Gram positive

JAMA, 1992 Dec 23-30, 268(24), 3452 - 5
Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome)
Bone RC.
BACKGROUND--New definitions for sepsis and the systemic inflammatory response syndrome (SIRS) have been established . Comparatively little is known, however, about the types of patients who will be included within these new definitions . OBJECTIVES--To determine what is--and what is not--known about the epidemiology and natural history of severe sepsis and SIRS . DESIGN--A comparative analysis of patient characteristics in the Methylprednisolone, Veterans Administration Systemic Sepsis, HA-1A, and E5 studies . RESULTS--At least 15% of patients in these studies had no documented infection; the proportion of all patients with severe SIRS and no documented infection is probably higher . Even among patients with presumed infection, less than half had bacteremia, and only about half had gram-negative infection or shock . The difference in the mean mortality rate of the combined studies at 14 days was 26%, while at 1 month it was 42% . Gram-negative sepsis and gram-positive sepsis seem to have similar mortality rates . Whether shock increases 30-day mortality is unclear . CONCLUSIONS--Patients with severe SIRS should not be assumed to have gram-negative infection; furthermore, data derived from studies of patients with gram-negative infection should be applied cautiously to all patients with SIRS . Studies of patients with sepsis or SIRS should include at least a 1-month follow-up if mortality is an end point . More consistent definitions of these disorders should permit more effective comparisons across studies.

Mol Gen Genet, 1992 Dec, 236(1), 76 - 85
Cloning and DNA sequence analysis of the mercury resistance genes of Streptomyces lividans; Sedlmeier R et al.; A broad-spectrum mercury resistance locus (mer) from a spontaneous chloramphenicol-sensitive (Cms), arginine auxotrophic (Arg-) mutant of Streptomyces lividans 1326 was isolated on a 6 kb DNA fragment by shotgun cloning into the mercury-sensitive derivative S . lividans TK64 using the vector pIJ702 . The mer genes form part of a very large amplifiable DNA sequence present in S . lividans 1326 . This element was amplified to about 20 copies per chromosome in the Cms Arg- mutant and was missing from strains like S . lividans TK64, cured for the plasmid SLP3 . DNA sequence analysis of a 5 kb region encompassing the whole region required for broad-spectrum mercury resistance revealed six open reading frames (ORFs) transcribed in opposite directions from a common intercistronic region . The protein sequences predicted from the two ORFs transcribed in one direction showed a high degree of similarity to mercuric reductase and organomercurial lyase from other gram-negative and gram-positive sources . Few, if any, similarities were found between the predicted polypeptide sequences of the other four ORFs and other known proteins.

J Antibiot (Tokyo), 1992 Dec, 45(12), 1848 - 52
The producer and biological activities of SO-75R1, a new mutactimycin group antibiotic {corrected}; Maeda A et al.; The producer of SO-75R1, a new anthracycline group antibiotic was identified as Nocardia brasiliensis . SO-75R1 was active against Gram-positive bacteria, but not active against Gram-negative bacteria or fungi . All tested Nocardia brasiliensis strains as well as the producer itself were resistant to SO-75R1, although four other pathogenic Nocardia, i.e . N . asteroides, N . nova, N . farcinica and N . otitidiscaviarum were sensitive {corrected}.

Br J Ophthalmol, 1992 Dec, 76(12), 714 - 8
Topical ofloxacin compared with gentamicin in the treatment of external ocular infection . Ofloxacin Study Group; Gwon A; In a double-masked, randomised, controlled study the effectiveness and safety of 0.3% ofloxacin solution were compared with those of 0.3% gentamicin ophthalmic solution in treating external bacterial ocular infections . The clinical improvement rate for patients treated with ofloxacin was 98% (51/52) and 92% (48/52) for those treated with gentamicin . Microbiological improvement was achieved in 78% (40/51) of the ofloxacin patients, compared with 67% (35/52) of the gentamicin group . Ofloxacin treatment eradicated or controlled 85% (86/101) of the Gram positive and 89% (17/19) of the Gram negative organisms cultured, compared with 83% (103/124) and 78% (29/37), respectively, after gentamicin treatment . None of these differences were statistically significant . The incidence of adverse effects attributable to ofloxacin treatment (3.2%) was less than that reported for gentamicin (7.1%) . Ofloxacin proved to be an effective, safe, and comfortable therapy for external bacterial ocular infection.

Antimicrob Agents Chemother, 1992 Dec, 36(12), 2816 - 20
Comparison of two antibiotic regimens (piperacillin plus amikacin versus ceftazidime plus amikacin) as empiric therapy for febrile neutropenic patients with cancer; Feliu J et al.; A total of 170 febrile episodes in neutropenic patients with cancer were randomly assigned to be treated with piperacillin-amikacin or ceftazidime-amikacin . The overall response rates were similar in both groups (68 and 65%, respectively) . Response rates for clinically or microbiologically documented episodes were 54.5% for piperacillin-amikacin and 58.8% for ceftazidime-amikacin . Response rates for gram-negative bacillary infections were 65 and 73%, respectively . There was also no difference for gram-positive infections (31 and 50%, respectively) . The toxicities were also comparable and consisted of skin rashes, hypokalemia, and diarrhea . Vancomycin was added if the fever persisted 72 h after the beginning of therapy; it increased the response rates to 94% when used with piperacillin-amikacin and 92% when used with ceftazidime plus amikacin . Our results suggest that the combinations show similar global efficacies in the treatment of febrile episodes in cancer patients.

Tierarztl Prax, 1992 Dec, 20(6), 557 - 71
{Digestive disorders in rabbits and guinea pigs}; Hollmann P; Numerous digestive tract diseases in pet rabbits and guinea pigs result from both an inherent physiological predisposition and from poor feeding and husbandry . A large proportion of digestive disturbances in rabbits and guinea pigs are secondary to changes in the oral cavity caused by inadequate teeth wear . The required regular trimming of the cheek teeth using a modified spatula and hollow pair of pincers is described and illustrated . The symptoms, diagnosis, prognosis and treatment of a selection of digestive disorders, as commonly encountered in small animal practice, are presented . The difficulties of using antibiotics in view of the gram positive intestinal flora and possible dysbacteria, dysentery and enterotoxaemia are considered . Finally, advice on feeding and on the rearing of orphan neonates is given.

Am J Obstet Gynecol, 1992 Dec, 167(6), 1579 - 82
Use of esterase inhibitors and zone electrophoresis to define bacterial esterases in amniotic fluid; Hoskins IA et al.; OBJECTIVE: The purpose of our study was to define further the role of bacterial esterases in amniotic fluid obtained from women with chorioamnionitis . STUDY DESIGN: Amniotic fluid samples from 39 patients with chorioamnionitis were submitted for bacterial cultures and in vitro assay . Esterase inhibitors diisopropyl fluorophosphate and iodoacetic acid were added and the degree of inhibition calculated . These results were compared with the amniotic fluid culture results . Chi square analysis was performed to compare the results of the esterase assay and the inhibition assay between the uninfected and infected amniotic fluid samples . RESULTS: Thirty-one patients had positive bacterial cultures, with 21 being infected with gram-negative organisms . All samples showed significant inhibition (range 55% to 82%) with diisopropyl fluorophosphate . There was partial inhibition with iodoacetic acid (range 10% to 30%) in the gram-negative samples but no inhibition in the gram-positive and uninfected samples . Six infected and two uninfected samples were analyzed by using zone electrophoresis with human plasma as a control . Minimal esterase motility was noted in the amniotic fluid samples as compared with that in plasma . CONCLUSION: The esterases in amniotic fluid appeared to be of bacterial, not human, origin . Furthermore, different groups of bacteria appeared to produce different esterases in infected amniotic fluid.

Biotechniques, 1992 Dec, 13(6), 928 - 34
Development of a rapid method for detecting bacterial cells in situ using 16S rRNA-targeted probes; Braun-Howland EB et al.; A rapid method for the identification of bacterial cells using 16S rRNA-directed, fluorescently tagged oligonucleotide probes has been developed . The parameters evaluated for their effect on labeling intensity included storage time, type of fixative, time of fixation, treatment time with methanol:formaldehyde and treatment time with borohydride . The results of tests using a variety of microorganisms, both Gram-positive and Gram-negative, are presented . Using this method, cells are spotted onto slides and stored desiccated until hybridized . This method may be especially applicable to environmental samples, which comprise diverse cell types and frequently require storage prior to examination.

Science, 1992 Nov 27, 258(5087), 1479 - 81
Porins in the cell wall of mycobacteria; Trias J et al.; The cell wall of mycobacteria is an efficient permeability barrier that makes mycobacteria naturally resistant to most antibiotics . Liposome swelling assays and planar bilayer experiments were used to investigate the diffusion process of hydrophilic molecules through the cell wall of Mycobacterium chelonae and identify the main hydrophilic pathway . A 59-kilodalton cell wall protein formed a water-filled channel with a diameter of 2.2 nanometers and an average single-channel conductance equal to 2.7 nanosiemens in 1 M potassium chloride . These results suggest that porins can be found in the cell wall of a Gram-positive bacterium . A better knowledge of the hydrophilic pathways should help in the design of more effective antimycobacterial agents.

Br J Ophthalmol, 1992 Nov, 76(11), 694 - 6
Nocardia choroidal abscess; Phillips WB et al.; Nocardia is a Gram positive, aerobic, filamentous branching micro-organism that rarely causes human infection . When infection does occur it usually takes the form of a subcutaneous abscess or a pneumonia-like illness . We describe a case of a patient with chronic lymphocytic leukaemia who developed painless loss of vision in the right eye secondary to a choroidal abscess after a prolonged course of treatment on several immunosuppressive agents . The patient also complained of right shoulder pain that was unresponsive to conventional therapy, and had been admitted and treated for several episodes of 'pneumonia' . A diagnostic transvitreal fine-needle aspiration biopsy of the ocular lesion was performed which demonstrated Nocardia asteroides . This allowed for appropriate antibiotic therapy to be instituted early in the course of the infection and prompted the systemic work-up which also demonstrated central nervous system and arthropic nocardial infection.

Ital J Gastroenterol, 1992 Nov-Dec, 24(9 Suppl 2), 10 - 3
New trends in non-absorbable antibiotics in gastrointestinal disease; Di Febo G et al.; Numerous antibiotics have been used for several years in the treatment of intestinal diseases, the majority belonging to the class of aminoglycosides . These are effective against gram-positive and some gram-negative bacteria, above all aerobes, and do not therefore cover the entire range of microorganisms responsible for intestinal infections . With these antibiotics, moreover, it is not possible to exclude intestinal absorption which can lead to serious side effects . Other intestinal antibiotics, however, such as Vancomycin, have a restricted spectrum of action which limits their use . This study analyzes the pharmacological characteristics of a new non-absorbable antibiotics with particularly interesting properties from a clinical pharmacokinetic and pharmacodynamic point of view: Rifaximin . This drug has an extremely broad spectrum of action covering all intestinal germs, and its absorption is practically zero . The results of some controlled clinical studies in gastrointestinal diseases are examined, such as the treatment of infectious diarrhoea, of acute or chronic portal-caval encephalopathy and of diverticular disease of the colon . The possible role of Rifaximin in some intestinal diseases, such as small bowel bacterial overgrowth and Crohn's disease and ulcerative colitis, is also analyzed.

Bol Med Hosp Infant Mex, 1992 Nov, 49(11), 766 - 76
{Septic shock in newborn infants}; Mancilla-Ramirez J; Systemic bacterial infections continue to be a main cause of death in newborns at neonatal intensive care units (NICU), worldwide . Bacteria causing neonatal septicemia are mainly the gram-negative, which possess endotoxin and are responsible for endotoxic shock . However, gram-positive bacteria are also able to induce septic shock, especially in immunocompromised hosts, like the newborns . Diagnosis and treatment of neonatal septic shock are quite difficult . Furthermore, there is not sufficient knowledge about its real frequency in Latin-american countries . The hyperdynamic phase of septic shock in newborns can be short and the hypodynamic phase is rapidly established, which increases the mortality . Since few years ago, some important aspects of physiopathology in septic shock have been studied and, at the same time that our knowledge about immunologic soluble mediators is increasing, new therapeutic modalities have been discovered . Such is the case of the therapeutic potentialities of cytokines, receptor antagonists and monoclonal antibodies, which is very encouraging at the present time.

J Dent Res, 1992 Nov, 71(11), 1803 - 6
Heterogeneity of surfaces of subgingival bacteria as detected by zeta potential measurements; Cowan MM et al.; Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans (A.a.) are Gram-negative bacteria which are implicated in various forms of periodontal disease . The Gram-positive Peptostreptococcus micros may also play an important role . For investigation of the possible adhesion and colonization mechanisms of these organisms, the charge properties of the outermost layers of bacterial cell surfaces were studied through the measurement of zeta potentials at various pH values . Eleven fresh clinical isolates, representing the four species, and one laboratory strain, P . gingivalis W83, were examined . Eleven of the 12 strains displayed heterogeneity with respect to pH-dependent zeta potentials . Within single cultures of each of these strains, two distinct populations of cells were found, one which was more negatively charged than the other . For the Gram-negative strains, the more negatively charged subpopulation was in the majority, while the P . micros strains appeared to be composed mainly of a less-negatively-charged subpopulation . Vesicles prepared from two strains displayed the same pH dependence and heterogeneity of zeta potentials as the parent cells . An A.a . strain which was passaged several times in fluid medium had lost its fimbriae and became homogeneous with respect to charge.

Antonie Van Leeuwenhoek, 1992 Nov, 62(4), 309 - 14
Mechanism of chlorpromazine binding by gram-positive and gram-negative bacteria; Molnar J et al.; Chlorpromazine forms charge-transfer complexes with xanthene dyes in bacteria . These complexes permit the differentiation of Gram-positive and Gram-negative bacteria in both light and polarization microscopy . The birefringence induced by the charge-transfer complex might explain the molecular basis of bacterial staining . The charge-transfer complexes formed between chlorpromazine and xanthene dyes accumulate in the bacterial cell, mainly inside the bacterial cell wall . The complexes give the cells a color, which depends on the chemical composition of the staining structure, and in particular the polysaccharides of the cell wall in bacteria . Metachromatic granules were seen inside Gram-positive bacteria after chlorpromazine and rose bengal staining . Although the nature of these granules remains unclear, this type of binding may have a role in the inhibition of biochemical processes in the bacterial cells.

J Appl Bacteriol, 1992 Nov, 73(5), 433 - 7
Globicatella sanguis gen.nov., sp.nov., a new gram-positive catalase-negative bacterium from human sources; Collins MD et al.; Phylogenetic studies were performed on some Gram-positive catalase-negative cocci from human clinical sources of uncertain taxonomic position . 16S rRNA sequence analysis demonstrated that the isolates represent a hitherto unknown line of descent within the low G+C Gram-positive bacteria for which the name Globicatella sanguis gen.nov., sp.nov . is proposed.

Burns, 1992 Oct, 18(5), 355 - 61
Simplified dosing and monitoring of vancomycin for the burn care clinician; Rice TL; Vancomycin has excellent activity against Gram-positive bacteria and is often selected for use in the infected burn patient . Because of multiple-compartment pharmacokinetics, vancomycin serum concentrations can decrease dramatically in a short time period following the end of an intravenous infusion . This accounts for the widely divergent recommendations for serum vancomycin peak concentrations, e.g . from 15 mg/l up to 80 mg/l, when the time for blood sampling following the end of intravenous infusion is different . It is in general not necessary to monitor vancomycin peak concentrations, not only because its toxic potential is overrated but also because potential toxicity and therapeutic efficacy are correlated with trough concentrations . Post-distribution 'peak' concentrations are generally only useful for determining the optimal dosing interval for patients with impaired renal function . A dosing and monitoring paradigm for vancomycin therapy in burned adults has been devised for burn care clinicians . It provides suggested dose and dosing intervals based on body weight and creatinine clearance, with specific recommendations for regimen modification based upon the results of trough serum concentration determinations.

FEMS Microbiol Lett, 1992 Oct 1, 76(1-2), 95 - 100
Mercuric reductase in environmental gram-positive bacteria sensitive to mercury; Bogdanova ES et al.; According to existing data, mercury resistance operons (mer operons) are in general thought to be rare in bacteria, other than those from mercury-contaminated sites . We have found that a high proportion of strains in environmental isolates of Gram-positive bacteria express mercuric reductase (MerA protein): the majority of these strains are apparently sensitive to mercury . The expression of MerA was also inducible in all cases . These results imply the presence of phenotypically cryptic mer resistance operons, with both the merA (mercuric reductase) and merR (regulatory) genes still present, but the possible absence of the transport function required to complete the resistance mechanism . This indicates that mer operons or parts thereof are more widely spread in nature than is suggested by the frequency of mercury-resistant bacteria.

Eur J Biochem, 1992 Oct 1, 209(1), 181 - 7
NMR study of the solution conformation of actinomycin D; Yu C et al.; The solution conformation of actinomycin D, the Gram-positive antibiotic and DNA-binding drug, has been determined by 1H-NMR in deuterated dimethyl sulfoxide . The structure determination is based on the experimental data set of NOE restraints . Four structures were obtained from the distance geometry and restrained molecular dynamics calculation . The resultant structures satisfy the experimental restraints very well . These structures are found to be compatible with the X-ray crystal structures.

Indian J Pathol Microbiol, 1992 Oct, 35(4), 357 - 61
Bacterial flora of the endometrium in infertile women from Manipal; Rao PS et al.; Endometrial curettage specimen culture of 140 infertile women showed 64 (45%) organisms . Mycobacterium tuberculosis 8 (5.7%) and Anonymous mycobacteria 14 (10%) were the commonest organisms isolated . Among the anonymous mycobacteria, following species were isolated M . scrofulaceum 10, M . kansasii 2, M . fortuitum 2 . Gram positive and gram negative organisms were isolated from 42 (30%) specimens of the endometrium; 76 (54%) of the endometrium specimens were sterile.

Biochim Biophys Acta, 1992 Sep 21, 1110(1), 11 - 9
Testing models for transport systems dependent on periplasmic binding proteins; Krupka RM; A carrier model in which transport across the cytoplasmic membrane is mediated by a periplasmic binding protein (Krupka, R.M . (1992) Biochim . Biophys . Acta 1110, 1-10) is shown to account for many of the properties of these systems: (i) Michaelis-Menten kinetics; (ii) seemingly irreversible uptake; (iii) the absence of exchange transport and counter-transport; (iv) substrate half-saturation constants that in different systems may be lower or higher than the dissociation constant of the binding protein; (v) the high concentration of the binding protein in the periplasm and its weak association with the membrane component . The binding protein appears to function as a valve or rectifier that permits the substrate to enter the cell, but blocks exit in both the energized and de-energized states . The asymmetry depends on both the abruptness and the extent of the conformational change in the binding protein . Characteristically, these systems build up steep gradients across the membrane, circumstances in which such a valve might be important . In agreement with the mechanism, (a) the binding protein is missing in members of the same family of transporters that function in export of the substrate rather than import; and (b) in Gram-positive organisms, which have no periplasmic space, binding proteins function while anchored to the cytoplasmic membrane.

J Am Vet Med Assoc, 1992 Sep 15, 201(6), 917 - 20
Cutaneous actinomycosis and nocardiosis in dogs: 48 cases (1980-1990); Kirpensteijn J et al.; Medical records of 48 dogs with cutaneous actinomycosis or nocardiosis were reviewed . Male, large-breed dogs kept outdoors were overrepresented . The mean age at admission was 3.6 years . Cutaneous swelling (68%), abscesses (65%), draining tracts (48%), fever (36%), and signs of pain (13%) were the most common clinical findings . The cervicofacial area was affected in 48% of the dogs . Abdominal and thoracic wall involvement was less common . Leukocytosis, neutrophilia with left shift, monocytosis, and hyperglobulinemia were common . The diagnosis was confirmed by cytologic examination, bacteriologic culture, or histologic examination . Gram-positive filamentous bacteria were seen in 69% of the fine needle aspirates and in 50% of the biopsy specimens . Actinomyces spp were isolated from cutaneous lesions in 27 (60%) dogs . Nocardia asteroides was isolated from 1 dog . Treatment consisted of surgical debridement, drainage, and administration of antibiotics in 29 dogs (group A) and antibiotics alone in 13 dogs (group B) . The infection redeveloped in 10 (42%) group-A dogs and 6 (60%) group-B dogs . Of the 10 group-A dogs with recurrent infection, 6 had resolution after a second surgery and 4 were euthanatized . Of the 6 group-B dogs, 1 had resolution after surgery, 4 were euthanatized or died because of persistent disease, and 1 had an unresolved infection . The combination of surgery and antibiotic treatment appeared to be superior to antibiotic treatment alone in resolving cutaneous Actinomyces and Nocardia infections.

Biochim Biophys Acta, 1992 Sep 4, 1159(1), 44 - 50
The lytic enzyme of the Pseudomonas phage phi 6 . Purification and biochemical characterization; Caldentey J et al.; The lytic enzyme of the lipid-containing bacteriophage phi 6, protein P5, has been purified to apparent homogeneity from disrupted viral particles . The enzyme is a monomer with a molecular mass of approx . 24 kDa . The optimal pH for P5 activity is 8.5 and the protein is readily inactivated at temperatures above 20 degrees C . Protein P5 is active against several Gram-negative bacteria, but no activity against Gram-positive species was detected . Analysis of cell wall digests indicates that P5 is not a glycosidase, but an endopeptidase splitting the peptide bridge formed by meso-diaminopimelic acid and D-alanine.

Am J Med, 1992 Sep, 93(3), 283 - 8
Risk factors for septic shock in the early management of bacteremia; Aube H et al.; PURPOSE: Aggressive treatment of bacteremia in patients at high risk of septic shock may prove to be beneficial and cost-effective since these patients account for 50% of the mortality . The purpose of this study was to identify risk factors for septic shock in bacteremic patients . PATIENTS AND METHODS: We retrospectively collected clinical, biologic, and radiologic data from medical records of patients who experienced one episode of bacteremia between March 1 and December 31, 1990, at the University Hospital of Dijon, France . Statistical analysis was univariate and multivariate (logistic regression) . RESULTS: During the survey, 331 patients experienced one episode of bacteremia . Bacteremia due to gram-negative species was more frequently found in surgical units . Septic shocks were equally attributed to gram-negative and gram-positive bacteria . The do-not-resuscitate order was associated with nearly half of the deaths secondary to underlying diseases or poor general condition . Neither hospital-acquired bacteremia nor underlying diseases were associated with a high risk of septic shock . Multivariate analysis showed the following to be risk factors for septic shock: male gender and age older than 75 years (odds ratio = 2.91), creatinine level greater than 20 mg/L (odds ratio = 4.52), prothrombin time less than 60% (odds ratio = 4.86), and presence of an interstitial pattern on the chest radiograph involving more than half of both lung fields (odds ratio = 4.1) . Our logistic model with these selected parameters allowed an overall classification of 77% of the studied patients, with a positive predictive value of 55% and a negative predictive value of 89% . CONCLUSION: Our results provide a positive predictive value that is similar to that of the clinical scores of severity proposed by other authors in selected populations . Our classification, in conjunction with a clinical classification, would allow improvement in the prognosis of patients with bacteremia by early treatment of those at high risk for developing septic shock . Validation of these results with further studies involving a larger population that includes patients with suspected infections, as well as bacteremic patients, is needed.

J Vasc Surg, 1992 Sep, 16(3), 337 - 45; discussion 345-6
Are gram-negative bacteria a contraindication to selective preservation of infected prosthetic arterial grafts?
Calligaro KD, Veith FJ, Schwartz ML, Savarese RP, DeLaurentis DA.
Management of infected prosthetic arterial grafts has traditionally included total graft excision especially when gram-negative bacteria were cultured . Between 1973 and 1991 we treated 42 patients with infected prosthetic grafts (33 polytetrafluoroethylene (PTFE), 9 Dacron) by complete graft preservation when the graft was patent, the anastomoses were intact, and the patient did not have sepsis . The infection involved the anastomosis (36 cases) or the body (6 cases) of 33 peripheral grafts and the distal segment of five aortofemoral and four iliac-distal grafts . Cultures of the 42 infected grafts grew gram-positive bacteria in 33 cases and gram-negative bacteria in 22 cases . Treatment adjuncts included repeated, radical operative wound debridement and rarely (7 of 42) rotational muscle flaps . This management resulted in a 10% (4 of 42) hospital mortality rate and an amputation rate in survivors of 3% (1 of 38 threatened limbs) . All four deaths were due to sepsis: gram-positive bacteria were cultured in all cases and gram-negative bacteria in two cases . Of the 38 survivors, 29 (76%) wounds healed and remained healed after average follow-up of 3 years (range, 1 to 18 years) . Nine other patients required total graft excision for nonhealing wounds (7 cases) or delayed anastomotic hemorrhage (2 cases) . Gram-negative bacteria were cultured in four, and gram-positive bacteria were cultured in six of these nine wounds . Four of nine (44%) graft infections that cultured Pseudomonas organisms healed without complications versus 23 of 33 (70%) wounds that cultured gram-positive bacteria, and 12 of 13 (92%) wounds that cultured gram-negative bacteria other than Pseudomonas organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Zentralbl Veterinarmed B, 1992 Sep, 39(7), 495 - 502
Experimental dermatophilosis; Bucek J et al.; The histopathologic features of an experimental dermatophilosis of rabbit skin were described . The strain of Dermatophilus congolensis used for the experimental infection was obtained from the unique isolation and cultivation of this actinomycete from the ulcerous leg lesion of one male patient . Further strains in experiment came from the collections of type cultures . The experimental infection was characterized as an exudative and crustal dermatitis with acanthosis and subcorneal abscesses . Branching hyphae and clusters of coccoid bodies were found mostly in the parakeratotic layer and infrequently in the abscesses . Both the coccoid bodies and the hyphae were Gram-positive . The hyphae were acid-fast but the coccoid bodies were non-acid-fast . The fine structure of hyphae and coccoid bodies, namely of those with flagella, was also described by means of a transmission and scanning electron microscope.

Biosci Biotechnol Biochem, 1992 Sep, 56(9), 1439 - 42
T1801 A, B, C, and D, new quinone and hydroquinone antibiotics produced by a strain of Pseudomonas; Kumagai K et al.; New antibiotics, T1801 A, B, C, and D, were isolated from the culture broth of Pseudomonas sp . SC-1801 . Their structures were found by spectroscopic analyses to be tri- and tetra(methylthio) derivatives of hydroquinone (T1801 A and C) or p-benzoquinone (T1801 B and D) . They are new quinone and hydroquinone antibiotics and are active against Gram-positive bacteria, some fungi, and yeasts.

J Hosp Infect, 1992 Sep, 22(1), 1 - 5
Antibiotic resistance associated with selective decontamination of the digestive tract; Webb CH; Selective decontamination of the digestive tract (SDD) appears to reduce infection, particularly pneumonia, in intensive care, and some patients benefit markedly . Gram-positive overgrowth and antibiotic resistance in both Gram-positive and Gram-negative organisms has been recorded . However, the clinical and epidemiological significance of these observations is still debated . Future studies will need to be of sufficient size and duration to provide good quality data on which the safety and efficacy of SDD can be properly judged.

Genetika, 1992 Sep, 28(9), 17 - 24
{Mapping of plasmid genes responsible for microcin R51 synthesis and immunity to it}; Kurepina NE et al.; Microcin R51 is plasmid-determined low-molecular-weight peptide antibiotic produced by Escherichia coli . The spectrum of its action includes many different species of gram negative and some gram positive bacteria . Microcinogenic strains are immune to the action of the microcin they synthesize . As shown earlier, genes responsible for MccR51 production and immunity are located in a continuous 11.1 kb DNA fragment . These genes were cloned in pUC19 and pACYC184 plasmid vectors . Deletion derivatives and Tn5 insertion mutant plasmids which determined no microcin synthesis and immunity were obtained . Analysis of clones' phenotypes and physical mapping of mutant plasmids demonstrated that the 5 kb DNA fragment was indispensable for microcin production . The region of about 4.6 kb confers complete immunity of the producing strains, while partial immunity is provided by 1.8-1.9 kb DNA fragment.

J Antibiot (Tokyo), 1992 Sep, 45(9), 1467 - 71
New antiviral antibiotics, cycloviracins B1 and B2 . I . Production, isolation, physico-chemical properties and biological activity; Tsunakawa M et al.; Kibdelosporangium albatum No . R761-7 (ATCC 55061) produced new antiviral antibiotics, cycloviracins B1 and B2 . They show weak activity against Gram-positive bacteria and potent antiviral activity against herpes simplex virus type 1 . Unique acylsaccharide structures were established for cycloviracins B1 and B2 by degradation and spectroscopic analysis.

Microb Pathog, 1992 Sep, 13(3), 243 - 9
The 17 kDa lipoprotein and encoding gene of Francisella tularensis LVS are conserved in strains of Francisella tularensis; Sjostedt A et al.; A T-cell-stimulating 17 kDa protein of the vaccine strain Francisella tularensis LVS has previously been cloned, sequenced and shown to be a lipoprotein . In the present study, it was investigated whether the protein, denoted TUL4, and its gene are present in various strains of the genus Francisella . By Western blot analysis, it was demonstrated that a TUL4-specific monoclonal antibody bound to a protein present in each of the Francisella strains . The immunoreactive proteins had an M(r) of 17 kDa in all F . tularensis strains and in the strain Francisella novicida, whereas the M(r) in strains of Francisella philomiragia was 20 kDa . When genomic preparations were probed with a radioactive DNA fragment of F . tularensis LVS encoding TUL4, hybridization was demonstrated in all strains of Francisella, although the F . philomiragia strains did not hybridize under conditions of high stringency . The hybridizing chromosomal DNA fragment of the F . philomiragia strains was larger than that of the other Francisella strains . No hybridization or Western blot reactivity was seen when various other Gram-negative and Gram-positive bacteria were probed . In summary, the 17 kDa lipoprotein of F . tularensis LVS appears to be Francisella-specific and present in the species F . tularensis and F . novicida, whereas an immunologically related protein is present in F . philomiragia.

FEMS Microbiol Lett, 1992 Aug 1, 74(1), 63 - 9
Rapid identification of Aerococcus viridans using the polymerase chain reaction and an oligonucleotide probe; Grant KA et al.; A polymerase chain reaction/oligonucleotide probe method was developed for the specific identification of the Gram-positive bacterium Aerococcus viridans . Primers for the enzymatic amplification reaction were designed from specific sequences within the 16S rRNA . The method was also highly sensitive and 10 cfu of A . viridans could be detected in 5 h although the reliability of detection was poor in mixed cultures with Escherichia coli.

J Dairy Res, 1992 Aug, 59(3), 381 - 8
Adherence of psychrotrophic bacteria to dairy equipment surfaces; Suarez B et al.; Psychrotrophic bacteria isolated from raw milk were tested for their ability to adhere to steel, two types of rubber, and glass, materials employed in the construction of milking equipment . The adherence assays were carried out by exposure of the materials to radioactively labelled bacteria in both a buffering solution (Ringer's) and milk . The degree of adherence of Gram-positive bacteria was lower (P less than 0.001) than that of Gram-negative bacteria . Glass was the material least prone to bacterial adherence (P less than 0.001); there were no significant differences between the other three materials . Milk was found to inhibit adhesion significantly (P less than 0.05), this inhibition being more evident with the most adherent bacteria . There was no statistically significant correlation between bacterial surface hydrophobicity and adherence . Our results suggest that intrinsic bacterial adherence cannot be considered a relevant factor in the contamination of milking equipment.

Infect Agents Dis, 1992 Aug, 1(4), 194 - 9
The role of mannose-binding proteins in host defense; Super M et al.; The human mannose-binding protein (MBP) appears to function as an "ante-antibody" as its physiological role is in first line host defense . Low baseline serum levels are rapidly increased as part of the acute phase reactant and circulating MBP can act as a direct opsonin or activate the classical alternative complement pathway . MBP appears to selectively recognize an array of apparently disparate oligosaccharides that decorate gram-negative and gram-positive bacteria as well as certain parasites, yeasts, and fungi . MBP may be considered a "pattern" recognition molecule that has homologs in primitive life forms . Its ability to distinguish self from nonself indicates that it may play an important role in innate immunity.

Hindustan Antibiot Bull, 1992 Aug-Nov, 34(3-4), 76 - 84
Screening and identification of antibiotic producing strains of Streptomyces; Haque SF et al.; About 450 actinomycetes were isolated from nearly 100 soil samples collected from different parts of West Bengal . The isolates were screened on the basis of their inhibitory effect against test organisms . Finally two potent antibiotic producers were chosen having maximum inhibitory effect on both gram positive and gram negative test bacteria . On the basis of morphological, structural, physiological and biochemical characters, the two potent antibiotic producers were identified as Streptomyces violaceus-niger and S . antibioticus.

Ann Surg, 1992 Jul, 216(1), 74 - 9
Infrainguinal anastomotic arterial graft infections treated by selective graft preservation; Calligaro KD et al.; The purpose of this study was to determine whether the type of graft material and bacteria involved in an infrainguinal arterial anastomotic infection can be used as guidelines for graft preservation . Between 1972 and 1990, the authors treated 35 anastomotic infections involving a common femoral or distal artery . The graft material was Dacron in 14 patients, polytetrafluoroethylene (PTFE) in 14, and vein in 7 . Of the 14 Dacron grafts, immediate graft excision was required for overwhelming infection in eight patients (bleeding in five, sepsis in three) and for an occluded graft in one patient . Three of five patients failed attempted graft preservation because of nonhealing wounds . Thus, 12 of the 14 Dacron grafts ultimately required graft excision . Of the 21 "smooth-walled" vein and PTFE grafts, 10 required immediate graft excision for occluded grafts (five PTFE, one vein) or bleeding (three PTFE, one vein) . Ten of the remaining 11 (91%) patients with patent "smooth-walled" grafts, intact anastomoses, and absence of sepsis managed by graft preservation healed their wounds and maintained distal arterial perfusion . Wound cultures grew pure gram-positive cocci in 17 of 21 "smooth-walled" graft infections versus 8 of 14 Dacron graft infections . In the absence of systemic sepsis, graft preservation is the treatment of choice for gram-positive infections involving an intact anastomosis of patent PTFE and vein grafts . Regardless of the bacterial cause, the authors recommend that any infrainguinal anastomotic infection of a Dacron graft be treated by immediate excision of all infected graft material.

