Postgrad Med J, 1979, 55 Suppl 4, 12 - 6 In vitro activity and pharmacokinetics of cefaclor in normal volunteers and patients with renal failure; Levison ME et al.; In both Mueller-Hinton agar (MHA) and antibiotic medium no . 1 (AB1) cefaclor was more active than cephalothin or cephalexin against Enterobacteriaceae . Its activity was equivalent to cephalexin against S . aureus in MHA . Cefaclor was particularly active against P . mirabilis . The activity of this antibiotic was greated in AB1 than in MHA . The inoculum effect was pronounced for cefaclor when compared with cephalothin, but cefaclor retained greater activity even against the higher inoculum . In volunteers with normal renal function, cefaclor produced slightly lower blood levels than those reported for cephalexin . Absorption after eating was decreased and delayed . Despite severe renal failure, substantial urine levels of antibiotic were still achieved . In contrast to cephalexin, plasma half-life for cefaclor was only moderately prolonged by renal failure (two-to-threefold) and only minimally shortened by haemodialysis . Adequate concentrations of cefaclor in sputum, active against common respiratory pathogens, could not be consistently demonstrated after the oral administration of a 1 gram dose of cefaclor. Zentralbl Gynakol, 1979, 101(23), 1489 - 94 {Common antigen for serological detection of urinary tract infections during pregnancy (author's transl)}; Naumann G et al.; All urinary tract infections cannot be safely detected by bacterial urine testing during pregnancy . Therefore, the question was studied whether detection of antibody to the "enterobacterial common antigen" (ECA) might be important to screening of pregnant women for urinary tract infections . Tests were applied to 202 sera obtained from 42 pregnant women with urinary tract infection, with pathological titres having been recorded from 21.8 per cent.--Detection of antibody to ECA, consequently, is not believed to be helpful in improving diagnosis of urinary tract infections during pregnancy. Arzneimittelforschung, 1979, 29(12a), 1967 - 9 Cerebrospinal fluid penetration of mezlocillin; Modai J et al.; The passage of 6-{(R)-2-{3-methylsulfonyl-2-oxo-imidazolidine-1-carboxamido}-2-phenyl-acetamido)-penicillanic acid sodium salt (mezlocillin, Baypen), into the CSF was studied in 9 patients with symptoms of acute meningitis, presumed to be of viral origin . The antibiotic was given as a single 5 g dose i.v . over 30 min . The CSF/serum concentration ratio of mezlocillin showed a variation from 0 to 10.7% . The antibiotic could be effective in the treatment of bacterial meningitis caused by ampicillin-resistant strains of Haemophilus influenzae and by most Enterobacteriaceae, provided these results will be confirmed by a study now in progress . In one patient suffering from meningococcal meningitis this concentration ratio varied between 72% (day 3) and 54% (day 12). Arzneimittelforschung, 1979, 29(12a), 1934 - 7 Synergistic action between sisomicin and mezlocillin against gram-negative bacteria and Staphylococcus aureus; Soares LA et al.; The combined effect of sisomicin and 6-{(R)-2-{3-methylsulfonyl-2-oxo-imidazolidine-1-carboxamido}-2-phenyl-acetamido-a1-penicillanic acid sodium salt (mezlocillin, Baypen) was studied against 50 bacterial strains, including Pseudomonas aeruginosa, Proteus spp . Klebsiella-Enterobacter, E . coli and Staphylococcus aureus . No antagonism or indifference was detected with the strains studied . Both antibiotics were synergistic against 62% of the strains, and partially synergistic against 38% . Out of the bacteria studied, Staphylococcus aureus was the most susceptible to the combined action of sisomicin and mezlocillin. Anat Anz, 1979, 146(3), 285 - 94 {Microbiological monitoring of embalmed cadavera during dissection courses (author's transl)}; Wewalka G et al.; Microbiological monitoring of normal anatomical specimens was done in order to evaluate results which were obtained in a investigation of decay of embalmed cadavera . The process of decay was characterized by massive colonisation with enterobacteria and aerobic sporeformers . Under normal conditions mainly germs from skin and air are cultivated from surfaces of anatomical specimens, but only in small numbers . The number of germs is increased after periods of intensive preparative work . The results show that the main criterion for the microbiological quality of embalmed cadavera is resistency against external germs during course work . This is to be achieved by consequent preventive measures in the dissection laboratory. Padiatr Padol, 1979, 14(4), 469 - 75 {Septic arthritis and osteomyelitis as a complication of neonatal intensive care (author's transl)}; Muller WD et al.; In a prematurely born infant of a diabetic mother a purulent arthritis with osteomyelitis of the elbow occurred 18 days after an enterobacter aerogenes-septicemia was proved . Enterobacter (aerobacter) aerogenes is a nosocomial gramnegative germ, that is more and more regarded responsible for infection of the newborn in intensive care units . In accordance with the literature recording a high rate functional loss after septic arthritis also our patient suffered from a mobility deficiency in his right elbow a year after the onset of the disease. Ann Biol Clin (Paris), 1979, 37(4), 221 - 3 {Use of the API 20E system for rapid identification of Enterobacteriaceae (six hours) (author's transl)}; Pinon G et al.; The authors propose a modification of the method of use of the API 20E system permitting more rapid identification of Enterobacteriaceae within six hours (3 hours preculture and 3 hours incubation on an API 20E plate) it was possible to identify correctly 67% of 192 strains studied at species level and 75.5% studied at generic level . One may note four mistakes (2.1%) of which 3 were minor, (species within the same genus) . The construction of a base of numerical data adapted to the technic within six hours would no doubt permit us to reduce the percentage undetermined. Acta Chir Scand, 1979, 145(6), 411 - 3 Contamination with enterobacteria and postoperative wound infection after appendicectomy; Nystrom PO; The impact of contamination on wound infections was investigated in 120 patients undergoing appendicectomy for appendicitis . A quantitative sample for culture of enterobacteria was obtained from the subcutaneous wound with the velvet pad imprint technique . Average number of enterobacteria (CFU) in the would was 1.2 logarithms higher in operations for gangrenous appendices and 2.3 logarithms higher in perforated appendices compared to flegmonous appendices . Infection rate was 2.5% in flegmonous, 10% in gangrenous and 27.5% in perforated appendices . The results focus the close relation between contamination and subsequent infection. Infection, 1979, 7(5), 226 - 30 Bacteroides fragilis in acute salpingitis; Soderberg G et al.; The bacteriology of acute salpingitis was studied in 87 patients . Gonococci were recovered from 18 patients . Lower yields of bacteria were isolated in the peritoneal fluid than from the vaginal cultures, and a poor correlation was observed between the peritoneal fluid and vaginal cultures . Anaerobic bacteria dominated in both sites . Staphylococci, streptococci, enterobacteria, peptostreptococci, peptococci, lactobacilli and bacteroides normally present in the vagina were the predominant isolates recovered from the culdocentesis . Paired acute and convalescent-phase sera obtained from patients with isolates of Bacteroides fragilis were assayed for antibody response to the polysaccharide antigen of B . fragilis . Significant titer increases were observed in sera from only two out of eight patients with non-gonococcal salpingitis and no titer changes were noticed in two patients with gonococcal . These findings suggest that B . fragilis only infrequently plays an etiologic role in acute salpingitis. Infection, 1979, 7(3), 113 - 8 Bactericidal or bacteristatic effects of two sulphonamide plus trimethoprim preparations in human urine; Broughall JM et al.; Rrine collections were made by ten volunteers taking cotrimoxazole and a sulphamoxole/trimethoprim combination on a cross-over basis . The latter was given in approximately half the dose of cotrimoxazole . Following collection of urine and its sterile filtration, the trimethoprim and sulphonamide concentrations were estimated . The urines were then inoculated with various species of Enterobacteriaceae whose minimum inhibitory concentrations had been previously determined . The viable counts in these urines were followed for 24 hours and from these the times to kill 90% of bacteria were calculated . These were very reproducible for any one experiment but showed no correlation with drug concentration, source of the urine or organism sensitivity, except for one organism which had high resistance to both sulphonamide and trimethoprim . When the organism was sensitive to at least trimethoprim a slow bactericidal effect was generally seen with either combination . We concluded that in this type of experiment the higher dosed combination showed no advantage contrary to a previous report, but in agreement with another . This brings into question the current dosage regime of cotrimoxazole when used to treat urinary tract infections in that its higher dosage over certain other sulphonamide/trimethoprim combinations appears to confer no advantage in our experiments. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1979 Jan-Mar, 24(1), 33 - 8 {Sensitivity to chemotherapeutic agents of bacteria isolated from generalized infections}; Voiculescu C et al.; A study carried out on 206 bacteriemia infections showed that: the following bacterial flora was implicated in the etiology of bacteremia infections: Staphylococcus aureus in 28.6% of cases, Staphylococcus albus in 20.4% Enterobacteriaceae in 25.7% and Pseudomonas in 3.8%; an increase existed in the number of generalized infections caused by opportunists belonging to the Enterobacteriaceae family and Pseudomonas genus . Similarly, an increase in the resistance to the recently introduced antibiotics, Septrin and Gentamycin, was noted . These observation require antibiotic lebel control and, if it is necessary the association of two or more antibiotics in severe infections. Am J Vet Res, 1979 Jan, 40(1), 35 - 9 Characterization of endotoxin from the rumen bacterium Megasphaera elsdenii; Nagaraja TG et al.; Phenol-water extraction of Megasphaera elsdenii, a predominant gram-negative coccus in rumens of cattle fed high-grain diets, yielded material that exhibited typical characteristics of endotoxin . The extract was lethal to mice and to chicken embryos, caused biphasic fever in rabbits, leukopenia in mice, and local and generalized Shwartzman reactions; and induced tolerance to the lethal effect of the endotoxin in mice . The material contained carbohydrate, protein, lipid, phosphorus, and 2-keto-3-deoxyoctonate, but no nucleic acid . The beta-hydroxymyristic acid was absent . Results imply that M elsdenii endotoxin has many biological and chemical characteristics common to enterobacterial endotoxin . However, the median lethal doses in mice and in chicken embryos, and minimal dose required to elicit a local Shwartzman reaction, indicate that M elsdenii endotoxin's potency is low, which may explain why the large gram-negative bacterial population in the rumen of cattle is generally innocuous. Infection, 1979, 7 Suppl 2, S225 - 7 {In vitro testing of newer cephalosporins (author's transl)}; Linzenmeier G et al.; The spectrum of activity of the newer cephalosporins is considerably wider and includes a number of gram-negative bacteria . Test results using cephalothin as 'class disc' of a class of antibiotics is therefore no longer valid for the newer members . Like cefazoline, all of the above-mentioned antibiotics are more effective against Escherichia coli . Cefuroxin and cefoxitin also display increased effectiveness against Klebsiella, as do cefoxitin against Serratia and indolpositive Proteus species, and cefamandole and cefuroxime against Enterobacter . Cefotaxim is superior to all other agents, as was also demonstrated in our own inhibition zone tests; in addition cefotaxim is effective against Pseudomonas aeruginosa . Since the various pathogens do not exhibit a uniform pattern of resistance to these antibiotics, the four new agents should for the time being be tested independently of cephalothin and cefazoline. Infection, 1979, 7 Suppl 6, 527 - 31 {Resistance of gram-negative bacteria against cefaclor and other antibiotics (author's transl)}; Schassan HH; Five hundred and eighty-six strains of eight species of Enterobacteriaceae were tested for their resistance against cefaclor, cefamandole, cephalothin, ampicillin, mezocillin, tetracycline and co-trimoxazole . Cefaclor showed a low rate of resistance against Escherichia coli (1.2%), Klebsiella (2%) and Proteus mirabilis (3.1%), but a high rate of resistance against indole-positive Proteus species (60%) and Serratia (80%) . Cefamandole was also effective against cefaclor and ampicillin resistant strains . Multiresistant strains were predominant especially amongst Enterobacter, Serratia and indole-positive Proteus species . Of 266 ampicillin resistant strains, 198 strains (74.4%) proved to be sensitive to cefaclor . Among the orally administered antibiotics cefaclor exhibited the best result with 12.1% resistant strains compared to 14.8% strains resistant to co-trimoxazole and 45.4% resistant to ampicillin. Zentralbl Bakteriol Naturwiss, 1979, 134(7), 611 - 6 {On the contamination of the citric acid fermentation . II . Sodium 5-nitrofurylacrylate as an antiseptic against representatives of the Enterobacteriaceae (author's transl)}; Leopold H et al.; In context with the first communication which deals with the characterization of the so-called brown contamination called forth by Enterobacteriaceae in the citric acid fermentation of molasses, the present paper describes the screening of antiseptic substances able to suppress the contamination mentioned without damaging the normal growth of the producing