Our findings confirmed that MRSA infections in the community have been increasing in Asian countries. Data also suggest that various MRSA clones have spread between the community and hospitals as well as between countries.

Isolates from Hong Kong showed the highest rate of ciprofloxacin resistance (11.8%), followed by isolates from Sri Lanka (9.5%), the Philippines (9.1%), and Korea (6.5%). Multilocus sequence typing showed that the spread of the Taiwan 19F clone and the Spain 23F clone could be one of the major reasons for the rapid increases in antimicrobial resistance among S. pneumoniae isolates in Asia. Data from the multinational surveillance study clearly documented distinctive increases in the prevalence rates and the levels of antimicrobial resistance among S. pneumoniae isolates in many Asian countries, which are among the highest in the world published to date.The global emergence of in vitro antimicrobial resistance in Streptococcus pneumoniae has become a serious clinical concern since the 1980s (1). During the past two decades, the rates of resistance to penicillin, other beta-lactams, and non-betalactam agents have been increasing rapidly in many parts of the world. In particular, data on rates of pneumococcal resistance from Asian countries at the end of the 1990s were alarming.

Appropriate antimicrobial treatment of community-acquired pneumonia (CAP) should be based on the distribution of aetiological pathogens, antimicrobial resistance of major pathogens, clinical characteristics and outcomes. We performed a prospective observational study of 955 cases of adult CAP in 14 hospitals in eight Asian countries. Microbiological evaluation to determine etiological pathogens as well as clinical evaluation was performed. Bronchopulmonary disease (29.9%) was the most frequent underlying disease, followed by cardiovascular diseases (19.9%), malignancy (11.7%) and neurological disorder (8.2%). Streptococcus pneumoniae (29.2%) was the most common isolate, followed by Klebsiella pneumoniae (15.4%) and Haemophilus influenzae (15.1%). Serological tests were positive for Mycoplasma pneumoniae (11.0%) and Chlamydia pneumoniae (13.4%). Only 1.1% was positive for Legionella pneumophila by urinary antigen test. Of the pneumococcal isolates, 56.1% were resistant to erythromycin and 52.6% were not susceptible to penicillin. Seventeen percent of CAP had mixed infection, especially S. pneumoniae with C. pneumoniae. The overall mortality rate was 7.3%, and nursing home residence, mechanical ventilation, malignancy, cardiovascular diseases, respiratory rate>30/min and hyponatraemia were significant independent risk factors for mortality by multivariate analysis (P<0.05). The current data provide relevant information about pathogen distribution and antimicrobial resistance of major pathogens of CAP as well as clinical outcomes of illness in Asian countries.

Bacillus subtilis spores are being used for oral bacteriotherapy and bacterioprophylaxis of gastrointestinal disorders in both humans and animals. Since B. subtilis is an aerobic saprophyte, how spores may benefit the gut microbiota is an intriguing question, since other probiotics such as Lactobacillus spp. which colonize the gut are anerobes. As a first step in understanding the potential effects of ingesting spores, we have characterized five commercial products. An extensive biochemical, physiological, and phylogenetic analysis has revealed that four of these products are mislabeled. Moreover, four of these products showed high levels of antibiotic resistance.Probiotics, or "friendly bacteria," are becoming increasingly available to the public as beneficial functional foods that purport to promote specific health benefits to consumers (2,14,18). In some countries probiotics are available for oral bacteriotherapy and bacterioprophylaxis of gastrointestinal disorders in humans. Often these disorders, many of which lead to diarrhea, are a direct result of antibiotic use, which produces an imbalance in the composition of the normal intestinal microbial flora. In the livestock industry the use of probiotics has potential as an alternative to antibiotics by competitive exclusion of pathogenic microorganisms (19), with some commercial products, such as Paciflor, already available. Bacteria most commonly used as probiotics include the lactic acid bacteria (e.g., lactobacilli, enterococci, streptococci, and bifidobacteria). Experimental evidence now suggests that the ingestion of substantial numbers of harmless bacteria does indeed provide a beneficial effect to the enteric flora (18). Precisely how this is achieved and whether the commercial claims are justified remains a contentious issue, though (14).In addition to the lactic acid bacteria, Bacillus species are also sold as probiotics. These consist of preparations of bacterial spores, with the potential advantage that the spore can survive transit through the stomach intact. Bacillus species are substantially different from other probiotic bacteria, though, being primarily aerobic saprophytes found in the soil. If indeed they have any health benefit, then one obviously important question is how? Do spores germinate and colonize the gut, do they competively exclude colonization by potential pathogens, or does the dormant spore provide some unique stimulus to the gut microbiota, such as enhanced local immunity?In an earlier study we have shown that one major Bacillus probiotic marketed in Europe contained spores of a taxonomically and phylogenetically unrelated Bacillus species (4). This was surprising, considering that in Europe probiotics must be licensed to be used as a functional or novel food.In this work we have examined and characterized five commercial Bacillus spore probiotics as a first step in understanding the nature of spore probiotics. MATERIALS AND METHODSBacterial strains. Bacteria were recovered by suspension of dried probiotic preparations in dist...

Bacterial spores are being consumed as probiotics, although little is known about their efficacy or mode of action. As a first step in characterizing spore probiotics, we have studied the persistence and dissemination of Bacillus subtilis spores given orally to mice. Our results have shown that spores do not appear to disseminate across the mucosal surfaces. However, we found that the number of spores excreted in the feces of mice was, in some experiments, larger than the original inoculum. This was an intriguing result and might be explained by germination of a proportion of the spore inoculum in the intestinal tract, followed by limited rounds of cell growth and then sporulation again. This result raises the interesting question of whether it is the spore or the germinated spore that contributes to the probiotic effect of bacterial spores.The gram-positive soil microorganism Bacillus subtilis has been studied extensively, primarily as a model with which to study cell differentiation and for exploitation in the biotechnology industry. While some Bacillus species are pathogenic (e.g., B. anthracis and some B. cereus strains), B. subtilis has, at most, been associated with opportunistic infections of immunocompromised patients (6,11,17). For these reasons, it has received relatively little clinical interest. Bacillus spores, though, are currently available as probiotics and as competitive exclusion agents (CE agents). Probiotics are live bacterial supplements which can enhance the normal intestinal flora, while CE agents are bacteria which can suppress infection and may contain undefined mixtures of more than one bacterial species (7,8,19). Ingestion of significant quantities of spores is thought to restore the normal microbial flora following extensive antibiotic usage or illness (13). How this occurs is unclear but could include competitive exclusion of pathogens, whether by immunostimulation or competition for adhesion sites. Spore probiotics are primarily used by humans as an over-the-counter supplement for oral bacteriotherapy and bacterioprophylaxis of mild gastrointestinal disorders, many of which lead to diarrhea (13). In the livestock and poultry industries, probiotics containing Bacillus spores are used extensively; an example is Biogrow (Provita Eurotech Ltd., County Tyrone, Northern Ireland), which contains a mixture of B. subtilis and B. licheniformis spores. With the recent ban on the use of antibiotics as growth promoters in Denmark, the use of probiotics or CE agents as antibiotic alternatives seems likely to increase.The validity of spores as probiotics or CE agents was recently demonstrated by showing that oral inoculation of 1-dayold chicks with 2.5 ϫ 10 8 B. subtilis spores suppressed all aspects of infection when chicks were challenged with Escherichia coli 078:K80 (12). One dogma regarding the use of spores as probiotics or CE agents is their mode of action, which presumably must be substantially different from that of the other, better known bacterial supplements, such as Lactobacillus spp....

Data confirm that macrolide resistance in pneumococci is a serious problem in many Asian countries.

To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.

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