Mol Microbiol, 1992 Jul, 6(13), 1809 - 20
Interaction of the regulatory protein NicR1 with the promoter region of the pAO1-encoded 6-hydroxy-D-nicotine oxidase gene of Arthrobacter oxidans; Bernauer H et al.; The D,L-nicotine catabolism of the Gram-positive soil bacterium Arthrobacter oxidans is linked to the presence within the cells of the 160 kb catabolic plasmid pAO1 . pAO1-cured cells lost the catabolic enzymes and reintroduction of pAO1 by electroporation into cured cells reestablished the nic+ phenotype . DNA band shift assays with extracts from cured and pAO1+ cells suggested that pAO1 encodes the regulatory protein NicR1 . Footprint analysis revealed that two homologous palindromes (IR1 and IR2), present in the 5'-regulatory region of the 6-HDNO gene, were protected from DNase I digestion . Binding of NicR1 to the palindromes is symmetrical, co-operative, and stronger to IR1 containing the 6-HDNO gene promoter than to IR2 . Site-directed mutagenesis revealed that steric constraints and sequence requirements for NicR1-binding are located exclusively in the palindromic sequences . Deletions and insertions in the interpalindromic region and in the 6-HDNO promoter -10 sequence had no effect on the binding characteristics of NicR1 to the 6-HDNO regulatory region . Acting as a repressor, NicR1 prevents binding of the E . coli RNA-polymerase to the consensus sigma 70 promoter in vitro . However, the interaction of NicR1 with the 6-HDNO promoter region in extracts of nicotine-induced cells from various growth stages did not differ from that observed with extracts of nicotine-uninduced cells.

J Bacteriol, 1992 Jul, 174(13), 4500 - 3
Transformation of the gram-positive bacterium Clavibacter xyli subsp . cynodontis by electroporation with plasmids from the IncP incompatibility group; Metzler MC et al.; We report the transformation of a gram-positive bacterium, Clavibacter xyli subsp . cynodontis, with several plasmids in the IncP incompatibility group from gram-negative bacteria . Our results suggest that IncP plasmids may be transferable to other gram-positive organisms . After optimizing electroporation parameters, we obtained a maximum of 2 x 10(5) transformants per microgram of DNA . The availability of a transformation system for this bacteria will facilitate its use in indirectly expressing beneficial traits in plants.

Infect Immun, 1992 Jul, 60(7), 2835 - 42
Interleukin-8 in sepsis: relation to shock and inflammatory mediators; Hack CE et al.; Because of its neutrophil-activating properties, interleukin-8 (IL-8) may play an important role in the pathophysiology of sepsis . We measured circulating IL-8 levels in 47 patients with clinical sepsis . Levels on admission were elevated in 42 of the 47 patients (89%) and were comparable in patients with gram-positive or gram-negative infections . Patients with shock had significantly higher IL-8 levels than normotensive patients (P = 0.0014, Wilcoxon-Mann-Whitney test), whereas no differences in IL-8 levels were found between patients with or without adult respiratory distress syndrome . Patients who died had higher IL-8 levels on admission than the patients who survived . The largest differences in IL-8 levels between survivors and nonsurvivors was found when only patients with positive cultures were considered (P = 0.0342) . IL-8 levels appeared to correlate significantly with lactate levels and inversely with leukocyte and platelet numbers and mean arterial pressure . In addition, the IL-8 level in the sepsis patients was found to correlate significantly with levels of IL-6, elastase-alpha 1-antitrypsin, and C3a . Serial observations revealed that in most patients IL-8 levels decreased, irrespective of the outcome . Thus, our results demonstrate that IL-8 levels are increased in most patients with sepsis and correlate with some important clinical, biochemical, and inflammatory parameters . These findings suggest a role for IL-8 in the pathophysiology of sepsis.

Plasmid, 1992 Jul, 28(1), 86 - 91
Nucleotide sequence of Mycoplasma mycoides subspecies Mycoides plasmid pKMK1; King KW et al.; To facilitate the development of mycoplasmal cloning vectors, we have determined the nucleotide sequence of pKMK1, a cryptic plasmid isolated from Mycoplasma mycoides subsp . mycoides . It is 1875 bp in length and contains two open reading frames (ORFs) that share homology with ORFs from members of a large family of gram-positive bacterial plasmids which replicate via a single-stranded DNA intermediate . Putative origins of replication and candidate cloning sites have been identified.

Arch Esp Urol, 1992 Jul-Aug, 45(6), 509 - 13
{Retroperitoneal abscess: analysis of 26 cases}; Gomez Vegas A et al.; Herein we present the experience of our hospital, which spans a period of 10 years, in the diagnosis and treatment of retroperitoneal abscess . The clinical features, origin and localization of the abscesses are described . We underscore the diagnostic value of ultrasound (US) and computerized tomography (CT) which afford a sensitivity of 86.3% and 100%, respectively . An increased incidence of abscess from gram-positive bacteria was observed in i.v . drug addicts.

Thorax, 1992 Jul, 47(7), 547 - 9
Rapid diagnosis of gram negative pneumonia by assay of endotoxin in bronchoalveolar lavage fluid; Pugin J et al.; BACKGROUND: Diagnosis of ventilator associated pneumonia can be made by quantitative cultures of bronchoalveolar lavage fluid or of protected specimen brushings, though cultures require 24-48 hours to provide results . In 80% of cases aerobic Gram negative bacteria are the cause . METHODS: A rapid diagnostic method of assessing the endotoxin content of lavage fluid by Limulus assay is described . Forty samples of lavage fluid were obtained from patients with multiple trauma requiring mechanical ventilation for a prolonged period . Pneumonia was diagnosed on the basis of clinical, radiological, and bacteriological findings, including quantitative cultures of lavage fluid . RESULTS: A relation was observed between the concentration of endotoxin in lavage fluid and the quantity of Gram negative bacteria . The median endotoxin content of lavage fluid in Gram negative bacterial pneumonia was 15 endotoxin units (EU)/ml; the range observed in individual patients was 6 to > 150 EU/ml . In patients with pneumonia due to Gram positive cocci and in non-infected patients the median endotoxin level was 0.17 (range < or = 0.06 to 2) EU/ml . An endotoxin level greater than or equal to 6 EU/ml distinguished patients with Gram negative bacterial pneumonia from colonised patients and from those with pneumonia due to Gram positive cocci . CONCLUSION: The measurement of endotoxin in lavage fluid is a rapid (less than two hours) and accurate diagnostic method . It should allow specific and early treatment of Gram negative bacterial pneumonia.

J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 9 - 14
RP 59500: a proposed mechanism for its bactericidal activity; Aumercier M et al.; RP 59500 is a combination of RP 57669 and RP 54476, which are semisynthetic water soluble derivatives of pristinamycin IA (PIA) and pristinamycin IIA (PIIA), respectively . Like their precursors, these molecules are bacteristatic in their own right . In association, they exert bactericidal activity against a variety of Gram-positive bacteria . Experiments involving the binding of these antibiotics to the target bacterial ribosome showed that both the binding sites and the mechanism of action of the components of RP 59500 are identical to those of the parent molecules . By affinity-labelling with a structural analogue of RP 57669, it was demonstrated that L24, a protein of the 70S ribosomal subunit, was specifically labelled . Experiments using radioactive N-ethylmaleimide to label proteins possessing a thiol residue, indicated that proteins L24, L10 and L11 are not only close to each other in the ribosomal structure, but are also adjacent (if not actually part of) the channel through which newly synthesized proteins are extruded . We propose that the mechanism of action of these compounds is to close or narrow the extrusion channel of these proteins, which could lead to their accumulation on the ribosome . We cannot exclude, of course, the possibility that this accumulation disturbs peptidyl-tRNA hydrolase (PHT) activity, thereby depleting free tRNAs within the cell and inhibiting protein synthesis.

Ginecol Obstet Mex, 1992 Jul, 60, 201 - 4
{Nosocomial infection during puerperium}; Barroso Aguirre J et al.; Material and methods used to assess the epidemiology of puerperal infection (PI) in the National Institute of Perinatology (Mexico) between 1984 and 1990, are described . We observed that the general rate of PI ranged between 1.6 and 3.1; post-cesarean section posed a higher risk of infection than vaginal partum . Endometritis, associated with cesarean section, was the most frequent form of PI and gram positive flora was the most frequently found etiological agent . In general terms, we found that the rate of PI remained constant through the years of study, even when there was a significant increase in the practice of cesarean operations . Finally, we emphasize the need for the standardization of clinical norms used to assess the epidemiology of infection events . Standard norms will allow health-service institutions to compare results, observe tendencies, predict changes and take preventive actions.

J Infect, 1992 Jul, 25(1), 11 - 9
Ceftazidime and amikacin as empiric treatment of febrile episodes in neutropenic patients in Saudi Arabia; Santhosh-Kumar CR et al.; Sixty-four consecutive febrile episodes in 50 consecutive patients with malignancy and neutropenia were empirically treated with a combination of ceftazidime and amikacin . Of 52 analysable episodes, the response rate was 59.6% overall and 26.3% of episodes with microbiologically documented infections with septicaemia . Infection-related death occurred in 10 patients (19.2% of episodes) . The response rates were similar in patients with acute leukaemia or other malignancies . Poor response is attributed to increased frequency of infections with Gram-positive and fungal organisms . A modified empiric regimen including cover for Gram-positive and fungal organisms is suggested in similar patient populations.

Ukr Biokhim Zh, 1992 Jul-Aug, 64(4), 72 - 7
{Glutamine metabolism by rumen microorganisms: effect of monensin}; Kalachniuk GI et al.; Transformation of glutamine of mixed population of microorganisms-symbionts is demonstrated . Protection of glutamine and its intermediates (glutamate and pyroglutamate) under the influence of ionophore (monensin) is found . It is accompanied by the reduced (by 30-70 per cent and more) levels of ammonia formation, total VFA, acetate, butyrate, pH, alpha-ketoglutarate dehydrogenase and glutamine synthetase at parallel increase of L-aspartate and L-alanine: 2-oxoglutarate, aminotransferase activity, redox potential of stability of protein content . It is suggested that the rapid change of Eh level on the 24th hour of incubation reflects the main stage of pyroglutamate formation being one of the final products of glutamine degradation when monensin is used . Ionophore affects first of all the inhibition of metabolic processes in gram-positive rumen microorganisms.

Am J Ophthalmol, 1992 Jun 15, 113(6), 638 - 44
Topically administered norfloxacin compared with topically administered gentamicin for the treatment of external ocular bacterial infections . The Worldwide Norfloxacin Ophthalmic Study Group; Miller IM et al.; In this double-masked study, we randomly assigned 488 patients with clinical signs of acute bacterial conjunctivitis or blepharitis, or both, to treatment with either norfloxacin ophthalmic solution 0.3% (245) or gentamicin ophthalmic solution 0.3% (243) for one week . Of the patients with positive cultures, 71% (85 of 120) of the norfloxacin-treated patients and 65% (86 of 133) of the gentamicin-treated patients were clinically cured . An additional 25% (30 of 120) of norfloxacin-treated patients and 32% (43 of 133) of gentamicin-treated patients were clinically improved . On the basis of posttreatment cultures, 89% of all cultured bacteria were eradicated (146 of 179 organisms) or suppressed (14 of 179 organisms) after treatment with norfloxacin . The condition of five norfloxacin-treated patients did not clinically improve, compared with the condition of eight gentamicin-treated patients . Both antibiotics had similar efficacy against gram-positive and against gram-negative organisms . One norfloxacin-treated patient and two gentamicin-treated patients withdrew from the study because of local intolerance . Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the eyelids or conjunctiva, or both . In this study, norfloxacin was clinically and microbiologically similar in activity to gentamicin.

J Antibiot (Tokyo), 1992 Jun, 45(6), 817 - 23
Isolation and characterization of new peptide antibiotics, plusbacins A1-A4 and B1-B4; Shoji J et al.; New antibiotics, plusbacins A1-A4 and B1-B4, were isolated from the culture broth of a strain of Pseudomonas sp . These antibiotics were isolated as a complex by column chromatographies on Diaion HP-20 and silica gel, and then separated by HPLC . They are amphoteric in nature . The hydrochlorides are obtained as colorless powders, soluble in methanol and alkaline water . From their physico-chemical properties, these antibiotics are presumed to be acyloctapeptides containing a lactone linkage, and their differences occur in amino acid and fatty acid residues . The antibiotics are active against Gram-positive bacteria in vitro and in vivo.

Infect Control Hosp Epidemiol, 1992 Jun, 13(6), 357 - 68
Azithromycin and clarithromycin: overview and comparison with erythromycin; Whitman MS et al.; Azithromycin and clarithromycin are erythromycin analogues that have recently been approved by the FDA . These drugs inhibit protein synthesis in susceptible organisms by binding to the 50S ribosomal subunit . Alteration in this binding site confers simultaneous resistance to all macrolide antibiotics . Clarithromycin is several-fold more active in vitro than erythromycin against gram-positive organisms, while azithromycin is 2- to 4-fold less potent . Azithromycin has excellent in vitro activity against H influenzae (MIC90 0.5 microgram/ml), whereas clarithromycin, although less active against H influenzae (MIC90 4.0 micrograms/ml) by standard in vitro testing, is metabolized into an active compound with twice the in vitro activity of the parent drug . Both azithromycin and clarithromycin are equivalent to standard oral therapies against respiratory tract and soft tissue infections caused by susceptible organisms, including S aureus, S pneumoniae, S pyogenes, H influenzae, and M catarrhalis . Clarithromycin is more active in vitro against the atypical respiratory pathogens (e.g., Legionella), although insufficient in vivo data are available to demonstrate a clinical difference between azithromycin and clarithromycin . Superior pharmacodynamic properties separate the new macrolides from the prototype, erythromycin . Azithromycin has a large volume of distribution, and, although serum concentrations remain low, it concentrates readily within tissues, demonstrating a tissue half-life of approximately three days . These properties allow novel dosing schemes for azithromycin, because a five-day course will provide therapeutic tissue concentrations for at least ten days . Clarithromycin has a longer serum half-life and better tissue penetration than erythromycin, allowing twice-a-day dosing for most common infections . Azithromycin pharmacokinetics permit a five-day, single daily dose regimen for respiratory tract and soft tissue infections, and a single 1 g dose of azithromycin effectively treats C trachomatis genital infections; these more convenient dosing schedules improve patient compliance . Azithromycin and clarithromycin also are active against some unexpected pathogens (e.g., B burgdorferi, T gondii, M avium complex, and M leprae) . Clarithromycin, thus far, appears the most active against atypical mycobacteria, giving new hope to what has become a difficult group of infections to treat . Gastrointestinal distress, a well known and major obstacle to patient compliance with erythromycin, is relatively uncommon with the new macrolides . Further clinical data and experiences may better define and expand the role of these new macrolides in the treatment of infectious diseases.

J Bacteriol, 1992 Jun, 174(12), 4036 - 41
Conjugative transposition of Tn916: the transposon int gene is required only in the donor; Bringel F et al.; Conjugative transposition of transposon Tn916 has been shown to proceed by excision of the transposon in the donor strain and insertion of this element in the recipient . This process requires the product of the transposon int gene . We report here the surprising finding that the int gene is required only in the donor during conjugative transposition . We find that Tn916 int-1, whose int gene has been inactivated by an insertion mutation, transposes when a complementing wild-type int gene is present only in the donor during mating . When the int+ gene is present in a plasmid and is expressed from the spac promoter, conjugative transposition is very inefficient . However, when the Int+ function is supplied from a coresident distantly linked Tn916 tra-641 mutant, which is defective in a function required for conjugation, efficient conjugative transposition of Tn916 int-1 occurs . This suggests either that Int is not required for integration of Tn916 in gram-positive bacteria or that the protein is transferred from the donor to the transconjugant during the mating event . When the nonconjugative plasmid pAT145 was present in the donor, it was rarely cotransferred with Tn916 . This suggests that complete fusion of mating cells is not common during conjugative transposition.

Harefuah, 1992 May 15, 122(10), 638 - 9, 687
{Actinomycosis mimicking abdominal neoplasm}; Rushrash G et al.; A case of actinomycosis mimicking abdominal neoplasm in a 56-year old woman is presented . Actinomyces israelii is a common saprophyte found in the mouth and gastrointestinal tract . It is an anaerobic, Gram-positive, branching filamentous fungus related in many respects to the bacteria . Damage to the mucosa by trauma, disease or surgery is an essential prerequisite to infection with this organism . In 20% of the cases the abdomen is involved, but an abdominal mass is a rare presentation . In such cases diagnosis prior to exploratory laparotomy is difficult.

Antimicrob Agents Chemother, 1992 May, 36(5), 1062 - 7
Vancomycin is not an essential component of the initial empiric treatment regimen for febrile neutropenic patients receiving ceftazidime: a randomized prospective study; Ramphal R et al.; The use of vancomycin as part of the initial antibiotic therapy of febrile neutropenic patients has become a controversial issue . Some studies support its incorporation in the initial regimen, and others suggest that vancomycin can be added later . We examined this issue in a prospective, randomized trial . We randomized 127 febrile neutropenic patients to receive either ceftazidime alone or ceftazidime plus vancomycin as the initial empiric antibiotic treatment . We added vancomycin to the ceftazidime arm of the study when fever persisted after 96 h of monotherapy, when new fever occurred after this time, or when a moderately ceftazidime-resistant gram-positive bacterium was isolated . Each of these regimens had similar initial response rates, similar durations of initial fever, similar frequencies of new fever during therapy, similar microbiological cure rates, similar superinfection rates, and similar survival rates . We observed more renal and cutaneous toxicities in patients receiving vancomycin and ceftazidime as initial therapy . We conclude that ceftazidime is appropriate as initial therapy for febrile neutropenic patients and that the addition of vancomycin is appropriate when fever persists after 4 days of monotherapy or when fever recurs following an initial response.

J Pediatr Ophthalmol Strabismus, 1992 May-Jun, 29(3), 139 - 41
Endophthalmitis following pediatric intraocular surgery for congenital cataracts and congenital glaucoma; Wheeler DT et al.; The incidence of endophthalmitis following pediatric anterior segment surgery is currently unknown . The paucity of reports of this entity has led some observers to recommend simultaneous bilateral surgery for congenital cataracts or glaucoma . In this study, we surveyed over 500 pediatric ophthalmologists and glaucoma specialists concerning their knowledge of, or involvement with, endophthalmitis following pediatric intraocular surgery . Seventeen cases of endophthalmitis were documented to occur out of 24,000 reported surgical cases . This results in an incidence estimate of 0.071%, or 7 cases per 10,000, which is similar to that recently reported following adult extracapsular cataract extraction . The presence of infection was diagnosed by the 3rd postoperative day in 82% of cases . An organism was documented by culture in 65% of cases . The organism was gram positive in all cases . Visual outcome was generally poor with 65% having no light perception . The presence of possible concurrent risk factors for postoperative endophthalmitis, including nasolacrimal duct obstruction and upper respiratory infection, was noted in 8 of the 17 cases.

Am J Dis Child, 1992 May, 146(5), 567 - 71
Long-term outcome of neonatal meningitis; Franco SM et al.; OBJECTIVE--To determine the long-term outcome of neonatal bacterial meningitis and the relationship between the outcome and specific features in the acute stage of the disease; and to compare the outcome between infants with neonatal meningitis and high-risk infants without meningitis . DESIGN--Prospective clinical evaluations of 21 survivors of meningitis and 21 matched controls who were retrospectively selected from a high-risk patient population . SETTING--Program of follow-up performed at the Children and Youth Project's High Risk Center of the Department of Pediatrics, University of Louisville, Louisville, Ky . Neonates were inborn at a university hospital with a high-risk obstetric unit and level III nursery . PATIENTS--Twenty-six consecutive neonates born between 1970 and 1980 with culture-proven bacterial meningitis, excluding neonates with congenital neurologic defects . Nineteen of 21 survivors and 21 controls matched by age, sex, race, birth weight, and gestational age were followed up from 1 to 14 years (mean, 7.8 years) . Both survivors and controls fell below the federal poverty guidelines . RESULTS--Gram-positive meningitis was twice as common as gram-negative meningitis with co-occurrence of meningitis and sepsis in half of the cases . Neonates with gram-positive meningitis and higher birth weight had a higher survival rate, but this finding was not statistically significant . The mortality rate in neonates with gram-negative meningitis was almost three times higher than that of neonates with gram-positive meningitis, but no significant difference was observed between their morbidity rates . Eight (38%) of 21 survivors were normal, while another eight (38%) and five (24%) had mild and moderate to severe sequelae, respectively . Survivors of meningitis had lower IQ scores and more severe sequelae than matched controls . CONCLUSION--Neonatal bacterial meningitis results in poorer long-term outcome than in controls, but improved outcome compared with previous studies of neonatal meningitis.

Klin Monatsbl Augenheilkd, 1992 May, 200(5), 541 - 2
{Primary antibiotic treatment of corneal ulcers in contact lens patients}; Willa E et al.; Two patient histories show that the therapy of contact lens corneal ulcers is complicated by bacterial resistance and mixed infection . To start an effective therapy against pseudomonas, gram-negative as well as gram-positive germs, a primary combination of tobramycin with fusidic acid seems to us as reasonable . Because of possible resistance to these antibiotics a smear should be taken from the ulcer and the contact lens case before therapy is begun and the clinical evolution must be controlled . In the choice of the antibiotics, the actual state of resistance and commercial availability was taken into account.

J Periodontal Res, 1992 May, 27(3), 161 - 6
Ultrastructural localization of alkaline and acid phosphatase activities in dental plaque; Lo Storto S et al.; Ultrastructural cytohistochemical techniques showed presence of acid and alkaline phosphatases in dental plaque . Both phosphatases had intra- and extramicrobial localization . In the extracellular matrix, phosphatases were associated with small vesicles of bacterial origin, or were freely scattered in the matrix without apparent connection with microbial structures . Intracellularly, alkaline (AlkP) and acid (AcP) phosphatases were observed in Gram-negative and Gram-positive bacteria, showing a different localization . The AlkP was mainly located in the periplasmic space, while AcP had a double preferential localization: along the outer surface of the cell wall and in the periplasmic space . Less frequently an intracellular phosphatase reaction was seen in the cytoplasm.

J Invertebr Pathol, 1992 May, 59(3), 222 - 7
Phagocytosis by hemocytes of the hard clam, Mercenaria mercenaria; Tripp MR; Large granular hemocytes of Mercenaria mercenaria avidly phagocytose a variety of biological particles (red blood cells of six species, yeast, and gram-positive and gram-negative bacteria) as well as polystyrene spheres . Clam hemolymph is not necessary for phagocytosis but may have some opsonic effect in certain circumstances (e.g., low temperature and low particle density) . Formaldehyde treatment of red blood cells enhances susceptibility to phagocytosis . Phagocytosis by Mercenaria hemocytes in vitro appears to be a nonspecific process.

J Vasc Surg, 1992 May, 15(5), 843 - 8; discussion 848-50
Wound complications of the in situ saphenous vein bypass technique; Reifsnyder T et al.; Wound complications after in situ saphenous vein bypass occur frequently, lengthen hospitalization, and threaten graft viability . From May 1981 to March 1991, 117 consecutive male patients underwent 126 in situ operations: 45 (36%) femoropopliteal, 75 (59%) femorotibial, and 6 (5%) grafts to the dorsal pedal artery for gangrene or ulcer (n = 69), rest pain (n = 54), or claudication (n = 3) . Wound complications developed in 55 grafts (44%): erythema developed in 11, but they healed primarily, 19 had skin edge necrosis or localized lymph leaks, 12 had necrosis or infection into the subcutaneous tissue without danger to the graft, and invasive infections that threatened the graft developed in 13 . Risk factors for a subsequent wound infection included the development of a lymph leak (p less than or equal to 0.05) and early postoperative graft revision for thrombosis, wound hematoma, retained valve or arteriovenous fistula (p less than or equal to 0.05) . The mean time to appearance of a graft-threatening wound infection was 31 days, and 10 of 13 were located in the distal limb . Twelve of the 13 deep infections required operative debridement, and seven required a flap or split thickness skin graft for coverage . Gram-negative as well as gram-positive infections responded equally well . No grafts were lost, and no deaths occurred . Despite the high incidence of wound complications, an aggressive therapy regimen permitted universal graft salvage.

J Infect Dis, 1992 May, 165(5), 886 - 90
Interleukin-6 and its relationship to C-reactive protein and fever in children with febrile neutropenia; Heney D et al.; The assessment of febrile neutropenia is problematic . C-reactive protein (CRP) values alone do not differentiate those patients with microbiologically documented infections from those with unexplained fevers . Plasma interleukin-6 (IL-6), measured by ELISA, was correlated with different diagnostic groups in 47 episodes of febrile neutropenia in children . Samples were collected daily from admission until resolution of fever . On admission, the median IL-6 value for gram-negative infections was 1610 pg/ml (range, 896-40,000), for gram-positive infections it was 138 pg/ml (range, 66-1045), and for unexplained fevers it was 50 pg/ml (range, 24-135, with a single high value of 665 pg/ml) . These medians were significantly different (P less than .005) . There was no significant difference in median CRP values . IL-6 values peaked 24-48 h before CRP values . There was a positive correlation of IL-6 with the presence of fever . Plasma IL-6 may be a more sensitive marker than CRP of acute infection and should prove useful in the assessment of fevers in these patients.

JPEN J Parenter Enteral Nutr, 1992 May-Jun, 16(3), 268 - 74
Vancomycin stability in heparin and total parenteral nutrition solutions: novel approach to therapy of central venous catheter-related infections; Yao JD et al.; To facilitate therapy of central venous catheter-related Gram-positive bacterial infection in patients who require total parenteral nutrition (TPN) therapy, we studied the stability of vancomycin in a commonly used TPN solution (V-TPN) at final concentrations of 0.5 mg/mL and 1.0 mg/mL and in heparin (100 U/mL in 0.9% NaCl) at 25 micrograms/mL (V-H) . Vancomycin concentrations in V-TPN and V-H after storage at 4 degrees C over 35 and 14 days, respectively, were stable (within 10% of the prestorage vancomycin concentration) . After 14 days at 4 degrees C heparin activity in V-H solution was 100 +/- 4% of that noted initially . Vancomycin remained stable (100 +/- 6% of the original vancomycin concentration) when the previously refrigerated V-TPN was held for an additional 24 hours at 22 degrees C . When the previously refrigerated V-H was held for an additional 24 hours at 37 degrees C, vancomycin concentrations decreased to 78 +/- 9% of the baseline concentrations (p less than .001) . The stability of vancomycin in this TPN solution allows the daily dose of vancomycin to be mixed with the solution and then infused over 10 hours . As shown with pharmacokinetic modeling, this form of therapy will achieve serum vancomycin concentrations within the therapeutic range throughout a 24-hour period . The relative stability of vancomycin in a heparin line-flush solution allows vancomycin concentration in the lumen of the catheter to be maintained at greater than or equal to 15 micrograms/mL during the interval between catheter flushing and the subsequent TPN infusion . A simplified method of administering vancomycin to patients receiving concurrent TPN is possible.

J Endod, 1992 May, 18(5), 216 - 27
Histological evaluation of the presence of bacteria in induced periapical lesions in monkeys; Walton RE et al.; In endodontic periapical lesions, both presence and location of bacteria are controversial . Various experimental techniques have produced differing results perhaps related to potential artifacts such as contamination during specimen recovery . Our objective was to examine for bacteria in uncontaminated, undisturbed periapical lesions in an animal model . Pulp necrosis was induced by exposing molars in nonhuman primates and closing the exposure after 1 week with amalgam . Lesions developed at 18 apices . After 7 months, block sections including tooth and surrounding tissues were removed, processed histologically, and Gram stained . Bacteria, primarily Gram positive, were consistently identified in necrotic tissue in canals . Two canals demonstrated bacterial masses to the apical foramen . No bacterial colonies, only intracellular microorganisms, were seen periapically . Inflammatory lesions seemed to resist the spread of bacteria, confining them to the canal space . Bacterial masses at the apical foramen could contaminate periapical tissues during surgery or extraction and give a false positive upon microbiological sampling.

Eur J Anaesthesiol, 1992 May, 9(3), 229 - 33
Bed-side infection screening of ICU patients using gram stained smears; Huemer G et al.; Bronchial, abdominal or pleural aspirates (n = 364) collected from 165 ICU patients were both cultivated and evaluated microscopically using Gram stained smears, and the results were compared: 331 aspirates (91%) were classified correctly . Fungi were confirmed in all cases (21/21, sensitivity and specificity 100%) . Gram-negative findings (n = 66) had a specificity of 97% (2/66 reclassified as Gram positive by culture): 21/85 Gram-negative cultures were overlooked by the Gram method (sensitivity 75%) . Of 106 Gram-positive results, culture was negative in 10/106 and 7/106 were diagnosed as Gram-negative (specificity 84%) . Sensitivity was 98% (only 2/91 not detected by the Gram technique) . In 171 cases, no organisms were seen; specificity was 92% (Gram-negative bacteria cultivated in 14/171) . Sensitivity was 94% (10/167 misdiagnosed as Gram-positive) . Gram diagnoses were available 63 +/- 14 h prior to the culture test results . Treatment decisions based upon the Gram results were correct in 90% (326/364) . It is concluded that Gram stained smears are a valuable tool for bed-side infection screening in ICU patients.

J Bacteriol, 1992 May, 174(9), 2986 - 92
Effects of the membrane action of tetralin on the functional and structural properties of artificial and bacterial membranes; Sikkema J et al.; Tetralin is toxic to bacterial cells at concentrations below 100 mumol/liter . To assess the inhibitory action of tetralin on bacterial membranes, a membrane model system, consisting of proteoliposomes in which beef heart cytochrome c oxidase was reconstituted as the proton motive force-generating mechanism, and several gram-positive and gram-negative bacteria were studied . Because of its hydrophobicity, tetralin partitioned into lipid membranes preferentially (lipid/buffer partition coefficient of tetralin is approximately 1,100) . The excessive accumulation of tetralin caused expansion of the membrane and impairment of different membrane functions . Studies with proteoliposomes and intact cells indicated that tetralin makes the membrane permeable for ions (protons) and inhibits the respiratory enzymes, which leads to a partial dissipation of the pH gradient and electrical potential . The effect of tetralin on the components of the proton motive force as well as disruption of protein-lipid interaction(s) could lead to impairment of various metabolic functions and to low growth rates . The data offer an explanation for the difficulty in isolating and cultivating microorganisms in media containing tetralin or other lipophilic compounds.

Vet Rec, 1992 Apr 18, 130(16), 343 - 9
Ruminal lactic acidosis in sheep and goats; Braun U et al.; The clinical findings in 37 sheep and goats with acute ruminal lactic acidosis included a disturbed general condition characterised by anorexia, apathy, teeth grinding and muscle twitching, ruminal stasis, and the excretion of soupy or watery faeces . The ruminal fluid of affected animals was milky, had a sour odour and a low pH . There was a predominance of Gram-positive bacteria in smears of ruminal fluid . In comparison with 10 control animals, the rumen fluid of 23 sheep with ruminal lactic acidosis had higher lactic acid and lower volatile fatty acid concentrations . In addition, the affected animals often had haemoconcentration and metabolic acidosis . Treatment included single or repeated transfer of ruminal fluid from healthy cows and, depending on the severity, the administration of antacids, yeast and chlortetracycline, and the intravenous infusion of isotonic sodium chloride and 5 per cent sodium bicarbonate solutions . Of the 37 treated sheep and goats, four died within 24 hours, and three others were euthanased after one, two and three days because their condition rapidly deteriorated . Thirty animals were discharged one to nine days after treatment . Twenty-nine of them (78.4 per cent) recovered completely but one was euthanased later.

J Pediatr, 1992 Apr, 120(4 Pt 1), 510 - 5
Correlation of plasma cytokine elevations with mortality rate in children with sepsis; Sullivan JS et al.; Cytokines are thought to be important endogenous mediators of the host immune response to bacterial infection . We hypothesized that plasma levels of cytokines are elevated in children with sepsis and that the magnitude of elevation of these cytokines is correlated with severity of illness and mortality rate . We determined plasma levels of tumor necrosis factor, interleukin-6, and interleukin-1 in 21 children with sepsis . Plasma samples were collected at presentation and at 12, 24, and 48 hours thereafter . Cytokine levels were elevated in pediatric patients with bacterial sepsis during the first 48 hours after presentation; levels were undetectable in study control subjects . The tumor necrosis factor and interleukin-6 levels (p less than 0.001), as well as levels of interleukin-1 (p = 0.05), were significantly higher in nonsurvivors than in survivors and were independent of severity of illness (pediatric risk of mortality (PRISM) score) at presentation . Elevations of tumor necrosis factor and interleukin-6 were sustained for longer than 24 to 48 hours in nonsurvivors: II-1 concentrations were significantly increased only at time zero . Of 11 children with an interleukin-6 value greater than 2 ng/ml during the first 48 hours, 10 died; only one of 10 not reaching that level died (p less than 0.001) . Cytokines were elevated as frequently with gram-positive as with gram-negative infections . We speculate that cytokine determinations may identify children who might benefit from immunotherapeutic interventions.

