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The diffusion and concentration of trimethoprim in human vaginal fluid.

Colonization of the vaginal introitus with Enterobacteriaceae was cleared dramatically in women receiving trimethoprim-sulfamethoxazole for recurrent urinary tract infections. Vaginal fluid was collected from seven women; five of the seven had two vaginal fluid collections each while on full-dose therapy (total, 10 samples), and five had two or more collections each while on prophylactic, low-dose therapy (total, 14 samples). Bactericidal concentrations of trimethoprim were found in all samples of vaginal fluid, often exceeding the serum level by severalfold. Sulfamethoxazole was either undetectable or present only in fractional concentrations.

Adult↗

Nosocomial urinary tract infections caused by two O-serotypes of Providencia stuartii in one hospital.

Providencia stuartii nosocomial urinary tract infections occurring in the same hospital over an 18-month period of retrospective study were shown, by serotyping and biotyping, to have been caused by two endemic strains. Two episodes, involving 38 patients in one ward and 11 patients in another, were caused by a mannitol-positive strain of serotype O55. Transmission of the strain through the movements of one patient appeared to have been the basis for the introduction of the agent from one ward to the other. In another episode, involving two patients in a third ward, the infections were caused by a mannitol-negative strain of serotype O49. The study demonstrated the usefulness of serotyping and biotyping in epidemiological studies of infections caused by P. stuartii.

Bacteriuria↗

Brain abscess. Review of 89 cases over a period of 30 years.

Eighty-nine cases of brain abscess, diagnosed over a period of 30 years, are reviewed. The incidence of this disease did not decline throughout the period. Abscesses of ear and nose origin constituted the largest group (38%). Postoperative abscesses seem to have increased in incidence, presumably due to routine postoperative antibiotic treatment. Antibiotics were possibly responsible for the suppression of signs of infection in 45% of the patients, who presented as suffering from a space-occupying lesion. The most accurate diagnostic tool was angiography, which localized the lesion in 90% and suggested its nature in 61%. Brain scan may prove as satisfactory. Staphylococcus was cultured in about two-thirds of the cases. Mortality seemed to decrease concomitantly with the advent of more potent antibiotics. The treatment of choice in terms of both mortality and morbidity seemed to be enucleation after previous sterilization. The hazards of radical surgery should be taken into consideration.

Adolescent↗

Deep infection after total hip replacement.

Sixty-eight patients suffering deep infection from a consecutive series of 1746 total hip replacement operations are reviewed. The infection rate has been reduced considerably by improved technique and multiple antibiotic prophylaxis without the use of a special operation enclosure. Factors affecting deep infection are analysed and discussed.

Anti-Bacterial Agents↗