Pre-accreditation Gap Analysis of Mongolian Laboratories / Эрүүл мэндийн лаборатори

Background@#Poor laboratory quality can lead to misdiagnosis and inappropriate treatment of patients. To demonstrate the quality and reliability of their services, medical laboratories seek accreditation to ISO 15189. We have initiated a project to assist laboratories in their efforts to obtain the accreditation. @*Goal@#Conduct a gap analysis of the status of preparedness of medical laboratories for accreditation.@*Materials and Methods@#Six laboratories are selected for participation in the project. In the first phase of the project, a gap analysis of the participant laboratories is conducted using an Excel program based on ISO 15189 requirements.@*Results@#The findings reveal that the participant laboratories are the strongest in Organization and management of laboratory, Quality of examination results, Personnel and facility management and in Laboratory information management. The majority of the laboratories are hospital based, and their organization and management are well established and functional mostly due to centralized administrative guidance. The concept of quality control is effectively adapted in medical laboratories, therefore ensuring the quality of examinations and the data management are usually in line with the requirements. Weaker areas include Evaluation and audits, and Document control. Even though the laboratories do conduct evaluations and control, they do not do it regularly and, most importantly, do not keep records routinely, which cause the higher gap rate.@*Conclusion@#Policies to meet ISO 15189 requirements are in place in the participant laboratories, but their documentation and records keeping are insufficient.

Three-dimensional STEM for observing nanostructures.

A new scanning transmission electron microscope has been developed for three-dimensional (3D) observations of nanostructures. Using double spherical fulcra, accurate eucentric rotation was achieved. Cylindrical specimens for 3D-observation were prepared by a microsampling technique using a focused ion beam. Copper via-holes of a semiconductor memory device and ZnO particles were observed by the 3D-STEM from different directions, and 3D-data of the ZnO particles were successfully reconstructed in a topography mode.

[Antimicrobial activities of cefozopran against Streptococcus pneumoniae from children].

In order to evaluate antimicrobial activity of cefozopran (CZOP), minimum inhibitory concentrations (MICs) of CZOP and control drugs were determined against Streptococcus pneumoniae from children that were isolated from October of 1995 to January of 1996. Determinations were made for the detection frequency of penicillin-insensitive or resistant strains in biovar utilizing hydrolysis products, and for the correlation of antibacterial susceptibility and macrolides (MLs)-resistant patterns. The results are summarized as follows; 1. MIC90 of CZOP was < or = 0.025 micrograms/ml against benzylpenicillin (PCG)-susceptible S. pneumoniae (PSSP, 50 strains). MIC distribution of CZOP against these strains was approximately equal to that of PCG, and showed stronger activities of CZOP than those of ceftazidime (CAZ), flomoxef (FMOX) and erythromycin (EM). 2. MIC90 of CZOP was 0.39 micrograms/ml against 50 strains of PCG-insensitive S. pneumoniae (PISP) and PCG-resistant S. pneumoniae (PRSP). Antimicrobial activities of CZOP against these strains were stronger than those of CAZ, FMOX, PCG and EM. 3. These isolated strains of PISP and PRSP did not show type III biovar, but showed types I and II. The detection frequency of MLs-constitutive resistant strains were high among type III PSSP and those of MLs-inductive resistant strains were high among types I and II PISP and PRSP. These data suggested that CZOP had strong antimicrobial activities against multiple drug resistant S. pneumoniae including penicillin-resistant strains. CZOP will be effective against S. pneumoniae which often are causative organisms in infections of children.

[Antibacterial activities of combination uses of isepamicin and beta-lactams in vitro against clinically isolated strains. Part 3. The results against Pseudomonas aeruginosa].

