[in Japanese]

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Two hundred and thirteen clinical strains of coagulase-negative staphylococci isolated in Japan between 1980 and 1997 were analyzed for glycopeptide susceptibility by determing MIC using both Mueller-Hinton agar (MHA) and Brain Heart Infusion agar (BHIA) plates. Of 37 Staphylococcus epidermidis strains isolated between 1980 and 1981, all were susceptible to vancomycin and teicoplanin on both MHA and BHIA. However, of 122 isolates of Staphilococcus epidermidis isolated between 1994 and 1997, 1 (0.8%) was intermediate to vancomycin on MHA and 39 (32%) were intermediate on BHIA, while 3 (2.5%) and 27 (22.1%) were intermediate or resistant to teicoplanin on MHA and BHIA, respectively. It was demonstrated that the susceptibilities of the strains in 1990s to vancomycin and teicoplanin were significantly decreased compared with those in 1980s. Population analysis was performed with six strains each of Staphylococcus epidermidis and Staphylococcus haemolyticus (three with vancomycin MIC≥8μg/ml and three with vancomycin MIC≤4μg/ml using BHIA). The population curves of the Staphylococcus epidermidis strains showed a homogeneous pattern of susceptibility.Whereas, those for two Staphylococcus haemolyticus strains (vancomycin MIC=8, 12g/ml using BHIA) showed a typical heterogeneous pattern. Vancomycin-resistant mutants (MIC≥32μg/ml) were obtained with a high frequency of 10^-4-5 from the strains by one-step selection with 16μg/ml of vancomycin.

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Clinical efficacy and safety of pareteral sulbactam/ampicillin (SBT/ABPC) was compared with cefotiam (CTM) in a randomized clinical trial of pneumonia in the elderly at 13 National Hospitals of Kyushu island. 37 patients received SBT/ABPC 3 g i.v., b.i.d., and 31 patients received CTM 1 g i.v., b.i.d. for 7 to 14 days.
1. 68 patients (37 for SBT/ABPC and 31 for CTM) were evaluated for safety. No statistical differences were noted in the patients' backgrounds of either group.
2. The clinical efficacy of SBT/ABPC was 96.3% (26/27 cases) while CTM was 75.2% (17/23 cases). This was found to be statistically significant (Fisher's exact test: p<0.05).
3. 100% of evaluated cases (10 for SBT/ABPC and 4 for CTM) showed bacterial elimination.
4. No side effects were observed in the study.
5. Abnormal laboratory findings were noted in 10.8% (4/37 cases) for SBT/ABPC and 3.2% (1/31 cases) for CTM. The major adverse events were mild elevation of GOT, GPT and Al-P for SBT/ABPC, and mild platelets overproduction for CTM. No statistical differences were noted in both groups. These results are consistent with SBT/ABPC as a highly effective antibiotic in the treatment of elderly patients with pneumonia.

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Ecological treatment of bacterial vaginosis and vaginitis with a Bio-three was studied, and the following results were obtained.
1. A total of 16 women with bacterial vaginosis and vaginitis were treated with intravaginal application of 2 g of Bio-three (E. faecalis T-110, C. butyricum TO-A, B. mesentericus TO-A, pH 6.9-0.3). The effect of the treatment was evaluated 3 days after administration by monitoring the vaginal discharge and bacteriological assessment.
2. The clinical improvement was evaluated and the decreases of vaginal discharge and vaginal redness were significant and vaginal pH was lowered significantly (5.29±0.24 vs. 4.31±0.37, p<0.05).
In the vaginal discharge 35 strains of bacteria were detected, but 3 days after administration, 16/30 strains of Gram-positive bacteria, and 2 strains of Gram-negative bacteria disappeared. As for the overall bacteriological effects, 7/16 cases were eradicated, 1 case was partly eradicated, 6 cases were replaced.
These findings indicated that the Bio-three therapy was effective in both clinical and bacteriological responses.

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The results of the semi-annual nationwide surveillance of antimicrobial susceptibilities, conducted by the Japanese Ministry of Health and Welfare during the period of January 1993 to July 1995, were analyzed for typical Gram-positive cocci and Gram-negative cocci in the purpose of provision of an index for antimicrobial selection.
During these 3 years, Streptococcus pyogenes (group A) and Streptococcus agalactiae (group B) showed slightly increasing tendency in susceptibility to ofloxacin (OFLX) and sulfamethoxazole/trimethoprim (ST), while Streptococcus pneumoniae and Moraxella (Branhamella) catarrhalis showed slightly decreasing tendency to cefaclor (CCL). However, these annual changes were almost negligible.
Generally, these microorganisms showed relatively good susceptibilities, every year, to the principal antimicrobial agents being approved for use against Gram-positive and-negative cocci. However, Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecalis showed tendencies of decreased susceptibility to some of the antimicrobial agents.
On the other hand, cefmetazole (CMZ), vancomycin (VCM), latamoxef (LMOX), ST and minocycline (MINO) showed good activities against some of the Gram-positive and-negative cocci to which no indication are approved. In conclusion, beside the identification of the causative microorganisms and the performance of antimicrobial susceptibility testing, such analyses (graphics of susceptibility tendency of clinical isolates to variety of antimicrobial agents) could be used as an index for selection of antimicrobial agents, when emergent and urgent selection of an antimicrobial agent isnecessary.

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