The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. IKEMOTO et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed
In 23 institutions around the entire Japan, 567 strains of presumably etiological bacteria were isolated mainly from the sputa of 459 patients with lower respiratory tract infections during the period from October 1995 to September 1996. MICs of various antibacterial agents and antibiotics were determined against 74 strains of Staphylococcus aureus, 82 strains of Streptococcus pneumoniae, 104 strains of Haemophilus influenzae, 85 strains of Pseudomonas aeruginosa (non-mucoid strains), 18 strains of Pseudomonas aeruginosa (mucoid strains), 52 strains of Moraxella subgenus Branham-ella catarrhalis, 25 strains of Klebsiella pneumoniae etc., and the drug sceptibilities of these strains were assessed except for those strains that died during ransportation.
1) S. aureus
S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4μg/ml (methicillin-resistant S. aureus) accounted for 52.7%. Arbekacin (ABK) showed the most highest activity against S. aureus with MIC80, of 0.5μg/ml. Vancomycin (VCM) showed the next highest activity with MIC80, of 1μg/ml. These drugs showed the high activities against MRSA with MIC80s of 1μg/ml.
2) S. pneumoniae Most of drugs tested showed potent activities against S. pneumoniae. Imipenem (IPM) and panipenem (PAPM), carbapenems, showed the most potent activitiy with MIC80s of 0.063μg/ml. Cefotaxime (CTX), cefmenoxime (CMX) and cefpirome (CPR) of cephems showed the next most potent activities with MIC80s of 0.25μg/ml. Erythromycin (EM) and clindamycin (CLDM) showed low activities with MIC80s 128μg/ml or high. Among these strains, however, 48.8% and 65.9% of respective strains were quite toward sensitive these agents with MICs of 0.063μg/ml.
3) H. influenzae The activities of all drugs were potent against H. influenzae tested with all MICs at 4μg/ml or below. Cefotiam (CTM), CMX, cefditoren (CDTR) and ofloxacin (OFLX) showed the most potent activity with MIC90s of 0.063μg/ml.
4) P. aeruginosa (mucoid strains) IPM and tobramycin (TOB) showed the most potent activity against P. aeruginosa (mucoid strains) with MIC80s of 1μg/ml. Ceftazidime (CAZ), cefsulodin (CFS) and carumonam (CRMN) showed next potent activity, with MIC80s of 2μg/ml. The MIC80s of the other drugs ranged from 4μg/ml to 32μg/ml. May 1997 THE JAPANESE JOURNAL OF ANTIBIOTICS 50-5 459(39)
5) P. aeruginosa (non-mucoid strains) TOB and ciprofloxacin (CPFX) showed the most potent activities against P. aeruginosa (non-mucoid strains) with MIC80s of 1μg/ml. The MIC80 of ampicillin (ABPC) was 128μg/ml in 1994, it was 16μg/ml in 1995.
6) K. pneumoniae All drugs except ABPC were active against K. pneumoniae. CPR and CRMN showed the most potent activities against K. pneumoniae with MIC80s of 0.063μg/ml. The MIC80s of the other drugs ranged from 0.125μg/ml to 2μg/ml.
7) M.(B.) catarrhalis Against M.(B.) catarrhalis, all the drugs showed good activities with MIC80s at 4μg/ml or below. And MICs of all strains were 8μg/ml or below. IPM, OFLX and minocycline (MINO) showed the most potent activity with MIC80s of 0.063μg/ml. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. Patients' backgrounds were examine for 567 isolates from 459 cases. The examination of age distribution found that the proportion of patients with ages over 60 years was 66.3% of all the patients showing a slight increase over that in 1994. Proportions of different diseases were as follows.

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Enterococcus spp. isolated from surgical infections during the period from July 1982 to June 1995 were investigated in a multicenter study involving 19 hospitals in Japan, and the following results were obtained.
1. Though the isolation rate of Enterococcus faecalis and other Enterococcus spp. were not high from primary infections, and from postoperative infections the isolation rate of other Enterococcus spp. was also low, the isolation rate of E. faecalis was highest from postoperative infections after 1993.
2. Vancomycin (VCM) showed strongest activity against E. faecalis, and followed by those of ampicillin (ABPC), imipenem, levofloxacin (LVFX) and meropenem in this order. Against other Enterococcus spp., VCM showed strongest activity, and followed by those of ABPC and LVFX. There were no resistant strains against VCM.

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In 95 patients with abnormal vaginal and cervical secreta (49 pregnant women and 46 non-pregnant women), the relation between intravaginal flora and intravaginal glanulocyte elastase (Elastase) and pH was investigated. The results were as follows.
1) Gram-positive bacteria were detected in the vaginal secreta at a high rate (87/144, 60.4%), and it mainly consisted of Lactobacillus sp.(67/142, 46.5%). It was followed by anaerobia (26/144, 18.1%) and fungi (26/144, 18.1%).
2) The patients with cervicitis or vaginitis had higher elastase value (6.65-6.69 ktg/ml) than the ones with vaginal erosion, and the patients who showed an intravaginal pH value not lower than 5.0 had significantly increased elastase value (6.44±1.40μg/ml) than the patients who showed the values 4.5 or higher.
3) Regarding the relation between the detected bacteria and elastase values, elastase values were higher in the patients infected by anaerobia (6.58±1.40μg/ml), Gram-negative bacteria (6.01±3.61μg/ml), Gram-positive bacteria (5.02±0.94μg/ml) and fungi (5.14±1.08μg/ml) than the values in patients with Lactobacillus sp.(pH<4.5). Further, the intravaginal pH value was higher than 4.5 in all of these groups, which was higher compared with the one in the patients infected with Lactobacillus sp.(4.04±0.04).

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Generally, clinical symptoms such as abnormal leukorrhea are caused by C. trachomatis, an ordinary bacteria in cervical infection.
The effects of levofloxacin administration at a dose of 300 mg/day for 5-14 days were investigated in the subjects (n=66) after the discussion of cystic cervicitis.
The treatment was made in combination with chloramphenicol?solcoseryl tablet for vaginal use.And it was demonstrated that treatment was effective in all subjects. Then, Sero IPALISA, an examination of IgA/IgG antibody was conducted for the screening of Chlamydia infection (n=258). The rate of antibody-positive case was 48/160 (30.0%) for the non-pregnant women and 26/98 (26.5%) for the pregnant. The occurrence rates for the women sanging in 15-24 and 35-39 years of age were 50 and 41%, respectively.
The results from the measurement of the antibody titer were as follows: the rate of IgA/IgG positive care was 61/87 for IgA and 56/87 for IgG when the cut-off index was 1.11 or more. The rates for both antibody were 11/87 (12.6%) and 24/87 (27.6%) for the indexes of 1.11-3.00 and 3.01 or more, respectively.
Next, one to three courses of levofloxacin at 300 mg/day for 14 days were given to 48 non-pregnant subjects infected with Chlamydia and one to two courses of clarithromycin at 400 mg/day for 14 days were given to 26 pregnant subjects. Side effects have not been noted in any care and there was no changes in the IgA/IgG antibody titer depending on these treatments.

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