We investigated antibacterial activities of combination uses of isepamicin (ISP) and beta-lactams in vitro against Pseudomonas aeruginosa, and the following conclusions were obtained. 1. ISP + piperacillin, ISP + ceftazidime, ISP + aztreonam, ISP + imipenem and ISP + panipenem against P. aeruginosa showed strong combined effects. 2. The minimum inhibitory concentrations (MICs) of these combinations were low and dependent on concentrations of ISP. And strong antibacterial activities were observed at ISP concentrations of sub-MIC levels. These results were similar to the results of previous reports, parts 1 and 2. 3. Concentrations of ISP sufficient to lower MIC90 values when by combined with beta-lactam agents were 4 approximately 8 micrograms/ml. These effects made it possible to lower the ISP dose to 400 mg at a single dose and the enhancement of activities by combinations resulted in strong antibacterial activities against multiple drug resistant stains at sub-MIC levels of ISP. Strong antibacterial activities were also obtained against beta-lactams-resistant strains of ISP-susceptible strains when ISP was combined with beta-lactam agents. 4. All results reported in parts 1 approximately 3 indicated that no antagonisms were produced by combining ISP + penicillins, ISP + cephems, ISP + monobactams and ISP + carbapenems against Staphylococcus aureus, Enterobacteriaceae and P. aeruginosa. These combinations showed strong antibacterial activities that were enhanced synergistically with wider spectra.

[Antimicrobial activities of meropenem against clinically isolated strains. The result against strains isolated from blood and cerebrospinal fluid].

In order to evaluate the antimicrobial activity of meropenem (MEPM), minimum inhibitory concentrations (MICs) of MEPM and control drugs were determined against clinical isolates from blood and cerebrospinal fluid that were obtained from January, 1993 to December, 1994. The results are summarized as follows; 1. The MIC-range, 50% MIC (MIC50) and 90% MIC (MIC90) of MEPM were equal to those of imipenem (IPM) and panipenem (PAPM) against Streptococcus pneumoniae including benzylpenicillin (PCG)-insensitive or -resistant S. pneumoniae, Streptococcus agalactiae and Listeria monocytogenes which are Gram-positive strains, and were stronger than those of ampicillin (ABPC) and cefotaxime (CTX). 2. The MIC-range, MIC50 and MIC90 of these 3 drugs of carbapenems (MEPM, IPM and PAPM) were different against Escherichia coli and Haemophilus influenzae which are Gram-negative strains. The MIC90 of MEPM was < or = 0.025 microgram/ml and those of IPM and PAPM were 0.2 microgram/ml against E. coli. The MIC90 of MEPM was 0.1 microgram/ml, that of IPM was 25 micrograms/ml and that of PAPM was 6.25 micrograms/ml against H. influenzae. Thus, the antimicrobial activity of MEPM was stronger than those of IPM and PAPM. The MIC90's of IPM and PAPM against H. influenzae were high with the MIC of IPM at 12.5 approximately 25 micrograms/ml and the MIC of PAPM at 3.13 approximately 12.5 micrograms/ml against 3 IPM-resistant strains among 17 isolates. 3. The MIC90 of ABPC was 0.39 microgram/ml and that of CTX was 0.1 microgram/ml against 20 strains of S. pneumoniae including 6 strains of PCG-insensitive or resistant S. pneumoniae. The MIC90 of ABPC and CTX were higher than those of 3 carbapenem drugs. There were E. coli of 8 strains with ABPC-high resistance (the MIC of ABPC was > 100 micrograms/ml) and 2 strains for which MIC of CTX were 0.39 microgram/ml and 3.13 micrograms/ml. It was found that 29.4% of H. influenzae were beta-lactamase producing strains. 4. It appeared that antimicrobial activities of carbapenems, particularly MEPM were strong against clinical isolates from blood and cerebrospinal fluid. MEPM will be first choice drug by empiric therapy in infections including sepsis and purulent meningitis.

[Antibacterial activities of combination uses of isepamicin and beta-lactams in vitro against clinically isolated strains. Part 2. The results against enterobacteriaceae].

