Since 1979, IKENiaro et al. have been retrospectively surveying the sensitivity ofmajor 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 bacteriaaccounted 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.
8. Proteus mirabilis was sensitive to a majority of drugs, including CMX, LMOX, CAZ, CZON and FMOX, all of which are third generation cephems, CRMN, a monobactam, and new quinolones, OFLX and CPFX.
9. Serratia marcescens was moderately sensitive to CRMN, a monobactam, and OFLX and CPFX, which are new quinolones but was only slightly sensitive to many other drugs.
10. P. aeruginosa was slightly sensitive to drugs on the whole but was moderately sensitive to IPM, CAZ, cefsulodin, and CRMN.

View full abstract

In the retrospective survey of the sensitivity of clinical isolates reported in this journal, patients' backgrounds were also investigated. Some findings are summarized below.
1. Age distribution by sex: Patients with ages 50 years and older accounted for a majority, irrespective of their sexes amounting 67.6% for both sexes combined.
2. Annual distribution of sexes by age group: Females accounted for a majority in younger age brackets, but the proportion of males increased with age, accounting for a majority in patients 70 years or older. This pattern has been repeated practically every year.
3. Distribution of infection types by sex: Complicated urinary tract infections were predominant in males, while simple urinary tract infections were more frequent in females.
4. Annual distribution of sexes by type of infection: Complicated and simple urinary tract infections combined accounted for approximately 70% in both males and females. This pattern has been repeated practically every year.
5. Distribution of infection types by age: Patients of advanced ages were predominant as a whole but this trend was particularly pronounced in complicated urinary tract infection cases.
6. Annual distribution of infection types by age: The frequency of simple urinary tract infections among patients older than 20 years of age declined with age and this pattern has been repeated practically every year. Among patients older than 20 years of age, annual frequencies of complicated urinary tract infections heve been on the decrease.
7. Distribution of isolated bacteria by sex: Escherichia coli was more frequent in females, while Enterococcus faecalis and Pseudomonas aeruginosa were more frequent in males. Compared with the previous year, the frequencies of coagulase-negative staphylococci, Enterococcus spp., and E. coli increased, while that of P. aeruginosa decreased.
8. Distribution of isolated bacteria by age: E. coli was most frequent on the whole, followed by E.faecalis, P. aeruginosa, Klebsiella spp., and coagulase-negative staphylococci, in that order. By age group, E. coli was frequent in younger patients and the frequencies of E. faecalis and P. aeruginosa increased with age.
9. Annual distribution of isolated bacteria by infection type: Coagulase-negative staphylococci increased as a whole and P. aeruginosa and Serratia marcescens decreased compared to 1986, but E.coli continued to be the most frequent. E. coli was isolated from a majority of simple urinary tract infection cases. The frequencies of E. faecalis and P. aeruginosa were high in cases of complicated urinary tract infections.
10. Relationship between duration of treatment with different antibacterial or antibiotic agents and isolated bacteria: The frequency of E. coli had been high before administration but decreased as treatment duration increased; whereas, E. faecalis and P. aeruginosa were found with increased frequencies. Compared to 1986, the frequencies of E. coli and P. aeruginosa declined on the whole, while those of E. faecalis and coagulase-negative staphylococci increased.

View full abstract

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 sinsitivities, 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.

View full abstract

Four cases of postoperative meningitis caused by methicillin-resistant Staphylococcus aureus (MRSA) are reported together with a review of the literature. These 4 cases were treated successfully by intravenous administration of minomycin, fosfomycin, and cefmetazole. Factors associated with the development of meningitis included multiple craniotomies, the presence of ventricular drainage or a ventriculo-peritoneal shunt, and irradiation.

