Diagn Microbiol Infect Dis, 1994 Apr, 18(4), 251 - 8 A comparison of serial plate agar dilution, Bauer-Kirby disk diffusion, and the Vitek AutoMicrobic system for the determination of susceptibilities of Klebsiella spp., Enterobacter spp., and Pseudomonas aeruginosa to ten antimicrobial agents; Fekete T et al.; The use of rapid, automated technologies for assessment of antimicrobial susceptibility and determination of minimum inhibitory concentrations has been evolving for over a decade . We compared the Vitek AutoMicrobic system and Bauer-Kirby disk diffusion with the National Committee for Clinical Laboratory Standards methods of serial plate agar dilution for qualitative and quantitative susceptibilities of 301 hospital isolates of Klebsiella spp., Enterobacter spp., and Pseudomonas aeruginosa . Antibiotics tested were aztreonam, cefoperazone, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, imipenem, piperacillin, ticarcillin-clavulanic acid, and tobramycin . Agar dilution and Bauer-Kirby results were more strongly correlated for all three genera than were the results for agar dilution and Vitek . If agar dilution is presumed to be the "gold standard," Bauer-Kirby disk diffusion had only half the number of false susceptibles as did the Vitek . Thus, the Vitek AutoMicrobic system seems to be somewhat less reliable for both qualitative and quantitative measurement of susceptibility and resistance than is Bauer-Kirby disk diffusion. J Chemother, 1994 Apr, 6 Suppl 2, 47 - 50 The choice of empirical antibiotic therapy for nosocomial pneumonia; Ramirez JA; Nosocomial pneumonia has the highest crude mortality rate of all hospital-acquired infections . The choice of empirical antibiotic therapy can be based on in vitro sensitivities of sputum bacterial isolates . Organisms recovered from purulent sputum of 500 intensive care unit (ICU) patients from five hospitals in Louisville, Kentucky, had antibiotic sensitivities measured by microbroth dilution . The most common isolates were Staphylococcus aureus (26.6%), Pseudomonas species (24.8%), Enterobacter species (11.8%), Escherichia coli (7.2%), Klebsiella species (7.0%), Streptococcus species (4.4%) and Serratia species (4.0%) . These organisms were tested for susceptibility to amikacin, ciprofloxacin, imipenem/cilastatin, ticarcillin/clavulanate, piperacillin, ceftriaxone and ceftazidime . The antibiotics effective against more than 80% of the seven most common isolates included amikacin (97%), imipenem (94%), ciprofloxacin (92%) and ticarcillin/clavulanate (84%) . These sensitivity patterns may serve as a guide to choosing empirical antibiotics for ICU-acquired pneumonia in Louisville . When the use of a beta-lactam antibiotic alone or in combination with an aminoglycoside is preferred, imipenem or ticarcillin-clavulanate may be considered the antibiotics of choice . Studies are in progress to delineate the clinical use of ciprofloxacin alone or in combination with beta-lactam antibiotics for treating nosocomial pneumonia. Proc Natl Acad Sci U S A, 1994 Mar 29, 91(7), 2420 - 7 Hospital-acquired infections: diseases with increasingly limited therapies; Swartz MN; About 5% of patients admitted to acute-care hospitals acquire nosocomial infections . A variety of factors contribute: increasing age of patients; availability, for treatment of formerly untreatable diseases, of extensive surgical and intensive medical therapies; and frequent use of antimicrobial drugs capable of selecting a resistant microbial flora . Nosocomial infections due to resistant organisms have been a problem ever since infections due to penicillinase-producing Staphylococcus aureus were noted within a few years of the introduction of penicillin . By the 1960s aerobic Gram-negative bacilli had assumed increasing importance as nosocomial pathogens, and many strains were resistant to available antimicrobials . During the 1980s the principal organisms causing nosocomial bloodstream infections were coagulase-negative staphylococci, aerobic Gram-negative bacilli, S . aureus, Candida spp., and Enterococcus spp . Coagulase-negative staphylococci and S . aureus are often methicillin-resistant, requiring parenteral use of vancomycin . Prevalence of vancomycin resistance among enterococcal isolates from patients in intensive care units has increased, likely due to increased use of this drug . Plasmid-mediated gentamicin resistance in up to 50% of enterococcal isolates, along with enhanced penicillin resistance in some strains, leaves few therapeutic options . The emergence of Enterobacteriaceae with chromosomal or plasmid-encoded extended spectrum beta-lactamases presents a world-wide problem of resistance to third generation cephalosporins . Control of these infections rests on (i) monitoring infections with such resistant organisms in an ongoing fashion, (ii) prompt institution of barrier precautions when infected or colonized patients are identified, and (iii) appropriate use of antimicrobials through implementation of antibiotic control programs. Presse Med, 1994 Mar 19, 23(11), 522, 527 - 31 {Resistance to antibiotics caused by decrease of the permeability in gram-negative bacteria}; Nguyen Van JC et al.; Due to their outer membrane, Gram negative bacteria are the only germs which can resist antibiotics by a mechanism of reduced permeability . This outer hydrophobic membrane allows hydrophilic molecules to pass only through its aqueous pores . The transmembrane pores have a trimere structure with a monomere component acting as an aqueous channel . Mean pore diameter is 1 to 1.2 nm . Changes in the absolute number of pores or in qualitative function reduce the diffusion of antibiotics entering the cell . This mechanism of reduced permeability can lead to cross resistance to several families of antibiotics . It is difficult to determine the clinical incidence since such resistances are not always detected . The species most often involved are enterobacteria including Klebsiella, Enterobacter, Serratia and Salmonella . For Pseudomonas aeruginosa, resistance to imipenem by reduced permeability results from a deficit in protein D2 and concerns 12 to 15% of the strains identified in French Hospitals . Reduced permeability is particularly effective when associated with another mechanism of resistance allowing the bacteria to express a higher level of resistance. Biochem Biophys Res Commun, 1994 Mar 15, 199(2), 767 - 71 Crystallization of monodisperse maltoporin from wild-type and mutant strains of various Enterobacteriaceae; Keller TA et al.; Maltoporin has been purified by affinity chromatography on starch gel columns . This single-step procedure affords the rapid purification of active protein from wild-type and mutants of E . coli, and from other Gram-negative bacteria . The monodisperse protein was crystallized under various conditions . Several preparations have yielded crystals amendable to X-ray analysis, notably a single cysteine substitution, S57C. Gene, 1994 Mar 11, 140(1), 109 - 13 Characterization of a Rickettsia rickettsii DNA fragment analogous to the fir A-ORF17-lpxA region of Escherichia coli; Shaw EI et al.; The firA and lpxA genes, as well as an ORF coding for a putative 16-kDa protein of unknown function, have been identified and characterized in the obligate intracellular bacterium . Rickettsia rickettsii . This is the first description of these genes, which code for enzymes involved in the biosynthesis of lipid A, in a species outside of the Enterobacteriaceae . The deduced amino acid (aa) sequences of FirA, ORF16 and LpxA of R . rickettsii, when compared to their Escherichia coli analogs, exhibited 35, 44 and 41% aa identity, respectively . In addition, the order of genes in R . rickettsii, firA-ORF16-lpxA, was identical to that found in E . coli; however, the spacing between the rickettsial genes was greater . Interestingly, the R . rickettsii FirA and LpxA deduced proteins retain an unusual hexapeptide repeat pattern found in E . coli and Salmonella typhimurium FirA/Ssc and E . coli LpxA, as well as other acyltransferases, providing additional support for the importance of this structure. Ann Gastroenterol Hepatol (Paris), 1994 Mar-Apr, 30(2), 60 - 3 {Vaccination against the enterobacteria responsible for enteric infections}; Sansonetti PJ; Development of vaccines against enterobacterial species responsible for enteric infections sounds like an unrealistic project . On the other hand, based on our growing understanding of the pathogenesis of infections caused by the major species (i.e . Salmonella typhi, Shigella flexneri and Shigella dysenteriae 1, Enterotoxigenic Escherichia coli) and on our better characterization of the immunological parameters of mucosal protection, it is likely that a limited number of vaccines controlling diseases such as typhoid fever, bacillary dysentery and cholera-like E . coli infections will become available . There are three major problems that still need to be solved: the variety of antigens and antigenic specificities, the nature of protective antigens and, provided that these prerequisites are fulfilled, the presentation of the vaccine and the immunization route . With the exception of typhoid fever, which has a systemic phase that probably makes immunization attempts by purified Vi antigen successful, experimental strategies rely very much on induction of a mucosal immunity . Either subunit vaccines, or genetically manipulated strains which attenuated virulence are currently considered. Antimicrob Agents Chemother, 1994 Mar, 38(3), 547 - 57 Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin . The Severe Pneumonia Study Group; Fink MP et al.; Intravenously administered ciprofloxacin was compared with imipenem for the treatment of severe pneumonia . In this prospective, randomized, double-blind, multicenter trial, which included an intent-to-treat analysis, a total of 405 patients with severe pneumonia were enrolled . The mean APACHE II score was 17.6, 79% of the patients required mechanical ventilation, and 78% had nosocomial pneumonia . A subgroup of 205 patients (98 ciprofloxacin-treated patients and 107 imipenem-treated patients) were evaluable for the major efficacy endpoints . Patients were randomized to receive intravenous treatment with either ciprofloxacin (400 mg every 8 h) or imipenem (1,000 mg every 8 h), and doses were adjusted for renal function . The primary and secondary efficacy endpoints were bacteriological and clinical responses at 3 to 7 days after completion of therapy . Ciprofloxacin-treated patients had a higher bacteriological eradication rate than did imipenem-treated patients (69 versus 59%; 95% confidence interval of -0.6%, 26.2%; P = 0.069) and also a significantly higher clinical response rate (69 versus 56%; 95% confidence interval of 3.5%, 28.5%; P = 0.021) . The greatest difference between ciprofloxacin and imipenem was in eradication of members of the family Enterobacteriaceae (93 versus 65%; P = 0.009) . Stepwise logistic regression analysis demonstrated the following factors to be associated with bacteriological eradication: absence of Pseudomonas aeruginosa (P < 0.01), higher weight (P < 0.01), a low APACHE II score (P = 0.03), and treatment with ciprofloxacin (P = 0.04) . When P . aeruginosa was recovered from initial respiratory tract cultures, failure to achieve bacteriological eradication and development of resistance during therapy were common in both treatment groups (67 and 33% for ciprofloxacin and 59 and 53% for imipenem, respectively) . Seizures were observed more frequently with imipenem than with ciprofloxacin (6 versus 1%; P = 0.028) . These results demonstrate that in patients with severe pneumonia, monotherapy with ciprofloxacin is at least equivalent to monotherapy with imipenem in terms of bacteriological eradication and clinical response . For both treatment groups, the presence of P . aeruginosa had a negative impact on treatment success . Seizures were more common with imipenem than with ciprofloxacin . Monotherapy for severe pneumonia is a safe and effective initial strategy but may need to be modified if P . aeruginosa is suspected or recovered from patients. Antimicrob Agents Chemother, 1994 Mar, 38(3), 422 - 7 Activity of Bay y3118 against quinolone-susceptible and -resistant gram-negative and gram-positive bacteria; Piddock LJ et al.; The activity of Bay y3118 against laboratory strains of bacteria, including those with mutations in gyrA, with decreased expression of outer membrane proteins, and/or that are multiply resistant, and 121 selected clinical isolates, including highly fluoroquinolone-resistant bacteria from Spain and Argentina, was determined . Bay y3118 was extremely active (MICs, < or = 1 microgram/ml) against all bacteria, including quinolone-resistant laboratory strains . However, Bay y3118 was less active against 46 of 121 quinolone-resistant clinical isolates, such that > or = 16 micrograms of Bay y3118 per ml was required to inhibit 3 isolates . The concentration of Bay y3118 required to inhibit DNA synthesis by 50% correlated well with the MIC . Bay y3118 had accumulation kinetics similar to those of previously studied fluoroquinolones, e.g., ciprofloxacin, and there was a 50% decrease in the steady-state concentration in those members of the family Enterobacteriaceae that lacked porin proteins . Magnesium chloride at 20 mM apparently abolished the accumulation of Bay y3118 into Escherichia coli and reduced the level of accumulation into other gram-negative bacteria and Staphylococcus aureus . Carbonyl cyanide m-chlorophenylhydrazone at 100 microM enhanced the accumulation of Bay y3118 into E . coli, but it had a minimal effect on accumulation into S . aureus. Antimicrob Agents Chemother, 1994 Mar, 38(3), 415 - 21 Cefepime compared with ceftazidime as initial therapy for serious bacterial infections and sepsis syndrome; Kieft H et al.; In an open randomized multicenter comparative study, we evaluated the safety and efficacy of cefepime (CP; 2.0 g given intravenously every 12 h) and ceftazidime (CZ; 2.0 g given intravenously every 8 h) as initial treatment for adult patients with suspected serious bacterial infections . A total of 133 patients entered the study, of whom 114 were evaluable for clinical and microbiological response assessment: 56 received CP and 58 received