We investigated antibacterial activities of combination uses of isepamicin (ISP) and beta-lactams in vitro against Klebsiella pneumoniae and Enterobacter cloacae, and the following conclusions were obtained. 1. ISP+cefazolin, ISP+cefotiam and ISP+flomoxef against K. pneumoniae and ISP+piperacillin, ISP+ceftazidime, ISP+aztreonam, ISP+imipenem and ISP+panipenem against E. cloacae showed strong combined effects. 2. The minimum inhibitory concentrations (MICs) of these combinations were low due to the dependence of ISP concentrations. Strong antibacterial activities were observed at sub-MIC levels of ISP. These combined effects were stronger than those against Staphylococcus aureus described in the first report at sub-MIC levels of ISP. 1/4 MIC approximately 1/8 MIC of ISP showed enhanced activities of beta-lactams. Similarly strong combined effects were observed against both beta-lactam-sensitive and -resistant strains.

[Antimicrobial activities of clarithromycin against clinical isolates].

To examine the antimicrobial activity of clarithromycin (CAM) against strains clinically isolated from outpatients in 1994, minimum inhibitory concentrations (MICs) were determined for CAM and the control drugs. The results were as follows; 1. MIC50 and MIC90 of CAM were similar to those investigated in 1980's against many bacterial species. 2. CAM showed strong antimicrobial activities against beta-lactamase producing Moraxella subgenus Branhamella catarrhalis, Bordetella pertussis, Campylobacter jejuni subsp. jejuni and Peptostreptococcus spp. 3. It appears that resistance to MLs including CAM is increasing among Streptococcus pneumoniae.

[Antimicrobial activities of meropenem against clinically isolated strains].

In order to evaluate antimicrobial activity of meropenem (MEPM), minimum inhibitory concentrations (MICs) of MEPM and control drugs were determined against clinical isolates in 1993. The results were as follows; 1. Antimicrobial activities of MEPM against Gram-positive bacteria were stronger than those of cephems (CEPs), were approximately equal to those of panipenem (PAPM), and were weaker than those of imipenem (IPM). 2. Carbapenems showed strong antimicrobial activities against Enterobacteriaccae, glucose non-fermentative Gram-negative rods and Bacteroides fragilis group that were multiple drug resistant including the third generation CEPs. Antimicrobial activities of MEPM against these organisms were stronger than those of IPM and PAPM. 3. MIC-ranges of MEPM against Enterobacteriaceae and Haemophilus influenzae were lower than those of IPM and PAPM. We observed that MEPM had better permeability into the cells of H. influenzae, higher affinities to 3 to 5 different penicillin-binding protein and high stability against beta-lactamase than those of IPM and PAPM.

[Antibacterial activities of combination uses of isepamicin and beta-lactams in vitro against clinically isolated strains. Part 1. Activities against Staphylococcus aureus].

In order to evaluate antibacterial activities of combination uses of isepamicin (ISP) and beta-lactams in vitro, minimum inhibitory concentrations (MICs) these drugs were examined singly and in combination against clinically isolated Staphylococcus aureus. The results are summarized as follows; 1. MICs of ISP + cefazolin (CEZ), ISP + cefotiam (CTM) and ISP + flomoxef (FMOX) were low and the activities against methicillin (DMPPC)-susceptible S. aureus (MSSA) were dependent on the concentration of ISP. Combined effects were observed when the concentrations of ISP were at sub-MIC levels (1/2 approximately 1/4 concentrations). 2. MICs of ISP + CEX, ISP + CTM, ISP + FMOX, ISP + imipenem and ISP + panipenem were low and the activities against DMPPC-resistant S. aureus (MRSA) were dependent on the concentration of ISP, and were similar to those against MSSA. Combined effects were observed when the concentrations of ISP were at sub-MIC levels of ISP. Lower MIC50 or MIC90 was observed at ISP concentrations of 4 approximately 16 micrograms/ml. 3. The blood Cmax of ISP exceeded 20 micrograms/ml at one-time administration of ISP 400 mg, and these results suggested that antibacterial activities of combination uses of ISP and beta-lactams was clinically effective against MRSA infections.

[Antibacterial activities of combination uses of cefpirome with various antibiotics in vitro against clinically isolated glucose non-fermentative gram-negative rods: part 1. the results against Pseudomonas aeruginosa].

