The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 848 bacterial strains isolated from patients with urinary tract infections in 10 hospitals during the period of June 1990 to May 1991. Of the above total bacterial isolates, Gram-positive bacteria accounted for 23.9% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 76.1% and most of them were Escherichia coli.
1. Enterococcus faecalis
Ampicillin (ABPC), imipenem (IPM) and vancomycin (VCM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC₉₀s of them were 2μg/ml Piperacillin (PIPC) was also active with the MIC₉₀ of 4μg/ml. The others were not so active with the MIC90s of 32μg/ml or above.
2. Staphylococcus aureus
VCM and arbekacin (ABK) showed the highest activities against S. aureus isolated from patients with urinary tract infections. The MIC₉₀s of them were 1μg/ml. The others were not so active with the MIC9s of 32μg/ml or above.
3. Escherichia coli
Cefozopran (CZOP), carumonam (CRMN) and ofloxacin (OFLX) showed the highest activities against E. coli isolated from patients with urinary tract infections. The MIC₉₀s of them were of 0.125μg/ml or below. IPM, cefotiam (CTM) and cefmenoxime (CMX) were also active with the MIC₉₀s of 0.25μg/ml. Penicillins were not so active with the MIC₉₀s of 32μg/ml or above.
4. Klebsiella pneumoniae
Flomoxef (FMOX), cefixime (CFIX), CZOP and CRMN showed the highest activities against K. pneumoniae isolated from patients with urinary tract infections. The MIC₉₀s of them were of 0.125μg/ml or below. IPM and gentamicin (GM) were also active with the MIC₉₀s of 0.25μg/ml and 0.5μg/ml, respectively. All other cephems were also active with the MIC90s of 4μg/ml or below.
5. Citrobacter freundii
GM and IPM showed the highest activities against C. freundii isolated from patients with urinary tract infections. The MIC₉₀s of them were 1μg/ml. Amikacin (AMK) was also active with the MIC₉₀ of 4μg/ml. The others were not so active.
6. Enterobacter cloacae
IPM and GM showed the highest activities against E. cloacae isolated from patients with urinary tract infections. The MIC₉₀s of them MIC₉₀s of 0.5μg/ml. AMK and OFLX were also active with the MIC9s of 4μg/ml. Penicillins and cephems generally showed lower activities.
7. Proteus mirabilis
Most of the agents were active against P. mirabilis. Cephems were generally active with the MIC90s in a range of ≤0.125μg/ml-4μg/ml. CRMN, OFLX and PIPC were also active with the MIC₉₀s in a range of ≤0.125μg/ml-0.5μg/ml. But minocycline (MINO) was not so active with the MIC₉₀ of 64μg/ml.
8. Serratia marcescens
Most of the agents were not so active against S. marcescens. Comparatively, CRMN was active with the MIC₉₀ of 16μg/ml. Penicillins and cephems were not active with the MIC₉₀s of over than 256μg/ml.
9. Pseudomonas aeruginosa
Most of the agents were not so active against P. aeruginosa. IPM showed the MIC₉₀ of 16μg/ml, CAZ, CZOP and aztreonam (AZT) showed the MIC₉₀ of 32μg/ml.

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Clinical background was investigated on 861 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period from June, 1990 to May, 1991.
1. Distribution of sex, age and infections
Among over fifties males, the complicated urinary tract infections was most frequent. Among Females, the uncomplicated urinary tract infections was most frequent without a relation of age.
2. Distribution of sex, age and pathogens isolated from UTIs
In uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age. In complicated UTIs without indwelling catheter,E. coli and Enterococcus faecalis were isolated with a frequency of 20-30%, respectively. In complicated UTIs with indwelling catheter, Pseudomonas aeruginosa were most frequently isolated, and next E. faecalis.
3. Administration of antibiotics and pathogens isolated from UTIs
In uncomplicated UTIs and complicated UTIs without indwelling catheter, pathoges, after administration of antibiotics, isolated from patients have obviously decreased. In complicated UTIs with indwelling catheter, pathogens, before and after administration of antibiotics, isolated from patients were not decreased. And the distribution of pathogens after administration of antibiotics was similar.

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Susceptibilities of Enterococcus faecalis, Citrobacter spp.,Enterobacter spp.,Escherichia coli,Klebsiella spp.,Proteus mirabilis, Pseudomonas aeruginosa, Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1990 to May 1991 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter.
The susceptibilities of E. faecalis to minocycline (MINO) and ofloxacin (OFLX) has decreased. As for Citrobacter spp.,Enterobacter spp. and P. mirabilis, which were detected very few in 1989 and 1990, their susceptibilities were not observed an obvious change. The susceptibilities of E. coli to MINO was observed a very clear alteration, that is, in uncomplicated UTIs and complicated UTIs, the susceptibilities has decreased. However, the susceptibilities of Klebsiella spp.,P. aeruginosa and Serratia spp. were not observed an obvious variation.

