Prospective cohort study. To determine incidence of contracture and develop prediction models to identify patients susceptible to contracture after spinal cord injury. Two Sydney spinal cord injury units. A total of 92 consecutive patients with acute spinal cord injury were assessed within 35 days of injury and 1 year later. Incidence of contracture at 1 year was measured in all major appendicular joints by categorizing range of motion on a 4-point scale (0—no contracture to 3—severe contracture), and in the wrist, elbow, hip and ankle by measuring range of motion at standardized torque. Multivariate models were developed to predict contracture at 1 year using age, neurological status, spasticity, pain and limb fracture recorded at the time of injury. At 1 year, 66% of participants developed at least one contracture (defined as ⩾1 point deterioration on the 4-point scale). Incidence of contracture at each joint was: shoulder 43%, elbow and forearm 33%, wrist and hand 41%, hip 32%, knee 11% and ankle 40%. Incidence of contracture determined by standardized torque measures of range (defined as loss of ⩾10 degrees) was: elbow 27%, wrist 26%, hip 23% and ankle 25%. Prediction models were statistically significant but lacked sufficient predictive accuracy to be clinically useful (R2⩽31%). The incidence of contracture in major joints 1 year after spinal cord injury ranges from 11–43%. The ankle, wrist and shoulder are most commonly affected. It is difficult to accurately predict those susceptible to contracture soon after injury.

Objectives: To study the antimicrobial susceptibility and molecular epidemiology of Salmonella enterica isolates from 2005 to 2010 in Hong Kong.Methods: S. enterica isolates from 2005 to 2010 in one of the hospital clusters were serotyped and studied their antimicrobial susceptibility by determining the minimal inhibitory concentration of 17 antimicrobial agents and their relatedness by pulsed-field gel electrophoresis (PFGE).Results: A total of 60 S. enterica serovars were identified among the 963 strains of Salmonella from 2005 to 2010. Enteritidis (47.3%) and Typhimurium (17.2%) were the two most common serovars. Ciprofloxacin non-susceptibility increased significantly from 39.3% in 2005 to 63% in 2010 (p < 0.05) and the percentage of multidrug resistant strains increased from 17.8% in 2005 to 36.2% in 2010 (p < 0.05). However, resistance to the third generation cephalosporins (1.4%) remained low. More strains of S. Typhimurium than other Salmonella serovars were resistant to the antimicrobial agents tested than S. Enteritidis. PFGE analysis showed there were predominant clones of S. Enteritidis, S. Typhimurium and S. Stanley circulating in the community, and two outbreaks caused by S. Enteritidis and S. Virchow during the study period.Conclusions: The study showed both a worrying percentage of Salmonella strains resistant to quinolone and of multidrug resistant strains. PFGE identified two outbreaks in the study period. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Of the 834 Salmonella spp. isolates collected from 2002 to 2004 in the New Territories East Cluster hospitals in Hong Kong, 21% were resistant to 3-14 antibiotics and 30% were resistant to nalidixic acid with reduced susceptibility to ciprofloxacin. A class 1 integron was present in 105 (13%) isolates, of which more than 50% were Salmonella Typhimurium. Class 2 or 3 integrons were not detected in any of the isolates. DNA sequencing showed that there were 16 different integrons, of which the most common, detected in 40% of isolates, was dfrA12-orfF-aadA2. Almost half of the isolates had lost the qacEdelta1-sulI 3' conserved segment (3'CS). Four isolates had an orf513 gene downstream of the 3'CS. There was probably one predominant clone among each heterogeneous population of integron-harboring S. Typhimurium, S. Virchow, and S. Derby isolates in our community. This is the first thorough study of the prevalence and characteristics of integrons in Salmonella isolates in Hong Kong and the first to report a class 1 integron in S. Birkenhead, S. Landwasser, S. Litchfield, and S. Reading.

1. PCR and RT-PCR methods for 5-hour and 3-hour detection, respectively, of salmonellae and Vibrio cholerae in stool, food and environmental water samples have been developed. 2. Such methods can be used in routine laboratories for rapid detection of salmonellae and V cholerae and are essential for infection control purposes.

of a fluoroquinolone. 4,5 The MICs of the six fluoroquinolones for the strains tested (shown to be clonally unrelated by PFGE) are shown in Table 1. All were highly susceptible to the six fluoroquinolones tested with MICs as much as 64-fold lower than the susceptible breakpoints recommended by the CLSI 6 or the BSAC. 4 However, when the strains were subcultured in the presence of a fluoroquinolone, resistant strains developed at 1·–32· MIC at a frequency ranging from10 –11 to10 –6 .Gemifloxacincouldselectresistantstrainsatthe highest frequencies (10 –10 –1 0 –6 ), indicating that both Salmonella

