It is important to select appropriate antimicrobials for the treatment of infection according to the results of antimicrobial susceptibility tests (ASTs), yet the clinical isolates are sometimes susceptible to antibiotics that are clinically ineffective or this is due to technical error of the ASTs. So, interpretive reading of ASTs is needed and especially for the beta-lactams for treating Enterobacteriacae. This review describes the interpretive reading of ASTs according to natural antimicrobial resistance and the mechanisms of mechanisms, with giving special attention to the antibiotics phenotypes for Enterobacteriacae. Further, as all the diffent tissues have a different antimicrobial concentration for identical antimicrobials, more information is needed on the antimicrobial tissue distribution for the appropriate treatment of infection. (ED note: I hope you send me the paper.)
Anti-Bacterial Agents ; beta-Lactams ; Phenotype ; Tissue Distribution

The study involved two groups: case group involved 65 patients with beta-lactam antibiotic allergy who were treating at B¹ch Mai Hospital during year 2000 and 25 healthy people were used a control group. Main findings: allergic symptoms onset rapidly within first 30 minutes in 43.07% of patients, onset after 1 hour of drug administration in 16.92% and after 1 day in 9.22%. 52.3% of patients have individual history and 13.84% have family history of allergy. Whole-body erythema occurred on 48.07% of patients, urticaria and Quinck edema on 27.69%, Stevens-Johnson syndrome on 18.46%, anaphylactic shock on 61.5% and drug-caused hepatitis on 4.61%. Levels of liver enzymes AST and ALT increase significantly in comparison with control group.
Drug Hypersensitivity ; Anti-Bacterial Agents ; beta-Lactams ; diagnosis

PURPOSE: To evaluate the clinical outcomes of ertapenem administered as an outpatient parenteral antibiotic therapy for intractable cystitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. MATERIALS AND METHODS: We retrospectively reviewed a case series of 3 years of therapeutic experience with ertapenem for intractable recurrent cystitis caused by ESBL-producing E. coli. Ertapenem 1 g/d was parenterally administered to the patients on an outpatient basis until the acquisition of symptomatic improvement and negative conversion of urine culture. Demographic and clinical characteristics of patients, antimicrobial resistance, and clinical response data were analyzed from the patients' medical records. RESULTS: During the course of this study, a total of 383 patients were diagnosed with cystitis, and 24 of them showed ESBL-producing E. coli (6.26%). The mean treatment duration of all patients was 8.5 days. The early clinical and microbiological cure rates 0 to 7 days after the end of treatment were 91.7% (22/24) and 90.9% (20/22), respectively. The late clinical and microbiological cure rates 4 to 6 weeks after the end of treatment were 72.2% (13/18) at both time points. CONCLUSIONS: Parenteral ertapenem treatment can be an effective and well-tolerated treatment option for intractable recurrent cystitis by multidrug-resistant ESBL-producing E. coli.
beta-Lactamases ; beta-Lactams ; Cystitis* ; Escherichia coli* ; Escherichia* ; Female* ; Humans ; Medical Records ; Outpatients* ; Retrospective Studies

BACKGROUND: A high proportion of currently isolated gram-negative bacilli are resistant to beta-lactams by producing beta-lactamases. beta-lactam and beta-lactamase inhibitor combinations have been successfully used to overcome the resistance. In this study, in vitro antimicrobial activity of a new combination, cefatrizine-clavulanic acid, was determined against gram-negative bacilli isolated from community-acquired urinary track infections. METHODS: Nonduplicate strains of Enterobacteriaceae, isolated in 2003 from urine specimens of outpatients and inpatients of less than 3 hospital days at Severance Hospital, were tested by the NCCLS agar dilution method. RESULTS: Of a total of 204 isolates, 144 (71%) were Escherichia coli and 30 (15%) were Klebsiella spp. MIC50 and MIC90 of cefatrizine for E. coli were 2 microgram/mL and 16 microgram/mL, respectively. MIC90s of both cefaclor and cefoxitin were also 16 g/mL. MIC50 and MIC90 of cefatrizine-clavulanic acid for E. coli were 1 microgram/mL and 4 microgram/mL, respectively, which were 1/2-1/4 of those of cefaclor and cefoxitin. For Klebsiella spp., MIC90 of cefatrizine was 4 microgram/mL with an MIC range of 1->128 microgram/mL, whereas that of cefatrizine-clavulanic acid was 2 microgram/mL with an MIC range of 0.5-32 microgram/mL. In vitro activity of cefatrizine-clavulanic acid was higher than that of cefatrizine. CONCLUSIONS: Improved in vitro activity of cefatrizine-clavulanic acid against isolates of E. coli and Klebsiella spp. from community-acquired urinary track infection suggested that the combination is useful for an empirical treatment of the infection.
Agar ; beta-Lactamases ; beta-Lactams ; Cefaclor ; Cefatrizine ; Cefoxitin ; Enterobacteriaceae ; Escherichia coli ; Humans ; Inpatients ; Klebsiella ; Outpatients

