Prototype of a reflux-preventing ureteral stent and its clinical use.

We have experimentally produced a ureteral stent which prevents vesicorenal reflux. This stent has a thin silicon sleeve at its distal end (intravesical portion). In a model experiment the sleeve demonstrated an excellent capability to prevent reflux. The sleeve allowed flow of fluid with minimal pressure rise. A patient with bilateral ureteral obstruction was managed with endoscopic insertion of a sleeved stent in the right ureter and a usual pigtail stent in left ureter. During cystography vesicorenal reflux was not observed on the right side while reflux occurred on the left side. Excretory urography forty days after stent placement demonstrated recovery of renal function and maintenance of drainage in both renal units. Thus, the drainage characteristic of this stent appears to be approximately the same as that of usual stent.

Purification and Characterization of Mannitol-l-Phosphatase in the Red Alga Caloglossa continua (Ceramiales, Rhodophyta).

Purification of mannitol-l-phosphatase, an enzyme catalyzing the final step of mannitol biosynthesis, was first achieved in the mannitol-accumulating red alga Caloglossa continua (Okamura) King et Puttock. The enzyme was shown to be a monomer, since gel filtration and sodium dodecyl sulfate-polyacrylamide gel electrophoresis gave close values of apparent molecular weights of 28,500 and 30,200, respectively. The protein exhibited an isoelectric point of 4.8. The substrate specificity for mannitol-l-phosphate (MIP) was very high, and that for K(m)(MIP) was 0.41 mM. The catalytic activity was optimal at pH 7.4. The enzyme was activated by Mg(2+), but was strongly inhibited by Ca(2+), NaF, N-ethylmaleimide, and p-hydroxymercuribenzoic acid. Seawater levels of NaCl and physiological levels of mannitol also inhibited the activity by 50% or more. Changes in the concentrations of those ions and metabolites may regulate the biosynthesis of mannitol as an osmoregulant in vivo.

Cefminox sodium penetration into prostatic tissue with and without inflammation.

The concentrations of cefminox sodium (CMNX) in serum and prostatic tissue were determined in 36 cases of prostatic hyperplasia with and without inflammation. Mean ratios of CMNX in tissue over concentration in serum were 0.11 +/- 0.07 for patients with inflammation and 0.09 +/- 0.06 for those without inflammation. There was no significant difference between the two groups. These data suggest that CMNX penetration into prostatic tissue is not influenced by the presence of inflammation.

Different types of median raphe cysts in the penis.

We report a case of different types of median raphe cysts in the penis. The literature is reviewed and the origin of these cysts is discussed.

Hormonal treatment of symptomatic spinal cord compression in advanced prostatic cancer.

The authors describe 2 cases of symptomatic spinal cord compression due to metastatic prostatic cancer. Both cases showed marked improvement of cord compression after hormone therapy, and decompressive laminectomy was not necessary. The management of prostatic cancer patients with symptomatic spinal cord compression is discussed.

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1983). I. Susceptibility distribution].

During 1979-1983 in vitro activities of antimicrobial agents against causative bacteria isolated from patients with urinary tract infections (UTI) were investigated by Microbiological Research Group of UTI including the 8 institutions in Japan. Of all strains (219) isolated from patients with simple UTI, 65.3% were E. coli, and 9.6% Klebsiella spp.; these species accounted for about 75% of all isolates in 1983. MPC and CCL among the oral antimicrobial agents have showed potent activities against E. coli, MPC at 1.56 micrograms/ml and CCL at 3.13 micrograms/ml inhibited 80% of E. coli from simple and complicated UTI. CTM, CTX, CZX, CMX and LMOX among the parenteral antimicrobial agents, at concentrations of 0.20 micrograms/ml or less inhibited 90% of E. coli isolated from simple and complicated UTI. The frequency of isolates from patients with complicated UTI, without catheter, was as follows; E. coli 27.6%, P. aeruginosa 20.1%, Streptococcus spp. 12.6%, Serratia spp. 8.8% and Klebsiella spp. 8.0%. The frequency of isolates from patients with complicated UTI, indwelling catheter, was as follows; P. aeruginosa 22.6%, Streptococcus spp. 18.0%, Serratia spp. 15.0%, Proteus spp. 12.4%, and Enterobacter spp. and Klebsiella spp. are 6.0%, respectively, in 1983. The antibacterial activity (MIC80) against E. coli, Klebsiella spp., P. mirabilis, Citrobacter spp. and Serratia marcescens from simple and complicated UTI was compared, for example, among third generation cephem antibiotics. Four drugs such as CMX, CZX, CTX and LMOX showed virtually comparable activities while CPZ was slightly less active against the strains tested. There have been many studies reported concerning the antibacterial activity of various drugs against clinical isolates from patients with infections, but it seems that, to our knowledge, no article has dealt with yearly surveys on antimicrobial susceptibility of bacterial isolates from defined clinical specimens with the same period of each year at the same series of institutions.

