Hemolytic Streptococci Group Research Articles

Associated Bacterial Coinfections in COVID-19-Positive Patients.

Background and Objectives: The aim of this study was to identify specific rhino- and oropharyngeal microbiological pathogens as well as associated comorbidities that favor SARS-CoV-2 infection and corelate them. Materials and Methods: This prospective clinical study enrolled 61 patients (28 COVID-19-positive and 33 controls) who were tested for other comorbidities and co-existence of associated oral pathogenic microbiota. Results: A total of 247 bacterial isolates were identified in the bacterial cultures in both groups. Viral hepatitis type A was more prevalent in the COVID-19-positive group (p = 0.026), as was the presence of oral candidiasis (p = 0.006). In the control group, a moderate direct relationship was observed between the Beta hemolytic streptococcus group G and dermatitis, and strong direct relationships were observed between the Beta hemolytic streptococcus group G and external otitis, Streptococcus pyogenes and dental alveolitis, and Streptococcus pyogenes and chronic lymphocytic leukemia. In the test group, strong direct relationships were observed between Hemophilus influenzae and pulmonary thromboembolism; Staphylococcus aureus and autoimmune thyroiditis; post-viral immunosuppression, chronic coronary syndrome, and hypernatremia; Beta hemolytic streptococcus group C and rheumatoid polyneuropathy; Beta hemolytic streptococcus group G and hyperkalemia, hypothyroidism, secondary anemia, and splenomegaly; and active oral candidiasis and SARS-CoV-2 viral pneumonia. The following relationships were strong, but inverse: Beta hemolytic streptococcus group G and acute respiratory failure, and active oral candidiasis and SARS-CoV-2 viral bronchopneumonia. Conclusions: Briefly, COVID-19-positive patients have the predisposition to build up associated comorbidities and coinfections, which can be the expression of the immune burden that this virus generates to the host.

Стан клітинного імунітету хворих на тонзиліт дітей, інфікованих вірусом герпеса 6 типу

Currently, the incidence of tonsillitis in children is very common and represents a serious medical and social problem. In young children, viral tonsillitis predominates, while bacterial tonsillitis is more common between the ages of 5–15. The frequency of registration of infection with viruses of the herpes group, including the human herpes virus (HHV) type 6, is increasing. The healing processes in infectious pathology are primarily due to the balanced work of the cellular and humoral links of the body’s immune response, the state of which can be influenced by concomitant infection with herpes viruses. The aim of the work was to study the cellular immune response of children with tonsillitis infected with HHV-6 type. The study of the influence of HHV-6 infection on the state of the cellular component of the immune response in 74 children with tonsillitis in the acute period and in the period of convalescence was carried out. All patients were diagnosed with a moderate form of tonsillitis; the etiological factor was hemolytic streptococcus group A. It was revealed that in children with mono-infection at the onset of the disease, there is a moderate response of cellular immunity (t = 2.76), while the presence of HHV-6 infection leads to more pronounced changes in the parameters of CD lymphocytes (t = 4.06). We found a significant increase in the content of CD16+-lymphocytes in tonsillitis of streptococcal etiology, but the maximum growth was recorded in patients with mono-infection (p < 0.05). By the time of convalescence, complete recovery of T-lymphocytes in infected HHV-6 patients does not occur. The degree of deviation from the standard for the entire complex of CD-lymphocytes during the period of convalescence was more pronounced in patients with co-infection (t = 2.83). The obtained data indicate the suppression of the cellular component of the immune response in patients with tonsillitis against the background of HHV-6 infection, which requires a differentiated approach to treatment and medical supervision of such patients.