CZ . About 50% (30 who received CP and 25 who received CZ) fulfilled the criteria of the sepsis syndrome . The treatment groups were comparable with respect to sex distribution, mean age, underlying diseases, treatment duration, APACHE II score, and type of infection . The most commonly cultured microorganisms were members of the family Enterobacteriaceae, Streptococcus pneumoniae, and Staphylococcus aureus . The causative microorganisms were eradicated from 92% (37 of 40) of patients with a microbiologically documented infection who underwent treatment with CP; they were eradicated from 86% (42 to 49) of patients who received CZ . The responses of only clinically documented infections in the CP group were 90% (27 of 30 patients); in the CZ group they were 87% (26 of 30 patients) . When patients fulfilled the criteria of the sepsis syndrome (septic shock excluded), the causative microorganisms were eradicated from 89% (16 of 18) of CP-treated patients and 86% (12 of 14) of CZ-treated patients . None of these differences was statistically significant . Mortality was the same in both groups (four patients in each group) and was not attributable to the study medication . In conclusion, CP is at least as effective and as safe as CZ, as initial antimicrobial therapy for suspected serious bacterial infections in nonneutropenic patients with or without the sepsis syndrome . CP has the additional advantage in that it can be given twice daily, which may lead to a decrease in hospital costs. J Clin Microbiol, 1994 Mar, 32(3), 596 - 602 Arbitrarily primed PCR, ribotyping, and plasmid pattern analysis applied to investigation of a nosocomial outbreak due to Enterobacter cloacae in a neonatal intensive care unit; Grattard F et al.; In December 1992, Enterobacter cloacae was isolated from the oropharynx and respiratory tract of six ventilated neonates hospitalized in the intensive care unit (ICU) of our hospital . To establish the spread of the outbreak, 41 strains of E . cloacae were analyzed for genotypic markers by three methods: plasmid profile analysis, ribotyping with EcoRI or PvuII endonuclease, and arbitrarily primed (AP) PCR . The tested strains included 12 isolates from the 6 epidemic cases, 4 isolates from the respiratory tract of 4 children hospitalized in other wards during the same period, 13 isolates from 12 children hospitalized in pediatric units before or after the outbreak, and 12 epidemiologically unrelated isolates . Ribotyping and AP PCR demonstrated that each of the last 12 strains exhibited distinct genomic patterns, as did each of the strains isolated from neonates hospitalized before or after the epidemic peak . Conversely, two clones of strains were found among the isolates recovered in December, with concordant results being obtained by the three typing methods: the first clone included seven strains from five ventilated children in the ICU and two children from another ward; another clone was shared by one neonate in the ICU and an infant from another ward . These results indicate that ribotyping and AP PCR-the latter applied, to our knowledge, for the first time to the genotypic analysis of E . cloacae--represent very discriminatory tools for the investigation of nosocomial outbreaks caused by this species. APMIS, 1994 Mar, 102(3), 227 - 35 Antimicrobial susceptibility of bacterial isolates in south Sweden including a 13-year follow-up study of some respiratory tract pathogens; Forsgren A et al.; The antibiotic susceptibility of consecutive isolates of the upper respiratory tract pathogens Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and Staphylococcus aureus, (100 strains of each species collected each year during March through April 1985, 1988 and 1992) to penicillin V, amoxycillin, cefaclor, cefuroxime, doxycycline, erythromycin, and cotrimoxazole was investigated by MIC determination on PDM and PDM II agar . The MICs of the upper respiratory isolates from 1992 supplemented with 100 isolates each of Escherichia coli, Klebsiella spp., Enterobacter cloacae, Proteus mirabilis and Staphylococcus saprophyticus collected during 1992 were determined against the above antibiotics plus cefadroxil, cefpodoxime, roxithromycin, ciprofloxacin, ofloxacin, and BAY Y 3118 . Beta-lactamase production was found in 10% of H . influenzae and 80-90% of S . aureus and B . catarrhalis in 1992 . Among H . influenzae isolates, non-beta-lactamase-induced resistance to all beta-lactam antibiotics was first detected in 1988 and amounted to 3% of isolates in 1992 . Decreased susceptibility of S . preumoniae to penicillin (> or = 0.12 mg/l), co-trimoxazole > or = 32 mg/l, doxycycline (> or = 2 ml/l) and erythromycin (> or = 1 mg/l) was detected in 11%, 7%, and 8%, respectively, in 1992, which is significantly higher than in previous years at the same laboratory . Decreased susceptibility of S . pyogenes to doxycycline and erythromycin was detected in 11% and 9% in 1992 . The two most recently developed antibiotics, cefpodoxime and BAY Y 3118, showed high antibacterial activity . The study emphasizes the need to screen for resistance mechanisms such as beta-lactamase production and lowered penicillin affinity. Clin Lab Med, 1994 Mar, 14(1), 17 - 30 Pediatric blood cultures; Paisley JW et al.; The clinical and laboratory issues important in pediatric blood cultures are similar to those in adult blood cultures with a few noteworthy exceptions . The collection of an uncontaminated specimen and an ample volume of blood is more difficult, especially in neonates . In addition, children often have previously received oral antibiotics or a broad-spectrum parenteral antibiotic . The relative frequencies of the pathogens causing bacteremia in children are different in important ways from in adults . Haemophilus influenzae b, although much less common than in the past, is still an important pediatric pathogen . Meningococcemia is relatively more common in children than in adults, and enterobacteriaceae and anaerobes are relatively less common . Group B streptococci, E . coli, coagulase-negative staphylococci, and Candida sp . are the principal pathogens in neonates . More changes in the distribution of blood-borne pathogens can be expected in the future with the introduction of new or more effective vaccines against the pneumococcus, meningococcus, and, possibly, group B streptococcus . In suspected community-acquired bacteremia in otherwise normal children, a single aerobic blood culture of adequate volume is sufficient . Sick neonates, hospitalized children with indwelling intravascular devices, and immunocompromised children may need multiple blood cultures, paired cultures from an indwelling vascular catheter and a peripheral vein, or use of special media . There is no single optimal system for pediatric blood cultures . The BACTEC systems have been adopted as a single system in many hospitals serving both children and adults because of the favorable results reported in children and the preference of using a single automated system . To maximize the detection of bacteremia and fungemia, some laboratories may wish to combine a BACTEC system with a second complementary system, such as the Isolator . Anaerobic, mycobacterial, and other special blood culture media should be reserved for selected patients. J Med Microbiol, 1994 Mar, 40(3), 221 - 6 Gentamicin resistance in clinical isolates of Escherichia coli encoded by genes of veterinary origin; Johnson AP et al.; Seven (27%) of 26 gentamicin-resistant human clinical isolates of Escherichia coli were resistant to the veterinary aminoglycoside antibiotic apramycin . A gentamicin-resistant Klebsiella pneumoniae isolate from a patient infected with gentamicin/apramycin-resistant E . coli was also resistant to apramycin . DNA hybridisation studies showed that all gentamicin/apramycin-resistant isolates contained a gene encoding the enzyme 3-N-aminoglycoside acetyltransferase type IV (AAC{3}IV) that mediates resistance to gentamicin and apramycin in bacteria isolated from animals . Seven of the eight gentamicin/apramycin-resistant isolates were also resistant to the veterinary antihelminthic agent hygromycin B, a phenomenon observed previously in gentamicin/apramycin-resistant Enterobacteriaceae isolated from animals . Resistance to gentamicin/apramycin and hygromycin B was co-transferable in six of the isolates . Restriction enzyme analysis of plasmids in apramycin-resistant transconjugants derived from E . coli and K . pneumoniae isolates from the same patient were virtually identical, suggesting that inter-generic transfer of plasmids encoding apramycin resistance had occurred in vivo . These findings support the view that resistance to gentamicin and apramycin in clinical isolates of E . coli results from the spread of resistant organisms from animals to man, with subsequent inter-strain or inter-species spread, or both, of resistance genes on transferable plasmids. J Pharm Biomed Anal, 1994 Mar, 12(3), 301 - 5 Capillary zone electrophoresis assay of the uridine diphosphate N-acetylmuramyl peptide precursors and the disaccharide pentapeptide derivative of bacterial cell wall peptidoglycan; Richards RM et al.; Uridine diphosphate N-acetylmuramyl peptide (EDP-MurNac) precursors and disaccharide pentapeptide of bacterial cell wall peptidoglycan were extracted from Enterobacter colacae cells and examined by capillary zone electrophoresis . Five UDP-MurNac derivatives with dibromopropamidine isethionate as the internal standard, and disaccharide pentapeptide with pyrimethamine as the internal standard, were successfully and rapidly analysed by using a fused-silica capillary and sodium phosphate buffer in methanol as the organic modifier at appropriate pH . Accurate quantitation was also achieved . The method provides the potential to investigate quantitatively the effect of antibacterials on the biosynthesis of peptidoglycan and to determine the relative cellular concentrations of the murein precursors within the cell cycle. Orthop Rev, 1994 Mar, 23(3), 262 - 5 Escherichia vulneris osteomyelitis of the tibia caused by a wooden foreign body; Levine WN et al.; A new species in the family Enterobacteriaceae, Escherichia vulneris, was characterized by the Centers for Disease Control and Prevention in 1982 . It has been shown to have a predilection for human wounds, and several case reports have described superficial wound infections with this rare organism . Until now, however, there have been no reports of osteomyelitis occurring secondary to E vulneris infection . The authors present the case of a 13-year-old boy who fell on a stick and sustained a penetrating injury to his right knee . Radiographs and magnetic resonance imaging revealed a lytic lesion with a foreign body in the tibial epiphysis . On culture, only E vulneris was found, and histologic examination showed the foreign body to be surrounded by acute and chronic inflammation, abscess formation, and foreign-body giant-cell reaction . Although a recent study questioned the pathogenicity of this organism after reviewing the cases of 12 patients in whom there was concurrent heavy growth of Staphylococcus aureus, the present case supports the finding that E vulneris is a human pathogen that should be treated when obtained from human wound cultures. J Oral Pathol Med, 1994 Mar, 23(3), 104 - 13 Oral and oropharyngeal prevalence of Enterobacteriaceae in humans: a review; Sedgley CM et al.; Members of the Enterobacteriaceae family are widely distributed in nature and exhibit substantial diversity in ecology, host range and pathogenic potential for man . While wide discrepancies in methodology exist between epidemiological studies, the available data indicate an increased prevalence of oral and/or oropharyngeal Enterobacteriaceae carriage in patients with illnesses of varying severity compared with healthy subjects . This paper reviews the prevalence of Enterobacteriaceae in the oral and oropharyngeal region of healthy human subjects and those affected by different disease entities, and discusses the complexities associated with collating and interpreting such data . The effect of antimicrobials and antiseptics on oral and oropharyngeal Enterobacteriaceae has also been reviewed, while highlighting the gaps in knowledge and future research directions. Can J Microbiol, 1994 Mar, 40(3), 184 - 91 The energy dependence of detergent resistance in Enterobacter cloacae: a likely requirement for ATP rather than a proton gradient or a membrane potential; Aspedon A et al.; The enteric bacterium Enterobacter cloacae was grown both aerobically and anaerobically in the presence of up to 1% of the anionic detergent sodium dodecyl sulfate (SDS) . A continuous energy supply was necessary to maintain cell integrity and cells grown in SDS (0.1-1%) lysed during carbon-limited stationary phase . The respiratory inhibitor KCN (3 mM) caused rapid lysis when added to aerobic, log phase, SDS-containing cultures growing on glucose as the carbon source . However, when the SDS (0.5%) was added 30 min after KCN, lysis did not occur . The likely reason for this discrepancy concerns the cellular ATP levels . In aerobic cells the ATP levels dropped 10- to 15-fold within 1 min of adding KCN and then increased gradually over the next 30 min . Similarly, the addition of 2 mM iodoacetic acid, an inhibitor of glycolysis, to anaerobic, log phase, SDS-containing cultures caused rapid lysis . However, unlike the situation for KCN-treated aerobic cells, lysis still occurred when SDS (0.5%) was added 30 min after addition of iodoacetic acid . The reason for this difference is that in anaerobic cells, ATP levels dropped 10- to 12-fold within 5 min of the addition of iodoacetic acid and then did not increase over the next 30 min . Evidence that the energy requirement was for ATP was provided by uptake experiments with {14C}benzoic acid and alpha-{14C} isoaminobutyric acid that showed that the proton gradient (delta pH) and the membrane potential (delta psi) were the same in cells grown in the presence or absence of SDS.