Two Salmonella enterica serovar Typhimurium isolates and one S. enterica serovar Enteritidis isolate that were resistant to 4 microg cefotaxime ml-1 and produced CTX-M-type extended-spectrum beta-lactamases (ESBLs) were characterized from patients in Hong Kong during 2003-2004. The S. Typhimurium strain isolated in 2003 produced a CTX-M-9 ESBL and harboured a blaCTX-M-9 gene that was associated with a class I integron-containing gene cassette and orf513 similar to those of In60. The second S. Typhimurium strain and the S. Enteritidis strain, both isolated in 2004, produced CTX-M-14; the former also produced TEM-1. The blaCTX-M-14 gene in these two isolates was associated with the insertion sequence ISEcp1. The CTX-M genes were present on a transferable plasmid of 62, 70 or 92 kb. PFGE of XbaI-restricted total DNA from the two S. Typhimurium isolates indicated that they were not clonally related. These three isolates were also resistant to one of the other non-beta-lactam antimicrobial agents tested. This is the first report of a CTX-M-9 ESBL in Salmonella in Hong Kong and the presence of blaCTX-M-9 and blaCTX-M-14 in S. Typhimurium.

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This study was initiated throughout Hong Kong, to reveal the characteristics of community-acquired infections. All specimens collected by general practitioners from infected patients were followed prospectively, and those that were culture-positive were analysed. Four thousand seven hundred and forty-one specimens were collected from 3977 patients by 89 doctors from July 2000 to October 2001. The most common specimens were throat swabs (33%), urine (26%) and sputa (16%). The average culture-positive rate was 28%. The most common organisms were Escherichia coli (18%), beta-haemolytic streptococci (15%) and Staphylococcus aureus (12%). Fluoroquinolone resistance was relatively high (up to 35%) in organisms commonly causing urinary tract infection (E. coli, Proteus and Morganella). Although none of the pneumococci was resistant to penicillin 1 mg/L, the proportion with intermediate resistance (0.1-1 mg/L) was alarming (81%). There were three strains of methicillin-resistant S. aureus. A decrease in ampicillin resistance but a high prevalence of macrolide resistance were noted in Haemophilus influenzae. All Neisseria gonorrhoeae isolates were resistant to penicillin, up to 79% to the fluoroquinolones, 15% to spectinomycin, but all were susceptible to ceftriaxone. Respiratory pathogens (Streptococcus pneumoniae, beta-haemolytic streptococci and H. influenzae) were relatively susceptible to the newer fluoroquinolones (0-2%, 0.5-6% and 2% resistant, respectively) or third-generation cephalosporins (0-2% resistant). The distribution of organisms and their antibiotic resistance varied over time. Thus frequent surveillance is needed to provide information on the drugs of choice for different infections.

ABSTRACT A total of 88 salmonella isolates (72 clinical isolates for which the ciprofloxacin MIC was >0.06 μg/ml, 15 isolates for which the ciprofloxacin MIC was ≤0.06 μg/ml, and Salmonella enterica serotype Typhimurium ATCC 13311) were studied for the presence of genetic alterations in four quinolone resistance genes, gyrA , gyrB , parC , and parE , by multiplex PCR amplimer conformation analysis. The genetic alterations were confirmed by direct nucleotide sequencing. A considerable number of strains had a mutation in parC , the first to be reported in salmonellae. Seven of the isolates sensitive to 0.06 μg of ciprofloxacin per ml had a novel mutation at codon 57 of parC (Tyr57→Ser) which was also found in 29 isolates for which ciprofloxacin MICs were >0.06 μg/ml. Thirty-two isolates had a single gyrA mutation (Ser83→Phe, Ser83→Tyr, Asp87→Asn, Asp87→Tyr, or Asp87→Gly), 34 had both a gyrA mutation and a parC mutation (29 isolates with a parC mutation of Tyr57→Ser and 5 isolates with a parC mutation of Ser80→Arg). Six isolates which were isolated recently (from 1998 to 2001) were resistant to 4 μg of ciprofloxacin per ml. Two of these isolates had double gyrA mutations (Ser83→Phe and Asp87→Asn) and a parC mutation (Ser80→Arg) (MICs, 8 to 32 μg/ml), and four of these isolates had double gyrA mutations (Ser83→Phe and Asp87→Gly), one parC mutation (Ser80→Arg), and one parE mutation (Ser458→Pro) (MICs, 16 to 64 μg/ml). All six of these isolates and those with a Ser80→Arg parC mutation were S. enterica serotype Typhimurium. One S. enterica serotype Typhi isolate harbored a single gyrA mutation (Ser83→Phe), and an S. enterica serotype Paratyphi A isolate harbored a gyrA mutation (Ser83→Tyr) and a parC mutation (Tyr57→Ser); both of these isolates had decreased susceptibilities to the fluoroquinolones. The MICs of ciprofloxacin, levofloxacin, and sparfloxacin were in general the lowest of those of the six fluoroquinolones tested. Isolates with a single gyrA mutation were less resistant to fluoroquinolones than those with an additional parC mutation (Tyr57→Ser or Ser80→Arg), while those with double gyrA mutations were more resistant.

