Prog Clin Biol Res, 1988, 272, 237 - 46 Endotoxaemia in multiple organ failure due to sepsis; Ramsay G et al.; Patients with multiple organ failure secondary to intraabdominal sepsis are often blood culture negative despite exhibiting the features of septic shock . This study examined the possible central role of endotoxin in such patients . In 15 consecutive intensive care patients with the above clinical picture endotoxin was measured by a chromogenic limulus (LAL) assay; on admission and thereafter 4 hourly . Regular blood cultures and cultures of any primary septic focus were also performed and liver function was assessed by measurement of indocyanine-green clearance from plasma (ICGC) . All 15 patients had significant endotoxaemia at least intermittently . No significant difference was observed between survivors (n = 5) and non-survivors (n = 10) in either initial or peak endotoxin levels, although the pattern of endotoxaemia differed with non-survivors exhibiting consistently high or steadily increasing levels . Of 5 patients with an intra-abdominal (I/A) septic focus only one had a positive blood culture while 5 of 10 patients with extra-abdominal (E/A) infection had positive cultures . Despite this the I/A group had higher initial and peak endotoxin levels . 3 patients with Gram-positive septicaemia had significant endotoxaemia in the absence of any gram-negative infection . Changes in ICGC appeared to be of useful prognostic significance . ICGC was significantly lower in the I/A group and in both groups there was a significant negative correlation between ICGC and the level of endotoxaemia . These results suggest that endotoxin may play a central role in the syndrome of multiple organ failure and further suggest that the endotoxin is endogenous (gut-derived) secondary to failure of hepatic filtration. Ann Inst Pasteur Microbiol, 1988 Jan-Feb, 139(1), 33 - 44 Contribution of new cryomethods to a better knowledge of bacterial anatomy; Ryter A; Electron microscopy has largely contributed to the study of bacterial anatomy . However, as varied alterations can occur during cell preparation, at the level of cell structure and at the molecular level, it is difficult to know to what extent electron micrographs correspond to the true appearance of the living state . The recent development of cryomethods which avoid some of the alterations which may occur during conventional fixation and embedding procedures, has shed new light on bacterial anatomy . These have definitively proved that mesosomes do not exist, but are artefactual structures induced by the fixative . New features of the bacterial "nucleus" relating to its shape and fine structure appeared in thin sections of Gram-positive and Gram-negative bacteria prepared by cryosubstitution . New information has also been obtained on the cell wall structure of different bacterial species. Am J Kidney Dis, 1988 Jan, 11(1), 63 - 5 Evaluation of an outpatient culture device in continuous ambulatory peritoneal dialysis; Rubin J et al.; From August 1983 through August 1986, we used a dipstick culture device for outpatient dialysate cultures among patients undergoing continuous ambulatory peritoneal dialysis . The device was used in 42% of 531 peritonitis episodes . In 21% of the peritonitis episodes, patients elected to be hospitalized for treatment and, therefore, did not obtain a dialysate culture . The frequency of noncompliance was 18% . All samples were received within four days of mailing . Forty percent of isolates were gram-positive organisms, 30% were gram-negative, 3% were fungal organisms, and 27% of the cultures failed to yield a growth . Aside from a greater incidence of failure to define a bacterial growth responsible for peritonitis, the spectrum of organisms was similar to culture results obtained from the patients who elected, during this same period, to be hospitalized . We believe the dipstick device may be used effectively for outpatient dialysate cultures. Chemotherapy, 1988, 34(4), 332 - 40 Sensitivity of clinical isolates from German hospitals to amoxicillin/clavulanic acid (Augmentin) compared with other antibiotics; Focht J et al.; 17,244 pathogens isolated from clinical specimens of 24 hospitals in the Moers area (North-Rhine Westphalia, FRG) were tested in regard to their susceptibility to Augmentin (amoxicillin and clavulanic acid) . For this purpose, minimal inhibitory concentrations were determined by use of microbroth dilution technique . 80% of Gram-negative, 98% of Gram-positive and 97% of anaerobic isolates were susceptible to Augmentin (breakpoint 4 mg/l amoxicillin in the presence of 2.5 mg/l clavulanic acid) . In a second part of the study the susceptibility to Augmentin of 4.137 Gram-negative and 10.958 Gram-positive pathogens was compared to their sensitivity against benzylpenicillin, flucloxacillin, mezlocillin, erythromycin, clindamycin, fusidic acid, ampicillin, cefaclor and doxycyclin. Br J Ophthalmol, 1988 Jan, 72(1), 55 - 61 Nocardial endophthalmitis: report of two cases studied histopathologically; Ferry AP et al.; We report two cases of nocardial endophthalmitis . Case 1 is a 66-year-old man whose left eye was enucleated about one month after onset of decreased vision . Ophthalmoscopic examination disclosed multiple choroidal masses . Six weeks before the onset of ocular manifestations he had undergone a prolonged carotid endarterectomy with intraoperative complications . The source of the ocular infection was probably exogenous . Case 2 is a 49-year-old woman who had systemic sclerosis (scleroderma) with severe pulmonary insufficiency . She had received moderate doses of corticosteroids . Seventeen months after initiation of therapy she developed ocular manifestations leading to enucleation of the eye one month later . Histopathologically, the enucleated eyes in both cases showed numerous branching, Gram-positive, filamentous organisms involving mainly the plane of Bruch's membrane and the subretinal space . The nosological and microbiological aspects of nocardiosis are reviewed. Microbios, 1988, 55(223), 115 - 25 Ability of bacteria isolated from the hospital environment to proliferate in infusion fluids; Lamikanra A et al.; The ability of some bacteria isolated from environmental sources to grow in commonly administered infusion fluids was investigated . Infusion fluids may become contaminated with bacteria present in the environment in which they are being administered and the ability of such bacteria to proliferate within commonly used infusion fluids is therefore clinically significant . Bacteria present in the air and sink drains in wards at the Ife State Hospital were isolated, identified, and comprised fifteen Gram-positive and five Gram-negative organisms . Fourteen of the organisms obtained were introduced into sterile distilled water and five different infusion fluid preparations and were monitored over a 48 h period . It was found that, in general, Gram-positive organisms did not grow in the fluids used, while Gram-negative organisms were able to proliferate in the same fluids . Some Gram-positive organisms showed remarkable ability to remain viable in infusion fluids for more than 48 h. Ann Rech Vet, 1988, 19(3), 175 - 80 {Aerobic and aero-anaerobic bacterial flora of the nasal cavities of lambs}; Menoueri N et al.; On the basis of bacteriological examinations carried out on 415 intranasal swabs, aerobic and aero-anaerobic respiratory microbes were studied in lambs . A great diversity of bacteria has been found (in total 35 bacterial species and genus have been identified) . This flora is characterised by the presence of gram positive cocci with a gram negative strain included in genus Moraxella and connected with Moraxella bovis species. APMIS Suppl, 1988, 3, 101 - 3 Incidence of peritonitis, distribution of causative bacteria and outcome in continuous ambulatory peritoneal dialysis (CAPD) in Kuwait; al-Hilali N et al.; In 28 CAPD patients in Kuwait, 69 peritonitis episodes occurred in an observation period of 311 patient treatment months (1 episode per 4.5 PTM) . Microorganisms were isolated 53 times (gram-positive 34, gram-negative 17, fungi 2) . Peritonitis was the principal cause for stopping CAPD, i.e . on 9 occasions . Gram-negative and fungal peritonitis had particularly high failure rates. Arthroscopy, 1988, 4(3), 182 - 6 Arthroscopic irrigation and debridement of infected total knee arthroplasty: report of two cases; Flood JN et al.; Various methods have been described for the treatment of the acutely infected total knee arthroplasty . These include antibiotic suppression, open debridement and irrigation, exchange arthroplasty, resection arthroplasty, arthrodesis, and amputation . A method not frequently reported is arthroscopic irrigation and debridement . Two cases of acutely infected total knee arthroplasty treated with arthroscopic irrigation and debridement are presented . In both cases there was a benign postoperative course averaging five months . Both infections were secondary to hematogenous seeding from a distant focus of infection . The patients presented within approximately 12 h after the onset of knee symptoms and were taken for arthroscopic irrigation and debridement within 12 h after presentation . Gram-positive organisms sensitive to the antibiotics being used were cultured in both . Postoperative knee function and range of motion returned rapidly and disability was minimal . At average 30-month follow-up both patients were pain free, had full activity of daily living, and had no clinical or radiographic evidence of infection . Arthroscopic irrigation and debridement appears to be an effective method of treatment in select cases of infected total knee arthroplasty. Curr Med Res Opin, 1988, 11(2), 142 - 8 A comparison of sodium fusidate ointment and mupirocin ointment in superficial skin sepsis; Morley PA et al.; Sodium fusidate ointment and mupirocin ointment were compared in 354 patients with superficial skin sepsis . The ointments were applied 3-times daily, or once daily when covered by a dressing, and the response assessed after 6 to 8 days . Both preparations proved effective clinically with 86% of patients responding . There was no difference between the two preparations in cases of primary infection (85% to both ointments), including a sub-group with impetigo (sodium fusidate 88% and mupirocin 84%), or secondary infection (sodium fusidate 81% and mupirocin 89%) . Sodium fusidate ointment (98%) was significantly better (p less than 0.05) than mupirocin (82%) in patients with other superficial infections . Both ointments were equally effective in cases where Gram-positive, Gram-negative or mixed Gram-positive/Gram-negative bacteria were isolated . Adverse effects were reported in 1.0% of patients using sodium fusidate ointment and in 7.4% of patients using mupirocin ointment . The majority of complaints concerned the greasiness of mupirocin ointment. Microb Pathog, 1988 Jan, 4(1), 71 - 83 Antigenic relatedness of a strongly immunogenic 65 kDA mycobacterial protein antigen with a similarly sized ubiquitous bacterial common antigen; Thole JE et al.; In gene libraries of Mycobacterium bovis BCG, Mycobacterium tuberculosis and Mycobacterium leprae recombinants were frequently found expressing an immunodominant 65 kDa protein antigen . In this study polyclonal and monoclonal antibodies against the 65 kDa antigen were found to react with a variety of different bacteria . Furthermore it is shown that the 65 kDa mycobacterial protein belongs to the family of antigens previously designated 'common antigen' due to their presence in a large variety of bacterial species . The molecular weight of this common antigen in 17 bacterial species was determined and it varied from 59 to 65 kDa . These bacteria included Gram-negative, Gram-positive and archae-bacteria, indicating that this antigen consists of members of an evolutionary well-conserved protein family . The 65 kDa protein was located in the cytoplasmic fraction of both Escherichia coli K12 and M . bovis BCG . Its function for the bacterial cell is presently unknown . The immunological relatedness of this common antigen to the MbaA protein might indicate a role in the etiology of rheumatoid arthritis, as was recently suggested for the mycobacterial 65 kDa antigen. Infection, 1988, 16 Suppl 1, S65 - 8 Haemostasis during treatment with ciprofloxacin; Ziemen M et al.; The effects of ciprofloxacin, a new quinolone derivative with high activity on gram-negative aerobic bacteria and gram-positive cocci, on haemostasis were investigated in 11 healthy volunteers . No influence on platelet function was detectable . In some cases a slight reduction in antithrombin III activity was observed at the end of the therapy . No other changes were evident in the plasma coagulation parameters. Folia Microbiol (Praha), 1988, 33(2), 81 - 7 Molecular properties of elongation factor Tu from Streptomyces aureofaciens and Escherichia coli; Weiser J et al.; Some molecular properties of the elongation factor Tu of protein synthesis purified in an aggregated state from gram-positive Streptomyces aureofaciens were studied and compared with those of Tu from gram-negative Escherichia coli . Electrofocussing under reducing conditions showed that the molecule of EF-Tu from S . aureofaciens has an isoelectric point shifted more to the acidic side compared with EF-Tu from E . coli . A comparison of amino acid composition revealed minor differences in the content of several amino acids in the two factors and showed that EF-Tu from S . aureofaciens contains four half-cystines per molecule . Under denaturing conditions only two mercapto groups reacted with 5,5'-dithiobis(2-nitrobenzoic acid) . Limited tryptic digestion of aggregated EF-Tu from S . aureofaciens yields six fragments: the four main fragments are of a similar size as those of the E . coli factor . All fragments detected after trypsin digestion of S . aureofaciens EF-Tu were immunologically cross-reactive with antibodies against E . coli EF-Tu . However, even after 2 h of the reaction there still remains a small part of streptomycete factor uncleaved, which documents high resistance of aggregated EF-Tu towards trypsin. J Antimicrob Chemother, 1988 Jan, 21 Suppl A, 105 - 11 Teicoplanin in empirical combined antibiotic therapy of bacteraemias in bone marrow transplant patients; Menichetti F et al.; Teicoplanin in