mould Aspergillus niger and its ability of producing citric acid . Among the substances tested the sodium salt of 5-nitrofurylacrylic acid (5-NFA) excelled partly because of its antiseptic effect in relatively small concentrations and partly because the mould tolerates appreciable amounts of this antiseptic . Therefore there may be applied, in the presence of a heavy contamination, relatively high concentrations of the antiseptic without fear of damaging the producing mould . Usually a dose of 10 to 15 mg 5-NFA in 11 of medium was sufficient to suppress the brown contamination. Zentralbl Bakteriol Naturwiss, 1979, 134(7), 604 - 10 {On the contamination of the citric acid fermentation . I . The contamination by representatives of Enterobacteriaceae (author's transl)}; Leopold H et al.; Among the most dangerous bacterial contaminations of the citric acid fermentation is the so-called brown contamination, which is called forth by non pathogenic representatives of Enterobacteriaceae like Escherichia coli, Aerobacter aerogenes, Enterobacter cloacae and Proteus vulgaris, while other bacteria do not produce the mentioned contamination . There is given a comprehensive characterization of the brown contamination . Enterobacteriaceae interrupt the growth of the mycelium of the mold Aspergillus niger and stop the production of citric acid, produce a characteristic repugnant smell and reduce nitrate to nitrite . In a case of weak contamination the phenomena of the brown contamination do not appear, but the yield of citric acid is rather low . The contamination may be transferred successfully within the first 24 hrs . of incubation . The effect of the bacteria is determined by their virulence and some other factors. Postgrad Med J, 1979, 55 Suppl 4, 22 - 9 Summary of laboratory studies on the antibacterial activity of cefaclor; Preston DA; Laboratory aspects of cefaclor, a new orally-effective cephalosporin antibiotic, are summarized . On the basis of data from a variety of studies, the useful antibacterial spectrum of cefaclor is shown to include all classes of bacteria that are generally susceptible to cephalothin and cephalexin . Against many Enterobacteriaceae, Haemophilus sp . and Streptococcus pneumoniae, cefaclor has a significant potency advantage over cephalexin . Bacteria that are susceptible to cefaclor are killed by concentrations at or near the inhibitory concentration . In vitro enzymatic hydrolysis experiments have shown that cefaclor is a relatively good substrate for several beta-lactamases . Orally administered cefaclor is effective in protection of mice from the lethal effects of intraperitoneal challenges with cefaclor-susceptible bacteria . The chemical instability of cefaclor, test medium composition and inoculum density influence the results of in vitro susceptibility tests with cefaclor . Methods for routine susceptibility testing are described. Zentralbl Bakteriol Naturwiss, 1979, 134(5), 402 - 11 Differential survival of Salmonella typhi, Escherichia coli, and Enterobacter aerogenes on lettuce in the field; Ercolani GL; Artificial contamination of young lettuce plants with Salmonella typhi (ST), Escherichia coli (EC), and Enterobacter aerogenes (EA) in the field in winter and summer resulted in presence of the pathogen and increased density of the two indicator bacteria (IB) in harvested produce . Viable counts of the three bacteria/g fresh weight declined at a decreasing rate with increasing time after contamination . The overall pattern of variation of the ST/IB ratio was correlated more closely with changes in the ST/EA than in the ST/EC ratio values . When viable counts were expressed as a proportion of the contaminating dose at different times after contamination, however, a closer similarity existed between ST and EC than between ST and EA values throughout winter and through the early part of summer experiments. Infection, 1979, 7 Suppl 4, S359 - 66 Development of sulphonamide-trimethoprim combinations for urinary tract infections . Part I: Comparison of the antibacterial effect of sulphonamides alone and in combination with trimethoprim; Ekstrom B et al.; Plasma half life and in vitro activity were major criteria for selection of sulphonamides which are likely to give a strong synergistic action with trimethoprim in vivo . On the basis of literature data six sulphonamides, sulphadiazine, sulphachloropyridazine, sulphamethoxazole, sulphaisodimidine, sulphamerazine and sulphamethomidine appeared particularly suitable for combination with trimethoprim . An investigation of the activity in vitro of these compounds and their combinations with the latter against clinically isolated, sulphonamide-sensitive Klebsiella-Enterobacter and Escherichia coli strains showed optimal synergy at trimethoprim-sulphonamide ratios between 1:10 and 1:40, but that appreciable mutual potentiation occurred within a rather broad range of concentration ratios . Limited experiments indicated that synergy occurs less frequently and is less pronounced against sulphonamide resistant bacteria . The different sulphonamides behaved rather similarly in their combinations with trimethoprim, and in order to find the best sulphonamide, detailed comparisons of the pharmacokinetic properties of the different combinations are necessary. Infection, 1979, 7 Suppl 4, S321 - 3 The effect of trimethoprim-sulphonamide, trimethoprim and sulphonamide on the occurrence of resistant enterobacteriaceae in human intestinal flora; Knothe H; After the administration of various antimicrobial agents for chemotherapeutic purposes a general change in the intestinal flora of the patient is often observed . In contrast, the combination trimethoprim-sulphonamide causes in most cases a strong selective decrease in the number of Enterobacteriaceae organisms for treatment periods as long as four to 12 weeks . The results correspond to clinical experience with trimethoprim-sulphonamide therapy in urinary tract infection where reinfections with resistant organisms are the exception. Infection, 1979, 7(5), 237 - 9 In vitro comparison of synergism between cefamandole and gentamicin or tobramycin by the triple layer agar method with enzymatic inactivation; Yourassowsky E et al.; A synergistic effect was shown with gentamicin and tobramycin by means of a triple layer agar technique and enzymatic inactivation of cefamandole after only four hours' incubation . When the strain is sensitive to cefamandole and aminoglycosides, synergy is observed against all the strains studied (Staphylococcus aureus, Proteus, Klebsiella, Escherichia coli, Enterobacter, and Haemophilus influenzae) . No significant difference was noted between the cefamandole-tobramycin and the cefamandole-gentamicin combinations when the microbial strains were sensitive to the three antibiotics. Avian Dis, 1979 Jan-Mar, 23(1), 179 - 93 Evaluation of several methods of detecting salmonellae in groups of chickens; Weinack OM et al.; Chickens exposed experimentally to Salmonella agona, S . blockley, S . enteritidis, S . infantis, and S . typhimurium were tested serologically by microagglutination and microantiglobulin procedures and culturally by cloacal swabs and environmental samples . Chicks infected at one day old yielded the highest level of positive cloacal swab cultures, whereas exposure of older birds gave maximal serologic titers . Recovery of salmonella from environmental samples is dependent on a number of factors, including excretion rate by the population and survival rate of salmonellae in the environment . Serologic titers persisted after salmonellae could no longer be isolated from cloacal swabs or environmental samples . The possibility of false-positive serologic reactions was explored in two groups of chickens, one exposed to other Enterobacteriaceae, and one composed of eight specific-pathogen-free flocks . Occasional serologic microantiglobulin titers were observed only in the latter group . Extensive culturing of the environment from these flocks had negative results. Scand J Plast Reconstr Surg, 1979, 13(1), 63 - 7 The prevention of wound infections in burn patients; van Saene HK et al.; To investigate the necessity of "protective isolation" and/or gastrointestinal tract decontamination in the prevention of infections in burn patients treated under ward conditions, a bacteriological inventory of burn sites, oropharynx and faeces was made 3 times a week . The origin of bacteria isolated from the lesions was determined by typing . In addition, the effect of local protection by topical application of silver-sulphadiazine or nitrofuralum was investigated . Of potentially pathogenic bacteria known to cause infections in burn, St . aureus was found to be almost exclusively exogenous in origin . Str . pyogenes, on the other hand, appeared either to be strongly inhibited by topical treatment or else to have colonized the wounds only from endogenous sources . Endogenous (gi-tract) Enterobacteriaceae biotype-positive samples were restricted to burn sites near the mouth and the anus . Enterobacteriaceae biotypes of exogenous origin appeared to colonize wounds of about one third of the patients . It is concluded that topical protection is insufficient in the prevention of bacterial colonization of the lesions . Therefore, protective isolation (St . aureus, etc.) and selective gastrointestinal decontamination are to be considered for infection prevention. Zh Mikrobiol Epidemiol Immunobiol, 1979 Jan, (1), 69 - 74 {Detection and study of the labile toxic factor of Proteus mirabilis}; Efimov GE; The author studied the dynamics of toxin formation of the high- and low-virulent Pr . mirabilis strains . The high-virulent strain produced toxic substances of the exotoxin type detectable in 1-2-day broth cultures . Later the activity of the culture medium of both cultures under study was due to substances of the endotoxin type . By physico-chemical and immunobiological properties, and also by chemical composition of Pr . mirabilis "early toxin" was similar to the exoenterotoxins of enterobacteria . A principal possibility of concentration and purification of Pr . mirabilis "early toxin" with the use of ultrafiltration and gel-chromatography was demonstrated. Zh Mikrobiol Epidemiol Immunobiol, 1979 Jan, (1), 64 - 8 {Distribution of pathogenic enterobacteria in the water of open reservoirs}; Rusnak BS et al.; Investigations carried out indicated that the main source of microbial contamination of open reservoirs were effluents often drained without any purification and disinfection . Salmonellae were isolated in 10.6 +/- 0.88% of the water samples examined in the Southern regions of the country . Isolation of pathogenic enterobacteria from the water of open reservoirs was seasonal, with the maximal percentage in winter and in spring, this being connected with delay of self-purification processes in the cold seasons of the year . Serovars isolated from water and patients proved to be identical . There was no direct correlation between the coli index and the isolation of pathogenic enterobacteria. Rev Infect Dis, 1979 Jan-Feb, 1(1), 165 - 9 Therapy of skin, soft tissue, and bone infections with cefoxitin sodium; Perkins RL et al.; Twenty-seven patients with skin and soft tissue infections, including three with contiguous osteomyelitis, were given cefoxitin intravenously or intramuscularly; the infections of 25 (93%) were resolved with cefoxitin therapy . Etiologic agents included staphylococci, streptococci, Enterobacteriaceae, and anaerobes . Susceptible pathogens were inhibited by less than or equal to 8 micrograms of cefoxitin/ml . This level of drug was surpassed by mean peak serum concentrations eight- to 12-fold after intravenous infusions and two- to threefold after intramuscular injections and resulted in eradication of susceptible organisms from lesions during treatment . Intravenously administered cefoxitin was well tolerated, although eosinophilia, phlebitis, elevation of levels of hepatic enzymes, and a positive direct Coombs' test were observed . Intramuscular injections of cefoxitin in 0.5% lidocaine caused pain and induration and thus were poorly tolerated. Microbios, 1979, 26(103), 31 - 6 Interaction of the mannosephilic lectins of Pseudomonas aeruginosa with luminous species of marine enterobacteria; Gilboa-Garber N et al.; The marine bacteria Beneckea harveyi and Photobacterium leiognathi were shown to bear mannose-containing binding sites for the mannosephilic lectins of Pseudomonas aeruginosa and concanavalin A (Con A) . The interaction between the lectins and the marine bacteria was demonstrated by the bacteriagglutination test, by adsorption of the lectins onto the bacteria and by mannose-specific peroxidase-binding to the lectin-coated bacteria . Treatment of the bacteria with formaldehyde, phenol, ethanol or boiling them for 15 min, did not alter their ability to adsorb the lectins . The growth rate of the marine bacteria was unaffected when either the Pseudomonas lectins or Con A was added to the culture medium. Contrib Microbiol Immunol, 1979, 5, 12 - 22 Contribution to the definition and the taxonomy of Yersinia enterocolitica; Bercovier H et al.; The phenotypic study of 6,000 strains of Y . enterocolitica and Y . enterocolitica-like organisms by the biochemical reaction of the identification of Enterobacteriaceae on one hand and of 100 strains representing different chemiotypes by an auxanogram technique shows a large homogeneity of these strains which are apparated from the other Yersinia within Enterobacteriaceae . Six chemiotypes are described . The strains fermenting thamnose, similar to chemiotype I, can be subdivided in two groups according to the acidification of melibiose . The future and the denomination of these strains are discussed . The biochemical characteristics difining Y . enterocolitica and six chemiotypes are defined. Paediatrician, 1979, 8(1-2), 73 - 82 Gram-negative germs infections in infancy; Corretger JM et al.; The incidence of systemic or local infections due to gram-negative bacilli in an Infant Ward from September 1969 to December 1976 was 7.9% . The 29.34% were septicemia, most of them as epidemic