Proteus Mirabilis Infection Research Articles

Indwelling Urinary Catheter Model of Proteus mirabilis Infection.

Uncomplicated urinary tract infections, especially those caused by Escherichia coli, have historically been widely studied. However, complicated urinary tract infections are presenting ever increasing healthcare challenges, particularly with Proteus mirabilis. P. mirabilis is often found on indwelling urinary catheters causing monomicrobial and polymicrobial catheter-associated urinary tract infection (CAUTI). Widespread antibiotic resistance, combined with the ability of P. mirabilis to form urinary calculi during infection, warrants further investigation of this pathogen and its host interaction in an infection model that more closely mimics the presence of an indwelling urinary catheter. Here, we describe the methods necessary to establish a murine model of P. mirabilis CAUTI.

Conservative Surgical Management of Uterine Incisional Necrosis and Dehiscence After Primary Cesarean Delivery Due to Proteus mirabilis Infection: A Case Report and a Review of Literature

We hereby describe the conservative surgical management of a case of infected uterine incisional necrosis and dehiscence after primary cesarean delivery, and report our brief review on risk factors, physiopathology and the management of this postpartum complication. We encountered a 25-year-old woman presenting to our emergency department (ED) with severe suprapubic pain and high grade fever. She had an urgent cesarean delivery performed 10 days prior to presentation due to fetal distress. At the ED, CT scan of pelvis was ordered and showed an intraperitoneal collection anterior to the uterus at the level of the uterine cesarean scar. Exploratory laparotomy showed a uterine rupture at the previous incision site. We performed resection of necrotic edges, peritoneal lavage, approximation of uterine edges with separate interrupted sutures, placement of a suction drain in the cul-de-sac and a passive drain inside the uterine cavity through the cervix and vagina. Postpartum uterine scar rupture secondary to infection and necrosis is a rare but serious complication of cesarean delivery. Conservative management by drainage and resection of necrotic edges in addition to intravenous antibiotics may be considered as an option before resorting to hysterectomy in selected young patients. A low threshold to diagnose this complication is warranted. J Clin Gynecol Obstet. 2017;6(3-4):65-70 doi: https://doi.org/10.14740/jcgo451w

A Case of Tetraplegia after Proteus mirabilis Infection.

A Case of Tetraplegia after Proteus mirabilis Infection.

Role of DAF-21protein in Caenorhabditis elegans immunity against Proteus mirabilis infection

Caenorhabditis elegans is emerging as one of the handy model for proteome related studies due to its simplest system biology. The present study, deals with changes in protein expression in C. elegans infected with Proteus mirabilis. Proteins were separated using two-dimensional differential gel electrophoresis (2D-DIGE) and identified using MALDI-TOF. Twelve distinctly regulated proteins identified in the infected worms, included heat shock proteins involved stress pathway (HSP-1 and HSP-6), proteins involved in immune response pathway (DAF-21), enzymes involved in normal cellular process (Eukaryotic translation Elongation Factor, actin family member, S-adenosyl homocysteine hydrolase ortholog, glutamate dehydrogenase and Vacuolar H ATPase family member) and few least characterized proteins (H28O16.1 and H08J11.2). The regulation of selected players at the transcriptional level during Proteus mirabilis infection was analyzed using qPCR. Physiological experiments revealed the ability of P. mirabilis to kill daf-21 mutant C. elegans significantly compared with the wild type. This is the first report studying proteome changes in C. elegans and exploring the involvement of MAP Kinase pathway during P. mirabilis infection. Biological significanceThis is the first report studying proteome changes in C. elegans during P. mirabilis infection. The present study explores the role and contribution of MAP Kinase pathway and its regulator protein DAF-21 involvement in the immunity against opportunistic pathogen P. mirabilis infection. Manipulation of this DAF-21 protein in host, may pave the way for new drug development or disease control strategy during opportunistic pathogen infections.

