Vol. 11, 1992
dures having been performed or prosthetic devices implanted, nor did she present predisposing factors such as compromised immune defences or corticosteroid therapy; and finally, Propionibacterium acnes was isolated in pure cultures both from the bone site of infection and from blood. Our therapeutic choice was based on sensitivity tests p e r f o r m e d (both antimicrobial agents Were active on the isolated strain), on in vitrodemonstrated synergism o f rifampicin and trimethoprim (9, 10), on favourable pharmacokinetics of both drugs (11,12) and on the better acceptability of long-term oral therapies. The paucity of data concerning the optimal treatment of these rare infections as well as discrepancies in the antibiotic choices among the reported cases (1-6, 8), show there is a need for new therapies to be investigated. The results obtained in the case presented here show this therapeutic regimen to be an interesting possibility in the treatment of infections due to Propionibacterium acnes. This organism must be regarded as a potential pathogen Whose presence (particularly when isolated in large quantities or in multiple specimens) should be correlated with the clinical situation and taken into consideration when the appropriate therapeutic decision is made. In our opinion, considering the results obtained in the treatment of osteomyelitis due to other bacteria (unpublished results), the same therapeutic regimen could also be considered a possible alternative to more classical antibiotic therapies in the treatment of osteomyelitis due to bacteria other than Propioni-
197
3. Noble RC, Overman SB: Propionibacterium aches osteomyelitis: case report and review of the literature. Journal of Clinical Microbiology 1987, 25: 251-254. 4. Hall BB, Fitzgerald RH, Rosenblatt JE: Anaerobic osteomyelitis. American Journal of Bone and Joint Surgery 1983, 65: 30-35. 5. Lewis liP, Sutter VL, Finegold SM: Bone infections involving as.aerobic bacteria. Medicine 1978, 57: 279305. 6. Kamme C, Lidgren L, Lindberg L, Marrdh PA: Anaerobic bacteria in late infections after total hip arthroplasty. Scandinavian Journal of Infectious Diseases 1974, 6: 161-165. 7. Strauss JS, Klignam AM: The pathologic dynamics of acne vulgaris. Archieves Dermatology 1960, 82: 779790. 8. Newman JH, Milchell liG: Diphteroid infection of the cervical spine. Acta Orthopaediea Scandinavica 1975, 546: 67-70. 9. Kerry DW, Hamilton-Miller JMT, Brumfitt W: Trimethoprim and rifampicin: in vitro activities separately and in combination. Journal of Antimicrobial Chemotherapy 1975, 1: 417-427. 10. Brumfitl W, Hamilton.Miller JMT: The possible clinical value of rifampicin and trimethoprim in combination. Infection 1978, Supplement 6: 53--56. 11. Buniva G, Pahninleri R, Berti M: Kinetics of a rifampin-trimethoprim combination. International Journal of Clinical Pharmacology and Biopharmacology 1979, 17: 256-259. 12. Sirot J, Prive L, Lopitaux R, Glanddier Y: Etude de la diffusion dc la rifampicinc dans le tissu osseux spongieux et compact au cours de proth~zses totales de hanchc. Pathologic Biologie 1983, 31: 438-441.
bacterium acnes. A C a s e o f Biliary Tract I n f e c t i o n C a u s e d by
E Suter 1 M.A. Silanos 2 G. T a b a c c h i 3 E Maggiolol, 1Department of Infectious Diseases, ~Department of Clinical Pathology, and 3Departmcnt of Cardiology, Ospedale di Circolo, Piazza Solaro 7, 21052 Busto Arsizio, Italy.
References 1. Finegold SM: Anaerobic bacteria in human disease. New York Academic Press, New York 1977,p. 577-578. 2. Lipkin AF, Mazer TM, Duncan NO, Parke RB: Propionibacterium aches: a neglected head and neck pathogen. Otolaringology Head Neck Surgery 1987, 97. 510--513.