(ABSTRACT TRUNCATED AT 250 WORDS) Can J Microbiol, 1994 Mar, 40(3), 161 - 8 Interaction of mutants of Xenorhabdus nematophilus (Enterobacteriaceae) with antibacterial systems of Galleria mellonella larvae (Insecta: Pyralidae); Dunphy GB; Xenorhabdus nematophilus mutants that took longer to kill insects than did the wild type were used to determine the relationship of the physicochemical properties and outer membrane composition to bacterial interaction with the antibacterial systems of Galleria mellonella larvae and to bacterial virulence . Insect serum slowed the growth of the wild-type and mutant bacteria . This was attributed to increased spheroplast formation for the mutants . Spheroplast formation was associated with an increased sensitivity to insect lysozyme and a reduction in overall bacterial cationic charge . Increasing bacterial hydrophobicity was correlated with both increased bacterial attachment to the insect's haemocytes and the accelerated removal of the bacteria from the haemolymph . Attachment of the mutants to the insect haemocytes also increased as the bacterial lipopolysaccharide content increased, the level of prophenoloxidase activation increased, and cationic charge declined . Bacterial emergence into the haemolymph occurred in parallel with haemocyte damage but neither the total lipopolysaccharide levels in the bacteria nor the rate of bacterial emergence were associated with virulence . The rate of lipopolysaccharide release into the haemolymph influenced the rate of haemocyte damage . The contribution of outer membrane proteins to lipopolysaccharide release, bacterial adhesion to haemocytes, and virulence is discussed . Virulence reflects bacterial tolerance to the host's antibacterial defences, favouring an increase in bacteria and toxic lipopolysaccharides. Diagn Microbiol Infect Dis, 1994 Mar, 18(3), 167 - 73 Antimicrobial activity of FK-037, a new broad-spectrum cephalosporin . International in vitro comparison with cefepime and ceftazidime; Frei R et al.; The in vitro activity of FK-037, a new parenteral 7-aminothiazolyl-methoxyimino cephalosporin, was compared with cefepime and ceftazidime against 6094 aerobic isolates collected in six medical centers worldwide . FK-037 demonstrated potent activity against the Enterobacteriaceae family except for some Enterobacter spp., Providencia spp., and Serratia liquefaciens (MIC90s, > or = 16 micrograms/ml) . Against nonenteric Gram-negative bacilli, all compounds tested showed similar, but more limited activity . The FK-037 MIC50s for Pseudomonas spp . and P . aeruginosa were 2 and 4 micrograms/ml, respectively . The least susceptible organisms were Xanthomonas maltophilia, enterococci, and Bacillus spp . (MIC50s, > 16 micrograms/ml), followed by Flavobacterium spp., other nonenterics, and oxacillin-resistant Staphylococcus aureus (MIC50s, 16 micrograms/ml) . Good FK-037 activity was observed against oxacillin-susceptible staphylococci as well as against beta-hemolytic and viridans-group streptococci (MIC90 range, < or = 0.12 to 2 micrograms/ml) . While FK-037 was slightly more active than cefepime against Gram-positive organisms, enteric bacilli were most susceptible to cefepime . Overall, the antibacterial spectrum of both FK-037 and cefepime was superior to ceftazidime. J Hosp Infect, 1994 Mar, 26(3), 167 - 72 Postoperative endophthalmitis caused by an Enterobacter species; Mirza GE et al.; Six patients (aged 8 to 75 years) who were operated upon during the same day developed bacterial endophthalmitis on the following day; seven eyes were affected . Two patients had intracapsular cataract extraction, one extracapsular lens extraction, two extracapsular cataract extraction with intraocular lens implantation and one repair of bilateral scleral or corneoscleral perforations . Vitreous cultures taken from six eyes were positive for an Enterobacter sp . Despite antibiotic treatment systemically, subconjunctivally and intravitreally, four eyes had to be eviscerated, while two eyes showed evidence of shrinkage (phthisis); only one eye retained useful vision (9/10) . Cotton swabs used during surgery, prepared manually from cotton wool moistened with saline, were identified as the source of infection; the batch had not been subjected to the prescribed autoclaving process . The importance of proper sterile procedures in association with surgery is emphasized. Infect Immun, 1994 Mar, 62(3), 843 - 8 Type 1 fimbrial shafts of Escherichia coli and Klebsiella pneumoniae influence sugar-binding specificities of their FimH adhesins; Madison B et al.; The type 1 fimbriae of enterobacteria comprise FimA, which constitutes most of the fimbrial shaft, and a cassette of three minor ancillary subunits including FimH, the mannose-binding moiety . The sugar-binding specificities of Escherichia coli and Klebsiella pneumoniae type 1 fimbriae were examined by determining the relative activities of two aromatic mannosides in inhibiting the yeast aggregation caused by the fimbriated bacteria . 4-Methylumbelliferyl alpha-mannoside (MeUmb alpha Man) was approximately 10-fold more effective than p-nitrophenyl alpha-mannoside (p-NP alpha Man) in inhibiting the yeast aggregation caused by the recombinant expressing native E . coli type 1 fimbriae . In contrast, MeUmb alpha Man was only fourfold more effective than p-NP alpha Man in assays employing the recombinant expressing native K . pneumoniae type 1 fimbriae . In order to elucidate the molecular mechanisms underlying the sugar-binding specificities of type 1 fimbriae in the two species, transcomplementation studies were performed and resulted in the creation of recombinants expressing two types of hybrid fimbriae: one consisting of a cassette of minor subunits of E . coli fimbriae borne on a filamentous shaft of K . pneumoniae FimA subunits and the other consisting of a cassette of K . pneumoniae minor fimbrial subunits borne on a shaft of E . coli FimA subunits . Although the heterologous FimH was incorporated into the fimbrial filaments in amounts comparable to those observed in native fimbriae, the hemagglutination activities of recombinants expressing hybrid fimbriae were significantly lower than those of their counterparts bearing native fimbriae . The sugar-binding specificity of the recombinant expressing hybrid fimbriae consisting of an E . coli shaft bearing K . pneumoniae FimH was different from those of recombinants expressing native K . pneumoniae fimbriae in its affinity for the two aromatic sugars but was remarkably similar to the specificities exhibited by recombinants expressing native E . coli fimbriae . Conversely, the sugar-binding specificity of the recombinant expressing hybrid fimbriae consisting of a K . pneumoniae shaft bearing E . coli FimH was different from that of the recombinant expressing native E . coli fimbriae but was very similar to those of recombinants expressing native K . pneumoniae fimbriae . We conclude that the differences in the sugar-binding specificity between E . coli and K . pneumoniae FimH fimbrial subunits is influenced by the fimbrial shafts which carry the adhesin molecules in a functionally competent form at the distal tips. Southeast Asian J Trop Med Public Health, 1994 Mar, 25(1), 107 - 15 Bacterial meningitis in children: etiology and clinical features, an 11-year review of 618 cases; Chotpitayasunondh T; During the period January 1980 to December 1990 (11 years) a retrospective study of patients with bacterial meningitis who were admitted to Bangkok Children's Hospital was carried out . There were 618 patients with 77 cases (12.5%) occurring below the age of one month (neonatal meningitis), and 541 cases (87.5%) between one month to 15 years (childhood meningitis) . Pseudomonas aeruginosa was the most common pathogenic organism (16.9%) in neonatal meningitis; other causative agents in this age group included Klebsiella pneumoniae (13.0%), group B Streptococcus (11.7%), Escherichia coli and Enterobacter sp (10.4% each) . In childhood meningitis, Haemophilus influenzae was the most common causative organism (42.3%), and followed by Streptococcus pneumoniae (22.2%) and Salmonella sp (12.4%) . Excluding a 13 year-old leukemic patient, Salmonella meningitis occurred exclusively in infants, 87% of them were under six months, and 13% of them developed relapsing meningitis . Presenting symptoms and signs on admission of neonatal meningitis such as fever (81.8%), convulsions (45.4%), neck stiffness (22.5%), bulging fontanelle (33.3%) and Brudzinski sign (11.5%) were significantly less frequent than in the patients beyond the neonatal period (p < 0.05) . The overall fatalities during 1980-1990 were 45.4% and 17.3% for neonatal meningitis and childhood meningitis, respectively . The fatalities of the two age groups declined significantly during 1987-1990 to 26.3% and 11.4% respectively. Clin Diagn Lab Immunol, 1994 Mar, 1(2), 206 - 13 Immunochemical identification of Brucella abortus lipopolysaccharide epitopes; Rojas N et al.; Sera from Brucella abortus-infected and -vaccinated bovines recognized four lipopolysaccharide (LPS) determinants: two in the O-polysaccharide (A and C), one in the core oligosaccharide from rough Brucella LPS (R), and one in lipid A (LA) . From 46 different hybridomas secreting monoclonal antibodies (MAbs) against various LPS moieties, 9 different specificities were identified . Two epitopes, A and C/Y, were present in the O-polysaccharide . Two epitopes were found in the core oligosaccharide (R1 and R2) of rough Brucella LPS . MAbs against R1 and R2 epitopes reacted against LPS from different rough Brucella species; however, MAbs directed to the R2 epitope also reacted against enterobacterial LPS from deep rough mutants . Three epitopes (LA1, LA2, and LA3) were located in the lipid A backbone . Different sets of MAbs recognized two epitopes in the lipid A-associated outer membrane protein (LAOmp3-1 and LAOmp3-2) . LPS preparations from smooth brucellae had small amounts of rough-type LPS . Although LPS from rough brucellae did not show smooth-type LPS in western blots (immunoblots), two hybridomas generated from mice immunized with rough B . abortus produced antibodies against smooth B . abortus LPS . Results are discussed in relation to the structure and function of B . abortus LPS and to previous findings on the epitopic density of the molecule. Carbohydr Res, 1994 Feb 17, 254, 105 - 32 Synthesis of pentasaccharide core structures corresponding to the genus-specific lipopolysaccharide epitope of Chlamydia; Kosma P et al.; The trisaccharides allyl O-(sodium 3-deoxy-alpha-D-manno-2-octulopyranosylonate)-(2-->6)-O-2-aceta mid o-2-deoxy- beta-D-glucopyranosyl-(1-->6)-2-acetamido-2-deoxy-alpha- and -beta-D-glucopyranoside (16a and 16b), the tetrasaccharides allyl O-(sodium 3-deoxy-alpha-D-manno-2-octulopyranosylonate)-(2-->4)-O-(sodium 3-deoxy-alpha-D-manno-2-octulopyranosylonate)-(2-->6)-O-2-aceta mid o-2-deoxy- beta-D-glucopyranosyl-(1-->6)-2-acetamido-2-deoxy-alpha- and -beta-D-glucopyranoside (19a and 19b), and the pentasaccharides allyl O-(sodium 3-deoxy-alpha-D-manno-2-octulopyranosylonate)-(2-->8)-O-(sodium 3-deoxy-alpha-D-manno-2-octulopyranosylonate)-(2-->4)-O-(sodium 3-deoxy-alpha-D-manno-2-octulopyranosylonate)-(2-->6)-O-2-aceta mid o-2-deoxy-bet a -D-glucopyranosyl-(1-->6)-2-acetamido-2-deoxy-alpha- and -beta-D-glucopyranoside (23a and 23b) were prepared . The glycosidic linkages were formed using 1,3,4,6-tetra-O-acetyl-2-chloroacetamido-2-deoxy-beta-D-glucopy ran ose (6) and FeCl3 as promoter as well as per-O-acetylated Kdo mono- and di-saccharide bromide derivatives (12 and 20) under Helferich conditions . The oligosaccharides, which correspond to dephosphorylated part-structures of enterobacterial and chlamydial lipopolysaccharides, were characterized by NMR spectroscopy as well as plasma desorption and matrix-assisted laser desorption mass spectrometry. J Immunol, 1994 Feb 15, 152(4), 1907 - 14 Mast cell phagocytosis of FimH-expressing enterobacteria; Malaviya R et al.; Most studies of mast cells have been directed at their role in the pathophysiology of IgE-mediated allergic reactions with little recognition of their participation in bacterial infections . We report that mast cells can specifically bind FimH, a mannose-binding subunit on type 1 fimbriae expressed by Escherichia coli and other enterobacteria . This interaction triggers mast cell phagocytosis and killing of the bacteria within vacuoles and through the release of superoxide anions . Also, in view of the fact that mast cells have the capacity to release inflammatory mediators and are particularly abundant in the skin, mucosal surfaces, and around blood vessels, we suggest that these cells play an important role in host defense against microbial infection. Gene, 1994 Feb 11, 139(1), 93 - 8 Characterization of a plasmid-borne and constitutively expressed blaMOX-1 gene encoding AmpC-type beta-lactamase; Horii T et al.; A 1954-bp DNA fragment containing the blaMOX-1 gene, identified on a large resident plasmid (pRMOX-1) of Klebsiella pneumoniae NU2936, was sequenced and an open reading frame (ORF) coding for a 390-amino-acid (aa) MOX-1 was found . The total deduced aa sequence of MOX-1 shared considerable homology with that of AmpC-type class C beta-lactamases of Gram- bacteria, especially of Pseudomonas aeruginosa PAO1 {51.3%; 63.8% at the nucleotide (nt) level} . However, the regulatory gene ampR and a 38-bp AmpR-binding region were not present upstream from blaMOX-1, although the expression of P . aeruginosa ampC is directly regulated by AmpR . Possible -35 and -10 regions, a Shine-Dalgarno (SD) sequence and terminators were identified which are peculiar to blaMOX-1 . On the other hand, a sequence highly homologous (91.6%) to the region upstream from dhfrX in the In7 integron carried by plasmid pDGO100 was found upstream from blaMOX-1 at nt 1 to 488 . No significant difference was detected between the promoter activities of blaMOX-1 in ampD- and ampD+ strains of Enterobacter cloacae, as measured by the chloramphenicol acetyltransferase (CAT) assay . These results clearly show that blaMOX-1 belongs to the group of ampC-related bla genes and that it is expressed constitutively, independently of transcriptional regulators such as AmpR, AmpG and AmpD . Homology analysis among AmpC enzymes or ampC genes implied that integration of the chromosomal ampC gene into a large resident plasmid, followed by transconjugation, was involved in the evolution of blaMOX-1. Pol Tyg Lek, 1994 Feb 7-14, 49(6-7), 154 - 7 {Clinical evaluation of norfloxacin