For many years, the history of surgery has been a history of fighting infection. Perioperative infection is as a result of risk during the preoperative, intraoperative, or postoperative periods, Postoperative infection, related to intraoperative procedures, and patient management accompanied to an operation, generates after operation, and is the most common complication among Postoperative complication, It is no exaggeration to say how to make a satisfactory postoperative result is influenced by the reduction of postoperative infection. For past decades, granting a preoperative patient to be not infected, a large amount of strong-acting, broad-spectrum agent for an antibiotic prophylaxis in a long period of postoperative time could be considered for routine in the prevention. Based of misunderstanding, the overconfidence, and the blind belief to an antibacterial potential, resulted in an inappropriate use of antibiotic prophylaxis in surgical patients, and an evil influence on the development drug-resistant strain such as the increasingly serious problem of methicillin-resistant Staphylococcus aureus (MRSA) infections, With this as a turning point, which lead to improvements in the choice of prophylactic antibiotic agents, and its usage emphasized the necessity for taking appropriate measures and for taking fully consideration to the wound contamination class and the resident flora of the intestine and the other. The Japanese Society of Chemotherapy and The Japanese Association for Infections Disease jpintly published a recommendation handbook supported by scrutinized discussions and consensus meetings held in the congresses of surgery and/or chemotherapy, was published: Practical Recommendations for Antimicrobial Therapy. The keypoint is 1) the use of antibiotic prophylaxis which has sufficient antimicrobial activity for a target (expected) causative pathogens, and which could maintain homeostasis of resident flora neither superinfection nor a resistant strain can appear easily, and 2) clearly distinguish “prophylactic agents” and “therapeutic agents.” Administration of a prophylactic agent may be just started before operation, and requiring a short time of duration, should not exceed 3-4 days including the day of surgery. After 3 days, if a postoperative infection is found or suspected, therapeutic agent administration must be selected. The CDC has also already detailed recommendation to antimicrobial prophylaxis. There are, however, some problems in application those recommendations to Japan, because there are many differences in the management of surgery between Japan and Western countries. The author suggested an urgent need for randomized control trials and surveillance in the country based on these guidelines.

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We surveyed the 418 clinical Streptococcus pneumoniae samples isolated from the nasopharynges of 300 infants and children with acute otitis media between April 2001 and December 2001 using PCR. We reviewed these samples for transmutation of penicillin-binding proteins and genetic transmission of macrolides tolerance. The genes reviewed were 1) LytA gene, 2) pbp 1a gene, 3) pbp 2b gene, 4) pbp 2x gene, 5) ermB gene, and 6) mefA gene. The classification of detected S. pneumoniae was PSSP 34 strains (8.1%); pbp 1a-independent variation 1 strain of PISP 147 strains (35.2%); pbp 2 b-independent transmutation 4 strains; pbp 2x-independent transmutation 73 strains; pbp 1a+pbp 2b-transmutation 0 strains; pbp 1a+pbp 2x-transmutation 44 strains; pbp 2b+pbp 2x-transmutation 25 strains; and PRSP 237 strains (56.7%). According to the macrolides tolerance gene, 143 of (35%) 418 strains (35%) demonstrated the ermB gene, 131 strains (31%) demonstrated the mefA gene-independent containment stock, both genes were found in 13 strains (3%), and 131 strains (31%) did not maintain a macrolides tolerance gene. With regard to pbp gene variation and eruption of a macrolides tolerance gene, the macrolides tolerance genetic detection coefficient increased to 81.0% in PRSP and 61.2% in PISP. However, we could not recognize macrolides tolerance 14.4% in PSSP. In relation to age, the rate of the tolerance, combining PISP and PRSP together, was more than 80% in all age groups. In addition, the only pbp 2x independent variant that has become a problem in Japan consisted of 73 of 147 PISP strains (49.7%), comprising 17.5% of 418 strains. These findings suggested that rapid identification of PSSP, PISP and PRSP, or macrolides-tolerance S. pneumoniae is possible and very useful for the survey and treatment of acute otitis media in infants and children.

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The therapeutic effect of pazufloxacin mesilate (PZFX mesilate), a new parenteral quinolone, against systemic infection with Pseudomonas aeruginosa S-406 in mice was evaluated and compared with that of ciprofloxacin (CPFX) and ceftazidime (CAZ).
1. The 50% effective dose (ED₅₀) of PZFX mesilate administered in a single dose and divided into 2 doses, and 4 doses, was 0.0991, 0.161, and 0.239mg/mouse, respectively. The ED₆₀ of PZFX mesilate and CPFX was significantly increased by divided administration (P<0.05), but that of CAZ decreased significantly (P<0.05).
2. Whether given in a single or divided dose, the C_max/MIC ratios in serum at the ED₅₀s were the same for each fluoroquinolone. The AUC_0-24h/MIC ratios of PZFX mesilate were similar to those of CPFX in each dosing regimen.
3. The ED₅₀ of PZFX mesilate and CPFX administered 7-hours post-infection was 2.20 times and 7.11 times, respectively, higher than at 1-hour post-infection. With the high inoculum size, ED₅₀ values of PZFX mesilate and CPFX were 35.3 times and 53.6 times, respectively, higher than with the low inoculum size. The ED₅₀ values of CPFX were more influenced than those of PZFX mesilate with both delayed treatment and high inoculum size.

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We analyzed 114 strains of Pseudomonas aeruginosa isolated from 66 children between 1997 and 2000. Drug susceptibility, serotypes, and the IMP 1 gene were studied. Thirty-six patients had underlying diseases, including 19 neoplastic disorders, and 6 neurological problems. Twenty one strains were from 13 newborn babies. Eighty-two strains were from the respiratory tract, 14 from urine, 10 from skin or pus, and 8 from blood. The most effective antimicrobial agent other than new quinolones was meropenem. The prevalent serotype was type A (23/114, 20%). Seventeen of strains had the IMP 1 gene (17/114, 15%) and most were from respiratory tract (10/17, 59%). Interestingly, there were two patients who isolated P. aeruginosa from blood repeatedly. And their strains were different on each case of bacteremia. We found no multidrug-resistant P. aeruginosa.

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