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In a patient with a 6-month history of nonspecific abdominal complaints, preoperative examination indicated malignant disease involving the right ovary, rectum and sigmoid, but laparotomy revealed abdominal actinomycosis. Removal of the ovary and low anterior colonic resection followed by penicillin treatment gave a good result.
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The Staphylococcal strains, identified by "The Simplified Lyogroups System" were tested for their susceptibility to methicillin and some aminoglycosides. The results, besides showing a higher ratio of susceptibility against aminoglycosides in methicillin-susceptible (MS) strains, show a different trend within each lyogroup. A total of 1616 wild Staphylococcus strains were isolated in microbiological units in Catania, Messina, Rome and Genoa. The results show a high susceptibility to aminoglycosides, both in MS and methicillin-resistant (MR) groups but with different trends among lyogroups.
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The effects of the antimicrobial agents tobramycin and netilmycin on the functions of human polymorphonuclear leucocytes (PMNLs) and on the mitogen-induced transformation of lymphocytes have been investigated both in vitro and in vivo before and 1 hour after a single intramuscular injection of the antibiotics. Neither antibiotic affected the migratory, phagocytic or antimicrobial capacities of PMNLs or the proliferative responses of lymphocytes to mitogens, at therapeutic concentrations or at 10-100-fold greater than therapeutic concentrations. Likewise, no alterations in these leucocyte functions accompanied the intramuscular injection of either antibiotic. neither tobramycin nor netilmycin therefore interferes with host immunodefence mechanisms.
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Little attention has been given to whether an effective concentration of an antibiotic is obtained in the urine of a patient without azotemia who has one poorly functioning kidney and a contralateral normal kidney. This study was undertaken to measure the concentration of various antibiotics in the urine from both kidneys of 20 patients with unilateral renal disease and a radiologically and functionally normal contralateral kidney. Prior to ureteric catheterization each patient received a single parenteral dose of an antibiotic. The peak urinary drug concentration from the damaged kidney per unit of its creatinine clearance exceeded that for the normal kidney for 11/13 patients treated with an aminoglycoside and 6/7 given a cephalosporin. The most severely damaged kidney had a creatinine clearance of 0.6 ml/min. This patient received sisomicin and the peak urinary concentration was only 1.8 micrograms/ml. If a damaged kidney has a creatinine clearance less than 10-15 ml/min it would seem more appropriate to use a cephalosporin rather than an aminoglycoside antibiotic.
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Transfer of high-level gentamycin-tobramycin-sisomycin resistance could be easily demonstrated in strains of P. morganii and P. mirabilis which emerged, in two hospitals, at the end of 1976. First such strains were demonstrated in a patient of a urological ward who died, in September 1976, from generalised sepsis caused by a high-level gentamycin-tobramycin-sisomycin-resistant P. morganii. Since that event, at least nine such strains were isolated in 1976, and the presence of transferable resistant to the antibiotics listed plus other antibacterial substances including carbenicillin and more classical antibiotics could be demonstrated either by a high-frequence direct transfer to suitable recipient strains of Gentamycin or Tobramycin resistance, or by indirect selection, i.e. by analysis of exconjugants selected with kanamycin, streptomycin or carbenicillin. Further numerous strains of P. morganii highly resistant to gentamycin, tobramycin and sisomycin (M.I.C. over 128 mcg/ml) still emerge from wards in the two hospitals monitored and their transferability is under experimental study. It is stressed that, in order to demonstrate a transfer of gentamycin or tobramycin resistance in strains resistant to these substances, it is inevitable to examine properly also exconjugnants showing direct transfer to other, more classical antibiotics. We could not demonstrate, in our strains, any prodromal signs of resistance to netilmycin or amikacin.