Prevalence and risk factors of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae

To study the clinical characteristics and associated risk factors of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. A case-control study at a large university hospital in Japan, comparing patients who were infected or colonized with ESBL-producing Enterobacteriaceae (n=212) and non-ESBL-producing Enterobacteriaceae (n=2089) in 2010-2013. Data were collected from medical charts, retrospectively. Multivariate logistic regression analysis was used to explore risk factors of ESBL-producing Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) infection or colonization for each pathogen, respectively. ESBL-producing Enterobacteriaceae [E.coli (n=113), K.oxytoca (n=46), K.pneumoniae (n=41), P.mirabilis (n=12)] were taken from patients were identified in 1409 outpatient and 892 inpatients. Infection or colonization caused by ESBL-producing Enterobacteriaceae was considered to be hospital-acquired, healthcare-associated and community-acquired in 60.4%, 17.9% and 21.7% patients, respectively. Independent risk factors for ESBL-producing Enterobacteriaceae infection or colonization were male sex, cerebrovascular disease, intubation/tracheostomy, major surgery within 60 days (p<0.001). Moreover, antimicrobial usage (more than 4 days) during preceding 60 days, especially aminoglycoside, oxazolidinone, tetracycline, fluoroquinolone, trimethoprim/sulfamethoxazole, and second- and fourth-generation cephalosporin were risk factors (p<0.001). However, acquisition location of infection (hospital-acquired and community-onset) was not a risk factor (p>0.05). The problem of ESBL production is no longer limited to hospital-acquired infections. The presence of chronic illness, such as cerebrovascular disease, and recent antimicrobial use were independent risk factors for ESBL-producing Enterobacteriaceae infection or colonization.

An in-situ infection detection sensor coating for urinary catheters

We describe a novel infection-responsive coating for urinary catheters that provides a clear visual early warning of Proteus mirabilis infection and subsequent blockage. The crystalline biofilms of P. mirabilis can cause serious complications for patients undergoing long-term bladder catheterisation. Healthy urine is around pH 6, bacterial urease increases urine pH leading to the precipitation of calcium and magnesium deposits from the urine, resulting in dense crystalline biofilms on the catheter surface that blocks urine flow. The coating is a dual layered system in which the lower poly(vinyl alcohol) layer contains the self-quenching dye carboxyfluorescein. This is capped by an upper layer of the pH responsive polymer poly(methyl methacrylate-co-methacrylic acid) (Eudragit S100®). Elevation of urinary pH (>pH 7) dissolves the Eudragit layer, releasing the dye to provide a clear visual warning of impending blockage. Evaluation of prototype coatings using a clinically relevant in vitro bladder model system demonstrated that coatings provide up to 12h advanced warning of blockage, and are stable both in the absence of infection, and in the presence of species that do not cause catheter blockage. At the present time, there are no effective methods to control these infections or provide warning of impending catheter blockage.

Neonatal sepsis and coagulopathy secondary to congenital transmission of Proteus mirabilis

Proteus mirabilis infection is rare in neonates. In this population, the majority of described infections involve the central nervous system (CNS). We describe an unusual case of congenitally acquired P. mirabilis infection in a neonate presenting as sepsis, pancytopenia, and coagulopathy. Providers should consider this organism as a cause of severe illness in the newborn period, even in the absence of CNS involvement.

Effects of indigowoad root (Radix Isatidis) on the immune responses and HSP70 gene expression of medicinal leeches (Poecilobdella manillensis) under Proteus mirabilis infection