Haem oph ilus para inf l u enza e Haemophilus parainfluenzae is a commensal of the oropharynx and has been isolated from throat and lower respiratory tract. Occasionally, this organism has been identified as the causative agent of genital and neonatal infections, meningitis, endocarditis, cutaneous abscesses, urinary tract infections, and septicemia (1, 2). During the last few years, Haemophihts parainfluenzae has b e e n described as the causative agent of two liver abscesses. One case was reported in a 26-year-old Nigerian student in Great Britain (3) and a second in a 12-month-old boy in the U S A (1). To o u r knowledge, there have b e e n no previous reports of biliary tract infections caused by Haemophilus parainfluenzae. This report describes one such case, and discusses the pathogenesis of the infection.
198
Eur. J. Clin. Microbiol. Infect. Dis.
A 65-year-old woman, height 1.52 m, weight 90 kg, with hypertension was admitted to the surgical ward. She complained of abdominal pains, particularly dorsally, which she had had for 10 days. Gallstones were suspected. Ultrasonography, plain abdominal X-ray and intravenous angiography confirmed this diagnosis. The results of a bile duct radiomanometry were normal. Histological analysis of the gallbladder wall showed a thin wall consistent with a chronic gallstone. Bile was cultured on blood agar, both aerobically and anaerobically, and on chocolate agar and under a CO2-enriched atmosphere. One strain of Streptococcus sanguis and one strain of Haemophilus parainfluenzae biotype II were isolated. Surgical therapy and a high single-dose of amoxicillin (2 g) and clavulanic acid (200 rag) led to a favourable outcome.
membrane proteins by Haemophilusparainfluenzae appears to be more closely related to that of the enteric bacteria than to that of Haemophilus influenzae (9). These two observations are not consistent with the postulate that all Haemophilus species found in the gastro-intestinal tract originate in the oropharynx and/or saliva (7). Rather, they suggest that some Haemophilus parainfluenzae strains belong to the intestinal flora. Using enzyme electrophoretic analysis and D N A - D N A hybridization, we recently described a genospecies of Haemophilus which possesses specific tropisms for a particular ecological niche: the genital flora (10). Such genetic characterization of Haemophilus parainfluenzae strains isolated from various origins will be necessary to determine if some clone families are adapted to the intestinal environment.
Hepatobiliary tract infections caused by Haemophilus parainfluenzae, as well as those caused by Haemophilus infiuenzae, have rarely been described. To date, only eight cases have been reported: two liver abscesses due to Haemophilus parainfluenzae and three liver abscesses and three biliary tract infections due to Haemophilus influenzae (1, 3-5).
The suggestion that the source of Haemophilus parainfluenzae strains causing hepatobiliary tract
This is the first reported case of biliary infection due to Haemophilus parainfluenzae. The low incidence of HaemophUus species in hepatobiliary infections could be explained by the fact that many Haemophilus infections may go unrecognized because of inadequate laboratory techniques. Thorough screening of hepatobiliary samples should include plating on chocolate agar incubated under 8-10 % CO2. Usually, Haemophilus inflUenzae and Haemophilus parainfluenzae pathogenicity are considered to be similar when liver abscesses or hepatobiliary tract infections are reported. However, because of the ecological and structural differences between the two species, the pathogenesis of Haemophilus parainfluenzae and Haemophilus influenzae hepatobiliary tract infections probably differs. The ecological difference is supported by the distribution of Haemophilus species isolated from faecal specimens. Haemophilus parainfluenzae is present in over 20 % of faecal samples analysed (6), whereas Haemophilus influenzae is rarely isolated from stools (7, 8). The structural difference concerns the protein composition of the outer membrane. Analysis of the outer membrane proteins of various Haemophilus species has revealed that the expression of iron-repressible outer
infections was the intestinal flora, from where the bacteria ascended, is supported by the fact that, in the three cases reported, blood cultures from the infected patients showed no concomittant bacteriemia.