combination with amikacin and ceftazidime was used as empirical therapy in treating 46 febrile episodes in 34 consecutive patients undergoing allogenic bone marrow transplantation . All but four of these febrile episodes occurred in neutropenic patients and 50% of them proved to be bacteraemias (23/46) . Cure was achieved in 90% of Gram-positive bacteraemias (18/20) and in six of them teicoplanin was the only antibiotic with activity in vitro against the infecting strain . All (3/3) Gram-negative bacteraemias were cured . Central venous catheter removal was required in five patients (three tunnel infections, one exit-site infection and one thrombophlebitis) . Two failures occurred among Gram-positive bacteraemias and in one case the patient died of infection . Four instances of side effects were documented but only one was severe (hearing loss). Dermatologica, 1988, 176(1), 29 - 38 Teicoplanin, a new antibiotic effective against gram-positive bacterial infections of the skin and soft tissues; Bochud-Gabellon I et al.; Teicoplanin is a new glycopeptide antibiotic chemically related to vancomycin with a similar bactericidal activity against aerobic and anaerobic Gram-positive bacteria but with a longer plasma elimination half-life of 40-100 h allowing a once daily parenteral administration . In an open prospective study, we treated 20 patients with skin and soft tissue infections such as erysipelas, cellulitis, folliculitis and furunculosis with a a success rate of 84% . The peak and trough serum levels of teicoplanin were above the minimal inhibitory concentrations of the bacteria isolated and the therapeutic index measured at the plateau level was between 24 and 146 . We observed a moderate increase of the transaminases in 3 patients which returned to normal at the end of treatment . We conclude that this new antibiotic, teicoplanin, is safe and effective in the treatment of skin and soft tissue infections . It can be administered once daily and is well tolerated even in long-term therapy. J Periodontol, 1987 Dec, 58(12), 847 - 55 Bacterial penetration of the pocket tissues in juvenile/postjuvenile periodontitis after the presurgical oral hygiene phase; Liakoni H et al.; Previous ultrastructural investigations of untreated sites of both adult and juvenile periodontitis have shown bacteria within the periodontal soft tissues . In the present study biopsies of the soft tissue walls of deep pockets from seven patients with juvenile (JP) or postjuvenile periodontitis (PJP) were removed at the end of the presurgical oral hygiene phase of treatment and examined in the transmission electron microscope . Bacteria were sparse, regardless of the level of tissue breakdown, both on the surface and within the superficial layers of the epithelium, deep to the basement membrane and throughout the underlying connective tissue . Of the 140 blocks from 20 biopsies, only two revealed intratissue accumulations of microorganisms . The organisms observed were gram-positive or gram-negative and appeared to be exclusively coccoid or rod-shaped . It is suggested that the reduced tissue content of bacteria reflects the establishment of adequate oral hygiene . Evidently either the tissue content of bacteria is less than has been reported previously or the host response is able to cope with residual bacteria that have penetrated the soft tissue. Br J Ophthalmol, 1987 Dec, 71(12), 933 - 7 Spontaneous hyphaema and corneal haemorrhage as complications of microbial keratitis; Ormerod LD et al.; Hyphaema developed spontaneously in 16 of 458 patients with microbial keratitis treated at two centres on the East and West Coasts of the United States . Chronic corneal conditions were often present, and three cases had rubeosis iridis . Inflamed iris vessels were assumed to be the source of the haemorrhage . The hyphaemas tended to persist longer than is usual, particularly when coincident with a hypopyon . Recurrent hyphaemas are reported in two patients from outside this series . Spontaneous corneal haemorrhage was seen in three cases . Subepithelial bleeding settled rapidly, but a combined midstromal and pre-Descemet's haematoma cleared more slowly . Anterior segment bleeding was significantly associated with advanced age, female sex, infection with Gram-positive organisms, and hypopyon. Am J Surg, 1987 Dec, 154(6), 602 - 7 Peritoneal dialysis catheter sepsis: a medical and surgical dilemma; Smith JL et al.; Peritoneal dialysis remains a viable and valuable alternative to hemodialysis in selected patients; however, the development of intraperitoneal sepsis should raise serious questions as to whether a particular patient should remain with this particular mode of dialysis . Six conclusions can be drawn from this retrospective review . (1) Vancomycin appears to be the first single drug of choice, especially in cases of gram-positive peritonitis . (2) In our experience, the dialysis catheter should be removed in patients who do not demonstrate major resolution of their peritoneal sepsis by 3 to 4 days . (3) If removal of the dialysis catheter does not resolve the issue within 2 to 3 days, exploratory laparotomy should be seriously considered . (4) If fungal organisms are present, exploration and debridement of the peritoneal cavity should be carried out and the patient should be aggressively treated with systemic amphotericin . This should be undertaken early in the course of the peritonitis . (5) Patients with polycystic kidney disease may be better served by hemodialysis . (6) Patients who experience multiple septic episodes should be, when feasible, electively converted to hemodialysis or should undergo transplantation. Chemioterapia, 1987 Dec, 6(6), 440 - 4 Amikacin plus ceftazidime versus amikacin plus piperacillin versus amikacin plus aztreonam in infections in neoplastic patients with granulocytopenia; Casali A et al.; Sixty granulocytopenic patients (granulocytes less than 1000/mm3) affected with solid tumors, previously submitted to antiblastic therapy and with infections, were treated with three antibiotic combinations: amikacin + ceftazidime, amikacin + piperacillin or amikacin + aztreonam . In 68% of the cases the infections were due to gram-negative and in the remaining 32% to gram-positive microorganisms . The results obtained with the three treatments show a slight but significant statistical difference (p less than 0.05), due to the greater efficacy of the amikacin + ceftazidime combination on gram-positive and amikacin + aztreonam on gram-negative bacteria. J Appl Bacteriol, 1987 Dec, 63(6), 545 - 50 Use of the direct epifluorescent filter technique for the enumeration of bacterial spores; Kelly AF et al.; Heat treatment at 80 degrees C for 10 min effectively destroyed all vegetative cells (except for Gram-positive cocci) and made easier the counting of bacterial spores, which stained orange, green or rarely transparent/black with a dull green halo, in the direct epifluorescent filter technique . The numbers of both orange- or green-staining spores were lower than the plate count . A variety of physiological conditions were used to investigate the relationship of the different staining patterns with germination status . It was concluded that orange-staining spores had germinated and their number agreed with the plate count after incubation in yeast glucose broth at 30 degrees C for 4 h . This observation was unreliable, however, but it was found that a total spore count in the DEFT gave a good agreement with the plate count. J Thorac Cardiovasc Surg, 1987 Dec, 94(6), 874 - 80 Proper donor selection for heart-lung transplantation . The Stanford experience; Harjula A et al.; Clinical cardiopulmonary transplantation is currently limited by the availability of suitable heart-lung donors . Distant graft procurement, with pretreatment, of the donor by intravenous prostaglandin E1 and cooling of the graft with pulmonary artery perfusion, is now clinically established and should increase the number of available donors . Between March 1981 and September 1986, 40 heart-lung transplantations were performed . The characteristics of the donor pool were analyzed . Gram stain of the donor tracheal aspirate revealed gram-positive bacteria in 80% and gram-negative organisms in 35% . Yeast was present on stain in 25% of the patients . Donor arterial oxygen tension was less than 100 torr inspired oxygen concentration 40%) repeatedly in one patient; this recipient died of lung failure at operation . Severe deterioration of allograft lung function was seen in 11 (27.5%) recipients . The causes of deterioration were substantial postoperative bleeding in six patients, sepsis in two, and acute rejection, poor lung function, and allograft heart failure in one patient each . HLA-A locus mismatch, poor donor alveolar-capillary gas exchange, tracheal colonization with heavy polymorphonuclear cells, and heavy bacteria and fungus resulted in increased operative mortality . Donor pretreatment with prostaglandin E1 was associated with improved survival . Recipient selection, emphasizing adequate liver function and absence of previous thoracic operation, careful surgical technique with minimal bleeding, and brief perfusion time were factors associated with improved survival . Early morbidity and mortality were principally related to recipient risk factors, and the strict criteria observed for selection of heart-lung donors were valid . The importance of appropriate recipient selection is underscored. Scanning Microsc, 1987 Dec, 1(4), 1983 - 9 Scanning electron microscopy of black stain on human permanent teeth; Theilade J et al.; Black stain may develop on the coronal surfaces of human teeth, and this type of stain is common in the Hong Kong Chinese population . The present study was undertaken to ascertain if the deposit conforms in composition to the black stain found elsewhere, and to describe its ultrastructure using the scanning electron microscope . Gram-stained smears were made from black stain on the teeth of 11 adult Hong Kong Chinese and studied microscopically . From another 15 persons extracted teeth exhibiting black stain were obtained and fixed . Two ground sections were made from each tooth, one was stained with toluidine blue, the other was dried and prepared for scanning electron microscopy . The gram-stained smears demonstrated predominantly gram-positive filamentous microorganisms with an admixture of gram-positive cocci and rods . The ground sections revealed a deposit on the outer surface of the enamel, which was clearly divided into two distinctly different layers: an inner yellow opaque layer, and an outer layer of microorganisms . Scanning electron microscopy demonstrated that the deposit consisted entirely of microorganisms, and that in portions close to the enamel they were often obscured by a substance indicative of calcification . Thus the black stain found on the teeth of Hong Kong Chinese is similar in composition and structure to that reported to occur in other populations . The black stain is a special type of dental plaque characterized by its simple flora and its tendency to calcify. J Infect, 1987 Nov, 15(3), 201 - 6 Endotoxaemia, fever and clinical status in immunosuppressed patients: a preliminary study; McCartney AC et al.; A prospective study was performed in order to find out whether endotoxaemia assays are clinically relevant in neutropenic patients . In a group of 10 immunocompromised patients, serial haematological, bacteriological and clinical investigations were done in parallel with serial plasma endotoxin assays . The chromogenic modification of the Limulus amoebocyte lysate (LAL) assay for endotoxin used in this study had a sensitivity of less than 10 pg endotoxin per ml plasma . It was found that endotoxaemia was associated with Gram-negative bacteraemia but infection with Gram-negative bacteria did not always produce endotoxaemia . Furthermore, infections with Gram-positive bacteria and administration of blood products may lead to raised endotoxin values . Endotoxin assays may be of value for elucidating mechanisms of fever in immunocompromised patients but it seems unlikely that routine assays of endotoxin will help in the clinical management of these patients. J Antibiot (Tokyo), 1987 Nov, 40(11), 1530 - 40 The structure of manumycin . I . Characterization, structure elucidation and biological activity; Zeeck A et al.; Manumycin (1), produced by Streptomyces parvulus (strain Tu 64), was isolated from the mycelium by extraction with acetone and could easily be purified chromatographically . Chemical degradation of 1 (C31H38N2O7) gave 2-acetamino-3-hydroxycyclopent-2-enone (2) by acetolysis, 2,4,6-trimethyl-2,4-decadienoic acid (3) by alkaline hydrolysis, and 2-(2,4,6-trimethyl-2,4-decadienoylamino)-5,6-epoxy-1,4-benzoquinon e (5) by chromic acid oxidation . In connection with a detailed spectroscopic analysis, the structure of 1 could be elucidated and the (E)-configuration of the double bonds in the triene and diene chain was established . Manumycin exhibits biological activity against Gram-positive bacteria and fungi and furthermore, an inhibition of the developmental processes of some insects. J Bacteriol, 1987 Nov, 169(11), 4972 - 9 Bacterial metabolism of alpha-pinene: pathway from alpha-pinene oxide to acyclic metabolites in Nocardia sp . strain P18.3; Griffiths ET et al.; Over 20 gram-positive bacteria were isolated by elective culture with (+/-)-alpha-pinene as the sole carbon source . One of these strains, Nocardia sp . strain P18.3, was selected for detailed study . alpha-Pinene-grown cells oxidized, without lag, alpha-pinene, alpha-pinene oxide (epoxide), and the cis and trans isomers of 2-methyl-5-isopropylhexa-2,5-dienal . No other tested terpene was oxidized at a significant rate . alpha-Pinene was not metabolized by cell extracts in the presence or absence of NADH or NADPH . Cell extracts catalyzed a rapid decyclization of alpha-pinene oxide, in the absence of added cofactors, with the formation of cis-2-methyl-5-isopropylhexa-2,5-dienal . Further oxidation of the aldehyde to the corresponding acid occurred in the presence of NAD . Both activities were induced by growth with alpha-pinene . A rapid, nonenzymic transformation of the cis aldehyde into the trans isomer occurred in glycine buffer . The trans isomer was also a substrate for the NAD-linked aldehyde dehydrogenase . The distribution of the