Is candidiasis the true cause of vulvovaginal irritation in women with diabetes mellitus?

Vulvovaginitis is common in diabetic women and is often treated with antifungal agents on the assumption that the causative organism is Candida albicans. In a survey of 100 consecutive diabetic women attending a diabetes clinic 36 had complained to their general practitioner about vulvovaginal irritation during the past three years and 26 were treated with antifungal agents without a vaginal examination or swabs being taken. In a separate study 27 post-menopausal women with non-insulin dependent diabetes and symptoms of vulvovaginitis were investigated. The organisms cultured were: Candida albicans (n = 6), beta haemolytic streptococci (n = 14), Gardnerella vaginalis (n = 2), Staphylococcus aureus (n = 2), Streptococcus milleri (n = 1), Streptococcus faecalis (n = 1), Klebsiella oxytoca (n = 1), no organisms (n = 3). Where a bacterial organism was isolated symptoms resolved in all but one case with appropriate antibiotic treatment. It is recommended that the practice of initiating antifungal treatment without taking high vaginal swabs should be reviewed and treatment should be given specifically rather than empirically.

Ciprofloxacin for soft tissue infections.

Twenty-one patients with cellulitis or other bacterial soft-tissue infections were treated with oral ciprofloxacin. One patient developed nausea and vomiting and was withdrawn from the study, but 19 of the other 20 were clinically cured or improved. Only nine of the original 18 bacterial isolates were completely eradicated, however, the majority of the failures being staphylococci or streptococci. There was no evidence from disc sensitivity testing of resistance developing during treatment. No serious toxicity was seen.

Teicoplanin in the treatment of skin and soft tissue infections.

Twenty-five patients with cellulitis or other soft tissue infections were treated with once daily teicoplanin. One patient was withdrawn from the study because of a protocol violation but 27 of the 29 assessable infections in the other 24 patients were clinically cured or improved. Eighteen of the 20 original Gram-positive bacterial isolates (11 Staphylococcus aureus and nine beta-haemolytic streptococcus strains) were completely eradicated. No severe adverse reactions were seen but a rise in the plasma platelet count was noted in the majority of the patients during teicoplanin administration.

Case control study of epidural catheter infections in a district general hospital.

Ten infections associated with the use of epidural catheters for post-operative pain relief were identified in patients of a district general hospital in 1997 and 1998. A case control study showed that the infections were commoner in the summer months and associated with analgesia infused by syringes rather than pumps. Infection rates and risk factors can be analysed regularly if pain teams maintain a database of epidural catheters inserted, which includes information about infections.

Actinomycetes in pyogenic liver abscess.

Three patients with pyogenic liver abscesses had actinomycetes cultured from aspirated pus, although it is unusual for hepatic actinomycosis to present in this way. The spectrum of bacteria found in liver abscesses appears to be changing, with the increased isolation of anaerobes partly due to improved techniques. It is important to recognise the presence of actinomycetes so that appropriate chemotherapy can be given.

The in-vitro and disc susceptibility testing of clarithromycin and its 14-hydroxy metabolite.

The in-vitro antibacterial activity of clarithromycin, its 14-hydroxy metabolite and a combination containing clarithromycin and the 14-hydroxy metabolite in a ratio of three parts of the former to one part of the latter were compared with erythromycin by determination of MICs. Disc susceptibility testing was also performed using discs containing 6 micrograms clarithromycin, 6 micrograms clarithromycin with 2 micrograms 14-hydroxy-clarithromycin, 3 micrograms clarithromycin and 3 micrograms clarithromycin with 1 microgram 14-hydroxy-clarithromycin. This was to determine a suitable disc content and minimum zone diameter to distinguish between sensitive and resistant strains using a breakpoint of 4 mg/l clarithromycin. Clarithromycin showed similar activity to erythromycin against Streptococcus pneumoniae and Haemophilus influenzae, although the 14-hydroxy metabolite was more active against H. influenzae. The clarithromycin/14-hydroxy metabolite combination was most active against beta-haemolytic streptococci (Groups A-C) (mode MIC 0.06 mg/l). The parent compound and the combination were similarly active against Staphylococcus aureus (MIC50 0.12 mg/l). Branhamella catarrhalis was more susceptible to clarithromycin (MIC90 0.06) than to erythromycin (MIC90 0.25 mg/l). Activities of all compounds against S. epidermidis and enterococci were similar but against Neisseria species erythromycin was the more active compound. The 6 micrograms clarithromycin disc strength was found to give the most consistent results for all isolates. Using a breakpoint of 4 mg/l, minimum zone diameters indicative of sensitivity were as follows: 16 mm for staphylococci, 17 mm for respiratory pathogens and 11 mm for streptococci and Neisseria spp.

Comparison of sensititre dried microtitration trays with a standard agar method for determination of minimum inhibitory concentrations of antimicrobial agents.

A total of 222 clinical isolates were used to test the accuracy of Sensititre dried microtitration trays for determining minimum inhibitory concentrations (MICs) of antimicrobial agents. In comparison with an agar dilution technique, 89.5% of all the pairs of results were within one doubling dilution. The 2,420 pairs of MIC results with finite values gave a corresponding figure of 86.8%. Exclusion of sulfisoxazole results, which demonstrated a significant interlaboratory variation in accuracy, raised this value to 89.1%. Very good differentiation of beta-lactamase-producing strains of Staphylococcus aureus (24 of 24 giving an MIC greater than or equal to 0.25 micrograms/ml) and Haemophilus influenzae (3 of 3 giving an MIC greater than or equal to 32 micrograms/ml) was obtained with the Sensititre system. This method also clearly distinguished erythromycin-resistant S. aureus strains (7 of 7 giving an MIC greater than 32 micrograms/ml) from the susceptible strains (26 of 28 giving an MIC less than or equal to 0.5 microgram/ml plus 1 strain at 1.0 microgram/ml and 1 at 2.0 micrograms/ml). Sensititre offers an accurate and convenient method of determining MICs comparable to those obtained with the agar dilution procedure, with the advantage of an extended shelf life when stored at room temperature.