In order to evaluate antibacterial activities of combination uses of cefpirome (CPR) and various antibiotics in vitro, minimum inhibitory concentrations (MICs) of CPR alone and combinations of CPR+other drugs against freshly isolated clinical strains of Pseudomonas aeruginosa. The results are summarized as follows; 1. Combined effects of CPR+beta-lactams, piperacillin (PIPC), aztreonam (AZT), imipenem (IPM) showed wider antibacterial spectra and stronger antibacterial activities than CPR alone with drugs concentrations of CPR and other drugs at sub-MIC levels. At concentrations of sub-MIC levels, antibacterial effects of CPR+PIPC and CPR+AZT combination were strong but CPR+IPM was weaker than those of the former two combinations. It appeared that stronger effects were demonstrated by some combinations against strains that were susceptible to both drugs of combination, but little additive effects were shown against strains that were resistant to both drugs. Antibacterial effect of CPR+fosfomycin combination was the same as those of CPR+PIPC and CPR+AZT combinations. 2. Combined effects of CPR+aminoglycosides (AGs), gentamicin, tobramycin, amikacin showed wider antibacterial spectra and stronger antibacterial activities at sub-MIC levels of CPR or ATs. The effect against CPR-resistant strains was same. But the combined effect was weak against AGs-resistant strains. 3. Effectiveness of combinations of CPR+beta-lactams and CPR+AGs depended on drug susceptibilities of strains tested. We cannot estimate effects of those combinations without investigating drug susceptibility of bacteria being tested. 4. In none of the combinations tested, antagonism was observed.

[Antimicrobial activities of ceftriaxone against fresh, clinically isolated strains].

In order to evaluate antimicrobial activity of ceftriaxone (CTRX), minimum inhibitory concentrations (MICs) of CTRX and control drugs were determined against clinically isolated strains including those from purulent meningitis and liver and biliary tract infections in 1995. The results are summarized as follows; 1. MIC90 of CTRX was 0.05 micrograms/ml against benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae or PCG-resistant S. pneumoniae and it was < or = 0.025 micrograms/ml against beta-lactamase producing strains of Haemophilus influenzae. Antimicrobial activities of CTRX against these strains were stronger than control drugs. 2. MIC distribution of CTRX was in a lower concentration range than those of ceftazidime and flomoxef against extend broad-spectrum beta-lactamase (EBLA)-producing Escherichia coli and Klebsiella pneumoniae subsp. pneumoniae. 3. These results suggested that CTRX will be effective against community-acquired pneumonia, purulent meningitis and liver & biliary tract infections.

[Antimicrobial activities of clavulanic acid/ticarcillin against clinical isolates].

In order to investigate antimicrobial activities of clavulanic acid/ticarcillin (CVA/TIPC) against Escherichia coli, Enterobacter spp. and Pseudomonas aeruginosa in 1992 and 1994, beta-lactamase activities were analyzed and minimum inhibitory concentrations (MICs) were determined including those of the control drugs. The results are as follows; 1. Compared to a report in 1980, the MIC distributions of CVA/TIPC against E. coli and P. aeruginosa did not show large differences. We found, however, that CVA/TIPC-resistant strains increased among Enterobacter spp. 2. Almost all of CVA/TIPC-resistant strains of Enterobacter spp. were also resistant to cephems and new quinolones, thus they were multiple drug resistant. 3. CVA/TIPC showed strong antimicrobial activities against penicillinase producing E. coli.

[Antimicrobial activities of cefepime against clinically isolated strains].