outbreaks caused by Pseudomonas aeruginosa, Klebsiella-Enterobacter and Serratia marcescens . Two facts are to be emphasized: an almost complete disappearance of systemic infections with Pseudomonas starting from 1972, and the global predominance of the group Klebsiella-Enterobacter, particularly evident from 1970 to 1972. Scand J Plast Reconstr Surg, 1979, 13(1), 69 - 71 Pseudomonas resistance to gentamicin; Ramirez AT et al.; 66 burned patients admitted to the Burn Unit from Jan . to Sept., 1977, were studied . Topical therapy employed was mafenide or silver sulfadiazine . The most common pathogens isolated in 288 burn wound cultures were Pseudomonas aeruginosa (42%), Klebsiella-Enterobacter (16%), and Staph, aureus (13%) . Pseudomonas was sensitive to gentamicin in only 36.2% of instances . In 1976, 42% of Pseudomonas isolates was sensitive . During the period 1969-1973, 85.7% of the Pseudomonas was sensitive to gentamicin. Contrib Microbiol Immunol, 1979, 5, 1 - 7 Common enterobacterial antigen and ONPG test in the taxonomy of the genus Yersinia; Le Minor L; The detection of the common enterobacterial antigen (Kunin) in strains of Y . pestis, Y . pseudotuberculosis and Y . enterotocolitica has brought an additional reason for separating them from the Pasteurella and for their inclusion in the family Enterobacteriaceae . Yersinia that give a positive ONPG test lack true beta-galactoridase, except when they harbour a lactose plasmid. Infection, 1979, 7 Suppl 6, 557 - 61 Summary of laboratory studies on the antibacterial activity of cefaclor; Preston DA; Laboratory aspects of cefaclor, a new orally-effective cephalosporin antibiotic, are summarized . On the basis of data from a variety of studies, the useful antibacterial spectrum of cefaclor is shown to include all classes of bacteria that are generally susceptible to cephalothin and cephalexin . Cefaclor has a significant potency advantage over cephalexin against many Enterobacteriaceae, Haemophilus sp . and Streptococcus pneumoniae . Bacteria that are susceptible to cefaclor are killed by concentrations at or near the inhibitory concentration . In vitro enzymatic hydrolysis experiments have shown that cefaclor is a relatively good substrate for several beta-lactamases . Orally administered cefaclor is effective in protection of mice from the lethal effects of intraperitoneal challenges with cefaclor-susceptible bacteria . The chemical instability of cefaclor, test medium composition and inoculum density influence the results of in vitro susceptibility tests with cefaclor . Methods for routine susceptibility testing are described. Ann Anesthesiol Fr, 1979, 20(6-7), 577 - 82 {2d-generation cephalosporins in the treatment of gram-negative superinfections}; Mouton Y et al.; The second generation cephalosporins are those drugs that are totally or partially resistant to betalactamases (cefamandole, cefuroxime) or the cephamycins (cefoxitine) . This property allows them to destroy the enterobacteria resistant to cefalotine and they may have a place in the treatment of certain post-operative infections (abdominal, gynaecological, urinary) on their own or in combination with an aminoglycoside . They also may be of use in combination with an aminoglycoside in the management of secondary septicaemia infections . Outside of these indications which are dependent on the bacteriological findings, their use should be limited even when there is an absence of organisms that are Cefalotine sensitive on the antibiogram . This careful approach (which applies particularly for cefotaxine) may be abandoned once a certain quantity of resistant strains have emerged . For the time being, the second generation cephalosporins ought to be used only for specific indications, and as a general rule should not be first line antibiotic treatment. Postgrad Med J, 1979, 55 Suppl 4, 9 - 11 Comparative in vitro microbiological activity and stability of cefaclor; Gillett AP et al.; The in vitro activity of cefaclor was compared with that of cephalexin and cephradine . This new antibiotic was the most active of the oral agents against Haemophilus influenzae (especially non-beta-lactamase producing strains) . It was also significantly more active against N . gonorrhoeae and the Enterobacteriaceae . The instability in agar raises some issues that need further study. Zentralbl Bakteriol {Orig A}, 1979, 245(3), 368 - 72 {Problems of serological diagnosis of chronic pyelonephritis (author's transl)}; Naumann G et al.; Using the passive hemagglutination test, 588 sera of patients with chronic pyelonephritis and 163 sera of pregnant women with persistent bacteriuria were investigated for the presence of antibodies aginst the enterobacterial common antigen (ECA) . 10.2 percent of titers in the pyelonephritis group and 6.1 percent of titers of the pregnant women showed values higher than 1:16 . The results were compared to a group of blood donors where 0.9 percent of the sera had pathological titers . The demonstration of ECA antibodies does not seem to be suitable for the diagnosis of urinary tract infections. Zentralbl Bakteriol {Orig A}, 1979, 245(3), 287 - 300 {An oral enteritis-vaccine composed of twelve heat inactivated Enterobacteriaceae . 1 . Communication: Theoretical and epidemiological considerations (author's transl)}; Raettig H; The infectious diseases of the human intestinal tract which are caused by bacteria must be distinguished into two groups on account of their different pathogenesis: the cyclic infections (typhoid fever, parathyphoid fever) and the local infections (cholera, dysentery, Salmonella enteritis, dyspepsia coli infections) . The local infections of the intestine do not cause a systemic but only a local immunity of the intestinal mucosa . It is necessary therefore to induce local immunity as active immunoprophylaxis by orally administering inactivated antigens . The twelve-fold enteritis vaccine consists of full antigens of 6 Salmonella strains, 2 Shigella strains, and 4 enteropathogenic coli strains pretreated by heat-inactivation (3 min/100 degrees C) . The following should be considered as indication to effect active immunoprophylaxis against enteritis: Travelling into tropical and subtropical countries, people in emergency areas, children in developing countries, workers in food industries, secondary hospital infections, and carriers . The active mouse protection test revealed that oral immunization with enterobacteriaceae does not only deliver the well-known specific effect but also a non-specific effect which included the protection against other related enterobacteriaceae . Moreover, the specific component of the combined vaccine is enhanced by heterologous components . The resulting synergism or the adjuvantal effect, respectively, allows to employ a relatively limited number of germs which are selected on the basis of high pathogenicity, good immunogenicity, and great frequency . The first field trial with the twelve-fold vaccine was completed successfully: Following an infection with Salmonella which affected the employees of a fowl slaughtery, eight different species could be demonstrated; the above described polyvalent vaccine was orally administered and proved to be successful . The latter case clearly demonstrates the fast-acting effect of the vaccine on account of the heterologous bacterial antigens contained therein . 51 out of 60 Salmonella carriers excreted germs of a different antigen pattern not contained in the vaccine . However, the good results obtained showed that the species chosen for the vaccine were still sufficiently effective to cover the wide spectrum of other species of related enterobacteriaceae. Arzneimittelforschung, 1979, 29(2a), 378 - 81 Microbiological activity of cefazedone as compared to cefazolin and cephalothin; Knothe H; In a comparison of the antibacterial activity of (6R,7R)-7-(2-{3,5-dichloro-4-oxo-1(4H)-pyridyl}-acetamido)-3-({5-methyl-1,3,4-thiadiazol-2-yl)-thio}methyl)-8-oxo-5-thia-1-azabicyclo{4,2,0}oct-2-ene-2-carboxylic acid (cefazedone, Refosporen) as compared to other cephalosporins it can be seen that cefazedone possesses good activity against gram-positive bacteria; as regards activity against Enterobacteriaceae, in particular strains of E . coli, Klebsiella species and Proteus mirabilis, they fall within the spectrum of activity of the substance. Rev Bras Pesqui Med Biol, 1978 Dec, 11(6), 369 - 76 {Acute pneumonia treatment with a new antibiotic (tobramycin) (author's transl)}; de Campos EP et al.; The authors have studied a new antibiotic Tobramycin in 30 patients with acute infectious pulmonary disease, denominated type I, II and III, according to associated factors, severity and previous pulmonary alterations, being 29 patients included in type II and III . The pneumonia diagnosis has obeyed to clinical, laboratorial, radiological and microbiological criteria . The results after the Tobramycin therapy in 28 evaluable cases were: 3 failures and 25 therapeutic successes . The gram negative bacteria predominated among the causative pathogens and, in 14 patients, strains of Klebisiella Enterobacter group were isolated . The M.I.C . for the pathogenic isolated bacteria in acute pulmonary processes was less than 1,0 microgram/ml in 26 cases . Adverse reactions were observed in 13 patients, from which 9 have presented only laboratorial alterations . The remaining 4 patients have also presented clinical manifestations . These findings were similar to those reported for other aminoglicosides. Ginecol Obstet Mex, 1978 Dec, 44(266), 473 - 8 {Bacteriology of the tubes in postpartum salpingoclasia}; Velasco Almeida R et al.; One hundred patients, randomly chosen, with post-partum salpingochlasia, were studied . The surgical procedures used were Pomeroy's Kroener's or a combination of both . Once the tubal segment was removed, a tube with BHI bacteriologic culture medium received the segment; it was placed latter in a specific medium . The parameters under study were: age of patients, number of gestations, number of deliveries, gestational age, vaginal infection antecedents during gestation, premature membrane rupture, post-partum uterine cavity revision and the time elapsed from the delivery to the time of tubal ligation . Seven positive cultures were seen, four of them due to enterobacteria, correlated with latency periods longer than 24 hours and cavity revision. Immun Infekt, 1978 Dec, 6(6), 217 - 22 {Activity of antibiotics in body fluids (author's transl)}; Helm EB et al.; MIC and kinetic of bactericidal activity was determined for various antibiotics in body fluids (plasmawater, bile, amniotic fluid and urine) . Beta-lactam antibiotics demonstrated slight loss of activity against enterobacteriaceae . The newer cephalosporine compounds, cefoxitin, cefuroxime and HR 756 showed an increase in activity in plasmawater . Carbenicillin was more active in plasmawater, bile and amniotic fluid than in broth . There was a difference in gentamycin activity against enterobacteriaceae and pseudomonas aeruginosa: enhanced activity against E . coli in body fluids and diminished against pseudomonas . Tetracycline was less active in body fluids, specially in alkaline bile . The combination ampicillin/gentamycin against E . coli was more effective in plasmawater than in DST agar . Cefazolin/gentamycin demonstrated no synergism . Although carbenicillin/tobramycin were not synergistic against pseudomonas aeruginosa in plasmawater . The marked differences in different body fluids should be taken into consideration when new antibiotics are introduced. Biotechnol Bioeng, 1978 Dec, 20(12), 1895 - 901 Laboratory-scale production of acetoin plus diacetyl by Enterobacter cloacae ATCC 27613; Gupta KG et al.; Conditions for the laboratory-scale production of acetoin plus diacetyl by Enterobacter cloacae ATCC 27613 were studied . Thirty-five g acetoin plus diacetyl/50 g sucrose were obtained when fermentation was carried out in 2.5 liter medium containing 12.5 g peptone and 12.5 g yeast extract, at pH 7.0, in a 5 liter conical flask on a shaker (240 rpm) at 28-30 degrees C for 48 hr . Recovery of pure diacetyl was 85% of the total acetoin plus diacetyl. Quad Sclavo Diagn, 1978 Dec, 14(4), 519 - 35 {Recent acquisitions concerning pathogenic enterobacteria}; Caroli G; A subdivision of enterobacteria is made into classic pathogens and saprophytic species which become opportunistic agents of various syndromes . After a review of the epidemiological situation in Central Italy regarding salmonellosis and shigellosis, an analysis of the E . coli types involved in the enteritis syndromes is carried out . Other topics discussed in the article are the sistemic infections by Serratia, Kelbsiella, Enterobacter and Proteus strains; moreover the causative agents of urinary tract infections are reviewed . The role played in human pathology by all the enterobacteria allows to conclude that the work of the laboratorist would be closely cooperative with one of clinician in order to evaluate correctly the etio-epidemiological significance of the microbiological findings. Rev Bras Pesqui Med Biol, 1978 Dec, 11(6), 359 - 63 Bacteriophage specificity in the identification of Yersinia pestis as compared with other enterobacteria; Nunes MP et al.; Bacteriophage typing of Yersinia pestis and the specificity of the phage among Enterobacteriaceae were investigated . The bacteriophage used for rapid identification of Y . pestis reacted with representative strains of all recognized species of Shigella as well as with Salmonella cholerae-suis . Reactive Shigella serotypes were Sh . dysenteriae 1 and 9, Sh . flexneri 2a, Sh . boydii 1 and 6, and Sh . sonnei . Patterns consisting of isolated plaques (two cases) or absence of plaques were observed when the routine test dilution (RTD) of the phage was used . Results were independent of the incubation temperature (20, 28 or 37 degrees C) . Representative strains of Escherichia, Proteus, Providencia and Klebsiella were resistant to the bacteriophage even at 1000 X the RTD established for Y . pestis. J Clin Microbiol, 1978 Dec, 8(6), 695 - 9 Evaluation of the Repliscan system for identification of