J Chemother, 1992 Apr, 4(2), 107 - 13
Aztreonam plus vancomycin versus gentamicin plus piperacillin as empirical therapy for the treatment of fever in neutropenic patients: a randomised controlled study; Kelsey SM et al.; The efficacy of aztreonam in combination with vancomycin was compared with that of gentamicin plus piperacillin as empirical antibiotic treatment for fever in 61 neutropenic patients . Aztreonam plus vancomycin was as effective, but no more effective, than gentamicin plus piperacillin . Aztreonam showed excellent clinical and in vitro efficacy against Gram-negative pathogens . Failure to respond to aztreonam plus vancomycin was, in most cases, due to presumed or documented fungal infection; by contrast, failure to respond to gentamicin plus piperacillin was frequently to be due to resistant or superadded infection with Gram-positive bacteria.

J Antibiot (Tokyo), 1992 Apr, 45(4), 470 - 5
New polyenic antibiotics active against gram-positive and gram-negative bacteria . IV . Structural elucidation of enacyloxin IIa; Watanabe T et al.; The chemical structure of a unique polyenic antibiotic enacyloxin IIa (former name: fr . 2) produced by Frateuria (formerly Gluconobacter) sp . W-315 has been determined by extensive spectroscopic studies, in particular by NMR spectral analysis . It has a novel non-lactonic structure involving 3,4-dihydroxycyclohexanecarboxylic acid with a chlorine-containing polyenic and polyhydroxy acyl side chain attached as an ester to the 3-hydroxyl substituent of the acid.

J Periodontol, 1992 Apr, 63(4), 243 - 52
The apical border plaque in chronic adult periodontitis . An ultrastructural study . I . Morphology, structure, and cell content; Vrahopoulos TP et al.; THIS STUDY CONCERNS THE APICAL BORDER (AB) plaque in relation to chronic adult periodontitis (AP) . Fifty-six teeth from 24 patients with AP were examined by transmission electron microscopy (TEM) . The AB was not discrete with islands of bacteria in the so-called plaque-free zone (PFZ) . Coronal to the AB, the established plaque commonly consisted of three to four layers of Gram-positive and Gram-negative cocci, rods, filaments, and spirochetes and a superficial layer, mainly of spirochetes, but including filaments, "test tube brush," and "corn-cob" formations . The most apical apparently intact organisms in the PFZ were in bacterial islands or in isolation and were predominantly Gram-negative cocci and rods, with occasional other morphotypes . The most apical microorganisms were invariably ghost cells . A cuticle of varying thickness and structure was present at the plaque/tooth interface . It was concluded that there was a limited range of intact bacterial morphotypes in the apical border plaque in chronic periodontitis.

J Mol Evol, 1992 Apr, 34(4), 345 - 50
Evolutionary origin of the class A and class C beta-lactamases; Kirby R; The protein sequences of 18 class A beta-lactamases and 2 class C beta-lactamases were analyzed to produce a rooted phylogenetic tree using the DD peptidase of Streptomyces R61 as an outgroup . This tree supports the penicillin-binding proteins as the most likely candidate for the ancestoral origin of the class A and class C beta-lactamases, these proteins diverging from a common evolutionary origin close to the DD peptidase . The actinomycetes are clearly shown as the origin of the class A beta-lactamases found in other non-actinomycete species . The tree also divides the beta-lactamases from the Streptomyces into two subgroups . One subgroup is closer to the DD peptidase root . The other Streptomyces subgroup shares a common branch point with the rest of the class A beta-lactamases, showing this subgroup as the origin of the non-actinomycete class A beta-lactamases . The non-actinomycete class A beta-lactamase phylogenetic tree suggests a spread of these beta-lactamases by horizontal transfer from the Streptomyces into the non-actinomycete gram-positive bacteria and thence into the gram-negative bacteria . The phylogenetic tree of the Streptomyces class A beta-lactamases supports the possibility that horizontal transfer of class A beta-lactamases occurred within the Streptomyces.

Chest, 1992 Apr, 101(4), 1005 - 12
Microbial etiology of acute pneumonia in hospitalized patients; Bates JH et al.; The purpose of this study was to determine the microbial etiology of pneumonia by using strict criteria among a group of hospitalized patients . Patients with acute community-acquired or hospital-acquired pneumonia were studied in a systematic and comprehensive manner for bacterial, viral, chlamydial, mycobacterial, and fungal pathogens . A total of 198 patients with 204 episodes of pneumonia were evaluated . Despite 100 percent follow-up of all surviving patients, a specific etiologic agent could be found in only 103 episodes . Among 154 episodes of community-acquired pneumonia, a diagnosis was made in 79; the most common pathogen was from the genus Legionella, followed by various Gram-negative enteric bacteria, Gram-positive cocci, influenza A virus, and Mycoplasma pneumoniae . The etiologic agent was found in 24 of the 50 patients with hospital-acquired pneumonia; no pathogen predominated . We conclude that even when elaborate diagnostic studies are done, including many invasive procedures, the etiology can be determined in only about half of the patients with acute pneumonia . The pathogens of pneumonia in this study are not markedly different between community-acquired and hospital-acquired infection.

Pediatr Hematol Oncol, 1992 Apr-Jun, 9(2), 115 - 23
Central venous catheter-related infections in pediatric hematology-oncology patients: role of home and hospital management; Rizzari C et al.; In a 61-month period, 135 single-lumen central venous catheters (CVCs) were positioned in 125 children with mainly hematological malignancies . We retrospectively investigated the different role of home and hospital CVC management in development of CVC-related infections (CI) during different hematological conditions (presence or absence of neutropenia) . Forty-nine percent of the children presented at least one CI, for a total of 109 episodes, during the 20,558 days a CVC remained in situ . CVC hospital management was safer and more reliable than CVC home management in both neutropenic and nonneutropenic patients . None of the CI was life threatening and only in 11% of the cases was it necessary to remove the catheter . Analysis of the microorganisms involved showed that they were mainly gram-positive with CVC home management and gram-negative with CVC hospital management . Careful evaluation of our retrospective survey study suggests that a better training of parents in the care of the CVC and more careful measures of asepsis in hospital could further decrease the incidence of CI, thus improving patients' quality of life.

Antimicrob Agents Chemother, 1992 Apr, 36(4), 801 - 7
Imipenem versus gentamicin combined with either cefuroxime or cephalothin as initial therapy for febrile neutropenic patients; Cornelissen JJ et al.; A prospective randomized study was conducted to determine the efficacy of imipenem-cilastatin (hereafter referred to as imipenem) (500 mg four times daily) versus combination therapy for febrile neutropenic patients receiving either no prophylaxis or ciprofloxacin for prevention of infections . Combination therapy consisted of gentamicin (80 mg every 8 h) plus either cefuroxime (1,500 mg every 8 h) or cephalothin (1,000 mg every 4 h) for suspected catheter-related infections . Ninety-four neutropenic fever episodes in 87 patients were evaluable for efficacy . The overall clinical rate of response to imipenem was significantly higher than that to combination therapy (91 versus 74%; P = 0.05) . The difference in efficacy was most pronounced in patients with microbiologically documented infections (89 versus 53%; P = 0.025), which were predominantly caused by gram-positive bacteria . Differences in susceptibility may have caused the better rate of response to imipenem . Two of 29 gram-positive bacteria were imipenem resistant, whereas 10 were resistant to cephalothin and cefuroxime and 12 were resistant to gentamicin . No causative gram-negative bacterium and 24 gram-positive bacteria were isolated in 61 fever episodes with ciprofloxacin prophylaxis (oral) . In contrast, nine causative gram-negative and five gram-positive bacteria were isolated in 33 episodes without prophylaxis . The difference in distribution proved to be statistically significant for gram-negative (P = 0.0001) as well as gram-positive (P = 0.025) bacteria, indicating that ciprofloxacin effectively prevented the occurrence of gram-negative bacteria and may have contributed to the relatively large number of gram-positive bacteria isolated . Empirical initial therapy with imipenem may be a valuable alternative to combination therapy for neutropenic fever episodes.

Comp Biochem Physiol C, 1992 Apr, 101(3), 607 - 13
Bactericidal action of a glycoprotein from the body surface mucus of giant African snail; Otsuka-Fuchino H et al.; 1 . Bactericidal action of a glycoprotein, Achacin, purified from the giant African snail, Achatina fulica Ferussac, has been studied . 2 . Achacin kills both gram-positive and gram-negative bacteria, but only in their growing states . 3 . Achacin does not have any bacteriolytic activity . 4 . The strain which has no cell wall is a little more sensitive than the native strain and the cell membrane-damaged strain . 5 . Achacin was observed on the cytoplasmic membrane and on the cell wall of treated Escherichia coli by immunoelectron microscopy . 6 . Achacin attacks the cytoplasmic membrane of the cell.

J Bacteriol, 1992 Apr, 174(8), 2724 - 8
Homology of a plasmid from the spirochete Treponema denticola with the single-stranded DNA plasmids; MacDougall J et al.; The 2,647-bp nucleotide sequence of cryptic plasmid pTD1, isolated from the oral spirochete Treponema denticola, was determined . The sequence revealed two open reading frames, A and B, which encode polypeptides of 335 and 235 amino acids, respectively . Open reading frame A shows sequence similarity to genes that encode replication proteins from a group of plasmids common in gram-positive bacteria, which replicate via a single-stranded intermediate.

Arch Biochem Biophys, 1992 Apr, 294(1), 55 - 63
Bactericidal activity of alkyl peroxyl radicals generated by heme-iron-catalyzed decomposition of organic peroxides; Akaike T et al.; To clarify the nature of cytocidal molecular species among the radicals generated in the iron-catalyzed reactions of peroxides (ROOH), we examined the cytocidal effects of these radicals against gram-positive and gram-negative bacteria in the presence or absence of various radical scavengers . Three organic peroxides, t-butyl hydroperoxide (t-BuOOH), methyl ethyl ketone peroxide (MEKOOH), and cumene hydroperoxide, were used . Each radical generated from these peroxides was identified and quantitated by electron spin resonance (ESR) spin trapping with 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) . The major cytotoxic radical species generated in the mixtures of various peroxides and heme iron, especially methemoglobin, metmyoglobin, or hemin, was the alkyl peroxyl radical (ROO.) . Strong bactericidal action against gram-positive bacteria was observed in the peroxide-heme iron system, especially in the case of t-BuOOH and MEKOOH . Killing curves for gram-positive bacteria showed an initial lag period, which may indicate the multihit/multitarget kinetics of cell killing . When the diethylenetriamine pentaacetic acid (DTPA)-Fe2+ complex was used as a catalyst for decomposition of various peroxides, alkyl, alkoxyl, and alkyl peroxyl radicals were identified by spin-trapping analysis . However, study of the time course of alkyl peroxyl radical production in the DTPA-Fe2+ complex system revealed that radical species generated in this system were very short lived: a maximal level was achieved within 1 min and then declined sharply, and no bactericidal activity was observed after 10 min . In contrast, the alkyl peroxyl radical level generated by the organic peroxide-heme iron system remained high for 30 min or longer . The generation of alkyl peroxyl radicals quantified by ESR correlated quite well with the bactericidal effect of the system of peroxide plus iron . In addition, bactericidal activity was completely inhibited by the addition of the spin trap DMPO, as well as of other various radical scavengers (alpha-tocopherol and L-ascorbic acid), into the peroxide-heme iron system, but this effect was not observed with superoxide dismutase, beta-carotene, dimethyl sulfoxide, diphenylamine, or butylated hydroxyltoluene . In view of these results, it is assumed that alkyl peroxyl radicals are the potent molecular species that are cytotoxic against bacteria, whereas alkoxyl radicals (RO.) generated in this system do not affect bacterial viability.

Nippon Ronen Igakkai Zasshi, 1992 Mar, 29(3), 174 - 8
{Hyperbilirubinemia associated with sepsis in the elderly}; Nishinaga M et al.; In order to elucidate the frequency of hyperbilirubinemia associated with sepsis in the elderly, as well as in clinical and histological characteristics, a total of 117 autopsy cases with sepsis were analyzed retrospectively . Based on the clinico-pathological findings, 48 cases with primary hepato-biliary, cardiac, hematological and shock complications, were excluded because these disorders were thought to affect liver function tests . Four cases out of the remaining 69 cases, 5.8% of the total, showed hyperbilirubinemia above 2 mg/dl (average 4.1 mg/dl), which was thought to be associated with sepsis itself . In these 4 cases, disproportionately high levels of blood total bilirubin were characteristic compared to changes of GOT, GPT, LDH, ALP and gamma-GTP levels . Blood culture of these 4 cases revealed Gram-negative organisms in 3 cases and Gram-positive in 1 case . Histological findings of the liver included cholestasis, Kupffer cell hyperplasia and cell infiltration in the sinusoid and portal areas, however these findings were mild and nonspecific . It is important to recognize the presence of hyperbilirubinemia associated with sepsis in order to properly treat febrile elderly patients with hyperbilirubinemia.

Zentralbl Veterinarmed A, 1992 Mar, 39(2), 152 - 9
Establishment of a pneumococcal septicemia model in the miniature swine; Izbicki JR et al.; Human pneumococcal septicemia, the prominent postsplenectomy complication, was as yet difficult to study in the porcine model, since this species appeared to be fairly resistant against pneumococcal infections . We have used two strains of pneumococci (serotype 1 and 6B) both of which had been isolated from patients with systemic infection and both of which were maintained in a virulent state by regular mouse passage . After challenge with 10(9) type 1 pneumococci, however, only one of the 5 pigs developed fever, none showed profound hematological alterations and each animal exhibited a rapid clearance of bacteria from peripheral blood . By contrast, challenge of 7 animals with type 6B pneumococci resulted in a slower and incomplete bacterial clearance with persistent bacteremia for up to 24 hours . All animals developed fever and a profound leukopenia with less than 5,000 leukocytes/ml and 3 of the 7 animals died after injection of type 6B pneumococci . The results show that potentially the type 6B pneumococci can be successfully employed for studies of gram positive septicemia in the miniature swine.

J Antibiot (Tokyo), 1992 Mar, 45(3), 306 - 12
Lanomycin and glucolanomycin, antifungal agents produced by Pycnidiophora dispersa . I . Discovery, isolation and biological activity; O'Sullivan J et al.; The antifungal agents lanomycin and glucolanomycin were isolated from Pycnidiophora dispersa . The compounds were active against species of Candida and dermatophytes but were inactive against Aspergillus fumigatus and Gram-positive and Gram-negative bacteria . The compounds inhibited the cytochrome P-450 enzyme lanosterol 14 alpha-demethylase, and are believed, therefore, to have a mode of action similar to the azole and bis-triazole class of antifungal agents.

J Appl Bacteriol, 1992 Mar, 72(3), 220 - 6
Selection of cell wall antigens for the rapid detection of bacteria by immunological methods; Labadie J et al.; Some proteins extracted from the cell wall of Gram-positive and Gram-negative bacteria that affect the time for which meat can be stored are antigens produced by the strains from our laboratory collection or from field samples . Moreover, the rapid detection of bacteria (within 8 h for Gram-positive or 5 h for Gram-negative) that influence the quality of meat is made possible by immunochemical techniques such as ELISA or by introducing simultaneous detection of these antigens, as no cross-reactions have been observed.

J Appl Bacteriol, 1992 Mar, 72(3), 180 - 7
Bactericidal activities of lysozyme and aprotinin against gram-negative and gram-positive bacteria related to their basic character; Pellegrini A et al.; Bactericidal properties of aprotinin, a proteinase inhibitor and possibly a defence molecule in bovine species, and of chicken egg white lysozyme, known as muramidase, were investigated . Incubation of various bacteria in the presence of either aprotinin or lysozyme showed that both proteins killed Gram-positive as well as Gram-negative bacteria without addition of complement or EDTA . Denaturation of the two proteins by dithiothreitol did not lead to loss of their bactericidal potency . Electron microscopic examination of Escherichia coli incubated either with lysozyme or aprotinin revealed that the bacterial cytoplasms gradually disintegrated . Both aprotinin and lysozyme were demonstrated within the affected cytoplasm by immunogold labelling . The results suggest that the bactericidal potency of lysozyme is not only due to muramidase activity but also to its cationic and hydrophobic properties . The bactericidal activity of aprotinin is probably also related to both these properties rather than to its activity as proteinase inhibitor.

J Biol Chem, 1992 Feb 25, 267(6), 3952 - 8
Extracellular autoprocessing of a metalloprotease from Streptomyces cacaoi; Chang PC et al.; We have previously demonstrated that the extracellular neutral metalloprotease (Npr) of Streptomyces cacaoi is synthesized as a 60-kDa preproenzyme (P60), then processed to the 35-kDa mature form (P35) (Chang, P . C., Kuo, T.-C., Tsugita, A., and Lee, Y.-H . W . (1990) Gene (Amst.) 88, 87-95) . In this study, we investigated the active site and the mechanism involved in the maturation of the protease . Site-specific mutations at the putative zinc-binding ligands and active site of Npr at His202, Glu203, His206, and Glu240 led to complete abolishment of Npr activity and concomitant accumulation of a 57-kDa inactive protein (P57) which was secreted . Sequence analysis of the NH2 terminus indicated that P57 was derived from P60 after removal of the signal peptide and represented the proenzyme form of Npr (pro-Npr) . Analysis of the zinc content of purified mutant P57 proteins revealed a dramatic loss of zinc atom as compared with the wild-type P35 protein . In vitro with the aid of exogenous active Npr, the mutant P57 protein could be converted to the mature inactive P35 with an identical NH2-terminal sequence and a molecular mass the same as that of the wild-type P35 . From these studies, we conclude that these highly conserved residues (His202, Glu203, His206, and Glu240) are indispensable for zinc binding and protease activity, as well as processing of Npr . In addition, we have clearly demonstrated that maturation of Npr occurs extracellularly via an autocatalytic cleavage of the pro-Npr propeptide . This is the first report of such a maturation mechanism for an extracellular protease in streptomycetes which can serve as a model for further studies on the mechanism of secretion and processing of proteases from Gram-positive bacteria.

J Biol Chem, 1992 Feb 15, 267(5), 3236 - 41
Two novel Streptomyces protein protease inhibitors . Purification, activity, cloning, and expression; Strickler JE et al.; In contrast to the Gram-negative bacteria, Gram-positive bacteria such as Streptomyces lack a mucopolysaccharide cell wall which allows them to produce and secrete a variety of proteins directly into their environment . In an effort to understand and eventually exploit the synthesis and secretion of proteins by Streptomyces, we identified and characterized two naturally occurring abundantly produced proteins in culture supernatants of Streptomyces lividans and Streptomyces longisporus . We purified these 10-kDa proteins and obtained partial amino acid sequence information which was then used to design oligonucleotide probes in order to clone their genes . Analysis of the sequence data indicated that these proteins were related to each other and to several other previously characterized Streptomyces protein protease inhibitors . We demonstrate that both proteins are protein protease inhibitors with specificity for trypsin-like enzymes . The presumptive signal peptidase cleavage sites and subsequent aminopeptidase products of each protein are characterized . Finally, we show that the cloned genes contain all of the information necessary to direct synthesis and secretion of the proteins by Streptomyces spp . or Escherichia coli.

J Natl Med Assoc, 1992 Feb, 84(2), 145 - 50
The role of surgery in treating pleuropulmonary suppurative disease--review of 77 cases managed at Queens Hospital Center between 1986 and 1989; Cordice JW Jr et al.; Despite the generally salutary experience in recent years of managing suppurative pleuropulmonary disease, empyemas and lung abscesses have persisted and increased in incidence in hospitals such as Queens Hospital Center that serve large numbers of the socioeconomically disadvantaged . This study documents the etiology, clinical presentation, treatment, and treatment results of suppurative pleuropulmonary disease at Queens Hospital Center, which serves a large segment of the urban poor, many of whom are black . Results indicate that contributory or antecedent etiologic factors include a history of prior disease (specifically pneumonia, lung abscess, obstructive lung disease, pulmonary neoplasia, and tuberculosis); a predisposition to constitutional or immunologic deficiencies (specifically, alcoholism, anemia/malnutrition, drug abuse, and acquired immunodeficiency syndrome {AIDS}); conditions contributing to tracheobronchial aspiration (specifically, alcoholism and seizure disorders); and a miscellaneous group such as prior surgery, cardiovascular disease, and sepsis syndrome . The patients in this study were young with maximal incidence occurring in the third to fifth decades of life . Patients were predominantly male (75%) and black (66%) . There were 18 deaths (23%), with sepsis being the cause in 10 (56%) . Most surgical interventions were conservative, ie, bronchoscopies (48), thoracenteses (43), and tube thoracotomies (39) . Thirty-one open thoracotomies were performed for drainage, decortication, or pulmonary resection . The surgical mortality was three cases or 5% of the patients who underwent surgery . The designated incidence of proven AIDS in this series (29%) was low, undoubtedly because many patients refused testing, and the multiple gram-positive and gram-negative infections that were seen did not conform to the Centers for Disease Control criteria for diagnosis and case reporting for AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Intern Med, 1992 Feb, 152(2), 283 - 91
A comparison of imipenem to ceftazidime with or without amikacin as empiric therapy in febrile neutropenic patients; Rolston KV et al.; BACKGROUND--Neutropenic patients with cancer are traditionally treated with empiric antibiotic combinations when they become febrile . The availability of broad-spectrum antibiotics such as ceftazidime and imipenem has made it possible to initiate therapy with a single agent (monotherapy) . The objectives of this trial were to compare ceftazidime and imipenem as single agents for the therapy of febrile episodes in neutropenic patients and to ascertain whether the addition of an aminoglycoside (amikacin) to either of these agents would provide an advantage . METHODS--A prospective clinical trial was conducted in which eligible neutropenic patients with cancer were randomized to one of four treatment arms: ceftazidime alone; imipenem alone; ceftazidime plus amikacin; and imipenem plus amikacin . Efficacy analysis was done for 750 assessable episodes . A multivariate logistic-regression analysis was also performed to examine the unique contribution of various prognostic factors . RESULTS--The overall response rates were 76% with imipenem plus amikacin, 72% with imipenem, 71% with ceftazidime plus amikacin, and 59% with ceftazidime alone . Single-organism gram-positive infections occurred in 101 of 750 episodes . Without a change in antibiotics, the response rates were 50% with imipenem, 40% with imipenem plus amikacin, 39% with ceftazidime plus amikacin, and 38% with ceftazidime . Most responded to vancomycin or other antibiotics, and the mortality associated with gram-positive infections was only 5% . Regardless of the antibiotic regimen, the majority of uncomplicated gram-negative infections responded to therapy and the majority of complicated gram-negative infections failed to respond . Multivariate logistic-regression analysis showed that recovery of the neutrophil count was the most favorable prognostic factor in a patient's response to infection, whereas the presence of gram-positive infection, acute leukemia, pulmonary or enteric infection, and therapy with ceftazidime were unfavorable factors . CONCLUSIONS--Single-agent therapy with imipenem is as effective as more conventional combination antibiotic therapy for the empirical treatment of febrile episodes in neutropenic patients with cancer.

Vnitr Lek, 1992 Feb, 38(2), 166 - 72
{Comparison of Tarivid and Biseptol in the prevention of bacterial infections in patients with acute leukemia}; Mocikova K et al.; In 42 patients with induction treatment of acute myeloblastic and lymphoblastic leukaemia the authors compared efficacy of selective decontamination of the gastrointestinal tract in prevention of infections during neutropenia less than 0.5.10(9)/l in two comparable groups . Twenty-two patients were treated with Ofloxacin (Tarivid, Hoechst Co.), 20 patients with Trimetroprim-Sulfamethoxazol (Biseptol, Polfa Co.) . Both groups had concurrently also Ketoconazol in prevention of mycotic infection . The investigation revealed that Tarivid is a suitable alternative drug for selective decontamination, because it delays the onset of acquired infection, as compared with Biseptol, it reduced more efficiently the frequency of Gram-negative colonization and life-threatening Gram-negative sepsis, caused by resistent strains; its tolerance is significantly better . There was no significant difference in the occurrence of febrile days, febrile episodes, the duration of antibiotic treatment, the number of sepsis in two groups . The effect of Tarivid and Biseptol on the Gram-positive microbial flora is inadequate . Subclavian catheter increases in particularly the risk of Gram-positive sepsis in both groups.

Tierarztl Prax, 1992 Feb, 20(1), 44 - 8
{Rumen fluid studies in calves with abnormal and normal sucking behavior}; Battig U et al.; Ruminal fluid and blood samples were analysed in 39 calves with poor suckling behaviour and reduced milk intake (group 1) and in 21 calves with normal suckling behaviour (group 2) . The pH level and chloride concentration was determined in the ruminal fluid as well as in the blood . In addition Gram stains and subsequent microscopical examinations of the ruminal fluids were carried out . Blood samples were submitted for blood gas analysis . Notable differences were found between the two groups . The pH level of the ruminal fluid was less than 5.5 in 29 of the 39 calves in group 1 (74.4%); in contrast, the pH was always above 5.5 in group 2 . In group 1, 22 calves with a pH of less than 5.5 also revealed a metabolic acidosis of the blood . Mainly gram-positive bacteria were found in the ruminal fluid of 74.4% of the calves in group 1 . On the other hand, 76.2% of the calves in group 2 revealed a mainly gram-negative flora . There was no difference in the chloride concentration, either in the blood or in the ruminal fluid and the values showed a high range of scatter.

Biochem Biophys Res Commun, 1992 Jan 15, 182(1), 115 - 20
Critical micelle concentration and hemolytic activity--a correlation suggested by the marine sterol, halistanol trisulfate; Moni RW et al.; The marine natural product, halistanol trisulfate, has a relatively low critical micelle concentration of 0.001% m/v (14.5 microM) and strong hemolytic potency with an EC50 of 0.00046% m/v (6.67 microM) . As expected of a detergent, it inhibits the growth of gram-positive but not gram-negative bacteria . The hemolytic activity of halistanol trisulfate and other detergents has been shown to correlate with critical micelle concentration . This correlation may have important implications in the mechanism of membranolytic bioactivity.

Clin Infect Dis, 1992 Jan, 14(1), 200 - 3
Tsukamurella paurometabolum: a novel pathogen causing catheter-related bacteremia in patients with cancer; Shapiro CL et al.; Tsukamurella paurometabolum is a weakly acid-fast, pleomorphic gram-positive bacterium found in soil . Human infection due to this organism has rarely been described, and there are no published accounts of bacteremia . Three cases of bacteremia due to T . paurometabolum and related to long-term use of a central venous catheter in patients with cancer who were receiving chemotherapy are described.

World J Surg, 1992 Jan-Feb, 16(1), 57 - 67
The changing epidemiology of infection in burn patients; Pruitt BA Jr et al.; Topical chemotherapy, prompt excision, and timely closure of the burn wound have significantly reduced the occurrence of invasive burn wound infection and its related mortality . Since wound protection is imperfect and invasive wound infection may still occur in patients with massive burns in whom wound closure is delayed, scheduled wound surveillance and biopsy monitoring are necessary to assess the microbial status of the burn wound and identify wound infections caused by resistant bacteria or non-bacterial opportunists at a stage when therapeutic intervention can control the process . As a reflection of the systemic immunosuppressive effects of burn injury, infection remains the most common cause of morbidity and mortality even though the occurrence of wound infections has been significantly decreased . Pneumonia is the most frequent infection occurring in burn patients today but the improvements in patient management, wound care, and infection control have made bronchopneumonia the most common form of this infection and gram-positive organisms the most common causative agents . The organisms causing bacteremia that exert a species specific effect on the mortality related to extent of burn injury and patient age have changed in concert with changes in wound flora . Infection control procedures, including scheduled surveillance cultures, utilization of cohort patient care methodology, strict enforcement of patient and staff hygiene, and patient monitoring have been effective in eliminating endemic resistant microbial strains, preventing the establishment of newly introduced resistant organisms, diagnosing infection in a timely fashion, instituting antibiotic and other necessary therapy in a prompt manner, and documenting the effectiveness of present day burn patient care and the improved survival of burn patients.

Lancet, 1992 Jan 4, 339(8784), 38 - 40
Allogeneic bone-marrow transplantation without protective isolation in adults with malignant disease; Russell JA et al.; Bone-marrow transplant (BMT) patients are severely immunocompromised immediately after the procedure and they are commonly nursed in strict protective isolation to reduce the risk of both infection and graft-versus-host disease (GvHD) . We have studied a consecutive series of patients to see whether protective isolation is of benefit as prophylaxis against infectious complications of BMT . 50 consecutive patients who had malignant disease and received their first BMT from siblings or unrelated donors were nursed in standard single rooms with visitors instructed to wash their hands . A subset of 20 patients living locally spent a median of 25 days in hospital after BMT; they also spent some time at home on a median of 8 days before engraftment and 3 patients went home on more than 90% of their hospital days . 16 patients (32%) had positive bacterial cultures and/or focal infection . Gram-positive bacteraemia was found in 12 subjects (24%) but there were no gram-negative or deep fungal infections . Grade II or III acute GvHD developed in 17 patients (34%) . There were no deaths from infection or acute GvHD . Transplant-related mortality was 6% in the first 100 days and 18% overall with a median follow-up of 22 months . Our mortality data compare favourably with those from institutions with strict isolation procedures . We conclude that BMT may be safely completed in some institutions without either protective isolation or the need to confine patients continuously in hospital.

Arch Ophthalmol, 1992 Jan, 110(1), 82 - 5
Microbial contamination of in-use ocular medications; Schein OD et al.; Two hundred twenty in-use medications from 101 patients with nonmicrobial ocular surface disease were studied by culturing the bottle caps, a drop produced by simple inversion, and the interior contents removed sterilely . Conjunctival cultures were taken from these patients and 50 age-matched controls . Pathogenic organisms were harvested from conjunctivae significantly more frequently (P less than .01) from cases (34 of 101) than from controls (five of 50) . Sixty-four medications (29%) had microorganisms cultured from at least one medication site . Gram-negative organisms were significantly more likely (P less than .00001) to be isolated from all medication sites than gram-positive organisms . Additionally, when isolated from medication sites, the gram-negative organisms were highly likely to be cultured from the conjunctiva as well . This was not true for pathogenic gram-positive organisms . We conclude that a cycle of contamination between in-use medications and conjunctivae may represent an important risk factor for microbial keratitis in patients with ocular surface disease.

Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Jan, 30(1), 95 - 9
{Mediastinitis with bilateral empyemas following neck phlegmon}; Suzuki T et al.; A 46-year-old male complaining of fever and neck swelling was transferred to our department because of bilateral empyemas in the pleural spaces following neck phlegmon . A culture of the right pleural effusion obtained at his local hospital revealed Gram-positive anaerobic cocci . Chest roentgenogram showed bilateral effusions and widening of the upper mediastinum . Neck roentgenogram confirmed widening of the retropharyngeal space . CT clearly demonstrated a continuous lesion from the neck to the mediastinum and occupying the pleural spaces bilaterally . The patient responded to intravenous antibiotics and tube drainage of the pleural cavities, and was discharged after 10 weeks of hospitalization . Because no mediastinal abscess requiring drainage was recognized on CT, surgical drainage of the mediastinal space was not performed . Sequential CT was used to follow the lesion in the retropharyngeal space, mediastinum and pleural spaces, to check and reposition the tubes for drainage of pleural exudate.

Indian J Lepr, 1992 Jan-Mar, 64(1), 28 - 41
On structural aspects of peptidoglycan of bacterial cell wall with special attention on mycobacteria by computer modelling; Pain S et al.; The cell wall components of mycobacteria are said to be vitally linked with their pathogenicity . Peptidoglycan, one of the major cell wall component in most of the bacteria are multilayered in gram positive bacteria and it is diverse in nature for the Gram positive strain rather than gram negative . The cell wall of bacteria are primary targets for many drugs and antibiotics and conformation of the major cell wall components provide invaluable information and understanding at molecular level to medicinal chemists and drug designers . Mycobacterial peptidoglycan has been studied critically by computer modelling on various aspects . A plausible structure and conformation has been identified and glycan chain is found to have a pseudo two fold symmetry taking disaccharide unit as monomer with Knox & Murthy H-bond scheme . This paper attempts to clarify the understanding of organisation and possible interaction mode of peptidoglycan of organisation in complex mycobacterial cell wall structure.

Avian Dis, 1992 Jan-Mar, 36(1), 172 - 6
Visceral granulomas in chickens infected with a filamentous bacteria; Hill JE et al.; Visceral granulomas containing gram-positive filamentous bacteria were diagnosed in eight chickens collected from processing plants over a period of 4 years . Formalin-fixed tissues were submitted from the chickens after slaughter, but no specimens suitable for bacterial culture were received . The bacteria lacked similar tinctorial, morphologic, and ultrastructural features of other gram-positive bacteria that have been identified in chickens . The bacteria were visible with hematoxylin and eosin and faintly visible with Gomori methenamine-silver, but negative with periodic acid-Schiff and Fite-Faraco acid-fast stains . Granulomas were found in the liver, spleen, and peritoneum.