preparation in treatment of bacterial infections of the urinary tract in patients with various kidney diseases}; Mazanowska O et al.; Norfloxacin (Nolicin Krka) has been administered to 22 patients with urinary tract infections . The drug has been administered in daily dose of 800 mg for 10 days . An ultimate result has been evaluated after 3 months . Sterile urine cultures or less that 10,000 cells per millilitre have been achieved in 13 (59%) patients . Relapse of infection with other strain have been found in 9 (41%) patients . No adverse reactions which required cessation of therapy have been noted . An examination of isolates sensitivity to norfloxacin in vitro has shown that the drug is active against Gram-negative Enterobacteriaceae, P . aeruginosa, and Gram-positive staphylococci . Various strains of streptococci have been insensitive to norfloxacin . The obtained results suggest that norfloxacin is useful antibacterial agent and produces both clinical and bacteriological improvement in about 60% of patients with urinary tract infections. J Bacteriol, 1994 Feb, 176(3), 861 - 70 Molecular characterization of enterobacterial pldA genes encoding outer membrane phospholipase A; Brok RG et al.; The pldA gene of Escherichia coli encodes an outer membrane phospholipase A . A strain carrying the most commonly used mutant pldA allele appeared to express a correctly assembled PldA protein in the outer membrane . Nucleotide sequence analysis revealed that the only difference between the wild type and the mutant is the replacement of the serine residue in position 152 by phenylalanine . Since mutants that lack the pldA gene were normally viable under laboratory conditions and had no apparent phenotype except for the lack of outer membrane phospholipase activity, the exact role of the enzyme remains unknown . Nevertheless, the enzyme seems to be important for the bacteria, since Western blotting (immunoblotting) and enzyme assays showed that it is widely spread among species of the family Enterobacteriaceae . To characterize the PldA protein further, the pldA genes of Salmonella typhimurium, Klebsiella pneumoniae, and Proteus vulgaris were cloned and sequenced . The cloned genes were expressed in E . coli, and their gene products were enzymatically active . Comparison of the predicted PldA primary structures with that of E . coli PldA revealed a high degree of homology, with 79% of the amino acid residues being identical in all four proteins . Implications of the sequence comparison for the structure and the structure-function relationship of PldA protein are discussed. J Bacteriol, 1994 Feb, 176(3), 702 - 13 Electric fields induce curved growth of Enterobacter cloacae, Escherichia coli, and Bacillus subtilis cells: implications for mechanisms of galvanotropism and bacterial growth; Rajnicek AM et al.; Directional growth in response to electric fields (galvanotropism) is known for eukaryotic cells as diverse as fibroblasts, neurons, algae, and fungal hyphae . The mechanism is not understood, but all proposals invoke actin either directly or indirectly . We applied electric fields to bacteria (which are inherently free of actin) to determine whether actin was essential for galvanotropism . Field-treated (but not control) Enterobacter cloacae and Escherichia coli cells curved rapidly toward the anode . The response was both field strength and pH dependent . The direction of curvature was reversed upon reversal of field polarity . The directional growth was not due to passive bending of the cells or to field-induced gradients of tropic substances in the medium . Field-treated Bacillus subtilis cells also curved, but the threshold was much higher than for E . cloacae or E . coli . Since the curved morphology must reflect spatial differences in the rates of cell wall synthesis and degradation, we looked for regions of active wall growth . Experiments in which the cells were decorated with latex beads revealed that the anode-facing ends of cells grew faster than the cathode-facing ends of the same cells . Inhibitors of cell wall synthesis caused spheroplasts to form on the convex regions of field-treated cells, suggesting that the initial curvature resulted from enhanced growth of cathode-facing regions . Our results indicate that an electric field modulates wall growth spatially and that the mechanism may involve differential stimulation of wall growth in both anode- and cathode-facing regions . Electric fields may therefore serve as valuable tools for studies of bacterial wall growth . Use of specific E . coli mutants may allow dissection of the galvanotropic mechanism at the molecular level. Infect Immun, 1994 Feb, 62(2), 729 - 32 Legionella pneumophila growth restriction and cytokine production by murine macrophages activated by a novel Pseudomonas lipid A; Arata S et al.; Peritoneal exudate macrophages from A/J mice activated by purified lipid A preparations from Pseudomonas vesicularis, which contain 2,3-diamino-2,3-dideoxy-D-glucose disaccharide phosphomonoester as the lipid A backbone, restricted the growth of Legionella pneumophila, an intracellular opportunistic bacteria which readily grows in otherwise permissive macrophages from susceptible A/J mice and induced production of the proinflammatory cytokines interleukin 1 and tumor necrosis factor alpha . Activation of the macrophages was similar to that which occurred after stimulation with more conventional lipid A from other bacteria such as salmonellae . A purified fraction A3 preparation from the Pseudomonas lipid A, which lacked only 1 mol of amide-linked fatty acid, in comparison with another fraction (A2), which contained the fatty acid, also markedly activated the usually permissive macrophages from susceptible A/J mice to resist growth of the legionellae . The fraction A3 also induced both interleukin and tumor necrosis factor alpha . These results show that this novel lipid A from P . vesicularis can activate macrophages to resist infection with an opportunistic bacterium in a manner similar to that induced by conventional enterobacterial lipid A and that the hydrophobic portion of this Pseudomonas molecule may have an important role in activation of macrophages. J Gastroenterol, 1994 Feb, 29(1), 84 - 7 Ulcerative colitis associated with Weber-Christian panniculitis and musculitis: a case report; Nozue M et al.; A case of 22-year-old man suffering from ulcerative colitis, in whom Weber-Christian panniculitis and musculitis occurred simultaneously, is reported . He had suffered from ulcerative colitis for 7 years and he again had bloody stools 1 month before being admitted . Two weeks before admission, large (2-4 cm) subcutaneous tumors appeared . Weber-Christian panniculitis, musculitis, and active stage ulcerative colitis were diagnosed . All the symptoms went into remission after steroid therapy . The possibility of the existence of a common antigen in enterobacterial wall, colonic epithelium, and adipose tissue was suggested. J Antimicrob Chemother, 1994 Feb, 33(2), 223 - 30 In-vitro activity of five beta-lactam/beta-lactamase inhibitor combinations against consecutive isolates of the Enterobacteriaceae and Pseudomonas aeruginosa; McLaughlin JC et al.; Susceptibility tests were performed on 2402 of consecutive isolates of Enterobacteriaceae and 254 strains of Pseudomonas aeruginosa in five separate medical centres . Five beta-lactams were evaluated with and without a beta-lactamase inhibitor . The effect of different inhibitors was species specific and the rank order of decreasing efficacy against all enteric bacilli was: cefoperazone-sulbactam > piperacillin-tazobactam > cefoperazone > ticarcillin-clavulanic acid > piperacillin > co-amoxiclav > ampicillin-sulbactam > ticarcillin > ampicillin > amoxycillin. Microbiology, 1994 Feb, 140 ( Pt 2), 379 - 87 Molecular characterization of a 40 kDa OmpC-like porin from Serratia marcescens; Hutsul JA et al.; An oligonucleotide that encodes the N-terminal portion of a 41 kDa porin of Serratia marcescens was used to probe S . marcescens UOC-51 genomic DNA . An 11 kb EcoRI fragment which hybridized with the oligonucleotide was subcloned into Escherichia coli, examined for expression, and sequenced . The product expressed by the cloned gene was 40 kDa . The nucleotide sequence has an ORF of 1.13 kb . When the deduced amino acid sequence was aligned and compared to other enterobacterial porins the cloned S . marcescens porin most closely resembled E . coli OmpC . Although we did not detect osmoregulation or thermoregulation of any porins in S . marcescens UOC-51, sequences analogous to the E . coli osmoregulator OmpR-binding regions are seen upstream to the cloned gene . We examined the regulation of the S . marcescens porin in E . coli and found that its expression increased in a high salt environment . A micF gene, whose transcriptional product functions to inhibit synthesis of OmpF by hybridizing with the ompF transcript, was also seen upstream of the S . marcescens ompC . An alignment with the E . coli micF gene revealed that the functional region of the S . marcescens micF gene is conserved . Based on the results obtained we have determined that S . marcescens UOC-51 produces a 40 kDa porin similar to the E . coli OmpC porin. Microbiology, 1994 Feb, 140 ( Pt 2), 289 - 96 Plasmids isolated from the sugar beet phyllosphere show little or no homology to molecular probes currently available for plasmid typing; Kobayashi N et al.; From a representative sample of bacteria, isolated from mature sugar beet leaves (Beta vulgaris) grown at three separate locations in the UK, 79 (18%) were shown to contain plasmids ranging in size from 10 kb to 200 kb . A sensitive colony blot method was developed to facilitate the screening of both Gram-negative and Gram-positive isolates to determine the distribution of known plasmid incompatibility groups among plasmids isolated from the natural environment using the collection of inc/rep probes derived from basic replicons {rep FIA, FIIA, FIB, HI1, HI2, I1, B/O, L/M, N, P, Q, U, W and X, as described by Couturier et al . (1988) Microbiol Rev 52, 375-395} . After hybridization with each of the radiolabelled replicon probes, 54 of these 79 plasmid-containing natural isolates, which included Erwinia spp., Pseudomonas spp . and Gram-positive bacteria, failed to react . Reactivity was observed with 25 of the 29 Klebsiella and Erwinia isolates investigated . Of the plasmid-containing Enterobacteriaceae examined, 18 reacted with the repFIB probe, six with the repFIIA probe and one isolate, Erwinia salicis SBN169, hybridized to both . Southern hybridization demonstrated that the different isolates which shared homology with the repFIB probe contained a common 1 kb PstI fragment.(ABSTRACT TRUNCATED AT 250 WORDS) Eur J Pediatr, 1994 Feb, 153(2), 84 - 9 Changing causes of septicaemia in paediatric oncology patients: effect of imipenem use; Gray JW et al.; One hundred and fifty-four episodes of septicaemia occurred in 78 patients on a Paediatric Oncology Unit over 2 years . Septicaemias with Gram-positive bacteria were more common than with Gram-negative organisms, coagulase-negative staphylococci (CNS) being the commonest pathogens . The mortality rate in patients with septicaemia was 1.9% . Azlocillin and gentamicin comprised the first-line of empirical antibiotic therapy for suspected infection for the first 10 months of the study; imipenem with cilastatin, as monotherapy, was used subsequently . More isolates of enterococci, and fewer isolates of Enterobacter, were seen after the introduction of imipenem . The use of imipenem was associated with an increased frequency of resistance to flucloxacillin in CNS . Such strains have been shown to contain sub-populations of cells that are resistant to imipenem . A clinical response was achieved in 82.9% of septicaemic episodes treated with imipenem, compared with 62.7% for azlocillin and gentamicin . However, imipenem as monotherapy may not be appropriate in central venous catheter related infections, owing to the frequent occurrence of imipenem-resistant organisms, CNS and Pseudomonas spp., in this situation. Anaesthesist, 1994 Feb, 43(2), 121 - 5 {Fulminating E . coli sepsis in Fournier's gangrene}; Zielmann S et al.; Fournier's gangrene is a necrotising soft-tissue infection of the scrotum and perineal region caused by gram-negative and gram-positive Enterobacteriaceae . The disease is characterised by its unique appearance, its speed of onset, and its high mortality . CASE REPORT . A 26-year-old male presented to the emergency room complaining of a painful, tremendously swollen scrotum and penis (Fig . 