Enterobacteriaceae; Brown SD et al.; The Repliscan system, a semiautomated method for identifying gram-negative bacilli, was evaluated for its potential usefulness in clinical microbiology laboratories . A total of 1,877 isolates, including 1,712 fermentative and 165 nonfermentative organisms, were tested in parallel with the Repliscan and Enterotube methods of enteric identification . Discrepancies were retested in each system as well as with conventional methods . The Repliscan method correctly identified 91%, misidentified 2%, and failed to identify 7% of the fermentative orgamisms tested . Of the genera under study, Enterobacter posed the greatest problem to the system in terms of overall identification rates . The Repliscan appears to be an efficient, economic, and effective laboratory tool for identification of Enterobacteriaceae. Am J Clin Pathol, 1978 Dec, 70(6), 905 - 8 Identification of Proteus morganii and distinction from other Proteus species; Braunstein H et al.; The identification of Proteus morganii in the clinical laboratory is complicated by the differences in incidence of hydrogen sulfide (H2S) production recorded by different sources . Since this quality appeared to be a frequent feature of strains of P . morganii at the author's center, all isolates of this species were studied over a six-month period . During this time, 12 of 21 were found to produce scant H2S in Kligler's iron agar (KIA) and triple-sugar iron (TSI) agar butts . The strains were, in every respect, biotypical, and were easily distinguished from other species of Enterobacteriaceae by biochemical study . They also possessed the features of high resistance to cephalothin and ampicillin and relative sensitivity to tetracycline, unlike strains of Proteus mirabilis . It is concluded that weak H2S production in TSI or KIA medium is a frequent normal characteristic of P . morganii, and its presence should not deter microbiologists from correctly identifying isolates manifesting this quality. Arch Intern Med, 1978 Dec, 138(12), 1815 - 6 Pharyngeal flora in ambulatory alcoholic patients: prevalence of gram-negative bacilli; Fuxench-Lopez Z et al.; The pharyngeal flora of a group of ambulatory alcoholic patients was studied and compared with the pharyngeal flora of a control group . Sixty-eight patients were studied, 34 alcoholics and 28 controls . Of the alcoholic patients, 59% had Gram-negative bacilli in their pharyngeal flora, while 14% of the control group had the same organisms . There were no differences in Gram-positive cocci colonization between the groups . Klebsiella pneumoniae was the most frequent isolate (40%) and the Klebsiella-Enterobacter group accounted for 76% of the isolates . Colonization rates of greater than 10 colony forming units/ml were found in 43% of the alcoholic patients . The high prevalence and higher colonization rates of Gram-negative bacilli in alcoholic patients might explain the higher incidence of Gram-negative bacillary pneumonia among alcoholics. Zentralbl Bakteriol {Orig A}, 1978 Dec, 242(4), 481 - 6 R plasmids in vibrionaceae - beta-lactamases in Vibrio cholerae (NAG-Heiberg II) and A . hydrophyla; Porazikova T et al.; 290 natural isolates of Aeromonas, Plesiomonas and Vibrio strains isolated from surface waters have been tested for antibiotic resistance, and 123 have been found resistant to various drugs, mostly beta-lactam antibiotics . 14 of them, with high-level of resistances, transfered antibiotic resistance using three recipient strains of Enterobacteriaceae . One strain of Vibrio NAG (Heiberg II) transfered the resistance to ampicillin, carbenicillin and cephaloridin to both E . coli K12 3110 and S . typhimurium LT2 recipient, and further, in the second cycle of transfer, to E . coli K12 185 Nx strain . One additional strain of Aeromonas hydrophyla transfered a high-level ampicillin- and a low-level gentamicin resistance to E . coli K12 3110 only . Here, the resistances could not be transfered in the second cycle, and, they did not occur in the same exconjugant colony . This confirms previous reports that antibiotic resistance is widely distributed among strains found in wild nature. J Infect Dis, 1978 Dec, 138(6), 719 - 30 Characterization of lipopolysaccharide of Haemophilus influenzae; Flesher AR et al.; Lipopolysaccharide from strains of Haemophilus influenzae was extracted and isolated by the hot phenol-water procedure . The preparations were relatively insoluble in water but could be solubilized with surface-active agents . The preparations contained carbohydrate (30%), fatty acid (29%), and phosphate (4.7%); protein content was less than 1% . Thin-layer chromatography, gas-liquid chromatography, and colorimetric assays detected glucose, galactose, glucosamine, heptose, and a 2-keto-3-deoxy-octonate-like molecule (less than 1%) . Neither methylpentose nor dideoxyhexose was detected . The lipid portion was composed of fatty acids common to lipopolysaccharide of Salmonella . The preparations provoked positive dermal Shwartzman reactions and biphasic febrile responses in rabbits, responses typical of endotoxic activity . The 50% lethal dose for mice was decreased from 16.5 microgram/g to 0.015 microgram/g by concomitant administration of actinomycin D . The preparations were shown to be polyclonal activators of bone marrow-derived (B) cells . Limulus lysate gelation was seen with 8.0 ng of lipopolysaccharide . Preliminary hemagglutination data suggested at least three different antigenic factors associated with the lipopolysaccharide of H . influenzae type b . The H . influenzae lipopolysaccharide appeared biologically similar to that of enterobacteria but chemically different. J Antibiot (Tokyo), 1978 Dec, 31(12), 1238 - 44 A sulfone beta-lactam compound which acts as a beta-lactamase inhibitor; Aswapokee N et al.; CP-45,899 {3,3-dimethyl-7-oxo-4-thia-1-azabicyclo(3,2,0)heptane-2-carboxylic acid, 4,4-dioxide {2S-(2alpha,5alpha)}} has low intrinsic activity against most Gram-positive cocci, Enterobacteriaceae and Pseudomonas . It inhibits Neisseria at concentrations of 0.1 approximately 6.2 microgram/ml . The combination of CP-45,899 and ampicillin inhibited Staphylococcus aureus and Enterobacteriaceae resistant to ampicillin by virtue of beta-lactamase activity . Combination of CP-45,899 and cephalothin was synergistic less often, and CP-45,899 did not act synergistically with carbenicillin or ticarcillin against Pseudomonas resistant to these agents . CP-45,899 acted synergistically with ampicillin against Bacteroides . Synergy of CP-45,899 and ampicillin was demonstrated at varying concentrations suggesting that it may significantly enlarge the antibacterial activity of ampicillin against resistant bacteria. Eur J Biochem, 1978 Nov 2, 91(1), 89 - 97 Enterobacterial common antigen: isolation from Shigella sonnei, purification and immunochemical characterization; Lugowski C et al.; In the studies presented the effective procedure of isolation and purification of enterobacterial common antigen from Shigella sonnei has been elaborated . The method is based on sonification of bacterial suspension in the presence of lysozyme and EDTA and subsequent extraction of the pellet with boiling water . The crude extract of common antigen was purified by fractionation with ethanol and chromatography on silica gel and Sephadex LH-20 . The comparison of several extraction procedures of enterobacterial common antigen from Shigella sonnei proved that the method described above is most effective . The purified enterobacterial common antigen preparation obtained preserved full biological activity: antigenicity (precipitation and activity in enzyme-linked immunosorbent assay), immunogenicity in rabbits, ability to coat erythrocytes (passive hemagglutination) and inhibitory activity in passive hemagglutination . The pure enterobacterial common antigen was identified to 90% as a polymer of N-acetyl-D-mannosaminuronic acid and N-acetyl-D-glucosamine (2:1, molar ratio), O-acetylated and containing 3.2% fatty acids (C16:0 and C18:1, not oleic) . It contains 5.3% nitrogen, less than 4% protein, less than 0.5% phosphorus and less than 1.6% neutral sugar; glycerol and RNA were not found in the preparation. Can J Microbiol, 1978 Nov, 24(11), 1306 - 20 {Antimicrobial activity of phenolic antioxidants}; Turcotte P et al.; The antimicrobial activity of three antioxydants, butylated hydroxytoluene (BHT), butylated hydroxyanisole (BHA) and ethoxyquin (ETO) was studied . In vitro assays showed that when these antioxydants are added to the culture media at concentrations lower or equal to that used in nutrition, they inhibit or decrease the growth of certain microorganisms . BHT showed the most marked effect, affecting Gram-positive bacteria at a higher degree than the Gram-negative bacteria belonging to the family Enterobacteriaceae . Inactivation study of different bacterial species by BHT revealed differences in sensitivity among a single genus and between strains of the same species . The association of ETO with BHT results in an increase of the inhibitory activity . The increased sensitivity to BHT resulting from the osmotic shock of Escherichia coli cells suggests that the resistance to BHT of the Gram-negative bacteria belonging to the family Enterobacteriaceae might be due in part to the structure of their cell wall. Chest, 1978 Nov, 74(5), 508 - 13 Failure of disposable domes to prevent septicemia acquired from contaminated pressure transducers; Buxton AE et al.; Between January and June 1976, eight cases of primary bacteremia due to Enterobacter cloacae occurred in patients after open-heart surgery in a hospital in Connecticut . Epidemiologic studies implicated radial arterial catheters as the route of acquistion of E cloacae, and bacteriologic studies confirmed arterial pressure transducers as the sources of bacteria . Prospective studies indicated that the disposable domes from the pressure transducers did not prevent the spread of bacteria from contaminated transducers to the arterial catheters . This is the first report of transducer-acquired bacteremic infections occurring with the use of disposable domes . Although disposable domes may decrease the chances of cross-contamination of circuits for monitoring pressure, they do not, as previously thought, eliminate the risk of bacteremia from this source. Naturwissenschaften, 1978 Nov, 65(11), 578 - 85 Chemical structure and biological activities of lipid A's from various bacterial families; Luderitz O et al.; The endotoxic principle of lipopolysaccharides (LPS) is localized in their lipid A component . Biological effects of LPS on, for instance, body temperature, blood pressure, and blood picture, are also induced by free lipid A . In contrast to the great variability of the 0-specific chains, the chemical structure of lipid A is much more constant . It is common for Salmonella and similar for other genera of the Enterobacteriaceae . Recently, a number of lipid A's have been recognized that exhibited distinct structural features compared with Enterobacteriaceae . These lipid A's were found to be also distinct with regard to some of their biological properties. J Gen Microbiol, 1978 Nov, 109(1), 37 - 47 Thermosensitive antibiotic resistance plasmids in enterobacteria; Smith HW et al.; Of 775 conjugative plasmids found in enterobacteria mediating antibiotic resistance, 24 (3.1%) were thermosensitive (ts); they were most common in Klebsiella pneumoniae . Ts plasmids were also found in all the samples of sewage and river water examined . Over half of 73 ts plasmids from unrelated sources mediated resistance to chloramphenicol in addition to several other antibiotics . Many of them mediated resistance to mercury (53.4%), arsenite (38.4%) and tellurite (79.5%) but not to copper, cobalt and silver . Fifty-eight belonged to incompatibility group H2 and 12 belonged to the H1 group . Resistance to mercury, arsenite and tellurite was common in strains containing H2 plasmids but not in H1 plasmids . The 73 plasmids transferred at high rates at 22 and 28 degrees C and at lower rates at 15 degrees C; they transferred at very low rates or not at all at 37 degrees C . They could be divided into two sets according to whether they transferred at a high or at a low rate at 33 degrees C . Unlike the prototype plasmid, Rts 1, they were solely or mainly ts for transfer and not for replication and only one of them brought about a marked reduction in growth rate of its host organism at 42 degrees C . None of the 73 plasmids mediated colicin or haemolysin production . Three plasmids, all from K . pneumoniae, mediated utilization of lactose, two of sucrose and raffinose and three, all belonging to group H1, of citrate . None of the plasmids increased the pathogenicity of Salmonella typhimurium for chicks or Escherichia coli K12 for mice. Am J Clin Pathol, 1978 Nov, 70(5), 808 - 15 Standardization of a rapid microbiologic assay for aminoglycosides using Enterobacter cloacae; Stevens DL et al.; The standardization of a rapid serum aminoglycoside assay using Enterobacter cloacae is described . This includes the sensitivity testing of the organism and its performance on various media, with Mueller-Hinton agar being the medium of choice . The precision and reproducibility of the assay, as measured by the within-run and between-run coefficients of variation, were 5.0 and 5.9, respectively . A significant positive correlation was obtained between the microbiologic assay for gentamicin and a 125I-labeled gentamicin radioimmunoassay with the use of both normal and uremic sera . When known amounts of gentamicin, tobramycin, and amikacin were added to antibiotic-free sera from normal persons, recovery rates of 80.0% to 97.9% were found . In the case of gentamicin, recovery rates of 85.0% to 97.9% were found with the use of sera from patients undergoing either hemodialysis or peritoneal dialysis . There were no effects on the recovery rates of the aminoglycosides from normal serum if high concentrations of clindamycin, methicillin, ampicillin, penicillin G, cephalothin, cefamandole or cefoxitin were also present in the sera . The newer