B. Cattier 1. J. Caillon 2 R. Quentin 1 1 D6partement de Microbiologie M6dicale et Mol,6culaire, Unit6 de Bact6riologie, Centre Hospitalier R6gional Universitaire Bretonneau, 37044 Tours Cedex, France. 2 Laboratoire de Bact6riologie B, Centre Hospitalier R6gional Universitaire La~nnec, BP 1005, 44035 Nantes Cedex 01, France.
References 1. Black CT, Kupferschmid JP, West KW, Grosfeld J J: Haemophilus parah~fluenzae infections in children, with the report of a unique case. Reviews of Infectious Diseases 1988, 10: 342-346. 2. Quentin R, Musser JM, Mellouet M, Sizaret P, Selander RK, Goudeau A: Typing of urogenital, maternal, and neonatal isolates of Haemophilus h~fluenzae and Haemophilus parainfluenzae in correlation with clinical source of isolation and evidence for a genital specificity of H. influenzae biotype IV. Journal of Clinical Microbiology 1989, 27: 2286-2294. 3. Chaltopadhyay B, Silverstone PH, Winwood RS: Liver abscess caused by Haemophilus parah~fluenzae. Postgraduate Medical Journal 1983, 59: 788-789.
V.ol. 11, 1992
4. Canton R, Leon A, de la Fuente S, Carda P, Morales .V, Baquero F, Messeguer MA: Beta-lactamase producing Haemophilus influenzae as causative agent of a
liver abscess. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 748-749. 5. Ferran M, Buti M, Gonzalez A, Boqu~ R, Esteban R, Guardia J: Pyogenicliver abscess by Haemophilus influenzae complicatinghydatid cysts. Infection 1986, 14: 197. 6. KUian M: Haemophilus. In: Lennette EH, Balows A, Hausler WJ, Shadomy HJ red): Manual of clinical microbiology. American Society for Microbiology. Washington, DC, 1985, p. 387-393. 7. M~graud F, B~b~ar C, Dabernat H, Deimas C: Haemophilus species in the human gastrointestinal tract. European Journal of Clinical Microbiologyand Infectious Diseases 1988, 7: 437-438. 8. Palmer GG: Haemophili in feces. Journal of Medical Microbiology 1981; 14: 147-150. 9. Morton D, WilliamsP: Characterizationof the outermembrane proteinsof Haemophilus parainfluenzae expressed under iron-sufficientand iron-restricted conditions. Journal of General Microbiology 1989, 135: 445--451. 10. Quentin R, Goudeau A, Wallace JR, Smith AL, Selander RK, Musser JM: Urogenital, maternal and neonatal isolates of Haemophilus influenzae: identification of unusually virulent serologically nontypable clone familiesand evidence for a new Haemophihts species. Journal of General Microbiology1990, 136: 1203-1209.
