Two patients with malignant lymphoma underwent autologous bone marl ow transplantation on the protected environment-prophylactic antibiotic program. Antibiotic prophylaxis consisted of the oral administration of dibekacin (DKB) in a dosage of 250 mg every 6 hours, vancomycin (VCM) in a dosage of 500 mg every 6 hours, and nystatin in a dosage of 3 million units every 6 hours ( “DVN”). The effect of “DVN” on suppression of intestinal flora, hence on infection prevention was investigated. Fecal flora was almost completely suppressed after one week of “DVN” intake, although organisms such as Lactobacillus or Candida, which were partially suppressed, remained as mono- or diflora during treatment with the antibiotics. Both patients were repopulated with a variety of organisms in similar concentrations in the pretreatment stools one week after cessation of “DVN” intakewhen they still stayed in the bioclean room, receiving sterile food. Rapid regrowth of enterobacteria was observed in one patient when he had transient difficulty in swallowing “DVN” because of nausea and vomiting due to the conditioning for transplantation. On the other hand, oro-pharyngeal decontamination was more difficult to achieve than intestinal one. Lactobacillus isolates from throat and stool, which originally had large MICs of DKB and VCM, became more resistant to DKB and lincomycin, which was inhalated in addition to “DVN” intake. The percent of administered dose of DKB recoverable in 24-hour urine specimens ranged from 0.7 to 2.7%, while urinary excretion of VCM was not seen. Both patients developed mild nausea and excreted soft stools two to three times a day during “DVN” intake. These symptoms were aggravated by the conditioning for transplantion, but without any evidence of malabsorption. Both patients showed no evidence of bacterial or fungal infections, but they suffered from severe stomatitis due to Herpes simplex virus soon after transplantation. In one patient, the oral herpetic lesion having occurred despite interferon prophylaxis was remarkably relieved by the addition of nebulized interferon. The serum cholesterol concentrations of both patients were markedly reduced during treatment with oral antibiotics, of which DKB was inferred to be an etiologic agent. In conclusion, “DVN” was thought to be one of the most excellent antibiotic regimens for intestinal decontamination.
Eight patients with malaria at the first department of internal medicine, Yokohama City University School of Medicine in twenty years were clinically studied. There are of 6 cases with plasmodium vivax, one with P. malariae, and one with vivax-falciparum mixed infection. The patients were all males and their ages ranged from 20 to 47 years (the mean of 30 years). Four cases had not taken any antimalarial drugs in epidemic areas, and three of them became sick while they were in malaria-endemic areas. Four patients had been given antimalarial drugs for prevention of the infection but their dosages and medication periods were insufficient. In some cases slight abnormal laboratory findings were found: Increase of erythrocyte sedimentation rate in 7 cases, normocytic normochromic anemia in 3 cases, monocytosis in 5 cases, thrombocytopenia in 3 cases, bilirubinemia in 4 cases, hypoproteinemia in 3 cases, and biological false positive reaction of the serologic test for syphilis in 3 cases. It is interesting that the decrease of serum complement level was observed in one case as the disease became worse and that hypocholesteremia remained unchanged in one case while his clinical and laboratory findings had been improved. The patients with P. vivax and the one with P. malariae were treated with chloroquine, quinine, or sulfamonomethoxine-pyrimethamine (MP). These drugs were effective to control the pyretic attack. Primaquine was medicated next to these drugs. One cases with mixed infection was treated with chloroquine (total 2010 mg base) and primaquine (tot a 210mg base). Drug-resistant malaria was not found. There was no fatal case, and no complication was found. These observations are discussed with reference to the reports in the literature and a case report with P. malariae is presented.
Two hundreds and twenty-eight strains of Ps. aeruginosa were isolated from 945 clinical materials from patients at the DCCM, Nippon Medical School, over a period of 33 months from April, 1977 to December, 1979. The isolated strains were typed serologically by the Honma's agglutination method with 13, standard sera and tested the sensitivity of Ps. aeruginosa to six antibiotics. following results were obtained. 1) The strains of Ps. aeruginosa were recovered from 228 among 945 specimens (24.1%), and 45.0% of the strans were isolated from sputum, 43.5% from wound secretion, 40.1% from burnt skin, and 13.1% from urine samples. 2) One hundred and twenty-one strains were tested serologically and 119 strains (98.3%) were typable with predominant occurence of type E in 88 strains (72.7%), and type G and B in 10 and 9 strains (8.2 and 7.4%), respectively. 3) When the MIC of 100 μg/ml or more was referred as resistant, 67 to 68% of the isolates were resistant to DKB and SBPC and 56% were resistant to TOB. Only 1% of the strains was resistant to AMK.
An experimental ascending urinary tract infection due to Proteus mirabilis was produced in mice by obstructing the urethra for 6 hrs. after transurethral inoculation of 103 to 103 colony-formng units (CHU) into the bladder. More than 80% of the mice undergoing the infection survived for 10 weeks or more. The infection was initially localized in the bladder and progressively extended to both kidneys within a few days. The number of bacteria in the bladder wall and kidneys in 3 days ranged 104 to 107 CFU per tissue, and these levels remained unchanged for several weeks. In the bloods of most mice, no bacteria was observed at various stages of the infection.
