IntroductionSimulated-use buildup biofilm (BBF) model was used to assess various extraction fluids and friction methods to determine the optimal sample collection method for polytetrafluorethylene channels. In addition, simulated-use testing was performed for the channel and lever cavity of duodenoscopes.Materials and methodsBBF was formed in polytetrafluorethylene channels using Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa. Sterile reverse osmosis (RO) water, and phosphate-buffered saline with and without Tween80 as well as two neutralizing broths (Letheen and Dey–Engley) were each assessed with and without friction. Neutralizer was added immediately after sample collection and samples concentrated using centrifugation. Simulated-use testing was done using TJF-Q180V and JF-140F Olympus duodenoscopes.ResultsDespite variability in the bacterial CFU in the BBF model, none of the extraction fluids tested were significantly better than RO. Borescope examination showed far less residual material when friction was part of the extraction protocol. The RO for flush-brush-flush (FBF) extraction provided significantly better recovery of E. coli (p = 0.02) from duodenoscope lever cavities compared to the CDC flush method.Discussion and conclusionWe recommend RO with friction for FBF extraction of the channel and lever cavity of duodenoscopes. Neutralizer and sample concentration optimize recovery of viable bacteria on culture.

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The proportion of enterococci isolated from blood and urine cultures that were highly resistant to gentamicin and streptomycin were determined. No blood or urine isolates highly resistant to gentamicin were seen in 1983, whereas by 1986-87 25% of blood and 17% of urine isolates were highly resistant. The rapid emergence of gentamicin resistance has serious implications for patients with life threatening enterococcal disease.

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. The comparative activity of daptomycin and teicoplanin against enterococci isolated from blood and urine. Can J Infect Dis 1992;3(4):173-178. The authors compared the activity of daptomycin with U1at of ampicilJ in. penicillin . teicoplanin and vancomycin against 304 strains of Enterococcus species isolated from blood and urine. Daptomycin was as active as penicillin against Enterococcusfaecalis: 90% of strains we re inhi bited by 2 mg/L. Daptomycin was more active than vancomycin (90% m in imal inhi bitory concentration [MlCgoJ 2 mg/L; 90% minimal bactericidal concen tration [MBCgoJ 8 mg/L) but was less active than teicoplan in (M!C5o 0.25: MBCgo 8 mg/L) or ampicillin (MICgo 1 mg/L: MBCso 2 mg/L) against Efaecalis. In time-kill studies daptomycin was not more rapidly bactericidal !.han ampicillin or penicillin but was s ignificanUy more rapidly bactericidal than either teicoplanin or vancomycin. In combination with genlamicin, daptomycin has activity similar to !.hat of penicillin, vancomycin and teicoplan in. Daptomycin may be a su itable alternative to penicillin in patients allergic to penicillins or for the treatment of enterococcal infections caused by beta-lactamaseproducing enterococci.Key Words: Daptomycin. Enterococci. En terococcus faecal is. Teicoplanin Activite comparative de Ia daptomycine et de Ia teicoplanine contre les enterocoques isoles dans le sang et l'urine RESUME: Les auteurs ont compare l'activite de la daptomycine a celle de l'ampic ill ine. de la penicilline. de la teicoplanine et de la vancomycine contre 304 souches d'enterocoques isoles dans le sang et !'urine. La daptomycine etait a u ssi active que Ia peniciJline contre Enterococcus faecalis , 90 % des souches etant inhibees par 2 mg/L. La daptomycine etait plus active (concentration minimale inhibitrice de 90 % ICMlsol a 2 mg/L: concentration minimale bactericide de 90 % JCMBgoJ a 8 mg/L) que la vancomycine mais moins que la teicoplanin e (CMlgo a 1 mg/L; CMBso a 2 mg/L) contre Efaecalis. Des essais ont detem1ine que !'action bactericide de Ia daptomycine n 'etait pas p lus rapide que celle de l'ampicilline ou de la pen icill ine mais qu'elle etait significativement plus rapide que celle de la te icoplanine ou de Ia vancomycine. En association avec la gentamycine. la daptomycine a une activite s im ilaire a celle de Ia penicill ine. de la vancomycine et de la teicoplanine. La daptomycine peut etre une solution de rechange appropriee dans le cas de patients allergiqu es aux penicillines ou dans le traitemenl des infections causees par des enterocoques producteurs de beta-lactamases.