alpha-pinene oxide lyase in alpha-pinene-utilizing Pseudomonas spp . was also investigated and was compatible with the two alternative ring-cleavage sequences that have been proposed on the basis of accumulated metabolites. Clin Orthop, 1987 Nov, (224), 138 - 46 Postoperative discitis . Diagnosis and management; Dall BE et al.; Postoperative discitis (POD) continues to be a diagnostic challenge and its management remains variable . This article raises the following questions and presents new observations . What is the current role of the CT scan in POD? Is a uniform pathogen involved and is there a basis for the duration of intravenous antibiotics? What is the expected long-term functional result? In a retrospective analysis of 12 consecutive patients with POD followed for an average of 29 months (17-42 months), the CT scan was extremely sensitive in showing a pathogen was present . The CT scan was misread in over one-third of the cases . Gram-positive cocci were the only organisms cultured (10 of 13 cultures, 8 of 12 patients) . The erythrocyte sedimentation rate (ESR) invariably fell predictably to normal within 90 days when patients were treated with IV antibiotics for more than 40 days . Most patients were clinically improved and subjectively better at follow-up examination . No correlation existed between the patient's subjective result and preexisting medical conditions, the type of antibiotic, or the length of treatment, the ESR, or the follow-up roentgenograms. Mol Gen Genet, 1987 Nov, 210(1), 23 - 32 Chromogenic identification of promoters in Streptomyces lividans by using an ampC beta-lactamase promoter-probe vector; Forsman M et al.; A promoter-probe system, based on the ampC beta-lactamase gene of Escherichia coli, has been developed for the isolation and characterization of transcriptional signals in the gram-positive bacterium Streptomyces lividans . The promoter-probe vector, denoted pJAS14, has the SLP1.2 replicon with a copy number of four-five plasmids per cell . It contains a unique BamHI site just in front of the ampC ribosome-binding site, and upstream of this BamHI site a transcriptional terminator signal that prevents readthrough transcription from plasmid-borne promoters has been inserted . Using pJAS14, we have shot-gun cloned chromosomal DNA from S . lividans and S . lavendulae into the BamHI site, and isolated a number of promoter containing DNA fragments by the use of the chromogenic cephalosporin nitrocefin . On plates, we identified promoters of varying strengths and also with differences in nutritional and temporal expression . Using liquid cultures of S . lividans, it has been demonstrated that one promoter, denoted P1 (SEP8), as well as the ampC gene of E . coli, show activity corresponding to the vegetative growth of the cells . The P1 (SEP8) promoter was shown to be expressed also in E . coli, and it initiates RNA synthesis at exactly the same nucleotides in both S . lividans and E . coli . The promoter shows good homology to the E . coli promoter consensus sequence in both the -35 and -10 regions . Thus, this promoter is a representative of the SEP (Streptomyces E . coli-type promoter) class of promoters recently described (Jaurin and Cohen 1985) . This indicates that an S . lividans RNA polymerase recognizes the same sequence determinants and chooses the point of initiation of RNA synthesis in the same way as the corresponding E . coli enzyme. Plasmid, 1987 Nov, 18(3), 193 - 204 Nucleotide sequence of the kanamycin resistance determinant of plasmid RP4: homology to other aminoglycoside 3'-phosphotransferases; Pansegrau W et al.; The kanamycin resistance determinant of the broad-host-range plasmid RP4 encodes an aminoglycoside 3'-phosphotransferase of type I . The nucleotide sequence of the kanamycin resistance gene (Kmr) and the right end of the insertion element IS8 of plasmid RP4 has been determined . The gene (816 bp) is located between IS8 and the region (Tra 1) encoding plasmid factors mediating bacterial conjugation . Kmr and Tra 1 are transcribed toward each other . The nucleotide sequence has been compared to five related aphA genes originating from gram-negative and gram-positive organisms and from antibiotic producers . Among these that of Tn903 shares the highest degree of similarity (60%) with the RP4 gene . Significant similarities were also detected between the amino acid sequences of the six enzymes . The C-terminal domains of six different aminoglycoside 3'-phosphotransferases (APH(3'} are highly conserved . They are substantially similar to segments of a variety of enzymes using ATP as cofactor . The role of the C-terminal sequences of APH(3') as potential domains for ATP recognition and binding is discussed. Antibiot Med Biotekhnol, 1987 Nov, 32(11), 811 - 4 {Kafamycin--a new pyrrol ether antibiotic}; Murenets NV et al.; Cafamycin is a novel polyether antibiotic active against gram-positive bacteria . It was isolated from the culture fluid of Streptomyces sp., an organism producing the anthracycline antibiotic galtamycin . The structure of cafamycin was assessed by spectral analysis: UV, PMR, mass spectroscopy and CD . Physico-chemical and biological properties of the antibiotic are described . Cafamycin was shown to be an analog of indanomycin (X-14547A), a pyrrol ether antibiotic. J Clin Pathol, 1987 Oct, 40(10), 1235 - 9 Activation of the alternative complement pathway: clinical application of a new technique to measure fragment Ba; Senaldi G et al.; A new laser nephelometric technique for the measurement of the alternative complement pathway fragment Ba has been developed . Activation of the alternative complement pathway was assessed in 16 patients with Gram negative bacteraemia, six with Gram positive bacteraemia, 20 with rheumatoid arthritis, and 18 healthy subjects . Patients with Gram negative bacteraemia had significantly higher values of Ba (median 14.8%) than controls (9.3%) (p less than 0.01), while patients with Gram positive bacteraemia and rheumatoid arthritis had values similar to those of controls (10.1% and 9.5%) . The technique proved sensitive and precise, and is suitable for the routine laboratory evaluation of complement activation through the alternative pathway. Am J Kidney Dis, 1987 Oct, 10(4), 300 - 5 Once weekly intraperitoneal therapy for gram-positive peritonitis; Morse GD et al.; The pharmacokinetics and clinical outcome following a 30 mg/kg/2 L intraperitoneal (IP) dose of vancomycin, which was administered once a week for 3 weeks, was studied in ten continuous ambulatory peritoneal dialysis patients with peritonitis . Vancomycin was 91% absorbed following the first dose and rapidly achieved therapeutic serum concentrations, 19 +/- 8 mcg/mL at 1 hour and a peak of 37 +/- 8 mcg/mL at 6 hours . Vancomycin was eliminated slowly with a mean total clearance of 7 +/- 3 mL/min/70 kg and a distribution volume of 1.2 +/- 0.3 L/kg . The resultant mean serum t1/2 over the first week was 184 hours and the mean serum concentration at 168 hours was 10 +/- 4 mcg/mL . Based on the positive clinical outcome (100% cure) among patients with uncomplicated gram-positive peritonitis, the potential use of this alternative vancomycin dosing regimen is proposed. Br J Urol, 1987 Oct, 60(4), 345 - 8 Double-blind study comparing aztreonam with placebo for prophylaxis of infection following prostatic surgery; Millar MR et al.; In a prospective, randomised, double-blind study, 179 patients undergoing retropubic or transurethral prostatectomy were given pre-operatively either 1 g aztreonam or a placebo . In patients treated with aztreonam there was a significant reduction in the number with post-operative bacteriuria and in the number requiring treatment of post-operative bacteriuria . Other differences were not significant . The mean duration of post-operative hospital stay for patients receiving aztreonam was 7.1 days compared with 6.9 days for those receiving placebo . In patients treated with aztreonam there was no increase in the frequency of infections due to Gram-positive bacterial species. Antimicrob Agents Chemother, 1987 Oct, 31(10), 1600 - 4 Pharmacokinetics of teicoplanin in critically ill patients with various degrees of renal impairment; Domart Y et al.; The pharmacokinetics of teicoplanin were studied in 15 adult patients in the acute phase of severe infections caused by gram-positive cocci . All the subjects were given a daily intravenous bolus dose of 6 mg of teicoplanin kg-1 (body weight) . The pharmacokinetic study was performed over a 48-h period after injection 4 . The subjects were categorized according to their mean creatinine clearances (ml.min-1.kg-1) during the study period: group 1 (n = 3), greater than 1.6; group 2 (n = 6), 0.8 to 1.6; and group 3 (n = 6), 0.15 to 0.8 . Mean concentrations of teicoplanin in serum at 1, 24, and 48 h were 33 +/- 8, 9 +/- 3, and 6 +/- 2.5 micrograms.ml-1, respectively . The mean half-lives of the concentration-time curve from 12 to 48 h were 28 +/- 4, 44 +/- 24, and 48 +/- 14 h in groups 1, 2, and 3, respectively (group 3 versus group 1: P less than 0.05) . The mean area under the serum concentration-time curve from time zero to 24 h was 344 +/- 92 mg.h.liter-1, and the mean hybrid volume of distribution was 1.09 +/- 0.46 liter.kg-1 . These values were similar for the three groups, with a trend for larger areas under the curve in group 3 . Creatinine clearance correlated directly with the total body clearance of teicoplanin (r = 0.70) and with the renal clearance of teicoplanin (r = 0.82) . However, in critically ill patients, the wide interindividual variations in pharmacokinetic parameters are more relevant than those related to the variations in renal function when creatinine clearance is above 0.30 ml.min-1.kg-1 . We concluded that, in such conditions, monitoring of concentrations of teicoplanin in serum is mandatory. N Engl J Med, 1987 Sep 10, 317(11), 659 - 65 Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis . The Veterans Administration Systemic Sepsis Cooperative Study Group; Infectious crystalline keratopathy; Eye Hospital, RotterdamIn seven patients white branched crystalline opacities, which grew very slowly, were seen in the corneal stroma . They were associated with very little inflammatory activity, so that the clinical picture at first did not suggest an infectious etiology . Pathological examination, however, demonstrated colonies of bacteria between intact corneal lamellae . On bacterial examination gram-positive commensals were mainly found . All the patients described so far were found to be taking corticosteroids regularly, sometimes in combination with antibiotics . The immunosuppression brought about by corticosteroids is probably an important factor in the development of these crystalline opacities . The therapy for this infectious crystalline keratopathy is difficult and lengthy . It consists of local bactericidal antibiotics and the lowest possible dosage of corticosteroids, if necessary combined with a partial lamellar keratectomy and removal of the affected corneal tissue by fraising. Antibiot Med Biotekhnol, 1987 Aug, 32(8), 571 - 6 {Eremomycin--a new antibiotic from the cyclic glycopeptide group}; Gauze GF et al.; Eremomycin, a novel antibiotic belonging to the group of cyclic glycopeptides is produced by an actinomycete designated INA-238 . Biosynthesis, isolation, physico-chemical and biological properties of the antibiotic are described . Eremomycin is shown to be close to vancomycin . However, by its chromatographic and electrophoretic mobility, presence of chlorine in the antibiotic molecule and optic characteristics eremomycin differs from vancomycin . Eremomycin is less toxic than vancomycin whereas its chemotherapeutic activity in treatment of infections caused by gram-positive organisms is higher. Br J Ophthalmol, 1987 Aug, 71(8), 598 - 601 Corneal and intraocular penetration of topical and subconjunctival fusidic acid; Taylor PB et al.; Corneal tissue absorption and intraocular penetration of fusidic acid were assessed in the rabbit after topical or subconjunctival application . Corneal tissue levels of fusidic acid one hour after the last topical application of the drug were well above the minimum inhibitory concentrations (MICs) for most Gram-positive and many Gram-negative organisms . Adequate levels were achieved in the aqueous at one hour following the last topical application, but no significant levels were detected in the vitreous . The corneal tissue and aqueous levels declined at 12 and 24 hours following the last drug application, however, corneal tissue levels at 24 hours were considered to be above the MICs for most Gram-positive organisms . A single subconjunctival injection of 100 mg of fusidic acid produced levels above the MICs of most organisms in the cornea, aqueous, and vitreous which persisted over 24 hours, but subconjunctival injection of fusidic acid at this concentration resulted in conjunctival necrosis and corneal decompensation . Fusidic acid penetrates well into avascular tissue and fully penetrates corneas with both intact and debrided epithelium, as evidenced by the intracameral drug levels . Good corneal penetration and absence of known topical toxicity make fusidic acid suitable for the treatment of microbial keratitis caused by susceptible organisms. Scand J Dent Res, 1987 Aug, 95(4), 297 - 307 Transmission electron microscopy of early microbial colonization of human enamel and root surfaces in vivo; Nyvad B et al.; This study describes the early microbial colonization of teeth by the use of light- and transmission electron microscopy . Six dental students carried a total of 60 test pieces of unerupted enamel and root surface in intraoral acrylic appliances for 4, 8, 12, 24 and 48 h, during which periods oral hygiene was abandoned . Pronounced variations were recorded in structure and thickness of the pellicle across the individual surfaces of both dental tissues . Bacterial single-cell colonization increased the electron density of the adjoining pellicle . Micro-colonies of bacteria were observed in relation to enamel surface irregularities such as perikymata, while the distribution on root surfaces appeared incidental . Root surfaces were generally colonized by thicker deposits than homologous enamel surfaces although the structural composition of the microbiota was similar . Gram-positive bacteria with thick cell walls