Abnormal phagocytic function in children under one year of age.

The action of white blood cells (WBC) against Proteus mirabilis was assayed in 22 children following meningitis or septicaemia and compared with that in control groups of: (1) adult volunteers, (2) children undergoing minor surgical procedures for non-infective conditions, and (3) children being investigated for suspected renal disease. WBC bacterial killing tests were normal in all 55 adult volunteers. Abnormal results were obtained in 11 of 22 (50%) children with meningitis or septicaemia, 10 of 21 (47.6%) children undergoing surgery and six of 13 (46%) children with suspected renal disease, thereby indicating that there were no significant differences in phagocytic function among these three groups. Of children aged 1 year or less, 75% had abnormal phagocytic function. The significance of this finding is discussed.

Encephalomyelitis with seroconversion to Listeria monocytogenes.

A previously healthy girl recovered from a lymphocytic encephalomyelitis with brain stem involvement after antibiotic and steroid treatment. Cultures of blood and cerebrospinal fluid were negative, but she seroconverted to Listeria monocytogenes serotype 4. Antilisterial treatment should be considered in similar cases.

Microbiology, chemotherapy and mortality of brain abscess in Newcastle-upon-Tyne between 1979 and 1988.

71 patients admitted to Newcastle Regional Neurosurgical Centre between 1979 and 1988 with a diagnosis of brain abscess are reviewed. The overall mortality was 9.9%, with an operative mortality of 7%. The bacteriology of these abscesses is discussed in detail, together with the importance of effective standardized antimicrobial treatment regimens. The low mortality figures appeared to be in direct relationship to early recognition of this condition, prompt surgical intervention and effective chemotherapy.

Five days versus one day of penicillin as prophylaxis in elective neurosurgical operations.

Of 423 patients undergoing elective cranial and spinal operations, infections due to Staphylococcus aureus occurred in 3 of 217 (1.4%) receiving penicillin for 1 day, in none of 206 receiving penicillin for 5 days. There was no significant difference in rates of infection between the two groups receiving penicillin. It is concluded that penicillin for 1 day is as effective as penicillin for 5 days, in the prevention of wound infections due to S. aureus.

Focal infections of the central nervous system due to Propionibacterium acnes.

Propionibacterium acnes as the single cause of intracranial infections has rarely been described. We present four patients in whom the infection arose as a result of a breach of skin tegument, and postulate that P. acnes is an under-recognised pathogen.

Bacteriology of chronic otitis media with effusion.

Samples of middle ear effusions from 102 children with serous and mucoid otitis media were cultured for mycoplasmas and bacteria. No sample yielded mycoplasmas but bacteria were cultured from 48 (47 per cent). Organisms commonly regarded as pathogens were present in 25 samples (Haemophilus influenzae 17, Streptococcus pneumoniae four, other streptococci four). The only sample from which anaerobic bacteria were isolated was from a patient with cholesteatoma.

Twelve-hourly dosage schedule for oral and intravenous metronidazole.

Paired samples of blood were examined from 48 patients undergoing major surgery who were receiving metronidazole at a 12-hourly dosage interval, as part of a regimen for prophylaxis or therapy. Twenty-five patients were given 400 mg metronidazole orally twice a day and 23 received 500 mg metronidazole iv twice daily. Assay of the samples demonstrated trough serum concentrations of metronidazole of 3-11 mg/l (mean 5.5 mg/l) and 2-15 mg/l (mean 6.7 mg/l) with the oral and intravenous routes, respectively. The corresponding peak serum concentrations were 10-26 mg/l (mean 17.4 mg/l) and 13-28 mg/l (mean 23.6 mg/l). The trough concentrations are well in excess of the MICs for the majority of obligate anaerobes and thus the 12-hourly regimen achieves and maintains therapeutic serum concentrations of metronidazole.

Simple peroperative antimicrobial chemoprophylaxis in elective neurosurgical operations.

From August 1981 to February 1982 postoperative infections due to different strains of penicillin-resistant Staphylococcus aureus occurred in 20 of 467 patients (4.3%) undergoing elective cranial and spinal operations. These infections were not attributable to defects in procedures or the theatre environment, therefore chemoprophylaxis was instituted. In the following 8 months, when patients were given penicillin G and sulphadiazine for 5 days commencing immediately postoperatively, S. aureus infections occurred in five of 579 patients (0.9%). In a subsequent randomized uncontrolled study, infections occurred in six of 265 patients receiving penicillin (2.3%), three of 270 receiving penicillin and sulphadiazine (1.1%) and one of 45 receiving erythromycin (2.2%) immediately postoperatively for 5 days. In a further study in which 587 patients received penicillin for 5 days commencing immediately preoperatively, infections due to S. aureus occurred in six (1.1%). Infections due to gram-negative organisms were seen in five (0.4%) of 1167 patients in the two uncontrolled studies.

A hospital outbreak of antibiotic-resistant Streptococcus pneumoniae.

We report six patients colonised with a multiply resistant strain of Streptococcus pneumoniae.

Carbon dioxide laser irradiation of bacterial targets in vitro.

Agar targets seeded with Escherichia coli and Staphylococcus aureus in roll tubes simulating the vaginal vault were irradiated with a CO2 laser at various power densities and durations. Viable bacteria were detected in the plume emissions in all instances. Staphylococcus aureus was found to be more resistant to the thermal effects of lasing than E. coli. This suggests that CO2 irradiation of cervical lesions could disseminate viable particles which may be a hazard for patients and operators.

Wise Anaerobic Work Station: an evaluation.

The Wise Anaerobic Work Station permitted the growth of type cultures of a range of fastidious obligate anaerobes. In the isolation of anaerobic bacteria from clinical specimens the performance equalled that of a standard anaerobic jar incubated for 48 hours, and gave results superior to those obtained when incubation of jar cultures was interrupted at 24 hours. The Wise Anaerobic Work Station was easy to use and provided comfortable working conditions; running largely on industrial nitrogen, it was more economic than anaerobic cabinets or jars using conventional gas mixtures.