Infection, 1992 Jan-Feb, 20(1), 12 - 8
Dose-dependent rate of nosocomial pulmonary infection in mechanically ventilated patients with brain oedema receiving barbiturates: a prospective case study; Eberhardt KE et al.; In a prospective case study we investigated whether the application of barbiturates in artificially ventilated patients with brain oedema has dose-dependent effects on the rate of nosocomial pneumonia . Pneumonia developed within the first seven days of controlled ventilation in patients receiving barbiturates; furthermore, the rate of nosocomial pneumonia was significantly higher in patients receiving barbiturates than in the control group without barbiturates (7.7%; p less than 0.0181); thus a clear dose dependency was shown (high-dose group: 43.8%, low-dose group: 21.4%) . In all patients with pneumonia, colonization of the respiratory tract with pathogenic organisms preceded the pulmonary infection by four days . Under barbiturate therapy colonization of the respiratory tract occurred in all patients and one or two days earlier than in the control group, in which only 70% of the patients were colonized . These differences were significant for each of the first six days after hospitalization (p less than 0.0001-0.013) . While in the high-dose group both colonization and pneumonia were caused mainly by gram-positive pathogens, mixed gram-positive and gram-negative pathogens were isolated in groups 2 and 3 . Thus the higher rate of pneumonia of 43.8% in the high-dose group suggests a need for regular and semiquantitative monitoring of the causative agents and their antibiogram . Such measures could lead to early recognition with high predictability of the development of nosocomial pneumonia in colonized patients, allowing for timely application of the most appropriate antibiotics.

Recenti Prog Med, 1992 Jan, 83(1), 27 - 34
{A review of clinical studies on the efficacy and tolerance of intravenous ciprofloxacin}; Memoli M; A review of the literature . Ciprofloxacin is a fluorinate quinolone with a broad spectrum of activity against gram-positive and gram-negative organisms . Orally administered ciprofloxacin has been successfully used in a variety of clinical settings, but reservations remain regarding the use of oral antibiotics in the treatment of serious infections . Furthermore, many seriously ill patients are unable to take drugs orally . An intravenous form of ciprofloxacin has undergone extensive clinical investigation for the treatment of a variety of infections in hospitalized patients . Reported here are the results of some clinical trials showing the effectiveness and safety of intravenous/sequential therapy with ciprofloxacin.

Plasmid, 1992 Jan, 27(1), 29 - 40
Plasmid-encoded resistance to arsenic and antimony; Kaur P et al.; Resistance determinants to the toxic oxyanionic salts of arsenic and antimony are found on plasmids of both gram-negative and gram-positive organisms . In most cases these provide resistance to both the oxyanions of +III oxidation state, antimonite and arsenite, and the +V oxidation state, arsenate . In both gram-positive and -negative bacteria, resistance is correlated with efflux of the anions from cells . The determinant from the plasmid R773, isolated from a gram-negative organism, has been studied in detail . It encodes an oxyanion-translocating ATPase with three subunits, a catalytic subunit, the ArsA protein, a membrane subunit, the ArsB subunit, and a specificity factor, the ArsC protein . The first two form a membrane-bound complex with arsenite-stimulated ATPase activity . The determinants from gram-positive bacteria have only the arsB and arsC genes and encode an efflux system without the participation of an ArsA homologue.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1992 Jan, 27(1), 37 - 8, 62
{Limulus lysate activity of some organisms resided in oral cavity}; Wang KF; Gram-positive and Gram-negative bacteria resided in oral cavity have been investigated using Limulus Lysate Assay . The study showed that both kinds of organisms have Limulus Lysate Activity (LLA) . The data from the present study indicated that various species of Gram-positive and Gram-negative bacteria possess different degrees of LLA . There is no significant difference of LLA between Gram-positive and Gram-negative bacteria.

Microbiol Immunol, 1992, 36(11), 1155 - 71
Species dependency of in vitro macrophage activation by bacterial peptidoglycans; Nagao S et al.; The effect of various bacterial cell wall components on in vitro biological function of murine peritoneal exudate macrophages was evaluated . We examined four different parameters of metabolic activity and monokine secretion . Peritoneal exudate macrophages from rats and guinea pigs, all of the strains tested, were stimulated by whole bacterial cell wall preparations, purified bacterial cell wall peptidoglucans, its water-soluble peptidolglycan fragments, muramyl dipeptides and amphipathic substances . Murine peritoneal exudate macrophages were activated by amphipathic substances of gram-positive bacteria . However, macrophages from mice, irrespective of strains, were not stimulated in the in vitro assay systems by purified bacterial cell wall peptidoglycan, water-soluble bacterial peptidoglycan fragments or muramyl dipeptides . These results suggest that macrophage activation by bacterial peptidoglycan in vitro is animal species specific.

Infection, 1992, 20 Suppl 3, S236 - 8
Detection of a local prostatic immune response to bacterial prostatitis; Kumon H; Bacteria-specific antibody responses in expressed prostatic secretions (EPS) were investigated by use of an indirect immunoperoxidase method . Positive responses were observed in all 12 patients with acute bacterial prostatis due to gram-negative rods . However, in 41 patients with chromic prostatitis, antibody responses varied depending on the bacterial species; no positive responses were observed in cases resulting from gram-positive cocci.

Annu Rev Microbiol, 1992, 46, 461 - 95
Penicillin and cephalosporin biosynthetic genes: structure, organization, regulation, and evolution; Aharonowitz Y et al.; Penicillins and cephalosporins are produced by a wide variety of microorganisms, including some filamentous fungi, many gram-positive streptomycetes, and a few gram-negative unicellular bacteria . All produce these beta-lactam antibiotics by essentially the same biosynthetic pathway . Recently, most of the penicillin and cephalosporin biosynthetic genes have been cloned, sequenced, and expressed . The biosynthetic genes code for enzymes that possess multifunctional peptide synthetase, cyclase, epimerase, expandase, hydroxylase, lysine aminotransferase, and acetyltransferase activities and are organized in chromosomal gene clusters and coordinately expressed . DNA hybridization screens of streptomycetes demonstrate that beta-lactam biosynthetic genes may be more widespread in nature than is indicated by conventional antibiotic screens . They offer the possibility of expanding the search for organisms with potential to make new beta-lactam antibiotics . Attempts to improve current yields of beta-lactams in production strains by introducing into them additional copies of biosynthetic genes have been partially successful . Comparative sequence analysis of bacterial and fungal beta-lactam biosynthetic genes show they share very high sequence identity . A model that explains the similarity of biosynthetic genes from an evolutionary standpoint assumes horizontal gene-transfer between the two groups of organisms . Indirect evidence suggests the transfer occurred from the bacteria to the fungi.

Annu Rev Microbiol, 1992, 46, 377 - 98
Autoregulatory factors and communication in actinomycetes; Horinouchi S et al.; The ability to produce a wide variety of secondary metabolites and a mycelial form of growth that develops into spores are two biological aspects characteristic of the gram-positive bacterial genus Streptomyces . Secondary metabolism and cell differentiation are controlled by diffusible low-molecular-weight chemical substances called autoregulators . A-factor, the representative of the autoregulators, triggers streptomycin production and aerial-mycelium formation in Streptomyces griseus . A-factor exerts its regulatory function with the aid of a receptor protein that itself acts as a repressor-type regulator . The A-factor signal via the A-factor-receptor protein is transferred to downstream genes, such as streptomycin-production genes and sporulation genes, through multiple regulatory genes in a complex regulatory cascade . Thus, A-factor can be termed a "microbial hormone." This review deals with the A-factor-regulatory cascade as a model system for other autoregulators . The biosynthesis of A-factor, the structures and characteristics of other autoregulators, and the importance of these autoregulators in the ecosystem are also included.

Eye, 1992, 6 ( Pt 1), 111 - 4
The safety and efficacy of topical norfloxacin compared with chloramphenicol for the treatment of external ocular bacterial infections . The Norfloxacin-Chloramphenicol Ophthalmic Study Group; Miller IM et al.; Two hundred and forty-six patients with signs of acute bacterial conjunctivitis and/or blepharitis were randomised to receive either norfloxacin or chloramphenicol for one week in this double-masked parallel group study . Ninety-two per cent of the norfloxacin-treated patients and 93% of the chloramphenicol-treated patients were rated as either clinically improved or cured at the end of the treatment period . Based upon pre-treatment bacteriological cultures, 31.3% of the patients had significant bacterial infection of the lids and/or conjunctiva . All of these culture-positive patients were rated as either clinically improved or cured . Based upon post-treatment cultures, 72 of 82 strains of Gram-positive and Gram-negative bacteria were eradicated or suppressed following treatment with either norfloxacin or chloramphenicol . However six of 41 strains persisted for norfloxacin and four of 41 for chloramphenicol . Two norfloxacin-treated patients and three chloramphenicol-treated patients had adverse experiences, predominantly ocular discomfort, which required cessation of drug therapy . Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the lids and/or conjunctiva . In this study, norfloxacin was clinically and microbiologically similar in activity to chloramphenicol.

Am J Nephrol, 1992, 12(1-2), 19 - 21
Early diagnosis of gram-negative peritonitis in continuous ambulatory peritoneal dialysis patients with the Lymulus amebocyte lysate assay; Peer G et al.; The treatment of peritonitis in continuous ambulatory peritoneal dialysis patients is empiric until the bacteriological results are available . The Lymulus amebocyte lysate assay (LAL) is a very sensitive method for the detection of endotoxin, a structural component of gram-negative bacteria . We performed the LAL assay in a prospective study in 36 consecutive episodes of peritonitis . The LAL assay was positive in all 10 episodes of gram-negative peritonitis (100% specificity) . Treatment directed specifically against gram-negative or -positive infection was started based on the LAL assay result . In 26 episodes with LAL-negative test, a gram-positive bacterium was cultured in 23 episodes, in 1 there was fungal infection and 2 were sterile . In summary: the LAL assay is a rapid (1 h) and sensitive method for the differentiation of gram-positive or -negative peritonitis and enables starting an immediate and more appropriate antibiotic therapy.

Scand J Infect Dis, 1992, 24(4), 467 - 75
A pilot study of piperacillin and ciprofloxacin as initial therapy for fever in severely neutropenic leukemia patients; Samuelsson J et al.; We studied the efficacy of piperacillin and ciprofloxacin as initial parenteral therapy in 41 adult patients with leukemia who developed 47 febrile episodes during severe neutropenia following chemotherapy . 40 patients (98%) survived their febrile episode(s), whereas 1 patient died of infection . When assessed at 72 h after initiation of treatment (early evaluation), 24/47 episodes (51%) had been successfully treated . These 24 favourable responses were seen in 15/24 (63%) microbiologically documented infections and 9/19 (47%) fever of unknown origin (FUO) . At the resolution of fever (late evaluation) 46 episodes were evaluable, and 28 (61%) had responded successfully to piperacillin and ciprofloxacin . Successful treatment was most frequently observed in microbiologically defined infections, 18/23 (78%) . Three of 5 (60%) Gram-positive, 11/12 (92%) Gram-negative and 1 of 2 mixed bacteremias were successfully treated . In contrast, only 10/19 (53%) FUO and none of 4 clinically defined infections had responded . Thus, this pilot study indicates that piperacillin and ciprofloxacin may be a safe and effective combination for the treatment of febrile episodes in severely neutropenic leukemia patients, which merits further investigation in randomized trials.

Ophthalmic Res, 1992, 24(3), 150 - 4
Intraocular kinetics of ceftazidime (Modacin); Mochizuki K et al.; The concentration of ceftazidime was determined in the aqueous humor and the vitreous body of normal, vitrectomized and aphakic/vitrectomized eyes and in the serum of albino rabbits 1 h after intravenous injection of 100 mg/kg ceftazidime . The intravitreal ceftazidime concentration was low (0.1-0.2 microgram/ml) in normal eyes 1 h after intravenous injection, and high (8.7 +/- 8.5 micrograms/ml) in vitrectomized and aphakic/vitrectomized eyes when injected immediately after surgery . The ceftazidime concentration was also determined in the aqueous humor and the vitreous body of normal eyes and in the serum of albino rabbits 3, 6, 12, 24 and 48 h after intravitreal injection of 200 micrograms . The intravitreal ceftazidime concentration after intravitreal injection decreased exponentially for 12 h (half-life about 7.4 h) . It decreased more slowly thereafter and remained at 13.0 micrograms/ml (mean) even 48 h after injection . This concentration exceeded the minimum inhibitory concentrations against common gram-positive and gram-negative organisms causing endophthalmitis.

J Med Assoc Thai, 1992 Jan, 75 Suppl 1, 38 - 44
Combined Sarcocystis and gram-positive bacterial infections . A possible cause of segmental enterocolitis in Thailand; Bunyaratvej S et al.; Between 1981 and 1990, 22 intestinal specimens surgically resected due to segmental enterocolitis were collected and examined . Grossly, the specimens were classified into 3 groups 1) Acute inflammation with hemorrhage and necrosis 2) Constrictive lesion 3) False diverticulum with perforation . Mostly, there was unisegmental involvement, distributed in jejunum, ileum and ileocolon . Microscopically, small parasitic structures, interpreted to be unconventional excystation stage of Sarcocystis hominis, (Railliet and Lucet, 1891) Dubey 1976, were present on the luminal border and within the crypt-lining epithelial cells . At the ulcerated area, tissue invasion by Gram-positive bacteria were always seen and considered as second pathogen . Source of the parasite was likely from cyst-containing beef available in markets, (Bos indicus and Bubalus bubalis) along with consumption of undercooked beef . Antismooth muscle antibody, IgG class, with the titer ranging from 1:16-1:256 were detected in 45 per cent of the patients . This is considered as autoimmunity against intestinal smooth muscle damaged previously from subclinical inflammatory condition . Present information suggests a long-standing existence of Sarcocystis in the patients' intestine, associated with Gram-positive bacterial infection, as the mechanism producing segmental enterocolitis found in the Central region.

Eur J Surg Suppl, 1992, (567), 39 - 42
Teicoplanin and prophylaxis of Hickman catheter insertions; Lim SH et al.; A total of 88 patients with haematological malignancies who required Hickman catheters for intensive chemotherapy, were randomized to receive either a single bolus intravenous injection of teicoplanin, or no teicoplanin, immediately before insertion of a double lumen Hickman catheter . There was a lower incidence of catheter-related Gram-positive sepsis in patients receiving prophylactic teicoplanin . This benefit was particularly clear in patients who were already neutropenic at the time of catheter insertion . Prophylactic teicoplanin may, therefore, be useful as a routine procedure during the insertion of Hickman catheters for this group of patients.

Eur J Surg Suppl, 1992, (567), 27 - 9
Teicoplanin--domiciliary use in surgical infections; Rubinstein E; This is an ongoing study designed to evaluate the role of teicoplanin in the therapy of sternal wound infections following cardiac surgery caused by Gram-positive microorganisms . Intravenous teicoplanin therapy is begun in the hospital, but once the patients return home it is given as a single intramuscular dose of 400 mg/day . Only a limited number of patients have been recruited so far, but in these, the clinical success rate and the bacteriological elimination rate are 85% . Only one patient had to be withdrawn from the study due to intolerable side-effects . These preliminary results suggest that teicoplanin is suitable for the therapy of chest wound infections following cardiac surgery; a major part of the course can be administered at home in a single daily intramuscular injection . This novel therapy regimen is expected to reduce considerably the hospital costs involved in the therapy of sternal wound infections.

Microbios, 1992, 70(282), 49 - 55
A new bacterial staining method involving Gram stain with theoretical considerations of the staining mechanism; Noda Y et al.; In order to investigate the mechanism of Gram staining of bacteria, tests with anionic dyes followed by treatment with cationic octyltrimethylammonium (OTMA) were carried out . The study revealed that tetrabromophenolphthalein ethylester (TBPE) gave the most reliable staining of Gram-negative bacteria with negative staining of Gram-positive bacteria . Tests on many species of bacteria showed that TBPE positive bacteria were Gram-negative and vice versa, without exception.

J Clin Pathol, 1992 Jan, 45(1), 72 - 4
Limulus amoebocyte lysate assay in the diagnosis of peritonitis in patients receiving continuous ambulatory peritoneal dialysis; Bowman RA et al.; AIMS: To evaluate the Limulus amoebocyte lysate (LAL) assay for differentiating Gram positive from Gram negative peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) . METHODS: One hundred and six patients with suspected peritonitis were studied . LAL assay was performed by adding 0.1 ml of CAPD fluid to 0.1 ml of LAL reagent and incubating in a heating block for 60 minutes at 37 degrees C . The sensitivity of the reaction was determined by: (i) diluting endotoxin in distilled water and used (filter sterilised) peritoneal dialysis fluid; and (ii) diluting a broth culture of E coli used in peritoneal dialysis fluid . A positive LAL assay was defined as the constant stability of the clot through an inversion of 180 degrees . RESULTS: Compared with bacterial culture, the LAL assay had a sensitivity of 65% and a specificity of 98% . The sensitivity of microscopy compared with culture of Gram negative organisms was 76%; overall sensitivity of microscopy in comparison was 80% . CONCLUSIONS: The Gram stain was more sensitive than has previously been reported; the LAL assay was specific but insensitive for the diagnosis of CAPD peritonitis . There was a correlation between reduced leucocyte count and culture; this was reduced in cases from which Gram negative organisms had been isolated . It is recommended that laboratories evaluate their Gram stain procedure to improve its sensitivity because the LAL assay is not a satisfactory substitute.

Int J Syst Bacteriol, 1992 Jan, 42(1), 79 - 83
Phylogenetic analysis of Alloiococcus otitis gen . nov., sp . nov., an organism from human middle ear fluid; Aguirre M et al.; The partial 16S rRNA sequence of an unknown bacterium that was originally isolated from middle ear fluids of children with persistent otitis media was determined by reverse transcription . A comparison of this sequence with sequences from other gram-positive species having low guanine-plus-cytosine contents revealed that this bacterium represents a new line of descent, for which the name Alloiococcus otitis gen . nov., sp . nov., is proposed . The type strain is strain NCFB 2890.

Glas Srp Akad Nauka {Med}, 1992, (42), 171 - 81
{New technology in maize breeding}; Konstantinov K et al.; Results obtained by several approaches in the application of Biotechnology in maize breeding are reviewed . RFLP technology in the determination of genetic variation; gene transfer by the use of different methods of gene delivery and the determination of gene integration . Three technologies for foreign gene introduction have been applied; injection of plasmid pRT100 neo into archesporial tissue before micro and macro sporogenesis, slightly modified pollen-tube pathway technology and dry seed incubation in plasmid DNA solution . NPTII gene integration was followed by dot-blot and Southern blot analysis of plant DNA of both T1 and T2 plants . Gene expression was analysed by neomycin phosphotransferase activity . Transformed plants contained the selective NPTII gene sequence in an active form . Bacterial gene integration induced several heritable changes of plant phenotype . As an important change, alteration of the flowering time has been used as a criterion for selection and plant propagation to keep transformed progeny . Besides plant genome transformation, endogenous bacteria living in different maize tissue were found . As a perspective approach for biotechnology application in maize breeding biological vaccine construction has been selected . Therefore, antagonistic effect of gram positive bacterial strains to several pathogenic fungi was investigated . Results obtained after in vivo experiments are discussed.

Bull Cancer, 1992, 79(5), 491 - 5
Infectious complications associated with granulocytopenia during the treatment of poor risk or relapsed germ cell tumors; Ribrag V et al.; Infectious complications associated with granulocytopenia during the treatment of poor risk or relapsed germ cell tumors were studied in order to assess the frequency, morbidity and characteristics of these complications . Thirty-three cases were investigated at the Institut Gustave-Roussy; 63 episodes of granulocytopenia were observed (mean duration 7.5 days) . Twenty-four (38%) of the episodes of granulocytopenia were associated with fever . In 11/24 episodes (46%), fever was associated with a documented infection . Eighteen organisms were isolated . Ten were found to be Gram-positive, 7 Gram-negative, and one Candida . The major site of infection was the lungs . One death from septicaemia occurred . In conclusion, post-chemotherapy granulocytopenia during the treatment of germ cell tumors is associated with fever in less than 50% of cases . Bacterial infection was diagnosed in only 46% of febrile neutropenic episodes and rarely appears to be associated with a fatal outcome.

Plasmid, 1992 Jan, 27(1), 4 - 16
Bacterial resistances to inorganic mercury salts and organomercurials; Misra TK; Environmental and clinical isolates of mercury-resistant (resistant to inorganic mercury salts and organomercurials) bacteria have genes for the enzymes mercuric ion reductase and organomercurial lyase . These genes are often plasmid-encoded, although chromosomally encoded resistance determinants have been occasionally identified . Organomercurial lyase cleaves the C-Hg bond and releases Hg(II) in addition to the appropriate organic compound . Mercuric reductase reduces Hg(II) to Hg(O), which is nontoxic and volatilizes from the medium . Mercuric reductase is a FAD-containing oxidoreductase and requires NAD(P)H and thiol for in vitro activity . The crystal structure of mercuric ion reductase has been partially solved . The primary sequence and the three-dimensional structure of the mercuric reductase are significantly homologous to those of other flavin-containing oxidoreductases, e.g., glutathione reductase and lipoamide dehydrogenase . The active site sequences are the most conserved region among these flavin-containing enzymes . Genes encoding other functions have been identified on all mercury ion resistance determinants studied thus far . All mercury resistance genes are clustered into an operon . Hg(II) is transported into the cell by the products of one to three genes encoded on the resistance determinants . The expression of the operon is regulated and is inducible by Hg(II) . In some systems, the operon is inducible by both Hg(II) and some organomercurials . In gram-negative bacteria, two regulatory genes (merR and merD) were identified . The (merR) regulatory gene is transcribed divergently from the other genes in gram-negative bacteria . The product of merR represses operon expression in the absence of the inducers and activates transcription in the presence of the inducers . The product of merD coregulates (modulates) the expression of the operon . Both merR and merD gene products bind to the same operator DNA . The primary sequence of the promoter for the polycistronic mer operon is not ideal for efficient transcription by the RNA polymerase . The -10 and -35 sequences are separated by 19 (gram-negative systems) or 20 (gram-positive systems) nucleotides, 2 or 3 nucleotides longer than the 17-nucleotide optimum distance for binding and efficient transcription by the Escherichia coli sigma 70-containing RNA polymerase . The binding site of MerR is not altered by the presence of Hg(II) (inducer) . Experimental data suggest that the MerR-Hg(II) complex alters the local structure of the promoter region, facilitating initiation of transcription of the mer operon by the RNA polymerase . In gram-positive bacteria MerR also positively regulates expression of the mer operon in the presence of Hg(II).

Drugs Exp Clin Res, 1992, 18(7), 295 - 7
Activity of vancomycin against recently isolated nosocomial gram-positive cocci; Maccanti O et al.; This study reports the in vitro activity of vancomycin against 174 Gram-positive cocci isolated in nosocomial patients . Vancomycin was shown to have a slightly better activity than teicoplanin and was the most active of all other agents tested including imipenem, new quinolones and aminoglycosides.

Chemotherapy, 1992, 38(6), 420 - 7
Randomized comparison of ceftriaxone versus ceftriaxone plus amikacin for the empirical treatment of infections in patients with altered host defense: microbiological and clinical evaluation; D'Antonio D et al.; Two hundred and eighty-four febrile episodes in immunocompromised patients were treated with ceftriaxone alone or in combination with amikacin . In the ceftriaxone-treated group, 60 out of 143 febrile episodes were microbiologically documented, while in the group receiving the combination therapy, there were 32 out of 140 (p = 0.0007) . Gram-positive microorganisms were more common than gram-negative ones, accounting for 59 of the 101 isolated bacteria . The ceftriaxone regimen appeared to have a response rate comparable to the combination regimen (73.91 vs . 78.88%) . Superinfections occurred under both regimens.

Chemotherapy, 1992, 38(5), 324 - 9
Incidence of beta-lactamase production among out patient clinical isolates in Middle Eastern countries and their antibiotic susceptibilities . Middle Eastern Study Group; Shibl AM; In a multicenter survey in seven Middle Eastern countries, 1,827 clinical isolates from patients with community-acquired infections (outpatients) were examined for both production of beta-lactamase and their susceptibility to commonly prescribed antibiotics . Of these isolates, 63% were gram-negative and 37% were gram-positive organisms . beta-lactamase was produced by 65% of all isolates, representing 61 and 75% of gram-negative and gram-positive organisms, respectively . Using standardized disk susceptibility testing, high rates of resistance were observed among gram-negative and gram-positive organisms, respectively, for penicillin (86 and 75%), ampicillin (67 and 66%) and amoxicillin (58 and 52%) . Resistance to tetracycline and co-trimoxazole were also seen, but to a lesser degree . Susceptibility of these organisms towards the cephalosporins cepharadine, cephalexin and cefadroxil ranged from 30 to 70%, which appears to correlate fairly closely with the prevalence of beta-lactamase production . Cefuroxime inhibited about 94 and 79% of gram-positive and gram-negative organisms, respectively, regardless of the production of beta-lactamase . These data are valuable since antibiotic therapy is usually instituted on a best-guess principle against the most likely potential pathogens.

Crit Care Med, 1991 Dec, 19(12), 1520 - 5
Hemodynamic responses to gram-positive versus gram-negative sepsis in critically ill patients with and without circulatory shock; Ahmed AJ et al.; OBJECTIVE: To examine the hemodynamic patterns of critically ill patients with septicemia to evaluate their relationship to blood bacteriology . DESIGN: Retrospective study . SETTING: Medical ICUs of a tertiary care medical center . PATIENTS: Total of 59 critically ill patients with bacteremia: 33 with Gram-positive and 26 with Gram-negative bacteremia . MEASUREMENTS: Hemodynamic variables and mixed venous oxygen saturation (SvO2) measurements associated with the highest cardiac index measured within 72 hrs of positive blood cultures . MAIN RESULTS: No significant differences in cardiac index, mean arterial pressure, systemic vascular resistance, oxygen extraction ratio, or SvO2 were observed comparing the two groups . CONCLUSION: We were unable to demonstrate clinically important differences between the hemodynamic responses to Gram-positive vs . Gram-negative sepsis.

Arch Ophthalmol, 1991 Dec, 109(12), 1737 - 43
Intraocular safety of ciprofloxacin; Stevens SX et al.; Retinal toxicity resulting from the treatment of exogenous bacterial endophthalmitis with multiple antibiotics has increased the importance of evaluating the efficacy of new potent antibiotics for monotherapy . The retinal and corneal toxicity of ciprofloxacin hydrochloride, which is rapidly bactericidal against gram-positive and gram-negative bacteria, was evaluated in the rabbit eye . Retinal toxicity was dose-dependent in phakic and aphakic rabbit eyes as determined with electroretinography, light microscopy, and transmission electron microscopy . An intravitreal dose of greater than 100 micrograms also resulted in dose-dependent acute corneal toxicity in aphakic vitrectomized rabbit eyes . Results of instillation of ciprofloxacin directly into the anterior chamber of phakic rabbit eyes confirmed dose-dependent corneal toxicity . No retinal or corneal damage was observed in aphakic or phakic rabbit eyes after administration of an intravitreal dose of 100 micrograms . Results of electroretinography and light microscopy alone are insufficient to evaluate the retinal toxicity of antibiotics . Ultrasonic pachymetry is the best method of detecting probable associated corneal toxicity.

J Antibiot (Tokyo), 1991 Dec, 44(12), 1444 - 51
Microbial de-mannosylation and mannosylation of teicoplanin derivatives; Borghi A et al.; The single components of the teicoplanin complex, glycopeptide antibiotics active against Gram-positive bacteria, can be converted in the corresponding de-mannosyl derivatives by cultures of Nocardia orientalis NRRL 2450 or Streptomyces candidus NRRL 3218 . Conversely, teicoplanin aglycone and other teicoplanin de-mannosyl derivatives can be converted in the corresponding teicoplanin mannosyl derivatives by cultures of Actinoplanes teichomyceticus ATCC 31121 . The biological transformation yields are approximately 40% for de-mannosylation and 90% for mannosylation . The processes allow for the preparation of gram quantities of the de-mannosyl derivatives of teicoplanin and of teicoplanin mannosyl derivatives . De-mannosyl teicoplanin and teicoplanin mannosyl-pseudoaglycone were not amenable to preparation by either acidic or basic chemical hydrolysis.

Jpn J Antibiot, 1991 Dec, 44(12), 1341 - 50
{Clinical evaluation of intramuscular imipenem/cilastatin sodium in surgical infections}; Konaga E et al.; A multi-center clinical study was carried out at the first Department of Surgery, Okayama University Medical School and its affiliated institutions to evaluate the efficacy and safety profiles of intramuscular imipenem/cilastatin sodium (IPM/CS) in surgical infections, which were mainly biliary tract infections and peritonitis . The following results were obtained: 1 . The efficacy rate was 72.0% in a total of 25 evaluable patients and 81.8% in patients with cholecystitis . 2 . The efficacy rates in patients with and without underlying diseases were 70.0% and 73.3%, respectively, and they were 71.4% in patients with mild or moderate infections and 75.0% in patients with severe infections . 3 . Bacteriologically, the eradication rate was 100% for Gram-positive bacteria and 62.5% for Gram-negative bacteria, with an overall eradication rate of 78.6% . The eradication rate for monomicrobial infections was 71.4% and that for polymicrobial infections was 100% . 4 . Out of 25 patients, one developed diarrhea as a drug-related adverse reaction, and laboratory abnormalities attributable to the treatment were observed in 5 patients . None of them was serious, however . 5 . The overall usefulness rate was 60.0%, and the usefulness for cholecystitis (72.7%) was superior to that for cholangitis (33.3%).

J Biol Buccale, 1991 Dec, 19(4), 271 - 82
Bacterial invasion of periodontal tissues after experimental immunosuppression in rats; Hemmerle J et al.; A moderate gingivitis was produced in 3 groups of 10 adult Wistar rats with diet 2000 of Keyes and Jordan (1964) delivered for 30 days with a controlled feeding unit . The first group served as untreated control . The second group received 5 intraperitoneal injections of cyclosporine A (15 mg/kg body weight) from day 20 to 30 to interfere with the activation of T lymphocytes and interleukin synthesis . The third group received 2 intraperitoneal injections of cyclophosphamide (100 mg/kg on day 20 and 25) which induced a severe neutropenia . The gingival areas between the upper molar regions were prepared for light and transmission electron microscopy . In the untreated control group, a layer of polymorphonuclear neutrophils (PMN) was observed between the dental plaque and the junctional epithelium with a round cell infiltration in the superficial connective tissue . No bacterial invasion was observed . In the cyclosporine group, despite the action on T lymphocytes, no bacterial invasion occurred, but a differentiated PMN layer was present between the apical dental plaque and the junctional epithelium . In the cyclophosphamide group an important bacterial invasion was observed in the interdental epithelium as well as in the underlying connective tissue . In the local absence of PMNs, a mixed flora of Gram positive and negative bacteria of various shapes invaded epithelial as well as connective tissue cells and came in contact with the alveolar crestal bone . Resorption of the alveolar crestal bone scored according to the Keyes and Gold method (1955) was significantly more important in the cyclosporine and the cyclophosphamide group when compared to the controls (p less than 0.05) . No statistical difference in bone resorption was noted between the cyclosporine and the cyclophosphamide groups . It can be concluded that the PMN layer constitutes the first line of defense opposed to bacterial invasion of the periodontal tissues.

Appl Environ Microbiol, 1991 Dec, 57(12), 3629 - 36
Occurrence and ultrastructural characterization of bacteria in association with and isolated from Azolla caroliniana; Nierzwicki-Bauer SA et al.; The occurrence and ultrastructure of bacteria in leaf cavities of symbiotic Azolla caroliniana were examined by transmission electron microscopy . Bacteria were observed in all leaf cavities of Azolla cultures . Five ultrastructurally distinct types of bacteria were observed in each individual leaf cavity . Features used to characterize the bacteria included morphology, cell wall structure, and cytoplasmic organization . At least one gram-positive and as many as four gram-negative types of bacteria reside in leaf cavities of A . caroliniana . The morphological and ultrastructural characteristics of the gram-positive bacterium suggest that it is an Arthrobacter sp . The gram-negative bacteria could not be cultured; therefore, they have not been classified further . Bacterial cell shape and cell wall structure were similar in leaf cavities of different ages, but cell size and cytoplasmic composition varied . The relative contributions of each bacterial type to the total community within individual leaves was determined . Ultrastructural characteristics of bacterial isolates cultured from A . caroliniana in a free-living state were also examined.

J Antibiot (Tokyo), 1991 Dec, 44(12), 1289 - 93
Alisamycin, a new antibiotic of the manumycin group . I . Taxonomy, production, isolation and biological activity; Franco CM et al.; Alisamycin is a new member of the manumycin group of antibiotics produced by Streptomyces sp . HIL Y-88,31582, which taxonomically appears to be Streptomyces actuosus . Alisamycin is active against Gram-positive bacteria and fungi, and has a weak antitumour activity.