1) that had developed within the past 24 h . Later, slurred speech, pallor, and hypotension were recognised, leading to the patient's admission to the intensive care unit . Suspecting a severe internal haemorrhage, vigorous volume therapy was started using crystalloids and colloids until blood and fresh frozen plasma were available . One hour later, septic shock was presumed and therapy augmented by IV antibiotics, tracheal intubation, and mechanical ventilation . Despite all efforts, the patients condition deteriorated rapidly and he died a few hours later due to multiple organ failure in septic shock . Postmortem, a perforated external hemorrhoidal node was found to be the primary focus of sepsis . Microbiologic cultures revealed Escherichia coli in blood and tissue samples . DISCUSSION . Fournier's gangrene is a rare disease; nevertheless, its clinical picture has to be recognised immediately in order to provide appropriate treatment in time . It occurs predominantly in males after minor trauma, colorectal or urological disease, and perineal or abdominal surgery . Fournier's gangrene usually begins with itching and pain in the scrotal region followed by swelling and dark-blueish discolouration of the scrotum and penis, occasionally including the lower abdominal wall . Fever and chills are usually present . The illness progresses to severe prostation and septic shock with a mortality of 20%-50% . Tissue cultures mostly reveal E . coli, gram-positive enterococci, Pseudomonas, Proteus, and various anaerobes . The treatment should include immediate radical surgical debridement, i.v . administration of broad-spectrum antibiotics, and cardiopulmonary support . CONCLUSION . The dramatic course of Fournier's gangrene requires early recognition, extensive surgical debridement, as well as intensive care treatment in order to prevent irreversible septic shock. Appl Environ Microbiol, 1994 Feb, 60(2), 749 - 51 Evaluation of Rambach agar for detection of Salmonella subspecies I to VI; Kuhn H et al.; Salmonella strains belonging to subspecies I to VI were investigated for colony color when grown on Rambach agar . Most strains of Salmonella subspecies I, II, IV, and VI behaved as described . All strains of Salmonella subspecies IIIa, IIIb, and V produced beta-D-galactosidase and blue-green colonies which could not be distinguished in color from Escherichia coli and other lactose-fermenting members of the family Enterobacteriaceae. Appl Environ Microbiol, 1994 Feb, 60(2), 554 - 61 Classification of the uptake hydrogenase-positive (Hup+) bean rhizobia as Rhizobium tropici; van Berkum P et al.; Phenotypic and genetic characterization indicated that Hup+ bean rhizobial strains are type IIA and type IIB Rhizobium tropici . The Hup+ strain USDA 2840, which did not cluster with either of the two types of R . tropici in a restriction fragment length polymorphism analysis, had electrophoretic patterns of PCR products generated with primers for repetitive extragenic palindromic and enterobacterial repetitive intergeneric consensus sequences similar to those of three reference strains of R . tropici type IIA . The Hup+ strain USDA 2738, which clustered with the reference strain of R . tropici IIB in a restriction fragment length polymorphism analysis, had electrophoretic patterns of PCR products generated with primers for repetitive extragenic palindromic and enterobacterial repetitive intergeneric consensus sequences more closely resembling those of the reference strains of R . tropici type IIA than those of type IIB . DNA amplification with the Y1 and Y2 primers to generate a portion of the 16S rDNA operon was useful to distinguish R . tropici type IIA strains from other bean rhizobial strains . The phylogenetic position of the type IIA strain of R . tropici USDA 2840, determined from the partial 16S rDNA sequence, indicated a more distant relationship with the type IIB strain of R . tropici CIAT899 than with the as yet unnamed rhizobial species of Leucaena leucocephala, TAL 1145 . Therefore, we suggest that it may be appropriate either to separate R . tropici types IIA and IIB into two different species or to identify TAL 1145 to the species level as a third type of R . tropici. Planta Med, 1994 Feb, 60(1), 34 - 6 Cytotoxic and antibacterial labdane-type diterpenes from the aerial parts of Cistus incanus subsp . creticus; Chinou I et al.; Seven labdane-type diterpenoids were isolated from the leaves of Cistus incanus subsp . creticus; their structures were established by spectroscopic means . All compounds were tested in vitro for their cytotoxicity against three cell line systems: KB, P-388; and NSCLC-N6 . Their antibacterial and antifungal activities were tested against Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosae, Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia, Torulopsis glabrata, Saccharomyces cerevisiae, and Candida albicans as well. Nippon Rinsho, 1994 Feb, 52(2), 415 - 21 {Infection in patient with malignant disease}; Shinagawa N; The rate of infection in patients with malignant disease was significantly high than that of patients with benign disease . Enterococcus spp . was the most predominant organism isolated from patients with malignant disease, followed by Staphylococcus spp., Pseudomonas spp., Enterobacter spp . and Klebsiella spp . in order . From patients with benign disease, E . coli was the most predominant organism, followed by Gram negative anaerobes, and Klebsiella spp. . The rate of postoperative infection in the patients with malignant biliary disease was significantly high than that without a risk factor . The rates of bacterial isolation from intraoperative bile culture and wound swab were significantly higher in patient with malignant disease . These findings suggest that the utmost care should be exercised in patients with malignant disease in order to prevent intraoperative contamination with prophylactic antibiotic therapy covering the bacteria isolated from the bile. Nippon Rinsho, 1994 Feb, 52(2), 297 - 302 {Current state of causative bacteria in infections diseases and trends in resistance to antimicrobial agents}; Igari J; The current state of causative bacteria in infectious diseases and the trends in resistance to antimicrobial agents were mentioned . The commonest micro-organisms isolated from the blood and intravascular catheter tips were CNS, S . aureus and C . albicans . Significant urine culture isolates were E . coli and other enterobacteriaceae in uncomplicated UTI, and Enterococcus spp . and Pseudomonas spp . in complicated UTI with a urinary catheter . In respiratory tract infections (RTIs), H . influenzae, S . pneumoniae, B . catarrhalis, S . aureus and P . aeruginosa, were common causative organisms . Community-acquired pneumonia was mainly caused by H . influenzae, S . pneumoniae and B . catarrhalis . In common with hospital-acquired pneumonia, P . aeruginosa, S . aureus and enterobacteriaceae were the frequent microorganisms isolated . In anaerobic infections, the most common micro-organisms were B . fragilis and other B . fragilis group isolated from intra-abdominal focus of post operative patients . The trends in the antimicrobial susceptibility of isolates of common bacteria over a period of 5 years (1988-1992) have been monitored . The proportion of isolates of S . aureus resistant to CEZ, CMZ, FMOX, IPM or MINO has increased . There was no trend towards increased resistance among isolates of P . aeruginosa except for CBPC . The incidence of resistance to PCG, ABPC, EM and LMOX increased in isolates of S . pneumoniae and that of resistance to PIPC, CMZ, LMOX and IPM increased in those of B . fragilis group. Eur J Biochem, 1994 Feb 1, 219(3), 737 - 42 Immunobiological properties of chemically defined lipid A from lipopolysaccharide of Porphyromonas (Bacteroides) gingivalis; Ogawa T; Porphyromonas gingivalis 381 lipid A, characterized by beta-(1-6)-linked glucosamine disaccharide 1-phosphate, with one hydroxyacyl group and one acyloxyacl group, i.e., 3-hydroxy-15-methyl-hexadecanoyl and 3-hexadecanoyloxy-15-methylhexadecanoyl groups at the 2 and 2' positions, respectively, was less endotoxically active than the synthetic Escherichia-coli-type lipid A (compound 506), which possesses beta-(1-6)-linked glucosamine disaccharide 1,4'-bisphosphate, with two acyloxyacyl groups at the 2' and 3' positions and two 3-hydroxytetradecanoyl group at the 2 and 3 positions and the synthetic Salmonella-type lipid A (compound 516), which has three acyloxyacyl groups at the 2,2' and 3' positions and one hydroxyacyl group at the 3 position . P . gingivalis lipid A exhibited no or very low endotoxic activities, i.e., lethal toxicity in galactosamine-loaded mice, preparative ability for local Shwartzman reaction, pyrogenicity and Limulus test as compared with compounds 506 and 516 . However, polyclonal B-cell activation of BALB/c mouse splenocytes was as strong as that of compound 506 . Furthermore, P . gingivalis lipid A had stronger immunoadjuvant and hemagglutinating activities than compound 506 . The absence of ester-linked phosphate at the 4' position and ester-linked fatty acids, and the presence and positions of fatty acids possessing considerable lengths of acyl chains are unique features of P . gingivalis lipid A, and they differentiate this lipid A from enterobacterial and other lipids A . The good balance between endotoxic properties and beneficial immunobiological activities of P . gingivalis lipid A may be attributable to these features. Res Microbiol, 1994 Feb, 145(2), 129 - 39 Phenotypic diversity of anaerobic glycerol dissimilation shown by seven enterobacterial species; Bouvet OM et al.; The anaerobic glycerol pathway was studied in seven enterobacterial species selected as representative of different behaviours in terms of anaerobic glycerol dissimilation . The presence of oxidative and reductive pathways of the dha regulon in Klebsiella pneumoniae enabled the cells to grow fermentatively on glycerol . The first two enzymes of the dha regulon (glycerol dehydrogenase type I and dihydroxyacetone kinase) represent the oxidative branch, while the latter two (glycerol dehydratase and 1,3-propanediol dehydrogenase) represent the reductive branch of glycerol fermentation . The slower utilization of glycerol by K . oxytoca was attributed to low production of 1,3-propanediol . K . oxytoca lacked glycerol dehydratase and demonstrated low 1,3-propanediol dehydrogenase activity . K . planticola and K . ozaenae differed from K . pneumoniae and K . oxytoca in lacking the ability to grow on glycerol . K . planticola lacked both enzymes of the reductive branch of glycerol fermentation, and K . ozaenae possessed glycerol dehydrogenase only . K . rhinoscleromatis and Hafnia alvei, like Escherichia coli, did not possess a dha regulon . The glycerol dehydrogenase type II of H . alvei was distinct from that of E . coli . The phenotypic diversity of anaerobic glycerol dissimilation may have taxonomic applications. Diagn Microbiol Infect Dis, 1994 Feb, 18(2), 129 - 32 Susceptibility of United States clinical trial isolates to cefprozil and cefaclor; Kessler RE et al.; First bacterial isolates (n = 2022) from patients enrolled in the United States cefprozil clinical trials were tested for susceptibility to cefprozil and cefaclor . Cefprozil was two- to eightfold more active than cefaclor against Gram-positive bacteria based on minimum inhibitory concentration (MIC50 and MIC90) values . The differential was greatest, for the most part, for the 80% of isolates of each species with the lowest MICs . Against Gram-negative bacterial species, the two cephalosporins were very similar in activity and MIC90 values ranged from 2 to 8 micrograms/ml for the most prevalent pathogens except Enterobacter spp., which were resistant . The majority of streptococci (98%) were susceptible to < or = 0.5 microgram/ml of cefprozil, and the majority of staphylococci tested (> 90%) were susceptible to < or = 4 micrograms/ml of cefprozil . These results for isolates primarily from community-acquired infections were similar to previously reported results from uncharacterized or hospital-associated isolates. J Bacteriol, 1994 Feb, 176(3), 748 - 55 FimH family of type 1 fimbrial adhesins: functional heterogeneity due to minor sequence variations among fimH genes; Sokurenko EV et al.; We recently reported that the type 1-fimbriated Escherichia coli strains CSH-50 and HB101(pPKL4), both K-12 derivatives, have different patterns of adhesion to yeast mannan, human plasma fibronectin, and fibronectin derivatives, suggesting functional heterogeneity of type 1 fimbriae . In this report, we provide evidence that this functional heterogeneity is due to variations in the fimH genes . We also investigated functional heterogeneity among clinical isolates and whether variation in fimH genes accounts for differences in receptor specificity . Twelve isolates obtained from human urine were tested for their ability to adhere to mannan, fibronectin, periodate-treated fibronectin, and a synthetic peptide copying the 30 amino-terminal residues of fibronectin . CSH-50 and HB101(pPKL4) were tested for comparison . Selected isolates were also tested for adhesion to purified fragments spanning the entire fibronectin molecule . Three distinct functional classes, designated M, MF, and MFP, were observed . The fimH genes were amplified by PCR from chromosomal DNA obtained from representative strains and expressed in a delta fim strain (AAEC191A) transformed with a recombinant plasmid containing the entire fim gene cluster but with a translational stop-linker inserted into the fimH gene (pPKL114) . Cloned fimH genes conferred on AAEC191A(pPKL114) receptor specificities mimicking those of the parent strains from which the fimH genes were obtained, demonstrating that the FimH subunits are responsible for the functional heterogeneity . Representative fimH genes were sequenced, and the deduced amino acid sequences were compared with the previously published FimH sequence . Allelic variants exhibiting >98% homology and encoding proteins differing by as little as a single amino acid substitution confer distinct adhesive phenotypes . This unexpected adhesive diversity within the FimH family broadens the scope of potential receptors for enterobacterial adhesion and may lead to a fundamental change in our understanding of the role(s) that type 1 fimbriae may play in enterobacterial ecology or pathogenesis. Mol Microbiol, 1994 Feb, 11(3), 437 - 48 A plasmid-encoded rfbO:54 gene cluster is required for biosynthesis of the O:54 antigen in Salmonella enterica serovar Borreze; Keenleyside WJ et al.; Previous studies demonstrated that the presence of a 7-8 kb plasmid is correlated with expression of the lipopolysaccharide (LPS) O:54 antigen in several Salmonella enterica serovars . In this study, a 6.7 kb plasmid from a field isolate of S . enterica serovar Borreze was shown to encode enzymes responsible for the synthesis of the O:54 polysaccharide . Curing the plasmid results in simultaneous loss of smooth O-polysaccharide-substituted LPS molecules and O:54 serotype . SDS-PAGE analysis of other O:54 isolates indicated that the O:54 O-polysaccharide can be co-expressed with an additional O-polysaccharide, likely encoded by chromosomal genes . The structure of the O:54 polysaccharide was determined by a combination of chemical and nuclear magnetic resonance (NMR) methods and was found to be an unusual homopolymer of N-acetylmannosamine (D-ManNAc) residues . The polysaccharide contained a disaccharide repeating unit with the structure:-->4)-beta-D-ManpNAc-(1-->3)-beta-D-ManpNAc-(1--> This structure does not resemble other O-polysaccharides in S . enterica . To examine the role played by plasmid functions in synthesis of the O:54 polysaccharide, the 6.7 kb plasmid was cloned to produce a hybrid plasmid (pWQ800) in pGEM-7Zf(+) . In Escherichia coli K-12 delta rfb, pWQ800 directed the synthesis of authentic O:54 