RahneUa aquatilis is an unusual gram-negative rod belonging to the family Enterobacteriaceae. It inhabits fresh water and is rarely isolated from clinical specimens. We report the case of a urinary tract infection caused by this organism in a renal transplant patient.

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Enterococci with high level aminoglycoside resistance are being reported from different parts of the world with increasing frequency. Treatment of infections caused by such isolates is associated with a high incidence of failure or relapse. This is attributed to the loss of the synergetic effect of aminoglycosides and cell wall active agents against isolates exhibiting this type of resistance. To determine the prevalence of enterococci with high level resistance to aminoglycosides in Riyadh, Saudi Arabia, 241 distinct clinical isolates were examined by disk diffusion method using high content aminoglycoside disks. Seventy-four isolates (30%) were resistant to one or more of the aminoglycosides tested. The most common pattern of resistance was that to streptomycin and kanamycin. Of the 241 isolates tested, 29 (12%) were resistant to high levels of gentamicin, 35 (15%) to tobramycin, 65 (27%) to kanamycin and 53 (22%) to streptomycin. The highest rate of resistance to a high level of gentamicin was found among enterococcal blood isolates (30%). Eighteen of the isolates were identified as Enterococcus faecium, 13 (72%) of these showed high level resistance to two or more of the aminoglycosides tested. Ann Saudi Med 1944; 14(4):290-293. Riyadh. 1994; 14(4): 290-293 Enterococci are an important cause of mortality and morbidity around the world. The mortality of the septicemic illness ranges between 19.6 and 71.4%. SR Al-Ballaa, SMH Qadri, High Level Resistance to Aminoglycosides in Enterococci from1 These organisms are also emerging as a significant cause of nosocomial infections; 2 currently they are the second leading cause of nosocomial infections in hospitals located in the United States. 3Management of enterococcal infections is complicated not only by natural resistance of the organism to a large number of antimicrobial agents, but also by the remarkable ability to acquire new resistance determinants. 4 These organisms are naturally resistant to low levels of aminoglycosides. The average minimum inhibitory concentration (MIC) for gentamicin and tobramycin is 8 to 64 μg/mL and that for streptomycin is around 250 μg/mL. 4 In spite of this, the combination of an aminoglycoside with a cell wall active agent like a beta-lactam or vancomycin exhibits a synergistic killing effect against most enterococcal strains. This property has been traditionally utilized for management of serious enterococcal infections. Among the resistance determinants that enterococci can acquire is the resistance to high level (MIC>2000 μg/mL) of aminoglycosides (HLA). This type of resistance eliminates the cell wall active agents' aminoglycoside synergy. [5][6][7] In patients infected with such isolates, the use of aminoglycosides (HLA). This type of resistance of an aminoglycoside to which high level resistance is exhibited is of no therapeutic value. The first aminoglycoside used with penicillin for the synergistic effect against enterococci was streptomycin. 8 Later, in the early 1970s, resistance to high level streptomycin (associate...