Acute tonsillitis in a pediatrician’s practice

Acute tonsillopharyngitis (ATP) is a common infectious disease in paediatric practice. Throat pain, as the main symptom of acute tonsillopharyngitis, is the most common cause of seeking outpatient care. ATP is a polyethyological disease and requires a clarification of the etiological factor. Viral tonsillitis is the most common in children’s practice. Among bacterial pathogens, the beta hemolytic streptococcus group A (BHSA Streptococcus pyogenes) is of particular importance. This pathogen is associated with 5 to 15% of cases of acute tonsillopharyngitis in adults and 20- 30% in children [5]. Suspicion of BHSA in ATP requires the mandatory prescription of systemic antibiotic therapy. Currently, there are no reliable criteria for differential diagnosis of viral and bacterial ATP. As a result, the choice of ATP treatment tactics is an important task. On the one hand, this pathology is most often associated with unnecessary and unjustified prescription of systemic antibiotic therapy, and on the other hand, the rejection of antibiotics can contribute to the development of serious complications. Given the high frequency of viral ATP, an important area of pediatric practice is the use of local antiseptic and anti-inflammatory drugs. Topical drugs can be used both as monotherapy and, if necessary, in combination therapy of ATP. Timely etiological diagnostics and rational therapy of ATP are an important part of the effectiveness of ATP treatment in children and prevention of antibiotic resistance of microorganisms.

β-HEMOLYTIC STREPTOCOCCUS GROUP A CARRIER IN CHILDREN: THE PROBLEM OF DIFFERENTIAL DIAGNOSIS

Streptococcal infection is characterized by a variety of manifestations from asymptomatic carriage of the pathogen to manifest forms. Recently, in addition to the bacteriological method for confirming streptococcal etiology, the rapid test for β-hemolytic streptococcus group A is increasingly being used. Isolation of streptococci does not always indicate their involvement in pathology, quite often a person is a healthy carrier of the pathogen. The share of carrier is 10—28% of cases. However, in the practical activities of a physician, positive tests for β -hemolytic streptococcus group A (rapid test or bacteriological culture) are often treated as acute streptococcal infection even in children without any clinical manifestations of acute tonsillopharyngitis and, as a result, antibiotic therapy is prescribed. For differential diagnosis, a correct evaluation of epidemiological and clinical data with a mandatory serological test — the determination of ASO in paired sera with an interval of 7—10 days is required. Absence of an increase in antibodies indicates carrier. b-hemolytic streptococcus group A carriers in most cases do not need antibiotic therapy. However, if there is a history or risk of developing rheumatic fever, acute poststreptococcal glomerulonephritis, antibiotic therapy is necessary. The authors proposed an algorithm for managing patients with the release of b-hemolytic streptococcus group A from the oropharynx.

CHARACTERISTIC OF CLINIC AND DIAGNOSTICS OF ERYSIPELAS. REVIEW

Erysipelas is one of the first places on the prevalence of infectious disease after acute respiratory and intestinal infections, viral hepatitis. Currently, in most cases erysipelas is caused by beta-hemolytic group A Streptococcus bacterium, but in some cases could be due to co-infection with Staphylococcus aureus. The pathogenesis of erysipelas is characterized by impaired tissue immunity, cellular and humoral immunity deficiency, hypersensivity to hemolytic streptococci group A (Lansfeld). Chronic recurrent erysipelas refers to endogenous infection caused by intradermal and intra-macrophage maintaining L-forms of Streptococcus, and biological damage caused by excess production of cytokines by T-lymphocytes and mononuclear cells. The disease is characterized by increased cases with primary and severe hemorrhagic forms (over 60%), a tendency to develop recurrent erysipelas (30 to 40%), slow regenerative process in the focus of inflammation, the multiplicity of the differential diagnosis. Risk factors of the erysipelas are the disruption of the skin barrier, fungal skin infections, emotional stress, body hypothermia or overheating. Women suffer from erysipelas more often than men. Adults over age 40 years and older are more likely to develop erysipelas in more than 60% of cases. Erysipelas is characterized by seasonality- rise in the incidence observed in spring and autumn than other streptococcal infections. Depending on the lack of treatment efficacy in resolving symptoms of erysipelas, impaired prevention of disease recurrence, recommended treatment by scientists involves antibiotics with immunomodulation therapy and laser therapy.