polysaccharide . Polymerized O:54 polysaccharide was also produced in S . enterica serovar Typhimurium rfb and rfc mutants . From these data, we conclude that pWQ800 carries the rfbO:54 gene cluster and synthesis of the O:54 polysaccharides does not require host chromosomal rfb functions . However, synthesis of the O:54 polysaccharide requires the function of the rfe and rffE genes which are part of the gene cluster encoding enzymes involved in biosynthesis of enterobacterial common antigen . The rffE gene product synthesizes the O:54 precursor, uridine diphospho-N-acetylmannosamine . This is the first description of a plasmid-encoded rfb gene cluster in Salmonella. Mutat Res, 1994 Feb, 320(3), 207 - 15 Cytotoxicity and DNA damaging potency of chloramphenicol and six metabolites: a new evaluation in human lymphocytes and Raji cells; Lafarge-Frayssinet C et al.; Chloramphenicol (CAP) is an antibiotic which has been implicated in the etiology of aplastic anemia in man . This product is also used in veterinary medicine . The medical use of chloramphenicol has been limited to cases where the drug is indispensible but veterinary use may lead to the presence of residues in the meat of treated animals and it is essential to establish acceptable levels of intake of such residues in order to protect human health . CAP is metabolized into at least 6 metabolites: nitroso-CAP (NO-CAP), formed in the liver, 3 excretion products: the glucuronide (CAP-G), the CAP base (NAPD), and an alcoholic derivative, HAP . Dehydro-CAP (DH-CAP) and the dehydro-CAP base (NPAP) are formed by enterobacteria in the large bowel . The objective of the present study was to investigate (1) the cytotoxicity of CAP and its metabolites and (2) their ability to induce DNA damage in human cells . This work was performed with human peripheral blood lymphocytes (PBL) and with a lymphoma cell line (Raji). Proc Natl Acad Sci U S A, 1994 Jan 18, 91(2), 489 - 93 A cytolysin encoded by Salmonella is required for survival within macrophages; Libby SJ et al.; A Salmonella gene encoding a cytolysin has been identified by screening for hemolysis on blood agar . DNA sequence analyses together with genetic mapping in Salmonella suggest that it is unrelated to other toxins or hemolysins . The gene (slyA) is present in every strain of Salmonella examined, in Shigella, and in enteroinvasive Escherichia coli but not in other Enterobacteriaceae . SlyA (salmolysin) purified from a derivative of the original clone has hemolytic and cytolytic activity and has a molecular weight predicted by the DNA sequence . The median lethal dose and infection kinetics in mice suggest that the toxin is required for virulence and facilitates Salmonella survival within mouse peritoneal macrophages. FEBS Lett, 1994 Jan 17, 337(3), 289 - 92 The novel hexapeptide motif found in the acyltransferases LpxA and LpxD of lipid A biosynthesis is conserved in various bacteria; Vuorio R et al.; Two bacterial acyltransferases (LpxA of Escherichia coli, LpxD of E . coli and Salmonella typhimurium) have previously been shown to consist of a very unusual tandem-repeat structure with tens of repeating hexapeptides (24 hexapeptides in LpxA, 26 in LpxD) . By sequencing LpxD of Yersinia enterocolitica (a distant relative of E . coli and S . typhimurium within Enterobacteriaceae) as well as LpxA of S . typhimurium and Y . enterocolitica, and by analyzing the existing data on these enzymes of Ricketsia rickettsii, it was now shown that the hexapeptide repeat pattern is a very conservative property of these enzymes . Even though the overall homology (allowing equivalent amino acids) between the four proteins was only 59% in LpxA and 58% in LpxD, the homology in the first residue of each hexapeptide was 87% in LpxA and 100% in LpxD . Secondary structure prediction by PredictProtein server suggested a very strong beta strand dominance in all the hexad regions . Accordingly, LpxA and LpxD of various bacterial origins can now be regarded as structurally very unusual enzymes, largely consisting of hexad repeats. Cas Lek Cesk, 1994 Jan 17, 133(2), 56 - 60 {Spiramycin}; Vacek V; Spiramycin is a 16-membered ring macrolide (antibiotic) . It was discovered in 1952 as a product of Streptomyces ambofaciens . As a preparation for oral administration it has been used since 1955, in 1987 also the parenteral form was introduced into practice . The antibacterial action involves inhibition of protein synthesis in the bacterial cell during translocation . Resistance to spiramycin can develop by several mechanisms and its prevalence is to a considerable extent proportional to the frequency of prescription in a given area . The antibacterial spectrum comprises Gram-positive cocci and rods, Gram-negative cocci and also Legionellae, mycoplasmas, chlamydiae, some types of spirochetes, Toxoplasma gondii and Cryptosporidium sp., Enterobacteria, pseudomonads and pathogenic moulds are resistant . Its action is mainly bacteriostatic, on highly sensitive strains it exerts a bactericide action . As compared with erythromycin, it is in vitro weight for weight 5 to 20 less effective, an equipotential therapeutic dose is, however, only double . This difference between the effectiveness in vitro and in vivo is explained above all by the great affinity of spiramycin to tissues where it achieves concentrations many times higher than serum levels . An important part is played also by the slow release of the antibiotic from the tissue compartment, the marked action on microbes in sub-inhibition concentrations and the relatively long persisting post-antibiotic effect . Its great advantage is the exceptionally favourable tolerance-gastrointestinal and general . It is available for parenteral and oral administration.(ABSTRACT TRUNCATED AT 250 WORDS) Cas Lek Cesk, 1994 Jan 3, 133(1), 10 - 4 {Bacterial resistance to antibiotics in the Czech Republic . The Working Group for Monitoring Resistance in the Czech Republic}; Urbaskova P et al.; In 1991 the authors made an investigation on the resistance of clinically important bacteria . Seventeen antibiotic centres in the Czech Republic participated in the investigation . The resistance to antibiotics of 32,567 strains of twelve bacterial species isolated from hospitalized patients depends on 1 . the type of bacteria and antibiotics, 2 . the source (specimen of pathological material) and 3 . the locality (hospital) . The resistance of Staphylococcus aureus to oxacillin with the exception of one hospital is not more than 6%, in rare instances also resistance to vancomycin was encountered . The frequency of resistance of gram-negative rods to so-called reserve antibiotics (cephalosporins of the third generation, quinolones and amikacin) depends markedly on the type of bacteria, being highest in typical causal agents of hospital infections--Enterobacter cloacae, Serratia marcescens, Providencia rettgeri and Pseudomonas aeruginosa . With the exception of cephalosporins the resistance of gram-negative rods and Pseudomonas aeruginosa isolated from urine is much greater than in strains from other clinical materials . The frequency of resistance in faculty hospitals which concentrate patients with more serious diseases is high, the highest resistance was, however, recorded in the North Bohemian area--in pneumococci against penicillin (13%) and in haemophili against ampicillin (17%) . Every hospital is a closed ecological niche with a typical bacterial population and resistance rate . A competent estimate of an adequate and probably effective antibiotic for immediate initiation of treatment of an urgent infection can thus be made only by somebody with close and steady knowledge of the state of resistance in a given hospital. J Postgrad Med, 1994 Jan-Mar, 40(1), 18 - 20 Bacteriological profile of neonatal septicemia cases (for the year 1990-91); Mathur M et al.; Blood culture reports were studied in 1266 cases of clinically suspected neonatal septicemia, to determine the bacteriological profile and antibiotic sensitivity pattern of the cultured isolates . Blood culture was positive in 24.88% of cases . Gram negative septicemia was encountered in 87.1% of these neonates . Klebsiella and Enterobacter species were the predominant pathogens amongst Gram negative organisms . Of Gram positive isolates, Staphylococcus aureus was the predominant isolate (79.0%) . Salmonella species was isolated in 2.4% of these cases. Folia Microbiol (Praha), 1994, 39(6), 582 - 3 Serological difference between Erwinia herbicola strains of plant and human origin; Mraz I et al.; Fifty Erwinia herbicola isolates obtained from host plants were examined in an agglutination reaction with antiserum prepared against E . ananas (E . herbicola) strain CCM 2407 antigen of plant origin and with antiserum prepared against Enterobacter agglomerans strain CNCTC M 269 antigen of human origin . In tests with strain CCM 2407 antiserum, 56% isolates showed a positive reaction, while in tests with strain CNCTC M 269 antiserum only 14% isolates showed a positive reaction . Among E . herbicola isolates which showed a positive reaction with CCM 2407 antiserum 18% showed a positive reaction with the CNCTC M 269 antiserum too . Our results confirmed the serological heterogeneity of E . herbicola population . In spite of the difference in the origin of the two antigens used for the preparation of antisera (plant, human; Japan, Czech Republic) our results indicate that some of our E . herbicola strains and E . agglomerans strain CNCTC M 269 are serologically identical. Am J Surg, 1994 Jan, 167(1), 201 - 6; discussion 206-7 Plasmid labeling confirms bacterial translocation in pancreatitis; Kazantsev GB et al.; To examine whether the gut is a source of infection in acute pancreatitis, bacterial translocation and alterations of intestinal microecology and morphology were studied in 16 dogs . Dogs were colonized with a strain of Escherichia coli (E . coli 6938K) bearing the plasmid pUC4K, which confers kanamycin resistance . In eight dogs (group I), pancreatitis was induced by sodium taurocholate/trypsin injection . Eight other dogs (group II) underwent laparotomy only . The pancreas, mesenteric lymph nodes, peritoneal fluid, liver, and spleen were harvested 7 days later for culturing and histologic analysis . Identification of E . coli 6938K was accomplished by plasmid DNA analysis . Group I dogs had severe pancreatitis and ischemic changes in small bowel mucosa . Group II dogs had no changes . Translocation to the pancreas occurred in five dogs and to mesenteric lymph nodes in six dogs with pancreatitis . No translocation occurred in group II dogs (p < 0.05) . In addition to E . coli 6938K, other gram-negative kanamycin-resistant species were isolated, including E . coli (other than 6938K) and Enterobacter cloacae . Enteric origin of these strains was confirmed by antibiography and plasmid DNA analysis . No overgrowth of cecal gram-negative bacteria was found . This study suggests that the gut is a primary source of infection in pancreatitis and that ischemic damage of intestinal mucosa may promote bacterial translocation. Chemotherapy, 1994 Jan-Feb, 40(1), 30 - 6 Postantibiotic effect, and postantibiotic effect of subinhibitory concentrations, of sparfloxacin on gram-negative bacteria; Odenholt-Tornqvist I et al.; The postantibiotic effect (PAE), the postantibiotic sub-MIC effect (PA SME), and the sub-MIC effect (SME) of a new oral quinolone, sparfloxacin, were determined for different strains of gram-negative bacteria . A PAE was induced by 10 x MIC of sparfloxacin for 2 h and the antibiotic was then eliminated by washing and dilution . The PA SME was studied by adding different sub-MICs during the postantibiotic phase, and the SME by exposing the controls to the sub-MICs alone . Growth curves were followed for 20 h by continuous monitoring of optical density in an automatic incubator . Sparfloxacin induced a PAE of 0.9-2.4 h for all strains except two clinical strains of Enterobacter cloacae . In accordance with earlier experiments with sparfloxacin and gram-positive bacteria, this study showed a PA SME that was nearly equal to the PAE plus the effect of the subinhibitory concentration alone (SME). J Med Microbiol, 1994 Jan, 40(1), 23 - 30 Antibiotic-induced release of endotoxin from bacteria in vitro; Crosby HA et al.; The ability of cefotaxime, ciprofloxacin, piperacillin and tobramycin to cause release of endotoxin was examined in vitro with cultures of Enterobacter cloacae and Escherichia coli . Endotoxin was measured by a quantitative limulus amoebocyte lysate assay and its presence was confirmed by silver staining of the lipopolysaccharide moiety following SDS-PAGE . The morphology of the bacteria during antibiotic exposure was examined by scanning electronmicroscopy . Cefotaxime, ciprofloxacin and piperacillin caused significant endotoxin release, correlating with their ability to affect cell-wall morphology, causing filamentation, wall breakage and cell lysis . In contrast, little endotoxin was released when bacteria were exposed to tobramycin and no morphological changes were observed when bacteria were exposed to bactericidal concentrations of this aminoglycoside . Its antimicrobial spectrum and bactericidal activity make tobramycin an appropriate agent for treatment of sepsis caused by gram-negative bacteria and its lack of propensity to elicit excessive release of endotoxin may avoid exacerbation of endotoxin-related shock in sepsis. J Bacteriol, 1994 Jan, 176(2), 368 - 77 Mutation of flgM attenuates virulence of Salmonella typhimurium, and mutation of fliA represses the attenuated phenotype; Schmitt CK et al.; Salmonella typhimurium ST39 exhibits reduced virulence in mice and decreased survival in mouse macrophages compared with the parent strain SL3201 . Strain ST39 is nonmotile, carries an indeterminate deletion in and near the flgB operon, and is defective in the mviS (mouse virulence Salmonella) locus . In flagellum-defective strains, the flgM gene product of S . typhimurium negatively regulates flagellar genes by inhibiting the activity of FliA, the flagellin-specific sigma factor . In this study, flgM of wild-type S . typhimurium LT2 was found to complement the mviS defect in ST39 for virulence in mice and for enhanced survival in macrophages . Transduction of