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1983). II. Background of patients].

We have been collected the causative isolates from patients with urinary tract infections (UTI) from the 8 institutions in Japan during 1980-1983. All strains isolated from UTI and recognized as etiologically responsible in each institution were sent to Bacteriology Laboratory of Juntendo University Hospital, Tokyo and the species of these strains were reidentified. We classified the UTI into 3 categories, simple, complicated without catheter and complicated with catheter. Of all strains isolated as etiologically responsible from cases of simple UTI, 65.3% were E. coli and 9.6%, Klebsiella spp. in 1983: these species accounted for about 75% of all isolates. Most frequently isolated from patients without catheter were E. coli 27.6% in 1983, followed in order by Pseudomonas spp. (20.9%), Gram-positive bacteria (16.7%), Serratia spp. (8.8%), Klebsiella spp. (8.0%) and Proteus spp. (7.1%). In complicated UTI with catheter, Pseudomonas spp. were most frequently isolated (25.6%), followed in order by Gram-positive bacteria (22.9%), Serratia spp. (15.0%), Proteus spp. (12.4%), Enterobacter spp. (6.0%) and Klebsiella spp. (6.0%). A remarkable difference, that is, Gram-positive bacteria, especially S. aureus, showed conspicuous increase of isolation between 1982 and 1983. Furthermore, we discussed the detailed analysis of patient background to clinical bacterial isolates from UTI in respect of patient distribution by sex, types of infections, distributions by age in male and female, interrelations between the species of bacterial isolates and types of infection and antimicrobial chemotherapy.

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1984). I. Susceptibility distribution].

Our research group was engaged for 3 years (1979-1981) in a study on sensitivities to antibiotics of 4 bacterial groups including representative pathogenic bacteria found in cases of urinary tract infections; i.e. E. coli, Klebsiella spp., Citrobacter spp., and Proteus spp. Since 1982, all the bacterial strains isolated by our group from patients with urinary tract infections and deemed by doctors in charge as pathogens were sent to the Laboratory of Clinical Pathology of Juntendo University, where they were refixed and subjected to MIC determination. This is the third year of the new study. E. coli was detected most frequently from patients with urinary tract infections and the detection frequency was 28% (323/1,153) this year (1984), whereas it was 35.3% (304/860) last year, showing a 7% decline from last year to this year. E. faecalis was next frequent organism (12.7% or 147/1,153) followed by P. aeruginosa (10.8% or 124/1,153). This order, however, was reversed from last year. Other pathogens, in a decreasing order of isolation frequencies following the above three, were as follows: Proteus spp. (9.5% or 109/1,153), S. marcescens (6.2% or 71/1,153), S. epidermidis (5.4% or 62/1,153), K. pneumoniae (4.9% or 56/1,153), Enterobacter spp. (2.4% or 28/1,153) and Citrobacter spp. (2.3% or 27/1,153). The results of the determination of the sensitivity of bacterial strains to the antibiotics are described below. Of all the oral antibacterial and antibiotic agents used against E. coli, mecillinam (MPC), cefaclor (CCL) and pipemidic acid (PPA) proved to have high antibacterial potency, and their MIC90 (the concentration to inhibit growths of 90% of the objective bacteria) was 3.13 micrograms/ml. The MIC90's of cefotiam (CTM), cefotaxime (CTX), ceftizoxime (CZX), cefmenoxime (CMX) and latamoxef (LMOX) were less than 0.39 microgram/ml. The MIC90's of cefmetazole (CMZ) and cefoperazone (CPZ) were invariably 1.56 micrograms/ml. K. pneumoniae was not sensitive to ampicillin (ABPC) and did not show much sensitivity to other oral antibacterial and antibiotic agents also. Of all the injectable preparations of antibiotics, cephem antibiotics of the third generation showed the most potent antibacterial effects against K. pneumoniae, and their MIC90's were lower than 0.10 microgram/ml for CZX, 0.20 microgram/ml for CTX, 0.39 microgram/ml for CMX, and 0.78 microgram/ml for LMOX, while MIC90's of CPZ was 6.25 micrograms/ml, which was equal to that of CMZ. The MIC90 of CTM was 0.78 microgram/ml which was identical to that of LMOX.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1984). III. Secular changes in susceptibility].

