Chlorhexidine as the probable cause of an increase in Proteus rettgeri infections of the urinary tract.
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The mouse model of intraperitoneal sepsis with Proteus rettgeri was used to evaluate the anti-endotoxic effect of polymyxin B sulfate. An unexpected reversal of the usual protective effect of polymyxin in experimental enterobacterial sepsis was observed in which the lethality of the infection was enhanced.
The study of 812 washings showed that Proteus is seldom detected in the environment of the patients with spinal traumas and infections of the urinary system. This can be attributed to the low resistance of Proteus to drying revealed by special experiments. The survival time was 1 day for Pr. vulgaris, 2 week for Pr. rettgeri, 5 and 7 months for E. coli and enterococcus, respectively. Dienes's test made with 90 Proteus strains revealed the common source of contamination in a half of the observations made, thus confirming the hospital origin of Proteus contamination of urine at a definite period of time (3-4 months) and establishing that an almost complete change of the strains occurred during 8 months of observation. In the author's opinion, the source of Proteus is the patients' urine; Proteus can spread therefrom as a result of the insufficiently thorough sanitary treatment of the hands of the medical personnel and the urogenital area of the patients.
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The effect of bacterial infection on excised renal papillae as a model for papillary necrosis and subsequent calcification was investigated. Sterile rat renal papillae were placed in 25 ml aliquots of filter sterilized human urine and then inoculated with one ml suspensions of sterilized human urine and then inoculated with one ml suspensions of sterile saline as a control, or 1 x 108/ml Escherichia coli or proteus mirabilis. After incubation at 37 degrees C for periods of 8 hr, 24 hr, 48 hr, 72 hr, 1 wk, 2 wk and 3 wk, urinary pH was measured, bacterial culture performed and the renal papillae were recovered and examined by scanning electron microscopy (SEM) and energy dispersive spectrophotometry (EDS). In the case of Proteus mirabilis, the sequence of events noted included bacterial-papillary interactions consisting of cell desquamation and strand formation, despite infrequent bacterial attachment. After 10 hr, a rapid, urease induced pH rise resulted in calcium salt deposition on the papillae surface. Organism death was apparent after 72 hr. Escherichia coli infected papillae demonstrated similar cell surface changes after a 8 hr as seen in P. mirabilis; however, frequent evidence of bacterial attachment and penetration was apparent. Bacterial attachment was a prominent feature throughout the incubation period with E. coli. After one week, rare areas of degenerating cells and bacteria with increased calcium levels as compared to surrounding areas were noted by EDS analysis. Urinary pH was stable throughout the incubation period. This study suggests varied roles for the organisms most associated with infection induced papillary necrosis (E coli) and papillary necrosis with subsequent stone formation (P. mirabilis). A role for bacterial calcification in the absence of bacterial urease activity by E. coli is also suggested.
We have undertaken a detailed retrospective study of urinary calculi in the Bristol clinical area from 1950 to 1978. Most calculi in children are detected in the upper urinary tract and the majority are associated with urinary infection. There were two predominant aetiological groups. First the children under 5 years of age, usually male, with a Proteus infection and triple phosphate calculi of the staghorn type in the renal pelvis and calyces. Of the 7 children with a sterile urinary tract in this age group, 4 were discovered to have a metabolic cause for the their calculi. These included 2 patients with cystinuria, 1 with uric acid calculi secondary to the treatment of leukaemia and 1 baby with the adrenogenital syndrome. A second smaller group of children between 8 and 13 years of age presented with ureteric calculi due to calcium oxalate stones in a sterile urinary tract. In the first group the importance of Proteus infections of the urinary tract is emphasised, and possibility of an underlying metabolic abnormality is noted if the urine is sterile. The second group presenting with ureteric colic are no different from adults with "idiopathic" calcium oxalate stones.
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Immunization with Providencia and Proteus rettgeri Formalin-treated bacterial suspensions produced high levels of protection in mice against homologous and heterologous challenge. Mice were also cross-protected, but less effectively, by passive administration of rabbit type-specific antisera. The protective activity appeared to be due to an antigen common to strains of different O-serotypes. It was not detectable in agglutination reactions, and preliminary results indicate that it is thermostable, not being inactivated in its antibody binding capacity at 121 degrees C for 1 h.