flgM::Tn10dCm into the parent strain SL3201 resulted in attenuation of mouse virulence and decreased survival in macrophages . However, a flgM-fliA double mutant was fully virulent in mice and survived in macrophages at wild-type levels . Thus, the absolute level of FliA activity appears to affect the virulence of S . typhimurium SL3201 in mice . DNA hybridization studies showed that flgM-related sequences were present in species other than Salmonella typhimurium and that sequences related to that of fliA were common among members of the family Enterobacteriaceae . Our results demonstrate that flgM and fliA, two genes previously shown to regulate flagellar operons, are also involved in the regulation of expression of virulence of S . typhimurium and that this system may not be unique to the genus Salmonella. J Am Geriatr Soc, 1994 Jan, 42(1), 45 - 9 A retrospective review of nosocomial infections in an acute rehabilitative and chronic population at a large skilled nursing facility; Smith MA et al.; OBJECTIVE: This study was undertaken to analyze infection rate, risk for acquisition of infection, and spectrum of infectious disease in two distinct sub-populations within a large, metropolitan, long-term care skilled nursing facility (LTCSNF) . DESIGN: A retrospective chart review over an 18-month period . SETTING: A large, metropolitan LTCSNF . PATIENTS: 786 acute rehabilitative patients and 554 chronic patients . MEASUREMENTS: The study compared infection rate, risk for acquisition of infection, and the microbiology of the most common infections in the two sub-populations . Analyses comparing the infection rate in the rehabilitative population with the infection rate in the chronic population were performed by multiple regression . The dependent variable in these analyses was the number of infections . The length of time that the patient was at risk for infection was included as a covariate . MAIN RESULTS: Approximately 75% of patients in both groups were women . The median age was 80 years in the rehabilitative group, 85 years in the chronic group . Urinary tract infection, pneumonia, skin/soft tissue infection were the most common infections in both groups . Five hundred forty-seven patients in the rehabilitative group and 479 patients in the chronic group had three or more underlying diseases . Enterobacteriaceae organisms were the most common isolates in urinary tract infectious episodes in both groups; mixed flora were the most common isolates for pneumonia and skin/soft tissue episodes in both groups . The calculated rate of infection for the rehabilitative and chronic groups was not significantly different (P = > 0.05) . CONCLUSIONS: In concordance with other studies, urinary tract infection, respiratory infections, and skin and soft tissue infections were the most common in the long-term care facility . Analyses of two distinct populations within a single, large, teaching nursing facility revealed, however, that the rate of infection was not significantly different between the groups and that length of stay or presence of underlying disease was not predictive of infection. Cell Transplant, 1994 Jan-Feb, 3(1), 103 - 6 Bacteremia due to transplantation of contaminated cryopreserved pancreatic islets; Taylor GD et al.; OBJECTIVE . To report two cases of pancreatic islet transplantation-related septicemia, and the results of an investigative protocol to identify potential sources of contamination . DESIGN . Case series . SETTING . University hospital clinical investigational islet transplantation program . RESULTS . The last two of our first seven islet transplantation recipients developed Enterobacter cloacae septicemia within hours of islet infusion . Both had received thawed cryopreserved islet infusions . No source of infection apart from islets could be identified . Pancreas harvesting and islet isolation protocols provided multiple opportunities for contamination . Environmental cultures during a mock islet isolation procedure failed to identify a source of Enterobacter . Previously cryopreserved islet lots were thawed and submitted for culture, 14/47 grew micro-organisms including E . cloacae in four instances . Following revision of protocols for aseptic handling of islets during processing and cryopreservation 55 consecutive pancreata undergoing processing were evaluated; 7 grew micro-organisms on arrival and in 3 cases these persisted through to cryopreservation . CONCLUSION . Two of seven islet transplantation recipients developed septicemia, likely related to infusion of contaminated cryopreserved islets . Using existing technology, for isolating islets from donor pancreata, recipients will remain at risk for this complication . Prevention should entail strict adherence to aseptic technique, and, possibly, use of surveillance microbial cultures during the islet isolation process. J Antimicrob Chemother, 1994 Jan, 33(1), 63 - 72 Effect of antimicrobial therapy on the gastrointestinal bacterial flora, infection and mortality in mice exposed to different doses of irradiation; Brook I et al.; The effect of antimicrobial therapy on gut flora, sepsis, and mortality was investigated in C3H/HeN female mice irradiated with 7.0, 8.0 or 8.5 Gy or 60Co . The antimicrobial agents tested were metronidazole, penicillin, imipenem, gentamicin and ofloxacin . In control mice, the greatest reduction of lactose fermenting organisms (1.7-2.8 logs) occurred on day 8 after irradiation and were related directly to radiation doses . After day 8, lactose fermenting organism levels increased and the increases were associated with mortality due to Enterobacteriaceae sepsis . Irradiation reduced the populations of strict anaerobic bacteria in control mice by 2-8 logs, and these remained at low levels . Treatment with either metronidazole or penicillin resulted in greater reductions of strict anaerobic bacteria than occurred in the controls and induced earlier and greater increases in lactose fermenting organisms and associated mortality . Therapies with either gentamicin or ofloxacin resulted in lesser reductions of strict anaerobic bacteria (1.1-2.2 logs) than occurred in controls, and caused greater decreases in lactose fermenting organisms and mortality . The changes in the bacterial flora and mortality following imipenem treatment were similar to controls . These data demonstrate that in animals exposed to irradiation, antimicrobial agents effective against strict anaerobic bacteria can be deleterious, but antimicrobial agents effective against lactose fermenting organisms may be beneficial. J Antimicrob Chemother, 1994 Jan, 33(1), 169 - 77 Sequential therapy with intravenous and oral cephalosporins; Janknegt R et al.; The pharmacokinetic, economic and practical aspects of sequential therapy with iv and oral cephalosporins are reviewed . New broad spectrum oral cephalosporins, such as cefixime, cefpodoxime proxetil and cefetamet pivoxil achieve serum concentrations above the MICs for most Enterobacteriaceae for at least as long as for parenteral cefuroxime . Substantial cost reductions are possible with an early switch from iv to oral cephalosporins . The clinical studies that have been performed so far have important shortcomings . Well designed clinical studies are necessary to prove the feasibility of sequential therapy with cephalosporins for serious infections in hospitalized patients. J Antimicrob Chemother, 1994 Jan, 33(1), 103 - 10 The comparative pharmacokinetics and tissue penetration of single-dose ciprofloxacin 400 mg i.v . and 750 mg po; Catchpole C et al.; The pharmacokinetics of ciprofloxacin following single doses of 400 mg i.v . and 750 mg po were compared in six healthy volunteers . Concentrations of ciprofloxacin were measured in plasma, cantharides induced blister fluid and urine, by microbiological assay and high performance liquid chromatography (HPLC) . Mean peak plasma concentration was 6.7 +/- 1.4 mg/L after i.v . and 3.9 +/- 1.7 mg/L after oral administration with mean elimination half-lives of 4.2 and 4.0 h respectively . Mean area under the concentration versus time curve (AUC) was greater following oral administration (19.2 +/- 1.1 mg/L.h versus 14.2 +/- 1.1 mg/L.h) . Blister fluid peak concentrations following i.v . and oral administration were 2.6 +/- 1.3 mg/L and 2.28 +/- 1.2 mg/L respectively . The elimination half-life from blister fluid was 4.1 +/- 1.1 h and the AUC 13.8 +/- 1.1 mg/L.h following i.v . administration compared with 4.6 +/- 1.5 h and 20.3 +/- 1.3 mg/L.h for the oral dose . A mean of 50.8% of i.v . administered drug and 39.6% or orally administered drug was excreted in urine in 24 h as measured by HPLC . The corresponding values by microbiological assay were greater, suggesting excretion of active metabolites . Both i.v . and oral doses produced levels in blister fluid concentration above the MICs for most Enterobacteriaceae, Pseudomonas aeruginosa, Haemophilus influenzae and Neisseria spp . at 12 h post dose . The pharmacokinetic data from inflammatory fluid indicate that ciprofloxacin 400 mg i.v . is more equivalent to 750 mg po than the plasma pharmacokinetic data suggest. J Rheumatol, 1994 Jan, 21(1), 115 - 22 Reactive arthritis: incidence, triggering agents and clinical presentation; Kvien TK et al.; OBJECTIVE . To study the incidence and presenting clinical and microbiological features in subgroups of reactive arthritides . METHODS . In a defined community and during a 2-year period, we studied prospectively patients between 18 and 60 years with onset of suspected reactive arthritis, primarily seen by general practitioners . RESULTS . Annual minimum incidence of Chlamydia induced arthritis (n = 25) was 4.6 and of arthritis triggered by enterobacteria (n = 27) 5.0/100,000 individuals between 18 and 60 years . Triggering infections were asymptomatic in 36 and 26%, respectively . Patients with self-limiting arthritis without identified triggering agents (n = 60, incidence 11.0/100,000) had a normal prevalence of HLA-B27 and a more heterogeneous pattern of arthritis . CONCLUSION . Our epidemiological study confirms suggested high incidence rates of reactive arthritides . Reactive arthritides must be considered in early arthritis, even without symptoms of triggering infections. Antimicrob Agents Chemother, 1994 Jan, 38(1), 71 - 8 Molecular characterization of an enterobacterial metallo beta-lactamase found in a clinical isolate of Serratia marcescens that shows imipenem resistance; Osano E et al.; A clinical isolate of Serratia marcescens (TN9106) produced a metallo beta-lactamase (IMP-1) which conferred resistance to imipenem and broad-spectrum beta-lactams . The blaIMP gene providing imipenem resistance was cloned and expressed in Escherichia coli HB101 . The IMP-1 was purified from E . coli HB101 that harbors pSMBNU24 carrying blaIMP, and its apparent molecular mass was calculated to be about 30 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Kinetic studies of IMP-1 against various beta-lactams revealed that this enzyme hydrolyzes not only various broad-spectrum beta-lactams but also carbapenems . However, aztreonam was relatively stable against IMP-1 . Although clavulanate or cloxacillin failed to inhibit IMP-1, Hg2+, Fe2+, or Cu2+ blocked the enzyme's activity . Moreover, the presence of EDTA in the reaction buffer resulted in a decrease in the enzyme's activity . Carbapenem resistance was not transferred from S . marcescens TN9106 to E . coli CSH2 by conjugation . A hybridization study confirmed that blaIMP was encoded on the chromosome of S . marcescens TN9106 . By nucleotide sequencing analysis, blaIMP was found to encode a protein of 246 amino acid residues and was shown to have considerable homology to the metallo beta-lactamase genes of Bacillus cereus, Bacteroides fragilis, and Aeromonas hydrophila . The G+C content of blaIMP was 39.4% . Four consensus amino acid residues, His-95, His-97, Cys-176, and His-215, which form putative zinc ligands, were conserved in the deduced amino acid sequence of IMP-1 . By determination of the amino acid sequence at the N terminus of purified mature IMP-1, 18 amino acid residues were found to be processed from the N terminus of the premature enzyme as a signal peptide . These results clearly show that IMP-1 is an enterobacterial metallo beta-lactamase, of which the primary structure has been completely determined, that confers resistance to carbapenems and other broad-spectrum beta-lactams. Antimicrob Agents Chemother, 1994 Jan, 38(1), 104 - 14 Sequence analysis of PER-1 extended-spectrum beta-lactamase from Pseudomonas aeruginosa and comparison with class A beta-lactamases; Nordmann P et al.; We have determined the nucleotide sequence (EMBL accession number, Z 21957) of the cloned chromosomal PER-1 extended-spectrum beta-lactamase gene from a Pseudomonas aeruginosa RNL-1 clinical isolate, blaPER-1 corresponds to a 924-bp open reading frame which encodes a polypeptide of 308 amino acids . This open reading frame is preceded by a -10 and a -35 region consistent with a putative P . aeruginosa promoter . Primer extension analysis of the PER-1 mRNA start revealed that this promoter was active in P . aeruginosa but not in Escherichia coli, in which PER-1 expression was driven by vector promoter sequences . N-terminal sequencing identified the PER-1 26-amino-acid leader peptide and enabled us to calculate the molecular mass (30.8 kDa) of the PER-1 mature form . Analysis of the percent GC content of blaPER-1 and of its 5' upstream sequences, as well as the codon usage for blaPER-1, indicated that blaPER-1 may have been inserted into P . aeruginosa genomic DNA from a nonpseudomonad bacterium . The PER-1 gene showed very low homology with other beta-lactamase genes at the DNA level . By using computer methods, assessment of the extent of identity between PER-1 and 10 beta-lactamase amino acid sequences indicated that PER-1 is a class A beta-lactamase . PER-1 shares around 27% amino acid identity with the sequenced extended-spectrum beta-lactamases of the TEM-SHV series and MEN-1 from Enterobacteriaceae species . The use of parsimony methods showed that PER-1 is not more closely related to gram-negative than to gram-positive bacterial class A beta-lactamases . Surprisingly, among class A beta-lactamases, PER-1 was most closely related to