Continuous WGS-based national surveillance of 3GC-R Ec , in combination with more detailed epidemiological information, can improve the ability to follow the population dynamics of 3GC-R Ec , thus allowing for the detection of potential outbreaks and the effects of changing treatment regimens in the future.

Compared to 2003 data the ESBL prevalence in Denmark has increased significantly. In the ESBL-producers, reduced susceptibility towards both gentamicin and ciprofloxacin was seen among 43% E. coli and 55% K. pneumoniae, leaving clinicians in these cases with only a carbapenem for the treatment of serious infections. Part of this study was presented at the 20(th) European Congress of Clinical Microbiology and Infectious Diseases, abstract P-1617.

According to the literature, Kingella kingae may be an underdiagnosed cause of joint and bone infections in children. The use of the Bactec blood culture system for culture of joint fluids has dramatically improved the isolation of this fastidious bacterium. The aim of this study was to test the recovery rate and detection time of four commercial blood culture systems: three different BacT/Alert (Organon Teknika, USA) bottles and one Bactec (Becton Dickinson Microbiology Systems, USA) bottle, all inoculated with Kingella kingae strains mixed with pooled synovial fluids. For each strain the same inoculum and volume of synovial fluid was distributed into each of the four bottles. All 24 strains tested grew in the BacT/Alert Aerobic (100%) and the BacT/Alert Pedi-BacT (100%) bottles. Twenty-one strains grew in the BacT/Alert FAN aerobic (88%) bottle, and 15 strains grew in the Bactec Plus Aerobic F (63%) bottle, in both systems within 12 days (P<0.01). The Kingella kingae strains were first detected in the BacT/Alert Pedi-BacT bottles (P<0.001). The results were reproducible. The BacT/Alert blood culture bottles were superior to previously described blood culture systems in isolating Kingella kingae from synovial fluid, even with small inoculums and small volumes of synovial fluid.

A clone of T type 28 seemed to be the cause of the largest cluster of PASI cases described thus far. Clarithromycin was effective as second line treatment. An estimated annual baseline incidence of 2 to 7 per 1000 in the local population indicates that PASI may not be as rare as previously estimated.

Vancomycin-resistant enterococci (VRE) have emerged to become a significant nosocomial pathogen. However, detection may be challenging and treatment possibilities are limited. Reports of resistance to linezolide, daptomycin and tigecycline underline the need for reliable susceptibility testing with respect to these compounds. We evaluated the in vitro activity of vancomycin, linezolid, daptomycin and tigecycline against a panel of VRE and vancomycin-susceptible enterococci by broth microdilution (BMD). Etest for determination of minimum inhibitory concentration of these four antibiotics and two disc diffusion assays for detecting VRE and for susceptibility testing against tigecycline and linezolid were evaluated. Before susceptibility testing, all isolates were classified by polymerase chain reaction as vanA or vanB gene positive or vanA/B gene negative. Linezolid, daptomycin and tigecycline had excellent in vitro activity towards all isolates. For daptomycin and tigecycline, the overall agreement between BMD and Etest was suboptimal. For both disc diffusion assays, use of current break points was inadequate to detect vancomycin resistance for isolates carrying the vanB gene. Inspection of the inhibition zone for a diffuse edge, as recommended, accurately predicted presence of the vanB gene.

A murine monoclonal anti-chromosomal I-lactamase antibody was developed and an immunoblotting technique was used to study the presence of serum and sputum antibodies against Pseudomonas aeruginosa chromosomal group 1 P-lactamase in patients with cystic fibrosis (CF). The serum antibody response was studied with serum samples collected in 1992 from 56 CF patients in a cross-sectional study and with serum samples from 18 CF patients in a longitudinal study. Anti--lactamase immunoglobulin G antibodies were present in all of the serum samples from the patients with chronic bronchopulmonary P. aeruginosa infection (CF+P) but in none of the CF patients with no or intermittent P. aeruginosa infection. Anti-13-lactamase antibodies were present in serum from CF+P patients after six antipseudomonal courses (median) and correlated with infection with a P-lactam-resistant strain of P. aeruginosa. The sputum antibody response and the P-lactamase activity in sputum samples from 14 of the CF+P patients were also studied. jB-Lactamase antibodies were present in 10 of these samples. P. aeruginosa strains isolated from these samples were partially derepressed, producing group 1 cephalosporinase. We found a wide range of chromosomal j-lactamase activity in the sputum samples, with no correlation with basal or induced activity of I-lactamase expression. The presence of anti-j-lactamase antibodies in endobronchial sputum could be an important factor in the defense against the infection. On the other hand, immune complexes between P-lactamase and corresponding antibodies could play a role in the pathogenesis of bronchopulmonary injury in CF by mediating hyperimmune reactions.Chronic bronchopulmonary infection with Pseudomonas aeruginosa is the major factor determining the severity of morbidity and mortality in cystic fibrosis (CF) patients (15). In spite of a high-level antibody response to P. aeruginosa both locally in the lungs (22) and systemically, as well as intensive antipseudomonal treatment, the bacteria are not eradicated. A major cause of ,B-lactam resistance is inactivation by ,3-lactamase (4,5,14,20). In vivo selection of resistant derepressed strains, permanently producing elevated amounts of the enzyme, occurs rapidly during antipseudomonal courses (5).In a previous study, we have demonstrated high levels of chromosomal 3-lactamase activity in sputum from CF patients (6). (10,24). After the diagnosis of CF, the patients were monitored during monthly visits to the Danish CF Centre at Rigshospitalet. The onset of chronic P. aeruginosa infection (CF+P) was defined as the point at which the bacteria had been detected in every sputum sample for at least 6 months and serum contained more than one immunoprecipitate (precipitin) formed by antibodies to P. aeruginosa wholecell extract in crossed immunoelectrophoresis (7) The anti-,-lactamase antibodies were investigated with three groups of CF patients. In the first group were 10 consecutive noncolonized CF patients without precipitins detectable by crossed immunoelectrophoresi...

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