Sole Organism Research Articles

Measles pneumonia. Bacterial suprainfection as a complicating factor.

During a 3 1/2-month period, 32 previously healthy young men were first seen typical prodromal symptoms and signs of measles. On admission or within 48 hours of admission, 16 patients (50%) manifested physical signs and roentgenographic evidence of pneumonia. Of these 16 patients, ten (63%) were found to have bacterial suprainfection or colonization confirmed by culture of transtracheal aspirates. From six of these ten patients, Neisseria meningitidis serogroup Y was isolated as the sole organism responsible for suprainfection. In the other patients, Haemophilus species, Neisseria species (not N gonorrheae or N meningitidis), Streptococcus pneumoniae, and beta-hemolytic Streptococcus (not group A or D were isolated alone or in combination. The data suggest that bacterial supra-infection associated with measles pneumonia is not unusual in adults and N meningitidis serogroup Y is a potential pathogen of the lower respiratory tract.

Lethal postoperative infections following cardiac surgery. Review of four years' experience.

Seventeen of 1,494 patients (1.1%) succumbed to infection following open-heart operations at New York University Hospital between January, 1968 and December, 1971. All but two of these patients had Starr-Edwards ball-valve prostheses inserted. One had repair of a tetralogy of Fallot, and one had aortic commissurotomy and a double coronary bypass graft. The sites of infection were pulmonary (15 patients), urinary tract (14), mediastinum or pleura (10), and blood (15). Pulmonary infection appeared as the source of endocarditis in 13 patients and as a source of pleural or mediastinal infection in nine. Candida species infection was directly responsible for the deaths of 10 of the 17 patients, being the sole organism isolated in 5 of the 10. Predisposing factors to infection were preoperative bacterial endocarditis 2 patients, prolonged cardiopulmonary bypass (>3½ hours) 6 patients, a "low output" state following operation 12 patients, postoperative cerebral dysfunction 6 patients, and postoperative disseminated intravascular coagulation 4 patients. The debilitated state of the patients, multiple sites of infection, degree of tissue destruction, and the variety and resistance of the organisms involved all combined to produce treatment failure. Removal of the infected valvular prosthesis coupled with antimicrobial therapy is considered the treatment of choice in instances of bacterial endocarditis when chemotherapy fails and in all cases of established fungal endocarditis.

TREATMENT OF SKIN INFECTIONS WITH NAFCILLIN.

In an effort to evaluate the effect of nafcillin, a new semisynthetic penicillin, on the staphylococcus, 53 patients with staphylococcal infections of the skin, soft tissues, or mucous membranes were treated orally with 250 or 500 mg four times daily. TheStaphylococcus aureus, coagulase-positive, was cultured in 52; the β-hemolytic streptococcus occurred as the sole infective organism in the throat of one. The β-hemolytic streptococcus complicated the infection in one and the enterococcus in seven. In vitro, all organisms were susceptible to nafcillin. Most were treated for one week or less. Eighty-one per cent were cured (lesions completely healed at termination of treatment), including all who received the 500 mg dose. Eight per cent were clinically or bacteriologically improved, including the one patient who had a complicating streptococcal infection and five of those who also had enterococcal infections. Eleven per cent (six patients) had a poor result. The clinical performance in this series suggests that the compound exerts a high degree of bactericidal activity against the organisms commonly recovered from infections of the human skin and soft tissues. Nafcillin therefore should be of value in dermatologic practice. The recommended oral dose is 500 mg four times a day.

GANGRENE OF THE SKIN

To the Editor:— I was much interested in the editorial inThe Journal, May 29, on progressive postoperative bacterial synergistic gangrene of the skin caused by the synergistic action of the nonhemolytic micro-aerophilic streptococcus and Staphylococcus aureus. This condition has been frequently confused with the chronic undermining burrowing ulcers in which the hemolytic micro-aerophilic streptococcus is the sole causative organism. A number of articles have appeared which have confused these two conditions and it is important to differentiate clearly between them. In both, zinc peroxide is now an established method of treatment after excision, as I stated in a paper that appeared in the Surgical Clinics of North America in June 1936. In the gangrenous cases, wide excision is essential and recovery will occur after excision alone, but zinc peroxide prevents recurrence, hastens the healing and permits skin grafting earlier than would otherwise be the case. In the undermining ulcer type, excision is sometimes not necessary because there is no gangrene, and frequently zinc peroxide can be brought into close apposition with the surface of the infection without extensive operation.