Background-Anthranoid laxatives are the most commonly used purgatives in the therapy of acute and chronic constipation. Recent experimental data and a prospective cohort study provide evidence of a possible risk of anthranoid use for the development of colorectal neoplasms. Materials and methods-We performed a prospective case control study at the University of Erlangen to investigate the risk of anthranoid laxative use for the development of colorectal adenomas or carcinomas. A total of 202 patients with newly diagnosed colorectal carcinomas, 114 patients with adenomatous polyps, and 238 patients (controls) with no colorectal neoplasms who had been referred for total colonoscopy were studied. The use of anthranoid preparations was assessed by standardised interview, and endoscopically visible or microscopic melanosis coli was studied by histopathological examination. Results-There was no statistically significant risk of anthranoid use for the development of colorectal adenomas (unadjusted odds ratio 1.0; 95% CI 0.5-1.9) or carcinomas (unadjusted odds ratio 1.0; 95% CI 0.6-1.8). Even after adjustment for the risk factors age, sex, and blood in the stools by logistic regression analysis the odds ratio for adenomas was 0.84 (95% CI 0.4-1.7) and for carcinomas 0.93 (95% CI 0.5-1.7). Also, there were no diVerences between the patient and control groups for duration of intake. Macroscopic and high grade microscopic melanosis coli were not significant risk factors for the development of adenomas or carcinomas. Conclusion-Neither anthranoid laxative use, even in the long term, nor macroscopic or marked microscopic melanosis coli were associated with any significant risk for the development of colorectal adenoma or carcinoma. (Gut 2000;46:651-655)

A Klebsiella pneumoniae strain resistant to oxyimino cephalosporins was cultured from respiratory secretions of a patient suffering from nosocomial pneumonia in Kiel, Germany, in 1997. The isolate harbors a bla resistance gene located on a transmissible plasmid. An Escherichia coli transconjugant produces a β-lactamase with an isoelectric point of 7.7 and a resistance phenotype characteristic of an AmpC (class 1) β-lactamase except for low MICs of cephamycins. Thebla gene was cloned and sequenced. It encodes a protein of 386 amino acids with the active site serine of the S-X-X-K motif at position 64, as is characteristic for class C β-lactamases. Multiple alignment of the deduced amino acid sequence with 21 other AmpC β-lactamases demonstrates only very distant homology, reaching at maximum 52.3% identity for the chromosomal AmpC β-lactamase ofSerratia marcescens SR50. The β-lactamase ofK. pneumoniae KUS represents a new type of AmpC-class enzyme, for which we propose the designation ACC-1 (Ambler class C-1).

With colostomy-free survival rates around 85 percent, long-term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.

A group of cefotaxime-resistant Citrobacter freundiiand Escherichia coli isolates were collected by a clinical laboratory in a hospital in Warsaw, Poland, in July 1996. Detailed analysis has shown that all of these produced a β-lactamase (pI, 8.4) belonging to the CTX-M family, one of the minor extended-spectrum β-lactamase families with a strong cefotaxime-hydrolyzing activity. Sequencing has revealed that C. freundii isolates produced a new CTX-M-3 enzyme which is very closely related to the CTX-M-1/MEN-1 β-lactamase, sporadically identified in Europe over a period of 6 years. Amino acid sequences of these two β-lactamases differ at four positions: Val77Ala, Asp114Asn, Ser140Ala, and Asn288Asp (the first amino acid of each pair refers to CTX-M-1/MEN-1 and second refers to CTX-M-3). The partial sequence of the E. coli CTX-M gene was identical to the corresponding region ofbla CTX-M-3, but a transconjugant of theE. coli isolate expressed higher levels of resistance to β-lactams than did C. freundii transconjugants. These resistance differences correlated with differences in plasmid DNA restriction patterns. Our results suggest that CTX-M genes have been spread among different species of the familyEnterobacteriaceae in the hospital and that the CTX-M-3-expressing C. freundii strain causing routine urinary tract infections has been maintained for a relatively long time in the hospital environment.