Methicillin-resistant Staphylococcus aureus (MRSA) is a typical pathogen of nosocomial infection, and has recently emerged as an important community-acquired pathogen. MRSA is notorious as a multidrug-resistant organism. Its resistance to all beta-lactams is mediated by PBP2a which is encoded by mecA, and it is also resistant to many antimicrobials of other classes due to frequently co-carrying resistance genes, which accounts for becoming a clinical and laboratory issue. This article reviews the microbiological characteristics, surveillance methods, and molecular epidemiology of MRSA.
Adenosine ; beta-Lactams ; Carrier State ; Cross Infection ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Molecular Epidemiology

Staphylococcal cassette chromosome mec (SCCmec) type and coagulase serotype are important epidemiologic factors in methicillin-resistant Staphylococcus aureus (MRSA). To investigate correlation between SCCmec type and coagulase serotype of MRSA, we analyzed SCCmec types of MRSA strains isolated from clinical sources and compared the results to coagulase serotypes and antimicrobial susceptibility patterns. A total of 108 MRSA isolates were classified into four SCCmec types: II (55.6%), IV (21.3%) III (13.0%) and IIIA (8.3%), and five coagulase serotypes: II (54.6%), IV (21.3%), V (18.5%) and VII (2.8%). All of coagulase type II, IV and V strains belonged to SCCmec type II, III/IIIA and IV, respectively. SCCmec types II, III and IIIA were multidrug resistant, whereas SCCmec type IV strains were non-multidrug resistant except beta-lactams and erythromycin. The data provide that there is a significant correlation between SCCmec types and phenotypic characteristic of coagulase serotypes.
beta-Lactams ; Coagulase ; Epidemiologic Factors ; Erythromycin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus

Hypersensitivity reactions to drugs are classified as immediate or nonimmediate reactions depending on the basis of time of appearance of reactions. Clinical and immunological studies suggest that immediate reaction is IgE-mediated and nonimmediate as type-IV (cell-mediated) reaction. For the evaluation of drug allergy, the patient's history is fundamental; the allergologic examination includes in-vivo and in-vitro tests selected on the basis of the clinical features. Prick, patch, and intradermal tests are the most readily available forms of allergy testing. However, there are some changes in the diagnostic evaluation of allergic reactions to beta-lactams, iodinated contrast media and local anaesthetics over the last several years. In immediate reactions, the sensitivity of skin testing and immunoassay is decreasing and for nonimmediated reactions, skin testing appears to be less sensitive than previous results. Drug provocation test is still the gold standard for identification of an causative drugs. The new diagnostic tools, such as the basophil activation test and the lymphocyte activation test, have been developed and are under validation. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and immediate drug reactions. This review provides an update to European Network for Drug Allergy (ENDA) document that gave the guidelines for the evaluation of drug allergy. The diagnosis of drug allergy needs to be standardized.
Basophils ; beta-Lactams ; Contrast Media ; Drug Hypersensitivity ; Hypersensitivity ; Immunoassay ; Intradermal Tests ; Lymphocyte Activation ; Skin Tests

OBJECTIVETo develop a rapid multi-residue assay for detecting 16 demanded by the European Union (EU).

METHODSA recombinant penicillin-binding protein (PBP) 2x* from Streptococcus pneumoniae R6 was expressed in vitro and six β-lactams were conjugated to HRP by four methods. A rapid multi-residue assay for β-lactams was established with PBP2x* and HRP-conjugate.