Serratiafonticola as an I n f e c t i o u s A g e n t A few weeks after Bollet et al. (1) had reported the first documented human infection due to Serratia fonticola, our laboratory was confronted With the isolation and identification of the very Same bacterium from pus. The organism was responsible for a severe infection of the right hand of a 39-year-old female patient. She had suffered an open fracture of the hand in a car accident. The WOund was subsequently debrided and treated locally with gentamicin. The entire lesion healed within a few days. Apart from a few colonies of Bacillus cereus, the primary plates were predominantly covered with Smooth colonies of Serratia fonticola. In the enrichment broth, Serratia fonticola again represented the major organism, in addition to some Colonies of Bacillus cereus and Staphylococcus aureus. In contrast to the bacterium isolated by Bollet et al., our strain developed a strong potatolike odor, a feature typical of some Serratia and Cedecea strains (2). In addition, it showed a
199
cocarde phenomenon which had been observed previously in Serratia marcescens and which is known to be induced by the cationic detergentlike activity of colistin (3). Our isolate showed excellent identification as
Serratiafonticota (97.7 % and 99.9 %) by the API 20E and API 50 CH systems (API System S.A., France), respectively. Except for positive reactions for both sucrose and cellobiose, our strain exhibited the same biochemical reactions as the organism described by Bollet et al. Additional biochemical tests provided by the API 50 CH system revealed that our strain was, furthermore, positive for fermentations of glycerol, ribose, Dxylose, galactose, D-fructose, D-mannose, dulcitol, inositol, cx-methyl-D-glucoside, N-acetylglucosamine, trehalose, D-raffinose, [3-gentiobiose, D-tagatose, D-arabitol, L-arabitol, gluconate, 2-keto-gluconate, 5-keto-gluconate and maltose. Negative reactions were observed for D-arabinose, L-xylose, l~-methyl-xyloside, Lsorbose, c~-ethyl-D-mannoside, amygdalin, inulin, melezitose, starch, glycogen, xylitol, Dturanose, D-lyxose, D-fucose and L-fucose. Compared with type strain ATCC 29844 (1), our isolate differed only in the utilization of cellobiose. It appears, furthermore, to be biochemically very similar to the strains described by Gavini et al. (4), Farmer et ai. (5) and MUller et al. (6). Most of these strains have been found either in water or bird feces, although a few were isolated from wounds (5) without their possible role as potential clinical pathogens recognized at that time. Antibiotic susceptibility of our strain was determined by the agar diffusion disk method according to the standard procedure of the National Committee for Clinical Laboratory Standards (7) using cation-supplemented Mueller-Hinton medium. The isolate was found to be susceptible to ciprofloxacin, cefoxitin, ceftazidime, ceftriaxone, gentamicin, netilmicin, tobramycin, piperaciIlin, imipenem and sulfamethoxazole-trimethoprim, but resistant to ampicillin, amoxicillin/clavulanic acid, cephalothin and cefamandole.
G.E. Pfyffer
Institute of Medical Microbiology, University of Ztirich, Gloriastrasse 32, 8028 Ztirich,Switzerland.
dures having been performed or prosthetic devices implanted, nor did she present predisposing factors such as compromised immune defences or corticosteroid therapy; and finally, Propionibacterium acnes was isolated in pure cultures both from the bone site of infection and from blood. Our therapeutic choice was based on sensitivity tests p e r f o r m e d (both antimicrobial agents Were active on the isolated strain), on in vitrodemonstrated synergism o f rifampicin and trimethoprim (9, 10), on favourable pharmacokinetics of both drugs (11,12) and on the better acceptability of long-term oral therapies. The paucity of data concerning the optimal treatment of these rare infections as well as discrepancies in the antibiotic choices among the reported cases (1-6, 8), show there is a need for new therapies to be investigated. The results obtained in the case presented here show this therapeutic regimen to be an interesting possibility in the treatment of infections due to Propionibacterium acnes. This organism must be regarded as a potential pathogen Whose presence (particularly when isolated in large quantities or in multiple specimens) should be correlated with the clinical situation and taken into consideration when the appropriate therapeutic decision is made. In our opinion, considering the results obtained in the treatment of osteomyelitis due to other bacteria (unpublished results), the same therapeutic regimen could also be considered a possible alternative to more classical antibiotic therapies in the treatment of osteomyelitis due to bacteria other than Propioni-
