Letters
to the Editor
317
instrument repair. It can be argued that this cost is more than balanced by the cost of nursing time spent on chemical disinfection, the cost of claims following glutaraldehyde itself and the cost of industrial glutaraldehyde hypersensitivity reactions in staff. The strongest counter argument, however, is that glutaraldehyde disinfection is ‘common practice’ and that disasters have not yet occurred. I can find no evidence to the contrary and wonder whether readers are facing similar problems, or have any comments.
Malila
Noone
North
Tees General Hospital, Cleveland TS19 8PE
Sir,
Penicillin-resistant
Streptococcus
pneumoniae
Penicillin has been widely used for many years in the treatment of infections due to Streptococcuspneumoniae. Although most isolates remain susceptible, pneumococci of many different serotypes have been associated with penicillin- and multiple antibiotic-resistance. The first isolation of penicillin-resistant pneumococci was from Australia in 1967.’ Over the next decade similar strains became widespread in New Guinea. During 1977 and 1979 multiple antibiotic resistance [including penicillin minimum inhibitory concentration (MIC) up to 4 mg ll’] was described in a nosocomial outbreak in South Africa and clinical isolates resistant to 2 mg 1-l of penicillin were reported from Durban, South Africa, Minneapolis, Minnesota, USA and from London, England.” Subsequently, studies of the prevalence of penicillin-resistant pneumococci have been carried out in many parts of the world. The prevalence in Spain is amongst the highest reported. From a figure of 6.3% resistant strains in 1979 the proportion has risen annually to 37.8% in 1988.” Since then an increasing number of multiply-resistant pneumococci are being referred to the Streptococcus Reference Unit, CPHL, London. During 1985 and 1986 there were 15 such isolates from patients in England and one from Scotland (CDR Weekly Edition 86/07). However, we know of no reports of such resistant strains in the North West Region. Previously, pneumococci isolated in our hospital were believed to be uniformly and highly susceptible to penicillin. Since January 1990, there have been four strains of penicillin-resistant pneumococci isolated, one of which was subsequently lost during sub-culture and another was found to be a multiply-resistant pneumococcus. Antibiotic susceptibility was initially assessedby Stokes disc diffusion method. The MICs were performed by the
* Strain
(89)*
JH
(c6;
gi)
:97
Patient (wars)
lost in subculture.
Chest infection
Pneumonia
Pneumonia and septicaemia Pneumonia
Clinical diagnosis
I.
Sensitivity
ND,
Not
+, Culture
+
9
done.
+
positive;
negative.
+
-
- , culture
-
-
-
Oropharynx
-
+
+
+
Blood culture
of isolate
Sputum
Source
of pneumococci to antimicrobial
6
9
9
Pneumococcal serotype
Table
2
2
1
2
Penicillin
Minimum
ND
64
0.06
0.06
Erythromycin
inhibitory
agents using agar dilution
ND
32
0.25
0.25
Chloramphenicol
concentration
technique 1-l)
ND
16
8
8
Tetracycline
(mg
E F 8
B
9 i;
ff ::
Letters
to the
Editor
319
standard agar dilution techniques using chocolate agar plates. Inocula were standardized to 10’ cfu ml-’ using the method of Miles & Misra. The plates were examined after an overnight incubation at 37°C in air + 5% CO,. All the strains were sent to Colindale CPHL in London for serotyping. The findings are shown in Table I. Nose and throat swabs from 150 ward contacts (patients, doctors, nurses, cleaning staff) were taken and also screened for penicillin-resistant pneumococci. We detected no carriers. This report highlights the fact that penicillin-resistant pneumococci will probably become more common in the near future. Regional resistance rates may be higher or lower than the national figures. Hence all laboratories should be encouraged to record sensitivity to several antibiotics for use in their own areas so as to enable them to advise clinicians on appropriate antibiotics to use in empirical treatment of infection. If drug-resistant pneumococci become widespread the treatment of pneumococcal infection will need re-evaluation. Curiously there was no evidence of patient-to-patient transmission. J. Myint H. Panigrahi
North
Department Manchester
of Microbiology, General Hospital, Delaunays Road, Crumpsall, Manchester M8 6RB
References 1. Hansman D, Bullin MM. A resistant pneumococcus. Lancet 1967; 2: 264-265. 2. Jacobs MR, Koornhof HJ, Robins-Browne RM et al. Emergence of multiply resistance pneumococci. N Engl J Med 1978; 299: 735-740. 3. Casal J, Fen011 A, Vicioso MD, Munoz R. Increase in resistance to penicillin in pneumococci in Spain. Lancet 1989; 1: 735.
Sir, Ciprofloxacin-resistant Staphylococcus
methicillin-sensitive aureus
We read with interest the recent report in theJournal of Hospital Infection by Dyas & Seymour-Shove (16: 175-177) of an outbreak of ciprofloxacinresistant methicillin-sensitive Staphylococcus aweus on a geriatric ward. While we agree with their recommendation for routine monitoring of ciprofloxacin sensitivity in S. aureus, our own experience does not support their assertion that the role of ciprofloxacin in the treatment of staphylococcal infection would seem to be curtailed.
to the Editor
317
instrument repair. It can be argued that this cost is more than balanced by the cost of nursing time spent on chemical disinfection, the cost of claims following glutaraldehyde itself and the cost of industrial glutaraldehyde hypersensitivity reactions in staff. The strongest counter argument, however, is that glutaraldehyde disinfection is ‘common practice’ and that disasters have not yet occurred. I can find no evidence to the contrary and wonder whether readers are facing similar problems, or have any comments.
