[Cerebrospinal fluid penetration of ofloxacin (Tarivid) in non-inflamed meninges]. / Die Liquorgängigkeit von Ofloxacin (Tarivid) bei nicht entzündeten Meningen.

In 9 patients, who underwent lumbar drainage after transsphenoidal surgery for pituitary adenoma, we collected 69 samples of CSF and plasma, respectively. The concentration of ofloxacin was measured bacteriologically. Considering the ofloxacin CSF and plasma levels related to time some aspects of pharmacokinetics are discussed. With maximum CSF concentrations coming up to 40% of plasma levels liquor penetrability is quite good. Ofloxacin seems to be able to prevent (postoperative) meningitis, even with grampositive Cocci.

Treatment of pseudomonas aeruginosa colonisation in cystic fibrosis.

To test whether early treatment could postpone the chronic colonisation of the respiratory tract with mucoid strains of Pseudomonas aeruginosa in patients with cystic fibrosis, we performed a pilot study in 28 patients aged 2 to 18 years. A two week course of azlocillin (150 mg/kg/day) and tobramycin (10 to 15 mg/kg/day) was given after a mean duration of P aeruginosa colonisation of five months (range one to 11 months). Weight for height increased significantly by 3.5% (SEM 0.7%) of the predicted normal after chemotherapy. The eradication of P aeruginosa that was achieved in 18 children directly after hospital treatment was only temporary. Samples from only 10 and five patients remained negative three and six months after treatment, respectively. Five children remained free from P aeruginosa for a prolonged period of 14 to 32 months. We conclude that, apart from the clinical improvement in all patients, some children might benefit from early antipseudomonas treatment with respect to the bacteriological outcome. Most children, however, experience only a temporary reduction in colonisation. Further investigations in form of controlled clinical trials seem justified.

[Tissue concentration and effectiveness of ofloxacin in surgical patients]. / Zur Gewebekonzentration und Wirksamkeit von Ofloxacin bei chirurgischen Patienten.

Following a 400 mg preoperative oral dose, ofloxacin concentrations were measured preoperatively in serum and at the time of tissue removal in serum, gall bladder fluid, the gall bladder wall, liver tissue, muscle, fascia, subcutaneous fat and skin. Serum values were more or less constantly above 3 mg/l at all times. The highest intraoperative ofloxacin concentration was 11.85 mg/l in the gall bladder fluid. In the gall bladder wall, liver and muscle, concentrations were slightly higher than in the serum, whereas concentrations in the fascia, subcutaneous fat and skin were clearly lower than serum concentrations. Good activity was observed with regard to the MIC90 of the pathogens most commonly encountered in surgical wards.

[Differentiation of clostridia]. / Beitrag zur Differenzierung von Clostridien.

162 Clostridium strains (20 species), isolated from clinical specimens, were identified by their morphological, biochemical, and gaschromatographic characteristics. The reliability of the Api 20A system in identifying Clostridium species was studied by performing biochemical tests both in the microsystem and according to the VPI Anaerobic Handbook. 66% of the Clostridium strains could be identified by the Api 20A system supplemented, in accordance with the Api Handbook by other tests such as morphology, lipase and lecithinase production. The following Clostridium species, known as clinically most significant, could be identified by the Api 20A system: Clostridium sordellii and C. sporogenes (92%), C. bifermentans (60%) and C. tertium (78%). Methods which can be used in the clinical laboratory for the identification of Clostridium species are described, i.e. isolation of Clostridium strains from mixed cultures, examination of morphological characteristics, performance of biochemical tests in the Api 20 A system as a micromethod, verification by conventional biochemical test systems and gaschromatographic analysis in special laboratories if necessary.

Antibacterial activity of temocillin.

The in vitro antibacterial activity of temocillin, a new penicillin, was determined in quantitative broth dilution tests, and compared with that of mezlocillin, piperacillin, cephazolin and cefotaxime. 805 clinical isolates of the Enterobacteriaceae family were tested, with temocillin exhibiting a high level of antibacterial activity against the various bacterial species, including mezlocillin-resistant strains. With the exception of Serratia marcescens, the minimum inhibitory concentrations (MICs) of 90% of tested strains of various species were in the range of 1 to 8 mg/L temocillin. Concentrations of 16 mg/L were required to inhibit 80% of S. marcescens strains, and some isolates were resistant. Significant differences between the MIC and MBC values were not observed. Furthermore, the pharmacokinetics of the bactericidal action of temocillin against mezlocillin-resistant strains was investigated, and killing curves showed that the compound was bactericidal at the MIC and the MBC.

[Clinical importance of Acinetobacter calcoaceticus isolations from blood and venous catheters]. / Klinische Bedeutung von Acinetobacter calcoaceticus-Isolierungen aus Blut und Venenkathetern.