197
3. Noble RC, Overman SB: Propionibacterium aches osteomyelitis: case report and review of the literature. Journal of Clinical Microbiology 1987, 25: 251-254. 4. Hall BB, Fitzgerald RH, Rosenblatt JE: Anaerobic osteomyelitis. American Journal of Bone and Joint Surgery 1983, 65: 30-35. 5. Lewis liP, Sutter VL, Finegold SM: Bone infections involving as.aerobic bacteria. Medicine 1978, 57: 279305. 6. Kamme C, Lidgren L, Lindberg L, Marrdh PA: Anaerobic bacteria in late infections after total hip arthroplasty. Scandinavian Journal of Infectious Diseases 1974, 6: 161-165. 7. Strauss JS, Klignam AM: The pathologic dynamics of acne vulgaris. Archieves Dermatology 1960, 82: 779790. 8. Newman JH, Milchell liG: Diphteroid infection of the cervical spine. Acta Orthopaediea Scandinavica 1975, 546: 67-70. 9. Kerry DW, Hamilton-Miller JMT, Brumfitt W: Trimethoprim and rifampicin: in vitro activities separately and in combination. Journal of Antimicrobial Chemotherapy 1975, 1: 417-427. 10. Brumfitl W, Hamilton.Miller JMT: The possible clinical value of rifampicin and trimethoprim in combination. Infection 1978, Supplement 6: 53--56. 11. Buniva G, Pahninleri R, Berti M: Kinetics of a rifampin-trimethoprim combination. International Journal of Clinical Pharmacology and Biopharmacology 1979, 17: 256-259. 12. Sirot J, Prive L, Lopitaux R, Glanddier Y: Etude de la diffusion dc la rifampicinc dans le tissu osseux spongieux et compact au cours de proth~zses totales de hanchc. Pathologic Biologie 1983, 31: 438-441.
bacterium acnes. A C a s e o f Biliary Tract I n f e c t i o n C a u s e d by
E Suter 1 M.A. Silanos 2 G. T a b a c c h i 3 E Maggiolol, 1Department of Infectious Diseases, ~Department of Clinical Pathology, and 3Departmcnt of Cardiology, Ospedale di Circolo, Piazza Solaro 7, 21052 Busto Arsizio, Italy.
References 1. Finegold SM: Anaerobic bacteria in human disease. New York Academic Press, New York 1977,p. 577-578. 2. Lipkin AF, Mazer TM, Duncan NO, Parke RB: Propionibacterium aches: a neglected head and neck pathogen. Otolaringology Head Neck Surgery 1987, 97. 510--513.
Haem oph ilus para inf l u enza e Haemophilus parainfluenzae is a commensal of the oropharynx and has been isolated from throat and lower respiratory tract. Occasionally, this organism has been identified as the causative agent of genital and neonatal infections, meningitis, endocarditis, cutaneous abscesses, urinary tract infections, and septicemia (1, 2). During the last few years, Haemophihts parainfluenzae has b e e n described as the causative agent of two liver abscesses. One case was reported in a 26-year-old Nigerian student in Great Britain (3) and a second in a 12-month-old boy in the U S A (1). To o u r knowledge, there have b e e n no previous reports of biliary tract infections caused by Haemophilus parainfluenzae. This report describes one such case, and discusses the pathogenesis of the infection.
198
Eur. J. Clin. Microbiol. Infect. Dis.
A 65-year-old woman, height 1.52 m, weight 90 kg, with hypertension was admitted to the surgical ward. She complained of abdominal pains, particularly dorsally, which she had had for 10 days. Gallstones were suspected. Ultrasonography, plain abdominal X-ray and intravenous angiography confirmed this diagnosis. The results of a bile duct radiomanometry were normal. Histological analysis of the gallbladder wall showed a thin wall consistent with a chronic gallstone. Bile was cultured on blood agar, both aerobically and anaerobically, and on chocolate agar and under a CO2-enriched atmosphere. One strain of Streptococcus sanguis and one strain of Haemophilus parainfluenzae biotype II were isolated. Surgical therapy and a high single-dose of amoxicillin (2 g) and clavulanic acid (200 rag) led to a favourable outcome.
membrane proteins by Haemophilusparainfluenzae appears to be more closely related to that of the enteric bacteria than to that of Haemophilus influenzae (9). These two observations are not consistent with the postulate that all Haemophilus species found in the gastro-intestinal tract originate in the oropharynx and/or saliva (7). Rather, they suggest that some Haemophilus parainfluenzae strains belong to the intestinal flora. Using enzyme electrophoretic analysis and D N A - D N A hybridization, we recently described a genospecies of Haemophilus which possesses specific tropisms for a particular ecological niche: the genital flora (10). Such genetic characterization of Haemophilus parainfluenzae strains isolated from various origins will be necessary to determine if some clone families are adapted to the intestinal environment.