appeared in coccoid or rod-shaped configurations depending on the age of the bacterial deposit . These bacteria were further characterized by selective invasion between collagen fibers . After 48 h the complexity of the microbiota was increased by the establishment of new bacterial species in the superficial layer . It is concluded that the pattern and composition of the early microbiota on teeth is more complex and variable than hitherto assumed. J Gen Microbiol, 1987 Aug, 133 ( Pt 8), 2147 - 54 Enzymological features of aromatic amino acid biosynthesis reflect the phylogeny of mycoplasmas; Berry A et al.; Acholeplasma laidlawii possesses a biochemical pathway for tyrosine and phenylalanine biosynthesis, while Mycoplasma iowae and Mycoplasma gallinarum do not . The detection of 7-phospho-2-dehydro-3-deoxy-D-arabino-heptonate (DAHP) synthase (EC 4.1.2.15), dehydro-shikimate reductase (EC 1.1.1.25) and 3-enol-pyruvoylshikimate-5-phosphate synthase (EC 2.5.1.19) activities in cell-free extracts established the presence in A . laidlawii of a functional shikimate pathway . L-Phenylalanine synthesis occurs solely through the phenylpyruvate route via prephenate dehydratase (EC 4.2.1.51), no arogenate dehydratase activity being found . Although arogenate dehydrogenase was detected, L-tyrosine synthesis appears to occur mainly through the 4-hydroxyphenylpyruvate route, via prephenate dehydrogenase (EC 1.3.1.12), which utilized NAD+ as a preferred coenzyme substrate . L-Tyrosine was found to be the key regulatory molecule governing aromatic biosynthesis . DAHP synthase was feedback inhibited by L-tyrosine, but not by L-phenylalanine or L-tryptophan; L-tyrosine was a potent feedback inhibitor of prephenate dehydrogenase and an allosteric activator of prephenate dehydratase . Chorismate mutase (EC 5.4.99.5) was sensitive to product inhibition by prephenate . Prephenate dehydratase was feedback inhibited by L-phenylalanine . It was also activated by hydrophobic amino acids (L-valine, L-isoleucine and L-methionine), similar to results previously found in a number of other genera that share the Gram-positive line of phylogenetic descent . Aromatic-pathway-encoded cistrons present in saprophytic large-genome mycoplasmas may have been eliminated in the parasitic small-genome mycoplasmas. J Int Med Res, 1987 Jul-Aug, 15(4), 245 - 50 Effects of intravenous erythromycin lactobionate in respiratory infections; Di Sciacca A et al.; The antibiotic erythromycin lactobionate given intravenously acts almost exclusively on Gram-positive bacteria . Even at high plasma and tissue concentrations there is an almost total absence of side-effects . It could be considered, therefore, as first choice in the treatment of patients with infectious respiratory diseases . Most of the 40 patients admitted to the present study were elderly and all had either acute or chronic and becoming acute respiratory disease . Their clinical symptoms and levels of phlogosis improved on treatment with erythromycin lactobionate without any interruption of therapy due to side-effects and toxicity . The absence of unfavourable pharmacological interactions further enhances the usefulness of the drug . In view of the excellent response to monotherapy with erythromycin lactobionate and the few groups of resistant bacteria found in those cases when it was possible to check, it was not considered necessary to investigate any synergistic association with other antibiotics . It can be concluded, therefore, that therapy with erythromycin lactobionate in patients with infective respiratory disease is favourable and patients show excellent tolerability. J Antibiot (Tokyo), 1987 Jul, 40(7), 991 - 1005 Synthesis and structure-activity relationships of a new oral cephalosporin, BMY-28100 and related compounds; Naito T et al.; The synthesis and structure-activity relationships of 7-{D-alpha-amino-alpha-(4-hydroxyphenyl)-acetamido}-3-{(Z)-1-propenyl}- 3-cephem-4-carboxylic acid (BMY-28100) and its analogs in the 3- and 7-side chains are described . The 3-(substituted-propenyl) groups were introduced by the Wittig reaction of the 3-phosphoniomethyl cephems which were derived from the 3-chloromethyl derivatives . The reaction gave predominantly the cis isomer regarding the 3-side chain . The cis and trans isomers showed characteristic UV and 1H NMR spectra . Most of cephems of this series were well-absorbed orally and more active both in vitro and in vivo than cephalexin and cefaclor against Gram-positive organisms . Their Gram-negative activity varied depending on the 3- and 7-substituents . Compounds with a cis-propenyl group showed the best Gram-negative activity among the 3-alkenyl analogs prepared, whereas the D-4-hydroxyphenylglycyl and D-4-hydroxy-3-methoxyphenylglycyl substitutions in the 7-side chain were found suitable to improve the Gram-negative activity of 3-cis-propenyl series of cephalosporins to the level favorably compared with that of cefaclor . The 3,4-dihydroxyphenyl analog was found to be metabolized in vivo to the 4-hydroxy-3-methoxyphenyl derivative and, therefore, showed nearly the same in vivo activity as that of the latter . BMY-28100 was selected for further evaluation and the results will be reported in the subsequent paper. Antimicrob Agents Chemother, 1987 Jul, 31(7), 1126 - 9 Prospective randomized clinical trial of teicoplanin for empiric combined antibiotic therapy in febrile, granulocytopenic acute leukemia patients; Del Favero A et al.; The increasing prevalence of bacteremia caused by gram-positive bacteria in granulocytopenic acute leukemia patients prompted us to evaluate, in a prospective randomized trial, the role of teicoplanin, a new glycopeptide antibiotic, when it was added to amikacin plus ceftazidime, as an empiric therapy of fever in these patients . Of 47 evaluable episodes, 22 were treated with the teicoplanin regimen and 25 were treated with the combination of amikacin and ceftazidime . The overall response to therapy of patients treated with teicoplanin was slightly better (82% improvement) than that obtained with amikacin plus ceftazidime (52%) . The response rate of patients with gram-positive bacteremias was 80% (4 of 5) to the regimen that included teicoplanin; 25% (1 of 4) of the patients treated with amikacin plus ceftazidime responded to treatment; and for patients with gram-negative bacteremias, the response rates were, respectively, 100% (4 of 4) and 70% (7 of 10) . The better results obtained with amikacin-ceftazidime-teicoplanin treatment were most evident in patients with profound (less than 100/mm3) and persistent neutropenia (83 versus 30% improvement) . Furthermore, a good response rate of patients with gram-positive bacteremias (seven of eight; 87% improvement) was achieved in a small group of bone marrow transplant patients who were all treated with amikacin-ceftazidime-teicoplanin . No severe side effects were documented in any patient . Teicoplanin, as a drug administered as a single daily dose, seems to be a safe and useful anti-gram-positive agent when used in combination with amikacin-ceftazidime as an empiric therapy of febrile episodes in granulocytopenic acute leukemia patients. Life Sci, 1987 Jun 29, 40(26), 2543 - 50 Radiation induced gram negative bacteremia and endotoxemia in rabbits: modification by anti-lipopolysaccharide hyperimmune equine plasma; Wells MT et al.; Lethal whole body irradiation damages the gut mucosa and leads to leakage of endotoxin or lipopolysaccharides (LPS) into the systemic circulation . Sixteen rabbits, irradiated with 900 rads 60Co, were randomly divided on day 4 into 2 groups, one of which received an intraperitoneal injection of normal saline (control) and the other (experimental) an equal volume of anti-LPS hyperimmune plasma . The time course of endotoxemia and bacteremia were determined for the duration of the experiment . While rabbits in both groups died within 13 days after irradiation, rabbits given saline died on average 2 days earlier, than rabbits given anti-LPS plasma . Plasma LPS concentrations rose to a small peak on day 2 prior to treatment . Thereafter plasma LPS in rabbits given saline increased forty fold by day 9 . In contrast, in rabbits given anti-LPS plasma, LPS concentrations in the plasma remained within pretreatment limits (p 0.01) . By day 12 after irradiation, plasma anti-LPS IgG had declined to 5.8% of pretreatment levels in rabbits given saline as compared to 46% in rabbits given anti-LPS plasma (p 0.005) . Whilst both groups developed gram-positive bacteremia, rabbits given saline in addition also developed gram-negative bacteremia . No rabbits treated with Anti-LPS showed gram-negative bacteremia . Treatment with Anti-LPS plasma thus significantly protects radiated rabbits from the incidence of gram-negative bacteremia, development of high plasma LPS levels and hence endotoxemia, and prolongs survival to a certain extent. Am J Med, 1987 Jun 26, 82(6B), 40 - 6 Norfloxacin for prevention of bacterial infections in granulocytopenic patients; Winston DJ et al.; The efficacy and safety of norfloxacin were compared with those of placebo, vancomycin-polymyxin, and trimethoprim-sulfamethoxazole (TMP/SMX) for prophylaxis of bacterial infections in granulocytopenic patients . The study results showed that norfloxacin treatment, which was well tolerated and not associated with any serious systemic adverse effects, prevented acquisition of gram-negative bacillary organisms . Fewer norfloxacin-treated patients (38 of 108 patients, or 35 percent) experienced microbiologically documented infections compared with patients receiving placebo (27 of 40 patients, or 68 percent), vancomycin-polymyxin (16 of 30 patients, or 53 percent), or TMP/SMX (14 of 28 patients, or 50 percent) . Gram-negative bacteremia developed in five of 108 norfloxacin-treated patients (5 percent), compared with 17 of 40 placebo-treated patients (43 percent), five of 30 treated with vancomycin-polymyxin (17 percent), and one of 28 patients treated with TMP/SMX (4 percent) . The incidence of gram-positive bacteremia was similar in all study groups and was not affected by norfloxacin or any other oral prophylactic antibiotics . These results suggest that norfloxacin is both safe and effective for the prevention of serious gram-negative bacillary infections in granulocytopenic patients . More effective prophylaxis of gram-positive bacterial infections, however, is needed. J Antibiot (Tokyo), 1987 Jun, 40(6), 750 - 60 Arginomycin: production, isolation, characterization and structure; Argoudelis AD et al.; Arginomycin is a new nucleoside antibiotic produced by Streptomyces arginesis . Arginomycin, C18H28N8O5, which inhibits the growth of Gram-positive bacteria and fungi in vitro, is structurally related to blasticidin S and found to be relatively non-toxic. J Clin Microbiol, 1987 Jun, 25(6), 996 - 1001 Rapid identification of obligately anaerobic gram-positive cocci using high-performance liquid chromatography; Harpold DJ et al.; High-performance liquid chromatography was evaluated as a rapid means of identifying obligately anaerobic gram-positive cocci of medical interest . Isolates were inoculated into a defined chemical medium consisting primarily of amino acids and were incubated aerobically for 1 h at 35 degrees C . After removal of organisms, the supernatant fluids were derivatized for 1 min at room temperature by the addition of o-phthalaldehyde . The total time required to run a chromatogram was approximately 50 min . Standardized peak heights for each medium component and any new peaks formed were calculated for each isolate and compared with those for uninoculated control medium . Multiple isolates of various species of anaerobic gram-positive cocci gave consistent patterns of medium utilization that could be used for identification purposes . This method can easily be adapted for laboratory use and has the potential for automated microbial identification. Arch Ophthalmol, 1987 Jun, 105(6), 831 - 7 Intravitreal vancomycin . Retinal toxicity, clearance, and interaction with gentamicin; Pflugfelder SC et al.; Some of the gram-positive isolates from exogenous bacterial endophthalmitis cases treated at our institution have been found to be resistant to either cefazolin sodium, gentamicin sulfate, or both . However, all of these isolates have been sensitive to vancomycin . These findings prompted us to reevaluate the retinal toxicity and clearance of intravitreal vancomycin in pigmented rabbits . Doses up to 2 mg were found to be nontoxic in phakic and aphakic-vitrectomized eyes . Clearance was determined in phakic and aphakic-vitrectomized rabbit eyes with or without intact lens capsules . The antibiotic was cleared most slowly in phakic eyes . Aphakic-vitrectomized eyes without an intact lens capsule cleared antibiotic most rapidly, while aphakic-vitrectomized eyes with intact capsules exhibited an intermediate clearance rate . In addition, the interaction between vancomycin and gentamicin on gram-positive endophthalmitis isolates was found to be additive or synergistic depending on the bacterial species . Based on these data, we recommend the combination of vancomycin and an aminoglycoside as the initial antibiotic therapy for exogenous bacterial endophthalmitis. Infect Control, 1987 Jun, 8(6), 260 - 3 Nocardia; Chazen G; N asteroides is an aerobic, gram-positive, partially acid-fast, branching rod . Cell-mediated immunity via both macrophage activation and direct cytotoxicity represents the main host defense . While clinical infection most commonly occurs in immunocompromised hosts, Nocardia can infect and exist as a saprophyte in normal hosts . Diligence on the part of the treating physician is necessary to confirm the diagnosis . A combination of trimethoprim and sulfamethoxazole is the mainstay of treatment . With an aggressive approach to diagnosis and therapy, the prognosis in patients with nocardiosis appears to be dependent on their underlying disease process. Eur J Biochem, 1987 Jun 1, 165(2), 267 - 73 Metabolism of glyphosate in an Arthrobacter sp . GLP-1; Pipke R et al.; The metabolism of glyphosate {N-(phosphonomethyl)glycine} in a bacterium tentatively identified as an Arthrobacter sp., capable of growth on this herbicide as its sole phosphorus source, has been investigated using solid-state NMR techniques as well as radiotracer analysis . The pathway involves the conversion of glyphosate to glycine, a C1 unit and phosphate . The phosphonomethyl carbon is specifically incorporated into the amino acids serine, cysteine, methionine, and histidine, as well as into purine bases and thymine, indicating the involvement of tetrahydrofolate in single-carbon transfer reactions . Glycine derived from glyphosate is utilized in purine and protein biosynthesis . This pathway for glyphosate degradation in a gram-positive bacterium is similar to that previously reported for Pseudomonas sp . PG2982 {Jacob et al . (1985) J . Biol . Chem . 