Cases with infections of urinary tracts were divided into 3 groups of the simple infections, and complicated infections without indwelling of catheter, and complicated infections with indwelling of catheter. Susceptibilities to antimicrobial agents of Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Pseudomonas aeruginosa and Serratia marcescens which were isolated from patients with these infections were determined. There was no tendency of decline in the susceptibilities of E. coli isolated from the patients with simple urinary tract infections (UTI). Susceptibilities of E. coli isolated from the patients with complicated UTI without and with indwelling of catheter to cephem antibiotics of the third generation were examined. The susceptibility of E. coli strains isolated from patients with complicated UTI without and with indwelling of catheter remained the same. More specifically, cefmenoxime (CMX) at a concentration of less than 0.10 microgram/ml inhibited the growth of E. coli isolated from cases without: with catheter at 74.1%: 78.3% in 1982, 75.4%: 73.3% in 1983, and 81.3%: 84.8% in 1984. Also, ceftizoxime (CZX) at a concentration of less than 0.10 microgram/ml inhibited the growth at 83.3%: 95.7% in 1982, 89.2%: 86.7% in 1983, and 91.7%: 97.0% in 1984. Latamoxef (LMOX) at less than 0.10 microgram/ml inhibited the growth at 59.3%: 43.5% in 1982, 47.7%: 40.0% in 1983, and 47.9%: 42.4% in 1984. The antibacterial effect of penicillin against Klebsiella spp. was found to be poor, while those of oral cephem antibiotics, cephalexin (CEX), cefaclor (CCL), and cefazolin (CEZ) which is the cephem antibiotics of the so-called first generation and cefotiam (CTM) among other cephem antibiotics of the so-called second generation were relatively good. A study of susceptibilities of Klebsiella spp. isolated from patients with complicated UTI without and with indwelling of catheter revealed inhibition of growth by CTM at a concentration of 0.39 microgram/ml at 84.0%: 75.9% in 1982, 70.6%: 75.0% in 1983, and 95.8%: 77.8% in 1984. Cefmetazole (CMZ) at a concentration of 0.39 microgram/ml showed a relatively lower rate of growth inhibition of Klebsiella spp., while at 0.78 microgram/ml it inhibited the growth at 88.0%: 72.4% in 1982, 52.9%: 50.0% in 1983, and 70.8%: 66.7% in 1984. The antibacterial effects of both CTM and CMZ against Klebsiella spp. isolated from patients with indwelling of catheter were found to be poor, and some of the bacterial strains showed a MIC over than 100 micrograms/ml.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical evaluation of cefmenoxime and cefsulodin in chronic complicated urinary tract infections].