Objectives: To study the distribution of hospital isolates of enterococci from urines, bile, blood and body fluids and to evaluate different methods for the identification of enterococci.Methods: Enterococci isolated from urine, bile, blood and body fluids collected during 1997 and 1998 were identified by polymerase chain reaction (PCR), API 20 Strep and conventional biochemical tests.Results: A total of 498 non-duplicate enterococci were studied: 398 and 43 isolates from urine and bile, respectively, 49 from blood, two from cerebrospinal fluid and six from body fluids. Both API 20 Strep and PCR gave the same identification results for 240 Enterococcus faecalis isolates, 45 E.faecium isolates and one isolate each of E. gallinarum and E. Casseliflavus. These isolates were re-defined by conventional biochemical tests. PCR could correctly identify 303 (98%) isolates while API 20 Strep could only correctly identify 287 (93%) isolates (99% of E.faecalis and 57-87% of the other Enterococcus sp.). Thus, PCR was used in the identification of the remaining isolates and the identity of isolates other than E. faecalis was subsequently confirmed by biochemical tests.Conclusions: The majority of enterococci isolated was E.faecalis (81(%) while only 15%, were E.faecium and 4% the other enterococcal species. PCR could correctly identify E. faecalis while the identity of other enterococcal species had to be confirmed by biochemical tests. (C) 2002 The British Infection Society. Published by Elsevier Science Ltd. All rights reserved.

We investigated the antimicrobial susceptibilities and molecular epidemiology of 200 strains of Salmonella enterica serotype typhimurium isolated from 1989 to 1996 in Hong Kong. Only 22% of strains were susceptible to all 19 antibiotics tested but all were susceptible to second- and third-generation cephalosporins. Up to 9% of strains were resistant to 0.12 mg/l concentrations of ciprofloxacin or ofloxacin but none were resistant to 1 or 2 mg/l concentrations of these 2 drugs, respectively. The isolates were grouped into 15 types by ribotyping with restriction endonuclease EcoRI and into 53 types by pulsed-field gel electrophoresis of XbaI-restricted DNA fragments. When DNA fragments of the ribotypes and pulsotypes were pooled and analyzed 87 types resulted, 76 (87%) of which were of > 90% similarity and were grouped into 15 clusters. About 60% of the isolates belonged to 3 clusters, which probably represented 3 clones endemic in the community. The rest of the isolates were of a large variety of types or clusters. For epidemiological purposes analysis of pooled results from different molecular techniques would be more discriminative than results from individual techniques alone.

A total of 217 and 73 strains of Salmonella enterica serotype Typhi isolated from 1985 to 1997 in Hong Kong and in 2 months of 1989 and 1990 in Vietnam, respectively, were studied. These isolates were typed by plasmid profile analysis, plasmid fingerprinting, ribotyping with PstI, and total DNA fingerprinting with NarI. There appeared to be no major outbreak of typhoid fever in Hong Kong during the study period since there was considerable heterogeneity among the isolates. Isolates from Hong Kong were different from those from Vietnam. Thirty-seven percent of Vietnamese isolates belonged to two predominant clones, with the rest being heterogeneous in nature. Total DNA fingerprinting supplemented with ribotyping could be a reliable and rapid method for epidemiological typing of S. enterica serotype Typhi.