We aimed to assess the effect of Radix Isatidis dietary supplementation on resistance to Proteus mirabilis infection in Poecilobdella manillensis. Six groups of leeches housed in tanks were randomly divided into five treatment groups (fed a basal diet supplemented with 2.5, 5.0, 7.5, 10.0, or 12.5g/kg of Radix Isatidis) and one control group (fed a basal diet). Compared with the control group, the specific growth rate (SGR) and weight gain (WG) were significantly decreased in the treatment groups supplemented with Radix Isatidis. However, supplementation with 2.5 to 10.0g/kg of Radix Isatidis did not produce an effect on mortality. Mortality was recorded after the leeches were challenged with P. mirabilis, and changes were observed in the serum cortisol, glucose, alanine aminotransferase (ALT), 3,5,30-triiodothyronine (T3), thyroxin (T4), alkaline phosphatase (ALP), total protein (TP), globin, and lysozyme contents. In the ingluvies, changes were observed in the total anti-oxidative capacity, superoxide dismutase (SOD) and catalase (CAT) activity, malondialdehyde (MDA) content and heat shock protein 70 (HSP70) gene expression over a period of 7d. Treatment with 5.0 to 10.0g/kg of Radix Isatidis increased the following parameters: total anti-oxidative capacity of the ingluvies prior to infection and at 1, 2 and 7d after infection; serum ALP activity and serum globin concentrations prior to infection and at 1 and 2d after infection; T4 concentrations prior to infection; serum lysozyme activity at 1d after infection; SOD and CAT activity in the ingluvies prior to infection and 7d after infection; T3 concentrations at 1 and 2d after infection; and the relative level of HSP70 mRNA expression in the ingluvies at 2d after infection. However, treatment with 5.0 to 10.0g/kg of Radix Isatidis increased the following parameters: ALT contents prior to infection and 1, 2 and 7d after infection; serum cortisol concentrations and serum glucose at 1, 2 and 7d after infection; MDA contents of the ingluvies at 1 and 2d after infection; and T4 concentrations at 2 and 7d after infection. Compared with the control group, significantly lower mortality was observed in the groups supplemented with 5.0 to 10.0g/kg of Radix Isatidis. These results suggest that supplementation with 5.0 to 10.0g/kg of Radix Isatidis in the basal diet could enhance resistance to P. mirabilis infection in P. manillensis. Statement of relevanceWe believe that this manuscript is appropriate for publication in Aquaculture because it provides a natural method of controlling disease in P. manillensis, thereby avoiding the use of antibiotics and the development of antibiotic resistance. Furthermore, the results of our study provide new information on the physiological and molecular mechanisms that underlie the protective effect of Radix Isatidis.

Ceftaroline for the Treatment of Complicated Skin and Skin-Structure Infections

Ceftaroline is novel “fifth generation” cephalosporin with broad acitivity, most notably including penicillinase-resistant Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA). Ceftaroline is inactive against Pseudomonas spp, other gram-negative non-fermenters, anaerobes and other multidrug resistant organisms. Ceftaroline has been evaluated for complicated skin and soft tissue infections in phase three clinical trials, CANVAS 1 and 2, which demonstrated non-inferiority to vancomycin and aztreonam. Infections evaluated included cellulitis, abscess, and skin and soft tissue ulcers. Decreased efficacy was noted in patient with Enterococcus faecalis and Proteus mirabilis infections. Ceftaroline is well tolerated with a favorable safety profile, and may play an important role in the future treating serious MRSA-related infections.

Spectrum and drug resistance of pathogens from patients with burns

Microbial infection is an obstacle of burn treatment. However, little is known on what types of microbial infection dominate in the burn center and how the dynamic change of those microorganisms occurs during the past several years in China. We conducted a retrospective study of nosocomial infection (NI) in a large burn center to analyze the spectrum and antimicrobial resistance of microbial isolates from January 2003 to December 2010. We studied 989 isolates from 677 patients who had signs and symptoms of infection 48h after admission. The number of NIs per 100 admissions was 10.9. The commonest isolates were Pseudomonas aeruginosa (23.1%), Staphylococcus aureus (18.7%), and Candida (11.4%). The result indicated that the numbers of patients with Acinetobacter sp. infection increased (P=0.004), but with Proteus mirabilis infection decreased (P=0.004). The isolated Acinetobacter sp. and P. aeruginosa were consistently highly resistant to almost all antibiotics tested. Notably, more frequent Acinetobacter sp. isolates appeared to be resistant to amikacin, gentamicin, tobramycin, ceftazidim, piperacillin, tazobactam, levofloxacin, and ciprofloxacin and more frequent Escherichia coli isolates were resistant to ceftazidime and aztreonam at the late time period although the P. aeruginosa and E. coli isolates were sensitive to less used ciprofloxacin and piperacillin/tazobactam. The increased rates of drug-resistant isolates in the later period might be associated with regular prophylactic therapy with antibiotics.