Neurosurgery, 1991 Dec, 29(6), 864 - 8
Intracranial infection after missile injuries to the brain: report of 30 cases from the Lebanese conflict; Taha JM et al.; This study reviews the features of 30 intracranial infections complicating 600 penetrating head injuries from missiles in patients treated at the American University of Beirut Medical Center between 1981 and 1988 . The follow-up period ranged from 1 month to 7 years (mean, 2.5 years) . Sixteen patients had a brain abscess, 9 had cerebritis, 2 had an infected intracerebral hematoma, and 5 had meningitis . Infection developed 4 days to 7 years after the initial debridement . The infecting organisms were Gram positive in 11 patients (36%), Gram negative in 12 (40%), and a combination of Gram positive and Gram negative in 2 (7%) . Twenty-four patients (80%) had wound dehiscence or cerebrospinal fluid leakage at the time the infection appeared . There was a 76% correlation between the organisms cultured from the dehiscent scalp wound and the brain . Twenty-three patients had intracranial retention of bone . Infection developed in 16 of the 30 patients (70%) around bone fragments, in 4 around a metallic fragment, in 2 around absorbable gelatin sponge, and in 3 along the missile tract; 2 had an infected intracerebral hematoma, and 3 had meningitis . At least one of the following risk factors was present in each patient: extensive brain injury, coma, trajectory through an air sinus, cerebrospinal fluid fistula, inadequate initial debridement, or incomplete dural closure . The incidence of intracranial infection in patients with postoperative retention of bone was 4% in the absence of scalp wound dehiscence, compared with 84.6% when wound dehiscence was present . Ten patients (43%) still retained a bone fragment measuring less than 1 cm after excision of a brain abscess or treatment of cerebritis or meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Physiol, 1991 Dec, 261(6 Pt 2), R1358 - 63
Role of gram-negative and gram-positive gastrointestinal flora in temperature regulation of mice; Conn CA et al.; An earlier study showed that the presence of gut flora elevates body temperature of mice and rats . In these experiments, we questioned whether the signal coming from the gut was endotoxin from gram-negative (Gm-) bacteria or some signal derived from gram-positive (Gm+) microorganisms . To test the idea that endotoxin is responsible for the effects of flora, we compared the temperature of the endotoxin-resistant mouse (C3H/HeJ) with that of endotoxin-sensitive strains of mice (C3H/SnJ and C3H/HeN) . Temperature of C3H/HeJ was not different from that of C3H/SnJ or C3H/HeN during the light period but was significantly lower during the later hours of the dark period . We speculated that, if endotoxin leaking across the gut wall were responsible for elevating temperature, then reduction of gut flora with nonabsorbable antibiotics would depress the temperature of the endotoxin-sensitive mice more than that of the endotoxin-resistant mice . Because antibiotics lowered the temperature of both strains of mice to the same extent, the signal coming from the gut is unlikely to be endotoxin . To test whether Gm+ flora can be responsible for elevating temperature, we inoculated one group of germfree mice with Gm+ organisms . Their mean temperature was significantly higher than that of mice that remained germfree . Cecectomy had no effect on temperature, indicating that the special properties of the germfree cecum were not involved in lowering the temperature of germfree mice . These data support the hypotheses that Gm+ organisms are a major source of the stimulatory effect of flora on normal body temperature and that the presence of Gm- organisms is unnecessary.

Proc Natl Acad Sci U S A, 1991 Nov 15, 88(22), 10282 - 6
Rolling-circle replication of the plasmid pKYM isolated from a gram-negative bacterium; Yasukawa H et al.; Plasmid pKYM isolated from a Gram-negative bacterium encodes a Rep protein that is essential for plasmid replication . A comparison of Rep protein from pKYM to Rep proteins encoded by other plasmids shows that it has homology to Rep proteins of the pUB110 plasmid family from Gram-positive bacteria . These plasmids replicate by a rolling-circle mechanism in which a tyrosine residue in the Rep protein acts as the acceptor for the 5' end of the single-strand break introduced by the Rep protein . A Tyr----Phe substitution in the pKYM Rep protein abolishes its activity . Strand-specific single-stranded circular plasmid DNA can be recovered from the cells carrying pKYM and thus we propose that the plasmid pKYM replicates by a rolling-circle mechanism.

Kansenshogaku Zasshi, 1991 Nov, 65(11), 1459 - 63
{A case of adult T-cell leukemia (ATL) complicated with multiple nocardial abscesses}; Ohguni S et al.; A 45-year-old woman was admitted to our hospital with complaints of fever and lumbago . She was treated for adult T-cell leukemia and thrombocytopenia with 20 mg/day of prednisolone . CT scan showed multiple abscesses in right peri-kidney, right iliopsoas muscle, left subcutaneous region in the abdominal wall and the brain . Left subcutaneous abscess was drained . Gram-positive organisms consisting of filaments were found, and Nocardia farcinica was grown in cultures . After two months of chemotherapy (FMOX, MINO and AMK), all abscesses except one in the brain disappeared . Cerebral abscess was cured fifty days after the start of the treatment with oral administration of Sulfamethoxazole-trimethoprim (SMX/TMP) . The mortality of Nocardial cerebral abscess is high . This patient is a very rare case in which multiple Nocardial abscesses including brain abscess was cured by chemotherapy.

Mol Microbiol, 1991 Nov, 5(11), 2707 - 18
The merR regulatory gene in Thiobacillus ferrooxidans is spaced apart from the mer structural genes; Inoue C et al.; Two distinct merR genes, which regulate expression of the mercuric ion resistance gene (mer), of Thiobacillus ferrooxidans strain E-15 have been cloned, sequenced and termed merR1 and merR2 . As a result of gene walking around two merR genes, it was found that these two genes were quite close in distance . The nucleotide sequence of the region (5,001 base pairs; PstI-EcoRI fragment) containing the merR genes was determined . Between the two merR genes, there were five potential open reading frames (ORFs) . Two of these were identified as merC genes, and the other three as ORFs 1 to 3 . ORFs 1 to 3 show significant homology to merA, tnsA from transposon Tn7, and merA, respectively . Both merR genes consist of a 408 bp ORF coding for 135 amino acids . Their gene products, MerR1 and MerR2, differed at three amino acid positions, and shared 56-57% and 32-38% identity with the MerRs from other Gram-negative and Gram-positive bacteria, respectively . Competitive primer extension analysis revealed that both regulatory genes were expressed in the host cells . These merR genes were located more than 6 kb from either end of the mer structural genes (merC-merA) . This is the first example of merR being separated from the mer structural genes . The two merC genes, each of which coded for a 140-amino-acid protein, appeared to be functionally active because Escherichia coli cells carrying these merC genes on plasmid vectors showed hypersensitivity to HgCl2 . However, ORFs 1 and 3, which were homologous to merA, seemed to be inactive both structurally and enzymatically . The gene arrangement in this region took on a mirror image, with the truncated tnsA as the symmetrical centre . It is suggested that the Tn7-like factor may have participated in gene duplication events of the mer region, and in its chromosomal integration.

J Burn Care Rehabil, 1991 Nov-Dec, 12(6), 564 - 8
The Baltimore Sepsis Scale: measurement of sepsis in patients with burns using a new scoring system; Meek M et al.; A new sepsis scale has been developed, and it consists of 13 parameters, each of which is measured daily on a variable point scale . In 41 patients with major burns the Baltimore Sepsis scale correlated well with death or survival, with occurrence of septicemia, and with the level of serum interleukin-6 . It did not correlate well with the level of plasma endotoxin or with the type of organism that was grown in blood cultures (gram-positive or gram-negative) . We propose that the Baltimore Sepsis Scale would be an accurate and easy scale to use for the measurement of interventions that are aimed at improving the septic state.

J Bacteriol, 1991 Nov, 173(21), 6705 - 8
Transfer of plasmid RSF1010 by conjugation from Escherichia coli to Streptomyces lividans and Mycobacterium smegmatis; Gormley EP et al.; The plasmid RSF1010 belongs to a class of plasmids (IncQ) that replicate in a range of bacterial hosts . Although non-self-transmissible, it can be mobilized at high frequency between different gram-negative bacterial species if transfer functions are supplied in trans . We report the transfer of RSF1010 by conjugation from Escherichia coli to the gram-positive actinomycetes Streptomyces lividans and Mycobacterium smegmatis . In its new hosts, the plasmid was stable with respect to structure and inheritance and conferred high-level resistance to streptomycin and sulfonamide . This is the first reported case of conjugative transfer of a naturally occurring plasmid between gram-negative and gram-positive bacteria.

J Pediatr, 1991 Oct, 119(4), 630 - 8
Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates . National Institute of Child Health and Human Development Neonatal Research Network; Uauy RD et al.; We studied the occurrence of necrotizing enterocolitis in 2681 very low birth weight infants during an 18-month period to characterize the biodemographic and clinical correlates . Proven necrotizing enterocolitis (Bell stage II and beyond) occurred in 10.1% of study infants; necrotizing enterocolitis was suspected in 17.2% of study infants . Positivity of blood cultures was related to necrotizing enterocolitis staging . The mortality rate increased only for stage III necrotizing enterocolitis (54% died) . Logistic regression identified medical center of birth, race, gender, birth weight, maternal hemorrhage, duration of ruptured membranes, and cesarean section as significant risk factors . For one center the odds ratio was 3.7, whereas for another center it was only 0.3 . For black boys, the odds ratio was 2.3 relative to nonblack boys; for girls, race did not affect prevalence of necrotizing enterocolitis . Age at onset was related to birth weight and gestational age . Intercenter differences in necrotizing enterocolitis prevalence were related to time required to regain birth weight and other indicators of fluid management . Gram-positive organisms predominated in positive blood cultures for stage I and II necrotizing enterocolitis; enteric bacteria were isolated more frequently in infants with stage III disease . We conclude that necrotizing enterocolitis prevalence varies greatly among centers; this may be related to early clinical practices of neonatal care.

Can J Surg, 1991 Oct, 34(5), 450 - 3
Abdominal wall actinomycosis associated with use of an intrauterine device: a case report; Groot G et al.; The association between pelvic actinomycosis and the use of intrauterine devices is well established . However, abdominal wall actinomycosis without clinical involvement of the pelvic organs has been reported only once in the literature . The authors present a second case, which occurred in a 24-year-old woman who was using a copper 7 intrauterine devicePIP: Described is the second reported case of isolated abdominal wall actinomycosis associated with use of an IUD . The patient, a 24-year-old white woman, presented with lower abdominal pain, dysuria, urgency, and frequency . Ultrasonography revealed a complex mass in the left lower quadrant of the abdomen that was separate from the uterus, left ovary, and tube . At laparotomy, the patient was found to have an anterior abdominal wall abscess and there was free pus within the abdomen . The omentum was inflamed and adherent to the anterior abdominal wall . The appendix, uterus, ovaries, and tubes were not involved in the inflammatory process . Histologic examination of the omentum demonstrated the typical actinomycotic picture of gram-positive filamentous bacteria within the mass and club-like extensions beyond the periphery of the mass . The patient had a copper-7 IUD in place . The only other reported such case also involved an IUD user . That patient had an isolated anterior wall abscess caused by Actinomyces . The fallopian tubes, ovaries, appendix, omentum, and intestines were normal . The possibility of abdominal wall actinomycosis should be considered in IUD users who present with intra-abdominal abscesses of unknown etiology .

Mol Microbiol, 1991 Oct, 5(10), 2377 - 89
Characterization of a plasmid from Helicobacter pylori encoding a replication protein common to plasmids in gram-positive bacteria; Kleanthous H et al.; A 1.5 kb cryptic plasmid was isolated from Helicobacter pylori . Low-stringency hybridization analysis using this plasmid as a DNA probe revealed base sequence homology with other plasmids in this species . Nucleotide sequence analysis identified an open reading frame encoding a putative polypeptide of 25 kDa . This protein showed marked amino acid sequence similarity to replication-initiation proteins commonly found in small plasmids endogenous to Gram-positive bacteria which replicate by the 'rolling-circle' mechanism . Sequence motifs corresponding to the origins-of-replication consensus sequences were found on this cryptic plasmid . DNA and oligonucleotide probes to these plasmid replication sequences were used in hybridization analysis to identify similar sequences in other H . pylori plasmids . We believe this is the first plasmid isolated from a Gram-negative bacterium to show replication determinants characteristic of the 'rolling-circle' group of plasmids from Gram-positive bacteria . The cloned plasmid will be used to develop a shuttle-vector for H . pylori.

Avian Dis, 1991 Oct-Dec, 35(4), 872 - 6
Clinical, pathological, and epizootiological features of long-segmented filamentous organisms (bacteria, LSFOs) in the small intestines of chickens, turkeys, and quails; Goodwin MA et al.; Long-segmented filamentous organisms (LSFOs) are easily recognized gram-positive bacteria that infect several species of animals . The present study describes the epizootiological, clinical, and pathological characteristics of LSFOs in chicks, turkey poults, and quails in Georgia and California . LSFOs are most likely to be seen in young poultry that have gastrointestinal illnesses during winter . Concomitant infections with other bacteria and protozoans are common . Although inflammation and displacement of microvilli are characteristics of LSFO infections in these birds, LSFOs are not necessarily pathogens . They may be normal intestinal flora or commensal organisms that overgrow when certain unknown gastrointestinal conditions are correct or certain unknown events occur.

Circ Shock, 1991 Oct, 35(2), 123 - 8
Tumor necrosis factor (cachectin) in the biology of septic shock syndrome; Tracey KJ; The high mortality of septic shock syndrome has prompted extensive investigation into its pathogenesis . Tumor necrosis factor (TNF), a cytokine that is often over-produced during Gram-negative or Gram-positive infection, occupies a critical role in triggering this catastrophic illness . The net effects of TNF are dependent upon its concentration in certain vital tissues, and may be dissociated from the presence of the invading pathogens . Agents that inhibit TNF have been developed; these protect against shock and tissue injury and are currently being investigated in clinical trials of septic shock syndrome.

J Periodontol, 1991 Oct, 62(10), 602 - 7
Bacteremia following subgingival irrigation and scaling and root planing; Lofthus JE et al.; The purpose of this study was to determine the incidence of bacteremia after a single professional subgingival irrigation with a 0.12% chlorhexidine gluconate mouthrinse (CHX) as well as after a subsequent scaling and root planing (S/RP) during the same visit . Thirty subjects each with at least 1 site that probed 4 mm or more and bled on probing were randomly assigned to the following groups: 1) irrigation with 0.12% CHX; 2) irrigation with sterile water; and 3) non-irrigated controls . To begin the study blood was drawn just before and 2 minutes after irrigation . Thirty minutes later, blood was drawn again just before and 2 minutes after S/RP at the same site . Specimens were cultured for anaerobic and aerobic microorganisms using standard cultural techniques . Eighteen blood cultures from 15 subjects yielded positive cultures resulting in 23 isolates . Gram-positive rods comprised 34.8% of the total isolates; Gram-positive cocci 34.8%, Gram-negative rods 21.7%, and Gram-negative cocci 8.7% . In the CHX group, bacteremia was detected in 5 subjects after irrigation and in 2 other subjects after S/RP . In the water group, bacteremia was detected in one subject after irrigation and in 4 subjects after S/RP . The control group had 3 bacteremias after S/RP . There was no significant difference between the incidence of bacteremia associated with irrigation by CHX or sterile water (P = 0.141) . There was also no significant difference in the incidence of bacteremia after S/RP between the CHX and sterile water irrigation groups and in patients who did not receive irrigation (control group) (P = 0.88).(ABSTRACT TRUNCATED AT 250 WORDS)

Minerva Med, 1991 Oct, 82(10), 633 - 56
{Cefixime . Microbiologic, kinetic and clinical profile}; Di Nola F et al.; The microbiological, kinetic and clinical profile of cefixime, a IIIrd generation cephalosporin, administered orally, is presented . Cefixime is highly active versus Gram-negative aerobic bacteria while, with respect to Gram-positive bacteria, it is only active against Str . pneumoniae, Str . pyogenes, Str . agalactiae, and Str . bovis . It has no action against anaerobics . Endowed with good kinetics, cefixime possesses a favourable tissue distribution . Cefixime is highly indicated in infections of the upper and lower airways where the aethiology is prevalently due to Str . pneumoniae, H . influenzae and B . catarrhalis, that are extremely sensitive to the antibiotic . It is concluded that the therapeutic armamentarium has been enriched by a new, highly active antibiotic that, administered in a monodese/die, ca satisfy patient compliance.

JAMA, 1991 Sep 25, 266(12), 1686 - 91
A critical evaluation of new agents for the treatment of sepsis; Bone RC; OBJECTIVE - To evaluate new treatments directed against endotoxin, tumor necrosis factor alpha, and interleukin 1 for use in sepsis and related disorders (sepsis syndrome and septic shock) . DATA SOURCES - Investigations of these treatments in animal models, healthy human volunteers, and patients with sepsis and related disorders . STUDY SELECTION - Particular attention was paid to studies of patients with sepsis and related disorders, especially randomized, double-blind, controlled trials . DATA EXTRACTION - Animal studies and investigations with human volunteers were judged by how closely the experimental model replicated the clinical disorder (sepsis) . Patient trials were assessed by sample size and design . Results of all studies were used to evaluate the likelihood that a given treatment would reduce mortality . DATA SYNTHESIS - Direct comparison of E5 and HA-1A antibody studies is difficult because of differences in their design, definitions of shock, and methods of subgroup analysis . However, both antibodies improve outcome in some subgroups: E5 benefits patients with gram-negative infection (bacteremic or focal) who do not have refractory shock, and HA-1A benefits those with gram-negative bacteremia (regardless of whether shock is present) but not those with focal gram-negative infection . Two agents that may be beneficial in gram-positive and gram-negative infection are monoclonal antibodies to tumor necrosis factor alpha and receptor antagonists to interleukin 1 . Preliminary results with both are reviewed . CONCLUSIONS - All three types of treatment may improve outcome in sepsis . The best results will probably be obtained with combination therapy that interrupts multiple points of the inflammatory cascade underlying sepsis.

Biochem Biophys Res Commun, 1991 Sep 16, 179(2), 892 - 6
Hydrogenosomal succinate thiokinase in Tritrichomonas foetus and Trichomonas vaginalis; Jenkins TM et al.; Succinate thiokinase displays a diversity of nucleotide specificity and molecular size throughout Nature . Eukaryotes and Gram-positive bacteria possess distinct 'small' (dimeric) thiokinase enzymes which are specific for adenine (ADP) or guanine (GDP) nucleotides, whereas Gram-negative bacteria contain a single 'large' (tetrameric) enzyme which utilizes both nucleotides . Succinate thiokinase activities, both ADP- and GDP-dependent, were shown to be hydrogenosomal in Tritrichomonas foetus and Trichomonas vaginalis . Surprisingly, the 'small' enzyme was found in T . foetus whereas T . vaginalis contained a 'large' enzyme.

Riv Eur Sci Med Farmacol, 1991 Sep-Dec, 13(5-6), 275 - 83
Clarithromycin in the treatment of bacterial relapses of chronic bronchitis; Dericoloso A et al.; Clarithromycin is a new semisynthetic macrolide, Erythromycin A derivative, which is bactericidal for the most of growing aerobic and anaerobic Gram-positive and Gram-negative organisms . The drug has also a potent activity against the pathogens surviving into intracellular medium and, just like all other macrolides, achieves its effect by inhibiting protein synthesis . Our study investigated the efficacy and tolerability of Clarithromycin in 11 ambulatory patients (8 m, 3f) suffering from bacterial relapses of chronic bronchitis . The macrolide was administered at the oral dosage of 250 mg twice daily for a period ranging from 7 to 11 days, only after microbiological evaluation of sputum . There was a withdrawal because one of the three bacteria isolated from sputum sample was resistant to Clarithromycin, 7 patients were clinically cured, 3 showed only clinical improvement . In all the ten patients there was eradication of causative agents . No adverse events or changes in biochemical and haematological tests were observed.

Mol Biol (Mosk), 1991 Sep-Oct, 25(5), 1197 - 206
{A universal instinct for designing thermoregulated promotors in gram-positive bacteria}; Khazak VE et al.; The construction of plasmid pVKH300, which is useful for modifying any promoter into the thermoregulated form in B . subtilis cells, is presented . The main features of the plasmid are the presence of effectively expressed in B . subtilis lambda C1857 gene and recognition site of BglII restriction enzyme between OR2 and OR3 lambda phage operator sites . Promoterless alpha-amylase gene of B . amyloliquefaciens is used as a reporter gene for promoter cloning into BglII site of pVKH300 . Examples of promoter-containing DNA fragments cloning with pVKH300 as vector are presented . It was found that the best regulated promoter, in a plasmid named pVKH332, was cloned in such a way that the distance between central nucleotides of OR2 and OR3 is equal to integer number of DNA helix turns (84 b.p . in the case).

DICP, 1991 Sep, 25(9), 914 - 8
Intravenous or intramuscular teicoplanin once daily for skin and soft-tissue infections; Edelstein HE et al.; Teicoplanin is a new glycopeptide antibiotic with potent activity against gram-positive bacteria and pharmacokinetics that allow once daily administration . To study the efficacy and safety of teicoplanin for skin and soft-tissue infections, 75 patients received teicoplanin intravenously (38) or intramuscularly (37, of which 16 were outpatients) . Of 62 clinically evaluable patients, 97 percent of teicoplanin iv and 93 percent of teicoplanin im patients were cured or improved . All teicoplanin iv patients and 64 percent of teicoplanin im patients were cured microbiologically at 24-48 hours posttherapy . Persistence of organisms frequently was associated with skin ulcers or abscess cavities and usually had no bearing on clinical outcome . Possible adverse clinical and laboratory reactions caused by teicoplanin occurred in 4 of 38 teicoplanin iv patients (11 percent) and in 8 of 37 teicoplanin im patients (22 percent) . Reactions were mild and resolved with discontinuation of teicoplanin in most cases . In this study, teicoplanin appeared to be safe, efficacious, and convenient for both hospital staff and patients, and potentially cost-effective for the treatment of skin and soft-tissue infections . In particular, teicoplanin appears to be appropriate for outpatient parenteral therapy.

Jpn J Med, 1991 Sep-Oct, 30(5), 420 - 3
Imipenem-cilastatin monotherapy in severe infections accompanying hematological malignancies; Urabe A et al.; Imipenem-cilastatin (imipenem 1 to 4 g/day) was administered to patients with severe infections accompanying granulocytopenia in hematological malignancies . Monotherapy with imipenem-cilastatin was effective in 62.1% of the patients, and also effective even they were severely neutropenic . When imipenem-cilastatin was administered as the first-choice therapy, the efficacy was much better, at 73.3% . Both Gram-positive and Gram-negative infections were curable by the monotherapy with imipenem-cilastatin.

J S Afr Vet Assoc, 1991 Sep, 62(3), 130 - 2
Encephalitozoon infection in a still-born foal; van Rensburg IB et al.; A stud Clydesdale foal was still-born near full term . Macroscopic examination revealed a normal placenta, pulmonary atelectasis and faint white mottling of the kidneys . Microscopically there was severe lymphoplasmacytic interstitial nephritis . Numerous organisms resembling Encephalitozoon cuniculi were present in the affected kidneys . The organisms occurred in the areas of inflammation as well as in the renal glomeruli and intracellular cysts in the renal tubular epithelial cells and exhibited Gram positive staining . Ultrastructurally the organisms possessed a polar vacuole and a spiral filament typical of Microsporidia . The organisms were not detected in sections of the other organs examined.

Appl Environ Microbiol, 1991 Sep, 57(9), 2758 - 61
Cloning vectors, mutagenesis, and gene disruption (ermR) for the erythromycin-producing bacterium Aeromicrobium erythreum; Miller ES; Genetic systems for study of Aeromicrobium erythreum, a gram-positive, G + C-rich (72%) bacterium with the capacity for erythromycin biosynthesis, are described . High-copy-number plasmids suitable as gene cloning vectors include derivatives of the Streptomyces plasmids pIJ101, pVE1, and pJV1 . pIJ101 derivatives with missense substitutions at the rep gene BamHI site do not replicate in A . erythreum . Ethyl methanesulfonate treatment generated several amino acid auxotrophs and non-erythromycin-producing (Ery-) strains . Using the Ery- strain AR1807 as a recipient for plasmid-directed integrative recombination, the chromosomal ermR gene (encoding 23S rRNA methyltransferase) was disrupted . Phenotypic characterizations demonstrated that ermR is the sole determinant of macrolide antibiotic resistance in A . erythreum.

J Gen Microbiol, 1991 Sep, 137 ( Pt 9), 2265 - 9
Classification of acidophilic, neutrotolerant and neutrophilic streptomycetes by nucleotide sequencing of 5S ribosomal RNA; Park YH et al.; Complete 5S ribosomal RNA sequences were obtained for four acidophilic actinomycetes, seven neutrophilic streptomycetes and a strain of Streptoverticillium baldaccii . All of the organisms contained RNAs belonging to the 120 nucleotide type . An evolutionary tree was generated after combining the test data with results from similar studies on representative Gram-positive bacteria . The acidophilic, neutrotolerant and neutrophilic actinomycetes were recovered in a distinct cluster that was equated with the genus Streptomyces . The sequence data support the view that the genera Chainia, Elytrosporangium, Kitasatoa and Microellobosporia should be considered as synonyms of the genus Streptomyces . The recovery of the Streptoverticillium baldaccii strain on the fringe of the Streptomyces cluster is also consistent with current trends in the taxonomy of these organisms . Further work is needed to determine the taxonomic status of the two streptomycete subgroups that comprised the streptomycete cluster.

Plasmid, 1991 Sep, 26(2), 108 - 15
Plasmid transformation of Mycoplasma mycoides subspecies mycoides is promoted by high concentrations of polyethylene glycol; King KW et al.; The recent isolation and characterization of two plasmids from Mycoplasma mycoides subspecies mycoides has opened up new possibilities for studying mycoplasmal genetics . In order to facilitate the development of a genetic system in M . mycoides subsp . mycoides, parameters of polyethylene glycol (PEG)-mediated transformation were examined, as existing protocols prove very inefficient in this organism . The effects of PEG concentration, DNA concentration, presence of Ca2+ ions, and choice of buffers on the transformation of the Tn916-containing plasmid pAM120 into M . mycoides subsp . mycoides were examined . The stability of Tn916 in the M . mycoides subsp . mycoides chromosome was also evaluated . The optimal PEG concentration (53-62% (w/v)) in the transformation mixture was substantially higher than the PEG concentration reported to be optimal for transformation of other mycoplasmas (36% (w/v)) . The PEG concentrations used here were also higher than the concentration used to promote transformation or fusion of gram-positive bacterial protoplasts . A necessity for the presence of Ca2+ ions for optimal transformation was shown, as was the possible involvement of cell culture growth stage . Our results demonstrate the need for expanding current transformation techniques for mycoplasmas . Studies also indicate that once Tn916 inserts into the M . mycoides subsp . mycoides chromosome, it can transpose to other sites at a relatively high frequency.

Biochem J, 1991 Aug 15, 278 ( Pt 1), 225 - 34
Citrate synthase from Mycobacterium smegmatis . Cloning, sequence determination and expression in Escherichia coli; David M et al.; A Mycobacterium smegmatis PstI library was constructed by cloning these fragments downstream from the lac promoter of the expression vector pHG171 . Three identically sized clones were isolated by complementation of an Escherichia coli strain (chi 2338) deficient in citrate synthase . One insert (pBL265) was used in hybridization experiments with DNA from E . coli and M . smegmatis and it was demonstrated that the clones were indeed from M . smegmatis . The transcription of the M . smegmatis citrate synthase gene in E . coli relied upon the lac promoter . In translation experiments performed in vitro pBL265 gave rise to a novel protein of about 42 kDa . This band was not seen in 'opposite-orientation' subclones . Various subclones in which the 5'-end was shortened nevertheless complement E . coli chi 2338 and produce the 42 kDa protein . This demonstrates that the M . smegmatis citrate synthase gene uses its own ribosome-binding site in E . coli . The relevant 1.8 kb of the 2.8 kb insert was sequenced . A consensus E . coli ribosome-binding site was found centred precisely 10 bp upstream of the methionine codon . Other interesting features revealed by the sequence are discussed . Citrate synthase activity was assayed in vitro and the mycobacterial enzyme was found to be similar to those of the Gram-positive bacteria.

Am J Surg, 1991 Aug, 162(2), 145 - 9
Total excision and extra-anatomic bypass for aortic graft infection; Ricotta JJ et al.; Reports of high mortality and amputation rates following total excision and extra-anatomic bypass for aortic graft infection have prompted the use of alternate approaches including local antibiotics, partial resection, in situ revascularization, and graft excision without revascularization . Experience with aortic graft infection was reviewed to establish current morbidity and mortality rates and evaluate our bias in favor of total excision and extra-anatomic bypass . Aortic graft infection was identified in 32 patients, 8 with aortoenteric fistulas . The mean interval between graft placement and infection was 34 months . History of groin exposure (75%) or multiple prior vascular surgery (50%) was common . Clinical signs included fever and/or leukocytosis (23 patients), false aneurysm (9 patients), graft thrombosis (6 patients), groin infection (11 patients), and gastrointestinal hemorrhage (6 patients) . Microbiologic data, available in 26 patients, demonstrated gram-positive organisms in 15 patients and gram-negative in 9 . Multiple organisms were seen in 11 patients . Patients were treated by partial removal with (8 patients) or without (4 patients) revascularization or total removal with (18 patients) or without (2 patients) revascularization . Revascularization was by an extra-anatomic route, either simultaneous or staged . Overall morbidity/mortality was less in the revascularized groups (p = 0.01), while late complications were seen only after partial removal (p less than 0.01) . The best results were found after total excision with revascularization . No patient in this group experienced late infection or amputation during a mean follow-up of 34 months (range: 1 to 168 months) . Complications after total excision and extra-anatomic bypass for aortic graft infection are lower than generally appreciated . This approach should remain the standard to which other approaches are compared.

J Vasc Surg, 1991 Aug, 14(2), 170 - 4
Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty; McCready RA et al.; Septic complications after cardiac catheterization and percutaneous transluminal coronary artery angioplasty are distinctly uncommon . However, we have recently treated nine patients with sepsis and life-threatening complications after cardiac catheterization alone or after catheterization and subsequent percutaneous transluminal coronary angioplasty . The common denominator in all patients was either repeat puncturing of the ipsilateral femoral artery or leaving the femoral artery sheath in for 1 to 5 days after the procedure . Two patients died as a direct result of their septic complications . One death occurred in a patient in whom bacterial endocarditis with congestive heart failure developed, and the other patient had a large retroperitoneal hematoma that became secondarily infected . Infected aneurysms that were successfully treated developed in three patients . Our study suggests that colonization of the needle tract by skin flora predisposes to septic complications if repeat arterial punctures are required or if a femoral artery sheath is left in place for more than 24 hours . Patients in whom sepsis develops after these procedures should be initially treated with antibiotics effective against gram-positive organisms . CT scanning or angiography should be considered for patients with persistent sepsis, septic emboli, and abdominal or flank pain . Infected aneurysms require resection or ligation because of the propensity of these aneurysms to rupture.

J Hosp Infect, 1991 Aug, 18(4), 307 - 12
Septicaemia in febrile neutropenic children with cancer in Saudi Arabia; al-Fawaz IM et al.; The pattern of sepsis among 56 children admitted for various forms of cancer to the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during a 6-year period, was retrospectively reviewed . A total of 148 febrile neutropenic episodes occurred and 55 of these, in 40 patients, were associated with positive blood cultures . The isolates were Gram-positive bacteria in 54% of instances, Gram-negative bacteria in 39.4% and Candida in 6.6% and polymicrobial sepsis occurred in five patients . Profound neutropenia (neutrophil counts less than 0.1 x 10(9) l-1) significantly predisposed to Gram-negative sepsis (P less than 0.02), which was responsible for about one-third of deaths in this series . Central venous catheters were present prior to 49% of the septicaemic episodes, but were not significantly associated with either increased Gram-negative or Gram-positive bacterial sepsis . However, all four cases of candidaemia occurred in patients with a central venous catheter in situ, and it is recommended that early empirical treatment for candida be considered in all febrile neutropenic cancer patients with central venous catheters.

Hepatology, 1991 Jul, 14(1), 112 - 5
Asymptomatic bacterascites: is it spontaneous bacterial peritonitis?
Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C, Etienne JP.
Asymptomatic bacterascites is defined as the presence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells . Asymptomatic bacterascites is a controversial entity, and little information is available regarding its spontaneous evolution . Clinical features, bacteriological data and outcome in 22 cirrhotic patients with asymptomatic bacterascites are reported and are compared with those of a group of 36 cirrhotic patients with spontaneous bacterial peritonitis . Eleven patients had gram-negative bacteria and 11 had one gram-positive bacteria . Only in three patients (13.6%) did peritonitis develop . Twelve patients received no antibiotic therapy, and in none did peritonitis develop . At 1 month, 27% of patients with asymptomatic bacterascites had died . Patients with asymptomatic bacterascites had less-severe liver disease; they more frequently had gram-positive bacteria in ascitic fluid and had a lower 1-mo mortality rate than did patients with spontaneous bacterial peritonitis . We conclude that asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid . Peritonitis rarely develops in patients with asymptomatic bacterascites and, in most of them, antibiotic therapy is not required.

Rev Infect Dis, 1991 Jul-Aug, 13 Suppl 9, S758 - 62
Ticarcillin/clavulanate for treatment of postpartum endometritis; Faro S et al.; Postpartum endometritis continues to be the leading cause of morbidity following cesarean section . This infection is commonly polymicrobial, involving aerobic, facultative, and obligate anaerobic gram-negative bacteria as well as gram-positive bacteria . The major risk factor for the development of post-cesarean section endometritis is duration of labor with ruptured amniotic membranes of greater than 6 hours . The most frequently utilized antibiotic regimen employed for treatment of postpartum endometritis is the combination of clindamycin and gentamicin . The combination ticarcillin/clavulanate has a spectrum of activity resembling that of clindamycin and gentamicin . In the data reported, cure rates among patients treated with ticarcillin/clavulanate were similar to the rates for those treated with clindamycin plus gentamicin as well as those for cefoxitin.

