewed for bacteria and antibiotic sensitivities. Patient medical records were reviewed for age, medical comorbidities, prior episodes, immune-compromised state, type of drainage procedure done and complications, and whether more than one procedure was needed. Results: Of the peritonsillar abscesses, 62.32% were polymicrobial and 34.78% were monomicrobial. The most common pathogens were beta hemolytic streptococcus (31.88%), alpha hemolytic streptococcus (21.74%), Neisseria (14.49%), and Streptococcus milleri (13.04%). Staphylococus was resistant to oxacillin (25%), erythromycin (25%), clindamycin (12.5%), and penicillin (12.5%). Alpha hemolytic streptococcus was resistant to clindamycin (6.67%) and erythromycin (6.67%). Streptococcus milleri was resistant to clindamycin (11.11%) and erythromycin (11.11%). Conclusions: Peritonsillar abscesses are most commonly polymicrobial, with beta and alpha hemolytic streptococci, Neisseria, and S milleri as the most prevalent pathogens. In addition, antibiotic resistance to clindamycin and erythromycin is common across streptococcal strains and staphylococcal strains, and methicillin resistance is also common in staphylococcal strains responsible for peritonsillar abscesses.

Development of species-specific quantitative real-time PCR primers for detecting anginosus group streptococci based on the rpoB.

In this study, we introduced species-specific quantitative real-time PCR (qPCR) primers designed based on a DNA-dependent RNA polymerase beta-subunit gene for detecting anginosus group streptococci (AGS), Streptococcus anginosus, S. constellatus, and S. intermedius. The specificity of the qPCR primers was confirmed by conventional PCR with the genomic DNAs of 76 strains regarding 44 bacterial species including the type strain for the target species. The standard curves revealed the lower detection limits of these species-specific qPCR primers was 40fg at below a cycle threshold (CT) value of 35. These results suggest that AGS species-specific qPCR primers are suitable for applications in epidemiological studies associated with infectious diseases related to AGS.

Rhinosinusitis in children: A comparison of patients requiring surgery for acute complications versus chronic disease

BackgroundPatient characteristics, risk factors, and microbiology are important to consider in the management of complications of acute bacterial sinusitis (ABS) in pediatric patients. This study evaluates this subset of patients and compares them to patients that undergo surgery for chronic rhinosinusitis (CRS). MethodsThis study is a retrospective review of all pediatric patients from 2002 to 2011, who underwent sinus surgery at a tertiary hospital. Patients who underwent surgery for ABS complication were compared to patients who underwent surgery for CRS. Statistical analysis was completed using chi-square test or Fisher's exact test with a statistical significance set at p<0.05. ResultsTwenty-seven patients with a complication of ABS and 77 patients with CRS were analyzed. The groups did not differ demographically. Patients with a complication were statistically less likely to have seasonal allergies, prior sinusitis, prior nasal steroid use, or adenoidectomy (p<0.05). In addition, they had more frequent involvement of ethmoid and frontal sinuses (p<0.05). The most common cultures results were no growth (30.8%), Streptococcus milleri (30.8%), and normal flora (19.2%) in ABS for the with a complication group, and normal flora (41.5%), coagulase negative Staphylococcus (22%), and Propionobacterium (19.5%) for the CRS group. Most prevalent complications were preseptal cellulitis (55.5%), orbital subperiosteal abscess (29.6%), subgaleal abscess (22%), and epidural abscess (22%). Five patients had simultaneous orbital and intracranial complications. ConclusionsPatients who present with complications of ABS vary significantly from the CRS patients. Location of most commonly affected sinuses and microbiology also differ and is crucial for understanding the management of this disease process.

Parotitis Caused by Streptococcus anginosus Group in a Patient After Splenectomy

Parotitis Caused by Streptococcus anginosus Group in a Patient After Splenectomy

Emerging cystic fibrosis pathogens and the microbiome

Cystic fibrosis (CF) respiratory infection is characterised by the presence of typical human bacterial pathogens such as Pseudomonas aeruginosa, Haemophilus influenzae and Staphylococcus aureus. Less typical pathogens such as Burkholderia, Stenotrophomonas, Achromobacter, Pandorea and Ralstonia have emerged as problematic infections which are largely unique to people with CF. Using molecular methods, two groups of anaerobic bacteria Prevotella species and the Streptococcus milleri group have also recently been shown to be highly prevalent in CF sputum. Collectively, the diversity of microorganisms present in respiratory specimens has been designated the CF microbiome. The challenges posed by emerging CF pathogens and a microbiome-based view of CF infection are discussed in terms of their impact on clinical outcome, diagnosis and therapy.