The purple urine bag syndrome: a visually striking side effect of a highly alkaline urinary tract infection

The purple urine bag is a visually striking and rarely seen side effect of a urinary tract infection. The change in colour is purely within the bag itself; interestingly, the urine itself remains unchanged in colour. Our patient, an 82-year-old female, had a long-standing supra pubic catheter (SPC) in situ; she presented for her routine 6-week SPC change. During this visit, the colour change of the urine drainage bag was noted. The change in colour was consistent throughout the bag and extended to the urinary catheter, although not in the same shade of deep purple noted in the drainage bag (Fig. 1). The urine from the bag contained sediment which was sent for analysis. Fig. 1. The urine bag still attached to the removed supra pubic catheter. Colour change in consistent throughout the bag and extends (red in colour) into the catheter. The urine contained within the purple drainage bag was not purple on visual examination (Fig. 2), although the urine collected following the re-insertion of a new SPC was noticeably lighter in colour. There was no hindrance to the removal of the old SPC, although the patient complained of mild discomfort upon removal. The new SPC was inserted without difficulty. Our patient denied any recent history of nausea, fevers, sweats, chills or vomiting. The patient also denied any recent changes to her medication regimen or unusual dietary changes. Fig. 2. Urine collected from the purple urine bag. The urine itself was dark in colour but not purple in colour. Urinary dipstick analysis indicated the presence of large leucocytes, positive nitrates and a pH of 8.5. Following consultation with our hospitals infectious diseases team, the patient started on a course of amoxicillin/clavulanic acid 875/125 mg BD for 5 days, while urine microscopy/culture/sensitivity (M/C/S) was conducted. Culture revealed the presence of Proteus mirabilis, sensitive to amoxicillin/clavulanic acid. Microscopy revealed the presence of phosphate crystals within the sediment from the purple urine bag (Fig. 3), while a smaller volume of phosphate crystals were noted in the second batch of urine from the fresh catheter/collection bag. The presence of phosphate crystals is a known side effect of a Proteus mirabilis infection. Fig. 3. Microscopy of the sediment collected from the urine sample within the purple urine bag, power of 10, indicating phosphate crystals. Based upon the patient’s history and the microbiology results, a diagnosis of purple urine bag syndrome was made. This is a rarely reported state where the urine collection bag is noted to change to purple. The condition is most common in patients with permanent urinary catheterization, either urethral or supra pubic, in combination with a highly alkaline urinary tract infection (UTI). Numerous organisms have been reported as being responsible for the purple urine bag and include Providencia bacteria, Escherichia coli, Proteus mirabilis or Klebsiella pneumonie.1,2 The pathogenesis of purple urine bag syndrome is due to the metabolism of tryptophan by bacteria to indole and later converted to indicant in the liver.3 This is excreted and broken down in the urine by bacteria possessing one or both enzymes, sulphatise and phosphatase that metabolize this pigment to indirubin and indigo in an alkaline environment (urine). The exact cause of the colour change in purple urine bag syndrome is still unclear. Dealler and colleagues suggest it is due to tryptophan being metabolized to indole which is absorbed into the portal system and converted to indicant by the liver.1,3 This, in turn, is excreted into the urine where the presence of an alkaline environment and bacteria are capable of metabolizing indicant to indirubin and indigo.1,3 The indigo can also be present in the catheter itself, giving a blue discolouration.4 While purple urine bag syndrome may seem harmless, the underlying UTI can lead to serious consequences in a patient with a long-term urinary catheter in which the standard warning signs of dysuria may not be apparent on top of other medical comorbidities. Medical management of purple urine bag syndrome does not require any special treatment apart from changing the catheter and administering appropriate antimicrobial therapy to treat the underlying bacterial infection.

Efficacy of Ertapenem for Consolidation Therapy of Extended-Spectrum β-lactamase-Producing Gram-Negative Infections: A Case Series Report