the recently reported CFXA from Bacteroides vulgatus, with which it shared 40% amino acid identity . This work indicates that non-Enterobacteriaceae species such as P . aeruginosa may possess class A extended-spectrum beta-lactamase genes possibly resulting from intergeneric DNA transfer. Isr J Med Sci, 1994 Jan, 30(1), 120 - 4 Oral complications in bone marrow transplantation patients: recent advances; Garfunkel AA et al.; This paper presents some of the oral aspects encountered in bone marrow transplant (BMT) patients, as reflected in recent research conducted in the Department of Oral Medicine . Oral infections caused by Enterobacteriaceae were found to be responsible for a large proportion of positive cultures, during different stages of the transplantation process . Mucositis was constantly detected concomitant with the infections . It correlated with granulocytopenia and fever . The mucositis improved together with the immune system reconstitution . Immunoglobulins in saliva of BMT patients showed a drastic reduction following the patients' conditioning protocol and a return to normal levels soon after the transplantation . IgA, IgM and IgG were studied . Saliva was also shown to play an important role in the fibrinolytic system, through its plasminogen activator inhibitory contents . It seems that the active molecules are contained in the oral epithelial cells. J Clin Microbiol, 1994 Jan, 32(1), 139 - 42 Differentiation of distribution systems, source water, and clinical coliforms by DNA analysis; Edberg SC et al.; During a 2-week period, Enterobacter cloacae was isolated from throughout the water distribution system in New Haven County, Connecticut . There was no forewarning of this event and no apparent reasons for it . Several epidemiologic and public health questions required rapid answers . Were these E . cloacae isolates the result of treatment failure and breakthrough or was regrowth occurring within the system? Did the E . cloacae isolates represent a health threat and were they causing infection? Pulsed-field gel electrophoresis utilizing whole-cell DNA digestion with restriction endonuclease SpeI permitted the rapid generation of specific information to answer these questions . Gel bands were stained with ethidium bromide and photographed with UV illumination . Homogeneity among isolates was confirmed by repeat digestion with XbaI . From each of the water distribution isolates, a single pattern of restriction endonuclease fragments was generated, indicating that only one clone of E . cloacae was in the distribution system . There was no homogeneity between source and distribution water E . cloacae isolates . Moreover, E . cloacae clinical isolates from patients from New Haven area hospitals showed no identity with E . cloacae isolated from the distribution system . Therefore, pulsed-field gel electrophoresis DNA analysis demonstrated that the E . cloacae from the distribution system was the result of a regrowth bloom within the system and not the result of treatment failure and that this clone was not causing a public health risk. Acta Paediatr Suppl, 1994, 396, 86 - 90 Necrotizing enterocolitis prophylaxis: oral antibiotics and lyophilized enterobacteria vs oral immunoglobulins; Fast C et al.; We conducted a prospective randomized trial to compare the efficacy of oral gentamicin versus oral IgA-IgG for the prophylaxis of necrotizing enterocolitis (NEC); 200 newborns considered at high risk for NEC were assigned to group A (oral IgA-IgG, n = 100) or group B (oral Gentamicin, n = 100) . NEC was diagnosed in 13 cases in group A and in 1 case in group B between the 3rd and 16th days of life . Surgical treatment was necessary in 3 cases (2 in group A) . All infants survived . We conclude that oral gentamicin is more effective than oral IgA-IgG in the prevention of NEC in infants at high risk. Acta Paediatr Suppl, 1994, 396, 45 - 8 A study of pre-antibiotic bacteriology in 125 patients with necrotizing enterocolitis; Chan KL et al.; Over a five-year period, 125 newborns with necrotizing enterocolitis (NEC) were managed by us . Their mean birthweight was 1700 g and mean maturity was 32 weeks . Before commencement of antibiotics, routine septic work-up was done in order to define the bacterial spectrum and antibiotic sensitivity . The study includes aerobic and anaerobic cultures of gastric and pharyngeal aspirates, blood cultures, umbilical swabs and culture of umbilical catheter tips in relevant cases . Peritoneal swab results were also analyzed if laparatomy was performed . Positive cultures were present in 45 patients (36%) with 55 positive specimens . Fifteen types of organism were isolated: the commonest was Enterobacter (29%), followed by E . coli (14.5%) and Klebsiella (13%) . They were resistant to ampicillin and first-generation cephalosporin . These organisms were usually opportunistic pathogens . Overgrowth of them may be the cause of NEC . Regular review of the antibiotic sensitivity of these organisms allows prompt and appropriate choice of antibiotics . At the same time, antibiotic sensitivity for these organisms was analyzed to guide us in the choice of antibiotic therapy. East Afr Med J, 1994 Jan, 71(1), 14 - 20 Childhood bacterial meningitis beyond the neonatal period in southern Nigeria: changes in organisms/antibiotic susceptibility; Akpede O et al.; Of 253 culture proven cases of bacterial meningitis in infants aged over a month and children up to one year old in Benin City, Nigeria, from 1985-1990, 49.8% were due to N . meningitidis, 21.4% S . pneumoniae, 15.4% H . influenzae and 13.4% other organisms, including S . aureus and enterobacteriaceae . Compared to the period 1974-1984 in Southern Nigeria, N . meningitidis has replaced S . pneumoniae as the commonest organism . N . meningitidis was relatively infrequent below two years of age while H . influenzae was rare after five years . Approximately half of isolates of S . aureus and enterobacteriaceae were in infants aged six months or less . The proportions of sensitive strains of three common organisms to three commonly used drugs were chloramphenicol (95.3%) > ampicillin (83.9%) > penicillin (67.6%) . Resistance to penicillin has increased while simultaneous resistance to ampicillin and chloramphenicol has emerged as a new problem among the three common bacteria . It is concluded that although the combination of ampicillin and chloramphenicol is still reasonable for initial "blind" therapy of meningitis, the emergence of multiple drug resistance suggests the need for consideration of a revision of current practice . The third generation cephalosporins are suggested as a suitable alternative. Klin Lab Diagn, 1994, (1), 51 - 2 {Errors in the microbiologic diagnosis of shigellosis}; Rubinov GE et al.; The authors analyze the diagnostic errors that occurred at bacteriologic laboratories of one of the districts of Russia and that led to misrepresentation of the true etiologic structure of acute enteric infections and therefore to useless ineffective antiepidemic measures . They emphasize strict adherance to a certain order of stages of laboratory diagnosis and to methodologic recommendations on microbiologic diagnosis of diseases induced by enterobacteria. Klin Lab Diagn, 1994, (1), 50 - 1 {Comparative assessment of two test systems for identification of enterobacteria}; Lazareva EB et al.; Ninety-seven enterobacterial isolates from patients were identified parallel by Enterotest and MMT E1, a new test system developed in Russia . Enterotest helped identify 97% of enterobacterial strains, MMT E1 86.6% . The results coincided in 83.5% of cases . Enterotest system often failed to demonstrate reaction to phenylalanine, this impeding Proteus identification . Some tests failed in MMT E1 as well . Elimination of these shortcomings will improve the reliability of the test systems and permit their wider use at practical clinical microbiology laboratories. Adv Perit Dial, 1994, 10, 85 - 8 Abdominal wall hernias in ESRD patients receiving peritoneal dialysis; Suh H et al.; The study was designed to investigate the incidence of abdominal wall hernias (AWH) and related outcome in all end-stage renal disease (ESRD) patients who started peritoneal dialysis (PD) from January 1989 to December 1993 . Between January 1989 and December 1993, a total of 158 ESRD patients (93 male, 65 female) entered our home program and were treated with peritoneal dialysis (PD) over 2789 patient-months . All PD catheters were placed in the lateral by two dedicated surgeons . AWH detected at the time of PD catheter placement was repaired simultaneously . The hernia repair was done using a polypropylene mesh . Inguinal hernias were noted by patients as a mass or discomfort . Umbilical and incisional hernias were observed during clinic visits . Twenty-one (13.3%) abdominal wall hernias were observed in 20 patients (12.7%) . Eight (38.1%) inguinal hernias occurred in 8 male patients . Six inguinal hernias were repaired . PD was resumed after a mean of 12 days of hernia repair . Two patients resumed PD in 8 and 14 days without dialysis . One patient transferred to hemodialysis (HD) due to catheter malfunction . No complications occurred related to inguinal hernias . Ten (47.6%) umbilical hernias were observed in 10 patients (7 male, 3 female) . The strangulation of umbilical hernias occurred in 2 patients, which required emergency small bowel resection and hernia repair . Both cases were complicated by candida peritonitis and enterobacter peritonitis, requiring PD catheter removal, and patients were then transferred to HD . Three (14.3%) incisional hernias were observed in 3 male patients . Two incisional hernias were repaired . No relation between AWH and PD modalities (CAPD/CCPD/IPD) was observed.(ABSTRACT TRUNCATED AT 250 WORDS) J Med, 1994, 25(3-4), 129 - 44 Microaerophilic streptococci as a significant pathogen: a twelve-year review; Brook I et al.; One hundred twenty three microaerophilic streptococci (MS) were isolated from 4,603 specimens submitted for the identification of anaerobic bacteria over the course of 12 years . The MS included 16 Streptococcus constellatus, 43 Streptococcus intermedius and 21 Gemella morbillorum . A total of 81 MS isolates (66%) identified from 75 patients were considered to cause infection . Predisposing or underlying conditions were noted in 48 (64%) patients . The most common conditions were previous surgery (15 instances), trauma (10), diabetes (9), immunodeficiency (6), malignancy, and prosthetic device (5 each) . MS were the only bacterial isolates in 23 instances . Mixed infection was encountered in 52 (69%) patients, where the number of isolates varied between two and five (average 2.7) . The organisms most commonly isolated with MS were anaerobic cocci, Bacteroides sp . and Enterobacteriaceae; their recovery varied at different sites . Significant infections caused by MS were associated with abscess (29 instances), sinuses (7), obstetrical and gynecological (OBG), chest and wounds (6 each), abdominal (5), and biliary infection (4) . Antimicrobial therapy as administered to 71 patients; for 43 patients, in conjunction with surgical drainage or correction . Surgical drainage alone was performed in three patients . Four patients (5%) died . These data illustrate that MS can occasionally be associated with serious infection. Med Dosw Mikrobiol, 1994, 46(1-2), 67 - 71 {Bacterial flora in urinary tract infections of children and susceptibility to drugs}; Pawluch D et al.; The material consisted of 902 strains isolated from children with urinary tract infection with significant bacteriuria . Among isolated strains, Enterobacteriaceae consisted 67.4%, Gram-positive cocci 18.8% and non-fermenting Gram-negative bacilli (both against Gram-negative bacilli and Gram-positive cocci), appeared aminoglycosides and III generation cephalosporins (from 63 to 83% of susceptible strains) . K . pneumoniae and P . aeruginosa were most resistant to antimicrobials tested . The authors point out that empiric antibiotic therapy of bacterial urinary tract infections in children which is not preceded by identification of the pathogen and determination of its drug susceptibility, can be ineffective in over 50% of cases. Med Dosw Mikrobiol, 1994, 46(1-2), 47 - 50 {"Dermomedium" test for evaluation of microorganism count from utilizable surfaces and skin}; Muszynski Z et al.; The study was aimed at determination of usefulness of a set "dip-Slide" for quantitative evaluation of bacterial contamination of skin and utilizable surfaces in comparison with traditional methods of taking smears . Investigation were carried on by application of test strains of E . coli, P . aeruginosa, P . mirabilis, Enterobacter sp . and S . aureus . It was established that application of the set "Dermomedium" brings results comparable to traditional methods, but is cheaper and easier in practice. Klin Lab Diagn, 1994, (4), 35 - 6 {Assessment of a multimicrotest system for biochemical identification of enterobacteria (MMT E1) in a controlled epidemiological experiment . I}; Ugrimov SA et al.; Comparative evaluation of a system of multimicrotests for biochemical identification of enterobacteria (MMT E1) developed at the ALLERGEN Research and Production Amalgamation and of tube tests for the same purpose in a controlled epidemiologic experiment has shown that the suggested system meets the requirements to such diagnostic preparations by all the major qualitative parameters (compatibility and reproducibility of the test results) . Practical use of MMT E1 system will simplify and facilitate the process of enterobacteria identification. Infection, 1994, 22 Suppl 2, S99 - 104 Prevalence of ciprofloxacin resistance in multiresistant gram-negative intensive care unit isolates; Khurana CM et al.; Of 107 gram-negative isolates obtained from intensive care units examined for patterns of multiresistance to 16 antimicrobial agents, 54.2% were multiresistant, defined as resistant to three or more test antimicrobials . Ciprofloxacin had excellent activity against all isolates with 93.4% susceptibility . Ciprofloxacin also performed well on multiresistant isolates with 89.7% susceptibility, which included 42.2% inducible Enterobacteriaceae . All six multiresistant ciprofloxacin-resistant isolates were re