Malila
Noone
North
Tees General Hospital, Cleveland TS19 8PE
Sir,
Penicillin-resistant
Streptococcus
pneumoniae
Penicillin has been widely used for many years in the treatment of infections due to Streptococcuspneumoniae. Although most isolates remain susceptible, pneumococci of many different serotypes have been associated with penicillin- and multiple antibiotic-resistance. The first isolation of penicillin-resistant pneumococci was from Australia in 1967.’ Over the next decade similar strains became widespread in New Guinea. During 1977 and 1979 multiple antibiotic resistance [including penicillin minimum inhibitory concentration (MIC) up to 4 mg ll’] was described in a nosocomial outbreak in South Africa and clinical isolates resistant to 2 mg 1-l of penicillin were reported from Durban, South Africa, Minneapolis, Minnesota, USA and from London, England.” Subsequently, studies of the prevalence of penicillin-resistant pneumococci have been carried out in many parts of the world. The prevalence in Spain is amongst the highest reported. From a figure of 6.3% resistant strains in 1979 the proportion has risen annually to 37.8% in 1988.” Since then an increasing number of multiply-resistant pneumococci are being referred to the Streptococcus Reference Unit, CPHL, London. During 1985 and 1986 there were 15 such isolates from patients in England and one from Scotland (CDR Weekly Edition 86/07). However, we know of no reports of such resistant strains in the North West Region. Previously, pneumococci isolated in our hospital were believed to be uniformly and highly susceptible to penicillin. Since January 1990, there have been four strains of penicillin-resistant pneumococci isolated, one of which was subsequently lost during sub-culture and another was found to be a multiply-resistant pneumococcus. Antibiotic susceptibility was initially assessedby Stokes disc diffusion method. The MICs were performed by the
* Strain
(89)*
JH
(c6;
gi)
:97
Patient (wars)
lost in subculture.
Chest infection
Pneumonia
Pneumonia and septicaemia Pneumonia
Clinical diagnosis
I.
Sensitivity
ND,
Not
+, Culture
+
9
done.
+
positive;
negative.
+
-
- , culture
-
-
-
Oropharynx
-
+
+
+
Blood culture
of isolate
Sputum
Source
of pneumococci to antimicrobial
6
9
9
Pneumococcal serotype
Table
2
2
1
2
Penicillin
Minimum
ND
64
0.06
0.06
Erythromycin
inhibitory
agents using agar dilution
ND
32
0.25
0.25
Chloramphenicol
concentration
technique 1-l)
ND
16
8
8
Tetracycline
(mg
E F 8
B
9 i;
ff ::
Letters
to the
Editor
319
standard agar dilution techniques using chocolate agar plates. Inocula were standardized to 10’ cfu ml-’ using the method of Miles & Misra. The plates were examined after an overnight incubation at 37°C in air + 5% CO,. All the strains were sent to Colindale CPHL in London for serotyping. The findings are shown in Table I. Nose and throat swabs from 150 ward contacts (patients, doctors, nurses, cleaning staff) were taken and also screened for penicillin-resistant pneumococci. We detected no carriers. This report highlights the fact that penicillin-resistant pneumococci will probably become more common in the near future. Regional resistance rates may be higher or lower than the national figures. Hence all laboratories should be encouraged to record sensitivity to several antibiotics for use in their own areas so as to enable them to advise clinicians on appropriate antibiotics to use in empirical treatment of infection. If drug-resistant pneumococci become widespread the treatment of pneumococcal infection will need re-evaluation. Curiously there was no evidence of patient-to-patient transmission. J. Myint H. Panigrahi
North
Department Manchester
of Microbiology, General Hospital, Delaunays Road, Crumpsall, Manchester M8 6RB
References 1. Hansman D, Bullin MM. A resistant pneumococcus. Lancet 1967; 2: 264-265. 2. Jacobs MR, Koornhof HJ, Robins-Browne RM et al. Emergence of multiply resistance pneumococci. N Engl J Med 1978; 299: 735-740. 3. Casal J, Fen011 A, Vicioso MD, Munoz R. Increase in resistance to penicillin in pneumococci in Spain. Lancet 1989; 1: 735.
Sir, Ciprofloxacin-resistant Staphylococcus
methicillin-sensitive aureus
We read with interest the recent report in theJournal of Hospital Infection by Dyas & Seymour-Shove (16: 175-177) of an outbreak of ciprofloxacinresistant methicillin-sensitive Staphylococcus aweus on a geriatric ward. While we agree with their recommendation for routine monitoring of ciprofloxacin sensitivity in S. aureus, our own experience does not support their assertion that the role of ciprofloxacin in the treatment of staphylococcal infection would seem to be curtailed.