260, 5899-5905} and is distinct from that reported for soil metabolism of glyphosate where aminomethylphosphonic acid has been shown to be a major metabolite . Preliminary evidence is presented which indicates that the conversion of glyphosate to glycine and the C1 unit involves the intermediate formation of sarcosine . Thus, the primary event in glyphosate degradation by Arthrobacter sp . GLP-1 is the cleavage of its C-P bound . This report constitutes the first demonstration of the metabolism of glyphosate in a gram-positive bacterium. Farmaco {Sci}, 1987 May, 42(5), 341 - 6 alpha-(1H-imidazol-1-ylmethylene)ketones with antimycotic activity; Mosti L et al.; A series of title compounds were synthesized starting from heterocyclic alpha-hydroxymethyleneketones and 1,1'-carbonyldiimidazole and tested against gram-positive and gram-negative bacteria, as well as fungi . 7,8-Dihydro-6-(1H-imidazol-1-ylmethylene)-2-phenylquinazolin -5(6H)-one showed a remarkable activity against Candida krusei. Rev Infect Dis, 1987 May-Jun, 9(3), 581 - 9 Primary actinomycosis of an extremity: a case report and review; Reiner SL et al.; Primary infection of an extremity is an uncommon feature of actinomycosis and can readily be confused with actinomycetoma caused by aerobic actinomycetes such as Nocardia and Streptomyces . A case of primary actinomycosis of the leg is reported, and 35 cases published in the English-language literature are reviewed . There were 14 cases of upper extremity infections and 22 cases of lower extremity infections . Antecedent trauma had occurred in 21 cases . Lesions began in the skin, subcutaneous tissue, muscle, bone, and joint space . Spread to contiguous structures was characteristic, and most lesions eventually involved all of the aforementioned structures . The lesions were typical of actinomycosis with sinus formation and granules in the pus . Cultures were positive in 17 cases . Surgical therapy was necessary in most instances; penicillin remains the drug of choice . Pending results of culturing, a lesion with granules of branching gram-positive bacteria would best be treated empirically with penicillin and a sulfonamide . Prognosis is excellent. J Neurosurg, 1987 May, 66(5), 701 - 5 Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections . A randomized clinical trial; Young RF et al.; The authors report the results of a randomized, prospective study to assess the effectiveness of perioperative antibiotic prophylaxis in preventing postoperative infections following clean neurosurgical operations . The study group comprised 846 patients treated between October, 1979, and June, 1984 . Antibiotics, including cefazolin and gentamicin, were administered only in the immediate preoperative and intraoperative periods . Sixteen patients, none of whom developed infections, were excluded from final statistical analysis because they had inadvertently been entered into the study while failing to meet entry criteria . Fifteen wound infections (3.64%) developed in the group of 412 patients who did not receive antibiotics, whereas only four infections (0.96%) were identified among the 418 patients who received antibiotics . The difference is statistically significant (p = 0.008) and represents a 74% reduction in infection rate with antibiotics . An analysis of subgroups of surgical procedures revealed a dramatic decrease in craniotomy infections from 6.77% to 0% (p = 0.003) . Of the four infections that occurred among the antibiotic-treated patients, three were in cases where foreign bodies had been implanted . No complications of antibiotic usage were identified . The rates of infection in areas of the body other than the surgical wound were no different in the antibiotic-treated and nontreated groups . All wound infections in both antibiotic-treated and nontreated patients involved similar types of Gram-positive organisms, suggesting that antibiotic prophylaxis did not produce infections with resistant or unusual organisms . This study, combined with other recently published analyses, suggests that routine perioperative antibiotic prophylaxis can significantly reduce the incidence of postoperative neurosurgical infections. J Clin Microbiol, 1987 May, 25(5), 889 - 92 Role of interleukin-1 in augmenting serum neutralization of bacterial lipopolysaccharide; Riveau GR et al.; We have previously described an assay to quantify the serum neutralization of bacterial lipopolysaccharide which is based on a spectrophotometric Limulus amoebocyte lysate test (T.J . Novitsky, P.F . Roslansky, G.R . Siber, and H.S . Warren, J . Clin . Microbiol . 21:211-216, 1985) . Studies since have shown that serum samples drawn from patients with leukemia and fever, gram-negative or gram-positive bacterial infections, or shock caused by gram-negative bacteria neutralize approximately 10-fold more lipopolysaccharide than do samples from normal controls . These findings suggested that the increased neutralization might reflect an acute-phase response and raised the question of whether it might be under the control of interleukin-1 . To answer this question, we studied the neutralization of lipopolysaccharide in serum samples drawn from rabbits before and after the administration of crude interleukin-1, prepared from activated macrophage supernatants, and recombinant human interleukin-1 . Crude interleukin-1 induced a 5.7-fold increase in serum neutralization 24 h after intravenous injection, and cloned interleukin-1 induced a 3.0-fold increase (P less than or equal to 0.01 and 0.05, respectively) . In individual rabbits given identical doses of crude interleukin-1 on a weight basis, the serum-neutralizing ability correlated significantly with three activities of interleukin-1: rise in temperature (r2 = 0.558; P less than or equal to 0.01), decrease in serum iron (r2 = 0.534; P less than or equal to 0.01), and increase in serum copper (r2 = 0.323; P less than or equal to 0.05) . We conclude that the increase in neutralization of bacterial lipopolysaccharide by serum samples drawn from patients with inflammatory states is mediated, at least in part, by interleukin-1, presumably through the induction of acute-phase serum proteins. Arthritis Rheum, 1987 Apr, 30(4), 443 - 7 Infective complications of plasma exchange: a prospective study; Singer DR et al.; We examined the incidence and types of infective complications which occurred in 41 patients whose medical management included plasma exchange (PX) by intermittent cannulation; femoral, subclavian, or internal jugular catheter; or arteriovenous shunt . A high incidence of positive cultures from vascular access catheters was demonstrated . Of 23 patients for whom data were available, 13 had positive cultures, and results on 3 of these showed greater than 1 species . Gram-positive cocci were typically found . Of the 34 patients who received drug immunosuppression with PX, 1 patient developed severe shunt-site infection, and an additional 4 developed bacteremia . Seven patients were given PX alone, and none of these developed clinically significant infection; however, this difference in infection rate did not reach statistical significance . Clinically significant access-related infection remains an infrequent but potentially important hazard of therapeutic PX. Orthop Rev, 1987 Apr, 16(4), 255 - 8 Overview of osteomyelitis; Gentry LO; Osteomyelitis is becoming a more common infection . This increase has been associated with an increase in the number of orthopaedic surgical procedures and with severe bone trauma . The etiology of osteomyelitis is also changing, with more gram-negative and more polymicrobial infections due to both gram-positive and gram-negative pathogens . Underlying diseases such as diabetes mellitus, peripheral vascular and sickle cell disease are associated with a poor cure rate when treated with antibiotics . The emergence of resistant strains of bacteria during the long-term treatment necessary for osteomyelitis has been documented, and continues to be a concern, as are the other side effects. Can J Vet Res, 1987 Apr, 51(2), 181 - 4 The resemblance of clinical attributes between mastitic cows with no growth on bacterial milk cultures and those with gram-positive bacteria cultured; White ME et al.; The clinical attributes of 40 dairy cows which had mastitis but no growth of bacteria from the milk were analyzed and compared to the attributes in 102 cows with only gram-positive and 61 cows with only gram-negative bacteria cultured from the milk . Cows with no bacteria cultured from the milk did not differ significantly from cows with gram-positive bacteria cultured, but 9 of 12 attributes were significantly different between cows with no bacteria cultured and cows with gram-negative bacteria cultured . Discriminant analysis was used to classify cows as members of the gram-positive or gram-negative culture groups . The discriminant equation was then applied to the cows with no bacteria cultured, and 78% of cows with no bacteria cultured were classified as members of the gram-positive group . Most mastitis in cows with no bacteria grown from the milk was probably due to gram-positive bacteria . If antibiotic therapy is used in cows with persistent mastitis and a negative culture in the belief that the culture is a false negative, treatment with antibiotics effective only against gram-negative organisms would not be appropriate. Ophthalmic Surg, 1987 Apr, 18(4), 268 - 71 Antibiotic resistance of crystalline bacterial ingrowth in a corneal graft; Kincaid MC et al.; Four recent reports have described the clinical appearance of fine needle-like opacities in the corneal stroma of six patients . In five of these patients these developed in a corneal graft . Histologically, all the corneal buttons had bacterial ingrowth between the stromal lamellae, with a striking lack of inflammatory response . We report a patient in whom this process occurred following penetrating keratoplasty . Intensive topical antibiotic treatment failed, and she underwent a second, successful, penetrating keratoplasty . Postoperatively, this patient has maintained good vision with no recurrence for over three years . Histologic and ultrastructural study of the corneal button revealed viable and nonviable gram-positive cocci with a marked paucity of inflammatory infiltrate. Infect Immun, 1987 Apr, 55(4), 848 - 55 Cloning and functional expression of the Coxiella burnetii citrate synthase gene in Escherichia coli; Heinzen RA et al.; The citrate synthase gene from the obligate intracellular rickettsial parasite Coxiella burnetii was cloned and expressed in Escherichia coli . Transduction into E . coli with a C . burnetii gene library constructed in the cosmid vector pHK17 resulted in the functional complementation of the gltA mutation of E . coli MOB154 . A GltA+ clone carrying 16.4 kilobase pairs of C . burnetii DNA and designated pJCC959 was isolated and characterized . Southern hybridization analysis confirmed that the pJCC959 cloned insert consists of C . burnetii DNA and that homology exists with the Rickettsia prowazekii citrate synthase gene . Subcloning analysis with the multicopy expression vector pUC8 revealed that citrate synthase expression was under control of a C . burnetti promoter . In vitro transcription-translation of subclones pLPM20 and pLPM30 established a molecular weight of ca . 46,000 for the monomer form of the cloned enzyme . Transposon Tn5 mutagenesis of pLPM30 defined the coding region to approximately 1.2 kilobase pairs of C . burnetii DNA . Maxicell analysis of selected pLPM30::Tn5 insertion derivatives identified the direction of transcription and the relative translational start and stop sites and substantiated the molecular weight value calculated from the in vitro analysis . Inhibition studies showed that citrate synthase activity in crude cell extracts obtained from strain MOB154 transformed with the cloned C . burnetii gene was markedly inhibited by 4 mM ATP, while 4 mM alpha-ketoglutarate had virtually no effect . These data indicate that the C . burnetii enzyme displays regulatory behavior characteristic of the small gram-positive bacterial and eucaryotic enzyme. Arch Pathol Lab Med, 1987 Mar, 111(3), 246 - 9 Botryomycosis in acquired immunodeficiency syndrome; Toth IR et al.; The first case, to our knowledge, of an integumentary form of botryomycosis is reported in a homosexual man with acquired immunodeficiency syndrome . Anal fistula and ischiorectal and gluteal abscesses developed following severe cryptosporidial diarrhea . Grains composed of gram-positive cocci were identified in the suppurative exudate . The grains had attached to multinucleated macrophages, many of which contained clusters of cocci in their cytoplasm . It is postulated that the cocci were able to survive and probably replicate in the cytoplasm of multinucleated macrophages, and were subsequently extruded as grains . These observations suggest a defect in intracellular killing of cocci by the monocyte-macrophage system . This may relate to failure in induction of control of macrophage activity by T4-inducer subsets. Mikrobiologiia, 1987 Mar-Apr, 56(2), 294 - 302 {Proposed neotype Streptomyces ruber (Krainsky, 1914) Waksman et Henrici, 1948}; Kuznetsov VD et al.; Culture 78 was proposed as a neotype of Streptomyces ruber . It was isolated from the soils of the Baikal region and was closest, in its taxonomic properties, to the original description of the species {13} whose representative had been lost . Cultures from different microbial collections designated as S . ruber were shown to be unlike the original description . The neotype had the following taxononic properties: the cell wall of type I; spiral sporophores with extended spirals having 2-3 coils; oval spores with a smooth envelope; greyish pink aerial and dark-red substrate mycelia; a red pigment not passing