cephalosporins, cefamandole and cefoxitin, had no in-vitro effect on the Kirby-Bauer sensitivity patterns of gentamicin, tobramycin, or amikacin, when tested against the assay organism. Ann Microbiol (Paris), 1978 Nov-Dec, 129 B(4), 581 - 90 {Fate of orally administered antibiotic sensitive "Escherichia coli" in the intestine of the newborn (author's transl)}; Borderon JC et al.; In an intensive care unit, 14 newborns, without antibiotic intake, received orally 1 ml of culture broth from an antibiotic-sensitive strain of Escherichia coli marked with resistance to sodium azide . The purpose was to study the fate of the E . coli administered and to determine whether an interaction was obtained between that strain and antibiotic-resistant enterobacteria in the gut flora . In 3 infants the strain administered developed and was the only enterobacterium excreted during the first week; in 4 others the strain was recovered during one week or more, in quantities greater than 10(6)/g of stools . In 6 others, the strain appeared for less than one week, and/or in quantity less than 10(6)/g of stools . In 1 child the strain could not be recovered at all . These data show what is obtained in "holoxenic" newborns in spite of challenge with many other bacteria . They have been obtained with an ubiquitus E . coli and can be used as a control for further studies. Zentralbl Bakteriol {Orig A}, 1978 Nov, 242(2), 216 - 21 R plasmids in enterobacteriaceae from the hospital environment; Prikazsky V et al.; R plasmids have been demonstrated in several group of strains of enterobacteriaceae from hospital environment . R + enteropathogenic strains of Escherichia coli were isolated from several items of baby-care as well as from the pre-prepared baby food in a newborn unit . Strains from environmental samples are thought to be identical with those causing nosocomial gastroenteritis of babies . From hospital waste waters of another larger country hospital we could isolate R + strains of Salmonella typhimurium and R + protei, both associated with occurence of gastrointestinal or urological hospital infections . R-factor-carrying strains of E . coli have been isolated also from surface water samples from the area surrounding the hospital monitored. Ann Intern Med, 1978 Nov, 89(5 Pt 1), 650 - 6 Cefazolin; Quintiliani R et al.; After 5 years of use, cefazolin can be considered similar to cephalothin as a therapeutic agent and in its potential for adverse reactions . When cefazolin and cephalothin are compared by appropriately designed clinical trials, neither cefazolin's slightly greater in-vitro susceptibility to staphylococcal beta-lactamase inactivation, nor its slightly greater microbiologic activity for some enterobacteraciae has been shown to result in any readily apparent therapeutic differences . The important differences between cefazolin and cephalothin--and this is also probably true with respect to cephapirin and cephradine--are not in therapeutic effectiveness, microbiologic activity, or toxicity but rather in pharmacokinetics and cost-effectiveness. J Bacteriol, 1978 Nov, 136(2), 790 - 4 Trypsin peptide patterns of tryptophan synthase beta2 protein among four species of the Enterobacteriaceae; Brennan EF et al.; The tryptophan synthase beta 2 protein (EC 4.2.1.20) of Escherichia coli, Enterobacter aerogenes, Serratia marcescens, and Erwinia carotovora was purified and compared . Two-dimensional total peptide patterns for each of the four beta2 proteins obtained after digestion with trypsin showed that approximately three quarters of the total peptides are common to all four peptides . Examination of only arginine-containing peptides showed that approximately half of these peptides are common . From a comparative standpoint, the data provide evidence that the primary structure of beta 2 proteins is relatively similar, indicating that the trpB cistron is evolutionarily conserved in the enteric bacteria group. J Med Microbiol, 1978 Nov, 11(4), 433 - 40 Jejunal microbial flora of southern indian infants in health and with acute gastroenteritis; Albert MJ et al.; The microbial flora of the jejunal lumen of 28 infants with acute gastroenteritis was compared with that of a group of 10 normal infants . The jejunum of control subjects harboured an "oral" type of flora and in a few instances enterobacteria in small numbers . The concentrations of all but one of the groups of organism were higher in the patients than in controls, and the differences were of statistical significance for enterobacteria and lactobacilli . In eight subjects, the same pathogen was identified in the jejunum and the stool . In six subjects with rotavirus infection, there were almost no Gram-negative aerobic rods in the jejunum . The possible role of other Gram-negative aerobic rods in producing gastroenteritis is discussed . It is suggested that studies of jejunal flora are of considerable importance in assigning an aetiological role to bacteria in the causation of acute gastroenteritis. J Clin Microbiol, 1978 Nov, 8(5), 575 - 9 Immune response in urinary tract infection determined by radioimmunoassay and immunofluorescence: serum antibody levels against infecting bacterium and Enterobacteriaceae common antigen; Sanford BA et al.; A solid-phase radioimmunoassay (RIA) procedure was compared with the indirect fluorescent antibody (IFA) test in a serological study of 76 female adults with urinary tract infections . Relative serum antibody activity was determined against patients' homologous infecting enterobacteria by RIA and IFA and against heterologous enterobacterial common antigen (Escherichia coli O14) by RIA . There was marked correlation between results of the IFA and RIA methods using the homologous system; 22 of 51 patients (43%) with pyelonephritis had significantly elevated serum antibody activity by both IFA (titers greater than or equal to 512) and RIA (binding ratio greater than or equal to 2.0) when compared with normal serum controls; three had significant antibody activity detectable by RIA only . Eighteen (72%) of 25 patients with pyelonephritis had RIA binding ratios of greater than or equal to 2.0 against their homologous bacterial isolates and the enterobacterial common antigen; an additional 6 patients had binding ratios of greater than or equal to 2.0 against the antigen only . All 25 patients with cystitis had low serum antibody levels by IFA and RIA when tested against their own isolate as well as enterobacterial common antigen . The RIA procedure was objective, quantitative, and less tedious to perform than IFA. N Z Med J, 1978 Oct 25, 88(622), 317 - 20 Urinary tract infection in general practice; Peddie BA et al.; In three studies, 616 patients (610 female and six male) presented with symptoms suggesting urinary tract infection (UTI) . Of these, 321 had greater than 100 X 10(6) bacteria per litre in a midstream urine sample . None of the presenting symptoms could be considered to be a reliable indicator of bacteriuria . Ninety percent of infected urines and 44 percent of uninfected urines had a raised white cell concentration . Escherichia coli was the most common infecting organism (71.3 percent) . Next were Gram positive cocci at 15.6 percent, Proteus mirabilis (7.5 percent), and Klebsiella-Enterobacter species (0.7 percent) . At follow-up over 30 days 25.6 percent of patients initially infected again had infected urine . The organisms isolated from initial MSUs were sensitive to most antibacterial agents by disc-sensitivity testing . The expected urine levels of drugs used in the study greatly exceeded the measured minimum inhibitory concentration. Sem Hop, 1978 Oct 18-25, 54(33-36), 1049 - 54 {The use of tobramycin in severe infections (author's transl)}; Babinet P et al.; The interest of tobramycin, studied here in 63 cases of severe infection, is due to several factors: --its ease of use including in cases of renal insufficiency; --the efficiency of subcutaneous administration, of particular interest to patients on anticoagulants; --its action on multi-resistant Enterobacteria and those not responding to gentamicin . Antibiotherapy is however only one of the elements of success in the treatment of severe infections, beside two factors which are often linked and determining: early treatment and the development of foci resistant to antibiotics. J Clin Microbiol, 1978 Oct, 8(4), 463 - 4 Rapid test for acetyl-methyl-carbinol formation by Enterobacteriaceae; Qadri SM et al.; A modified Voges-Proskauer test is described which distinguishes within 4 to 8 hours between organisms that can produce acetyl-methyl-carbinol (acetoin) from glucose fermentation and those that cannot. J Bacteriol, 1978 Oct, 136(1), 227 - 33 Biosynthesis of uridine diphosphate N-acetylmannosaminuronic acid in rff mutants of Salmonella tryphimurium; Lew HC et al.; In Salmonella typhimurium, three groups of genes located in rfb, rfe, and rff clusters are known to be involved in the biosynthesis of the enterobacterial common antigen . We found that enzymatic synthesis of uridine diphosphate N-acetylmannosaminouric acid, the activated form of a constituent sugar of the common antigen, followed the pathway previously described in Escherichia coli (N . Ichihara, N . Ishimoto, and E . Ito, FEBS Lett . 39:46--48, 1974) . All of the six rff mutants tested, which fail to synthesize the common antigen, were deficient in one or both of the two enzymes needed for the synthesis of this sugar nucleotide from uridine diphosphate N-acetylglucosamine; these results established the physiological role of the pathway studied for the biosynthesis of N-acetylmannosaminuronic acid residues . The levels of these enzymes were not reduced in rfe mutants or rfb deletion mutants, although they produced no or only traces of the common antigen. Arch Fr Pediatr, 1978 Oct, 35(8), 854 - 62 {Duodenal bacterial flora in the child during post-surgical stasis}; Ghnassia JC et al.; The bacterial flora of the small bowel was studied in infants with stasis after surgery . Samples were obtained, with radiological assistance, by duodenal aspiration and then immediately analysed by the laboratory in blind tests, both qualitatively and quantitatively . There were two groups of patients: one receiving parenteral nutrition and a second on enteral elementary diet; patients without any gastro-intestinal tract disease formed the control group . Pseudomonas aeruginosa and Enterobacteria were isolated significantly more often in both groups of patients compared to the control group . Quantitatively, the predominant flora -- and not total flora -- was different in the three groups . When considering bacteriological species, only P . aeruginosa (greater than 10(6)/ml) differed significantly in numbers in both groups compared to the control group . With these bacteriological investigations, the "contaminated proximal small bowel syndrome" is better defined and a group of high-risk patients may be identified. J Biol Chem, 1978 Sep 10, 253(17), 6021 - 5 5-Methylthioribose kinase . A new enzyme involved in the formation of methionine from 5-methylthioribose; Ferro AJ et al.; The presence of a previously unidentified enzyme, tentatively designated 5-methylthioribose kinase, has been demonstrated in cell-free extracts of Enterobacter aerogenes . The enzyme catalyzes the ATP-dependent phosphorylation of 5-methylthioribose . ADP is one of the products of the reaction and, based on functional group analyses, the other product is 5-methylthioribose 1-phosphate . A 40-fold purified enzyme preparation has been obtained from a cell-free extract of E . aerogenes . Activity of the partially purified enzyme is totally dependent on the presence of a divalent cation and a sulfhydryl reagent . The substrate specificity of the enzyme is quite narrow, and the Km values for ATP and 5-methylthioribose are 7.4 X 10(-5) M and 8.1 X 10(-6) M, respectively . These results suggest that 5-methylthioribose kinase may be a primary enzyme involved in the recycling of the methylthio group of 5-methylthioribose back into methionine. Zentralbl Bakteriol {B}, 1978 Sep, 167(3), 262 - 71 {Numerical taxonomic studies on enterobacteria of surface-water (author's transl)}; Thurner K et al.; 435 enterobacterial strains of surface-water were tested in 35 physiological characters and classified numerically by a single-linkage procedure . The relations of similarity are shown in a "Vernetzungsdiagramm" (connected graph, Fig . 1) . Tab . 1 specifies the characters of the taxa, which were formed graphically . The following facts are the result of this taxonomic classification: 1 . 32% of the Escherichia group are KCN-positive . In addition it was found that 60% of the E . coli isolated from the faeces of wild ducks were KCN-positive . 2 . The type strains of the species Enterobacter aerogenes and Klebsiella aerogenes show a far reaching conformity in their physiological character . The splitting into two genera does not seem to be of significance any longer . 3 . By reason of the "Vernetzungsdiagramm" and the table of characters (Tab . 1) we propose to regroup the genera Enterobacter and Erwinia . The genus Erwinia represented here by bacteria of the Herbicola-Lathyri-group is clearly divided into two groups . In the discussion we propose for Erwinia I the name of Enterobacter agglomerans and for Erwinia II the name of Enterobacter herbicola . 