Laboratory diagnosis of infective endocarditis

The diagnosis of infective endocarditis is based on positive blood cultures. Modern microbiological techniques can isolate the aetiological agent in 90-95% of cases. The rapidity of detection has been improved by inoculation of 10 ml of blood, adequate dilution and media and systematic subcultures. Lysis-centrifugation has yreatly improved the detection of fungi in bloo

In-vitro activity of newer quinolones against aerobic bacteria

Nalidixic and five newer 4-quinolones, ciprofloxacin, enoxacin, norfloxacin, ofloxacin and pefloxacin were tested against 576 recent clinical aerobic bacterial isolates. The 4-quinolones were regularly active (MIC90 < 4 mg/1) against the following bacteria: Staphylococcus aureus, S. epidermidis, S. saprophyticus, different Enterobacteriaceae, Haemophilus influenzae, Campylobacter jejuni, Pseudomonas aeruginosa, Agrobacter spp., Aeromonas spp., Plesiomonas spp., Neisseria meningitidis. Other bacteria were usually intermediately susceptible or resistant: different streptococci, Listeria monocytogenes, Nocardia asteroides, P. maltophilia, Achromobacter xylosoxydans and Alcaligenes denitrificans. Ciprofloxacin was the most potent compound, followed by ofloxacin and pefloxacin, norfloxacin and enoxacin being less active. All the 4-quinolones were much more active than nalidixic acid. The MBC/MIC ratios of the 4-quinolones were between 1 and 2 with a majority of strains, and between 2 and 3 with Streptococcus agalactiae, Str. faecalis and L. monocytogenes. A two- to eight-fold increase of MIC was observed by increasing the inoculum 10,000-fold with most of the strains tested. Susceptible bacterial population of Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens and P. aeruginosa contained more clones resistant to nalidixic acid (104 to 108 at four times the MIC) than to 4-quinolones (105 to 109 at four times the MIC). Supplementing the media with MgSO4 produced smaller inhibition zone diameters with a disc diffusion method than those obtained with non-supplemented agar, with all quinolone or strains. Less regular effect, or no effect was obtained after supplementation with ZnSO4 or Ca(NO3)

Emergence of resistance after therapy with antibiotics used alone or combined in a marine model

A murine model of peritonitis allowing detection and quantification of in-vivo acquired resistance during short term therapy has been used in order to evaluate the capacity of antimicrobial combinations to limit emergence of resistance, as compared to individual components of the regimens. Mice were challenged intraperitoneally with 108 cfu of bacteria. Two hours later, a single antibiotic dose was injected subcutaneously: amikacin (15 mg/kg), ceftriaxone (50 mg/kg), pefloxacin (25 mg/kg), amikacin + ceftriaxone, amikacin + pefloxacin or ceftriaxone + pefloxacin. Escherichia coli and Staphylococcus aureus never became resistant. Single drug therapy yielded resistant mutants in Enterobacter cloacae, Serratia marcescens, Klebsiella pneumoniae and Pseudomonas aeruginosa as follows: 74% of ceftriaxone-treated animals, 57% of pefloxacin treated animals and 27% of amikacin treated animals. All the tested combinations reduced the frequency of in-vivo acquired resistance produced by single drugs, and no combination selected resistance when the separate agents of the combination did not. Combining antimicrobial agents limits the risk of emergence of resistance during antibiotic therap

Comparative in-vitro activity of new quinolones against clinical isolates and resistant mutants

The in-vitro activity of five new fluoroquinolones, WIN 57273, sparfloxacin, flerox-acin, temafloxacin and tiprofloxacin was determined against 543 recent clinical isolates and eight quinolone resistant strains derived by mutation and their five parent strains. WIN 57273 was the most active compound against Gram-positive bacteria, sparfloxacin had a broad spectrum which was similar to that of cipro-floxacin. Ciprofloxacin showed the greatest activity against Gram-negative bacteria. Temafloxacin showing some activity against Gram-positive organisms and Acinetobacter spp. Fleroxacin was the least active compound studied. Compared to wild type parent strains, the mutated strains produced the following results. In Enterobacter cloacae OmpF deficiency increased the MICs of all quinolones by 8-32-fold. In Pseudomonas aeruginosa OmpF deficiency had a limited effect, Omp D2 deficiency combined with an increased lipopolysaccharide content produced greater resistance, i.e. 4-16-fold; mutations in gyrase were associated with variously increased MICs, depending on the strain and compound teste

A Novel Approach to Combining Client-Dependent and Confidence Information in Multimodal Biometric

The issues of fusion with client-dependent and confidence information have been well studied separately in biometric authentication. In this study, we propose to take advantage of both sources of information in a discriminative framework. Initially, each source of information is processed on a per expert basis (plus on a per client basis for the first information and on a per example basis for the second information). Then, both sources of information are combined using a second-level classifier, across different experts. Although the formulation of such two-step solution is not new, the novelty lies in the way the sources of prior knowledge are incorporated prior to fusion using the second-level classifier. Because these two sources of information are of very different nature, one often needs to devise special algorithms to combine both information sources. Our framework that we call ``Prior Knowledge Incorporation'' has the advantage of using the standard machine learning algorithms. Based on $10 \times 32=320$ intramodal and multimodal fusion experiments carried out on the publicly available XM2VTS score-level fusion benchmark database, it is found that the generalisation performance of combining both information sources improves over using either or none of them, thus achieving a new state-of-the-art performance on this database