To patients with chronic complicated urinary tract infections (UTI) which were in compliance to the UTI standard, cefmenoxime (CMX) was given singly or in combination with cefsulodin (CFS) and efficacies of the respective preparations were examined. Of 53 patients examined, 40 were given CMX alone while 13 were given a combined preparation of CMX and CFS. Results are summarized as follows. With respect to the general clinical effects, 7 patients given CMX alone were markedly improved, 21 improved and 12 unchanged indicating an efficacy rate of 70%. In case of the CMX-CFS combined administration, 2 patients were markedly improved, 7 improved and 4 unchanged giving an efficacy rate of 69%. As for the bacteriological effects, 38 of 54 strains isolated from the patients given CMX alone were eliminated, 4 decreased, 12 unchanged and 15 substituted. Of 16 strains isolated from the patients given the CMX-CFS combined preparation, 4 were eliminated, 2 unchanged and 3 substituted. Thus, incidence of bacterial substitution was low in the combination treatment. The combination of CMX and CFS was more inhibitory to P. aeruginosa than CMX alone. Regarding side-effects, drug eruption was observed in one of the 53 patients and slight elevation of GOT and GPT was recognized in another.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1987). I. Susceptibility distribution].

Since 1979, Ikemoto et al. have been retrospectively surveying the sensitivity of major species of bacteria isolated from patients with urinary tract infections to various antibacterial agents and antibiotics. Their findings for the past year are reported below. A total of 825 clinical strains of bacteria was investigated. Of this total, Gram-positive bacteria accounted for 28.0% (231 strains) and Gram-negative bacteria for 72.0% (594 strains). Taxonomically, Escherichia coli accounted for 34.7% (286 strains), Enterococcus faecalis for 14.3% (118), Pseudomonas aeruginosa for 11.0% (91), Klebsiella pneumoniae for 7.8% (64), and coagulase-negative staphylococci for 7.3% (60). Sensitivity spectra of these major bacteria to various drugs were as follows. 1. E. faecalis was sensitive to parenteral imipenem (IPM) and ampicillin and oral vancomycin. It was also sensitive to ofloxacin (OFLX) and ciprofloxacin (CPFX), which are new quinolones. Some strains were only slightly sensitive to second and third generation cephems cefmenoxime (CMX) and cefuzonam (CZON) aminoglycosides amikacin (AMK) and arbekacin (HBK), and erythromycin which is a macrolide. 2. Staphylococcus aureus was sensitive to dicloxacillin (MDIPC) which is a penicillin drug, cefotiam (CTM) which is a cephem, IPM, minocycline (MINO), and HBK. A fairly large number of strains were only slightly sensitive to cefazolin (CEZ), OFLX and CPFX. 3. Coagulase-negative staphylococci were sensitive to MDIPC which is a penicillin derivative, cephems CTM and CZON, IPM, HBK, clindamycin (CLDM) and MINO. Some strains, however, were only slightly sensitive to a majority of these drugs. 4. E. coli was sensitive to CTM, CMX, latamoxef (LMOX), ceftazidime (CAZ), CZON, and flomoxef (FMOX), all of which are second or third generation cephems. It was also sensitive to IPM, a carbapenem, carumonam (CRMN), a monobactam, and new quinolones, OFLX and CPFX. 5. K. pneumoniae was sensitive to cephems, viz. CTM, CAZ, CZON, FMOX and cefixime, CRMN which is a monobactam, IPM, a carbapenem and new quinolones, OFLX and CPFX. Some strains were only slightly sensitive to CTM, cefmetazole cefoperazone (CPZ), and FMOX. 6. Citrobacter freundii was sensitive to CRMN which is a monobactam, and new quinolones, OFLX and CPFX. Many strains were only slightly sensitive to cephems, viz. CEZ, CTM, CPZ and CAZ. 7. Enterobacter cloacae was sensitive to gentamicin and AMK which are aminoglycosides, but showed a bimodal pattern of sensitivity to CPZ, CAZ and CZON, all of which are cephems, and to quinolones, OFLX and CPFX.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1987). III. Secular changes in susceptibility].

