The swabbing up method (SW technique) was investigated, in an attempt to use the results of this technique in detecting the exact degree of microbiological cleanness of bioclean rooms (BCR) used for treatment of patients with acute leukemia. This method was compared with the agar sausage method (AS technique). The bacterial contamination status as detected by these methods was categorized into 5 classes, depending on bacterial counts (Cn) per 100 cm2: Bioclean index class (BC) 50 was given to Cn<50, BC 100 to 50≤Cn< 100, BC 500 to 100≤Cn<500, BC 1000 to 500≤Cn< 1000, and BC 5000 to 1000≤Cn<5000. Bioclean maps were made for bioclean rooms, using these categories of bioclean status. In the map obtained by the results of the SW technique, contamination of BC 500 was most frequently seen at 34.5%, followed by BC 50 at 28.8%. The highest degree ofcontamination, BC 5000, was seen at 7.7%. In the map obtained by the AS technique, BC 500 was also most frequently observed, and its incidence was 42.3%. This technique worked only in classes of less than BC 500, and did not work at all in the environment heavily contaminated. The effect of the AS technique was about 50% of that of the SW technique. These results show that the SW technique works in wider ranges of bacterial contamination tha n the AS technique, and thus, produces more reliable results in detecting bacterial contamination. Bioclean maps as described in the present study ensure correct identification of the source of contamination, and thus, plays an important role in infectious control. The effect of the SW technique in relation to that of the AS technique can be expressed by the regression equation of Y= 0.375X+ 0.990 (n=82, r=0.472), where X is bacterial counts as detected by the SW technique, and Y, those detected by the AS technique. The results of both techniques were significantly correlated (P<0.01).
This report describes the clinical and bacteriological features of 6 patients with septicemia due to Serratia at Juntendo University Hospital in Tokyo during the period of one-year and 6 months from Jan. 1. 1978 to May 30. 1979. All of the infections were hospital aquired. Factors that appear to predispose to Serratia infection included chronic debilitating disease, prior to multiple and broad spectrum antibiotic therapy, corticosteriod therapy, and anticancer chemotherapy, the postoperative status and indwelling intravenous or arterial catheters. Whereas the pathogenecity of Serratia has been doubted in the past, these data demonstrate that Serratia can become pathogenic for man in certain clinical situations, especially in patients with chronic debilitating disease who have been treated with multiple antibiotics.
Although many investigators have demonstrated that the dip-slide method is reliable in the diagnosis of significant bacteriuria, the reliability in the diagnosis of low grade bacteriuria, which is necessary for evaluating the efficacies of antimicrobial agents on urinary tract infections, is still nuclear. Therefore, we attempted to estimate whether the dip-slide method is also available in the diagnosis of low grade bacteriuria. Firstly, Bacterial counts of low grade bacteriuria determined by six kinds of commercially available dip-slides were compared with those determined by the standard flood plate method. Low grade bacteriuria were experimentally prepared by inoculating the strains of urinary isolated E. coli or S. epidermidis in normal urine obtained from healthy volunteer. As far as bacterial counts were determined by the criteria indicated in the standard pictures of each dip-slides, correlation between the bacterial counts determined by the two methods was not so high. Bacterial counts were overestimated in four kinds of dip-slides and underestimated in two. However, if colonies on the dip-slides were counted, the correlation coefficients were 0.9 or higher and a significant correlation was observed between the bacterial counts detemined by the two methods, even though the absolute colony counts on dip-slides were approximately 100-1000 fold smaller than those determined by flood plate method. Secondly, bacterial counts in the clinical urine specimens which contain single organism with bacterial counts of less than 105CFU/ml were compared by the dip-slide and standard flood plate method. The correlation of bacterial counts determined by both methods was also not so good and similar to the results observed in the experimental bacteriuria. According to the Criteria proposed by the UTI Committee in Japan, differentiation of four grades of bacteriuria, 104CFU/ml, 103CFU/ml, < 103CFU/ml and negative, is necessary for the assessment of clinical efficacies of antimicrobila agents. Nevertheless, of the six kinds of dip-slides, five could differentiate these three degree of bacteriuria in less than 60% of the urine specimens tested. Furthermore, the detection of negative urine culture was impossible as mentioned before. These results suggest that the differentiation of low grade bacteriuria with dip-slide method is inadequate in several points. Improvement and some device of dip-slide method should be attempted in the future.