Research-based assessment of antibiotic resistance of β hemolytic group B streptococci

Since the 1950s, beta hemolytic streptococcus group B have constituted the major etiological factor of perinatal infections. GBS colonization of the genital tract among pregnant women is diagnosed between 35 and 37 weeks of gestation, and is associated with approximately 25% risk of neonatal early-onset infections (EOD). The infection is severe among 1-3% of the newborns, and usually results in sepsis or pneumonia. beta-lactam antibiotics are drugs of choice to prevent vertical infection of group B streptococcus. In case of hypersensitivity to penicillin among pregnant women, second line drugs are macrolides and lincosamides. In light of numerous reports on the decreasing susceptibility of GBS, the aim of this study was to characterize the isolated strains of Streptococcus agalactiae in terms of their resistance to antibiotics. The study included 395 pregnant women in the third trimester of pregnancy hospitalized in the Department of Perinatology and Department of Gynecology and Obstetrics, Medical University of Lodz, between 02.2010 -02.2012. Vagino-rectal swabs were collected from all pregnant women. We recovered 121 GBS positive isolates. Identification was based on the streptococcal agglutination test. Antimicrobial susceptibility was determined by disk diffusion method. A positive result for GBS colonization was found among 89 patients, representing 22.5% of the studied population. Inducible MLSB resistance to erythromycin and clindamycin was 23.1% and 10.7% of the isolated strains, respectively Constitutive MLSB resistance was detected in 14.9% of the cases. The obtained results confirm that all GBS isolates are sensitive to beta-lactam antibiotics and prove that phenotypes resistant to macrolides and clindamycin are becoming more widespread. This leads to the conclusion that regular supervision of drug sensitivity of Streptococcus agalactiae is necessary

Glomérulonéphrites aiguës postinfectieuses

Acute postinfectious glomerulonephritis are defined by an acute nonsuppurative inflammatory insult predominantly glomerular. Its current incidence is uncertain because of the frequency of subclinical forms. The most common infectious agent involved is beta hemolytic streptococcus group A. Acute postinfectious glomerulonephritis is uncommon in adults, and its incidence is progressively declining in developed countries. Humoral immunity plays a key role in the pathogenesis of kidney damage. Complement activation by the alternative pathway is the dominant mechanism, but a third way (lectin pathway) has been recently identified. The classic clinical presentation is sudden onset of acute nephritic syndrome after a free interval from a streptococcal infection. Treatment is essentially symptomatic and prevention is possible through improved hygiene and early treatment of infections.

Microbiology of otitis externa in the secondary care in United Kingdom and antimicrobial sensitivity

Introduction Otitis externa is one of the most common conditions seen in the otolaryngology clinics. There are no recently published studies that have looked at the causative pathogens of the otitis externa seen in secondary care in the United Kingdom and their antimicrobial sensitivities. We present results of a prospective study to determine the current bacteriology of the condition. Methods Swabs were taken from the external auditory canals of the patients who presented to the otolaryngology emergency clinic with symptoms of otitis externa. These were analysed using microscopy, culture and sensitivity testing in one laboratory. The samples were cultured on blood agar, chocolate agar, Sabouraud agar, fastidious anaerobes agar with neomycin and staph/strep agar. Antimicrobial sensitivities of isolated pathogens were tested on iso-sensitest and blood agars using the BSAC disc diffusion template program. Results The most commonly identified pathogen was Pseudomonas aeruginosa (45.1%), followed by Staphylococcus aureus (9%), anaerobes (6.3%), β haemolytic Streptococcus group G (2.8%), β haemolytic Streptococcus group A (1.4%), Streptococcus pneumoniae (0.7%), methicillin resistant S. aureus (0.7%), Candida species (9.7%), Aspergillus species (4.2%) and Absidia corymbifera (0.7%). One hundred percent resistance of Pseudomonas isolates to neomycin, chloramphenicol, trimethoprim and amoxicillin was observed while most were sensitive to ciprofloxacin (100%), polymixin B (100%) and gentamicin (98.5%). S. aureus isolates were sensitive to gentamicin and flucloxacillin (100%). 92.3% were sensitive to neomycin and chloramphenicol. Resistance to penicillin and amoxicillin is observed. All isolates anaerobes were sensitive to metronidazole. Conclusion Polymixin B, gentamicin or ciprofloxacin topical preparations should be used as first line treatment of otitis externa. If the infection does not settle swab results should be used to guide further treatment.