Sensitivity spectra of major species of bacteria (namely Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Serratia marcescens and Pseudomonas aeruginosa) which were among the clinical isolates mentioned in the first and second reports to various antibacterial and antibiotic agents and time courses of the spectra are reported below. 1. E. coli was sensitive to cefmenoxime (CMX), latamoxef (LMOX), ceftazidime (CAZ), cefzonam (CZON) and flomoxef (FMOX) which are third generation cephems, carumonam (CRMN) which is a monobactam, imipenem (IPM) which is a carbapenem, ofloxacin (OFLX) and ciprofloxacin (CPFX) which are new quinolones. Compared to the preceding 5-year period, sensitivities to most drugs have increased. 2. Klebsiella spp. were sensitive to CMX, CZON and FMOX which are third generation cephem antibiotics, CRMN which is a monobactam and gentamicin (GM) and arbekacin (HBK) which are aminoglycosides. Compared to the preceding 5-year period, the sensitivity on the whole has increased slightly. 3. Proteus spp. were sensitive to CMX, LMOX, CAZ and CZON which are third generation cephems, CRMN, a monobactam and OFLX and CPFX which are new quinolones. Compared to the preceding 5-year period, increased sensitivities, particularly to parenteral cephems, were found. 4. Citrobacter spp. were sensitive to CPFX which is a new quinolone antibiotic and CRMN, a monobactam. Compared to the preceding 5-year period, the sensitivity as a whole increased but there were still strains against which cefotiam, cefmetazole and, cefoperazone (CPZ) showed high MIC values. 5. Enterobacter spp. were sensitive to OFLX and CPFX, which are new quinolones, IPM, a carbapenem, and GM and HBK which are aminoglycosides. Compared to other bacteria, bacteria of this group were less sensitive to CPZ, CAZ, CZON, and FMOX which are third generation cephems. Compared to the preceding 5-year period, slight increases in sensitivity were found in cases of simple urinary tract infections. 6. S. marcescens as a whole was not very sensitive to antibiotics tested. Compared to the preceding 5-year period, sensitivities to CRMN and minocycline improved slightly. 7. P. aeruginosa was not very sensitive to any drug, as other bacteria were. Compared to the preceding 5-year period, sensitivities to new quinolones OFLX and CPFX and carbapenem IPM decreased slightly.

[Comparison of antibacterial potencies of oral and parenteral antibiotic preparations against Escherichia coli, Klebsiella, Citrobacter, and Proteus isolated from urinary tract infections (3: 1981) 1. Susceptibility distribution].

In vitro activities of antibacterial agents against E. coli, Klebsiella, Citrobacter and Proteus which were isolated from patients with urinary tract infections at 8 hospitals in Japan, were investigated by dilution broth method using MIC 2000 (Dynatec) during July to October in 1981. The summarized results are as follows: Among oral antibacterial agents, MPC and PPA have showed potent antibacterial activities against E. coli and Klebsiella. In vitro activities of oral antibacterial agents against Proteus and Citrobacter showed not so potent. Among the first and second generation's parenteral antibacterial agents, CTM has showed potent antibacterial activities against E. coli and Klebsiella. Among the third generation's parenteral antibacterial agents, CMX, CTX and CZX have showed potent antibacterial activities against E. coli, Klebsiella, Proteus and Citrobacter.

[Comparison of antibacterial potencies of oral and parenteral antibiotic preparations against Escherichia coli, Klebsiella, Citrobacter, and Proteus isolated from urinary tract infections (3: 1981). 2. Changes in bacterial sensitivities].

Since 1979 the antibacterial activity of antibiotics against E. coli, Klebsiella, Citrobacter and Proteus isolated from patients with urinary tract infections has been investigated. The serious transition of susceptibilities of E. coli and Klebsiella could not be recognized in these antibiotics (MPC, ABPC, NA, PPA, CEX, CEZ, CTM, CMZ and CFX). However, a few resistant organisms against the third generation's antibiotics (CTX, CMX, CZX, LMOX and CPZ) have already been appeared, we have to observe these results, continuously.

[Comparison of antibacterial potencies of oral and parenteral antibiotic preparations against Escherichia coli, Klebsiella, Citrobacter, and Proteus isolated from urinary tract infections (3. 1981). 3. Patient backgrounds and bacterial sensitivities].

Routine susceptibilities testing of microorganisms isolated from patients are of restricted usefulness in the treatment of patients because of the delay in obtaining results. Thus, the empiric chemotherapy based on the susceptibility of microorganisms isolated from patients is necessary for the majority of patients with simple and complicated urinary tract infections. In this study the relation between changing susceptibility and background factors such as age, a sex distinction, antibiotics, areas in Japan, simple and complicated UTI and so on, has been investigated.