4 . The taxa Kluyvera and Levinea are placed in the vicinity of Enterobacter cloacae and Erwinia II (Enterobacter herbicola), respectively. J Med Chem, 1978 Sep, 21(9), 962 - 4 Semisynthetic cephalosporins . Synthesis and structure-activity relationships of 7-(1-pyrryl)- and 7-(1-indolyl)acetamidocephalosporin derivatives; Nudelman A et al.; A series of 1-pyrrole- and 1-indoleacetamido derivatives of 3-heteroaryl-substituted cephalosporins was prepared . The most active compound in the series was 7-{{2-(1-pyrryl)acetyl}amino}-3-{{(1-methyltetrazol-5-yl)thio}-methyl}-8-oxo-5-thia-1-azabicyclo{4.2.0}oct-2-ene-2-carboxylic acid (6), which showed comparable potency in vitro and in vivo to that of cefazolin, and, in addition, was more potent than cefazolin against Enterobacter sp . and Providencia stuartii. Diabetes Care, 1978 Sep-Oct, 1(5), 289 - 92 Microbiology of deep tissue in diabetic gangrene; Sharp CS et al.; Information on the incidence and nature of the causative organisms in the infected tissues of patients with diabetic gangrene is scanty . Studies in which material for culture was obtained from the presenting lesion reveal multiple organisms in host isolates . No data are available regarding the bacterial flora of the deep infected tissue itself, uncontaminated by surface organisms . In this investigation 58 specimens from 52 patients were obtained utilizing aerobic and anaerobic culture techniques . In the surgical theater, material was obtained from the infected deep tissues using careful aseptic dissection techniques . All patients had been on antibiotic therapy from 2 to 10 days before the study . An average of 2.3 organisms per specimen was found . The predominant organisms were Proteus sp., Enterococcus, Staphylococcus aureus, and other enterobacteriacae in that order . Anaerobes were isolated in 27 per cent of cases, but never as the only organism . Prior antibiotic therapy did not eradicate infection in infected diabetic gangrene. Am J Epidemiol, 1978 Sep, 108(3), 207 - 13 The role of nationwide nosocomial infection surveillance in detecting epidemic bacteremia due to contaminated intravenous fluids; Goldmann DA et al.; Since January, 1970, the Center for Disease Control (CDC) has corridnated surveillance of nosocomial infections in a group of voluntarily cooperating hispitals in the United States . In 1970, this surveillance system failed to realize one of its major goals: detection of a nationwide epidemic of septicemia caused by contaminated intravenous products . However, retrospective review of infections reported to CDC revealed that the data received were sufficient for the outbreak to have been recognized . Beginning in July, 1970, one month after the contaminated products were first distributed and five months before the outbreak was actually detected . CDC data showed a persistent increase in the incidence of Enterobacter and Erwinia (presently designated Enterobacter agglomerans) bacteremia . Furthermore, monthly rates of cases of bacteremia caused by these organisms were higher in hospitals using the contaminated intravenous products than for hospitals not using them . Failure to detect this outbreak at the time of its occurrence was due to delays in data processing and insufficiently sophisticated data analysis . Based on this experience, CDC has modified the surveillance system to aid recognition of future outbreaks. Pediatrics, 1978 Sep, 62(3), 304 - 6 Enterobacter aerogenes primary bacteremia in pediatric patients; Edwards KE et al.; Enterobacter aerogenes bacteremia associated with the infusion of contaminated admixed intravenous (IV) fluid occurred in seven patients in a pediatric hospital over a five-day period . Clinical illness was characterized by spiking fever in all patients . The temporal clustering of cases allowed for rapid recognition of the problem . The primary control measure was the prompt replacement of the IV fluids, although IV antibiotics were also administered . Hospital pharmacy practices for admixing IV solutions should follow published recommendations to minimize this source of potential contamination of fluids. Acta Paediatr Scand, 1978 Sep, 67(5), 577 - 82 New knowledge in human milk immunoglobulin; Hanson LA et al.; PIP: It has been discovered through various studies that human milk protects infants against infections . 1 of the antiinfection elements of maternal milk is the main milk immunoglobin, secretory IgA, which contains antibodies against many pathogens and potential pathogens, viral as well as bacterial . The antigenic stimuli for these milk antibodies seem to occur in the Peyer's patches of the intestine . Lymphoid cells which leave the patches after antigenic exposure seem to home to the mammary glands through the lymph and blood circulatory systems . It, thus, results that the milk contains secretory IgA antibodies against the intestinal bacteria of the mother, as well as other substances . The mechanism for production and the mode of function of the secretory IgA is explained in detail and diagrammed . Subcutaneous vaccination with a cholera vaccine has been shown to induce an increase in SIgA antibodies in milk and saliva . Breast-feeding, it is believed, largely eliminates possible allergens and provides antibodies to protect against the allergens of mixed feeding . Monatsschr Kinderheilkd, 1978 Sep, 126(9), 549 - 55 {Hospital acquired infections in children (author's transl)}; Daschner F; The incidence of hospital-accquired infections in children as given in the literature varies between 0.3%--25% . The most frequent infections are those of the urinary tract, respiratory tract, skin, wounds, gastrointestinal tract, or septicemia, and meningitis, caused by staphylococcus aureus, E . coli, klebsiella, enterobacter, pseudomonas, proteus, fungi or virus . Besides the identification of the type of infectious agent it is most important for the prevention and therapy of hospital-acquired infections to wash and desinfect hands, to isolate affected children, especially those with low resistance, employment of trained staff, improvement of special nursing techniques, repeated training and motivation of staff personal, and the critical use of antibiotics. Zhonghua Min Guo Wei Sheng Wu Xue Za Zhi, 1978 Sep, 11(3), 99 - 103 Antibiotic resistance of vibrio cholerae: special considerations of R-plasmids; Kuwahara S; Studies on the transmission of R plasmid by conjugation between enterobacteria and vibrio or related bacteria were reviewed . The majority of the reports confirmed successful transmission from enterobacteria to Vibrio cholerae and related species, although the transmission frequencies were extremely low and the transmitted R plasmid was very unstable except for thermosensitive kanamycin plasmid and usual R plasmid coexisting with P plasmid . Strains of V . cholerae and Aeromonas liquefaciens as well as A . salmonicida bearing R plasmid were detected in nature . R plasmid was relatively unstable in V . cholerae strains with which transmission of R plasmid to enterobacteria was confirmed . At present, only 3 R plasmids have been obtained from naturally occurring strains of V . cholerae . Although the 2 European plasmids belong to the C incompatibility group with 98 megadalton closed covalent circular DNA molecule, one plasmid belongs to the J group with more than 25 megadalton molecular weight, and no CCC of satelite DNA was detected in bacteria harboring this plasmid. Zh Mikrobiol Epidemiol Immunobiol, 1978 Sep, (9), 30 - 3 {Gibbs free energy in periodic enterobacterial cultures}; Smirnov SG; The authors present the results of study of the Gibbs' free energy (--delta G) output in periodic cultures of nonpathogenic and enteropathogenic escherichia, shigellae, salmonellae, Proteus, serratia, and klebsiellae in the hydrolysate broth in a special twelve--chamber cultivator . Graphic expression--deltaG = f(N) permitted to reveal differences in the energy characteristics of individual enterobacteria genera and species . It is supposed that such studies could be useful in the choice of redox-indicators during the construction of differential-diagnostic media for the laboratory diagnosis of intestinal infections. Zentralbl Bakteriol {Orig A}, 1978 Sep, 241(3), 308 - 18 Acquisition of multiple antibiotic resistance by Salmonella dublin from the gramnegative hospital flora, in a kidney allograft recipient; Kayser FH et al.; The case of a kidney allograft recipient, who suffered from several episodes of Salmonella dublin sepsis following massive immunosuppressive therapy to overcome a transplant rejection crisis, is presented . The focus of sepsis was the chronic inflamed gallbladder . The Salmonella dublin strain isolated from the blood during the last episode was found to exhibit multiple resistance to antimicrobiol drugs . Because the resistance phenotype was characteristic for the gramnegative flora of the university hospital, it was suggested that transfer of a resistance plasmid, frequently found in gramnegative enterobacterial isolates, to the Salmonella strain had occurred in the patient . The comparative examination of a Klebsiella pneumoniae strain, representing the hospital flora, and Salmonella dublin revealed that both strains produced the aminoglycoside 3'-phosphotransferase type 1, the 2''-nucleotidyltransferase and the 3''-adenylyltransferase, enzymes responsible for resistance to aminoglycoside antibiotics . Furthermore, in both strains a TEM type beta-lactamase was found to render the organism resistant to penicillins and cephalosporins . Transfer experiments showed that the host ranges of the R-plasmids of both strains were identical . Furthermore, both plasmids were found to be the fi+ type . These data support the view of in vivo transfer of an R-plasmid from the enterobacterial hospital flora to a potential pathogen in a patient. Rev Esp Fisiol, 1978 Sep, 34(3), 247 - 52 {Effect of glucose concentration on the biosynthesis of prodigiosin by serratia marcescens (author's transl)}; Loren JG et al.; Serratia marcescens is an enterobacteria which produces a characteristic red pigment denominated prodigiosin . To study the effect of glucose on the kinetics of this secondary metabolite, cultures of Serratia marcescens S10 were incubated at 30 degrees C in the mineral medium GL, with glucose (2 g/l) as the carbon source . Prodigiosin production in relation to glucose consumption is studied, and parallel-wise, the effect of various concentrations of glucose on prodigiosin production . The kinetics data show the close correlation between glucose consumption and the synthesis of prodigiosin . This substrate inhibits the synthesis of pigment in cultures grown on solid medium GL with concentrations of glucose up to 15 g/l. Lancet, 1978 Aug 12, 2(8085), 342 - 4 Enterotoxigenicity of colonising coliform bacteria in tropical sprue and blind-loop syndrome; Klipstein FA et al.; The enterotoxigenicity of strains of Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli, which represented the predominant coliform species isolated from the jejunum of 12 patients with tropical sprue and 5 with the blind-loop syndrome, was quantitatively assessed in terms of the ability of toxin preparations to induce water secretion as assayed by in-vivo perfusion in the rat jejunum . All 12 patients with sprue harboured 1 or more highly toxigenic strains--14 of the 16 strains isolated from this group produced heat-labile and/or heat-stable toxins which were as potent as toxins derived from strains isolated from persons with acute diarrhoea and documented as toxigenic . None of the 9 strains isolated from patients with the blind-loop syndrome produced potent toxins . This difference between the coliform bacteria in sprue and the blind-loop syndrome probably accounts, at least partly, for the different intestinal response in these two disorders to contamination by these organisms. Immun Infekt, 1978 Aug, 6(4), 140 - 5 {Antibiotic treatment of gynecologic and obstetric infections (author's transl)}; Hirsch HA; 1 . Obstetric and gynecologic infections especially ascending intrauterine infections, pelvic inflammatory disease (PID) and postoperative infections are usually polymicrobial infections involving enterobacteria and anaerobes . 2 . The antibiotic treatment of these infections must primarily be active against the two groups of organisms mentioned . Semisynthetic penicillins, cephalosporines or aminoglycosides combined with clindamycin or one of the new large spectrum penicillins, or cephalosporines alone proved to be effective . In addition to the antimicrobial therapy surgical intervention is very often required in postoperative infections after obstetric and gynecologic surgery and for pelvic abscesses . 3 . For treatment of infections in pregnancy specific side effects of antimicrobial agents concerning the mother and the fetus have to be considered . Transfer of the antibiotic to the fetus and the amniotic fluid in sufficiently high concentrations is mandatory for the treatment of intrauterine infections . 