In order to evaluate antimicrobial activity of cefepime (CFPM), minimum inhibitory concentrations (MICs) of CFPM and other drugs were determined against clinical isolates that were obtained in 1994. 1. CFPM showed a wide antibacterial spectrum against Staphylococcus spp. and glucose non-fermentative Gram-negative rods ((G)NF-GNR). Antimicrobial activities of CFPM against Staphylococcus spp. were stronger than those of ceftazidime (CAZ) and somewhat stronger than those of cefotaxime (CTX), and antimicrobial activity of CFPM against Pseudomonas aeruginosa was same as that of CAZ. 2. Antimicrobial activities of CFPM against almost all of Enterobacteriaceae were stronger than those of CAZ and CTX. And CFPM showed strong antimicrobial activities against CAZ-resistant Escherichia coli, Citrobacter freundii and Enterobacter spp. 3. Antimicrobial activities of CFPM were weaker than those of CAZ against some of strains of Klebsiella oxytoca, beta-lactamase high producing strains of Moraxella subgenus Branhamella catarrhalis and than those of CTX against beta-lactamase high producing strains of Prevotella spp. 4. The feature of new cephems was demonstrated in that CFPM had wider antibacterial spectrum than cephems of previous genenations against Staphylococcus spp. and (G)NF-GNR and CFPM showed strong antimicrobial activities against almost all of oxacephem-resistant Enterobacteriaceae.

[Antimicrobial activities of clavulanic acid/amoxicillin against freshly isolated clinical strains from outpatients].

In order to investigate antimicrobial activities of clavulanic acid/amoxicillin (CVA/AMPC) against freshly isolated clinical strains obtained in 1995, beta-lactamase activities and minimum inhibitory concentration (MICs) were determined including those of the control drugs. The results are summarized as follows; 1. Detection frequencies of beta-lactamase producing strains were as follows: methicillin-susceptible Staphylococcus aureus subsp. aureus (MSSA, 90.0%), Haemophilus influenzae (22.0%), Moraxella subgenus Branhamella catarrhalis (100.0%), Escherichia coli (100.0%), Klebsiella pneumoniae subsp. pneumoniae (100.0%) and Neisseria gonorrhoeae (14.0%). It appeared that beta-lactamases produced by these strains were mostly penicillinase or enzyme of similar that. 2. Antimicrobial activities of CVA/AMPC against beta-lactamase producing strains were stronger than those of AMPC, and MIC90 of CVA/AMPC against benzylpenicillin (PCG)-insensitive or resistant Streptococcus pneumoniae was lower than those of sultamicillin, cefaclor and cefpodoxime. 3. CVA showed strong beta-lactamase inhibitory effect against M.(B.) catarrhalis of direct and indirect pathogenicity. We can expect CVA/AMPC to negate or decrease the influence of indirect pathogenicity.

[Frequency of clinical isolation of glucose non-fermentative gram-negative rods and their susceptibilities to antibacterial agents].

A comparison was made for frequencies of isolation o glucose non-fermentative Gram-negative rods ((G)NF-GNR) from clinical specimens during a period from July, 1986 to June, 1987 (the first period) and that from January, 1994 to December, 1994 (the second period). Also, minimum inhibitory concentrations of principal drugs were determined against these isolates. The obtained results are summarized as follows: 1. Thirty four (34) species of (G)NF-GNR were found from 35,200 clinical specimens in the two periods. Numbers of strains of (G)NF-GNR obtained were 4,575 during the first period and 4,704 during the second period, thus no significant difference existed in numbers of strains isolated in the two periods. 2. Among the 34 species to which the 4,704 strains were classified into, Pseudomonas aeruginosa comprised 68.4%, Stenotrophomonas maltophilia 6.9%, Acinetobacter baumannii 5.6%, Burkholderia cepacia 3.1%, Acinetobacter Iwoffii 2.6%, Alcaligenes xylosoxidans subsp. xylosoxidans 2.4%, Flavobacterium indologenes 1.7%, Pseudomonas putida 1.1%, Acinetobacter junii 1.1% and Moraxella subgenus Moraxella lacunata 0.9%. When these frequencies of isolation were compared with those in the first period, it was found that B. cepacia decreased significantly (P < 0.01) and that S. maltophilia increased significantly (P < 0.001). 3. MIC determinations revealed multiple drug resistance strains in many different species of bacteria. Minocycline, however, were active against many such strains, and ofloxacin was found to have strong antibacterial activity against some strains.

[Antimicrobial activities of norfloxacin against clinical isolates from ocular infections].

