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Bacteriology of chronic tonsillitis in young adults.

Tonsils were obtained from 22 young adults (mean age, 23 years) suffering from chronic tonsillitis. Mixed aerobic and anaerobic flora was obtained from core tonsillar cultures in all patients, yielding an average of 9.0 isolates (5.3 anaerobes and 3.7 aerobes) per specimen. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium sp, and gram-positive cocci. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, Branhamella catarrhalis, beta-hemolytic streptococci, and hemophilus sp. beta-Lactamase-production was noted in 32 isolates recovered from 18 tonsils (82%). These included all eight isolates of S aureus and five B fragilis, and 11 of 24 B melaninogenicus group (46%). Our findings indicate the polymicrobial nature of deep tonsillar flora in young adults with chronic tonsillitis, and demonstrate the presence of beta-lactamase-producing organisms in most of the patients.

Adolescent↗

A review. Lessons from an animal model of intra-abdominal sepsis.

Intra-abdominal sepsis that involves multiple aerobic and anaerobic bacteria derived from the colonic flora was studied in Wistar rats to determine the relative roles of various microbial species. The rats challenged with pooled colonic contents showed a biphasic disease. Initially, there was acute peritonitis, Escherichia coli bacteremia, and high mortality. In rats that survived this acute peritonitis stage, intra-abdominal abscesses developed, and anaerobic bacteria were the preponderant organisms. Subsequent experiments showed that antibiotics directed against coliforms prevented mortality, whereas agents active against anaerobes reduced the incidence of abscesses. Challenges with Escherichia coli alone produced bacteremia and death, whereas pure cultures of Bacteroides fragilis caused intra-abdominal abscesses. These observations suggest that both coliforms and anaerobes are important pathogens in intra-abdominal sepsis, although the different types of microbes appear to play distinctive roles in the sequence of pathological events.

Abdomen↗

A rapid method for the detection of tryptophanase in anaerobic bacteria.

A total of 633 anaerobic bacteria were examined for tryptophanase production using a rapid method which distinguishes within 5 to 180 minutes between anaerobes that contain tryptophanase and those that do not. Of the 196 tryptophanase-positive isolates tested, 99% showed tryptophanase activity within 2 hours as compared with 94.4% in 24 hours by a conventional method. A total of 299 tryptophanase-negative organisms were tested. Ninety three percent of these remained negative after 24 hours as compared with 95.3% when tested within a 24-h conventional method. Additional information was obtained on the sensitivity of this test and the time-dependent production of indole by tryptophanase.

Bacteria↗

In vitro activity of ceftazidime in combination with other antibiotics.

189 bacterial strains were investigated for their in vitro sensitivity against ceftazidime (alone and in combination with another antibiotic). Moreover, the possibility to prevent development of secondary bacterial resistance as observed in subcultures at subinhibitory antibiotic concentrations, was studied using specific antibiotic combinations. Of 115 staphylococcal strains (91 strains of Staphylococcus aureus, 24 strains of Staphylococcus epidermidis), 2% were sensitive, 82% were moderately sensitive and 16% were resistant to ceftazidime. On combining ceftazidime with vancomycin, synergism was found in 61% of the strains, and secondary resistance to ceftazidime could be prevented with this combination. The combination of ceftazidime and clindamycin showed synergism in 26% and an additive effect in 48% of the strains. Secondary resistance to ceftazidime did not develop with this combination in subcultures at subinhibitory concentrations in which loss of activity was only minimal with clindamycin alone. Rifampicin and fusidic acid were highly active against staphylococci. In combination with ceftazidime, only weak synergism or additive effects were seen in most strains; no antagonism could be observed. In subcultures at subinhibitory concentrations, secondary resistance to rifampicin and fusidic acid developed rapidly and could be partially prevented by adding ceftazidime. Of 60 Pseudomonas aeruginosa strains, 84% were sensitive, 13% were moderately sensitive and 2% were resistant to ceftazidime. Synergism was most frequently observed when ceftazidime was combined with tobramycin. Using this combination, secondary resistance of Pseudomonas strains to ceftazidime did not develop. When ceftazidime was combined with piperacillin, synergism was observed in most strains, but the development of secondary resistance in vitro was not prevented.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

Comparative activity of LY146032 against anaerobic cocci.

Fifty strains of anaerobic gram-positive cocci were tested in vitro against benzylpenicillin, teicoplanin, vancomycin and LY146032. The organisms displayed a wide range of susceptibility to penicillin and the minimum inhibitory concentration for 11 of the strains was greater than or equal to 1 mg penicillin/L. The activity of teicoplanin exceeded that of vancomycin by a factor of two. The activity of LY 146032 varied in different culture media and was dramatically potentiated by the addition of a physiological concentration of calcium. Peptococci were, in general, more susceptible than peptostreptococci to penicillin and to LY146032 in the absence of added calcium.

Anti-Bacterial Agents↗

Evaluation of a test kit for identification of anaerobic bacteria.