THE CLASSIC: Intrapelvic Protrusion of the Acetabular Component Following Total Hip Replacement

THE CLASSIC: Intrapelvic Protrusion of the Acetabular Component Following Total Hip Replacement

Encefalomielitis aguda. Experiencia de un hospital terciario español

To describe the epidemiological, clinical, microbiological, neuroimaging and laboratory features, treatment, and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM). Retrospective chart review was performed of children with a diagnosis of ADEM over a 23-year period in a tertiary hospital in Spain. Twelve cases were identified. Ten cases (83%) occurred after 1992. Nine patients (75%) presented between April and September. The mean age was 6 years. Nine patients (75%) were male. Fifty percent of the patients had a history of infectious disease or vaccination. The most frequent nonspecific symptom was fever in 75%. The most frequent neurological manifestations were motor deficits and altered consciousness in 75%. Cerebrospinal fluid abnormalities were found in 83%. All patients had at least one brain scan and one brain magnetic resonance imaging (MRI) scan. Three patients underwent spinal MRI. The sensitivity of MRI was greater than that of the scanner in the diagnosis of ADEM. An etiologic diagnosis was made in four patients: Mycoplasma pneumoniae, beta hemolytic streptococcus group A, Epstein-Barr virus and measles-mumps-rubella vaccination. Eleven patients were treated with corticosteroids and one was treated with intravenous immunoglobulin therapy. One patient died while 75 % of the patients had a good outcome. ADEM is in an infrequent disease in children. The clinical features are similar to those of infectious encephalitis. Etiologic diagnosis is difficult to establish but this entity is usually preceded by an infection. The neuroimaging test of choice to establish the diagnosis is MRI. In most patients, the prognosis is good.

A Case-Control Study of Acute Respiratory Tract Infection in General Practice Patients in The Netherlands

Background. Acute respiratory tract infections (ARTIs) are responsible for considerable morbidity in the community, but little is known about the presence of respiratory pathogens in asymptomatic individuals. We hypothesized that asymptomatic persons could have a subclinical infection and thus act as a source of transmission. Methods. During the period of 2000–2003, all patients with ARTI who visited their sentinel general practitioner had their data reported to estimate the incidence of ARTI in Dutch general practices. A random selection of these patients (case patients) and an equal number of asymptomatic persons visiting for other complaints (control subjects) were included in a case-control study. Nose and throat swabs of participants were tested for a broad range of pathogens. Results. The overall incidence of ARTI was 545 cases per 10,000 person-years, suggesting that, in the Dutch population, an estimated 900,000 persons annually consult their general practitioner for respiratory complaints. Rhinovirus was most common in case patients (24%), followed by influenza virus type A (11%) and coronavirus (7%). Viruses were detected in 58% of the case patients, β-hemolytic streptococci group A were detected in 11%, and mixed infections were detected in 3%. Pathogens were detected in ∼30% of control subjects, particularly in the youngest age groups. Conclusion. This study confirms that most ARTIs are viral and supports the reserved policy of prescribing antibiotics. In both case and control subjects, rhinovirus was the most common pathogen. Of bacterial infections, only group A β-hemolytic streptococci were more common in case patients than in control subjects. Furthermore, we demonstrated that asymptomatic persons might be a neglected source of transmission.