Infection, 1991 Jul-Aug, 19(4), 216 - 27
Supplemental immunoglobulin (ivIgG) treatment in 163 patients with sepsis and septic shock--an observational study as a prerequisite for placebo-controlled clinical trials; Pilz G et al.; In a multicenter observational study of 163 medical and surgical patients with a total of 173 episodes of sepsis or septic shock (Elebute sepsis score: 19.0 +/- 0.5), the effects of supplemental i.v . immunoglobulin (i.v . IG) treatment (unmodified polyvalent IgG pH 4.25, n = 123; for Pseudomonas sepsis, n = 50, Pseudomonas IgG) on multiple organ failure (MOF) were investigated by means of APACHE II score changes (pretreatment: 23.7 +/- 0.6) . In 44% of the cases ("responders"), a prompt improvement in APACHE II score (defined as decrease greater than or equal to 4) was evident from day 0 to day 4 after onset of therapy, thus being in close time relationship to the i.v . IG administration . This improvement, associated with a better prognosis (mortality 24% vs . 55%), was found in all subgroups, most importantly the following: polyvalent IgG vs . Pseudomonas IgG treatment; medical vs . surgical patients; moderate vs . severe MOF; and gram-positive vs . gram-negative septicemia . In a small-sized second comparative nonrandomized control group (n = 27, antibiotic treatment alone) of septic patients (Elebute: 14.7 +/- 1.0) with similar MOF severity (APACHE II: 23.6 +/- 1.4), the response rate (30%) was, though not statistically significant, lower by one-third . The optimal baseline score ranges for patient inclusion into future placebo-controlled randomized i.v . IG trials were found to be 20-35 for the APACHE II score and 12-27 for the Elebute score.

Head Neck, 1991 Jul-Aug, 13(4), 311 - 7
Antibiotic prophylaxis in cranial base surgery; Carrau RL et al.; The role of perioperative antibiotic prophylaxis was investigated in 95 patients undergoing 100 clean-contaminated cranial base surgeries . A variety of antibiotic regimens were employed . Potential risk factors for local infection were analyzed . Seven patients (7%) developed infections at the surgical site (meningitis, intracranial abscess, cellulitis/abscess, and osteomyelitis) . Antibiotic prophylaxis for 24 hours or less was associated with a significantly increased risk of infection (p less than 0.04) . Prolonged antibiotic prophylaxis (greater than 48 hours) was not more efficacious than prophylaxis for 48 hours . The surgical approach, type of reconstruction, duration of surgery, and use of drains were not significantly correlated with wound infection . The risk of intracranial infection following cranial base surgery is low despite the presence of bacterial contamination intraoperatively . Broad-spectrum coverage of gram-positive and gram-negative organisms for at least 48 hours is recommended . Attention to surgical technique is important in preventing infectious complications.

Angiology, 1991 Jul, 42(7), 552 - 60
The role of two-dimensional echocardiology in the diagnosis of infective endocarditis {corrected}; Burger AJ et al.; Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis . Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis . The diagnosis of endocarditis was determined by strict clinical and laboratory criteria . All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed . Five echocardiograms were technically inadequate, resulting in a study population of 101 patients . The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years) . The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%) . Twelve patients had preexisting valvular or congenital heart disease . Gram-positive cocci were the most common microorganisms . Complications included mitral regurgitation, subarachnoid hemorrhage, renal infarction, stroke, and a pulmonary embolus . The patients were divided into two groups: Group I consisted of 36 patients with definite vegetations by echocardiography, and Group II had 65 patients with no vegetations . In Group I, acute infective endocarditis was present in 35 patients, whereas only 4 patients had endocarditis in Group II . The sensitivity of two-dimensional echocardiography for detecting endocarditis was 90% . The specificity was 98% . The predictive accuracy for a positive test was 97%, and the predictive accuracy for a negative test was 94% . Thus, two-dimensional echocardiography appears to have a high sensitivity, specificity, and predictive value in the evaluation of patients with suspected endocarditis.

Mater Med Pol, 1991 Jul-Sep, 23(3), 209 - 14
Results of histological examinations of afterbirth and other factors of infection risk in high-risk newborns; Maszkiewicz W et al.; Seventy-two newborns at risk of infection were studied . In the afterbirth of these newborns leucocytic infiltrations were found in 31.9% of cases and Gram-positive organisms prevailed . In the group of newborns with leucocytic infiltrations present in the afterbirth, bacteraemia, left-shift of the differential white blood cell count, and decreased platelet count were more frequent . The course of the adaptation period of these newborns was more frequently disturbed, and infections developed more frequently and earlier . The presence of leucocytic infiltrations in the afterbirth of infected newborns points out that the infection developed within the uterus.

J Antimicrob Chemother, 1991 Jul, 28(1), 109 - 16
A prospective randomized study of prophylactic teicoplanin to prevent early Hickman catheter-related sepsis in patients receiving intensive chemotherapy for haematological malignancies; Lim SH et al.; Eighty-eight patients with haematological malignancies requiring Hickman catheters for intensive chemotherapy were randomized to receive either one single bolus intravenous injection of teicoplanin or no teicoplanin immediately before insertion of a double lumen Hickman catheter . There were lower incidences of catheter-related Gram-positive sepsis in patients receiving prophylactic teicoplanin . There were less exit site infections, tunnel infections and catheter-related Gram-positive septicaemia . The benefit of prophylactic teicoplanin was observed especially among patients who were already neutropenic at the time of catheterization . All Gram-positive organisms isolated from the infected skin sites or from blood cultures taken from the Hickman catheters were sensitive to teicoplanin . No adverse reaction was reported in any of the patients in the prophylactic group . Prophylactic teicoplanin therefore may be used routinely for patients requiring insertion of Hickman catheters for intensive chemotherapy to reduce the early incidence of catheter-related sepsis, especially during the associated period of neutropenia following chemotherapy.

Oncology (Huntingt), 1991 Jul, 5(7), 137 - 44, 147; discussion 148
Management of the febrile neutropenic patient with cancer; Gucalp R; Infection remains the most serious complication of intensive anticancer therapy, particularly in patients with hematologic malignancies . The spectrum of organisms responsible for these infections in neutropenic cancer patients has changed markedly during the last three decades . In most centers, gram-positive cocci have become the most common isolates . The development of broad-spectrum antibiotics has prevented early death from bacterial infections in these patients . As the duration of neutropenia becomes more protracted, the likelihood of invasive fungal infection with candida and aspergillus increases . Encouraging new developments include innovative methods for delivery of amphotericin B and new antifungal agents such as fluconazole in the treatment of invasive fungal infections in these critically ill patients.

J Antimicrob Chemother, 1991 Jul, 28(1), 117 - 29
Aztreonam therapy in children with febrile neutropenia: a randomized trial of aztreonam plus flucloxacillin versus piperacillin plus gentamicin; Heney D et al.; In a prospective, randomized trial in 100 febrile neutropenic children, aztreonam plus flucloxacillin was compared with piperacillin plus gentamicin . At the 72 h clinical assessment there was no statistically significant difference between the two groups . However, in microbiologically documented infections there was a higher response rate in the piperacillin/gentamicin group (57%) than in the aztreonam/flucoxacillin group (41%) . This was contributed to by the poorer Gram-positive cover of the aztreonam/flucloxacillin combination . In clinically documented infections and unexplained fevers the response rate of the two antibiotic regimens was identical . There were two deaths; one early death (in the piperacillin/gentamicin arm) and one late death . At the final assessment a successful outcome was obtained in the remaining patients . In the aztreonam/flucloxacillin group 75% of the episodes required modification compared with 59% in the piperacillin/gentamicin group.

Plasmid, 1991 Jul, 26(1), 10 - 9
Sequence analysis of the inducible chloramphenicol resistance determinant in the Tn1696 integron suggests regulation by translational attenuation; Stokes HW et al.; The sequence of the Tn1696 determinant for inducible nonenzymatic chloramphenicol resistance has been determined . The cml region, the fourth insert of the Tn1696 integron, is 1547 bases and includes a 59-base element at the 3' end, as is typical of integron inserts . One gene, designated cmlA and predicting a polypeptide of 44.2 kDa, is encoded in the insert . However, the cmlA region shows one feature not previously found in an integron insert . A promoter is located within the cmlA insert, and translational attenuation signals related to those of the inducible cat and ermC genes found in gram-positive organisms are also present . The regulatory region includes a leader peptide of nine amino acids, a ribosome stall sequence related to those preceding cat genes, and two alternative pairs of stem-loop structures which either sequester or disclose the ribosome binding site and start codon preceding the cmlA gene.

FEMS Microbiol Lett, 1991 Jun 15, 65(2), 165 - 9
Cloning and expression of the Arthrobacter globiformis KZT1 fcbA gene encoding dehalogenase (4-chlorobenzoate-4-hydroxylase) in Escherichia coli; Tsoi TV et al.; The fsbA gene controlling the first step of 4-chlorobenzoic acid (4CBA) metabolism in the Gram-positive soil bacterium Arthrobacter globiformis KZT1 has been cloned and analysed in Escherichia coli . The E . coli minicells analysis showed that a polypeptide(s) with Mr = 58 kDa (and/or Mr = 32 kDa) can be the fcbA product(s) . Despite the gene dose amplification and control of the E . coli inducible Plac promoter, the level of functional expression of the fcbA gene in E . coli cells seems comparable only with that in the parental KZT1 strain . Effective 4CBA dechlorination by recombinant cells during growth in the presence of substrate within a range of concentrations 0.1 g/l to 0.7 g/l as well as a sudden reduction in the reaction efficiency at higher substrate concentrations were observed.

Biochem Biophys Res Commun, 1991 Jun 14, 177(2), 821 - 7
The macrophage response to bacteria: flow of L-arginine through the nitric oxide and urea pathways and induction of tumoricidal activity; Keller R et al.; The consequences of the interaction of heat-killed bacteria and lipopolysaccharide (LPS) with a pure population of bone marrow-derived mononuclear phagocytes (BMMo) were investigated, utilizing changes in the flow of L-arginine and expression of tumoricidal activity as parameters of macrophage (mo) function . Gram negative bacteria and LPS proved potent in inducing the flow of L-arginine through the nitric oxide and the urea pathways but were mostly poor in eliciting tumoricidal activity . Gram positive bacteria affected the metabolism of L-arginine only little but were often efficient in triggering tumoricidal activity . The findings show that the mo response to bacteria, which may determine the outcome of their interaction with the host, may differ considerably depending on the type of bacteria.

J Med Microbiol, 1991 Jun, 34(6), 339 - 48
The differentiation of asaccharolytic anaerobic gram-positive cocci by protein electrophoresis; Taylor EA et al.; Conventional biochemical and antibiotic sensitivity tests were used to allocate 87 clinical isolates of anaerobic gram-positive cocci to currently recognised species, in comparison with type and other authentic reference strains . Whole-cell protein electrophoresis was then performed with extracts of each strain . Allowing for difficulties of standardisation, it was possible to allocate most of the organisms to species-related groups on the basis of protein patterns . Organisms identified conventionally as Peptostreptococcus anaerobius and P . micros formed homogeneous groups by protein electrophoresis . There was evidence for heterogeneity amongst strains identified as P . asaccharolyticus (two groups, including P . indolicus), P . prevotii and P . magnus . However, aberrant P . prevotii strains were allocated to the P . asaccharolyticus groups, leaving a homogeneous P . prevotii group, and if P . variabilis were re-instated as a species, the remaining P . magnus strains could be divided into two groups . Of the anaerobic gram-positive cocci in the National Collection of Type Cultures deposited by Hare, Group IV is P . magnus, Group IX is P . micros and Groups I, III and VIII appear to be related to the butyrate-producing species P . asaccharolyticus and P . prevotii, but are strongly saccharolytic.

J Clin Invest, 1991 Jun, 87(6), 2048 - 55
Biological and biochemical characterization of a factor produced spontaneously by adherent cells of human immunodeficiency virus-infected patients inhibiting interleukin-2 receptor alpha chain (Tac) expression on normal T cells; Ammar A et al.; Adherent cells from human immunodeficiency virus (HIV)-infected subjects but not from normal blood donors, patients with Gram-positive or -negative bacteremia, active tuberculosis, toxoplasmosis, pulmonary aspergillosis, and cytomegalovirus infection produce spontaneously an activity which inhibits alpha chain of interleukin-2 (Tac) expression and interleukin 2 (IL-2) production by normal activated T cells and IL-2 production by these cells . A similar biologic activity was detected in culture supernatants of in vitro HIV-I-infected normal adherent and leukemic U937 cells . Tac-inhibitory activity is not cytotoxic and it could be detected in serum-free conditioned media . Recombinant granulocyte/macrophage colony-stimulating factor and phorbol myristate acetate stimulation of patients' and normal adherent cells did not enhance specifically the production of the Tac inhibitor . Biologically active conditioned media did not contain infectious virus as well as secreted p24, gp120 viral proteins; the biologic activity could not be abolished by anti-p24, anti-gp120, and anti-nef monoclonal antibodies or human purified polyclonal anti-HIV IgG . Gel filtration of conditioned media followed by anion exchange chromatography resulted in a 1,200-fold degree of purification and revealed that the biologically active molecule was cationic . Sodium dodecyl sulfate polyacrylamide gel electrophoresis of this fraction and gel elution of the proteins showed that the biologic activity was associated with a 29-kD protein which was distinct from alpha- or gamma-interferon, tumor necrosis factor-alpha, and prostaglandin E2 . The above findings demonstrate the production of inhibitory factor(s) during HIV infection, which might be involved in the pathogenesis of the patients' immune defect.

Nippon Geka Gakkai Zasshi, 1991 Jun, 92(6), 750 - 2
{Case of primary aorto-jejunal fistula caused by gram-positive cocci}; Tsukamoto Y et al.; A 46 year-old man was transferred to our department with a pulsating abdominal mass and back pain . On arrival he suddenly developed hematemesis . CT suggested the presence of an infrarenal aortic aneurysm and the jejunum was filled with contrast medium . An emergency operation was done . We found an aorto-jejunal fistula at the branching point of the renal artery . We directly sutured the aortic wall laceration and the jejunum wall in two layers . Then we resected infrarenal pseudoaneurysm as completely as possible, with replacement by a Dacron Y-shaped prosthesis . Culture of the aortic wall showed gram-positive cocci, but the species could not be identified . Gram stain of the aortic wall also showed infection by gram-positive cocci . The patient is alive and well 3 months after surgery.

Orthopade, 1991 Jun, 20(3), 239 - 43
{Problems of infected knee prosthesis}; Drobny TK et al.; Our report is based on 47 infected knee arthroplasties that were revised and followed up in our hospital between 1984 and 1990 . Various surgical and therapeutic management options are assessed . In our patient population our experience revealed that the two-stage reimplantation seemed to offer the best chances for management of infected knee arthroplasty . Infections with gram-negative bacteria tend to take a less favorable course than those caused be gram-positive organisms . A division into categories of infected knee joints is presented and the complexity of problems related to the diagnosis is discussed.

Biochim Biophys Acta, 1991 May 23, 1058(1), 5 - 7
Why do c-type cytochromes exist? Reprise; Wood PM; An earlier paper (Wood, P.M . (1983) FEBS Lett . 164, 223-226) proposed that the covalent links that characterize c-type haem originated in order to prevent the haem being lost into the external medium . This is discussed in relation to Gram-negative and Gram-positive bacteria, cyanobacterial thylakoids and eukaryotes . The practical application is for unravelling complex electron transfer chains: c-type cytochromes may be assumed to be absent from the cytoplasm . Sulphate reducing bacteria provide the only confirmed exception to this rule . Examples of non-covalent haem at risk of being lost are considered . Analogies are drawn with flavin and pyrroloquinoline quinone as prosthetic groups.

J Burn Care Rehabil, 1991 May-Jun, 12(3), 224 - 8
Reduced bacteria on transplantable allograft skin after preparation with chlorhexidine gluconate, povidone-iodine, and isopropanol; May SR et al.; A comparison was made of the residual microbiologic contamination on transplantable allograft skin for burn wound coverage taken from cadaver donors prepared by two different protocols . One group was prepared with povidone-iodine, detergent, and 70% isopropanol; the other was prepared with these agents and 4% chlorhexidine gluconate (CG) . The skin from each of the donor bodies was removed from independently prepared body areas . Without CG, 13.7% of donor body areas were contaminated; with CG, only 5.6% were contaminated . The number of gram-positive bacterial species isolated from skin after CG preparation was dramatically reduced . The gram-positive bacterial contamination rate dropped from 12.1% to 2.2% of donor body areas, a drop of 82% . With CG, 12 of the 15 contaminant species were eliminated; and we saw a general reduction in the total number of contaminated body areas, a specific and pronounced reduction in gram-positive bacteria, and an increase from 86.3% to 94.4% in the amount of skin obtained from donor cadavers that tested negative for bacterial contamination.

J Med Microbiol, 1991 May, 34(5), 295 - 308
The laboratory identification of gram-positive anaerobic cocci; Murdoch DA et al.; A collection of 256 clinical strains and 40 reference strains of gram-positive anaerobic cocci (GPAC) was studied, to characterise the recognised species more fully and to define groups of strains which might correspond to previously undescribed species . The methods used were: gas-liquid chromatography (GLC) for the detection of volatile fatty acids (VFAs); determination of the pre-formed enzyme profile with a commercially available kit, ATB 32A; microscopic appearance; colonial morphology; and antibiotic sensitivity tests . Strains were placed in one of five VFA groups according to their GLC profile; 96% of strains were further assigned to 12 groups by their enzyme profile . There was less than 99% agreement between the two methods . Of 111 clinical strains in the VFA-negative group, 110 gave one of three distinct enzyme profiles corresponding to Peptostreptococcus magnus, P . micros and P . heliotrinreducens . The assignment of strains to groups based on their microscopic appearance and colonial morphology agreed well with groupings according to enzyme profile . Identification of butyrate-producing GPAC was unsatisfactory because it relied heavily on the enzyme profile; testing for indole production was of limited discriminative value . Most strains of P . asaccharolyticus and P . indolicus were very similar in enzyme profile, microscopic appearance and colonial morphology, but a sub-group of P . asaccharolyticus could be distinguished . A further indole-positive group corresponding to Hare group III was also noted . Strains of P . prevotii and P . tetradius were very similar, but easily distinguished from other butyrate-producing GPAC . However, 45% of the butyrate-producing cocci could not be assigned to recognised species; most of these were assigned to one of two new groups, the ADH group and the bGAL group, by their enzyme profile, microscopic appearance and smell . Four strains that produced a terminal VFA peak of isovaleric acid formed a new group designated 'ivoricus' . Reliable features for the identification of P . anaerobius were GLC (all GPAC that produced isocaproic acid were identified as P . anaerobius), enzyme profile and sensitivity to SPS . Two clinical strains that produced caproci acid were identified as Hare group VIII; they were distinguished from Peptococcus niger by their enzyme profile and colonial morphology . A phenotypic classification based on GLC and enzyme profile is presented, with a method for the identification of most strains of GPAC within 48 h of primary isolation.

J Infect Dis, 1991 May, 163(5), 1029 - 32
Serum tumor necrosis factor-alpha concentrations in children hospitalized for acute lower respiratory tract infection; Nohynek H et al.; Tumor necrosis factor-alpha (TNF alpha) concentrations were measured by radioimmunoassay in sera of 118 children (median age, 1.7 years; range, 2 months-15 years) hospitalized for acute lower respiratory tract infection (ALRI) . Both viral and bacterial ALRI were associated with elevated concentrations of TNF alpha . Concentrations greater than 40 ng/l were seen in children with bacterial or mixed ALRI in 64% and with viral ALRI in 50% of cases . Elevated concentrations were associated with longer duration of fever before admission (P less than .05) and with a higher serum C-reactive protein concentration (P less than .05) . There were no significant differences in TNF alpha concentrations between gram-positive and gram-negative infections, nor was there an association with clinical severity of ALRI . TNF alpha concentrations decreased in most patients to normal within 5 days of hospitalization, irrespective of the etiology of the infection.

Hematol Oncol, 1991 May-Jun, 9(3), 137 - 46
Ceftazidime and amikacin as empiric antibiotic therapy of febrile granulocytopenic patients with hematological malignancies . Report of 171 consecutive episodes; Todeschini G et al.; One hundred and seventy-one consecutive febrile episodes occurring in 130 neutropenic adult patients with hematological malignancies (mainly acute leukemia) were empirically treated with a combination antibiotic therapy consisting of ceftazidime (100 mg/kg/day) + amikacin (15 mg/kg/day) . Of these, 161 were evaluable . In the majority of episodes (75 per cent) documented infections were identified as a cause of fever . There were 73 bacteremias (34 Gram-negative, 29 Gram-positive, 10 polymicrobial) . One third of patients had pneumonia . Cure without change of the initial regimen was achieved in 45/73 (62 per cent) bacteremic episodes and in 12/13 episodes of microbiologically documented infections without bacteremia . There were 35 clinically documented infections and 26 (74 per cent) of these were cured . Of the 40 patients presenting with possible infections 26 (65 per cent) were cured . Overall, cure without modification of the initial antibiotic combination was achieved in 109/161 episodes (68 per cent) . In spite of the frequent occurrence of persistent neutropenia (82 per cent), the infectious mortality was low (8.6 per cent), and often due to superinfection . The deaths due to primary infections were 6/161 (3.7 per cent) . Side effects were mild and rare . In our experience ceftazidime + amikacin was an effective and safe empirical regimen for this population of hematologic patients with persistent neutropenia and severe documented infections.

Eur J Epidemiol, 1991 May, 7(3), 200 - 6
Some contributions of electron microscopy to the study of the rickettsiae; Silverman DJ; Electron microscopy has provided valuable insights into the study of rickettsiae as intracellular parasites from several important perspectives . This tool has allowed researchers to delineate the fine structural features of these organisms and to show that they truly resemble free-living bacteria . Furthermore, it has been shown that there are subtle, but distinct differences in the outer envelope structure of some members of the genus Rickettsia that may explain reported differences in tinctorial properties and in their sensitivity to certain antibiotics . With Coxiella burnetii, electron microscopy has helped significantly in the characterization of the pleomorphic nature of the organism including formation of terminal bodies that resemble endospores of gram-positive bacteria . Electron microsxopy has also helped to define the relationship of the rickettsiae to their host cells . For example, ultrastructural analysis can reveal whether organisms exist free within the cytoplasm or nucleus (members of the genus Rickettsia), or whether they are bound by a phagosomal or phagolysosomal membrane (Ehrlichia and Coxiella) . Finally, although all rickettsiae eventually destroy their host cell, it has been shown through transmission electron microscopy that this destruction might be mediated by different mechanisms that are specific for different rickettsial species.

Antonie Van Leeuwenhoek, 1991 May, 59(4), 215 - 23
Changes in pulmonary surfactant during bacterial pneumonia; Brogden KA; In pneumonia, bacteria induce changes in pulmonary surfactant . These changes are mediated by bacteria directly on secreted surfactant or indirectly through pulmonary type II epithelial cells . The bacterial component most likely responsible is endotoxin since gram-negative bacteria more often induce these changes than gram-positive bacteria . Also, endotoxin and gram-negative bacteria induce similar changes in surfactant . The interaction of bacteria or endotoxin with secreted surfactant results in changes in the physical (i.e . density and surface tension) properties of surfactant . In addition, gram-negative bacteria or endotoxin can injure type II epithelial cells causing them to produce abnormal quantities of surfactant, abnormal concentrations of phospholipids in surfactant, and abnormal compositions (i.e . type and saturation of fatty acids) of PC . The L/S ratio, the concentration of PG, and the amount of palmitic acid in PC are all significantly lower . The changes in surfactant have a deleterious effect on lung function characterized by significant decreases in total lung capacity, static compliance, diffusing capacity, and arterial PO2 and a significant increase in mean pulmonary arterial pressure . Also decreased concentrations of surfactant or an altered surfactant composition can result in the anatomic changes commonly seen in pneumonia such as pulmonary edema, hemorrhage, and atelectasis.

Arch Fr Pediatr, 1991 May, 48(5), 317 - 21
{Neonatal septicemias: biological diagnosis and antibiotherapy . Apropos of a series of 46 cases}; Treluyer JM et al.; The records of 46 neonates with proven septicaemia were retrospectively studied . Patients could be divided in 2 groups: in group 1 (21 infants) a positive blood culture was obtained before one day of life; in group 2 (25 infants) a positive blood culture was obtained between days 1 and 28 . The sensitivity of 9 chemical and bacteriological tests and the efficacy of the initial antibiotic treatment were examined in both groups . Of the 21 germs isolated in patients from group 1, 86% were Gram positive bacteria and 95% were susceptible to ampicillin . Of the 26 germs isolated in patients from group 2, 80% were Gram negative enteric bacteria and 86% were susceptible to cefotaxime . Bacterial tests (gastric aspiration, antigen detection, feces culture) had a better sensibility than biochemical tests (C reactive protein, orosomucoid, fibrinogen).

J Antimicrob Chemother, 1991 May, 27 Suppl C, 113 - 20
Serum concentrations and safety of single daily dosing of amikacin in children undergoing bone marrow transplantation; Viscoli C et al.; The serum concentrations and safety of single daily dosing of amikacin were studied in 16 episodes of fever and granulocytopenia in children undergoing bone marrow transplantation . Amikacin (20 mg/kg) was administered as a 20 min iv infusion once daily for 7 to 19 days; all patients received concomitant therapy with ceftazidime . Peak amikacin concentrations measured immediately after infusion on day 1 and 4 of therapy averaged 72.29 +/- 11.6 mg/l and 74.02 +/- 19.29 mg/l respectively . A slight but statistically significant increase 30 minute post-infusion concentrations was observed in most patients during therapy . Serum amikacin were less than 3 mg/l in all trough samples and within 6 h post-infusion in most patients . A significant increase in serum creatinine was observed in one patient, who was also receiving cyclosporin A . Auditory function was evaluated in 10 patients and showed no changes . Although other drugs were added to cover Gram-positive or fungal pathogens, all patients survived . These data combined with the recent experience of single daily dose amikacin in adults supports further evaluation of novel dosage regimens of aminoglycosides in children.

J Anim Sci, 1991 May, 69(5), 2196 - 203
Effect of monensin and a protonophore on protein degradation, peptide accumulation, and deamination by mixed ruminal microorganisms in vitro; Chen GJ et al.; Mixed ruminal bacteria (80 mg N/liter) degraded casein and soluble soy protein rapidly (.68 and .72 mg N/{liter.min}, respectively), but ammonia was produced at a slower rate (.08 and .10 mg N/{liter.min}, respectively) . Because there was little increase in cell protein, ammonia production could not account for all the degraded protein . Large quantities of non-ammonia, non-protein nitrogen (NAN-NPN) accumulated, and this NAN-NPN reacted more strongly (2- to 14-fold) with ninhydrin after it was treated with 6 N HCl (110 degrees C, 24 h) or pronase E . Even after 96 h of incubation, 10% of the protein N was still found in the NAN-NPN pool . Monensin had little effect on protein degradation, but it caused a large decrease in ammonia production (P less than .05) and an increase in NAN-NPN (P less than .05) . These results indicated that significant quantities of peptide N could not be degraded by ruminal microorganisms and that monensin could increase peptide flow from the rumen . Because 3,3',4',5-tetrachlorosalicylanide, a protonophore that inhibits both Gram-positive and Gram-negative bacteria, did not cause a greater decrease (P greater than .05) in ammonia than monensin, an ionophore that is primarily effective against Gram-positive bacteria, it seemed that the "protein sparing" of monensin could largely be explained by its inhibition of Gram-positive bacteria.

J Med Assoc Thai, 1991 May, 74(5), 271 - 7
Pulmonary nocardiosis in Chulalongkorn Hospital; Wongthim S et al.; From 1982 to 1988, 20 patients with pulmonary nocardiosis were diagnosed at the Department of Medicine, Chulalongkorn Hospital University . The infection was found to be common in immuno-compromised hosts particularly in patients who were suffering from lymphoreticular malignancy, systemic lupus erythematosus, nephrotic syndrome, pulmonary alveolar proteinosis and in patients who were receiving corticosteroids . The clinical manifestations were usually nonspecific . Diagnosis of pulmonary nocardiosis in cases who presented with a short duration of fever and productive cough was often delayed because they were considered to have acute bacterial pneumonia . The findings on chest roentgenogram were nonspecific as nonhomogeneous airspace infiltrates, cavitary lesions, nodule, or miliary infiltrates . The complete blood count frequently showed leukocytosis and neutrophilia . The diagnosis of nocardiosis was suspected if the staining of specimens obtained from the lesions showed typically weakly gram-positive and modified acid-fast branching filament organism and the diagnosis was confirmed by culture . The skin and the central nervous system were the most common hematogenous disseminations . Sulfamethoxazole and trimethoprim in combination were the drugs of choice . The treatment for a minimum of 6 months was appropriate in order to prevent relapse . Poor prognostic factors in nocardiosis were acute infection, Cushing's disease; and disseminated infection involving the central nervous system.

Int Endod J, 1991 May, 24(3), 108 - 18
The effects on the dental pulp of a composite resin and two dentine bonding agents and associated bacterial microleakage; Grieve AR et al.; The pulpal reaction associated with a composite resin alone and composite resin used in conjunction with two dentine bonding agents was studied . Class V cavities were prepared on the labial surfaces of the canine teeth of 18 male ferrets . After acid etching of the enamel margins, the cavities were restored with either a composite resin alone or in combination with one of two dentine bonding agents, Scotchbond and Gluma . One cavity in each animal was filled with Kalzinol as a control . The animals were killed after 7, 14 and 28 days . After histological processing, the pulpal changes were assessed qualitatively and quantitatively according to standard criteria . There were variations in the pulpal response at all time intervals . The responses to the two dentine bonding agents were similar to those found with composite resin alone . No pulpal inflammation was observed in the control teeth . Gram-positive micro-organisms were identified at the interface of restoration and cavity wall, or within the dentinal tubules in virtually all cases in which pulpal inflammation was observed.

J Antibiot (Tokyo), 1991 Apr, 44(4), 403 - 14
Maduropeptin, a complex of new macromolecular antitumor antibiotics; Hanada M et al.; Maduropeptin, a complex of new macromolecular antitumor antibiotics, is a metabolite of Actinomadura madurae H710-49 . The active components maduropeptins A1, A2 and B are acidic chromopeptides with MW of around 22,500 and composed of 14 types of amino acids and an unstable chromophore . The antibiotics are active in vitro against Gram-positive bacteria and highly cytotoxic to tumor cells . They produced significant prolongation of survival time of mice implanted with P388 leukemia and B16 melanoma.

J Antibiot (Tokyo), 1991 Apr, 44(4), 396 - 402
Dioxamycin, a new benz{a}anthraquinone antibiotic; Sawa R et al.; A new antibiotic, dioxamycin (1) was isolated from the culture broth of the strain MH406-SF1, which was closely related to Streptomyces xantholiticus . This antibiotic was purified by countercurrent chromatography, column chromatography and preparative HPLC . The molecular formula of 1 was determined to be C38H40O15 by HRFAB-MS . The structure was determined by spectral analysis of 2D NMR; 1H-1H COSY, 13C-1H COSY, long range 13C-1H COSY (HMBC) and NOESY . The antibiotic is active in vitro against Gram-positive bacteria and some tumor cells . Dioxamycin is a benz{a}anthraquinone antibiotic related to capoamycin.

Appl Environ Microbiol, 1991 Apr, 57(4), 1252 - 4
Aerobic mineralization of vinyl chloride by a bacterium of the order Actinomycetales; Phelps TJ et al.; A gram-positive branched bacterium isolated from a trichloroethylene-degrading consortium mineralized vinyl chloride in growing cultures and cell suspensions . Greater than 67% of the {1,2-14C}vinyl chloride was mineralized to carbon dioxide, with approximately 10% of the radioactivity appearing in cell biomass and another 10% appearing in 14C-aqueous-phase products.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Apr, (4), 3 - 5
{An electron microscopic study of the intercellular contact of a vaccinal strain of Francisella tularensis with gram-negative and gram-positive bacteria}; Gerasimov VN et al.; The use of transmission electron microscopy (the negative contrast and ultrathin section techniques) has made it possible to show that F . tularensis vaccine strain is capable, under normal conditions and in mixtures with other gram-negative and gram-positive bacteria, of forming cell aggregations with close contacts between cells, this contact being probably irreversible . The ultrastructure of bacteria taking part in the formation of intercellular contacts remains intact.

Eur J Clin Microbiol Infect Dis, 1991 Apr, 10(4), 361 - 7
Use of quinolones in the immunocompromised host; Maiche AG; Immune deficiency generally leads to infections . Cancer chemotherapy, medical interventions and various investigational procedures are important factors in the development of infection . In recent decades, there has been a major change in most cancer centers in the etiology of bacterial infections occurring in the immunocompromised host, most infections now being caused by gram-positive organisms . This might be partly due to prophylactic use of agents effective against gram-negative bacteria . The quinolones are now widely used in the treatment of serious infections of the immunocompromised patient . Prophylaxis with quinolones is also practised in cancer centers.

J Dairy Sci, 1991 Apr, 74(4), 1227 - 34
Deacylation of endotoxin during natural cases of bovine mastitis; McDermott CM et al.; Acyloxyacyl hydrolase, a lysosomal enzyme that deacylates and thus detoxifies lipopolysaccharide (endotoxin) has been identified in bovine peripheral blood and milk neutrophils . Enzymatic activity increases on a per neutrophil basis during cases of experimental Escherichia coli mastitis . The objective of this study was to quantify acyloxyacyl hydrolase activity from milk neutrophils collected from mammary glands naturally infected with a variety of bacteria . Acyloxyacyl hydrolase activity was detectable in milk neutrophils isolated from cases of both Gram-negative and Gram-positive bacterial infections, with highest activities found in milk neutrophils from glands infected with organisms known to cause the most severe forms of mastitis . In addition, acyloxyacyl hydrolase activity was inhibited to varying degrees in mastitic milk by a nonprotein inhibitory substance . Nonenzymatic deacylation of endotoxin also occurred in mastitic milk, but to a lesser degree than enzymatic deacylation . Nonenzymatic deacylation of endotoxin was not found to occur in clinically normal milk . Severity of coliform mastitis in individual cows may be dependent in part on the interaction of endotoxin with milk neutrophil acyloxyacyl hydrolase activity, inhibition of acyloxyacyl hydrolase activity by an inhibitory substance, and the inherent ability of milk to deacylate endotoxin nonenzymatically.