The old bedridden patients, especially in combination with the sequelae of cerebrovascular disorders, are frequently suffered from urinary tract infections (UTI). This paper reviews the clinical microbiological study on UTI of the aged. 638 mean aged 75 yr bedridden patients (159 male, 479 female), who admitted to Koseiso Hospital, Tama Institute for Adult Diseases, between 1974 and 1979, because of the sequelae of cerebrovascular disorders were studied for the purpose of observing annual incidence of microorganisms. Samples for quantitative culture examinations were obtained by urinary catheter, and in some female cases, vaginal microbilological examinations were also performed. Results were as follows: 1) A total of 1901 strains of microorganisms were isolated from 1267 cultures during six years observation. The most important infecting organisms were Staph. aureus, E. coli, Klebsiella, indole positive Proteus groups. Comparing the annual frequency of the organisms, there was the decrease in the proportion of Staph.aureus, Klebsiella, Pr.mirabilis in the year from 1976 to 1979, whereas E. coli, indole positive Proteus groups and Ps. aeruginosa were increasing year by year, especially very striking was the rise of the percentage of indole positive Proteus groups, which were found in 18% of samples during 1974, in 26% during 1975, in 39% during 1978, and in 34% during 1979. Another interesting features is that very often mixed infections with these organisms were observed. 2) In annual change of antimicrobial susceptibilities against commonly used antimicrobials to the isolates, the rise in frequency of antimicrobial resistant strains was observed year by year, especially in the predominant isolates of Proteus groups. 3) Among 56 cases of UTI, 8 cases (14.3%) presented a change of the original bacteria after a course of antibacterial treatment. 4) A total of 25 vaginal specimens were collected from female bedridden patients. In vaginal cultures, numorous species were recovered. Many of them were gram negative rods, but other bacteria of low pathogenicity, so called “opportunistic pathogens” such as glucose nonfermentative gram negative rods, anaerobes and fungi, were also isolated. These results indicated that many cases of UTI of the aged were complicated type of infection and sometimes took longterm course with change of spectrum of bacteria, and was often in combination with mixed infection due to resistant type of oragnisms. These facts represent a serious problem in antimicrobial chemotherapy. Effective chemotherapy, of course, seems to be essential condition for a treatment of these infections. In addition to this, good nursing care, maintenance of hygine including urinary bladder and vagina are also important measures for prevention and treatment for these types of UTI.
To evaluate antibacterial effectiveness, safety and clinical usefulness of mezlocillin (MZPC), multi clinical comparative studies against ampicillin (ABPC) were conducted in patients with lower respiratory tract infections. The patients were treated for up to 14 days with a dose of 2 g b.i.d. of either MZPC or ABPC by drip infusion. A total of 264 patients entered the trials. A comparison of the effectiveness of both test drugs was made in 233 cases (MZPC; 111 cases, ABPC; 122 cases). An evaluation of their respective safety in 252 patients (MZPC; 120, ABPC; 132) and usefulness for 237 patients (MZPC; 113, ABPC; 124) was made. Comparison between the two treatment groups was made for all cases and stratified by diagnosis, namely, bacterial pneumonia, pneumonia group (bacterial pneumonia, mycoplasmal pneumonia, PAP and lung abscess) and R.T.I other than pneumonia. A comparison of clinical efficacy, rated MZPC in 76.6%, and ABPC treatment in 64.8% as “effective”. The difference between the two drugs in statistically significant. When patients were stratified by diagnosis, MZPC treatment showed an efficacy rate of 80.4%, and ABPC treatment of 70.0% in patients with bacterial pneumonia. In patients with pneumonia, MZPC treatment was effective in 76.6%, and ABPC treatment in 70.3% of the case load, without however any statistical difference. Comparison of the therapeutic results of the two treatment groups in patients with RTI other than pneumonia, MZPC was effective in 76.5%, and ABPC in 56.3%. The difference is statistically significant. Comparison of efficacy after stratified by severity of diseases and complications, MZPC treatment showed superiority in the group of all moderate to severe cases. On further stratification of all cases superiority of MZPC was seen in the group of moderate to severe cases of RTI other than pneumonia. When studied in connection with complications, superiority of MZPC was observed in all cases of A group complications, namely with complications which may affect the clinical course of infections and/or the therapeutic effect of the drugs, and also in the pneumonia group with A group complications. Adverse reactions attributable to the test drugs were noted in 5.0% of patients treated with MZPC and in 9.1% of those who received ABPC. MZPC treatment was rated as useful in 75.2% of patients as compared with 60.5% with ABPC, showing statistically significant superiority of MZPC over ABPC. These results justify to conclude that MZPC is a highly effective, useful and safe drug for the treatmens of lower respiratory tract infections especially for patients with intractable and/or moderate to severe infections.