Antibacterial properties of human amnion and chorion in vitro

Objective: The purpose of the present study was to explore the direct effects of amnion and chorion on bacterial growth in vitro including the antibacterial spectrum. Chorioamniotic membranes were obtained under sterile conditions from 13 healthy women undergoing elective cesarean section at term. Likewise, chorioamniotic membranes were obtained from 10 healthy women with spontaneous vaginal delivery at term. Five strains of Hemolytic streptococci group B (GBS) were tested and one clinical isolate of the following species or bacterial groups: Hemolytic streptococcus group A, Staphylococcus aureus, Staphylococcus saprophyticus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter calcoaceticus and Lactobacillus species. Bacteriological media included (1) blood-agar medium; (2) a transparent agar medium for submerged cultures; and (3) a nutrient broth medium. Results: An inhibitory effect of fetal membranes against a range of bacteria was found. Consistent results were obtained in experiments with cultures on agar and cultures suspended in agar (membranes from eight women in both studies). In experiments with liquid cultures (seven women) only chorion showed a marginal inhibitory effect. All strains were inhibited, but the most pronounced inhibition was obtained for streptococcus group A, S. aureus and S. saprophyticus by both chorion and amnion. Conclusion: This study demonstrated an inhibitory effect of the fetal membranes on a diverse panel of bacteria

Epidemiological survey for hemolytic streptococci isolated from children in Tokyo

During the 20-year period between 1979-1998, a total of 4,176 strains of hemolytic streptococci have been isolated from 20,118 healthy primary school children and little children in Tokyo Metropolitan (Tokubetsuku, Tama and Tosho). Culture of throat swabs every November and the following February during the 20-year period were made and serological grouping and typing for isolates were done by T agglutination method. The results were as follows. 1) Serological group of hemolytic streptococci isolated from children were 3,188 strains (76.3%) for isolates of group A out of total strains of 4,176, 569 strains (13.6%) for isolates group B, 63 strains (1.5%) for isolates of group C and 356 strains (8.5%) for isolates of group G. 2) The most dominant was T12 during 1979-1998, and other relatively frequent serotypes were T28, T1, T4, T6 in that order. These ranks of and the main epidemic serotypes showed a similar trend in the 3 areas. 3) The isolation rates of group A streptococci were 15.9% in Tokubetsuku, 17.1% in Tama and 14.9% in Tosho. The average of 3 areas were 15.8%. 4) The epidemic cases seemed to be caused by group A streptococci were 20 cases, their isolated serotype were 7 cases by T28, 5 cases by T12, 4 cases by T6, 2 cases by T4, each 1 case by T1 and T25. 5) A total of 2,927 strains of group A streptococci were examined for drug sensitivity. All strains were sensitive to beta-lactam group of antibiotics (benzylpenicillin and cephaloridine). Resistant (MIC > or = 25 micrograms/ml) to TC, CP and EM etc. were 740 strains (25.3%) in this study. The incidence of resistant strains were to TC 493 strains (66.6%) out of 740 strains, 81 strains (10.9%) for TC.CP, 72 strains (9.7%) for EM and 66 strains (8.9%) for TC.CP.EM.OL.LCM. TC resistant strains have not varied much through the whole period, but CP and EM resistant strains were very variable by year. Many resistant strains to TC were T4, to EM and multiple drug resistant were T12. 6) The rates of isolates of the same type of group A streptococci in school child individual during for the tests taken twice a year were 12.3%, indicating group A streptococci, according to the duration of the carrier state, seems to be a short period.

