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 b