RESULTSPBP2x* was expressed and purified successfully and the ideal HRP-conjugate was identified. The multi-residue assay was developed. After optimization, penicillin G, ampicillin, amoxicillin, cloxacillin, dicloxacillin, oxacillin, nafcillin, cephalexin, ceftiofur, cefalonium, cefquinome, cefazolin, cefoperazone, cephacetrile, and cephapirin can be detected at levels below MRL in milk with simple pretreatment.

CONCLUSIONThis assay developed can detect all 16 β-lactams demanded by the European Union (EU). The whole procedure takes only 45 min and can detect 42 samples and the standards with duplicate analysis.

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp. isolates are clinically resistant to all the beta-lactams except for carbapenems. The most important task facing clinical microbiologists today is the reliable detection of ESBL-producing microorganisms. There is currently a little reliable methods designed specifically for the detection of ESBLs in isolates of E. coli and Klebsiella spp. that can be performed easily in a clinical laboratory. This study was designed to evaluate the ability of the Vitek GNS 121 card to detect the ESBL-producing E. coli and Klebsiella spp. METHODS: One hundred and twenty-two isolates of E. coli, 141 of K. pneumoniae, and 3 of K. oxytoca from patients of the Kosin Medical Center, Pusan, Korea were tested. Antimicrobial susceptibilities were tested by the disk diffusion method. And the double disk synergy (DDS) test and the Vitek GNS 121 card determined the ESBL-production. RESULTS: Among the 135 DDS-positive isolates (K. peumoniae, 104; E. coli, 28; K. oxytoca, 3), 131 isolates (K. pneumoniae, 103; E. coli, 25; K. oxytoca, 3) showed positive results with the Vitek GNS 121 card as well. And all the isolates of K. pneumoniae (37) and E. coli (94) showed negative results with both the DDS test and the Vitek GNS 121 card except for 1 isolate of E. coli. The Vitek GNS 121 card showed 97% ESBL detection-sensitivity, 99% specificity and 99% positive predictive value. Three isolates of E. coli and 1 of K. pneumoniae resistant to cefoxitin showed positive results with the DDS test but showed negative results with the Vitek GNS 121 card. CONCLUSIONS: The Vitek GNS 121 card seems to be adequate for routine use in the detection of ESBL-producing isolates of E. coli and Klebsiella in clinical microbiology laboratories. Also, additional evaluation should be taking place on its detection ability for other members of the ESBL-producing Enterobacteriaceae.
beta-Lactamases ; beta-Lactams ; Busan ; Carbapenems ; Cefoxitin ; Diffusion ; Enterobacteriaceae ; Escherichia coli* ; Escherichia* ; Humans ; Klebsiella* ; Korea ; Pneumonia ; Sensitivity and Specificity

To study the resistant mechanism and clinical significance of pseudomonas aeruginosa to beta-lactam antibiotics, the outer membrane permeability rate of 30 P. aeruginosa strains to 5 beta-lactam antibiotics was measured and their production of beta-lactamase and the beta-lactamase genes they carried detected. Furthermore, the relationship between the permeability, beta-lactamase and the clinical effects of beta-lactam antibiotics was observed. By using 14C-penicillin and liquid-scintillant isotope assay, the affinity of penicillin binding proteins (PBPS) was measured and their roles in the resistant mechanism studied. It was revealed that the permeability rate was higher in sensitive strains than in resistant ones (P < 0.05). All strains harbored 1-4 beta-lactamase genes and produced beta-lactamase. Higher permeability rate and higher degree of stability to beta-lactamase indicated better clinical therapeutic effects. The affinity of PBPs changed little without regard to the permeability and beta-lactamase. These results suggested that the permeability of outer membrane and beta-lactamase, but not PBPs, played important roles in the resistant mechanism of P. aeruginosa to beta-lactam antibiotics and affected the clinical therapeutic effectiveness of some patients.
Anti-Bacterial Agents/*pharmacology ; Bacterial Outer Membrane Proteins/metabolism ; Microbial Sensitivity Tests ; Permeability ; Pseudomonas aeruginosa/*drug effects ; beta-Lactam Resistance/*genetics ; beta-Lactamases/metabolism ; beta-Lactams/*pharmacology