Acute mastoidectomy in a Danish county from 1977 to 1996 with focus on the bacteriology

To evaluate if the nature of acute mastoiditis (AM) treated surgically has changed during the last 20 years (1977–1996), the data from patients undergoing acute mastoidectomy were examined retrospectively. Cases with cholesteatomas and intracranial complications were excluded, while 79 patients (48% male) with a median age of 16 months were included. There was a history of infectious middle ear disease in 37% and the mean duration from onset of symptoms to admission was 9 days. The well-being was affected in 46 and 82% had fever. Purulent middle ear effusion was recognized in 92%. A subperiosteal abscess in 66% of the ears peroperatively. Specimens yielded growth of pathogens in 58%, predominantly gram positive bacteria, fully or partially sensitive to penicillin. Antimicrobial treatment before admittance masked or reduced more symptoms significantly. The patients from the last 10-year-period had less frequently acute otitis media in their history, shorter duration of hospitalization, and more frequently haemolytic Streptococcus group A. Conclusively, AM affects especially infants without previous middle ear disease. The clinical picture has become more subtle in time, probably due to antibiotics, and concomitantly the bacteriological pattern has changed.

Group A streptococcal carriage: Can the troll be tamed?

The dilemma of determining optimal care for the child with repeatedly positive throat cultures for group A beta hemolytic streptococcus (group A strep) has bedevilled paediatricians, family practitioners and generalists for decades. Unfortunately, the state of the art has not changed substantially over the past 20 years, as attested to by the dearth of publications and the similarity of the definitive recommendations spanning that period (1,2). The purpose of this column is to review briefly the state of knowledge about chronic streptococcal carriage and to suggest a rational approach to treating children who present with this problem. The challenge of evaluating a child with a positive throat culture for group A strep results from the inability to distinguish between the carrier (one who harbours the organism without a host response) and the child who is acutely infected (one who has evidence of inflammation and host response). Carriers are often identified when they continue to harbour the organism in the throat asymptomatically after an appropriate 10-day course of penicillin or alternative agent (3). There is a high rate of carriage in the general population (approximately 5% to 15% of school-aged children are colonized but not infected with group A strep at any time), and there is no foolproof way to differentiate a priori between carriers and those who are acutely infected. Therefore, many children are diagnosed with streptococcal pharyngitis who are chronic carriers and who are probably acutely infected with another organism (such as a respiratory virus). In this era of evolving antibiotic resistance and a desire to limit unnecessary use of antimicrobial agents, a logical strategy for avoiding therapy of chronic carriers is required. Chronic carriers of group A strep probably do not pose a threat to themselves or to others. There is no evidence that these children or their contacts become infected with the strains that these children carry. Therefore, they do not require antibiotic therapy to prevent suppurative or nonsuppurative (acute rheumatic fever, acute poststreptococcal glomerulonephritis) complications. So why do doctors need to worry? The simple answer is that physicians are unable to differentiate at presentation between the child who is acutely infected and the one who is a chronic carrier presenting with acute nonstreptococcal pharyngitis. The methods for making that discrimination (testing for serological response and strain typing) require time and the aid of reference or research laboratories. What can the medical practitioner do when confronted with a child who repeatedly returns to the office or clinic for evaluation of or therapy for acute respiratory illnesses in which group A strep is recovered from the throat? If it could be determined a priori whether that child is a streptococcal carrier, antibiotic therapy could be avoided. A child is likely a carrier if he or she has symptoms most consistent with a viral upper respiratory infection and has consistently harboured group A strep in the past. However, the discriminatory power of clinical evaluation of such patients is notoriously unreliable. Perhaps the most expedient strategy is to attempt eradication of the carrier state. If successful, ie, the child has a negative culture after completion of therapy, one might assume that if the child presents again with pharyngitis and a throat culture positive for group A strep, this is evidence of bone fide acute streptococcal infection. Eradication of carriage should probably be reserved for children who remain culture-positive after a full and appropriate course of antibiotic therapy, and who have had at least three symptomatic episodes of pharyngitis with

Group B Streptococcus During the Perinatal Period

The beta hemolytic streptococcus group B (GBS) emerged as a major pathologic threat to infants in the 1960s and continues to be the leading cause of maternal and neonatal morbidity in the 1990s. Current approaches to prevention are directed toward eliminating exposure to the pathogen through chemoprophylaxis or enhancing host resistance through immunoprophylaxis. Because research is advancing rapidly in this area, perinatal nurses should keep abreast of changes in prevention and treatment strategies to enhance patient education and improve care.