Hepatobiliary tract infections caused by Haemophilus parainfluenzae, as well as those caused by Haemophilus infiuenzae, have rarely been described. To date, only eight cases have been reported: two liver abscesses due to Haemophilus parainfluenzae and three liver abscesses and three biliary tract infections due to Haemophilus influenzae (1, 3-5).
The suggestion that the source of Haemophilus parainfluenzae strains causing hepatobiliary tract
This is the first reported case of biliary infection due to Haemophilus parainfluenzae. The low incidence of HaemophUus species in hepatobiliary infections could be explained by the fact that many Haemophilus infections may go unrecognized because of inadequate laboratory techniques. Thorough screening of hepatobiliary samples should include plating on chocolate agar incubated under 8-10 % CO2. Usually, Haemophilus inflUenzae and Haemophilus parainfluenzae pathogenicity are considered to be similar when liver abscesses or hepatobiliary tract infections are reported. However, because of the ecological and structural differences between the two species, the pathogenesis of Haemophilus parainfluenzae and Haemophilus influenzae hepatobiliary tract infections probably differs. The ecological difference is supported by the distribution of Haemophilus species isolated from faecal specimens. Haemophilus parainfluenzae is present in over 20 % of faecal samples analysed (6), whereas Haemophilus influenzae is rarely isolated from stools (7, 8). The structural difference concerns the protein composition of the outer membrane. Analysis of the outer membrane proteins of various Haemophilus species has revealed that the expression of iron-repressible outer
infections was the intestinal flora, from where the bacteria ascended, is supported by the fact that, in the three cases reported, blood cultures from the infected patients showed no concomittant bacteriemia.
B. Cattier 1. J. Caillon 2 R. Quentin 1 1 D6partement de Microbiologie M6dicale et Mol,6culaire, Unit6 de Bact6riologie, Centre Hospitalier R6gional Universitaire Bretonneau, 37044 Tours Cedex, France. 2 Laboratoire de Bact6riologie B, Centre Hospitalier R6gional Universitaire La~nnec, BP 1005, 44035 Nantes Cedex 01, France.
References 1. Black CT, Kupferschmid JP, West KW, Grosfeld J J: Haemophilus parah~fluenzae infections in children, with the report of a unique case. Reviews of Infectious Diseases 1988, 10: 342-346. 2. Quentin R, Musser JM, Mellouet M, Sizaret P, Selander RK, Goudeau A: Typing of urogenital, maternal, and neonatal isolates of Haemophilus h~fluenzae and Haemophilus parainfluenzae in correlation with clinical source of isolation and evidence for a genital specificity of H. influenzae biotype IV. Journal of Clinical Microbiology 1989, 27: 2286-2294. 3. Chaltopadhyay B, Silverstone PH, Winwood RS: Liver abscess caused by Haemophilus parah~fluenzae. Postgraduate Medical Journal 1983, 59: 788-789.