In order to evaluate antimicrobial activity of norfloxacin (NFLX), minimum inhibitory concentration (MICs) of NFLX and control drugs were determined against clinical isolates from ocular infections that were obtained in our laboratory from July, 1993 to December, 1994. The results are summarized as follows; 1. Compared to MIC distributions of NFLX against clinical isolates from ocular infections studied in 1986 and 1987, the MIC80 of NFLX against Corynebacterium spp., Enterobacter spp., Serratia spp., Burkholderia cepacia, Flavobacterium spp., Alcaligenes spp. increased 8 times. Almost all of NFLX-resistant strains among them were ofloxacin (OFLX)-resistant, new quinolones resistant strains, and a part of them were aminoglycosides, beta-lactams-resistant as well, thus all of these strains were multiple drug resistant. 2. MIC of NFLX against Pseudomonas aeruginosa were lower than that of OFLX. 3. NFLX showed strong antimicrobial activities against so-called "particular bacteria" including Staphylococcus aureus subsp. aureus, Moraxella spp., Haemophilus spp., and P. aeruginosa from ocular infections. And MIC80 of NFLX against these bacteria was 0.05-1.56 microgram/ml. We observed that NFLX eye drops was administered so that concentrations above the MIC against these clinical isolates were maintained.

[Study of clinically isolated new quinolones-resistant Haemophilus influenzae. Part 1].

A study was done to determine susceptibilities of Haemophilus influenzae that were obtained in our laboratory in 1994 to new quinolones (NQ) and other drugs. The results were as follows; 1. Among the 300 isolates, the detection frequency of NQ-resistant strains was 8.7% (26 strains), including isolates from chronic lower respiratory tract infections (22 strains) and those from middle meatus of nose (2 strains), etc. NQ-resistant strains were not isolated from children. 2. The cross resistance was studied for different NQs against NQ-resistant strains. Clavulanic acid/amoxicillin, cefteram, cefpodoxime, cefditoren, cefodizime (CDZM) and cefpirome showed strong antimicrobial activities against NQ-resistant strains. MIC90 of CEPs against all isolated strains including NQ-resistant strains and beta-lactamase producers was low. And the MIC90 of CDZM was < or = 0.025 microgram/ml, which was the lowest among all the antibiotics tested. 3. We found 47 strains (15.7%) of beta-lactamase producers among the 300 isolates, the frequency of beta-lactamase producing strains was high among strains obtained from children.

[Clinical and bacteriological effects of cefetamet pivoxil against community-acquired respiratory tract infections].

We investigated clinical and bacteriological effects of cefetamet pivoxil (CEMT-PI) in community-acquired respiratory tract infections and obtained the following findings. 1. Of the 420 respiratory tract infection cases that were treated with CEMT-PI according to a same protocol at a total of 42 institutions in Tokyo, Kanagawa-ken, Saitama-ken and Chiba-ken from February to the beginning of April 1994, 359 cases in which clinical evaluations were considered possible were selected as the subjects of the clinical study. Regarding genders of patients, slightly more females (56.3%) than males were included. Diagnoses given to these patients included laryngopharygealitis (60.7%), tonsillitis (14.2%) and acute bronchitis (13.6). Outpatients accounted for 94.4% of the subjects. 2. For the bacteriological study, a written material describing the method of collecting specimens, storage and transport in detail was distributed to the above mentioned institutions. The isolation and identification of suspected causative bacteria, determination of minimum inhibitory concentrations (MIC) and investigation of beta-lactamase production were conducted all together. Suspected causative bacteria were detected from 238 (66.3%) out of the 359 cases. They included 85 strains of Haemophilus influenzae, 76 strains of Streptococcus pneumoniae, 20 strains of Streptococcus pyogenes and 17 strains of Moraxella subgenus Branhamella catarrhalis. 3. Clinical efficacy rates (the ratio of those excellent+good) among those who were treated with 1 CEMT-PI tablet (194 mg, titer) twice a day was 76.5% and among those who were given 2 tablets twice a day was 87.4%. The improvement rate of the latter was higher at a significant level of P < 0.05. 4. The clinical efficacies classified by suspected causative bacteria (single bacterium) were 93.3% against M.(B.) catarrhalis, 91.7% against beta-streptococci, 87.1% against H. influenzae and 78.4% against S. pneumoniae, etc. Though 7 (9.2%) of the 76 strains of S. pneumoniae were benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP), the bacteriological efficacy was assessed either excellent or good in all of the 7 patients from whom PISP were detected. The clinical efficacy was assessed 100.0% in those from which a plural number of bacteria were detected. The 13 cases from which small numbers of Staphylococcus aureus was detected with other bacterium were also included in these cases.