4 . In cervicitis and salpingitis the possibility of a gonococcal infection has to be kept in mind. Arch Intern Med, 1978 Aug, 138(8), 1224 - 7 Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons; Mackowiak PA et al.; We compared the prevalence of Gram-negative bacilli in the pharyngeal flora of two groups of patients with a known predilection for Gram-negative bacillary pneumonia (chronic alcoholics and diabetics), two other groups of aspiration-prone persons with no known predilection for Gram-negative bacillary pneumonia (epileptics and narcotic addicts), and normal control subjects . Quantitative cultures of saline gargles showed pharyngeal Gram-negative bacilli to be significantly (P less than .05) more prevalent among alcoholics (35%) and diabetics (36%) but not epileptics (17%) or addicts (20%) than controls (18%) . Counts of greater than or equal to 100 Gram-negative bacilli per milliliter were also significantly more common in alcoholics (14%) and diabetics (24%) than controls (5%, P less than .05) . Enterobacter sp, Klebsiella pneumoniae, and Escherichia coli were the most common Gram-negative bacilli isolated . Increased colonization by Gram-negative bacilli might be a factor contributing to the propensity of alcoholics and diabetics for Gram-negative pneumonia. Zh Mikrobiol Epidemiol Immunobiol, 1978 Aug, (8), 134 - 8 {Gibb's free energy as a index of the assimilation of carbohydrate sources by bacteria}; Smirnov SG; The author presents substantiation of the use of thermodynamic function--of free Gibbs' energy (--deltaG) for energy characteristics of enterobacteria periodic cultures on synthetic media . Examination of strains of E . coli K12P4X Hfr, E . coli PA-309, and Sh . newcastle 762S showed the --detlaG = f (N) curves to characterise the energy value of various carbohydrate sources more completely, and also permitted the choice of their optimal concentrations in synthetic media for each of the enterobacteria strain. J Clin Microbiol, 1978 Aug, 8(2), 219 - 27 Time- and media-saving testing and identification of microorganisms by multipoint inoculation on undivided agar plates; Burman LG et al.; Motility and various biochemical activities of isolates of bacteria and yeasts were tested on undivided agar plates by using a simple, manually operated multipoint inoculation apparatus that allowed the analysis of 25 isolates per 9-cm-diameter petri plate . Fermentation of all 17 carbohydrates tested as well as 13 other biochemical activities commonly used for identification of bacteria were readily demonstrated by the multipoint inoculation plate method, and the results agreed very well with those of conventional tube tests . In addition to speedy inoculation and low cost of materials, the multipoint inoculation plate method offers several other advantages when compared with conventional tube tests or with some of the manufactured test kits currently available for recognizing members of the family Enterobacteriaceae. Arch Microbiol, 1978 Aug 1, 118(2), 219 - 21 Protoplast-like structures formation from two species of Enterobacteriaceae by fosfomycin treatment; Rodicio MR et al.; A procedure for protoplasts formation from Escherichia coli and Serratia marcescens by treatment with fosfomycin alone is described . This method gives high and low yields of stable protoplasts from E . coli and S . marcescens respectively . In the last case numerous spheroplasts were obtained . Electron micrographs of intact cells, protoplasts and spheroplasts are shown. J Infect Dis, 1978 Aug, 138(2), 227 - 31 Sources of gram-negative bacilli colonizing the tracheae of intubated patients; Schwartz SN et al.; Twenty acutely ill patients requiring prolonged orotracheal intubation were studied to determine the source and progression of gram-negative bacilli colonizing the trachea . Organisms recovered from daily tracheal, hypopharyngeal, and rectal cultures were typed and speciated to identify identical strains at the three sites . All patients acquired gram-negative bacilli in the trachea by day 3 after intubation . Thirty organisms that were not recovered from the tracheal aspirate immediately following intubation were isolated for at least two days some time thereafter . Nine of the 30 colonizing bacteria were Enterobacteriaceae, and all were found in another culture site, usually the hypopharynx, before isolation from the trachea . In contrast, only four of the 21 non-Enterobacteriaceae that colonized the trachea were recovered previously from either the hypopharynx or rectum, a finding which represents a significant difference (P = 0.0002) . Quantitation of isolates from the hypopharynx was of no value in predicting subsequent acquisition in the trachea, and the numbers of bacteria recovered from the first positive tracheal specimen were not predictive of subsequent persistence in the trachea. J Bacteriol, 1978 Aug, 135(2), 348 - 53 Enterobacterial common antigen in mutant strains of Salmonella; Mannel D et al.; A good correlation was found to exist between the serologically determined presence of enterobacterial common antigen (ECA) and the amount of the rare sugar constituent D-mannosaminuronic acid . Strains classified by serological techniques as ECA+, ECA-, and ECAtrace were found to possess the expected amounts of mannosaminuronic acid in the ECA-enriched phenol-soluble PL-L fractions . This correlation provides strong evidence on the identity of the mannosaminuronic acid-glucosamine polymer with the ECA as defined by Kunin (J . Exp . Med . 118:565-586, 1963). J Bacteriol, 1978 Aug, 135(2), 342 - 7 Microcin plasmids: a group of extrachromosomal elements coding for low-molecular-weight antibiotics in Escherichia coli; Baquero F et al.; Microcins are low-molecular-weight compounds produced and excreted by Enterobacteriaceae . They inhibit the growth of a wide spectrum of microorganisms . Microcin-synthesizing transconjugants were obtained in seven out of eight experiments of conjugational transfer between wild-type microcinogenic strains of Escherichia coli and E . coli strain BM21 . The physical analysis of one of the transconjugant strains that has acquired the ability to produce microcin 17 showed the presence of extrachromosomal DNA as a plasmid (pRYC17) of molecular weight 36 X 10(6) (18.3-micron length), which is absent in the "microcincured" derivative strain . pRYC17 was incompatible with plasmids of the IncFII group . Other suspected plasmids containing the information for the synthesis of microcins have not been clearly classified . Strains producing microcins 93, 136, and 140 show a partial incompatibility with IncFIII group of plasmids. Gastroenterology, 1978 Aug, 75(2), 255 - 62 Reversal of jejunal water secretion by glucose in rats exposed to coliform enterotoxins; Klipstein FA et al.; Glucose absorption and glucose-facilitated water transport were assessed in rats exposed to semipurified preparations of the heat-labile (LT) and heat-stable (ST) enterotoxins of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae by in vivo jejunal perfusion of these toxins alone and with varying amounts of glucose . Progressive increases in the glucose concentration of from 12 to 56 mM resulted in incremental rises in water absorption from perfusates containing each of these toxins, with similar delta water values to those for the electrolyte perfusion solution without toxins . Water secretion was reversed to absorption by the addition of 12 mM glucose when secretion was mild, but 24 mM was required to achieve this in the presence of severe secretion; absolute values for water transport did not return to normal in any instance . Glucose absorption from solutions containing 24 and 56 mM glucose was severely reduced by all of the ST toxins and marginally reduced by some of the LT toxins; the effect of LT was not attributable to the toxin itself, however, but to another unidentified factor present in LT, but not ST, preparations from both toxigenic and nontoxigenic strains . These observations indicate that glucose-facilitated water transport remains intact in intestinal tissue exposed to various coliform enterotoxins and that this occurs despite the presence of impaired glucose absorption in some instances . They provide a rational basis for treatment with oral glucose-electrolyte solutions of persons whose diarrhea is caused by toxigenic coliform bacteria. Aust N Z J Med, 1978 Aug, 8(4), 383 - 6 Gentamicin and amikacin---an in vitro comparison using 1000 clinical isolates; Forgan-Smith WR et al.; The in vitro antimicrobial activities of gentamicin and amikacin against 1000 bacterial isolates from clinical material were compared . The minimum inhibitory concentrations were determined by an agar dilution technique . Both of these aminoglycoside antibiotics had a similar spectrum of activity, being highly active against most species of aerobic Gram negative bacilli . Gentamicin was more active than amikacin against most species of enterobacteria, Haemophilus influenzae and Staphylococcus aureus but amikacin was more active against a proportion of Klebsiella and Providencia isolates . For most isolates, the differences in activity between gentamicin and amikacin were small, however, amikacin achieves higher serum levels . Most resistant isolates in this survey did not influence patient mortality. J Clin Pathol, 1978 Aug, 31(8), 724 - 9 Evaluation of some methods for the laboratory examination of sputum; Tebbutt GM et al.; Methods for the quantitation of leucocytes, squamous epithelial cells, and potential pathogens in sputa are described . Microscopic examination showed that 58% of sputa tested (554/957) were purulent or moderately purulent and 48% were moderately or heavily contaminated by squamous epithelial cells . The presence of squamous epithelial cells indicated oropharyngeal contamination . A simple dilution technique was chosen to compare the isolation of potential pathogens from direct cultures and from dilutions of sputa (10(-7) per ml original sputum) . The dilution technique permitted easier reading of sputum cultures and avoided the possible over-reporting of enterobacteria and Pseudomonas aeruginosa, which were frequently found on direct examination . Enterobacteria and Pseudomonas aeruginosa were more likely to be isolated from sputa moderately or heavily contaminated with squamous epithelial cells . The use of counter-current immunoelectrophoresis (CIE) and co-agglutination tests to detect pneumococcal antigen in sputa is described . The presence of antigen in sputum was a more reliable index of lower respiratory tract infection than a positive culture . Co-agglutination tests were simpler to perform and used smaller amounts of expensive antiserum than CIE. Eur J Biochem, 1978 Jul 17, 88(1), 211 - 8 Structural studies on the immunogenic form of the enterobacterial common antigen; Kiss P et al.; It has been shown that enterobacterial common antigen is chemically linked to the hexose region of the R1-type lipopolysaccharide fo the Escherichia coli strain F470 which is immunogenic for this antigen . The number of R core stubs substituted is very small but it is a-parently sufficient to induce antibody formation to the enterobacterial common antigen in the rabbit. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1978 Jul-Sep, 23(3), 171 - 6 {Isolation by uroculture of bacterial flora from ambulatory patients}; Rozen P et al.; In the out patients investigated between 1974 and 1977 a number of 14046 quantitative urocultures were performed; 2206 (15.5%) gave relevant results for a diagnosis of urinary infection . In 98.5% of the cases, infection was caused by Gram negative bacilli, particularly Enterobacteriaceae (98.14%) . A set of 11 biochemical tests, performed in a single stage, was used, correctly establishing the genus and in most cases also the species, thus realizing marked economy of material and work . It is considered that the taxonomic listing by this set is sufficient for a diagnosis of urinary infection . In such cases the clinical interest and testing the sensitivity of the strains to antibiotics is of greater importance than determination of the serotype, lysotype or biotype, of prevalent interest in other types of infection produced by enterobacteria, particularly those known to be pathogens. Nord Vet Med, 1978 Jul-Aug, 30(7-8), 318 - 23 Bacteriological examination of urine specimens from non-catheterized and catheterized dogs with symptoms of urinary tract infection; Wierup M; A bacteriological investigation of 199 urinary specimens from dogs with symptoms of urinary tract infections is presented . No bacterial growth was detected in 55.7% of all specimens examined . Isolation rates from urine specimens from noncatheterized and catheterized dogs were 35.2 and 66.7%, respectively, thus emphazising the importance of the sampling method and also that urinary tract infections in dogs can not be diagnozed solely on the basis of clinical symptoms . Bacteria belonging to the Enterobacteriaceae were most common isolated . Ampicillin was the drug to which resistance was least common (16.2%) while 79.1% of the strains examined were resistant to sulphonamide. Lab Anim, 1978 Jul, 12(3), 157 - 8 Selective decontamination of the digestive tract of Syrian hamsters; Angulo AF et al.; Conventional Syrian hamsters colonized with aerobic gram-negative bacteria such as Pasteurella pneumotropica and various Enterobacteriaceae species were successfully and permanently freed from these microorganisms by oral treatment for 4 weeks with dihydrostreptomycin and 'Orabase' premixed with appropriate antibiotics . Concomitant oral treatment with dimetridazol for the elimination of intestinal flagellates was unsuccessful . During treatment the animals were maintained under germ-free isolation conditions. Med Klin, 1978 Jun 16, 73(24), 914 - 7 {The antimicrobial activity of amikacin in comparison with three other aminoglycoside-antibiotics (author's transl)}; Jotzoff M; We report about the in-vitro-sensitivity tests of 1756 Enterobacteriaceae and Pseudomonas strains to amikacin, gentamicin, tobramycin and sisomicin . It was established, that amikacin is more effective than gentamicin, tobramycin and sisomicin in case of infections with Klebsiella, Proteus species, Psuedomonas strains and Enterobacter . The four aminoglycosides are well active against E . coli . Hospital acquired infections with Serratia are a domain of amikacin . Tobramycin is more effective than gentamicin and sisomicin against Pseudomonas infections . Amikacin is the drug of choice against gentamicin-resistent strains, which are also not infrequently resistant to other aminoglycosides . Resistance to gentamicin-tobramycin and gentamicin-tobramycin-sisomicin, is most frequent among Klebsiella strains . The cross-resistance rate is considerably higher among Enterobacteriaceae strains than among Pseudomonas species . The lowest rate of resistance (2.1%) and the high antimicrobial activity are the considerable advantages of amikacin. Med Klin, 1978 Jun 9, 73(23), 861 - 6 {The effect of benzbromarone on fasting-hyperuricemia as a model (author's transl)}; Schrapler P et al.; The effect of daily therapeutic doses of 100 mg benzbromarone (Normurat) and 2.0 g probenecid on the purine metabolism of 40 test subjects was investigated . Fasting-hyperuricemia was used as the model and particular attention paid to the mechanisms of renal elimination . Urate concentration remains under the solubility threshold when benzbromarone is administered, in contrast to medication with probenecid . The significantly greater hypouricemic effect of benzbromarone correlates with a significant rise in the excretion and clearance of uric acid in comparison to probenecid, accompanied by a stronger depression of tubular reabsorption . Serum levels, clearances and reabsorption rates demonstrate the prolonged effect of the benzofurane derivative Normurat even during strict fasting . Supplementary allantoin and urea determinations gave no indication of increased enterobacterial uricolysis . Normurat was well tolerated, side effects