Coagulase-negative staphylococci cause about 5% of native-valve endocarditis. Staphylococcus lugdunensis, a recently-described species of coagulase-negative staphylococci, has been reported to cause destructive native-valve endocarditis with a high mortality. We report four consecutive cases of definite Staphylococcus lugdunensis native-valve endocarditis by the Duke criteria over a 4-year period. All patients required urgent aortic valve replacement 1-5 days after admission, and recovered. An intriguing, aspect in the presentation of these patients was a history of vasectomy and inguinal skin breaks in the immediate period preceding the occurrence of endocarditis.
The in-vitro susceptibilities of aerobic bacteria isolated from 1804 blood and 4529 urine specimens collected at nine hospitals in the UK were examined. An agar dilution method was used to determine the MICs of each isolate to three cephalosporins, cefotaxime, cefuroxime and ceftazidime, and to two fluoroquinolones, ofloxacin and ciprofloxacin. Sensitivities were then calculated using British Society for Antimicrobial Chemotherapy recommended breakpoints. Of the cephalosporins tested cefotaxime was the most active against the Enterobacteriaceae. All the systemic staphylococcus isolates collected were sensitive to both cefotaxime and cefuroxime. As expected, ceftazidime was the only cephalosporin active against the Pseudomonas isolates. Both quinolones were highly active against the Enterobacteriaceae and Pseudomonas spp. They also demonstrated good Gram-positive activity, particularly against Staphylococcus aureus and Enterococcus spp.
The speciesHaemophilus influenzae belongs to the genus Haemophilus and the family Pasteurellaceae. H influenzae are small, nonmotile, nonspore forming, Gram-negative, pleomorphic rods that range in shape from coccobacilli to long filaments. They require X and V factors (hemin and NAD, respectively) for aerobic growth, and may be facultatively anaerobic (1) Encapsulated H. influenzae are classified into six antigenically distinct serotypes (a-f), and have a clonal population structure with two major global subdivisions (I and II) (2,3). Nonencapsulated H. infuenzae (NCHi) appear to have a nonclonal population composition, but a broader analysis of NCHi in the future may reveal that the population is not so distinct from encapsulated H influenzae (4). Both encapsulated H influenzae and NCHi exhibit wide genetic diversity (5).
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