From 1980 to 1982 Acinetobacter calcoaceticus (A.c.) derived from blood cultures and venous catheters of 29 patients could be grown. 6 patients with clinical signs of Gram-negative septicemia had two or more blood cultures positive for A.c. Thus, the role of A.c. as the etiologically relevant pathogen seems to be evident. In 14 cases with clinical signs of septicemia but only one set of blood cultures positive for A.c. it is felt to be the causative agent since no other cause could be found. In 9 cases isolation of A.c. seems to be due to contamination - most likely from skin -, because neither evidence of septicemia nor relationship to the diseases present of A.c. existed.

[Microbiological studies with the new penicillin BRL 17421 (temocillin)]. / Mikrobiologische Untersuchungen mit dem neuen Penicillin BRL 17421 (Temocillin).

In vitro Evaluation of BRL 17421 (Temocillin), a New Penicillin. The in vitro antibacterial activity of BRL 17421 (temocillin), a new penicillin, was determined in quantitative serial broth dilution tests and was compared to that of mezlocillin, piperacillin, cefazolin and cefotaxime against 751 clinical isolates of the Enterobacteriaceae family. In addition, the sensitivity of 211 mezlocillin-resistant gram-negative rods to BRL 17421 was also determined. Temocillin exhibited a high level of antibacterial activity against various bacterial species of the Enterobacteriaceae family, including isolates resistant to mezlocillin. The 90% MICs against Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Enterobacter cloacae, Salmonella spp., Yersinia spp. and indole-negative and indole-positive Proteus strains ranged from 0.5 mg/l to 16 mg/l. Concentrations of 16 mg/l were required to inhibit 80% of the Serratia marcescens strains; some isolates were resistant. No significant difference between MIC and MBC values was observed.

[Bacteriological investigations with a new Semisynthetic oxy-beta-lactam antibiotic LY 127935 (AUTHOR'S TRANSL)]. / Bakteriologische Untersuchungen mit einem neuen halbsynthetischen Oxy-Beta-Laktam-Antibiotikum LY 127935.

The antimicrobial activity of a new oxy-beta-lactam antibiotic LY 127935 against 1066 strains of gram-negative and gram-positive bacterial was evaluated in comparison to cephalothin. The antibiotic has a very wide spectrum and is exceptionally active, in particular against gram-negative rods. It is also active against multiresistant problem strains found in intensive care units (Enterobacter cloacae, Serratia marcescens, indole-positive Proteus), and proved to be quite effective against Pseudomonas aeruginosa. Although LY 127935 is effective against Staphylococcus aureus, cephalothin is superior. Its use is not indicated against Streptococcus faecalis.

[Hospital infections with pseudomonas aeruginosa. II. Intensive care units (author's transl)]. / Untersuchungen zum Hospitalismus durch Pseudomonas aeruginosa. II. Mitteilung: Pseudomonas-aeruginosa-Infektionen bei Intensivpflegepatienten: Infektkettenanalyse mittels Phagenlysotypie.

72 newly admitted patients of three surgical intensive care units of the Medical School Hannover were examined bacteriologically for pseudomonas aeruginosa for a period of 7 months. A total of 810 specimens was examined during therapy. 95 strains of pseudomonas aeruginosa were isolated in 32 of 72 patients, taken either at the time of admission or during the stay of the patients in the hospital. The frequency of contamination increased with the duration of the stay of the patients in the hospital as follows: 20 per cent at the time of admission, 71 per cent after 8 to 10-day stay and up to 100 per cent for a duration of stay exceeding 14 days. The germs were mainly localized in the nose-throat region and in the respiratory tract. The results of phage typing suggested a hospital infection in about 50 per cent of the patients. The relationship between infection and infectious disease was discussed with respect to the epidemiologic characteristics of intensive care units. Furthermore, it was attempted to formulate recommendations for interrupting or abolishing the infection chains.

[Hospital infections with pseudomonas aeruginosa: I. Technical devices and wet areas as sources of infection in intensive care units (author's transl)]. / Hospitalismus durch Pseudomonas aeruginosa. I. Technische Geräte und Nassbereiche als Infektionsquellen auf Intensivstationen.

In an intensive care unit system comprising three surgical intensive care wards bacteriologic investigations on the presence of Pseudomonas aeruginosa were carried out over a period of 7 months (as an example for the aetiology of hospital infections). Centers of contaminations were found to exist in wet areas and in technical devices (ultrasonic nebulizers, respirators etc.). In many cases, the bacterial strains isolated from patients were found by means of phage-typing to be identical with strains isolated from devices and wet areas. Additional experimental investigations showed the predominant role of ultrasonic nebulizers for germ dissemination. On the basis of the results obtained a patient oriented scheme of probable infection chains was tried to establish. Hereby the wet areas play a central role as reservoirs of germs and therapeutical devices as vectors. The results obtained were evaluated in order to define a catalogue of practical measures for interruption of infection chains.