into the medium; slow gelatin liquefaction and milk peptonization; weak starch hydrolysis; assimilation of glucose, xylose, rammose, fructose, and inositol; weak growth on arabinose, raffinose and mannitol, but not on sucrose; no formation of melanoid pigments; synthesis of riboflavin and prodigiosin pigments; inhibition of Gram-positive bacterial and acid-resistant mycobacterial growth; no inhibition of yeast and fungal growth . The culture was sensitive to streptomycin, neomycin, gentamycin, monomycin, tetracycline,erythromycin, oleandomycin, lincomycin, ristomycin, levomycetin, polymyxin and fusidin, but resistant in penicillin . The population was composed of six variants {3}: main, faded, asporogenic red, asporogenic yellow, asporogenic white and nocardia-like . The latter two were not capable of riboflavin and prodigiosin formation . The asporogenic yellow variant was a monosynthetic organism: it formed riboflavin, but could not synthesize prodigiosin . The neotype of S . ruber 78 is deposited withthe national Collection of Microorganisms (the reference number is VKM A-611). J Appl Bacteriol, 1987 Mar, 62(3), 223 - 6 A note on the use of the Catalasemetre in assessing the quality of milk; Phillips JD et al.; The Catalasemetre, for assessing the quality of raw and pasteurized milk, has been studied . No correlation was found between catalase activity and bacterial counts for farm bulk tank milks within the range 5.2 X 10(2)-5.4 X 10(5) cfu/ml . Similarly, no relation was observed between catalase activity and somatic cell counts of milk (range of counts from 0.08 to 3.5) . However, the catalase activity and bacterial count of pasteurized milks which had been pre-incubated at 21 degrees C for 25 h in the presence of crystal violet-penicillin-nisin to inhibit Gram-positive bacterial growth were significantly related . Thus, the use of this pre-incubation procedure coupled with the Catalasemetre to estimate bacterial growth, has potential in assessing the keeping quality of pasteurized milk samples within 25.5 h of production . Results on the thermostability of native milk catalase are also presented. Rev Infect Dis, 1987 Mar-Apr, 9 Suppl 2, S160 - 7 Potential role of trimethoprim-sulfamethoxazole in the treatment of serious hospital-acquired bacterial infections; Quintiliani R et al.; Although trimethoprim-sulfamethoxazole (TMP-SMZ) has become a standard agent for the treatment of a broad range of infections, it may often be overlooked as a choice for treatment of serious hospital-acquired infections . A review of the literature shows that a number of common and uncommon gram-negative and gram-positive organisms susceptible to TMP-SMZ are frequently resistant to cephalosporins . TMP-SMZ has, in addition to its exceptional microbiologic activity, pharmacokinetic characteristics that make it a potentially cost-effective alternative to third-generation cephalosporins in the treatment of serious hospital-acquired infections caused by susceptible organisms. J Antibiot (Tokyo), 1987 Mar, 40(3), 258 - 65 The aurachins, new quinoline antibiotics from myxobacteria: production, physico-chemical and biological properties; Kunze B et al.; The aurachins, new quinoline alkaloids, were extracted with acetone from the biomass of the myxobacterium, Stigmatella aurantiaca strain Sg a15 and purified by column chromatography . The four described aurachins A, B, C and D, were inhibitory for Gram-positive bacteria and a few yeasts and molds . They blocked NADH oxidation in beef heart submitochondrial particles. Antimicrob Agents Chemother, 1987 Mar, 31(3), 455 - 7 In vitro activity of a new cyclic lipopeptide antibiotic, LY146032, against gram-positive clinical bacteria; Huovinen P et al.; The in vitro activity of LY146032, a novel cyclic lipopeptide antibiotic, was tested against different gram-positive clinical isolates . The activity of LY146032 was clearly higher than that of vancomycin against all isolates tested . However, in some instances rifampin and imipenem showed higher activity than did LY146032. Arch Intern Med, 1987 Feb, 147(2), 337 - 40 The Limulus amebocyte lysate assay . A rapid and sensitive method for diagnosing early gram-negative peritonitis in patients undergoing continuous ambulatory peritoneal dialysis; Clayman MD et al.; The Limulus amebocyte lysate (LAL) assay was used in a blinded, prospective fashion to analyze peritoneal fluids from 35 consecutive patients undergoing continuous ambulatory peritoneal dialysis (CAPD), who presented with clinical peritonitis . The results were correlated with standard microbiologic culture results . The LAL assay was positive in all three patients with gram-negative peritonitis, was appropriately negative in 24 of 28 gram-positive infections (sensitivity, 100%; specificity, 86%) and was positive in two of five cases in which there was no microbiologic growth . One of the two patients in this last group yielded a gram-negative organism two days later . It was then demonstrated that therapeutic concentrations of a variety of antibiotics (cefazolin sodium, gentamicin sulfate, tobramycin sulfate, ticarcillin disodium, penicillin G potassium, vancomycin hydrochloride, metronidazole hydrochloride, piperacillin sodium, and trimethoprim/sulfamethoxazole) did not interfere with the LAL assay . Together, these data indicate that the LAL assay is useful for identifying patients at high risk for gram-negative peritonitis and for excluding from possible aminoglycoside exposure the majority of patients with peritonitis undergoing CAPD, most of whom will have gram-positive infections . Furthermore, lack of antibiotic interference allows the possibility of monitoring treatment efficacy. Acta Pathol Microbiol Immunol Scand {B}, 1987 Feb, 95(1), 75 - 8 Can decreased phagocytosis and killing of autologous gram-positive bacteria explain the finding of gram-positive bacteria in "non-bacterial prostatitis"? Wedren H, Holm SE, Bergman B. Immunological deficiency is seldom considered in the pathogenesis of chronic prostatitis, despite clinical symptoms of prostatic inflammation and occasionally also in other tissues . Investigations in three patients with severe bacterial prostatitis with Gram-positive bacteria in the prostatic secretion revealed a decreased phagocytotic activity of the polymorphonuclear leukocytes (PMN-cells) derived from patients' sera towards the autologous Gram-positive bacteria from their own prostatic secretions but not towards heterologous Gram-positive bacteria from other patients or controls . These observations indicate a hitherto unobserved, altered host-parasite interaction in patients with prostatitis possibly caused by Gram-positive bacteria. Int J Clin Pharmacol Ther Toxicol, 1987 Feb, 25(2), 113 - 20 Combination of amikacin and ceftazidime as empiric treatment of febrile leukopenic patients affected by solid tumors; Gasparini G et al.; A combination of amikacin and ceftazidime was used as initial empiric therapy for the treatment of 25 evaluable febrile episodes (temperature greater than or equal to 38.5 degrees C) in leukopenic adult patients (wbc less than or equal to 1,000/mm3) with solid tumors, characterized by poor prognosis because of low performance status (median Karnofsky score: 50) and progressive disease (76% of cases) . Nineteen (76%) of the 25 episodes responded to the initial empiric antibiotic combination . In the microbiologically documented infections, there was no significant difference in the response rate between bacteremia (67%) and localized infections (81%) . The response in localized infections caused by gram-negative organisms (81%) was similar to that obtained in gram-positive organisms (82%), whereas gram-positive bacteremia responded better than gram-negative (100 vs 50%) . No serious side effects were observed . Reversible nephrotoxicity occurred in 12% and hypokalemia in 20% of the patients treated . This antibiotic combination is a safe and efficacious empiric therapy for infections in leukopenic patients with solid neoplasia. Arch Intern Med, 1987 Feb, 147(2), 232 - 6 Bacteremic hypocalcemia . A comparison between the calcium levels of bacteremic and nonbacteremic patients with infection; Aderka D et al.; Hypocalcemia has been documented in critically ill patients, including those with sepsis and shock . However, its incidence and significance in bacteremic patients without shock has not been established . In the present study the presence of hypocalcemia was evaluated in a group of 67 consecutive bacteremic patients, as compared with 64 infected but nonbacteremic patients . After correction of serum calcium level for serum protein, 25 of the bacteremic patients (37.3%) had "corrected" hypocalcemia (less than 8.5 mg/dL {2.12 mmol/L}), compared with only three in the nonbacteremic group (4.5%) . The incidence and magnitude of hypocalcemia in gram-positive and gram-negative infections was similar . In hypocalcemic patients, the "corrected" calcium level was found to be inversely correlated with day of disease and attained a nadir on day 6 to 8 of bacteremia . This nadir was significantly lower in male than in female subjects . Hypocalcemic patients had a significantly higher maximal temperature than normocalcemic ones, but hypocalcemia was unrelated to serum levels of albumin, transaminase, and creatinine. Am Surg, 1987 Jan, 53(1), 29 - 33 Early diagnosis and outcome of pancreatic abscesses in pancreatitis; Hurley JE et al.; During the past 3.5 years the authors have evaluated 191 patients, both retrospectively and prospectively, to establish factors which might help to identify those patients at higher risk of developing pancreatic abscesses . Those factors included etiology of pancreatitis, number of severity indices present, and specific indices present . Once an abscess developed, severity indices, etiology, and bacteriology were examined as factors in mortality . Six specific severity indices occurred more often (P less than 0.05) in patients developing abscesses . These indices were lactate dehydrogenase evaluation, leukocytosis, metabolic acidosis, hypoxemia, hypocalcemia, and fluid sequestration . In addition, seven of 18 abscess patients had six or more indices present as opposed to five of 161 pancreatitis patients . This was significant at P less than 0.05 level . The etiology of the pancreatitis was not a significant factor . Once an abscess developed, gram-negative infections were polymicrobial (8 of 9 patients) and were associated with a 56 per cent mortality . The gram-positive abscesses (6 patients) were all monomicrobial and none of these patients died . In addition, age greater than 55 years, serum glucose greater than 200 mg%, hematocrit decrease of 10 per cent, and fluid sequestration greater than 6 L were associated with a 50 per cent or greater mortality . The authors believe that patients presenting initially with six or more severity indices, especially the six mentioned above, are at significantly increased risk for developing a pancreatic abscess and those abscess patients with gram-negative abscesses, as well as having any of the four severity indices previously mentioned, have a much worse prognosis. Nephron, 1987, 46(3), 316 - 8 Intravenous or intraperitoneal vancomycin for the treatment of continuous ambulatory peritoneal dialysis associated gram-positive peritonitis? Bailie GR, Morton R, Ganguli L, Keaney M, Waldek S. A clinical and pharmacokinetic study was carried out to determine whether an intraperitoneal (IP) loading dose of vancomycin was as effective as an intravenous (IV) load in the treatment of continuous ambulatory peritoneal dialysis (CAPD)-associated gram-positive peritonitis . Each patient continued a 14-day treatment on IP maintenance doses . All cases of peritonitis (10 in each group) were eradicated . Side effects occurred in 3 patients following IV vancomycin and in none following IP vancomycin . Serum and peritoneal vancomycin concentrations equilibrated fully and rapidly with each route . It is concluded that an IP loading dose of vancomycin, followed by IP maintenance doses, is as effective as and produces fewer side effects than an IV loading dose in the treatment of CAPD peritonitis. Nephron, 1987, 45(4), 283 - 5 Treatment of gram-positive peritonitis with two intraperitoneal doses of vancomycin in continuous ambulatory peritoneal dialysis patients; Bastani B et al.; Eight patients with end-stage renal failure on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis, received an intraperitoneal dose of vancomycin (30 mg/kg body weight) with 6 h of peritoneal dwell and then resumed their routine CAPD schedule . Vancomycin concentration in serum, peritoneal dialysate (PD) from an overnight dwell and 1, 2 and 3 h after a new exchange was measured at 48 h (in 5 patients) and 7 days (in 6 patients) . Except for an occasional 1-hour peritoneal fluid sample on the 7th day, all samples had satisfactory vancomycin levels . Five of the 8 patients who had gram-positive peritonitis and 1 with 'sterile' peritonitis received another similar intraperitoneal dose of vancomycin at the 7th day . All of these patients had good therapeutic response with a negative PD culture 3 weeks after the cessation of therapy and no relapse of infection in at least 1 month of follow-up . We conclude that 2 intraperitoneal doses of vancomycin (30 mg/kg body weight) given 1 week apart with 6 h of intraperitoneal dwell is an effective and adequate treatment for gram-positive and 'sterile' peritonitis in CAPD patients. Anaesthesist, 1987 Jan, 36(1), 9 - 18 {The effect of stress ulcer prevention on the incidence of pneumonia in artificial respiration}; Daschner F et al.; The role of stress ulcer prophylaxis in increasing the risk of pneumonia in ventilator patients was analyzed prospectively in 142 artificially ventilated patients at a medical and surgical intensive care unit (104 males, 38 females, mean time of ventilation 7.9 days, mean age 46.5 years) . The pH of gastric aspirate and bacterial counts in gastric fluid and tracheal secretions were investigated daily . Identical isolates from gastric aspirates and tracheal secretions were typed by agglutination, bacteriocin, or phage typing . An average of 2.1 bacterial species were isolated in 80.5% of all gastric aspirates . Bacterial counts increased with rising gastric aspirate pH, which was especially true for Gram-negative and less so for Gram-positive