were not noted. Zentralbl Bakteriol {Orig A}, 1978 Jun, 240(4), 503 - 16 Antibiotic resistance factors and other plasmids in bacterial isolates from hospitalized patients; Laufs R et al.; Among 186 arbitrarily selected gram-negative as well as gram-positive bacterial strains isolated from hospitalized patients, 63% were found to harbour plasmids, 42% of the strains with extrachromosomal DNA showed more than one plasmid DNA band in the agarose gel electrophoresis . The highest plasmid frequency was found in the enteric gram-negative microorganisms: 95% to 76% of the analyzed Enterobacter species, Klebsiella pneumoniae and E . coli isolates harboured plasmids . The plasmid frequency in the Staphylococci and group D Streptococci ranged between 36% and 75% . The examined Pneumococci strains were sensitive to all antibiotics and were found to be free of plasmids . In 45% of the enteric strains studied, the resistance markers were found to be transferable to a sensitive E . coli recipient by conjugation . Some of the resistance genes had not formed a stable complex with a plasmid and were lost during in vitro passage of their bacterial host . The loss of R-factors in vitro causes false diagnostic findings in regard to the in vivo antibiotic sensitivity of such strains . With purified plasmid DNA, individually isolated from E . coli strains, transformants were obtained carrying ampicillin resistance specifying plasmids of different molecular size . This result indicates that plasmids of different molecular size in a single bacterial cell can simultaneously carry ampicillin resistance genes . All findings indicated that the plasmids play an important role for the transfer and the maintenance of antibiotic resistance specifying genes in the bacterial isolates from clinical patients . However, most of the functions coded for by the numerous plasmids in the bacterial isolates remained unknown. J Antibiot (Tokyo), 1978 Jun, 31(6), 570 - 9 Diastereomeric 7-ureidoacetyl cephalosporins . III . Contribution of D- and L-isomers to the growth inhibiting activities of 7alpha-H and 7alpha-OCH3 derivatives for gram-positive and gram-negative bacteria; Gadebusch HH et al.; A series of 7beta-ureidoacetyl, 7alpha-H and 7alpha-OCH3 cephalosporin antibiotics have shown broad-spectrum antibacterial activity in vitro . In the 7alpha-H but not in the 7alpha-OCH3 series, contrary to experience in the antibiotic field, the L-isomers were substantially more active than the D-isomers both in vitro and in vivo particularly, but not exclusively, against Enterobacteriaceae that produce potent chromosomal cephalosporinases . Enhanced resistance to and inhibition of beta-lactamase (s) appeared to be responsible for this effect . Studies in vitro specifically with 7beta-thienylureidoacetyl derivatives showed that D-isomers interacted with L-isomers in the 7alpha-OCH3 series in a synergistic manner against "cephalosporinase-type" enzyme producers while isomers in the 7alpha-H series did not . Examples were presented in which this favorable event resulted in improved efficacy of the racemic mixture over the pure D- or L-isomer alone in appropriate experimental infections. Zentralbl Bakteriol {Orig A}, 1978 Jun, 240(4), 517 - 24 {The localization of the anodically-moving thermolabile antigen (ATA) of gram-negative bacteria with ferritin-labelled antibodies (author's transl)}; Wagner B et al.; In studies on the antigenic structure of shigellae, an anodically-moving thermolabile antigen (ATA) was found, which furthermore could be detected in many other enterobacteriae (9, 10) . ATA is a glycoprotein with a high molecular heterogeneity, resulting from aggregates of a subunit with a molecular weight of about 22000 Daltons . In the present paper the antigen was localized on the cell surface of several species by means of the immunoferritin technique . Antibodies against the purified ATA were raised in rabbits and were coupled with ferritin using glutaraldehyde . The antigen was found focally distributed over the whole circumference of the cell . According to the location of the ferritin granules, the ATA is tightly attached to the outer membrane . Especially some rough forms of the bacteria were heavily labelled on their surface . From the results obtained we conclude that in the smooth form the polysaccharide side chains of the somatic antigen cover the ATA. Can J Microbiol, 1978 Jun, 24(6), 658 - 61 Effect of pH on the antimicrobial activity of some triphenylmethane dyes; Moats WA et al.; Four common dyes were tested as inhibitors of four types of bacteria over the pH range 5.0-9.0 . Inhibition of the gram-negative types, Salmonella anatum and Enterobacter aerogenes, was markedly affected by the pH of the medium . These organisms tolerated concentrations of crystal violet and ethyl violet about 100-fold higher at pH 5.0 than at pH 9.0 . Above pH 7.0 brilliant green (BG) and malachite green (MG) were precipitated as their respective carbinols and lost their inhibitory properties with these two organisms . Two gram-positive types, Staphylococcus aureus and Bacillus cereus, were more sensitive to dyes and results were less affected by pH . The carbinol forms of MG and BG were nearly as inhibitory to these organisms as the ionized forms. J Pediatr, 1978 Jun, 92(6), 893 - 6 Bacterial etiology of otitis media during the first six weeks of life; Shurin PA et al.; Tympanocentesis was performed on 70 infants who had otitis media during the first six weeks of life . The bacteria isolated from their middle-ear effusions were Streptococcus pneumoniae (13 patients), Neisseria catarrhalis (11 patients), Hemophilus influenzae (ten patients), Enterobacteriaceae (four patients), Staphylococcus aureus (four patients), streptococci (groups A and B) (three patients), and Pseudomonas aeruginosa (two patients) . Thirty patients (42.9%) had middle-ear effusions which did not contain pathogenic bacteria . Twenty-seven infants were followed for at least 12 months and 12 (44.4%) of these infants had six or more episodes of otitis media during the observation period . Further studies will be needed to establish the significance of middle-ear disease at this age and the role of therapy in improving its outcome. Br Med J, 1978 May 20, 1(6123), 1314 - 7 Periurethral aerobic microflora of pregnant and non-pregnant women; Bollgren I et al.; Seventy-two pregnant and 88 non-pregnant women were examined to see whether the periurethral region had been colonised with group B streptococci (Streptococcus agalactiae), enterococci, and Gram-negative rods belonging to the Enterobacteriaeceae . A semi-quantitative method was used for periurethral sampling, and paired urethral swabs were also collected to compare the isolation rates of group B streptococci from the two sites and with the two sampling methods . A higher isolation rate was found with periurethral sampling . Most specimens showed no or scanty growth of Gram-negative rods . Pregnancy was often associated with heavy growth of enterococci . Sampling performed during menstruation and while oral contraceptives were being used produced high isolation rates of group B streptococci . These results seem to suggest that the periurethral area might protect against genital colonisation with group B streptococci as it does against urinary tract infection and that hormonal factors influence the carriage of these organisms. N Engl J Med, 1978 May 18, 298(20), 1108 - 11 Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged; Valenti WM et al.; To assess the factors responsible for oropharyngeal colonization with gram-negative bacilli among elderly persons in institutions, we performed a cross-sectional survey of 407 volunteers, 65 years of age and older, who had not received antimicrobials in the previous four weeks . Colonization increased with level of care: from 9 per cent in independent residents of apartments to 60 per cent in patients on an acute hospital ward (P less than 0.0001) . Klebsiella species was found in 41 per cent of those with colonization, Escherichia coli in 24 per cent and enterobacter species in 14 per cent . There was no association between numbers of normal flora and numbers of gram-negative bacilli . Associated with colonization were bladder incontinence, deteriorating or terminal clinical status, inability to walk or perform activities of daily living and incapacitation due to neoplastic, respiratory and cardiac disease (P less than 0.05) . Multivariate analysis indicated that respiratory disease and being bedridden contributed most to colonization. Eur J Biochem, 1978 May 16, 86(2), 311 - 5 L-2-hydroxytetradecanoic acid as a constituent of Salmonella lipopolysaccharides (lipid A); Bryn K et al.; L-2-Hydroxytetradecanoic acid was recognized as a characteristic, although minor, constituent of the lipid A component of Salmonella lipopolysaccharides . The 2-hydroxy fatty acid was present in lipid A as an ester, probably bound to the hydroxyl group of some D-3-hydroxytetradecanoic acid residues . A survey of enterobacterial lipopolysaccharides showed that L-2-hydroxytetradecanoid acid was also present in Klebsiella and Serratia strains . It was absent, however, from lipopolysaccharides of other genera of the family including Escherichia, Shigella, Proteus, Enterobacter and Yersinia . This restricted distribution of the 2-hydroxy acid may be of significance for taxonomic studies of bacterial genera. Schweiz Med Wochenschr, 1978 May 13, 108(19), 701 - 8 {Epidemiology of resistance factors to antibiotics}; Charpie MA et al.; Resistance factors are small independent extrachromosomal DNA molecules (plasmids) conferring resistance on one or more antibiotics to the bacteria which harbour them; in Enterobacteriaceae and other gramnegative bacteria they are transferable by conjugation . The work is reviewed which has been undertaken to underline the importance of the R factors in nature, and more precisely in the current environment of the intestinal bacteria (animal and human gut, sewage) under the selective pressure of antibiotics or otherwise. J Trauma, 1978 May, 18(5), 317 - 23 Resistant Enterobacter cloacae in a burn center: the ineffectiveness of silver sulfadiazine; Gayle WE et al.; Enterobacter cloacae sepsis was found in 15 burn center patients in 1976, of whom 13 died . Nine of the deaths occurred in the first 60 days . The Burn Center isolates were resistant to silver sulfadiazine (AgSD) in agar cup-plate tests and confirmed by tube dilution tests . Hospital, non-burn isolates of E . cloacae were sensitive to AgSD . All E . cloacae isolates were sensitive to mafenide acetate (MA) in the agar cup-plate tests, but this was not confirmed by the tube dilution tests . The agar cup-plate susceptibility test is a simple, rapid and effective technique for determining resistant and sensitive isolates of E . cloacae . Patients who were changed from AgSD to MA because of resistant E . cloacae infection did not have improved survival . An animal study showed that AgSD was ineffective against this strain of E . cloacae and that MA was more effective than AgSD when applied 24 hr postburn but neither were effective at 48 hr postburn . MA was bacteriostatic but not bactericidal with this E . cloacae strain. J Clin Microbiol, 1978 May, 7(5), 448 - 53 New medium for selection and presumptive identification of the Bacteroides fragilis group; Livingston SJ et al.; A medium, Bacteroides fragilis bile-esculin (BBE) agar, was designed for the selection and, presumptive identification of the B . fragilis group . BBE agar contains bile, esculin, ferric ammonium citrate, hemin, and gentamicin in a Trypticase soy agar base . Growth in the presence of 20% bile and esculin hydrolysis, detected by blackening of the medium, provide presumptive evidence for the identification of the B . fragilis group . In addition to stimulating the growth of many strains of the B . fragilis group, hemin provides the option of testing isolates for catalase production . Gentamicin and bile prevent the growth of most organisms other than the esculin-positive bacteroides that can tolerate bile . Of 160 clinical isolates of the B . fragilis group tested on BBE agar, 159 grew well on the medium and 157 blackened it . Other anaerobes, Enterobacteriaceae, and enterococci either failed to grow on BBE agar or did not produce the characteristic morphology and blackening associated with isolates of the B . fragilis group . In a clinical laboratory trial, 687 specimens from patients were inoculated onto BBE agar plates . The B . fragilis group was recovered from 81 (11.8%) of these specimens in 24 to 48 h . Use of BBE agar in the clinical laboratory enables earlier recovery and identification of this important pathogen. J Infect Dis, 1978 May, 137 Suppl, S125 - S132 Cefamandole in the treatment of infections due to Enterobacter and indole-positive Proteus; Levine LR et al.; Clinical and bacteriologic results are reported for 80 patients treated with 1.5--12 g of cefamandole daily for a variety of infections caused by Enterobacter and indole-positive Proteus, organisms that have been resistant to most available cephalosporins . Of 45 patients with infections due to Enterobacter, 41 (91%) had satisfactory clinical responses; 36 were bacteriologic successes, and six cases of complicated urinary tract infections relapsed . Of 37 patients with infections due to indole-positive Proteus, 28 (88%) were clinical successes and 30 (81%) were bacteriologic successes . Fourteen cases of complicated urinary tract infection relapsed . Of 104 patients in whom the drug was evaluated for safety, use of cefamandole was discontinued in five; nine adverse reactions were considered drug-related . A summary of published in vitro data shows that the majority of strains of these organisms were susceptible to cefamandole at concentrations achievable in the serum . Minimal inhibitory concentrations are variable, and there is a significant inoculum effect, the clinical significance of which has not been determined. Arch Intern Med . 1978 May;138(5):788. Septic arthritis caused by Enterobacter agglomerans; Flatauer FE et al.; A case of septic arthritis was caused