In a prospective side-by-side comparison conducted from September through November 1994, we compared the MicroScan WalkAway system, a conventional biochemical identification system (Dade MicroScan, Inc., Sacramento, Calif.), with the Vitek system (bioMerieux Vitek, Hazelwood, Mo. [analysis software version AMS-RO8.2]) for the identification of gram-negative bacteria. Three-hundred thirty-one nonurine isolates and 493 urine isolates were tested. For nonurinary isolates, there was 91.5% agreement between the two methods. For urinary isolates, there was 97.4% agreement between the two methods. Overall, there was 95% agreement between the two systems. The results suggest that the current version of the MicroScan WalkAway system with conventional panels is essentially comparable to the current Vitek system.
Actin is present in high concentrations in most eukaryotic cells and can polymerize into filaments under physiological buffer conditions. As a result of tissue injury and cell lysis, large quantities of actin are released locally and may obstruct the downstream microvasculature, causing further damage to already injured organs. It has been postulated that this mechanism contributes to the development of the adult respiratory distress syndrome and to the diverse complications of falciparum malaria. Actin scavenging proteins--e.g., gelsolin--counteract the effects of extracellular actin, but the capacity of these plasma proteins can be overwhelmed by massive tissue injury. We examined the temporal relationship between serum levels of gelsolin (and tumor necrosis factor-alpha) and the clinical findings for a patient with severe falciparum malaria. The level of gelsolin decreased and then increased as the patient's status first worsened and then improved. We could not determine whether gelsolin served a biologically important function in this patient's recovery or was simply an epiphenomenon of disease activity. Gelsolin levels may be an early prognostic indicator in patients with a systemic inflammatory response syndrome. Moreover, the potential therapeutic role of recombinant human plasma gelsolin in patients with delayed organ dysfunction that commonly follows a self-limited initial insult merits investigation.
Recent studies have reported RP59500 (Synercid) (quinupristin-dalfopristin), a semisynthetic streptogramin, to have good in vitro activity against certain enterococcal strains, including vancomycin-resistant strains of Enterococcus faecium (3-5). The purpose of the present study was to determine the in vitro activity of this new compound against a larger sample of resistant strains of enterococci and to compare its activity with those of several currently available antimicrobials. We analyzed 1,044 strains of vancomycin-resistant enterococci (990 E. faecium and 54 E. faecalis) which had been isolated from clinical specimens at 52 New Jersey hospitals between March 1993 and February 1996. Following identification of isolates to species level, MICs were determined by broth microdilution (6). The results are summarized in Table 1. All isolates demonstrated resistance to vancomycin (MIC Ն 32 g/ml); 803 (76.9%) were also resistant to teicoplanin (MIC Ն 32 g/ml). RP59500 had excellent activity against most isolates of E. faecium, with 968 (97.8%) inhibited at a concentration of 1 g/ml or less, making it the most active agent of those we tested. This supports data obtained in prior studies involving vancomycinresistant E. faecium which have reported a range of MICs from 0.06 to 32 g,/ml, with MICs at which 90% of isolates are inhibited (MIC 90) between 0.5 and 16 g/ml (2-5, 7). RP59500 was considerably less active against E. faecalis, with only one-third of strains inhibited at 4 g/ml, an observation consistent with earlier findings (3-5). In addition, the MIC 50 s and MIC 90 s of RP59500 for the two species were not affected by differences in the vancomycin resistance phenotype (1). Like that to RP59500, resistance to ampicillin was found to be species specific, with E. faecium (MIC 90 Ն 128 g/ml) significantly more likely to be resistant to ampicillin (MIC Ն 16 g/ml) than E. faecalis (MIC 90 ϭ 2 g/ml). High-level resistance to gentamicin, defined by a MIC of Ͼ500 g/ml, was
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