organisms; colony counts of Candida sp . decreased slightly . In 31.6% of patients identical bacterial species were first isolated from gastric aspirates and 1 to 2 days later from tracheal secretions . Of these microbes that were first isolated from gastric aspirate and later from tracheal secretions, 50.3% were Gram-negative, 37.5% Gram-positive, and only 4.2% Candida sp . One-half of all bacterial aspirations occurred between the 2nd and 7th day of ventilation; 80% occurred within 11 days of ventilation . Only 20% of all migrations of Gram-positive organisms from stomach to respiratory tract lead to pneumonia, as compared with 60% of Gram-negatives . At a gastric pH below 3.4 the incidence of ventilation pneumonia was 40.6%; above pH 5.0 the incidence was 69.2% (P less than or equal to 0.05) . As pH increased, the organism causing pneumonia was significantly more often isolated first from the gastric aspirate and 1 to 2 days later from the tracheal secretion of the same patient. Chemotherapy, 1987, 33(2), 93 - 6 Kinetics of cefatrizine penetration into gynaecological tissues after oral administration; Fraschini F et al.; Twenty-four patients, hospitalized in order to undergo radical gynaecological surgery, were orally administered cefatrizine in a single dose of 1 g at different times before surgery . The tissue levels determined in the organs considered (uterus, ovary, tubae, vagina) proved that cefatrizine possesses good absorption in the genital tract, reaching concentrations near to the MICs of most gram-negative and gram-positive sensitive bacteria lasting even 12 h after administration. Can J Vet Res, 1987 Jan, 51(1), 27 - 31 In vitro growth inhibition of mastitis pathogens by bovine teat skin normal flora; Woodward WD et al.; One factor contributing to differences in the susceptibility of cows to mastitis may be differences in the teat skin normal flora, which could inhibit or enhance the growth of pathogenic bacteria . Using in vitro cross-streaking methods, we found that 25% of the isolates of teat normal flora of non-lactating heifers inhibited the growth of selected mastitis pathogens, but enhancers were not detected . Gram-positive pathogens were inhibited to a greater extent than Gram-negative pathogens . Inhibition was not a characteristic of specific genera or species of normal flora, but rather a property of certain variants within a species . This phenomenon of inhibition of mastitis pathogens in vitro by normal flora may be useful as an in vivo biological control method to reduce the incidence of mastitis. Ann Intern Med, 1987 Jan, 106(1), 1 - 7 Oral norfloxacin for prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia . A randomized, double-blind, placebo-controlled trial; Karp JE et al.; We evaluated the effect of norfloxacin, 400 mg given orally every 12 hours, on the prevention of bacterial infections in 68 adult patients who had acute leukemia throughout prolonged courses of granulocytopenia (median, 32 days) . Gram-negative infections were documented in 13 of the 33 patients receiving placebo, but only in 4 of the 35 patients receiving norfloxacin; no effect on the frequency of gram-positive or fungal infections was noted . Norfloxacin administration resulted in the suppression of gastrointestinal tract colonization by aerobic bacteria without the development of norfloxacin resistance . Patients receiving norfloxacin developed first infectious fevers later than did those receiving placebo, had more rapid resolution of that fever after systemic antibiotic treatment, and spent less time febrile . Therefore, although no difference was seen in survival duration, we found that the prophylactic administration of oral norfloxacin led to decreases in overall morbidity and gram-negative infections, was well tolerated, and did not predispose to the development of multiply drug-resistant bacteria. Int J Clin Pharmacol Res, 1987, 7(3), 199 - 201 A comparative study of ofloxacin versus cefazolin in lower respiratory tract infections; Bariffi F et al.; An open study was conducted in 40 randomized patients to evaluate the efficacy of ofloxacin in comparison with cefazolin in the treatment of acute, chronic and recurrent lower respiratory tract infections . The therapeutic efficacy of the two drugs was evaluated on the basis of bacteriological and clinical examinations . Bacteriological assays revealed that ofloxacin eliminated bacterial flora from sputum in 20/21 cases (14 Gram-negative and 7 Gram-positive), while cefazolin eradicated the pathogens in 12/19 cases (16 Gram-negative and 3 Gram-positive) . In clinical terms, 20/21 (95.2%) infections were cured and 1/21 (4.8%) improved in the ofloxacin group as against 12/19 (63.2%) cured, 5/19 (26.3%) improved and 2/19 (10.5%) unchanged in the cefazolin group . The results of this study confirm the efficacy and excellent tolerance of ofloxacin in the treatment of lower respiratory tract infections. Arkh Patol, 1987, 49(11), 44 - 9 {Morphology of infectious endocarditis affecting bioprostheses of the cardiac valves}; Iaroshinskii IuN et al.; Four varieties of infectious endocarditis were identified after cardiac valve bioprostheses: early acute, early subacute, late acute, and late subacute forms . Any of these forms may be of bacterial, fungal, or mixed (bacterial and fungal) origin . In the early forms, the infection was of exogenous origin, with a predominance of Gram-positive organisms, whereas in the late forms it was endogenous with a preponderance of Gram-negative flora . The hallmarks of fungal thromboendocarditis were an early massive thrombosis of the bioprosthesis, multiple thromboembolism, and an absence of cellular reaction in the cuspal tissue . In the subacute bacterial endocarditis, progressive dysfunction of the bioprosthesis resulting from calcination of bacteria-containing cusps and thrombi was noted. Microbiol Immunol, 1987, 31(10), 1017 - 23 A simple method for quantitative determination of bacterial adherence to human and animal epithelial cells; Valentin-Weigand P et al.; A simple quantitative method for determining bacterial adherence to epithelial cells was devised . The method involved incubation of fluorescein-labeled bacteria with oral epithelial cells . Non-adherent bacteria were subsequently removed by Percoll density centrifugation . The degree of bacterial adherence was then determined fluorospectrophotometrically by measuring the fluorescein extracted from the adherent bacteria . The degree of adherence corresponded well with the microscopic counts of adherent bacteria . The method proved to be suitable for assaying adherence of both gram-positive and gram-negative bacteria to human as well as animal epithelial cells. Scand J Rheumatol Suppl, 1987, 64, 49 - 54 Intestinal bacteria and rheumatic disease; Midtvedt T; The striking clinical and pathological similarities between certain naturally occurring infectious diseases in animal species and those of some human rheumatic diseases, such as rheumatoid arthritis (RA), have stimulated the search for a microbial etiology of the latter syndrome . A long series of microbial species, including aerobic and anaerobic intestinal bacteria, mycoplasma and several viruses have been put into focus . Most often, however, an initially positive report has been followed by several reports denying an etiological role of the microbial species in focus . However, the concept of a microbial trigger in the etiology and symptomatology of RA is still a subject of intense debate . Recent results have indicated a reversed effect of gram-positive vs . gram-negative intestinal bacteria on adjuvant-induced arthritis in germfree rats and microbial peptidoglycans have been shown to play a major role in this experimental model . It has been shown that the intestinal flora may include bacteria containing antigenic determinant(s) cross-reacting with some markers within the HLA-system . The intestinal flora may also influence upon several digestive and absorptive functions and thereby acting upon parameters of importance in the development of rheumatic disease. Toxicol Pathol, 1987, 15(4), 388 - 400 2,2,2-Trifluoroethanol-induced enteropathy in rats: chemically or bacterially mediated effects; Kim JC et al.; The lethal effects of the fluorinated ether anesthetic, fluroxene, in rats are a consequence of its metabolism, which is catalyzed by cytochrome P-450 to the toxic metabolite 2,2,2-trifluoroethanol (TFE) . The anesthetic or TFE (0.21 g/kg) caused decreased white blood cell counts, necrosis of bone marrow and lymphocytes, and decreased small intestine dry weight and was associated with septicemia . To elucidate the mechanism of TFE toxicity in rats we undertook histopathologic, ultrastructural and bacteriologic studies . TFE produced severe edema of intestinal lamina propria and submucosae, dilatation of crypts, loss of surface epithelium, vacuolation and necrosis of intestinal epithelial cells, and infiltration of polymorphonuclear leukocytes into the edematous lamina propria . Intestinal epithelial villi lost their cellular tissue integrity . Coccobacillary organisms were numerous in the ulcerated intestine . Hemolytic E . coli were isolated from intestinal tissue at a two-log increase in concentration relative to controls . Hemograms from TFE-treated rats exhibited marked leukopenia and morphologic differences . The platelets lost their discoid shape, extended pseudopods, and centralizing granules . Hemoglobin precipitation as Heinz bodies and crystalloid structures was observed in TFE-treated rats . Together the data suggest that TFE-induced enteropathy was most probably due to E . coli precipitated from TFE-mediated alterations in the population of small intestinal microbes . The antibiotics erythromycin, active against gram-positive bacteria, and streptomycin, active against gram-negative bacteria, and the antiendotoxin, polymyxin B, were administered to rats prior to TFE in an effort to differentiate between these mechanisms by altering the intestinal bacteria populations . The results indicate that the TFE-induced small intestinal lesions are initiated by the direct focal necrotic effect of TFE or its metabolites on the small intestinal epithelium . The focal coagulation necrosis produced by TFE predisposes the animals to lethal enteritis and systemic bacteremia. Drugs, 1987, 34 Suppl 2, 205 - 15 Use of cephalosporins in the immunologically compromised patient; Newland AC et al.; Infection is a major threat to patients with neutropenia, particularly those with haematological malignancies who are undergoing chemotherapy . Early use of an empirical antibiotic regimen with the broadest possible spectrum of activity is recommended until culture data can guide the choice . A standard combination in many centres is an amino-glycoside and a semisynthetic penicillin with antipseudomonal activity or a cephalosporin . However, no regimen can adequately cover all potential pathogens and in these patients, who are exposed to many toxic insults, the choice of antibiotics may significantly increase the incidence of side effects, particularly nephrotoxicity . There has, therefore, been considerable interest in simpler, less toxic (and less expensive) regimens and the concept of monotherapy has been explored . Although recent studies using ceftazidime alone have supported this as an effective approach, there remain several issues to resolve; and on a more cautionary note preliminary results from the latest EORTC study, which recruited more than 1200 patients, suggest that in Gram-negative bacteraemia, conventional combination therapy remains the treatment of choice in neutropenia . While monotherapy is attractive in an environment of low drug resistance when exposure to third generation cephalosporins is infrequent, this is rarely the case . In addition, the widespread use of tunnelled catheters for venous access had led to an increase in Gram-positive infections, and the more intensive immunosuppression to the emergence of fungal infections . Although these tend not to be rapidly fatal, their presence must be considered in designing treatment strategies . The influence of the host and treatment on the type of infection and the relative merits of the differing concepts in therapy are explored in detail in this article. Acta Med Austriaca, 1987, 14(1), 21 - 4 {Clinical value of endotoxin determination in infection . Comparison of the Limulus amebocyte lysate test with detection of bacterial pathogens}; Watzke H et al.; To evaluate usefulness of Limulus amoebocyte lysate test and blood culture in the diagnosis of septicemia both tests were performed in 27 intensive care patients . Test results were compared with a clinical sepsis score . Ten (62%) out of 16 patients with clinical diagnosis of septicemia showed a positive endotoxin test and 11 (69%) a positive blood culture . In 14 patients (87%) either endotoxin test or blood culture revealed a positive result . Two out of 11 patients (20%) classified by the sepsis score as non-septic showed positive blood cultures as well as positive endotoxin tests . 4 patients with gram-positive bacteria in the blood cultures showed a positive endotoxin test . Due to lack of sensitivity and specificity the Limulus amoebocyte lysate test is of rather low value in the diagnosis of septicemia . Simultaneous performance of Limulus amoebocyte lysate test and blood culture is able to improve the sensitivity, which then over-rules the one obtained when only blood cultures are performed. Helv Paediatr Acta, 1987, 42(4), 297 - 303 Preliminary experience with ceftazidime monotherapy in perinatal infection; Amato M et al.; Ceftazidime, a new cephalosporin antibiotic, was used as monotherapy to treat 75 term neonates with suspected perinatal bacterial infection . Septicemia was documented in ten patients (13%) . Ceftazidime was administered as 25 mg/kg doses intravenously every 12 h . Peak serum concentrations at 0.5 h after dose ranged from 57 to 115 micrograms/ml and trough serum concentrations prior to next dose from 2 to 15 micrograms/ml . The overall clinical, bacteriological and laboratory response to ceftazidime was satisfactory and the drug was well tolerated . However, reservations with regard to study design, limited gram-positive drug activity and potential emergence of drug resistance require further well-controlled clinical evaluations of ceftazidime in neonatal intensive care units, before definite recommendations for the use of this antibiotic in perinatal infection can be formulated. Lung, 1987, 165(5), 279 - 82 Rothia dentocariosa pneumonia in an immunocompromised patient; Schiff MJ et al.; An 84-year-old woman with acute myelocytic leukemia presented with fever and a left upper lobe infiltrate on chest x-ray . She failed to respond to initial broad spectrum antibiotic therapy . Bronchoalveolar lavage fluid and a transthoracic needle aspirate subsequently both grew Rothia dentocariosa, a gram-positive branching rod . The pneumonia resolved after prolonged treatment with Clindamycin . Rothia dentocariosa must be considered a cause of opportunistic pulmonary infection. Comp Biochem Physiol A, 1987, 87(4), 911 - 4 Pyrogens fail to produce fever in the snakes Psammophis phillipsii and Lamprophis fuliginosus; Zurovsky Y et al.; 1 . Preferred body temperature of five diurnal, Psammophis philipsii and three nocturnal, Lamprophis fuliginosus, snakes was measured in a thermal gradient chamber by indwelling colonic thermocouples, before and after injection of a variety of pyrogens . 