Infections caused by extended-spectrum beta-lactamase (ESBL)-producing gram-negative organisms are becoming increasingly common and present significant challenges in terms of treatment. Carbapenems is the antibiotic class of choice for treatment of these types of infections. Ertapenem is the newest carbapenem, capable of being dosed once daily, and has some in vitro but little in vivo evidence supporting its use for the treatment of these resistant infections. To examine the clinical and microbiologic outcomes associated with ertapenem therapy of ESBL-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis infections. This was a retrospective case series that examined the clinical and microbiologic outcomes of 22 patients who received ertapenem for treatment of an ESBL infection at Rush University Medical Center in Chicago, IL, during 2003-2005. The majority (16/22) of patients received ertapenem for consolidation rather than initial therapy. Different antibiotics most commonly used were other carbapenems, piperacillin/tazobactam, and aminoglycosides. The most common infections treated were lower urinary tract infections and osteomyelitis. Clinical efficacy was determined in all 22 patients, with 20 (91%) patients having a positive outcome, defined as either clinical improvement or clinical cure. The best clinical cure rate was seen with wound infections, where all 3 patients examined were found to be clinically cured. Microbiologic efficacy was determined in 7 patients, with 6 (85.7%) defined as microbiologic cure. One patient was found to be both a clinical and microbiologic failure and was also found to have developed an ertapenem-resistant strain of E. coli. These results demonstrate potential microbiologic and clinical efficacy of ertapenem for treatment of ESBL-producing infections and the need for a prospective, randomized study examining its efficacy versus that of other carbapenems.

Successful surgical treatment of spear wounds in a Hawksbill Turtle, Eretmochelys imbricata (Testudines: Cheloniidae)

Sea Turtles are frequently poached by spearing in the neck region and subsequently holding them alive until slaughter. Thus the ability of stranding networks to repair and rehabilitate these animals is of interest. Two Hawksbill Turtles, Eretmochelys imbricata, illegally collected by spear fishing 8 May 1993 were confis- cated by the Puerto Rico Maritime Police and referred to the Caribbean Stranding Network for rehabilitation (Case # NEPCH136). The lacerated cervical region of both animals was surgically repaired. One adult male turtle 67 cm in carapace length and weighing 46.8 km lacking additional injuries recovered and was released (flipper tags QQD915, QQD916). A juvenile female was 46.0 cm in carapace length and 15.2 kg in weight with additional injuries succumbed to bacteria (Proteus mirabilis and Serratia rubridea) infections despite treatment with ampicillin trihydrate. A necropsy found routine numbers and diversity of parasites that were reported elsewhere. This result demonstrates that speared sea turtles without further complications can be rehabilitated. Since this somewhat early surgery, new techniques have been developed to even more successfully manage

Case report: Acute unintentional carbachol intoxication

IntroductionIntoxications with carbachol, a muscarinic cholinergic receptor agonist are rare. We report an interesting case investigating a (near) fatal poisoning.MethodsThe son of an 84-year-old male discovered a newspaper report stating clinical success with plant extracts in Alzheimer's disease. The mode of action was said to be comparable to that of the synthetic compound 'carbamylcholin'; that is, carbachol. He bought 25 g of carbachol as pure substance in a pharmacy, and the father was administered 400 to 500 mg. Carbachol concentrations in serum and urine on day 1 and 2 of hospital admission were analysed by HPLC-mass spectrometry.ResultsMinutes after oral administration, the patient developed nausea, sweating and hypotension, and finally collapsed. Bradycardia, cholinergic symptoms and asystole occurred. Initial cardiopulmonary resuscitation and immediate treatment with adrenaline (epinephrine), atropine and furosemide was successful. On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg/l.ConclusionThis case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure.

The incidence of Proteus mirabilis infection increases in patients on treatment but does not trigger disease activity

The aim of this study is to determine whether treatment increases the levels of anti-Proteus antibodies (APA) in patients with rheumatoid arthritis (RA). The blood samples of 32 patients suffering from RA who were recruited in our previous study and continued to participate in our follow-up study were collected after 1 year. Their first and follow-up samples were analysed for the presence of IgG isotype and total immunoglobulins (IgG+IgA+IgM) against Proteus mirabalis (PM) using enzyme-linked immunosorbent assay with two kinds of antigen preparations: whole bacteria and sodium dodecyl sulphate (SDS) lysed bacterial extract. All patients were treated with methotrexate and hydroxychloroquine with adequate dose of non-steroidal anti-inflammatory drug. After 1 year, 11 patients were in clinical remission [erythrocyte sedimentation rate (ESR) less than 30 mm/h and C-reactive protein (CRP) less than or equal to 10 mg/l], while the rest of the 21 were in the state of active disease. Correlation and Student's t test were used for statistical analysis. APA titres were significantly elevated in patients after 1 year of therapy. However, the rise was not different between patients who were in clinical remission and those in the state of active disease. APA titre increases in the treatment of RA, and the probable mechanisms are discussed.

