INFECTIONS OF THE URINARY TRACT: ANTIBACTERIAL MANAGEMENT.
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Amniotic membranes are widely used in a multitude of surgical applications and have been shown to reduce bacterial counts and promote healing in infected wounds. Antibacterial properties of amniotic fluid are well documented and the presence of many potentially antibacterial factors has been demonstrated. No such factors have yet been found in amniotic membranes. We have applied a direct disc-diffusion susceptibility test to try to establish the possible existence of such a factor. Amniotic membranes did not inhibit five bacterial species when tested at 3 X 10(6) and 3 X 10(8) colony forming units/ml. However, complete growth inhibition of all organisms was seen immediately under the amniotic membrane discs. These results support the hypothesis that the antimicrobial effect of amniotic membranes in vitro is due to their close adherence to the wound surface.
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We established a human burn isolate of Proteus mirabilis as an experimental pathogen. Infliction of a nonfatal scald injury (30%) rendered rats highly susceptible to lethal surface infection with this isolate. Dose-response experiments indicated that the lethal inoculation dose (50%) was less than 10(3) organisms per square centimeter. Histopathologically, surface colonization was followed by progressive growth with subsequent invasion of viable tissue. The invasion was not characterized by the perivascular or perineural lesions observed in experimental Pseudomonas burn sepsis. Bacteriologic examinations showed moribund animals to be bacteremic with the test strain and to have wound biopsy counts exceeding 10(6) organisms per gram of tissue. The role of bacterial motility as a virulence factor in this surface infection was investigated. Substrains selected for loss of subsurface spreading in soft agar lost virulence. This model of burn infection with a member of the Enterobacteriaceae should be used to evaluate topical and parenteral antimicrobial agents needed for the control of wound infections caused by such agents.
The authors study the Dienes effect in 136 P.mirabilis and 2 P.vulgaris strains, isolated from different infection or colonization sites, in 27 spinal cord injured patients, admitted to a Paraplegic Unit, during a 9 month period. It is shown that 7 cross-infection and 18 cross-contamination episodes occurred, affecting 13 of 27 patients, which indicates the great spreading capacity of these microorganisms; 97% of the results obtained were observed once again after 6 months' storage of strains. In addition, in 7 of these strains their resistance to several antibiotics was cured by treating them with acriflavine salts, demonstrating that the Dienes effect persists even when resistance to antibiotics is modified; the authors conclude that the Dienes effect is an accurate stable epidemiological tool to identify cross-infections and its origins, and to facilitate the interruption of the chain of infection.
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Dense cultures of bacteria were exposed to changing concentrations of beta-lactam antibiotics in an in-vitro model of the urinary bladder. The results suggest that uncomplicated urinary infection may respond to lower doses than are usually given without compromising the success of subsequent treatment in those cases in which such minimal treatment fails.
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