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The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 751 bacterial strains isolated from patients with urinary tract infections in 11 hospitals during the period of June 1991 to May 1992. Of the above total bacterial isolates, Gram-positive bacteria accounted for 28.6% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 71.4% and most of them were Escherichia coli.
1.Enterococcus faecalis
Ampicillin (ABPC), imipenem (IPM) and vancomycin (VCM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC₉₀s of them were 2μg/ml. Piperacillin (PIPC) and chloramphenicol (CP) were also active with the MIC₉₀s of 8μg/ml. The others were not so active with the MIC₉₀s of 32μg/ml or above.
2.Staphylococcus aureus including MRSA
Arbekacin (ABK) showed the highest activities against S. aureus isolated from patients with urinary tract infections. Its MIC90 was 0.5μg/ml. VCM was also active with its MIC90 of 1μg/ml. The others were not so active with the MIC₉₀s of 32μg/ml or above.
3.Citrobacter freundii
Ciprofloxacin (CPFX) showed the highest activities against C. freundii isolated from patients with urinary tract infections. Its MIC₉₀ was 0.5μg/ml. IPM, gentamicin (GM), ABK and norfloxacin (NFLX) were also active with the MIC₉₀s of 1μg/ml. Penicillins and cephems were not so active.
4.Enterobacter cloacae
IPM showed the highest activities against E. cloacae isolated from patients with urinary tract infections. Its MIC₉₀ was 0.5μg/ml. CPFX was also active with the MIC₉₀ of 2μg/ml. Aminoglycosides were active comparatively. The MIC₉₀s of them were 4μg/ml. Penicillins and cephems generally showed lower activities.
5.Escherichia coli
IPM and ciprofloxacin (CPFX) showed the highest activities against E. coli isolated from patients with urinary tract infections. The MIC₉₀s of them were 0.125μg/ml or below. Flomoxef (FMOX), cefmenoxime (CMX), cefuzonam (CZON), latamoxef (LMOX), norfloxacin (NFLX) and ofloxacin (OFLX) were also active with the MIC₉₀s of 0.25μg/ml. Penicillins except mecillinam (MPC) were not so active showing the MIC₉₀s of 32μg/ml or above.
6.Klebsiella pneumoniae
IPM showed the highest activities against K. pneumoniae isolated from patients with urinary tract infections. Its MIC₉₀ was 0.25μg/ml. Gentamicin (GM) and arbekacin (ABK) were also active with the MIC₉₀s of 0.5μg/ml, respectively. But minocycline (MINO) and penicillins were not so active showing the MIC₉₀s of 32μg/ml or above.
7. Proteus mirabilis
Most of the agents were active against P. mirabilis. Cephems except CEZ were generally active with the MIC90s in a range of ≤0.125μg/ml-2μg/ml. CRMN, NFLX, OFLX and CPFX were also active with the MIC₉₀s of 0.125μg/ml or below. Penicillins were not so active.
8.Pseudomonas aeruginosa
Most of the agents were not so active against P. aeruginosa. IPM showed the MIC₉₀ of 8μg/ml. CAZ, CRMN and AMK showed the MIC₉₀s of 32μg/ml. IPM and TOB showed the MIC₅₀s of 1μg/ml, 2μg/ml, respectively.
9.Serratia marcescens
Most of the agents were not so active against S. marcescens. Comparatively, IPM was active with the MIC₉₀ of 2μg/ml. CAZ, CRMN and ABK showed the MIC₉₀s of 16mu;g/ml. Penicillins and cephems except CAZ were not active showing the MIC₉₀s of 64μg/ml or above.

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Clinical background was investigated on 632 bacterial strains isolated from patients with urinary tract infections (UTIs) in 11 hospitals during the period from June, 1991 to May, 1992.
1. Distribution of sex, age and infections
Among over forties males, the majority was taken by complicated urinary tract infec tions. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age.
2. Distribution of sex, age and pathogens isolated from UTIs
In uncomplicated UTIs,Escherichia coli was most frequently isolated without a relation of age, and next Enterococcus faecalis in over fifties. In complicated UTIs without indwelling catheter, E. coli and E. faecalis were isolated with a frequency of 17.4-26.6%, respectively. In complicated UTIs with indwelling catheter, E. faecalis were most frequently isolated, and next Pseudomonas aeruginosa.
3. Administration of antibiotics and pathogens isolated from UTIs
In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 319 to 34 isolates. And also, pathogens of complicated UTIs without indwelling catheter, have decreased from 122 to 49 isolates. However, in complicated UTIs with indwelling catheter, pathogens after or before administration of antibiotics, were not revealed an obvious change.
4. Pathogens and UTIs with or without factor and operation
In uncomplicated UTIs with or without factor and operation,E. coli was mainly detected. In complicated UTIs without indwelling catheter and with or without factor and operation,E. faecalis and E. coli were mainly detected. In complicated UTIs with indwelling catheter and with factor and operation, E. faecalis and P. aeruginosa were detected, 24.3% and 22.9%, respectively. Without factor and operation, E. faecalis was detected 18.4%, and next Klebsiella spp. 15.8%. And the distribution of pathogens after administration of antibiotics was similar.