Solitary lung abscess was produced by inoculating intrabronchially Staphylococcus aureus in Freund's incomplete adjuvant through a tube inserted perorally to one lung of a rabbit which had been sensitized with killed Staphylococcus aureus in Freund's incomplete adjuvant. After the inoculation the followings were investigated at several times; macroscopic and histological findings of lung abscess, viable cell counts in the various tissues of the lung, and body temperature and peripheral leukocytes counts of the rabbits with lung abscess. The results obtained were as follows. 1) The lung abscess was produced in 48.3% of rabbits inoculated 5 mg of Staphylococcus aureus and in 37.9% of those inoculated 10 mg. 2) The lung abscess produced by above-mentioned method was pathologically similar to that in man. The inflammatory changes were most remarkable two weeks after the inoculation. 3) Viable cell counts one week after the inoculation in the lesions of the rabbits inoculated 5 mg of Staphylococcus aureus were as follows: approx. 107CFU/g in the pus, 105CFU/g in the wall and 104CFU/g in the surrounding tissue of the abscess. Viable cell counts two weeks after the inoculation were almost same as those one week after. Then, the viable cells decreased gradually to almost nil 8 weeks after the inoculation. 4) The big differences were observed among the rabbits regarding body temperature, leukocytes counts and pseudoeosinophil counts. Accordingly, it seemed difficult to judge the couse of disease by observing these changes. 5) Infiltration of pseudoeosinophils diminished and viable cell counts decreased in the surrounding tissue of the abscess by administering antibiotics for six days from the 8th day after the inoculation of Staphylococcus aureus. As a result fundamental studies on the chemotherapy of pulmonary infection are possible by using this animal model of lung abscess, are surggested.
The clinical efficacy and safety of CTX for respiratory infections were objectively studied with CEZ as the control. In principle, 2 g/day of CTX and 4 g/day of CEZ were intravenously dripinfused for 14 days. 1. The rates of effectiveness for all the cases were 69.9% for CTX and 64.5% for CEZ, those for pneumonia were 70.1 % for CTX and 69.9% for CEZ, those for bacterial pneumonia were 75.9% for CTX and 75.4% for CEZ and those for the cases without pneumonia were 69.9% for CTX and 75.4 for CEZ. In the stratified analysis, the rates of effectiveness of CTX were significantly higher than those of CEZ in the cases having no underlying diseases or complications, in all the severe cases and in the cases with pneumonia. 2. The rates of effectiveness evaluated by the investigators were 78.8% for CTX and 72.8% for CEZ when all the cases were considered, 82.2% for CTX and 76.0% for CEZ in pneumonia, 87.9% for CTX and 82.8% for CEZ in bacterial pneumonia and 73.2% for CTX and 66.0% for CEZ in the cases without pneumonia. CTX displayed significantly higher rates of effectiveness than CEZ in all the cases (U-test). 3. CTX had generally higher rates of improvement than CEZ in individual symptoms, clinical findings and laboratory test results. Significant improvements were observed in 6 cases for CTX and in 3 cases for CEZ. 4. As for bacteriological effects, CTX showed a disappearance rate of 50.0% in 2 strains of gram positive bacteria and that of 80.0% in 31 strains of gram-negative bacteria, while the corresponding rates for CEZ were 100% in 3 strains of gram-positive bacteria and 76.7% in gram-negative bacteria. Although replacement of bacteria by Pseudomonas was observed in 2 cases with CEZ, there were no such cases with CTX. 5. The incidence of side effects was 3.5% for CTX and 4.1% for CEZ. Abnormal laboratory results were observed at the rate of 24.9% for CTX and 23.6% for CEZ. Side effects were all mild, including eruption and an increase in the level of transaminase, and there were no significant differences between CTX and CEZ. 6. Compared with CEZ, CTX showed generally superior values in the evaluation of usefulness, but there were no, significant differences between the two. It may be concluded from these results that 2 g/day of CTX produced effects on respiratory infections which were equal to or better than the effects of CEZ, and that CTX had significantly higher rates of effectiveness than CEZ, especially in severe cases. CTX was relatively free from side effects and is considered to be useful for respiratory infections, especially for severe cases.
A case of pseudomembranous colitis due to Clostridium difficile and the new th erapeutic approach. A 5 year 7 months old Japanese girl has been in good health untile 5 days before admission when she started to complain of abdominal pain, high fever, vomiting and generalized convulsion. The initial clinical impression was septicemia. She was given ampicillin 100 mg/kg and gentamycin 5 mg/kg. On the 5th hospital day severe colic and watery stools with blo od developed. The leukocytecount was 15, 400/cmm with 90% neutrophiles. The hemoglobin was 10.4 g/dl, serum protain 3.8 g/dl and albumin 1.99 g/dl. Blood and albumin transfusions were performed but the hypoalb uminemia and anemia persisted. The Gordon test was 2.8%. An X-ray film of the abdomen showed thumbprinting, and a scintigram of abdomen ruled out hemorrhagc gastroduodenitis and Meckel's diverticulitis. The proctosigmoidoscopy revealed an edemato us mucosa with white-yellow plaques indicating PMC. Administration of antibiotics was stopped. The plasma FDP was above 40 μg/ml and the thrombocyte count remained 30.5 × 104/cmm. The plasma factor XIII level was 42%, but the plasma plasmin activity, fibrinogen, bleeding time, coagulation time were normal A total of 1250 units (5 vials) of factor XIII concentrate (Behringwe rke-Hoechst) was administered in 3 days. The abdominal pains subsided and the bowel movement became normal. Clostridium difficile of over 108/g were found in the stool on the 7th hospital day. Heat labile enterotoxin to the mouse Y-1 adrenal cell was also demonstrated These results suggests that treatment with factor XIII offers a new possibility of controlling severe hemorrhagic diarrhea in antibiotics-associated PMC.