SummaryBackground Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it diffi cult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the fi rst structured survey on the occurrence of carbapenemaseproducing Klebsiella pneumoniae and Escherichia coli in European hospitals.

Tetracycline is useful in combination therapies against the gastric pathogen Helicobacter pylori. We found 6 tetracycline-resistant ( mutants that had acquired mutant rDNA alleles were resistant to tetracycline at levels higher than those to which either parent strain was resistant. Thus, tetracycline resistance in H. pylori results from an accumulation of changes that may affect tetracycline-ribosome affinity and/or other functions (perhaps porins or efflux pumps). We suggest that the rarity of tetracycline resistance among clinical isolates reflects this need for multiple mutations and perhaps also the deleterious effects of such mutations on fitness. Formally equivalent mutations with small but additive effects are postulated to contribute importantly to traits such as host specificity and virulence and to H. pylori's great genetic diversity.

The macrolide and levofloxacin susceptibilities of 992 isolates of Streptococcus pneumoniae from clinical specimens collected in 1999 and 2000 were determined in 10 centers in Central and Eastern European countries. The prevalences of penicillin G-intermediate (MICs, 0.125 to 1 g/ml) and penicillin-resistant (MICs, <2 g/ml) Streptococcus pneumoniae isolates were 14.3 and 16.6%, respectively. The MICs at which 50% of isolates are inhibited (MIC 50 s) and the MIC 90 s of telithromycin were 0.016 and 0.06 g/ml, respectively; those of erythromycin were 0.06 and >64 g/ml, respectively; those of azithromycin were 0.125 and >64 g/ml, respectively; those of clarithromycin were 0.03 and >64 g/ml, respectively; and those of clindamycin were 0.06 and >64 g/ml, respectively. Erythromycin resistance was found in 180 S. pneumoniae isolates (18.1%); the highest prevalence of erythromycin-resistant S. pneumoniae was observed in Hungary (35.5%). Among erythromycin-resistant S. pneumoniae isolates, strains harboring erm ( (2 strains [1.1%]). Similar pulsed-field gel electrophoresis patterns suggested that some strains containing L4 mutations from the Slovak Republic, Bulgaria, and Latvia were clonally related. Of nine strains highly resistant to levofloxacin (MICs, >8 g/ml) six were isolated from Zagreb, Croatia. Telithromycin at <0.5 g/ml was active against 99.8% of S. pneumoniae isolates tested and may be useful for the treatment of respiratory tract infections caused by macrolide-resistant S. pneumoniae isolates.

Among 1,011 recently isolated Streptococcus pyogenes isolates from 10 Central and Eastern European centers, the MICs at which 50% of isolates are inhibited (MIC 50 s) and the MIC 90 s were as follows: for telithromycin, 0.03 and 0.06 g/ml, respectively; for erythromycin, azithromycin, and clarithromycin, 0.06 to 0.125 and 1 to 8 g/ml, respectively; and for clindamycin, 0.125 and 0.125 g/ml, respectively. Erythromycin resistance occurred in 12.3% of strains. Erm(A) [subclass erm(TR)] was most commonly encountered (60.5%), followed by mef(A) (23.4%) and erm(B) (14.5%). At <0.5 g/ml, telithromycin was active against 98.5% of the strains tested.Streptococcus pyogenes strains continue to be penicillin susceptible, but erythromycin resistance has increasingly been reported. A recent Canadian study (10) has documented that 2.1% of S. pyogenes strains collected in 1997 were macrolide resistant. Significant rates of erythromycin resistance have been reported in many countries including Finland, Sweden, Spain, France, and Italy (1,3,6,8,11,12,16,18,20,21,24). In the United States, it has been assumed that the rate of erythromycin resistance is low (14, 15). However, a recent study has reported erythromycin resistance rates of 32% among isolates from specimens from patients with invasive disease and 9% among isolates from cultures of throat swab specimens isolated between 1994 and 1995 in the San Francisco, California, area (25).For S. pyogenes isolates from most areas tested, macrolide resistance is mediated by the mef(A) gene (23), making the isolates resistant to 14-and 15-membered-ring macrolides but susceptible to 16-membered-ring macrolides and clindamycin. Erm(A) [subclass erm(TR)] has also been described (21); strains containing erm(A) are usually inducibly resistant to 14-and 15-membered-ring macrolides but are susceptible to 16-membered-ring macrolides and lincosamides. The erm(B) gene has also been described, with strains that contain this gene being resistant to macrolides and lincosamide (6,10,11,16).Telithromycin is a ketolide (9, 13, 19) with low MICs for erythromycin-susceptible and -resistant S. pyogenes strains except those carrying erm(B). To understand macrolide susceptibility in areas where high rates of drug-resistant pneumococcci have been described, Central and Eastern Europe (2), we tested the activities of telithromycin, erythromycin, azithromycin, clarithromycin, and clindamycin against 1,011 isolates of S. pyogenes. Levofloxacin was tested as the representative fluoroquinolone.Strains were consecutively obtained from clinical isolates recovered during 1999 and 2000 and were screened by the bacitracin disk method. Organisms were frozen at all collection sites except Warsaw (where swabs in Amies transport medium were used) and were transported on dry ice to Hershey Medical Center, where they were stored frozen in double-strength skim milk (Difco Laboratories, Detroit, Mich.) at Ϫ70°C until use. The identities of the organisms were confirmed by colonial morphology, bacitracin testing, beta-hemolys...

Objectives: High-quality diagnosis of bloodstream infections (BSI) is important for successful patient management. As knowledge on current practices of microbiological BSI diagnostics is limited, this project aimed to assess its current state in European microbiological laboratories. Methods: We performed an online questionnaire-based cross-sectional survey comprising 34 questions on practices of microbiological BSI diagnostics. The ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES) was the primary platform to engage national coordinators who recruited laboratories within their countries.