Typing of Streptococcus Milleri group by molecular and biochemical methods

Background: Streptococci detected in various regions of the body as normal flora are Gram positive diplococci, non-spore forming and non-motile bacteria. Streptococci can be classified according to biochemical and antigenic properties and the ability to produce hemolysis on blood agar. The diameter of beta hemolitic streptococci colonies are generally greater than 0.5mm and these are called pyogen; on the other hand bacteria whose colonies are smaller than 0.5mm (pin-point) are called Streptococcus milleri group in Europe and Streptococcus anginosus group in America. Streptococcus milleri group are classified into three species; Streptococcus anginosus, Streptococcus intermedius, Streptococcus constellatus. S. milleri group bacteria are genetically related to non-hemolitic streptococci. Methods & Materials: 100 streptococci strains were isolated from throat samples and also from other body sites such as abcess, blood and pustules. VP, CAMP tests, esculin and urease hydrolisis, sugar fermatation tests and Niven’s arginin hydrolysis test were carried out for pin-point colonies and species identification was carried by API 20 Strep kit and by PCR (table). Antibiotic susceptibility testing was carried out according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: All isolates were VP positive, PYR negative and did not hydrolyse hippurat; two strains were urease positive. All strains was found to be susceptible to vancomycin, ceftriaxone, cefepime, cefotaxime, levofloxacin, linezolid antibiotics. 16% of strains (10 S.anginosus, 4 S.constellatus)were found to be resistant to erythromycin. 6% of the strains (5 S.anginosus, 3 S.constellatus) were resistant to clindamycin and 5% (3 S.constellatusve 2 S.anginosus) of the strains were found to be resistant to tetracycline. According to PCR results of 100 isolates, 56 were identified as S.anginosus and 8 were identified as S.intermedius. Conclusion: It was determined that biochemical identification scheme is not satisfactory forStreptococcus milleri group. No emergence antibiotic resistance was determined. However, MIC should be investigated for strains isolated from sterile body parts. Commercially available biochemical kits are inadequent and identification should besupported with molecular methods. This study is thought to be a backbone for other studies in the future.

Typing of Streptococcus milleri group by molecular and biochemical methods

Background: Streptococci detected in various regions of the body as normal flora are Gram positive diplococci, non-spore forming and non-motile bacteria. Streptococci can be classified according to biochemical and antigenic properties and the ability to produce hemolysis on blood agar. The diameter of beta hemolitic streptococci colonies are generally greater than 0.5mm and these are called pyogen; on the other hand bacteria whose colonies are smaller than 0.5mm (pin-point) are called Streptococcus milleri group in Europe and Streptococcus anginosus group in America. Streptococcus milleri group are classified into three species; Streptococcus anginosus, Streptococcus intermedius, Streptococcus constellatus. S. milleri group bacteria are genetically related to non-hemolitic streptococci. Methods & Materials: 100 streptococci strains were isolated from throat samples and also from other body sites such as abcess, blood and pustules. VP, CAMP tests, esculin and urease hydrolisis, sugar fermatation tests and Niven’s arginin hydrolysis test were carried out for pin-point colonies and species identification was carried by API 20 Strep kit and by PCR (table). Antibiotic susceptibility testing was carried out according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: All isolates were VP positive, PYR negative and did not hydrolyse hippurat; two strains were urease positive. All strains was found to be susceptible to vancomycin, ceftriaxone, cefepime, cefotaxime, levofloxacin, linezolid antibiotics. 16% of strains (10 S.anginosus, 4 S.constellatus)were found to be resistant to erythromycin. 6% of the strains (5 S.anginosus, 3 S.constellatus) were resistant to clindamycin and 5% (3 S.constellatusve 2 S.anginosus) of the strains were found to be resistant to tetracycline. According to PCR results of 100 isolates, 56 were identified as S.anginosus and 8 were identified as S.intermedius. Conclusion: It was determined that biochemical identification scheme is not satisfactory forStreptococcus milleri group. No emergence antibiotic resistance was determined. However, MIC should be investigated for strains isolated from sterile body parts. Commercially available biochemical kits are inadequent and identification should besupported with molecular methods. This study is thought to be a backbone for other studies in the future.

Early diagnosis of enteric fever in resource limited countries

Background: Streptococci detected in various regions of the body as normal flora are Gram positive diplococci, non-spore forming and non-motile bacteria. Streptococci can be classified according to biochemical and antigenic properties and the ability to produce hemolysis on blood agar. The diameter of beta hemolitic streptococci colonies are generally greater than 0.5mm and these are called pyogen; on the other hand bacteria whose colonies are smaller than 0.5mm (pin-point) are called Streptococcus milleri group in Europe and Streptococcus anginosus group in America. Streptococcus milleri group are classified into three species; Streptococcus anginosus, Streptococcus intermedius, Streptococcus constellatus. S. milleri group bacteria are genetically related to non-hemolitic streptococci. Methods & Materials: 100 streptococci strains were isolated from throat samples and also from other body sites such as abcess, blood and pustules. VP, CAMP tests, esculin and urease hydrolisis, sugar fermatation tests and Niven’s arginin hydrolysis test were carried out for pin-point colonies and species identification was carried by API 20 Strep kit and by PCR (table). Antibiotic susceptibility testing was carried out according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: All isolates were VP positive, PYR negative and did not hydrolyse hippurat; two strains were urease positive. All strains was found to be susceptible to vancomycin, ceftriaxone, cefepime, cefotaxime, levofloxacin, linezolid antibiotics. 16% of strains (10 S.anginosus, 4 S.constellatus)were found to be resistant to erythromycin. 6% of the strains (5 S.anginosus, 3 S.constellatus) were resistant to clindamycin and 5% (3 S.constellatusve 2 S.anginosus) of the strains were found to be resistant to tetracycline. According to PCR results of 100 isolates, 56 were identified as S.anginosus and 8 were identified as S.intermedius. Conclusion: It was determined that biochemical identification scheme is not satisfactory forStreptococcus milleri group. No emergence antibiotic resistance was determined. However, MIC should be investigated for strains isolated from sterile body parts. Commercially available biochemical kits are inadequent and identification should besupported with molecular methods. This study is thought to be a backbone for other studies in the future.