Spread of serious disease-producing M3 clones of group A streptococcus among family members and health care workers.

Streptococcus pyogenes causes a variety of diseases ranging from mild pharyngitis to severe toxic shock syndrome (TSS) and acute rheumatic fever. Since 1987 there has been a resurgence of severe group A streptococcus infections including TSS, necrotizing fasciitis, and myositis. Using molecular and serotyping procedures, we recently studied two clusters of group A streptococcus disease that occurred within separate family units. The first cluster involved two family members (one with TSS and one with necrotizing fasciitis) and three health care workers who attended one of the index patients. The second cluster included a mother (with necrotizing fasciitis of the hand) and her three children. Group A streptococci isolated from individuals within both cluster groups were serotype M3;T3/13/B3264, and pulsed field gel electrophoresis revealed that all isolates except one had identical fingerprints of Sma I-digested chromosomal DNA. The findings demonstrate the potential for spread of serious group A streptococcus disease among individuals and the need for barrier protection when health care workers are exposed to secretions from infected individuals.

Multicentered clinical evaluation of cefoperazone for the treatment of lower respiratory tract infections.

Adult patients with bacterial infections of the lower respiratory tract were given either cefoperazone or cefamandole in a multicenter clinical study of the clinical and bacteriologic efficacy of cefoperazone. Clinical diagnoses included pneumonia, bronchitis, lung abscess, and bronchiectasis. Efficacy was evaluated in 119 patients given cefoperazone and 73 patients given cefamandole. Major pathogens isolated included Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Satisfactory clinical responses were noted for 96% of the patients in both treatment groups, including 14 of 17 patients given cefoperazone who were primarily infected with P. aeruginosa. Satisfactory bacteriologic responses were noted for 88% of the group given cefoperazone and 89% of the group given cefamandole. Adverse reactions related to the antibiotic occurred infrequently in each treatment group. The results of this study indicate that cefoperazone is a safe and effective antibiotic for the treatment of lower respiratory tract infections due to S. pneumoniae, H. influenzae, S. aureus, and many gram-negative bacilli, including susceptible strains of P. aeruginosa, in adult patients.

Cefoperazone versus cefamandole in the treatment of acute bacterial lower respiratory tract infections.

In a randomized comparative study, 113 patients were treated with cefoperazone or cefamandole for acute bacterial lower respiratory tract infections. Most patients had Streptococcus pneumoniae or Haemophilus influenzae infections, although five patients in the cefoperazone group had infections caused by other Gram-negative bacilli (two with Pseudomonas aeruginosa). The clinical responses and adverse effects were not significantly different between the two treatment groups. Satisfactory clinical responses occurred in 36/39 (92%) of evaluable patients in the cefoperazone group and 33/34 (97%) of evaluable patients treated with cefamandole. Two failures in the cefoperazone group were secondary to superinfection (Acinetobacter and Ps. aeruginosa). Bacteriological and symptomatic failure occurred in one patient with Ps. aeruginosa lung abscess treated with cefoperazone and in one patient with a polymicrobial empyema treated with cefamandole. The results of this study indicate that cefoperazone is safe and effective in the therapy of acute bacterial lower respiratory tract infections.

Clindamycin and gentamicin for aerobic and anaerobic sepsis.

Thirty-eight adult patients with serious pleuropulmonary, soft-tissue, bone, and intra-abdominal infections caused by combinations of aerobic, facultative, and anaerobic bacteria were treated with parenterally given clindamycin phosphate and gentamicin sulfate and surgery when appropriate. Nine had associated bacteremia. In 29, infections failed to respond to other therapeutic regimens, which included penicillins, cephalosporins, aminoglycosides, and chloramphenicol. Results with clindamycin and gentamicin were excellent and were attributed primarily to the activity of clindamycin against anaerobes, particularly Bacteroides fragilis. Serum concentrations of clindamycin surpassed by manyfold the minimal inhibitory concentrations (MICs) for anaerobes. Serum concentrations of gentamicin did not consistently surpass the MICs for Enterobacteriaceae and Pseudomonas aeruginosa, although those organisms were consistently gentamicinsusceptible by disk diffusion susceptibility tests. Persistent colonization with Enterobacteriaceae, P aeruginosa, enterococci, or Candida were common, and occasionally they were significant in prolonging the clinical courses of patients with extensive infections.

Tobramycin: in vitro and clinical evaluation in 30 patients.

Clinical evaluation of intramuscular tobramycin was accomplished in 30 patients with respiratory, soft tissue, urinary tract, bone or septicemic infections due to gram negative bacilli. Median sensitivity to tobramycin of Pseudomonas aeruginosa isolates (19 strains) was 0.62 mug/ml and range 0.31-2.5 mug/ml; less activity was observed for Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae and Enterobacter species isolates but median minimum inhibitory concentrations were less than or equal to 2.5 mug/ml. Therapy resulted in clinical and bacteriologic cures in 16 patients (53 per cent) including 13 of 16 (181 per cent) with urinary tract infections; 9 of the 14 patients who did not obtain bacteriologic cure had satisfactory clinical responses. Tobramycin was effective for selected gram negative bacillary infections and particularly for P. aeruginosa.

Fluid and pharmacological dynamics in a subcutaneous chamber implanted in rats.

Antibiotic dynamics in the fluid obtained from subcutaneously implanted chambers in rats were similar to those observed in serum following single intramuscular injections of carbenicillin.