Efficacy and safety of oral cefixime therapy in common infectious diseases in children.

Twenty-nine children, including 20 boys and 9 girls, were enrolled in an open trial of oral cefixime therapy for common pediatric infectious diseases. Patients aged between 0.5 month and 12 years with a mean +/- standard deviation of 2.3 +/- 2.8 years. The diagnoses included 10 of acute otitis media, 2 of purulent rhinitis, 4 of acute enterocolitis, and 13 of urinary tract infection. Most children received 6-12 mg/kg/day of cefixime granules, orally twice daily for more than five days. All 10 cases (100%) of acute otitis media and 2 cases of purulent rhinitis were either cured, or improved by oral cefixime treatment. None of them was microbiologically evaluable. Four cases (100%) of acute enterocolitis, 3 due to Salmonella group B, one due to Shigella flexneri, were also successfully treated with bacteria eradication. However, the cure rate of 13 cases of urinary tract infection was only 85% (11/13). Seven Escherichia coli and 4 Proteus mirabilis infections were eradicated, whereas one each of Enterobacter cloacae and Klebsiella pneumoniae infections did not respond to treatment; these two cases had a complicated course. The overall cure and improvement rate was 93%. Although five patients had transient episodes of mild diarrhea, no significant adverse reaction was observed. In summary, oral cefixime given twice daily was effective and safe in the treatment of a variety of common infectious diseases in pediatric patients.

Monoclonal antibody-mediated protection and neutralization of motility in experimental Proteus mirabilis infection.

A panel of monoclonal antibodies with specificity for a wound isolate of Proteus mirabilis was established. Of nine antibodies studied in detail, three were broadly reactive with various Proteus isolates, while six reacted in a serotype-specific fashion with the strain used for immunization. Five of the six serotype-specific antibodies were reactive with lipopolysaccharide. The sixth serotype-specific antibody, 4-F (immunoglobulin G1 [IgG1]), was potently protective in a burn wound sepsis model and recognized a protein antigen. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot (immunoblot) analysis were used to determine that 4-F was reactive with flagellar protein. Approximately 1.3 micrograms of the antibody was sufficient to provide protection against 8 50% lethal doses of wound isolate, and approximately 26 micrograms provided full protection against challenge with 333 50% lethal doses. In vitro test results indicated that 4-F inhibited the motility of the wound isolate, and in vivo testing showed that it inhibited dissemination of the inoculum from the burn site to the liver and spleen. Whereas the antibody was highly effective in preventing the death of mice subsequent to challenge at a burn site, no protection was seen following an intraperitoneal challenge. These results may therefore indicate that the protection observed in the burn model is solely a reflection of the capacity of 4-F to neutralize bacterial motility.

Proteus mirabilis infection in quail in Burma.

Proteus mirabilis infection in quail in Burma.

Synergy of amoxycillin combined with clavulanate and YTR 830 in experimental infections in mice.

YTR 830, a new beta-lactamase inhibitor, is synergistic with amoxycillin in vitro against a number of beta-lactamase-producing organisms. The combination of amoxycillin-YTR 830 was compared to amoxycillin-clavulanate in the treatment of experimental Staphylococcus aureus, Citrobacter freundii and Proteus mirabilis infections in mice. Both combinations were synergistic with amoxycillin against all three test organisms. The amoxycillin-clavulanate combination was superior against S. aureus and C. freundii while amoxycillin-YTR 830 was more effective against P. mirabilis. The difference in efficacy between the two drug combinations appears to relate to the degree of protection afforded the animals by the beta-lactamase inhibitor alone. YTR 830 is a promising new agent and should undergo further investigation.

The use of the Dienes test in the epidemiology of proteus urinary tract infections in patients with spinal cord disease

The incidence of urinary tract infections in 47 patients with spinal cord injuries (11 women and 36 men) was studied and the aetiological agents identified. A high incidence of Proteus mirabilis infection was found and both auto- and cross-infection were identified by the Dienes test.