Mater Med Pol, 1991 Apr-Jun, 23(2), 111 - 6
Results of histological examinations of afterbirth and other parameters of threatening infection in newborns at high risk of infection; Maszkiewicz W et al.; The studied material comprised 72 newborns at risk of infection . In the afterbirth of these newborns histological examination demonstrated leucocytic infiltrations in 31.9% of cases . In the studied material Gram-positive flora prevailed . In the group of children with the presence of leucocytic infiltrations in the afterbirth bacteremia, left-shift in the differential blood cell count and reduced platelet count were more frequent . The course of the adaptation period was disturbed in a greater number of these babies, and infection became manifest earlier and more frequently . Demonstration of leucocytic infiltrations in the afterbirth of infected newborns is an evidence of intrauterine infection.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 672 - 8
Ceftazidime as monotherapy or combined with teicoplanin for initial empiric treatment of presumed bacteremia in febrile granulocytopenic patients; Novakova I et al.; In a prospective randomized study, 120 febrile, granulocytopenic patients received as initial therapy ceftazidime with or without teicoplanin . At the onset of fever, patients had no obvious infectious focus . For 103 assessable episodes, initial bacteremias were detected in 18 of 51 patients (35%) given ceftazidime and 20 of 52 patients (38%) given the combination; 13 and 17 bacteremias caused by gram-positive bacteria occurred in these groups, respectively . There was no difference in terms of the final response (25 of 51 patients {49%} treated with ceftazidime alone versus 33 of 52 patients {63%} given the combination), and the morbidity was comparable for both treatment groups . The duration of fever and of total antibiotic therapy were similar in both groups . Initial therapy was modified in 26 patients (51%) treated with ceftazidime, with 20 surviving the infection, and in 19 patients (37%) treated with the combination, with 15 surviving . Persistent fever was the main reason for changing treatment, and no patient died of a gram-positive infection . Subsequent infective events occurred in 16 patients (31%) given ceftazidime and in 25 patients (48%) given the combination . Lung infiltrates developed in 12 and 13 patients, respectively, but more new infections occurred in the combination group . Allergic skin reactions were also more frequent in this group . Thus, while teicoplanin provides simple, reliable, and safe treatment of patients with presumed gram-positive infections, it is not useful when given empirically to this patient population, and treatment may result in more infective complications and adverse events.

J Antimicrob Chemother, 1991 Apr, 27 Suppl B, 37 - 41
Infections due to gram-positive organisms in children: possible role for teicoplanin; Dagan R et al.; The disruptive effect on, and potentially hazardous exposure to nosocomial infection, together with the relative cost of hospitalization, of children favours the need for ambulatory care . An increasing proportion of infections in children are due to beta-lactam resistant Gram-positive organisms . Teicoplanin is proposed as a suitable candidate for treating paediatric patients with serious Gram-positive infections in hospital or ambulatory care . The experience acquired in children is still limited . However, over 200 paediatric patients have been treated with once or twice daily im or iv teicoplanin in daily doses of 3-10 mg/kg . The main clinical diagnoses were skin and soft tissue infections, skeletal infections and septicaemia . The drug was safe and clinical efficacy was greater than 90% . Comparative studies with defined uniform protocols are now required to assess the potential of this drug.

Curr Opin Dent, 1991 Apr, 1(2), 179 - 84
Root caries; Derand T; Increasing interest in root caries has resulted in several reports during the year . Problems with diagnosis, epidemiology, structural histopathology, and treatments have clarified some problems concerning root caries . Only active lesions should be registered, but it is important to search for lesions in the periodontal pocket . In several countries, root caries have been found in 30% to 50% of elderly people . In structural investigations, remineralization may occur as irregular precipitation of crystals clearly distinguishable from those of normal sound dentin . Presence of plaque with gram-positive bacteria is closely associated with root caries . Treatment with varnish containing chlorhexidine and thymol may have a reducing effect . Little has been written about the operative treatment of root caries.

Antibiot Khimioter, 1991 Apr, 36(4), 3 - 5
{Fusion of protoplasts of inactive variants of 2 producers of actinomycin C and the biosynthesis of an antibiotic of non- actinomycin nature}; Orlova TI; Fusion of protoplasts of double auxotrophic mutants of spontaneous inactive variants of two cultures producing actinomycin C, i.e . Streptomyces chrysomalus 305 and Streptomyces sp . 26-115 induced by PEG-600 yielded a number of stable recombinants . One of the recombinants requiring proline for its growth was designated as recPro . Unlike its parent strains, it synthesized an antibiotic substance active against gram-positive bacteria and Saccharomyces cerevisiae . The nature of the substance is under investigation.

Oral Microbiol Immunol, 1991 Apr, 6(2), 88 - 96
Use of randomly cloned DNA fragments for the identification of oral spirochetes; DiRienzo JM et al.; DNA probes were produced for the detection and identification of 4 cultivable species of oral spirochetes, Treponema denticola, Treponema socranskii, Treponema vincentii and Treponema pectinovorum . To obtain probe sequences, chromosomal DNA, isolated from representative strains within each species, was cloned in Escherichia coli K-12 . Cloned DNA fragments were screened for the ability to hybridize to DNA only from homologous strains . Several such fragments were identified and shown to be specific when tested against a series of DNAs from gram-negative and gram-positive oral bacteria . The selected probe sequences were semi-conserved within strains of T . denticola and T . socranskii such that restriction fragment length polymorphism (RFLP) was observed . In the case of T . socranskii, RFLP was useful in distinguishing between the 3 known subspecies . Chromosomal DNA fragments from 2 strains of T . vincentii failed to cross-hybridize, under stringent conditions, to genomic DNA from each of these strains . The hybridization probes were suitable for the identification of clinical isolates of T . denticola and could be used to detect the presence of individual Treponema species in mixed cultures . On this basis, the probes were used successfully to detect T . denticola in uncultured plaque samples.

Bol Med Hosp Infant Mex, 1991 Mar, 48(3), 140 - 3
{Continuous ambulatory peritoneal dialysis (CAPD): an alternative for the treatment of children with terminal chronic renal insufficiency in Argentina}; Ramirez JA et al.; Twenty three children aged 0.4 to 15 years, (x 7.5 years) with end-stage renal disease were treated with continuous ambulatory peritoneal dialysis (CAPD) over 46 months . The mean time of treatment for the group was 13 months (range 1.0 to 31 months) . Sixty five percent of the patients had readmission after catheter placement; 53% were for peritonitis . Nine out of 23 patients (39%), presented 20 episodes of peritonitis, an incidence of one episode per 15 patient months . Gram positive organisms were culture in 60% of these episodes . A total of 26 peritoneal catheters were placed in 23 patients . Of the five catheters that required replacement, three were for peritonitis . Seven out of 23 patients had nephrotic syndrome when admitted to CAPD, four of which develop peritonitis . Although no difference was seen between nephrotic and non nephrotic patients in relation to CAPD initiation and peritonitis development, nephrotic patients without peritonitis and non nephrotic had significantly higher initial growth index for height and iron binding capacity than those with nephrotic syndrome and peritonitis (-1.71 +/- 0.90 vs -2.29 +/- 0.27, P less than 0.05, and 265 +/- 50.5 vs 175 +/- 5.0 mg/dL, P less than 0.0005, respectively) . No difference in mean plasma gamma globulin concentration was seen between patients with and without peritonitis . In 14 patients followed for a period greater than to 6 months, the delta growth index for weight and height and was: -0.13 +/- 0.31 and -0.31 +/- 0.46, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Clin Microbiol Infect Dis, 1991 Mar, 10(3), 139 - 45
Single agent therapy for infections in cancer patients: a prospective randomized trial comparing three extended-spectrum cephalosporins; Rolston KV et al.; Three hundred and twenty patients were enrolled in a prospective randomized trial comparing cefoperazone, ceftizoxime and ceftriaxone for initial therapy of infectious episodes in cancer patients . Patients with neutropenia were excluded . In 286 evaluable episodes, the response rates associated with the three agents were 77% for cefoperazone, 70% for ceftizoxime and 72% for ceftriaxone, with no statistically significant differences between the three treatment groups . The overall response rate for all episodes of pneumonia (64%) was significantly lower than the response rate for all other infections (81%; p = 0.002), and the mortality associated with pneumonia (9%) was higher than that associated with all other episodes (2%; p = 0.01) . Patients with infections due to gram-negative organisms responded well to all three agents, whereas patients with gram-positive infections responded more favorably to cefoperazone . Two different schedules of ceftriaxone were used . The clinical response did not differ significantly between patients receiving ceftriaxone once daily and those receiving it twice daily . The incidence of superinfection and relapse was extremely low and all three agents were well tolerated . It is concluded that extended spectrum cephalosporins are effective as single agents for the treatment of infections in cancer patients with adequate neutrophil counts.

J Vet Dent, 1991 Mar, 8(1), 9 - 11
Aerobes in periodontal disease in the dog: a review; Hennet PR et al.; Periodontal disease has been shown to be caused by bacteria . Periodontal inflammation results as the plaque bacteria change from a predominantly non-motile, Gram-positive, aerobic coccoid microbiotal flora to a more motile, Gram-negative, anaerobic, rod-shaped flora . A review of the literature related to aerobic flora is included . The important effects of aerobic flora as well as their importance in contributing to periodontal disease development is reported.

Bol Asoc Med P R, 1991 Mar, 83(3), 96 - 8
Prevalence of the microbiologic flora in contact lens wearers at the Puerto Rico Medical Center; Izquierdo N et al.; The prevalence of microbioogic flora was determined in a convenience sample of contact lens wearers at the Puerto Rico Medical Center, ophthalmology clinics obtaining cultures from the conjunctival fornices . Gram positive bacterial prevalence was 100% in the control group, as well as in rigid gas permeable lens wearers . In the soft contact lens group, gram positive bacterial prevalence was 94.7% . On the other hand prevalence of Gram negative bacteria is null in the soft contact lens wearer population, being only 2.5% in control group, and 45.5% for Rigid Gas Permeable wearers . These contact lens wearers were using different disinfection systems.

Nutrition, 1991 Mar-Apr, 7(2), 93 - 7; discussion 98
Decreased lipolytic activity in tissues during infectious and inflammatory stress; Meraihi Z et al.; The clearance rate of endogenous and exogenous circulating lipids during the septic or inflammatory state remains a controversial subject . Thus, we have developed rat models of gram-negative and gram-positive sepsis and of sterile inflammation to study this problem . In addition to the febrile response, these stresses induced some of the following metabolic changes in the blood: decreased total protein, albumin, and ketone body levels and increased lactate, pyruvate, alanine, cholesterol, and triacylglycerol levels . The activities of heart, diaphragm, and adipose tissue lipoprotein lipase and of hepatic lipase decreased to differing extents depending on whether the enzyme substrate was a long-chain or a medium- and long-chain triglyceride-based emulsion . However, the latter emulsion was always hydrolyzed faster than the former . This observation suggests that, during infection/inflammation, the medium- and long-chain triglyceride-based emulsion would be cleared more quickly, would induce less hypertriglyceridemia, and would thus deliver lipid energy more rapidly than a traditional long-chain triglyceride-based emulsion.

Nippon Saikingaku Zasshi, 1991 Mar, 46(2), 533 - 9
{Effect of heat-staining procedure on the gram staining properties of mycobacteria}; Nakamura M et al.; Since the establishment of Gram stain by H.C.Y . Gram in 1884, it has been widely and routinely used as an aid for differentiation of bacteria . The bacteria are divided into three categories by the staining properties; Gram-positive, -negative, and -indefinite . All the text books in the world describe that mycobacteria such as M . tuberculosis are Gram-positive . By the merest chance, however, it was found that M . lepraemurium grown in tissues was not stained by the routinely used Gram staining method . Therefore, we tried to stain some of the mycobacteria by the Gram staining procedure which is widely used at present . The results obtained indicated that the mycobacteria tested were divided into three groups; the unstainable group such as M . leprae and M . lepraemurium, the Gram-positive and difficult-to-stain group which involves such slow growing mycobacteria as M . tuberculosis, M . avium, and M . intracellulare, and the Gram-indefinite group which contains such rapid growing mycobacteria as M . phlei, M . smegmatis, and M . chelonae . However, if Gram stain is carried out by the heating procedure at the first staining step, all the mycobacteria would become Gram-positive . Therefore, we emphasize that Gram staining of mycobacteria should be performed by the heating procedure.

J Hosp Infect, 1991 Mar, 17(3), 231 - 4
Enumeration of bacteria in clinically significant blood cultures in neutropenic and non-neutropenic patients using a pour plate method; Rice P et al.; A 3-year review of clinically significant positive blood cultures was undertaken to assess any differences in the blood bacterial count between haematological neutropenic and other non-neutropenic patients . The pour-plate method was used . In Gram-positive infections the pour plate contained colonies in 61% of haematological patients and in 41% of others . In Gram-negative infection the figures were 54% and 25% respectively . The mean numbers of bacteria per ml of blood were increased in haematological patients compared with the others for both groups of organisms.

Exp Parasitol, 1991 Feb, 72(2), 184 - 90
Purification and characterization of dihydrofolate reductase from wild-type and trimethoprim-resistant Mycobacterium smegmatis; Sirawaraporn W et al.; Dihydrofolate reductase (DHFR) from extracts of Mycobacterium smegmatis strain mc2(6) and trimethoprim-resistant mutant mc2(26) was purified to homogeneity . In crude extracts, the specific activity of the enzyme from the trimethoprim resistant strain was comparable to that from the sensitive strain . The DHFR from both sources was purified using affinity chromatography on MTX-Sepharose followed by Mono Q FPLC . The enzyme has an apparent molecular mass of 23 kDa from gel filtration on Sephadex G-100 and from SDS-PAGE . Amino terminal sequence analysis showed homology with DHFRs from a subset of other gram-positive organisms . The purified enzyme from the trimethoprim-sensitive organism exhibited Km values for H2folate and NADPH of 0.68 +/- 0.2 microM and 21 +/- 4 microM, respectively . The Km values for H2folate and NADPH for the enzyme from the drug-resistant organism were 1.8 +/- 0.4 microM and 5.3 +/- 1.5 microM, respectively . A kcat of 4.5 sec-1 was determined for the DHFR from both sources . The enzyme from both sources was competitively inhibited by pyrimethamine and trimethoprim . The Ki value of trimethoprim, for the enzyme from the drug-resistant organism was about six-fold higher than for the enzyme from drug-sensitive strain . Our data suggest that mutation of DHFR contributes to trimethoprim resistance in the mc2(26) strain of M . smegmatis.

J Hand Surg {Am}, 1991 Jan, 16(1), 136 - 8
Swine bites of the hand; Van Demark RE Sr et al.; Severe infections of the hand may follow bites by swine who carry a wide range of gram-negative and gram-positive flora . Early treatment must be primarily surgical, with prompt and thorough wound cleansing, superficial and deep debridement of the wound, drainage, and delayed closure of wounds only after cultures show no bacterial growth . Appropriate antibiotics are especially important with local or systemic symptoms of infection, as well as prophylactically . An illustrative case is presented.

Klin Wochenschr, 1991, 69 Suppl 26, 162 - 7
Immunotherapy of sepsis syndrome: a comparison of the available treatments; Fisher CJ Jr et al.; OBJECTIVE: To evaluate the current range of immunotherapy for sepsis syndrome . DATA: Three major, recent anti-endotoxin and two human polyclonal, immunoglobulin clinical trials are reviewed . COMPARISONS: Comparisons are made in their trial design, definitions, patient selection and exclusion criteria and patient demographics . The results in specific subsets are compared and reasons for the differences in efficacy, discussed . RESULTS: J5 anti-sera, E-5, and HA-1A are all effective in reducing the mortality in patients with gram-negative infections . They also result in enhanced resolution of organ failure . Similarities in the efficacies of J5 anti-sera and HA-1A for bacteremic patients with and without shock are noted . High-dose polyclonal human immunoglobulins have been shown to be of benefit in both gram-positive and gram-negative infections in two small clinical trials and deserve further evaluation . CONCLUSION: Anti-endotoxin monoclonal antibodies benefit patients with gram-negative sepsis . They are proof of a concept, but are costly and do not show an overall intention-to-treat effect . There is an urgent need to accurately identify, clinically or by a cytokine profile, those patients who will specifically benefit.

Verh K Acad Geneeskd Belg, 1991, 53(1), 39 - 58; discussion 58-9
{Nontraditional beta-lactam antibiotics}; Vanderhaeghe H; In recent years several beta-lactam derivatives have been obtained, which differ markedly from the traditional penicillins and cephalosporins, some of which have been introduced in the clinic . Clavulanic acid has an oxygen atom instead of sulfur but differs also markedly on C2 and C6 . This inhibitor of penicillinase is used in association with amoxicillin and ticarcillin . Sulbactam and tazobactam are other beta-lactamase inhibitors, which are also used in association with penicillins . In the carbapenems sulfur is replaced by a carbon atom and a double bond is also present . Thienamycin, which is rather labile, has been transformed into a more stable product, imipenem, which is used in the treatment of infections with gram-positive and -negative bacteria . Other carbapenems are being studied . Several synthetic penems also present an interesting activity and may be used in medicine . Monobactams are monocyclic beta-lactams isolated from bacteria . By modification of the natural products aztreonam was obtained, a substance which is used in the treatment of infections with gram-negative bacteria . Other monobactams, prepared by total synthesis like aztreonam, are being studied.

Acta Haematol, 1991, 85(3), 135 - 8
Bacterial infections in lymphoma patients treated with recombinant interleukin-2; Lim SH et al.; 10 lymphoma patients given a total of 26 courses of intravenous continuous infusion of recombinant interleukin-2 (rIL-2) alone without lymphokine-activated killer cells were analysed retrospectively for the frequency and pattern of bacterial infections associated with the immunotherapy . 4 episodes of septicaemia and 7 episodes of soft tissue infections resulted from the 26 courses of rIL-2 infusion . Although there was no death due to infection, all these infections were clinically significant, needing systemic antibiotic therapy and resulting in prolonged hospitalisation . Gram-positive infections occurred significantly (p less than 0.001) more often than gram-negative infections . Patients with non-Hodgkin's lymphoma had a higher incidence of infection than patients treated for Hodgkin's disease, analysed either as infection per patient treated (p less than 0.05) or infection per course of rIL-2 given (p less than 0.02).

Pharmacotherapy, 1991, 11(2 ( Pt 2)), 90S - 98S
Diagnosis and treatment of skin and soft tissue infections: clinical experience with ticarcillin disodium-clavulanate potassium; Pankey GA; The skin has highly effective mechanical, chemical, and immunologic defenses against microbial invasion . These defenses can be breached, however, when the surface of the skin is broken or when hematologic spread of infection reaches the skin or its underlying tissues . Host factors such as diabetes mellitus may also predispose individuals to skin and soft tissue infections, some of which may threaten limb or life . Management of serious infections of the skin and soft tissue often requires thorough drainage and surgical debridement, as well as aggressive antibiotic therapy . Empiric antibiotic therapy of life-threatening skin structure infections should use an agent effective against a broad range of gram-positive and gram-negative, aerobic, and anaerobic organisms, including producers of beta-lactamase enzymes . The combination of ticarcillin disodium and clavulanate potassium is such an agent, and is safe and effective in the treatment of serious skin and soft tissue infections.

Avian Dis, 1991 Jan-Mar, 35(1), 192 - 6
Characteristics of Actinomyces pyogenes involved in lameness of male turkeys in north-central United States; Barbour EK et al.; A new condition of clinical lameness in 20 male turkey flocks of North-Central United States, associated with isolation of gram-positive rod bacteria from lesions of osteomyelitis, is characterized . The characterization confirmed the randomly selected isolates as Actinomyces pyogenes based on macroscopic and microscopic observations and 17 biochemical tests . The disease was reproduced within 3 weeks in all male turkeys, following an intravenous challenge at 15 weeks of age . The agar gel precipitin test and immunoblotting confirmed the antigenic similarity of the isolates recovered from the osteomyelitis lesions of lame birds.

Nippon Kyobu Geka Gakkai Zasshi, 1991 Jan, 39(1), 98 - 102
{A case of infected left atrial myxoma}; Kouzu S et al.; A rare case with infected left atrial myxoma is described . A 52 year-old male was admitted to our hospital because of pain and redness in the left forearm . He has had a history of fever and treatment with antibiotic after pulling out his tooth for two months . At admission, the temperature was 37.4 degrees C . A systolic ejection murmur was heard at the apex on auscultation . Initial investigation of blood showed infective signs . Ultrasonics and angiography revealed a embolus in the left brachial artery at the bifurcation of the radial artery and the ulnar artery . Echocardiography showed the typical feature of a large left atrial myxoma with vegetation . Embolectomy was performed . At the next day, the left atrial myxoma was removed and mitral valve with vegetation was replaced with a prosthetic valve . On microscopic examination, colonies of gram-positive cocci were seen in the thrombus on the typical myxoma . After treatment with antibiotics for six weeks, the patient was discharged from the hospital . He remains asymptomatic for ten months after the operation . Only 12 cases of infected left atrial myxomas have been reported previously in the world.

Eur J Clin Microbiol Infect Dis, 1991 Jan, 10(1), 25 - 31
C-reactive protein in the diagnosis and management of infections in granulocytopenic and non-granulocytopenic patients; Ligtenberg PC et al.; The serum levels of C-reactive protein (CRP) were assayed in 64 non-granulocytopenic and 35 granulocytopenic patients with or without fever and infection . Most patients showed a direct CRP response within 24 hours after onset of fever (95% of non-granulocytopenic patients, 100% of granulocytopenic patients) . The mean peak level of CRP in febrile patients with septicemia was 207 mg/l (median 214 mg/l) in non-granulocytopenic patients and 173 mg/l (median 168 mg/l) in granulocytopenic patients, and differed significantly (p less than 0.001) from that in febrile patients without positive blood cultures . A significant difference between patients with major and minor infections was also found (p less than 0.01) . No significant difference in the CRP level was found between patients with microbiologically and clinically documented infections (p greater than 0.05), nor did the serum CRP levels differ between patients with infections due to gram-positive and gram-negative organisms . The most favorable cut-off limit for detection of an inflammatory process in this study was 25 mg/l . There was no quantitative difference between CRP levels measured by a latex-agglutination method and the nephelometry assay.

J Bacteriol, 1991 Jan, 173(2), 472 - 8
Choline oxidase, a catabolic enzyme in Arthrobacter pascens, facilitates adaptation to osmotic stress in Escherichia coli; Rozwadowski KL et al.; Choline oxidase (EC 1.1.3.17) is a bifunctional enzyme that is capable of catalyzing glycine betaine biosynthesis from choline via betaine aldehyde . A gene (cox) encoding this enzyme in the gram-positive soil bacterium Arthrobacter pascens was isolated and characterized . This gene is contained within a 1.9-kb fragment that encodes a polypeptide of approximately 66 kDa . Transfer of this gene to an Escherichia coli mutant that is defective in betaine biosynthesis resulted in an osmotolerant phenotype . This phenotype was associated with the ability of the host to synthesize and assemble an enzymatically active choline oxidase that could catalyze biosynthesis of glycine betaine from an exogenous supply of choline . Although glycine betaine functions as an osmolyte in several different organisms, it was not found to have this role in A . pascens . Instead, both choline and glycine betaine were utilized as carbon sources . In A . pascens synthesis and activity of choline oxidase were modulated by carbon sources and were susceptible to catabolite repression . Thus, cox, a gene concerned with carbon utilization in A . pascens, was found to play a role in adaptation to an environmental stress in a heterologous organism . In addition to providing a possible means of manipulating osmotolerance in other organisms, the cox gene offers a model system for the study of choline oxidation, an important metabolic process in both procaryotes and eucaryotes.

Crit Rev Microbiol, 1991, 18(2), 115 - 58
Pore-forming bacterial protein hemolysins (cytolysins); Braun V et al.; Protein toxins forming pores in biological membranes occur frequently in Gram-positive and Gram-negative bacteria . They kill either bacteria or eukaryotic cells (at most, a few seem to act on both groups of organisms) . Most of the toxins affecting eukaryotes have clearly been shown to be related to the pathogenicity of the producing organisms . Toxin formation frequently involves a number of genes which encode the toxin polypeptide as well as proteins for toxin activation and secretion . Regulation of toxin production is usually coupled with that of the synthesis of a number of other virulence factors . Iron is the only known environmental factor that regulates transcription of a number of toxin genes by a Fur repressor-type mechanism, as has been originally described in Escherichia coli . Interestingly, the thiol-activated hemolysins (cytolysins) of Gram-positive bacteria contain a single cysteine which can be replaced by alanine without affecting the cytolytic activity . The Gram-negative hemolysins (cytolysins) are usually synthesized as precursor proteins, then covalently modified to yield an active hemolysin and secreted via specific export systems, which differ for various types of hemolysins.

Zentralbl Mikrobiol, 1991, 146(3), 163 - 72
{Hydrophobicity and microbial production . 1 . Selection of oleophilic microorganisms and qualitative characterization by several ecologically and technologically relevant activities}; Sattler K et al.; From samples of different origin microorganisms were selected using the property of oleophily . All oleophilic isolates (30 strains are characterized in more detail) proved to be Gram-positive, nonsporogenic bacteria, obviously belonging to the group of coryneforms . They are growing on a broad spectrum of substrates, 11 strains are facultatively methylotrophic . They are utilizing methanol as well as n-alkanes and glucose without any supplines . 6 strains are able to degrade and decolorize triphenylmethane dyes, for example crystal violet and malachite green . Because of the degradative capacities, combined with the hydrophobic properties of the cell surface, the group of the oleophilic bacteria seems to be very promising in relation to the development of environmental technologies and ecological investigations.

Dermatologica, 1991, 182(1), 32 - 4
Do cutaneous coryneform bacteria produce short-chain fatty acids in vitro?
Lukacs A, Korting HC, Ruckdeschel G, Ehret W.
According to an opinion shared by many, human axillary and inguinal odour is related to short-chain fatty acids produced by gram-positive bacteria . Especially coryneform bacteria are said to produce these odiferous substances . After sampling 22 different strains of coryneform bacteria we cultured them for 48 h in a rich medium . Short-chain fatty acids were extracted afterwards by shaking the liquid medium with ether . Gas chromatography was used for detection . Only one of the tested bacteria produced propionic acid . Acetic acid, (iso)butyric acid or (iso)valeric acid could never be detected . The production of substances of the short-chain fatty acid type might, however, be a consequence of the particular substrate found under physiologic conditions by these organisms in human apocrine sweat . The theory that the metabolism of these skin bacteria necessarily produces short-chain fatty acids could not be supported . Another explanation might be that unspecific secreted enzymes of the bacteria are responsible for the production of short-chain fatty acids by a cleavage of skin surface lipids.

Khirurgiia (Sofiia), 1991, 44(3), 53 - 7
{The treatment of burn wounds with silver sulfadiazine}; Vuglenova E; Results of clinical and bacteriologic studies of the preparation dermazin, produce of LEC, Ljubljana, Yugoslavia are reported . Dermazin is a 1 percent silver sulphadiazin creme . It has very good antiseptic qualities which allow to maintain for a long time a low count of bacterial colonization in a burn wound . This furnishes opportunity for performing necrectomies . A disadvantage of the cream is its moistening effect on necroses, which renders difficult their removal by chemical necrolytic agents . In comparison with the 0.5 percent silver nitrate solution used so far, dermazin has the following advantages penetrates better in the wound; more convenient form for local application; better tolerated by patients; does not stain skin and bedspread; causes no electrolyte disturbances; has strong bactericidal effect against most common gram-positive and gram-negative bacteria.

Med Microbiol Immunol (Berl), 1991, 180(2), 53 - 8
T lymphocyte-stimulating microbial toxins as "superantigens"; Fleischer B; Infectious pathogens generally have to cope with the host's adaptive immune system, i.e., T and B lymphocytes . Common evasion mechanisms in this complex interaction are antigenic variations, the escape to immunologically priviledged sites or the use of immunosuppressive mechanisms . Many bacteria and other microorganisms eleborate soluble factors or toxins that act suppressively on cells of the immune system, such as pore-forming molecules or proteins that interfere with the function of G proteins . Gram-positive cocci and a mycoplasma have developed an extremely potent mechanism of T cell stimulation by closely mimicking recognition of specific antigen . From the functional similarity to antigen recognition and the multiclonal activation of T cells the designation "superantigens" has been suggested for these molecules.

Rev Fac Cien Med Univ Nac Cordoba, 1991, 49(1), 35 - 8
{Actinomycosis of the abdominal wall . Report of a case}; Viotti JA et al.; Actinomycosis is a chronic infectious disease, caused by an anaerobic gram positive microorganism, the actinomyces israelii . It grows by continuity toward adjacent organs, with formation of dense masses of woody tissue, producing draining abscesses and fistulae . General symptoms of this disease are fever, chills, in association with symptoms proper of each localization . The diagnosis is made when the "sulphur granules" that are characteristic of the pus of actinomycosis are found.

Eur J Drug Metab Pharmacokinet, 1991, Spec No 3, 256 - 60
Teicoplanin binding in plasma following administration of increasing intravenous doses to healthy volunteers; Bernareggi A et al.; Teicoplanin is a new long half-life glycopeptide antibiotic active against Gram-positive bacteria . Binding to plasma protein can significantly affect the pharmacokinetics of drugs with low extraction ratio, such as teicoplanin; clearance, volume of distribution and half-life of the drug change as the fraction of drug unbound (fu) varies, with obvious clinical implications . In this study, the linearity of teicoplanin binding to plasma protein was studied in healthy volunteers receiving single increasing intravenous doses of 15, 20 and 25 mg/Kg teicoplanin . Unbound fraction of teicoplanin in human plasma was determined by ultrafiltration . Unbound and total teicoplanin concentrations, Cu and Cp, were measured by microbiological assay . The results indicate that Cu was linearly correlated to Cp in the Cp range from 7 to 280 mg/L, according to the following regression model: Cu = 0.105 Cp - 0.234 (r = 0.9947) in which the coefficient 0.105 represents the average fu . Individual estimates of fu were calculated for every sample as the ratio between Cu and Cp; mean fu values were 0.100 +/- 0.002 (SE), 0.101 +/- 0.002 and 0.097 +/- 0.002, after 15, 20 and 25 mg/Kg, respectively . No statistical difference was found between groups . We conclude that the binding of teicoplanin to plasma protein is linear up to about 300 mg/L and fu value is not dose-dependent from 15 to 25 mg/Kg dose . These conclusions are in keeping with the observation that the pharmacokinetics of teicoplanin is linear in the dose range from 15 to 25 mg/Kg . These estimates of teicoplanin unbound fraction using ultrafiltration are also in agreement with previously reported values obtained by equilibrium dialysis . A mathematical model is proposed to predict changes of fu as the total plasma concentration increases.

J Med Vet Mycol, 1991, 29(6), 381 - 6
Identification of a gene encoding an HPr-like protein in Aspergillus fumigatus; Barker S et al.; The gene encoding a histidine-containing protein (HPr)-like protein was identified in a cDNA library of Aspergillus fumigatus . The predicted amino acid sequence of the fungal HPr showed greater homology with HPr from Gram-positive bacteria than from Gram-negative bacteria . Since other components of the phosphoenolpyruvate: carbohydrate phosphotransferase system have not been identified in eukaryotes, this raises the question of what regulatory function the HPr-like protein might have evolved in this fungus.

Klin Wochenschr, 1991, 69 Suppl 26, 178 - 84
{Supplemental infection therapy with i.v . immunoglobulins (polyvalent IgG and Pseudomonas IgG)--results of an observational case study with 163 patients}; Pilz G et al.; The impact of i.v . immunoglobulin (IVIG) therapy on the survival of adult septic patients cannot yet be considered either proved or disproved . To define optimal criteria for a large multicenter placebo-controlled trial, a multicenter observational study was carried out in 163 medical and surgical patients exhibiting a total of 173 episodes of sepsis and septic shock {Elebute (El) sepsis score; 19 +/- 0.5) . The effects of supplemental IVIG treatment (unmodified polyvalent IgG, pH 4.25, n = 123; for Pseudomonas sepsis, n = 50, Pseudomonas IgG) on multiple-organ failure (MOF) were investigated according to changes in the APACHE II score (AP) (pretreatment value 23.7 +/- 0.6) . In 44% of the cases ("responders"), a prompt improvement in AP (defined as a decrease of greater than or equal to 4) was evident from day 0 to day 4 after the onset of therapy, thus showing a close temporal relationship to IVIG administration . This improvement, associated with an improved prognosis (mortality, 24% vs 55%), was found in all subgroups, most importantly, polyvalent IgG vs Pseudomonas IgG treatment; medical vs surgical patients; moderate vs severe MOF; and gram-positive vs gram-negative septicemia . Thus, all of these patients should be included in future placebo-controlled, randomized IVIG trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Beitr Gerichtl Med, 1991, 49, 175 - 81
{Sudden death in Sanarelli-Shwartzman phenomenon with an unusual pathogen}; Graw M et al.; The classical generalized Sanarelli-Shwartzman phenomenon (SSP) in animal experiments is induced by two conservative endotoxin injections . The experimental animals mostly die within 24 hours in irreversible shock . They show numerous microthrombi with as high fibrin content in the peripheral vessels of many organs (especially the kidneys) in the context of a consumption coagulopathy . In a 49-year-old man who died within one day of a condition associated with high fever, the clinical picture could be defined on the basis of the clinical and morphological findings as a human equivalent of SSP . The detection of a gram-positive bacterium (Diplococcus pneumoniae), which has been described as the causative organism of SSP only in a few exceptional cases, was noteworthy . The special features of the pathophysiology are described.