2 . The snakes achieved their preferred body temperature by moving up and down in the gradient chamber; it was about 33 degrees C for P . phillipsii and 25 degrees C for L . fuliginosus . 3 . The snakes did not develop fever in response to any of the pyrogens, whether gram-negative or gram-positive in origin, either on the day of injection or on the subsequent day . 4 . We believe that fever is rare amongst reptiles. Microbiol Immunol, 1987, 31(2), 113 - 21 A simple metachromatic and fluorescent staining method for microorganisms using carbocyanine dye; Umeda M; The cationic carbocyanine dye, 1-ethyl-2-{3-(1-ethylnaphtho{1, 2d}-thiazolin-2-ylidene)-2-methylpropenyl}-naphtho{1, 2d}thiazolium bromide, interacts with several classes of anionic polymers, exhibiting metachromasia . We were able to stain various kinds of microorganisms with this dye . Gram-negative bacteria were stained reddish purple, while Gram-positive bacteria were stained violet or bluish purple . Stains of molds were of various colors . Yeast vegetative cells were stained reddish purple, but zygotic asci were bluish . Chlamydia trachomatis inclusions, which are surrounded by cytoplasmic membranes, were also stained red . Microorganism and cell stains have different features and can be identified also by use of fluorescent microscopy . The new staining method we report here is rapid and simple enough for routine microscopical examinations of smears of clinical specimens including microorganisms. J Antibiot (Tokyo), 1986 Dec, 39(12), 1657 - 69 Metabolic products of microorganisms . 234 . Urdamycins, new angucycline antibiotics from Streptomyces fradiae . I . Isolation, characterization and biological properties; Drautz H et al.; The colored urdamycins A to F, six new angucycline antibiotics produced by Streptomyces fradiae strain Tu 2717, were detected by chemical screening . They are biologically active against Gram-positive bacteria and stem cells of murine L1210 leukemia . The urdamycins are glycosides and differ in their aglycones, which can be liberated by acidic hydrolysis besides the sugars D-olivose and L-rhodinose . The structure of the main compound, urdamycin A, follows from the spectroscopic and chemical data in connection with an X-ray analysis . The aglycone urdamycinone A is identical with aquayamycin . The structures of urdamycin B, E, F and partial structures of urdamycin C and D, will be presented in a subsequent paper . The new term "angucycline/angucyclinone" is used for an increasing group of related antibiotics. Minerva Med, 1986 Nov 30, 77(45-46), 2163 - 82 {Cefotiam, a new cephalosporin . Microbiological research, preliminary evaluation of its effect on phagocytosis and clinical multicenter research}; Di Nola F et al.; After a brief review of the data on cefotiam in the literature the report presents the results of microbiological research, a preliminary study into the drug's possible actions on phagocytosis and a polycentric clinical study of 93 cases of broncho-pleuro-pulmonary pathology and one sinusitis of the jaw . In vitro cefotiam was found to have an excellent inhibitory effect on gram positive and gram negative bacteria with MICs50 and 90 respectively 0.2 and 0.8 mcg/ml V . Staph . aureus, Str . pyogenes . E . Coli, K . pneumoniae and Pr . mirabilis . A dose-dependent increase in phagocytosis was noted . The clinical response was excellent with 90.43% (88/94) of the cases achieving clinical and radiological cure or very much improved . Cefotiam was very well tolerated with the appearance of 2/94 skin rashes (2.12%) . The liver and kidney parameters showed no change at the end of treatment . No increase in enzymuria was noted during treatment with cefotiam. Jpn J Antibiot, 1986 Nov, 39(11), 2938 - 44 {Clinical evaluation of astromicin administered by intravenous drip infusion . Report II . Bacterial infections in the field of surgery}; Sakai K et al.; A clinical evaluation of astromicin (ASTM) administered by intravenous drip infusion against infections in the surgical field was made, and the results were summarized as follows . Excellent effect was observed in 19 out of a total of 44 cases, good effect in 19, fair in 1 and poor in 5 . The efficacy rate calculated from the 38 cases of "excellent" and "good" was 86% . In stratification by disease, the efficacy rate was 91% in localized peritonitis (31/34 cases) and 63% in diffuse peritonitis (5/8 cases); the overall efficacy rate in peritonitis was 86% . The efficacy rate in 2 cases infected by Gram-positive bacteria was 50%, and that in 16 cases by Gram-negative bacteria was 94% . The disappearance rate of Gram-negative bacteria was 93%, and this drug was especially effective against E . coli . There were no subjective or objective side effects and no abnormal laboratory test values that were related to the administration of ASTM. Rev Infect Dis, 1986 Nov-Dec, 8 Suppl 5, S470 - 81 Classification of beta-lactamases; Bauernfeind A; Traditionally, the classification of beta-lactamases has followed the general principles of describing enzymes by the characterization of their activity against substrates . New types of beta-lactam structures with therapeutic relevance have emerged, necessitating more specific substrate profiles . Biophysical characterization, i.e., primarily isoelectric focusing, has greatly improved classification, particularly of nonchromosomal beta-lactamases . The classification of beta-lactamases of both gram-positive and gram-negative organisms is reviewed and updated by adding data on recently discovered enzymes . Data on amino acid sequence and molecular structure that are available for an increasing number of beta-lactamases will gradually be incorporated into the established system . In addition, the introduction of evolutionary aspects should serve to modify the existing system, which to date has been based on arbitrarily selected characteristics. J Bacteriol, 1986 Nov, 168(2), 917 - 22 Diglycosyl diacylglycerol of Mycobacterium tuberculosis; Hunter SW et al.; A diglycosyl diacylglycerol was isolated from Mycobacterium tuberculosis, and its structure was established by a combination of methylation analysis, 1H nuclear magnetic resonance, and fast atom bombardment-mass spectrometry . It is a 1,2-diacyl-{beta-D-glucopyranosyl(1"----6')-beta-D-glucopyranosyl(1'---- 3)}- sn-glycerol and exists in at least five molecular species differing in fatty acyl substituents . The major constituent fatty acids were identified as iso- and anteisopentadecanoate, iso- and n-hexadecanoate, and iso- and anteisoheptadecanoate . Although glycosyl diacylglycerols are common membrane components of gram-positive bacteria, this report represents the first substantial evidence for the presence of a glycosyl diacylglycerol within a member of the Mycobacterium genus . Although the glycolipid is not a major component of M . tuberculosis, it reacts readily in enzyme-linked immunosorbent assay against rabbit antibodies raised against whole bacteria and thus may be useful for the serodiagnosis of tuberculosis. Experientia, 1986 Oct 15, 42(10), 1167 - 70 Two sulfur-containing ansamycin antibiotics from Streptomyces albolongus; Tanida S et al.; Two sulfur-containing ansamycin antibiotics were isolated from the culture broth of Streptomyces albolongus C-46366; the major one was identical with awamycin and the minor one was a new ansamycin antibiotic, ansathiazin . Their structures were elucidated from their reactions and spectroscopic analyses . These antibiotics were active against gram-positive bacteria, acid-fast bacteria and a protozoan. Antibiot Med Biotekhnol, 1986 Oct, 31(10), 741 - 3 {Formation of a new polyene antibiotic octamycin by a culture of Actinoplanes ianthinogenes subsp . octamycini}; Lysenkova LN et al.; A culture of Actinoplanes ianthinogenes subsp . octamycini producing a polyenic antibiotic with the UV spectrum characteristic of octaens was isolated . Optimal conditions for biosynthesis of the antibiotic were developed and an active variant 4041-6 producing 2 mg of octamycin per 100 ml of the medium was selected . A procedure for recovery of the antibiotic with the use of Sefadex LH-20 was used . Certain physicochemical characteristics of octamycin were defined . The data on the UV and IR spectra suggested the presence of an alkyl substituent in the octamycin chromophore . The antibiotic showed antitumor activity, sufficient activity against gram-positive bacteria and low activity against fungi and yeasts. Acta Pathol Microbiol Immunol Scand {B}, 1986 Oct, 94(5), 293 - 300 Isolation and characterization of a mucin-degrading strain of Peptostreptococcus from rat intestinal tract; Carlstedt-Duke B et al.; A mucin-degrading microorganism was isolated from the intestinal tract by serial sectioning from the serosal side of the caecum wall from a conventional rat . The ability of degrading the intestinal water-soluble mucin was present both in vivo after monocontamination of germ-free rats and in vitro, when adding the microbe to Mucin medium . The morphology, Gram-positive cocci single or in short chains and the very weak biochemical activities allow us to place this strain in the species Peptostreptococcus micros. Clin Orthop, 1986 Oct, (211), 122 - 7 Significance of operative cultures in total hip arthroplasty; Dupont JA; The significance of operative cultures to the development of deep infections in total hip arthroplasties performed for failures of previous surgeries was studied . Four hundred fifty conversion total hips were followed for three or more years . Twenty-nine percent had had more than one prior surgery . One hundred twenty-one organisms in 81 hips (18%) were found . Gram-positive cultures were increased in rheumatoid arthritis . Twenty (4.4%) of the hips became infected . Nine (11%) of the hips with positive cultures and 11 (3%) of the hips with no growth at conversion later developed infections . Failed total hip arthroplasties with a positive culture had a 40% rate of reinfection . Rheumatoid hips had a two-times higher infection rate, and 80% were caused by gram-negative organisms . Hips with a gram-negative growth at the time of conversion had a higher infection rate than hips infected with gram-positive organisms. J Antimicrob Chemother, 1986 Oct, 18 Suppl C, 13 - 23 R plasmid transfer; Thompson R; This paper is a brief survey of the systems of genetic exchange in bacteria relevant to the spread of antibiotic resistance genes . Emphasis is given to those systems most likely to be important in nature, particularly conjugation . Several recently described examples of conjugation in Gram-positive bacteria are discussed and contrasted with the better studied examples in Gram-negative bacteria. J Antimicrob Chemother, 1986 Oct, 18(4), 521 - 9 Comparative multicentre evaluation of the safety and efficacy of ceftazidime versus cefamandole for pneumonia; Yangco BG et al.; Ceftazidime and cefamandole were compared in a randomized multicentre trial in hospitalized patients with pneumonia . Of 290 patients enrolled, 92 patients in the ceftazidime group and 71 patients in the cefamandole group were evaluable . Geometric mean MICs of organisms isolated and tested to ceftazidime were within achievable therapeutic serum concentrations of ceftazidime . Satisfactory clinical responses were observed in 91% (84/92) of ceftazidime-treated patients and 83% (59/71) of cefamandole-treated patients (P greater than 0.05) . Superinfection occurred in one (1%) ceftazidime-treated patient and in five (7%) cefamandole-treated patients . Side effects were infrequent with either treatment . Ceftazidime is as safe and effective as cefamandole for the treatment of pneumonia due to a variety of Gram-positive and Gram-negative pathogens. Blut, 1986 Oct, 53(4), 333 - 9 Ceftazidime does not enhance cyclosporin-A nephrotoxicity in febrile bone marrow transplantation patients; Verhagen C et al.; Ceftazidime was used as monotherapy for 30 febrile episodes in 28 patients, who underwent allogeneic bone marrow transplantation and who were treated concomitantly with the immunosuppressive agent cyclosporin-A . Ceftazidime did not enhance the well established nephrotoxicity of cyclosporin-A as measured by serum creatinine levels or creatinine clearance . Although an increasing number of Gram-positive infections in these patients warrants vigilance, ceftazidime as initial empirical monotherapy proved to be successful in 95% of all febrile post-transplantation patients . All Gram-negative and 69% of the Gram-positive infections were cured with ceftazidime alone . The overall clinical cure rate was 72%, with microbiological clearance in 63% . This compares favourably with aminoglycoside containing schedules and avoids the aminoglycoside associated nephrotoxicity. J Ethnopharmacol, 1986 Sep, 17(3), 205 - 11 Investigation of Grewia bicolor Juss; Jaspers MW et al.; Grewia bicolor is a small tree, parts of which are used in Sudanese traditional medicine for treating pustulent skin lesions, internally on indication of a delayed afterbirth and sometimes as a tranquilizer . A phytochemical investigation of Grewia bicolor gave the following results: the petroleum ether extract afforded beta-sitosterol and beta-sitosterol- and triterpene esters, and the triterpenes lupeol and betulin . The methanol ext