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1982). I. Susceptibility distribution].

In vitro activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections were investigated by dilution method using MIC 2000 (Dynatec) during July to October in 1982. The summarized results are as follows: PMPC and CCL have showed potent activities against E coli among the oral antimicrobial agents. PMPC and CCL at 3.13 micrograms/ml inhibited 90% of E. coli tested. CTM, CTX, CZX, CMX and LMOX at concentrations of 0.39 microgram/ml or less among the parenteral antimicrobial agents inhibited 90% of E. coli tested. The value of MIC90 (concentration at which 90% of isolates are inhibited) against K. pneumoniae results in the resistant range for ABPC, NA, CEX, CCL and ST. Among the parenteral cephems, CMX seemed most effective against K. pneumoniae tested. C. freundii seemed generally low susceptible to antimicrobial agents tested. Among the oral agents, PMPC, PPA and ST have showed moderate activity against C. freundii. Among the parenteral agents, CMX and LMOX also showed moderate activity against C. freundii, inhibiting 50% of the strains tested at 6.25 micrograms/ml. Among the oral agents, PMPC showed the most potent activity against E. cloacae. E. cloacae tested were highly resistant to the first and second generation cephems. Among the third generation, CMX seemed the most potent activity against E. cloacae isolated. However, CMX concentration of 1.56 micrograms/ml was necessary to inhibit 50% of tested E. cloacae. P. mirabilis tested was resistant to all oral antimicrobial agents except CCL and ST. The value of MIC90 of the first and second generation cephems against P. mirabilis results in the moderately susceptible range (6.25-25 micrograms/ml). The third generation seemed most effective against P. mirabilis tested. PMPC, NA, PPA and ST concentrations of 0.78-1.56 micrograms/ml were necessary to inhibit 50% of tested P. vulgaris. CEZ and CTM, seemed less potent activity than CFX and CMZ against P. vulgaris. CTX, CZX, CMX and LMOX except CPZ have showed potent activities against P. vulgaris, these at 0.1 micrograms/ml or less inhibited 50% of P. vulgaris tested. P. aeruginosa has been resistant to the third generation cephems except CPZ, but TOB, GM, AMK, CFS, PIPC and CPZ have showed high activities against P. aeruginosa, inhibiting 50% of the strains tested at 0.39-6.25 micrograms/ml. The oral antimicrobial agents, and first and second generation cephems had not showed significant activity against S. marcescens. And strains of S. marcescens were relatively susceptible to the third generation cephems.(ABSTRACT TRUNCATED AT 400 WORDS)

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1982). III. Secular changes in susceptibility].

In vitro susceptibilities have been investigated against several species isolated from patients with simple and complicated urinary tract infections (UTI) during 1980-1982. Antimicrobial activities of the third generation cephems against E. coli isolated from patients with complicated UTI were found to decrease slightly in 1982. And those against Klebsiella spp. isolated from patients with simple and complicated UTI were also found to decrease similarly. Against P. mirabilis, all the drugs tested have showed relatively potent activities and slight changes in the susceptibility. The marked decrease of susceptibility against Citrobacter spp. isolated from UTI have been found even in the third generation cephems. Especially, Citrobacter spp. exhibited a greater degree of resistant to CZX and CPZ. Strains of P. aeruginosa were on the whole susceptible to the drugs tested, CFS, GM, TOB and AMK, inhibiting 50-80% of the strains tested at 1.56 micrograms/ml. CTX, CZX and CMX seemed most effective against S. marcescens among the third generation cephems, inhibiting 50-90% of the strains tested at 3.13 micrograms/ml.

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1982). II. Background of patients].

The frequency of the causative strains in urinary tract infections was investigated from the point of view of the patient's background such as age, sex administration of antibiotics and so on. Especially, the frequency of the causative strains isolated from patients within 3 days after the administration of antibiotics has markedly decreased. However, the frequency of the resistant strains such as P. aeruginosa, Enterobacter spp., Citrobacter spp. and Serratia spp. has increased after 8 days' administration of antibiotics.