Pandoraea spp. are gram-negative, glucose nonfermenting rods detectable in blood cultures and sputa of cystic fibrosis patients. They are resistant to various antibiotic groups, with imipenem being the only active ␤-lactam. We isolated an imipenem-resistant (MIC, 64 g/ml) Pandoraea pnomenusa strain from a cystic fibrosis patient. Cloning and sequencing identified two ␤-lactamases of Bush group 2d, namely, the known OXA-33, located on an integron, and the novel carbapenem-hydrolyzing oxacillinase OXA-62. OXA-62 is only distantly related to other oxacillinases (OXA-50 being closest with 43% amino acid identity). It hydrolyzes penicillins, oxacillin, imipenem, and meropenem but not expanded-spectrum cephalosporins. The bla OXA-62 gene is chromosome located. No transposable elements were found in its genetic neighborhood. With OXA-62-specific primers, bla OXA-62 could be identified in all P. pnomenusa strains and appears to be species specific. This additional mechanism of carbapenem resistance further complicates the treatment of infections caused by P. pnomenusa.The genus Pandoraea was established by Coenye et al. in 2000 (6) as a result of reanalyzing strains not definitely identified to the species level which were phenotypically closest to Burkholderia cepacia, Ralstonia pickettii, or Ralstonia paucula. The genus Pandoraea includes five named species (Pandoraea apista, P. norimbergensis, P. pnomenusa, P. pulmonicola, and P. sputorum) and four unnamed genomospecies (9). Pandoraea sp. strains have been isolated from patients with septicemia and respiratory tract infections (mostly cystic fibrosis), as well as from food, water, and soil (6,9,14,17,21).Antibiotic therapy of infections caused by Pandoraea spp. is impaired by their resistance to multiple antibiotics, including penicillins, cephalosporins, cefoxitin, meropenem, aminoglycosides, and chloramphenicol. Their resistance to fluoroquinolones is variable. Only tetracycline, trimethoprim-sulfamethoxazole, and imipenem were found to be active against the majority of isolates (9,14,17,21). We recently cultured a P. pnomenusa strain from a cystic fibrosis patient. For this multiresistant strain, the MIC of imipenem was unusually high. A novel carbapenemhydrolyzing oxacillinase, OXA-62, turned out to be involved in the mechanism of resistance to imipenem.(Part of this work was presented at the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy [abstr. C1-666 and C2-2180].) MATERIALS AND METHODSStrains and plasmids. The strains used in this study are characterized in Table 1. The Pandoraea spp. were isolated from sputa of cystic fibrosis patients between 1997 and 2004 in different centers in Germany, partly as Burkholderia spp. not identifiable to the species level. They were identified by phenotypic (API 20 NE [BioMérieux, Marcy l'Etoile, France] and additional biochemical tests) and genotypic methods (PCR with species-specific oligonucleotides) with Pandoraea sp. type strains obtained from the Laboratorium voor Microbiologie (Universiteit Ghe...

Twelve ceftazidime-resistant isolates of the familyEnterobacteriaceae (11 Klebsiella pneumoniaeisolates and 1 Escherichia coli isolate) were collected in 1995 from three Polish hospitals located in different cities. All were identified as producers of extended-spectrum β-lactamases (ESBLs). Detailed analysis of their β-lactamase contents revealed that six of them expressed SHV-5-like ESBLs. The remaining six were found to produce three different TEM enzymes, each characterized by a pI value of 6.0 and specified by new combinations of amino acid substitutions. The amino acid substitutions compared to the TEM-1 β-lactamase sequence were Gly238Ser, Glu240Lys, and Thr265Met for TEM-47; Leu21Phe, Gly238Ser, Glu240Lys, and Thr265Met for TEM-48; and Leu21Phe, Gly238Ser, Glu240Lys, Thr265Met, and Ser268Gly for TEM-49. The new TEM β-lactamases, TEM-47, TEM-48, and TEM-49, belong to a subfamily of TEM-2-related enzymes. Genes coding for TEM-47 and TEM-49 could have originated from the TEM-48-encoding sequence by various single genetic events. The new TEM derivatives probably document the already advanced microevolution of ESBLs ongoing in Polish hospitals, in a majority of which no monitoring of ESBL producers was performed before 1996.

Six female and 39 male outpatients, who suffered from acutely inflamed pilonidal sinus were treated by sclerotherapy between January 1985 and December 1988. Under local anaesthesia, 1-2 ml 80% phenol was injected into the sinus. The phenol, which was allowed to act for a minute, was washed out by irrigating the sinus with physiological common-salt solution. Of the questionnaire sent to all 45 patients, 37 proved suitable for evaluation. Complete healing occurred in 22 cases (59.8%). The healing time was 6.2 weeks on average. Besides a rather frequently observed transient reddening as a result of the local inflammation caused by the phenol, 5 patients developed an abcess which needed operative treatment. This study does not support the encouraging results of previous series.

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