[Studies on the standardization of acute experimental ascending urinary tract infections due to Bact. proteus].
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BACKGROUND: To assess the value of intra-aortic ultrasound (US) for diagnosing intraprosthetic vegetations in atypical aortic graft infection. METHODS: A 66-year-old man presented with fever 12 months after emergency insertion of a straight infrarenal aortic graft because of rupture of an inflammatory abdominal aneurysm. Blood cultures, leukocyte scan, transabdominal US study, and digital angiography were negative. Spiral CT was equivocal. The patient was imaged with a mechanically rotating US transducer at 12.5-MHz from inside the graft. RESULTS: Intravascular catheter ultrasound showed mobile lesions at the graft wall in the absence of periprosthetic fluid. Immediately after the procedure the patient developed several small cutaneous septic infarctions on both feet. At operation the presence of graft infection was confirmed. CONCLUSIONS: This case report suggests that intra-aortic US may constitute a helpful adjunctive modality in suspected atypical infection of prosthetic aortic grafts.
Sera from seven girls with acute symptomatic pyelonephritis and nine children with acute symptomatic cystitis caused by Proteus mirabilis were analysed for antibodies against the bacterial O and H1 antigens and the Tamm-Horsfall protein. An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli. In contrast no difference in adhesive ability was noted comparing Proteus strains causing acute pyelonephritis or cystitis.
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Bacteria were isolated and cultured from the ears of outpatients with chronic suppurative otitis media (OMC) who attended the otologic clinics of Kyushu University Hospital from 1976 to 1991. Bacterial isolates were analyzed retrospectively to determine their incidences and antibiotic sensitivities. Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly isolated organisms. The incidence of S. aureus infections gradually rose over 16 years, while the incidence of Proteus infections gradually declined. The frequency of isolation of glucose non-fermenting gram-negative rod (NF-GNR) species, fungi and anaerobic bacteria gradually increased. The species of bacteria isolated from OMC cases with acute and chronic infections, cholesteatoma and postoperative infections were compared. Over the 16 years, the isolation of S. aureus increased in frequency. The differences in each type of OMC ceased to exist. S. aureus were quite sensitive to most of the antibiotics tested, whereas Ps. aeruginosa and NF-GNR showed poor sensitivity.
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The authors report a series of 130 children suffering from urinary lithiasis (essentially between the age of 4 to 6 years) and particularly in boys (2.5 to 1). There were 108 cases of reno-ureteric lithiasis as against 23 vesico-urethral. In 69 cases, pyelocalyceal lithiasis predominated. Thirty per cent of the children had bilateral lithiasis, and 19% of all cases of lithiasis were staghorn calculi. Presenting symptoms : haematuria, diffuse abdominal pain, anuria (6 cases), complete urinary retention (5 cases). Study of these cases failed to indicate whether obstruction of the upper urinary tract (14%) or infection (27%) was the cause or the effect of the lithiasis. Particularly notable were 8 cases of cystinuria (6%), 1 of glycinuria, 1 of hyperoxaluria and 7 of hypercalciuria. At least in Spain, lithiasis in children would appear to be essentially idiopathic. However, 40% of these cases of lithiasis were secondary to obstruction of the excretory tract and/or urinary infection. All types of entero-uroplasty were lithogenic (6 cases). 32% of the children had a proteus infection. Treatment : 14 children were treated medically as against 125 surgically. 70% are free of any recurrence. 7% have a residual lithiasis. The rarity of recurrences and the quality of the results obtained indicate that complete surgical treatment represents the essential feature of the treatment of urinary lithiasis in children.
During a period of 10 weeks, four patients in one hospital became infected with gentamicin-resistant Proteus mirabilis. In two of them septicaemia associated with indwelling catheters developed, one had urinary tract and wound infections, and in the fourth patient the organism was isolated from a superficial wound. The P. mirabilis strains showed multiple drug resistance. Strains form the first three patients were apparently identical and were sensitive to tobramycin. Their gentamicin resistance was not transferable to Escherichia coli K12, but could be transferred to another strain of P. mirablilis (PM13-3). The fourth strain was resistant to tobramycin; its gentamicin/tobramycin resistance was transferable to E. coli K12.
The effect of immersion in sterile urine, infected urine and plasma on the breaking strength and stiffness of polydioxanone (PDS), polyglycolic acid (PGA) and chromic catgut was studied. Tests were done under closely controlled conditions with immersion periods varying from zero to ten days. The breaking strength and stiffness of the three suture materials was not significantly changed by immersion in plasma for periods up to ten days. In sterile urine, PDS lost all of its strength after three days of immersion while PGA lost 64% of its initial breaking strength after ten days. Catgut maintained its strength over the ten day study period. In E. coli-infected urine, PDS lost all of its strength in six days while PGA lost 71% and catgut 8% after ten days. In proteus-infected urine, PDS and PGA lost all their breaking strength after one day of immersion while catgut lost 5.8% of its initial strength after 10 days. Corresponding decreases in stiffness were also observed.
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Brain abscess has only recently been considered a complication of cystic fibrosis. Three patients are reported here and a fourth cited from the literature. All of our patients were young adults with advanced pulmonary disease. The bacteria involved were mouth organisms and were found in the sputum culture in only one of the patients. Resistance was present to previously given antibiotics. As patients with cystic fibrosis survive into adulthood, the risk of developing a brain abscess appears to increase.
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Because of the unavailability of strictly comparable data, seven representative penicillins and the five cephalosporins currently used in Britain were evaluated in parallel, both in vitro and in vivo. Penicillin sensitive and resistant strains of Staphylococcus aureus and Proteus mirabilis were the main test organisms. Minimum bacteriocidal concentrations of cloxacillin, flucloxacillin, cephalothin, and cephazolin in serum were much higher than conventional minimum inhibitory concentrations in the absence of serum. Cephalexin and cephradine showed the smallest divergence in these values. Staph, aureus beta-lactamase caused least damage to methicillin and cephradine, whereas enzymes from Escherichia, Klebsiella, and Bacillus cereus had least effect against cephradine followed by cephalexin. In mouse protection experiments, highly protein-bound antibiotics had relatively low efficacy. Cephradine had the highest mean activity followed closely by cephaloridine and cephalexin. From the data, cephradine was the cephalosporin of choice, and firm decisions were also made about the choice of penicillins.
A series of penicillin derivatives of quinoxaline di-N-oxide carboxylic acids was prepared. These compounds were prepared from the acid chlorides and mixed anhydrides of the quinoxaline di-N-oxides. The compounds prepared exhibited minimal antibacterial activity against gram-negative organisms.
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Gram-negative bacillary osteomyelitis secondary to sepsis is a rare condition. It most frequently attacks the vertebrae, occasionally in the long bones, and can on occasion be multiple. We present 2 patients with severe sepsis of urinary origin who, after a latent period, developed bilateral and symmetrical osteomyelitis due to the same microorganism that caused the sepsis. We discuss this peculiar presentation, its possible pathogenetic mechanism and the need to consider osteomyelitis in the presence of bilateral and symmetrical arthritis after an episode of severe sepsis.