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Susceptibilities of Enterococcus faecalis, Citrobacter spp.,Enterobacter spp.,Escherichia coli, Klebsiella spp.,Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June 1991 to May 1992 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter.
The susceptibilities of E. faecalis to cefmenoxime and amikacin has decreased. As for Citrobacter spp.,Enterobacter spp.,P. mirabilis and Serratia spp., which were detected very few in 1989, 1990 and 1991, their susceptibilities were not observed an obvious change.
The susceptibilities of E. coli to minocycline was observed a very clear alteration, that is, in uncomplicated UTIs and complicated UTIs without indwelling catheter, the susceptibilities has decreased. However, the susceptibilities of Klebsiella spp. was not observed an obvious variation.
The susceptibilities of P. aeruginosa to quinolones isolated from uncomplicated UTIs has clearly decreased.
These data should be considered in clinical treatment of various urinary tract infections.

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Using clinically isolated 114 strains of Pseudomonas aeruginosa that were collected from April to October 1994, activity of antipseudomonal agents against these organisms was determined using the method of liquid microdilution. In addition, antimicrobial activities of the agents were graded according to serological groups of organisms. The results of this study are summarized as follows.
1. Many strains of P. aeruginosa were isolated mainly from sputum, pus and urine.
2. Serological group G organisms of sputum origin, group I of pus and bile origin, and group E of urine origin were isolated most frequently.
3. The most powerful antipseudomonal agent was cefclidin. Its MIC₅₀ and MIC₉₀ were 0.78 and 6.25μg/ml, respectively. The second most powerful agent was ciprofloxacin whose MIC₅₀ and MIC₉₀ were 0.39 and 12.5μg/ml, respectively.
4. The proportions of resistant strains ranged from 0.9% for cefclidin to 40.4% for ofloxacin. The antipseudomonal agents to which 30% or more of strains were resistant were cefpirome, gentamicin and ofloxacin.
5. Cefclidin showed the most powerful activity against strains that were resistant to ceftazidime, imipenem, gentamicin and ofloxacin. Its MIC₉₀ against all strains resistant to ceftazidime, gentamicin and ofloxacin was 6.25μg/mi. The MIC₉₀ of cefclidin and tobramycin against imipenemresistant strains was 3.13μg/ml.
6. Group E organisms were found among strains resistant to ceftazidime, gentamicin and ofloxacin at high rates, but no group E strains were found among imipenem-resistant organisms.
7. Agents with highest activities by serological group of organisms were cefclidin against group A, tobramycin and ciprofloxacin against group B, imipenem against group E, ciprofloxacin against group G, and cefclidin and ciprofloxacin against group I. The MIC₉₀ of these agents against these serological groups of organisms was distributed in a range of 3.13μg/ml or less.
8. There were 56 multiple drug-resistant strains (49.1%). All strains (12) of group E were resistant to 7 to 9 different antipseudomonal agents. Group E organisms showed stronger multiple drug resistance than organisms of other serological types.

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MICs of imipenem (IPM), panipenem (PAPM), cefozopran (CZOP), cefpirome (CPR), gentamicin (GM), tobramycin (TOB) and amikacin (AMK) against Pseudomonas aeruginosa were determined using Mueller-Hinton agar and low-amino-acid agar. On Mueller-Hinton agar, the antibacterial activity of TOB was superlative, followed in order by GM, CZOP, IPM, AMK, PAPM and CPR, whereas on low-amino-acid agar, the order changed to IPM, PAPM, TOB, CZOP, GM, AMK and CPR. The largest decrease of MICs was seen with PAPM on low-amino-acid agar, and the antibacterial activity of PAPM was not stronger than that of IPM. The growth of P. aeruginosa on the low-amino-acid agar were significantly weaker than that on Mueller-Hinton agar, hence the evaluation of appearance colonies was difficult and misjudgement may result. Based on the above observations, we believe further investigations are needed before the application of low-amino-acid agar becomes routine.

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