[Antibacterial activities of cefmenoxime against recent fresh clinical isolates from patients in sinusitis].

In order to evaluate antimicrobial activity of cefmenoxime (CMX), minimum inhibitory concentrations (MICs) of CMX and control drugs were determined against clinical isolates from patients of sinusitis that were obtained in our laboratory from October of 1993 to March of 1994. The results are summarized as follows; 1. CMX showed strong antimicrobial activities against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella subgenus Branhamella catarrhalis that were 3 major aerobic bacteria from sinusitis. Antimicrobial activities of CMX against benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP) and PCG-resistant S. pneumoniae (PRSP) were stronger than those of ampicillin (ABPC), and these strong activities suggested that CMX might have strong antimicrobial activities against beta-lactamase producing H. influenzae and M. (B.) catarrhalis. 2. Antimicrobial activities of CMX against microaerophiles, Streptococcus constellatus, Streptococcus intermedius and Gemella morbillorum and against Peptostreptococcus spp., from chronic sinusitis and odontogenic maxillary sinusitis, were stronger than those of most of the control drugs. 3. The MIC90's of CMX against isolates from patients of sinusitis were < or = 0.025-0.39 micrograms/ml. These values were lower than transitional concentrations in mucous membrane of maxillary sinus obtained when "1% CMX nasal solution" was used with nebulizer. It appears likely that sufficient concentrations exceeding MICs against main organisms would be obtained by nebulizer treatment using CMX nasal solution.

[Antimicrobial activities of sulbactam/ampicillin against clinically isolated microbial strains].

Antimicrobial activities were examined for sulbactam/ampicillin (SBT/ABPC) against clinically isolated microbial strains in 1987, 1990, 1994. Besides, the beta-lactamase productivity and MICs of these strains were measured, and the following conclusions were obtained. 1. The ratio of beta-lactamase producing strains were 90% of methicillin (DMPPC)-susceptible Staphylococcus aureus subsp. aureus (MSSA), about 80% of DMPPC-resistant S. aureus (MRSA), 100% of Escherichia coli, Klebsiella pneumoniae subsp. pneumoniae and Proteus mirabilis, 95% of Moraxella subgenus Branhamella catarrhalis and 15-20% of Haemophilus influenzae. Several kinds of beta-lactamase productivity were observed. 2. Antimicrobial activities of SBT/ABPC against beta-lactamase producing strains of MSSA, M. (B.) catarrhalis, H. influenzae, and almost all of Enterobacteriaceae were stronger than those of ampicillin (ABPC) and piperacillin (PIPC), but antimicrobial activities of SBT/ABPC were weak against MRSA and cephems (CEPs)-resistant strains detected in some of Enterobacteriaceae. 3. It appeared that benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae (PISP) or PCG-resistant S. pneumoniae (PRSP) and CEPs-resistant Escherichia coli increased year by year. 4. Antimicrobial activities of SBT/ABPC were strong against Streptococcus pyogenes, S. pneumoniae, M. (B.) catarrhalis and H. influenzae including beta-lactamase producing strains. Additionally, beta-lactamase inhibiting effect of SBT was observed against beta-lactamase produced by S. aureus and K. pneumoniae which demonstrate indirect pathogenicity. Thus, SBT/ABPC is an injectable antibiotic that is expected to demonstrate clinical usefulness, especially as the first line drug for the respiratory tract infections that are community-acquired.