Otolaryngol Pol, 1991, 45(5), 346 - 53
{Perioperative preventive use of ciprofloxacin in patients with cancer of the larynx}; Szmeja Z et al.; In comparative study of patients with laryngeal cancer, perioperative prophylaxis with ciprofloxacin was estimated . The drug was administered intravenously 200 mg twice daily, for five days to groups of 95 patients . Bacteriological examinations performed intraoperatively mostly revealed Gram-positive germs . The intravenous form of ciprofloxacin was very effective, resulting in complete healing of the operative wound in shorter time than in control groups . The drug has been well tolerated and no side effects were observed.

Infection, 1991, 19 Suppl 6, S320 - 5
Nosocomial pneumonia: comparative multicentre trial between monotherapy with cefotaxime and treatment with antibiotic combinations; Fernandez-Guerrero M et al.; In a multicentre clinical trial involving 32 hospitals, 588 adult patients diagnosed with nosocomial pneumonia and not receiving mechanical ventilation were treated randomly with monotherapy with cefotaxime or the antibiotic combination routinely used in each particular hospital . Both groups of patients were similar regarding demographic data, concurrent diseases, additional therapies and causative organism . Protocol violations were recorded in 40 patients, and these patients were excluded from the evaluation of treatment efficacy . The cure rate was 79% in the cefotaxime group and 71% in the group receiving antibiotic combinations; this difference is statistically significant (p = 0.03, Fisher's two-tailed test) . In the patients receiving combinations of cephalosporins having activity predominantly against gram-positive organisms plus aminoglycosides, the cure rate obtained was very low . The frequency of serious adverse reactions was significantly higher in the group treated with antibiotic combinations . It is concluded that monotherapy with cefotaxime is the regimen that offers better results for the empirical treatment of nosocomial pneumonia.

J Bacteriol, 1991 Jan, 173(1), 130 - 40
Ultrastructure, inferred porosity, and gram-staining character of Methanospirillum hungatei filament termini describe a unique cell permeability for this archaeobacterium; Beveridge TJ et al.; By light microscopy, Methanospirillum hungatei GP1 stains gram positive at the terminal ends of each multicellular filament and gram negative at all regions in between . This phenomenon was studied further by electron microscopy and energy-dispersive X-ray spectroscopy of Gram-stained cells, using a platinum compound to replace Gram's iodine (J . A . Davies, G . K . Anderson, T . J . Beveridge, and H . C . Clark, J . Bacteriol . 156:837-845, 1983) . Crystal violet-platinum precipitates could be found only in the terminal cells of each filament, which suggested that the multilamellar plugs at the filament ends were involved with stain penetration . When sheaths were isolated by sodium dodecyl sulfate-dithiothreitol treatment, the end plugs could be ejected and their layers could be separated from one another by 0.1 M NaOH treatment . Each plug consisted of at least three individual layers; two were particulate and possessed 14.0-nm particles hexagonally arranged on their surfaces with a spacing of a = b = 18.0 nm, whereas the other was a netting of 12.5-nm holes with spacings and symmetry identical to those of the particulate layers . Optical diffraction and computer image reconstruction were used to clarify the structures of each layer in an intact plug and to provide a high-resolution image of their interdigitated structures . The holes through this composite were three to six times larger than those through the sheath . Accordingly, we propose that the terminal plugs of M . hungatei allow the access of larger solutes than does the sheath and that this is the reason why the end cells of each filament stain gram positive whereas more internal cells are gram negative . Intuitively, since the cell spacers which partition the cells from one another along the filament contain plugs identical in structure to terminal plugs, the diffusion of large solutes for these cells would be unidirectional along the filament-cell axis.

Adv Perit Dial, 1991, 7, 272 - 4
Peritonitis in children on chronic peritoneal dialysis: analysis at 10 years; Neiberger R et al.; Peritoneal dialysis is the major form of renal replacement therapy for children awaiting renal transplantation . Peritonitis is the major associated morbidity . We retrospectively identified the pathogens, co-morbid factors and outcome of peritonitis in children on peritoneal dialysis from 1980-1989 . Seventy-three children, mean age 12.4 years, received 1,234 patient months of chronic peritoneal dialysis . Twenty-four patients (33%) remained peritonitis free until their dialysis catheters were removed after transplantation . Forty-nine children (67%) developed 219 episodes of peritonitis . Peritoneal fluid cultures were positive in 169 episodes (77%) . Of the pathogens identified, 73% were gram positive cocci, 22% gram negative rods, 3% were fungus, and 2% other organisms . The incidence of peritonitis was one episode per 5.6 months . Over a 10 year period: 1) 67% of children on peritoneal dialysis developed peritonitis; 2) gram positive cocci accounted for most episodes; 3) the incidence in children was higher than that reported for adults; 4) there were no deaths attributable to peritonitis.

Am J Obstet Gynecol, 1990 Dec, 163(6 Pt 1), 1944 - 7
In vitro inhibition of esterase activity in amniotic fluid: comparison with bacterial cultures; Hoskins IA et al.; Assessment of leukocyte esterase activity in amniotic fluid for the rapid and reliable diagnosis of chorioamnionitis has been demonstrated previously . We compared in vitro inhibition of esterase activity in amniotic fluid with bacterial cultures to identify the origins of the specific esterases released by the infecting organisms . One hundred forty-one samples were tested (90 uninfected, 51 infected) . Each sample was evaluated for Gram stain, cultures, and an in vitro esterase assay followed by ebelactone inhibition . Forty-two patients had positive amniotic fluid cultures . Ebelactone produced varying degrees of inhibition of esterase activity (range, 20% to 60%) in the uninfected samples and in those infected with gram-negative organisms . There was no inhibition in the samples infected with gram-positive organisms . Thus different groups of bacteria may elicit the production of different and specific esterases in infected amniotic fluid, as shown by the differences in in vitro inhibition.

Br J Haematol, 1990 Dec, 76 Suppl 2, 6 - 9
Teicoplanin compared to flucloxacillin for antibiotic treatment of neutropenic patients; Smith CL et al.; Ninety-eight neutropenic patients were randomized to receive piperacillin and gentamicin in combination with either teicoplanin or flucloxacillin . Sixty-seven of these patients, most of whom had myeloma, were given this combination as prophylaxis 5 d after high dose chemotherapy, 35 receiving flucloxacillin and 32 receiving teicoplanin . Of 31 patients with leukaemia who were febrile and neutropenic following induction chemotherapy or bone marrow transplantation, 18 received flucloxacillin and 13 received teicoplanin . For those given flucloxacillin, the mean number of days to change of antibiotics was 7.8 in the prophylaxis group and 5.1 in the treatment group . In the teicoplanin arm, the mean number of days to change antibiotics was 6.8 in the prophylaxis group and 6.1 in the treatment group . Two patients in the flucloxacillin arm developed drug rashes . Four patients developed rigors after teicoplanin administration and one asthmatic became wheezy . One patient had a progressive rise in creatinine, but overall the patients having teicoplanin did not have any appreciable increase of renal toxicity compared to the flucloxacillin arm . Blood cultures were positive prior to commencement in the treatment group in nine patients, and during treatment in six patients . Organisms grown were Gram-positive in 14 patients . Teicoplanin appears to be as effective as flucloxacillin when each is used in combination with piperacillin and gentamicin in the treatment of neutropenic patients, with similar rates of toxicity.

Br J Haematol, 1990 Dec, 76 Suppl 2, 49 - 53
Ceftazidime plus teicoplanin versus ceftazidime plus amikacin as empiric therapy for fever in cancer patients with granulocytopenia; Meunier F et al.; In a prospective randomized study, 100 episodes of fever (greater than 38 degrees C) and granulocytopenia (less than 1000/microliters) in cancer patients were empirically treated with ceftazidime (2 g every 8 h) plus teicoplanin (400 mg every 8 h on day 1; 400 mg every day thereafter) or ceftazidime (2 g every 8 h) plus amikacin (500 mg every 8 h) . Bacteraemia, clinically documented infection and possible infection were documented in seven, 11 and 19 patients treated with ceftazidime plus teicoplanin and in 11, four and 17 patients treated with ceftazidime plus amikacin . Overall, the response rate was similar in the two groups of patients as was the need for treatment modifications and the rate of death . For documented Gram-positive bacteraemia, the response rate was 2/5 patients treated with ceftazidime plus teicoplanin and 2/7 with ceftazidime plus amikacin; for documented Gram-negative bacteraemia, the response rate was 1/2 and 3/4 patients respectively . No breakthrough bacteraemia was observed . Tolerance was excellent, although renal toxicity (elevation of serum creatinine) was observed in three patients treated with ceftazidime plus teicoplanin and in none allocated to ceftazidime plus amikacin.

Br J Haematol, 1990 Dec, 76 Suppl 2, 35 - 40
A prospective study comparing vancomycin and teicoplanin as second-line empiric therapy for infection in neutropenic patients; Cony-Makhoul P et al.; In recent years, the most common cause of infection in neutropenic patients has shifted from Gram-negative to Gram-positive bacteria . To compare the efficacy and toxicity of teicoplanin and vancomycin in neutropenic patients, we conducted a prospective study of 151 adult leukaemic patients hospitalized for intensive chemotherapy . After chemotherapy, the median duration of granulocytopenia (less than 500/mm3) was 25 d (range 13-49) . When the patients became febrile, they received ceftazidime (CTZ) alone (2 g every 12 h, intravenously) . If fever persisted more than 48-72 h after administration of CTZ, the patients were randomly assigned to receive CTZ combined with either vancomycin (vanco) (30 mg/kg/d) or teicoplanin (teico) (6 mg/kg every 12 h on day 1, then daily) . When fever persisted further, an aminoglycoside antibiotic and/or amphotericin B were usually added to the previous combination . Of the 151 patients, 116 patients became febrile during the period of aplasia . Fifty-nine patients had persistent (or recurrent) fever despite administration of CTZ and received either vanco (n = 35) or teico (n = 24) . Sixteen of these latter 59 patients had septicaemia (vanco n = 9; teico n = 7) due to Candida sp . (n = 2), Gram-negative (n = 2) or Gram-positive (n = 12) bacteria . The main characteristics of patients and infection were similar in both arms . The treatment was considered as a success (disappearance of fever within 48 h) in 21/35 patients of the vanco group (60%) compared to 13/24 patients of the teico group (54%; P not significant) . The percentage of failures for infection due to Gram-positive bacteria was 2/11 for vanco versus 2/7 for teico (P not significant) . Two patients in each group died from infection . The main cause of failure was retrospectively attributed to fungal pathogens . No major toxic effects were found in either group . These preliminary results do not show any difference between vanco and teico as second-line antibiotic therapy in leukaemic patients with severe and prolonged granulocytopenia.

Clin Exp Immunol, 1990 Dec, 82(3), 479 - 84
Tumour necrosis factor production in fulminant hepatic failure: relation to aetiology and superimposed microbial infection; de la Mata M et al.; Tumour necrosis factor-alpha (TNF-alpha), a cytokine derived from macrophages, is considered to be an important endogenous mediator of endotoxic shock . Patients with fulminant hepatic failure are particularly susceptible to infection and the development of multi-organ failure and similarities to endotoxic shock suggest a possible pathogenetic role for TNF in fulminant hepatic failure . In vitro TNF production was therefore investigated serially in 21 consecutive patients with fulminant hepatic failure and in 21 healthy controls . Spontaneous and lipopolysaccharide-stimulated TNF production were elevated in viral-induced fulminant hepatic failure, compared with healthy controls (P less than 0.05 and P less than 0.01, respectively) . By contrast, patients with paracetamol-induced fulminant hepatic failure had normal spontaneous and lipopolysaccharide-stimulated TNF production, while those who died had significantly reduced spontaneous TNF production compared with survivors (P less than 0.02); this difference was present throughout admission . In this group elevations in TNF production above baseline were associated with Gram-positive bacterial or fungal infection but not Gram-negative bacterial infection . There was no correlation between any of the clinical complications of fulminant microbial stimuli in fulminant hepatic failure, but do not support a direct role for TNF in the evolution of the clinical complications of fulminant hepatic failure.

Kansenshogaku Zasshi, 1990 Dec, 64(12), 1550 - 5
{An autopsied case of infective endocarditis with cardiac tamponade due to myocardial rupture}; Takaki K et al.; Since it is very rare that cardiac tamponade due to myocardial rupture caused by infective endocarditis, occurs we are reporting this case . A 62 year old man, who had underlying diseases of pneumoconiosis and hypertensive heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general fatigue on Feb . 7, 1987 . He was diagnosed as having ischemic heart disease by electrocardiogram . Two days later, he suddenly had chills and a fever, and the laboratory data showed leukocytosis and a positive C-reactive protein (CRP) . The echo cardiogram showed mitral regurgitation (MR) and aortic regurgitation (AR), but neither vegetation nor pericardial effusion was observed . On Feb . 16, he was admitted with shock, and he died the next day . The blood cultures grew gram-positive cocci, respectively . From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a cardiac tamponade . On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and hypertrophies . The rupture hole was observed in the left ventricles, which was just under the aortic valve through the pericardiac space . It seemed that he died of a cardiac tamponade due to the outflow of blood from this hole . On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.

Nature, 1990 Nov 8, 348(6297), 176 - 8
An unusually large multifunctional polypeptide in the erythromycin-producing polyketide synthase of Saccharopolyspora erythraea; Cortes J et al.; Erythromycin A, a clinically important polyketide antibiotic, is produced by the Gram-positive bacterium Saccharopolyspora erythraea . In an arrangement that seems to be generally true of antibiotic biosynthetic genes in Streptomyces and related bacteria like S . erythraea, the ery genes encoding the biosynthetic pathway to erythromycin are clustered around the gene (ermE) that confers self-resistance on S . erythraea . The aglycone core of erythromycin A is derived from one propionyl-CoA and six methylmalonyl-CoA units, which are incorporated head-to-tail into the growing polyketide chain, in a process similar to that of fatty-acid biosynthesis, to generate a macrolide intermediate, 6-deoxyerythronolide B . 6-Deoxyerythronolide B is converted into erythromycin A through the action of specific hydroxylases, glycosyltransferases and a methyltransferase . We report here the analysis of about 10 kilobases of DNA from S . erythraea, cloned by chromosome 'walking' outwards from the erythromycin-resistance determinant ermE, and previously shown to be essential for erythromycin biosynthesis . Partial sequencing of this region indicates that it encodes the synthase . Our results confirm this, and reveal a novel organization of the erythromycin-producing polyketide synthase, which provides further insight into the mechanism of chain assembly.

Srp Arh Celok Lek, 1990 Nov-Dec, 118(11-12), 455 - 7
{Results of Visiren administration in patients with respiratory infections}; Plavsic Z et al.; One of the most frequent causes of deterioration of chronic obstructive lung diseases is the infection . The existence of microorganisms resistant to antibiotics is becoming an increasingly serious therapeutical problem . Kinolones have a wider spectrum of action than the majority of other antibiotics, with strong effect on multiresistant gram-negative and gram-positive bacteria . Visirene (Ophloxacine) is a new antibiotic in this group . The efficiency of Visirene in the treatment of acute infections of the upper and lower respiratory organs, and acute deterioration or chronic obstructive lung diseases due infections, were investigated . The treatment was carried out on 30 patients in outpatient services . In all patients the appearance and duration of symptoms characteristic for the infection of the respiratory organs were examined (cough, coughing out, increase of body temperature, physical lung findings, dyspnea) . The isolation of the causative agent was made from the sputum, throat and nose smears . Medical treatment began only if findings and antibiogram results were positive . The positive effect of Visirene was manifested in rapid withdrawal of symptoms and disappearance of bacteria in the sputum 7-10 day after the beginning of its administration . The administration of the drug provoked no side effects in these thirty patients . All findings suggested a very good effect of Visirene (Ophloxacine) in the treatment of infections of the respiratory system.

Haematologica, 1990 Nov-Dec, 75(6), 541 - 5
Ciprofloxacin for infection prophylaxis in granulocytopenic patients with acute leukemia; Cortellaro M et al.; Forty consecutive neutropenic patients with acute leukemia receiving oral ciprofloxacin (500 mg twice daily) and ketoconazole (200 mg daily) for selective intestinal decontamination were compared retrospectively with 33 comparable patients treated with polymyxin E (1,500,000 U x 3/day) and nystatin (1,000,000 U x 3/day) . The incidence of febrile episodes was slightly lower in ciprofloxacin treated patients (87.5% vs 100%) . No gram-negative sepsis was observed in this group compared with seven cases in patients receiving polymyxin E (p less than 0.01) . Furthermore, eight patients in ciprofloxacin group (20%) had gram-positive sepsis, compared with five (15.5%) in the polymyxin E group . The incidence of documented fungal infections was similar in the two groups . Ciprofloxacin appears to be an effective agent for the prevention of gram-negative infections in granulocytopenic patients with acute leukemia, but may contribute to a shift in the type of infections in these patients towards those caused by gram-positive microorganisms, intrinsically fairly sensitive or with acquired drug resistance.

Farmaco, 1990 Nov, 45(11), 1245 - 50
Synthesis and anti-microbial activity of benzo-condensed heterocyclic derivatives; Bonsignore L et al.; The synthesis of 2,4-dione derivatives of 1,5-benzodithiepine, 1,5-benzodiazepine and 1,5-benzothiazepine and the anti-microbial activity in vitro of these derivatives and of analogous of 1,5-benzodioxepine, 1,5-benzoxathiepine and 1,5-benzoxazepine, previously prepared, are reported . Some of these compounds showed a good activity against some Gram positive microorganisms and blastomycetes.

Z Gesamte Hyg, 1990 Nov, 36(11), 617 - 20
{Microbial colonization of the upper respiratory tracts of day care children in relation to acute morbidity episodes}; Ritter E et al.; The upper respiratory tracts of 20 children attending a creche were studied for bacteria up to the 128th day of creche attendance . To this end nose and throat swabs as well as double blood withdrawals were to determine antibodies against various respiratory viruses . The germ spectrum thus obtained was correlated with the acute pathological processes occurring during the period of investigation . In addition to the normal flora, the nasopharynx of infection-stable children was, with one exception, only populated with gram-positive pathopotent bacteria during the first four months of creche attendance . In infection-labile children, however, gram-negative pathopotent bacteria, blastomycetes of the Candida group as well as Mycoplasma, virus and mixed infections were discovered apart from gram-positive bacteria . This broad germ spectrum should be taken into wider consideration in the chemotherapy of respiratory infections.

Plasmid, 1990 Nov, 24(3), 163 - 89
The Tn21 subgroup of bacterial transposable elements; Grinsted J et al.; The Tn3 family of transposable elements is probably the most successful group of mobile DNA elements in bacteria: there are many different but related members and they are widely distributed in gram-negative and gram-positive bacteria . The Tn21 subgroup of the Tn3 family contains closely related elements that provide most of the currently known variation in Tn3-like elements in gram-negative bacteria and that are largely responsible for the problem of multiple resistance to antibiotics in these organisms . This paper reviews the structure, the mechanism of transposition, the mode of acquisition of accessory genes, and the evolution of these elements.

Agric Biol Chem, 1990 Nov, 54(11), 2855 - 61
Features of regenerated clones with or without fusion treatment between auxotrophic mutants of Streptomyces antibioticus and their antibiotic productivity; Fujimoto Y et al.; During experiments on protoplast fusion of complementary auxotrophic mutants (194 and 11M-21) of Streptomyces antibioticus for strain improvement, the clones (typified by F-40) regenerated on minimal regeneration medium (MRM) were found to be prototrophs, and to produce an antibiotic different from those produced by the parent strain . The protoplast regeneration of each parent was examined as a negative control experiment . In the regenerated clones of 194, half of them produced actinomycins similar to those produced by the original mutant 194, but others (typified by R-20) seemed to produce antibiotics similar to those produced by F-40 . In the taxonomic characterization of morphological, cultural, and physiological properties of each strain, F-40, R-20, and the parent mutant 194 had no significant differences with a few exceptions . The problem here is whether the antibiotic of R-20 is the same as that of F-40, which was first isolated and found to be a peptide antibiotic different from actinomycins, with activity against Gram-negative and Gram-positive bacteria.

Med Clin (Barc), 1990 Oct 20, 95(13), 481 - 5
{Infectious complications in neutropenic patients with malignant hemopathies . A prospective study of 279 cases of neutropenia}; Berenguer J et al.; We prospectively evaluated the infective complications in 279 neutropenic episodes which developed during the treatment of 79 patients with malignant hemopathies over a 35 month period . In 150 episodes (53.73%) infections were detected: one infection in 121 episodes and two in 29 episodes . Overall 179 infections were detected . 75 of them (41.89%) were considered as possible, 57 (31.84%) were microbiologically documented with bacteremia/fungemia 24 (13.40%) were clinically documented, and 23 (12.84%) were microbiologically documented without bacteremia/fungemia . The portal of entry could not be identified in 121 infections (67.59%), 26 (14.76%) originated in the skin and soft tissues, 14 (7.82%) in the lung, 7 (3.91%) in the oropharynx, 5 (2.79%) in a catheter, and 6 (3.33%) were of miscellaneous origin . Of 80 microbiologically documented infections, 39 (48.75%) were due to gram-negative bacteria, 23 (28.75%) to gram-positive bacteria, 12 (15%) to fungi, and 6 (7.5%) to polymicrobial flora . The overall mortality rate was 4.3% . It was 8% for episodes complicated by infection and 0 in episodes of neutropenia without infection.

Mikrobiyol Bul, 1990 Oct, 24(4), 383 - 5
{Activity of cefoperazone and cefoperazone-sulbactam against gram-positive and gram-negative bacteria}; Baykal M et al.; The activity of cefoperazone-sulbactam combination against 79 gram-positive and 205 gram-negative microorganisms was tested and compared with that of cefoperazone alone . Cefoperazone-sulbactam combination was active against gram-positive and gram-negative microorganisms than cefoperazone.

Appl Environ Microbiol, 1990 Oct, 56(10), 3209 - 12
Production of a novel steroid sulfate metabolite {4,4,24-trimethylcholesta-8,14,24(28)-trien-2 alpha,3 beta,11 alpha,12 beta-tetrol 12-acetate, 3-sulfate} by Fusarium species and its biological activity; Burmeister HR et al.; A novel steroid sulfate, 4,4,24-trimethylcholesta-8,14-24(28)-trien-2 alpha,3 beta,11 alpha,12 beta- tetrol 12-acetate, 3-sulfate, was discovered in Fusarium spp . Forty Fusarium strains belonging to F . sporotrichioides, F . chlamydosporum, E . equiseti, F . acuminatum, F . sambucinum, F . culmorum, and F . graminearum produced the steroid on white corn grits at 25 degrees C for 20 days . This steroid sulfate is one of the more abundant and easily attainable microbial steroids . At a concentration of 160 micrograms/ml, it inhibited the growth of six fungi, two gram-positive bacteria, and an alga, as well as the germination of both wheat and tomato seeds.

Nippon Hinyokika Gakkai Zasshi, 1990 Oct, 81(10), 1458 - 65
{Clinico-bacteriological studies on the etiology of bacterial prostatitis . I . The distribution of clinical isolates and bacteria-specific immunoglobulin in EPS}; Yamada D; The distribution of clinical isolates from patients with prostatitis and pathogenicity of the isolates were studied . A new method for measuring the bacteria-specific immunoglobulins in expressed prostatic secretion (EPS) was developed and used for the detection of local immuno-reaction against pathogenic bacteria in the cases with prostatitis . There were no cases with increased antibodies specific for gram-positive cocci (GPC), indicating that the pathogenecity of GPC in bacterial prostatitis was doubtful . On the other hand, specific antibodies against gram negative rods (GNR) were elevated in all cases with acute prostatitis and changes of the antibody titers were correlated well to clinical courses . The present clinico-statistic and immuno-biological studies re-confirmed that E . coli was the main organism in uncomplicated bacterial prostatitis.

Hinyokika Kiyo, 1990 Oct, 36(10), 1253 - 7
{The therapeutic effect of norfloxacin on chronic prostatitis}; Morikawa M et al.; The clinical efficacy of norfloxacin (NFLX) was evaluated on 40 patients . They had subjective symptoms suggestive of prostate inflammations and more than five white blood cells (WBC)/hpf in their prostatic secretions (EPS) or VB3 . Of these, gram negative rods were isolated from the EPS in 3 patients and gram positive cocci were obtained in 26 patients . The overall clinical efficacy was determined at the second week . The effectiveness rate of the subjective symptoms was 82.5% . The effectiveness rate of the WBC in the EPS was 47.4% . The effectiveness rate of the bacteria in the EPS was 64.3% . The overall clinical effectiveness rate was 77.8% . A subjective side effect was observed only in one patient who had skin eruption like urticaria . Mild liver dysfunction of blood chemistry analysis was shown only in two patients but they had had long standing chronic hepatitis . We conclude that NFLX is an effective drug for the patients with chronic prostatitis.

Jpn J Antibiot, 1990 Oct, 43(10), 1806 - 12
{Clinical investigation of cefdinir in the pediatric field}; Takekuma K et al.; We performed pharmacokinetic, bacteriological and clinical studies on cefdinir granules (CFDN, FK482), and obtained the results summarized below . 1 . Serum levels of CFDN when granular form was given in a single dose of 6 mg/kg before meal peaked at 0.81 micrograms/ml 6 hours after dosing . The serum half-life of the drug was 2.45 hours . 2 . CFDN was administered to 18 patients with bacterial infections which consisted mainly of respiratory tract infections in doses of 1.3-7.4 mg/kg three times daily for 3-9 days . Clinical efficacies were "excellent" in 10 patients, "good" in 7, and "poor" in one, with an overall efficacy rate of 94.4% . 3 . As for bacteriological effects on 20 strains of causative organisms, all the 10 strains of Gram-positive organisms were eradicated, with an eradication rate of 100% . Meanwhile, the eradication rate on 10 strains of Gram-negative organisms was 87.5% . Overall, bacteriological effect was "eradicated" in 17 strains, "decreased" in one, and "unknown" in 2, with an eradication rate of 94.4% . 4 . No side effects nor abnormal laboratory test values were noted in any of the patients . We have concluded that cefdinir is useful in the treatment of infection in the pediatric field.

J Am Vet Med Assoc, 1990 Sep 15, 197(6), 731 - 5
Evaluation of systemic administration of gentamicin for treatment of coliform mastitis in cows; Jones GF et al.; Recovery of cows (n = 61) with mastitis caused by gram-negative bacteria and treated systemically with an antibiotic (gentamicin) to which the bacteria were susceptible in vitro, was compared with recovery of cows (n = 13) with similar infections treated with a systemically administered antibiotic (erythromycin) to which the bacteria were resistant in vitro or with recovery of cows (n = 12) not given an antibiotic systemically . In the first part of the study, cows were selected for treatment groups by use of a diagnostic scheme designed to predict whether the mastitis was caused by gram-negative or gram-positive bacteria . In the second part of the study, all cows were treated without systemic administration of an antibiotic . Significant difference was not observed in the outcome of the disease between cows given gentamicin and cows of the other 2 treatment groups at 24 hours or at 4 weeks after treatment . At 24 hours after initial treatment, 71.9% of cows treated with gentamicin, 92.3% of those treated with erythromycin, and 45.5% not treated systemically had improved appetite . At 4 weeks after initial treatment, of the cows treated with gentamicin, 11.5% died; in 32.8%, lactation ceased in the affected mammary gland; in 21.3%, lactation was decreased in the affected gland; and 34.4% returned to normal lactation and health . Of cows treated with erythromycin, none died; in 23%, lactation ceased in the affected mammary gland; in 23%, lactation decreased in the affected gland; and 54% returned to normal lactation and health.(ABSTRACT TRUNCATED AT 250 WORDS)

Mol Microbiol, 1990 Sep, 4(9), 1603 - 5
Conservation of a hexapeptide sequence in the anchor region of surface proteins from gram-positive cocci; Fischetti VA et al.; A highly conserved hexapeptide sequence (both at the protein- and DNA level) has been identified within the C-terminal end of all 11 known surface proteins from Gram-positive cocci . The hexapeptide, with the consensus sequence LPXTGE, is located about 9 amino acids N-terminal from the C-terminal hydrophobic domain which is found in all these surface molecules . The conservation of the hexapeptide, despite sequence variation within the regions flanking it, suggests that it is important for the attachment of these proteins within the cell.

Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi, 1990 Sep, 6(3), 177 - 9, 237
{Bacteriology and disinfection of porcine skin}; Lei WJ; The microbial flora and counting were studied in split porcine skin . The results indicated that the routine method for the preparation of porcine heterograft could not reduce the indigenous flora in the dermal appendages efficiently . The indigenous flora of porcine skin consists of not only Gram positive cocci and Gram negative rods, fungus are the another predominant ones, the later may contribute to the frequent complication of fungal infection and the early rejection of porcine heterograft . A tincture of iodine compound was prepared and used for the purpose of disinfection, a better result was obtained.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Sep, (9), 15 - 20
{Electron microscopic study of bacterial development in colonies . The morphology of bacterial colonies}; Pavlova IB et al.; The morphology of colonies of some pathogenic Gram-negative and Gram-positive bacteria has been studied by scanning and transmitted electron microscopy . The presence of covers on the surface of cells in colonies has been revealed . The examination of colony fragments in ultrathin section has revealed that cells exist in associations and the elements of cell covers are differentiated in the form of fibrillar structures in the intracellular space . This investigation has shown that covers in the colonies of the bacteria under study should be regarded as their morphological feature playing an important role in the development of the infectious process.

Aviat Space Environ Med, 1990 Sep, 61(9), 802 - 6
Anti-LPS antibodies reduce endotoxemia in whole body 60Co irradiated primates: a preliminary report; Wells MT et al.; Long periods in space may expose astronauts to the potentially harmful effects of ionizing radiation . We have used a primate model to evaluate any role of lipopolysaccharide (LPS, endotoxin) in radiation sickness . Vervet monkeys, which had been whole-body 60Co irradiated with an LD100 exposure, had periodic blood samples taken for the determination of LPS, anti-LPS IgG antibodies and bacteriological studies . On day 2 post-irradiation, primates were treated i.m . with either sterile 0.9% saline, or equine anti-LPS hyperimmune plasma (Anti-LPS), or orally with tripotassium-dicitrato-bismuthate ("Denol") . Gram positive bacteria were evident in blood samples of all animals as early as 2 d post-irradiation . Gram negative bacteria were found in the blood of saline- and Denol-treated primates by days 5 and 8, respectively, but first appeared on day 13 in the anti-LPS-treated animals . The saline controls and Denol-treated animals showed insignificant rises in plasma LPS on day 3, which increased further thereafter achieving significance on day 8 (p less than 0.01) . These elevated levels persisted until death . However, in anti-LPS-treated monkeys, LPS concentrations remained below baseline until day 9, after which they rose significantly until death, but, were significantly less than the concentrations in both other groups (p less than 0.001) . The anti-LPS-treated animals survived significantly longer than both the other groups (p less than 0.005) . Since LPS may cause nausea, vomiting, diarrhea, anorexia and headaches, Anti-LPS administration may be of value in reducing plasma LPS concentration in humans and improving their performance and survivability.

Vet Pathol, 1990 Sep, 27(5), 335 - 9
Neosporosis in cats; Dubey JP et al.; Six cats (Nos . 1-6) were inoculated intramuscularly with (1 x 10(6)) and orally (5 x 10(5)) tachyzoites of Neospora caninum . Three (Nos . 1-3) of the six cats were given 40 mg/kg methylprednisolone acetate 7 days before and on the day of inoculation with N . caninum tachyzoites, and three cats (Nos . 4-6) were not given methylprednisolone acetate . Two of the cats (cat Nos . 1 and 2) given methylprednisolone acetate died suddenly . Cat No . 1 died 8 days post-inoculation, and cat No . 2 died 16 days post-inoculation . Cat No . 3 was euthanatized 21 days post-inoculation . Cat No . 1 had lesions of gram-positive bacterial septicemia . Necrotizing encephalitis, myelitis, disseminated skeletal muscle necrosis, hepatic necrosis, interstitial pneumonia, and renal tubular necrosis were the main lesions in cat Nos . 2 and 3 . The cats that were not given methylprednisolone acetate remained clinically normal except for slight weight loss in cat No . 6 . All three of these cats were euthanatized 55 days post-inoculation . Mild myositis and encephalitis were noted on microscopic examination of tissues from these three cats . Neuromuscular lesions were not seen in six control cats (Nos . 7-12) not inoculated with N . caninum and euthanatized 21 or 22 days after administration of the first two doses of methylprednisolone acetate (40 mg/kg), given at a weekly interval.

APMIS, 1990 Sep, 98(9), 839 - 44
Intestinal microbial conversion of cholesterol to coprostanol in man . Influence of antibiotics; Midtvedt T et al.; The intestinal microbial conversion of cholesterol to coprostanol has been measured in groups of healthy subjects before, during and after they received the antibiotics ampicillin, bacitracin, clindamycin, co-trimoxazole, doxycycline, erythromycin, metronidazole, nalidixic acid, ofloxacin or vancomycin orally for 6 days . Before they received antibiotics, the subjects demonstrated two distinct patterns of cholesterol conversion . One pattern was characterised by extensive conversion of cholesterol, the other by little or no conversion . Intake of bacitracin, clindamycin, erythromycin, metronidazole and vancomycin significantly reduced the conversion to coprostanol . In the groups receiving ampicillin or doxycycline, marked reductions were found in most of the subjects . No alterations were found in the groups receiving co-trimoxazole, nalidixic acid or ofloxacin . In 6 subjects no conversion of cholesterol to coprostanol was found up to 5 weeks after the end of the antibiotic intake . We conclude that orally given antibiotics may cause alterations in the intestinal conversion of cholesterol, reflecting changes in the anaerobic, Gram-positive component of the gut flora.

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