A test kit for identification of anaerobic bacteria--API--has been compared for accuracy in individual tests and for identification on the genus or species level with pre-reduced anaerobically sterilized media methods on 241 anaerobic strains. The microsystem was found to be reliable and permits identification of the clinically most significance anaerobic bacteria if it is supplemented with other tests such as gaschromatographic analysis, morphology, lecithinase, lipase and antibiotic sensitivity pattern.

Actinomyces↗

Anaerobic infections of the female genital tract.

Anaerobic bacterial organisms are a frequent cause of female genital tract infections. There has been a lack of appreciation of the significant role anaerobes play in obstetric and gynecologic infections. Utilization of newer appropriate anaerobic culture techniques has shown the importance of these organisms as pathogens in serious infections of the genital tract. Many species of anaerobic bacteria appear to be part of the normal microflora of the lower genital tract in female subjects. Similar organisms are frequently isolated from pelvic infections. Bacteroides, anaerobic cocci, and Clostridia are the most commonly isolated anaerobes associated with clinical infections. The clinician must recognize the presence of anaerobic infections, utilize proper anaerobic culture methods, and institute appropriate antibiotic and/or surgical therapy.

Anaerobiosis↗

Puerperal endometritis: a prospective microbiologic study.

This study was undertaken to determine the flora in the endometrial cavity of two groups of puerperal patients: 47 afebrile control subjects and 27 with endometritis. A transcervical culturing technique designed to avoid cervical contamination and to preserve aerobes, anaerobes, and mycoplasma was employed, and bacterial colony counts were reported semiquantitatively. No difference was found in the flora of these two groups. Furthermore, the most common pathogenic organisms (in decreasing order of frequency) were peptostreptococci, peptococci, Bacteroides sp., gamma-streptococci, enterococci, beta-streptococci, alpha-streptococci, and E. coli.

Adult↗

Quantitative microflora of the vagina.

This study enumerated the predominant vaginal flora in 25 healthy patients: 18 prenatal (six with and 12 without gonorrhea) and seven nonpregnant without gonorrhea. All 25 patients had aerobes and 19 of the 25 had anerobes isolated in titers of greater than or equal to 10(5) colony-forming units (CFU per milliliter). The most frequently isolated microorganism was the lactobacillus (aerobic and anaerobic species) followed by C. vaginale, viridans streptococci, anaerobic gram-positive cocci, and Bifidobacterium sp. Bacteroides fragilis was not isolated. There were no significant differences in the frequency of isolation of any specific microorganism or bacterial counts between pregnant and nonpregnant women or between pregnant women with and without gonorrhea (p greater than 0.05), except pregnant patients had significantly higher total facultative counts associated with significantly lower anaerobic lactobacilli counts and higher C. vaginale counts (p less than 0.01) than in nonpregnant patients.

Actinomycetaceae↗

Cervical and vaginal bacterial flora: ecologic niches in the female lower genital tract.

The bacterial flora of the cervix and vaginal vault were compared by obtaining duplicate specimens for quantitative bacteriologic studies in 14 patients electively admitted for hysterectomy. There were a total of 137 isolates from the 28 specimens, including 71 aerobes and 66 anaerobes. Aggregate data showed that the flora of the two sample sites were similar by both qualitative and quantitative analysis. However, individual comparison of paired specimens showed considerable differences in that 75 of the 137 isolates were recovered from only the cervix or vaginal vault. Additional studies showed that neither low concentrations of bacteria nor the culture techniques accounted for these differences. It is concluded that most women harbor distinctive bacterial populations in the cervix and vaginal vault.

Aerobiosis↗

Treatment of obstetric and gynecologic infections with cefamandole.

Cefamandole nafate is a derivative of 7-aminocephalosporanic acid which has been shown to have good in vitro activity against aerobes traditionally susceptible to cephalosporins as well as many anaerobes, including B. fragilis. One hundred women with obstetric or gynecologic infections completed treatment with cefamandole: 53 had post-cesarean section infections: 24, acute pelvic inflammatory disease: 16, posthysterectomy cuff cellulitis/abscess; and seven, vulvar or abdominal wound abscess. Almost 90% of these women had either polymicrobial aerobic/anaerobic bacterial infections or an anaerobic infection alone. Ninety women responded to cefamandole alone; in 10 cases chloramphenicol was added, but in addition five of these women required surgical therapy for eradication of infection. Mild to severe phlebitis at the infusion site that responded to conservative therapy was demonstrated in 14 women. Of 312 bacterial isolates from these women, 89% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level; 93% of anaerobic streptococci, the most common isolates, were sensitive at 32 microgram/ml. Also, 90% of all Bacteroides species were susceptible at 32 microgram/ml; 82% of B. fragilis were susceptible at this concentration. These data indicate that cefamandole is safe and effective for treatment of women with polymicrobial pelvic infections but that approximately 5% of these women will require surgical exploration in addition to antimicrobial administration.

Abscess↗