A Follow-up of an Outbreak of Erythromycin-resistant Hemolytic Streptococci Group A in Göteborg

A Follow-up of an Outbreak of Erythromycin-resistant Hemolytic Streptococci Group A in Göteborg

Recurrent Group C Streptococcal tonsillopharyngitis in an adolescent

Sore throat is a frequent complaint in the adolescent age group. Beta-hemolytic Streptococcus Group C is not a commonly reported etiology of tonsillopharyngitis. This is a case report of a 14-year-old adolescent female who had repeated episodes of pharyngitis secondary to beta hemolytic streptococcus Group C.

The trends of hemolytic streptococci isolated from clinical specimens in hospitals in Saitama during the period of 1979-1987

In order to analyze the trends of hemolytic streptococcal infections, we have investigated the source of clinical specimens, monthly isolation rates, and the isolation rates by sex and age o patients of 6,440 hemolytic streptococci (group A, B, C and G) isolated from clinical specimens in hospitals in Saitama during the period of 1979-1987. 1) Serological group of 6,440 hemolytic streptococci isolated from clinical specimens were 4,691 (72.9%) isolates of group A, 1,535 (23.8%) isolates of group B, 47 (0.7%) isolates of group C, and 169 (2.6%) isolates of group G. 2) The main clinical sources of hemolytic streptococci, group A streptococci were 4,243 (90.7%) isolates from throat swabs, 117 (2.5%) isolates from ear secretions, 87 (1.9%) isolates from nose secretions, and 58 (1.2%) isolates etc., group B streptococci were 647 (42.2%) isolates from urines, 446 (29.1%) isolates from vaginal swabs, 127 (8.3%) isolates from throat swabs, 118 (7.7%) isolates from semen, 55 (3.6%) isolates from urethral secretions, 13 (0.8%) isolates from blood, and 9 (0.6%) isolates from cerebrospinal fluid etc.. 3) The monthly isolation rates of hemolytic streptococci, showed that group A streptococci had a general trend by the season, that is, the highest ratio in winter and the lowest ratio in summer, group B streptococci was not influenced by the season. 4) The isolation rates by sex of patients showed that group A streptococci had no difference between male and female, however, group B streptococci showed that the isolation rate of female was higher than that of male with the ratio of 7 to 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of ofloxacin on oral and gastrointestinal microflora in patients undergoing gastric surgery.

The effect of ofloxacin on the microflora in saliva, gastric juice, and feces was evaluated in 24 patients undergoing gastric surgery. A single peroral dose of 400 mg ofloxacin was given to each patient 2-4 h before surgery. The concentrations of ofloxacin in serum, saliva, gastric juice, and gastric mucosa tissue were assayed. Only Branhamella cocci were affected in the saliva. In the gastric juice, both the aerobic and anaerobic flora were suppressed on the day of surgery, but increased in number afterwards. There was a significant correlation between gastric pH and the number of microorganisms isolated in the gastric juice on day 0. In faeces, the aerobic and part of the anaerobic flora were suppressed by the administration of ofloxacin. Ofloxacin was well tolerated by the patients. Four of 24 patients developed postoperative complications. Microorganisms isolated from wound sepsis and intraabdominal sepsis (three patients) were Staphylococcus epidermidis, Staphylococcus aureus, hemolytic streptococci group A, Streptococcus sp. and Escherichia coli. All related infections occurred in patients with very low ofloxacin serum concentrations, probably due to impaired absorption. Oral antibiotic prophylaxis is not recommended in patients in whom impaired gastric emptying can be expected.