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1983). III. Secular changes in susceptibility].

The in vitro antimicrobial activities of antibiotics against causative pathogens isolated from patients with urinary tract infections (UTI) in the 8 institutions in Japan during the period from 1980 to 1983 were compared. A number of new beta-lactam antibiotics with broad spectrum of activity have become available for clinical use in recent years. Some of them, in particular so-called third generation cephems, are reported to be responsible for developing microbial-cross resistance to multiple beta-lactam antibiotics. We have been making survey in recent years to explore changes in susceptibility to various antimicrobial agents of clinical isolates. All bacterial isolates from clinical specimens were submitted to the Department of Clinical Pathology, Juntendo University School of Medicine, where they were tested for antimicrobial susceptibility with MIC 2000 apparatus. Of all pathogens from patients with simple UTI, the majority of the isolates was E. coli and Klebsiella spp. In cases of complicated UTI, on the other hand, Pseudomonas spp. were most frequent, followed in order by Proteus spp., Klebsiella spp., Serratia spp., Citrobacter spp. and E. coli. Conspicuous changes in antimicrobial activity of antibiotics against E. coli and Klebsiella spp. from simple UTI have not been found in our survey. Against strains of Citrobacter spp., even the third generation cephems proved to be not remarkably active and there was a significant decrease in susceptibility of isolates to the drugs test-showed MIC values of 50 micrograms/ml and the proportion increased to 50% (22/44) with isolates obtained in 1982. The antimicrobial activity of cefsulodin and gentamicin against P. aeruginosa was decreased in 1982 compared with that in 1980 and 1981. However, resistant strains were slightly more frequent with gentamicin. In 1983, the antimicrobial activity of third generation cephems against Serratia spp. was significantly reduced from that in 1982.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1988). I. Susceptibility distribution].

Isolation frequencies and sensitivities to antibacterial and antibiotic agents were investigated on 801 bacterial strains isolated from patients with urinary tract infections in 9 hospitals during the period of June to November 1988. Of the above total bacterial population, Gram-positive bacteria accounted for 29.3% and a majority of them were Enterococcus spp. Gram-negative bacteria accounted for 70.7% and most of them were Escherichia coli. 1. Enterococcus faecalis: Vancomycin was most active with its MIC90 < or = 0.78 microgram/ml. Ampicillin, piperacillin, ofloxacin (OFLX), ciprofloxacin (CPFX) and imipenem (IPM) were also active. 2. Staphylococcus aureus: Arbekacin and minocycline were most active with their MIC90s 0.39 microgram/ml and 1.56 micrograms/ml, respectively. Among penicillins, dicloxacillin was the most active. Activities of cephems were considerably lower. 3. E. coli: Most of the agents were tested active. Particularly the second and third generation cephems were active in a range of < or = 0.10-0.20 microgram/ml. Carumonam (CRMN), IPM, OFLX and CPFX were also active with MIC90s < or = 0.10 microgram/ml. 4. Klebsiella pneumoniae CRMN and IPM were highly active. Penicillins generally showed lower activities. Cephems and new quinolones had high activities with their MIC90s in a range of 0.39-0.78 microgram/ml. 5. Proteus mirabilis: The third generation cephems were active with their MIC90s in a range of < or = 0.10-0.20 microgram/ml. CRMN, OFLX and CPFX were also active with their MIC90s < or = 0.10 microgram/ml, 0.39 microgram/ml and 0.20 microgram/ml, respectively. 6. Pseudomonas aeruginosa: IPM and tobramycin were active with their MIC90s 1.56 micrograms/ml and 3.13 micrograms/ml, respectively. CRMN and new quinolones showed MIC80s of 25-100 micrograms/ml. Most of penicillins and cephems were not active. 7. Other Gram-negative rods: Against Citrobacter freundii, Enterobacter cloacae and Serratia marcescens, IPM, CPFX and OFLX were active. Penicillins and cephems were not so active. CRMN was active against S. marcescens with its MIC80 at 6.25 micrograms/ml.