View full abstract

Clinical and bacteriological efficacies of sulbactam/cefoperazone (SBT/CPZ) were studied in 44 patients with serious infections associated with hematological malignacy.
1. SBT/CPZ was clinically effective in 33 cases (76.7%). Excellent effects were obtained in 23 cases, good effects in 10 cases and fairly good effects in 7 cases. Clinical effectiveness of SBT/CPZ was not dependent on neutrophil number in peripheral blood.
2. Bacteriologically SBT/CPZ was effective against all of the isolated organisms from 21 cases.
3. Adverse reactions were not significant except one case with eruption, 2 cases with abnormalities in hepatic function tests and 3 cases with abnomalities in renal function tests.

View full abstract

1. A macrolide antibiotic acetylspiramycin (ASPM) was separated into seven fractions using high performance liquid chromatography (HPLC) with Lichrosorb RP-8 and mobile phase of a mixed solvent of 0.025M phosphate ammonium (pH 7.4) and acetonitrile at a ratio of 10: 18.
2. Five components were purified over 90%, and analyzed using mass spectroscopy, ¹H NMR, and ¹³CNMR, and their chemical structures were determined as 4″-acetylspiramycin I, 4″-acetylspiramycin II, 4″-acetylspiramycin III, 3″, 4″-diacetylspiramycin II and 3″, 4″-diacetylspiramycin III, respectively.
3. The weight component ratio of the seven fractions of ASPM separated by HPLC was constant throughout several lots of ASPM which had been stocked for nearly 15 years at room temperature, indicating an excellent chemical stability of the antibiotic.
4. Some physicochemical parameters were determined for the five ASPM components. Solubilities in water at 24°C were in a range from 0.14 mg/ml to 4.9 mg/ml, and they were, in the decreasing order, 3″, 4″-diacetylspiramycin III, 3″, 4″-diacetylspiramycin II, 4″-acetylspiramycin III, 4″-acetylspiramycin II, and 4″-acetylspiramycin I.
Relationships between solubilities and numbers an positions of acyl substituents in spiramycin molecule are discussed.

View full abstract

Ceftazidime (CAZ) was administered to 51 patients (37 males, 14 females) with respiratory infections including severe cases, acompanied by various underlying respiratory diseases. The clinical efficacy and side effects of CAZ were investigated.
The mean age and body weight of these 51 cases were 62.6 years and 48.0 kg, respectively. CAZ was administered by intravenous drip infusion (daily dose of 2-4 g) for a mean of 14.7 days to a mean total dose of 56.7 g.
Clinical efficacy rates were 64% (18 of 28 cases), 80% (16 of 20 cases) and 67% (2 of 3 cases) for airway and intermediary regional infections, pneumonia (including lung abscess) and pyothorax, respectively. In the bacteriological study, efficacy rates and bacterial eradication rates were 69% and 67%, 33% and 20%, 100% and 100%, and 100% and 100% for infections caused by Pseudomonas aeruginosa (13 cases), Stapylococcus aureus (6 cases), Streptococcus pneumoniae (6 cases) and Klebsiella pneumoniae (4 cases), respectively, and bacterial eradication was achieved in both of 2 cases of Peptostreptococcus anaerobius and 2 cases of Haemophilus influenzae, and 1 case each of Peptococcus sp., Fusobacterium necrophorum and Serratia marcescens. Side effects observed were eruption in 1 case (2%) and elevated GOT, GPT and Al-P values in 1 case (2%), but these cases tended to recover after CAZ treatment was discontinued.

View full abstract

Cefbuperazone (CBPZ) was given in 15 patients after surgery. There was no infections except for 1 case in which signs of infections were suspected. As side effects, slight elevations in hepatic transaminase levels were observed in 3 patients during the CBPZ chemotherapy.
CBPZ concentrations in 7 patients were studied. The subjects were divided into 3 groups according to CT findings during the chemotherapy to correlate CBPZ concentrations to degrees of blood-brain barrier lesions; Group I: no enhancement, Group II: mild or focal enhancement, Group III: diffuse and marked enhancement.
It was interesting to note that the more marked enhancement were obtained, the higher levels of CSF concentration of CBPZ.

View full abstract

[in Japanese]

View full abstract