Seven beta-lactam antibiotics (cefepime, cefoperazone, ceftazidime, ceftriaxone, cefamandole, imipenem and meropenem) were tested for their potential to select resistance in standard and clinical strains of Enterobacter cloacae (n = 9). The strains were subcultured daily with the test antibiotics at doubling concentrations starting at 0.125 x MIC. Development of resistance throughout the passages was detected by a disc diffusion test. Ceftazidime, ceftriaxone and cefamandole selected resistance at a faster rate than cefoperazone, cefepime and meropenem. Imipenem did not select resistance in the nine strains tested and was the only antibiotic that eradicated all the strains during selection. The resistance patterns of strains selected by meropenem, cefepime and the other cephalosporins were markedly different, although cross-resistance to the early generation cephalosporins was common. The resistance phenotypes of most strains remained stable upon serial passages in antibiotic-free medium. The findings of this study highlight the importance of the choice of antibiotic for therapy not only on the basis of its antibacterial activity, but also on its potential to select resistance to itself and other antibiotics.

ABSTRACT The incidence of salmonellosis has been increasing in Hong Kong since 1989. The most common Salmonella enterica serotype isolated in 1994 was S. enteritidis . The antimicrobial susceptibilities and molecular epidemiology of 275 S. enteritidis strains isolated in this locality between 1986 and 1996 were studied. Over 99% of the isolates were susceptible to 17 of the 19 antimicrobial agents tested. One isolate harbored an autotransferring plasmid that confers resistance to tetracycline and trimethoprim-sulfamethoxazole. Another isolate harbored a mobilizable plasmid that confers resistance to ampicillin and cephalothin. This isolate was found to produce a β-lactamase with a pI of 5.2. A total of 264 isolates (96%) were found to harbor one to five plasmids, and the majority (254) harbored a 60-kb plasmid. Of these isolates, 94% contained identical 60-kb plasmids. Based on plasmid profiles, plasmid and chromosomal fingerprints, ribotypes, and randomly amplified polymorphic DNA (RAPD) patterns, 170 (62%) isolates were allocated to group 1b. About 90% of isolates had identical or similar DNA fingerprints, ribotypes, and RAPD patterns, suggesting that a predominant clone of S. enteritidis was circulating in Hong Kong during the period being studied.

Three hundred and thirty-three Shigella isolates obtained in 1986 to 1995 were tested for their susceptibilities to 19 antimicrobial agents. Nalidixic acid resistance had emerged in 59.6% of Shigella flexneri isolates during 1994 to 1995, with all tested resistant isolates having the mutation in gyrA encoding the Ser-83 alteration. Multiresistance (resistance to four or more agents) was more common in S. flexneri than in Shigella sonnei.

The susceptibility of 140 Acinetobacter spp. isolated from blood cultures of patients from the Prince of Wales Hospital, Hong Kong, from 1990 to 1994 to 23 antimicrobial agents was studied by an agar dilution method. Resistance to most of the beta-lactams, aminoglycosides and fluoroquinolones tested was high, being 11%-92%. Only amikacin, imipenem and meropenem were reliably active against this organism. Most of the isolates produced cephalosporinases with very high pIs while 33% produced beta-lactamases with pI ranges of 5.2-8.7.

Two hundred and two isolates of Acinetobacter anitratus from 126 patients in 36 wards belonging to 11 specialties of a university teaching hospital were compared by ribotyping and restriction enzyme digest analysis (REA) of total DNA. Forty-six groups were defined by both techniques and there was 96 center dot 5% agreement between the methods for the designation of isolates into groups. Only two groups were endemic and circulating in the whole hospital while others were less common. Burns and intensive therapy units had the highest number of isolates and these were mainly of the two endemic groups while renal dialysis and neonatal units had isolates belonging to the less common groups. Of the 32 patients with multiple isolates, 17 were infected or colonized at different sites by two and up to four groups of A. anitratus. Both ribotyping and REA of total DNA are discriminatory methods for typing A. anitratus, however, the latter is a simpler and more rapid method and it can be used in a routine clinical laboratory.

High rates of acinetobacter bacteremia were observed in a large teaching hospital in Hong Kong. A retrospective study of 94 acinetobacter bacteremic episodes in patients in 1993-94 revealed 70 episodes of significant bacteremia. 53% of the patients were over 60 years with a male to female ratio of 1.5:1. Cases were most rare during the fourth quarter. The intensive care unit was the commonest location of acquisition of bacteremia. Most infections were hospital acquired. Intravascular catheters, urinary catheters, antibiotic therapy and respiratory tract manipulations were common risk factors. Lower respiratory tract infections and catheter-related sepsis were predominant foci of bacteremia. One-third of the patients received appropriate antibiotics within 48 hours after bacteremia onset. Mortality attributable to acinetobacter infection was 27%. Prognosis of underlying diseases, location in intensive care unit, lower respiratory tract infection as foci of infection as well as diabetes mellitus were associated with mortality.