V.ol. 11, 1992
4. Canton R, Leon A, de la Fuente S, Carda P, Morales .V, Baquero F, Messeguer MA: Beta-lactamase producing Haemophilus influenzae as causative agent of a
liver abscess. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 748-749. 5. Ferran M, Buti M, Gonzalez A, Boqu~ R, Esteban R, Guardia J: Pyogenicliver abscess by Haemophilus influenzae complicatinghydatid cysts. Infection 1986, 14: 197. 6. KUian M: Haemophilus. In: Lennette EH, Balows A, Hausler WJ, Shadomy HJ red): Manual of clinical microbiology. American Society for Microbiology. Washington, DC, 1985, p. 387-393. 7. M~graud F, B~b~ar C, Dabernat H, Deimas C: Haemophilus species in the human gastrointestinal tract. European Journal of Clinical Microbiologyand Infectious Diseases 1988, 7: 437-438. 8. Palmer GG: Haemophili in feces. Journal of Medical Microbiology 1981; 14: 147-150. 9. Morton D, WilliamsP: Characterizationof the outermembrane proteinsof Haemophilus parainfluenzae expressed under iron-sufficientand iron-restricted conditions. Journal of General Microbiology 1989, 135: 445--451. 10. Quentin R, Goudeau A, Wallace JR, Smith AL, Selander RK, Musser JM: Urogenital, maternal and neonatal isolates of Haemophilus influenzae: identification of unusually virulent serologically nontypable clone familiesand evidence for a new Haemophihts species. Journal of General Microbiology1990, 136: 1203-1209.
Serratiafonticola as an I n f e c t i o u s A g e n t A few weeks after Bollet et al. (1) had reported the first documented human infection due to Serratia fonticola, our laboratory was confronted With the isolation and identification of the very Same bacterium from pus. The organism was responsible for a severe infection of the right hand of a 39-year-old female patient. She had suffered an open fracture of the hand in a car accident. The WOund was subsequently debrided and treated locally with gentamicin. The entire lesion healed within a few days. Apart from a few colonies of Bacillus cereus, the primary plates were predominantly covered with Smooth colonies of Serratia fonticola. In the enrichment broth, Serratia fonticola again represented the major organism, in addition to some Colonies of Bacillus cereus and Staphylococcus aureus. In contrast to the bacterium isolated by Bollet et al., our strain developed a strong potatolike odor, a feature typical of some Serratia and Cedecea strains (2). In addition, it showed a
199
cocarde phenomenon which had been observed previously in Serratia marcescens and which is known to be induced by the cationic detergentlike activity of colistin (3). Our isolate showed excellent identification as
Serratiafonticota (97.7 % and 99.9 %) by the API 20E and API 50 CH systems (API System S.A., France), respectively. Except for positive reactions for both sucrose and cellobiose, our strain exhibited the same biochemical reactions as the organism described by Bollet et al. Additional biochemical tests provided by the API 50 CH system revealed that our strain was, furthermore, positive for fermentations of glycerol, ribose, Dxylose, galactose, D-fructose, D-mannose, dulcitol, inositol, cx-methyl-D-glucoside, N-acetylglucosamine, trehalose, D-raffinose, [3-gentiobiose, D-tagatose, D-arabitol, L-arabitol, gluconate, 2-keto-gluconate, 5-keto-gluconate and maltose. Negative reactions were observed for D-arabinose, L-xylose, l~-methyl-xyloside, Lsorbose, c~-ethyl-D-mannoside, amygdalin, inulin, melezitose, starch, glycogen, xylitol, Dturanose, D-lyxose, D-fucose and L-fucose. Compared with type strain ATCC 29844 (1), our isolate differed only in the utilization of cellobiose. It appears, furthermore, to be biochemically very similar to the strains described by Gavini et al. (4), Farmer et ai. (5) and MUller et al. (6). Most of these strains have been found either in water or bird feces, although a few were isolated from wounds (5) without their possible role as potential clinical pathogens recognized at that time. Antibiotic susceptibility of our strain was determined by the agar diffusion disk method according to the standard procedure of the National Committee for Clinical Laboratory Standards (7) using cation-supplemented Mueller-Hinton medium. The isolate was found to be susceptible to ciprofloxacin, cefoxitin, ceftazidime, ceftriaxone, gentamicin, netilmicin, tobramycin, piperaciIlin, imipenem and sulfamethoxazole-trimethoprim, but resistant to ampicillin, amoxicillin/clavulanic acid, cephalothin and cefamandole.
G.E. Pfyffer
Institute of Medical Microbiology, University of Ztirich, Gloriastrasse 32, 8028 Ztirich,Switzerland.
