Specific Antibacterial Therapy Research Articles

Community-acquired Pneumonia Caused by Mixed Aerobic Bacteria

Mixed bacterial pneumonia caused by organisms other than anaerobes has been infrequently reported. We describe six cases and review the literature. Two patients had co-infection with S pneumoniae and L pneumophila. Two were infected with S pneumoniae and K pneumoniae and the others simultaneously harbored M tuberculosis and N asteroides. The first two sets of patients had bacteria isolated from usually sterile sites (blood and lung), while the latter harbored repeatedly isolated organisms not usually felt to be part of the normal respiratory flora. Mixed infection may help explain the substantial mortality still seen from pneumonia. This is especially true if Legionella, mycobacteria, or Nocardia species are encountered where routine smears and cultures may not aid in the diagnosis. Poor clinical response to specific antibacterial therapy in pneumonia should trigger further investigation for other potential pathogens.

Bacterial pneumonia in patients with the acquired immunodeficiency syndrome.

Eighteen episodes of community-acquired bacterial pneumonia were diagnosed in 13 patients among 336 with the acquired immunodeficiency syndrome (AIDS) cared for at Memorial Sloan-Kettering Cancer Center since 1979. Bacterial pathogens isolated in 16 of 18 episodes were Haemophilus influenzae in 8, Streptococcus pneumoniae in 6, group B streptococcus in 1, and Branhamella catarrhalis in 1. Eight episodes were presumed Pneumocystis carinii pneumonia until cultures obtained at bronchoscopy confirmed a bacterial cause. Specific antibacterial therapy was curative in 16 of 18 episodes; 2 patients died. Given an estimated yearly incidence of pneumococcal pneumonia in the general population of 2.6/1000, 1.09 cases were expected in our patients with AIDS; we saw 6 (p = 0.001), for an attack rate of 17.9/1000. Bacteria associated with B-cell defects should be anticipated when formulating empiric antibiotic therapy, pending a definitive diagnosis, for pulmonary infiltrates in patients with AIDS.

Study of infective (secondary) renal calculus formation in vitro

The factors of infective calculus formation and the conditions favoring their prevention were studied by examining in vitro the role of the most common representative of urease-producing bacteria, Proteus mirabilis. The stream of Proteus-containing urine was found to form deposits of magnesium ammonium phosphate, carbonate apatite and ammonium-urate on the glass surfaces. Application either of mandelic acid or of Gentamycin was found to reduce the production of these deposits, and their joint application proved fully preventive to their formation. Gentamycin applied in saline acidified with mandelic acid was capable of dissolving previously formed crystals. A medication of this composition is advocated for preventive use after surgery for staghorn calculi. The necessity for continuing peroral medication and specific antibacterial therapy for months is emphasized.

Urinary infection and prostatectomy.

The incidence of urinary infection before and after operation for benign prostatic hypertrophy has been reviewed in 140 patients. Repeated screening for bacteriuria was used throughout the hospital admission. Infection was present in 24% before operation and there was a significant correlation between the incidence of infection and the duration of preoperative catheterisation. Postoperative infection developed in 31% and there was no relation between this incidence and the type of prostatectomy; specific antibacterial therapy was significantly more effective in eradicating urinary infection acquired after operation than before. At the time of discharge from the ward, 10% had infected urine, but only 3% of patients had persistent infection at follow-up 6 weeks after operation.

BACTERIAL MENINGITIS

Prior to the introduction of specific antibacterial therapy, bacterial meningitis was a disease with a universally fatal or disastrous outcome. The introduction of typespecific antiserum, and then of the antibacterial drugs, improved this situation dramatically. Improvements in the general medical care of acutely ill children, and the introduction of a series of more potent antibiotics against its bacterial causes helped to generate an attitude that bacterial meningitis was, or soon would be, a disease of the past. The experience of the past two decades belies this thesis. Today, interest in many facets of this disease has been renewed by many physicians concerned with the health of children: the epidemiology, pathophysiology, diagnosis, and treatment. This symposium attempts to summarize for the practitioner the highlights of current knowledge in this area, and to outline certain areas in which recent advances can be anticipated, or will be studied. Tuberculous meningitis will be omitted for the sake of brevity, as will the special problems of meningitis in the newborn infant. There has been a resurgence of interest in developing vaccines to prevent Hemophilus influenzae b, pneumococcal, and meningococcal Group A, B, and C meningitis. These organisms cause almost all the bacterial meningitis after the first two months of life. If, as now seems possible, vaccines against most or all of these organisms will soon become available, those children having the greatest risk must be defined to determine who, and at what age should have priority in receiving the vaccine(s). A. THE CURRENT MAGNITUDE OF THE PROBLEM

The clinical significance of asymptomatic bacteriuria.

Asymptomatic bacteriuria occurs in various diseases and conditions. Although it does not indicate actual pyelonephritis, it is nevertheless an early symptom of pyelonephritis. Once it has been recognized, specific antibacterial therapy should be started, the primary disease should be cured and the patient kept under medical supervision.

Quantitative bacteriological analysis of sputum as a test of antibiotic efficacy.

After 5 days of treatment, sputa were analyzed from 40 patients treated with sodium fusidate and 20 patients treated with naficillin. There was a significant decrease in the number of staphylococci, but no significant change in the other flora. The quantitative bacteriological analysis of sputum specimens proved to be a useful laboratory procedure for providing information on the in vivo effectiveness of specific antibacterial therapy in respiratory infections.

Quantitative Bacteriological Analysis of Sputum as a Test of Antibiotic Efficacy

After 5 days of treatment, sputa were analyzed from 40 patients treated with sodium fusidate and 20 patients treated with naficillin. There was a significant decrease in the number of staphylococci, but no significant change in the other flora. The quantitative bacteriological analysis of sputum specimens proved to be a useful laboratory procedure for providing information on the in vivo effectiveness of specific antibacterial therapy in respiratory infections.

Current status of therapy in infantile diarrhea.

This paper is a brief review of the therapeutic problems of diarrhea in infancy, especially acute diarrhea. Practical aspects of treatment are presented rather than theoretical principles. Other sources should be consulted for information on basic problems such as bacterial resistance, pharmacology of antibiotics, water and electrolyte physiology, and gastrointestinal allergy. The incidence of diarrhea in infancy and childhood remains relatively high, although modern therapy has markedly lowered mortality. Each year several hundred cases of diarrhea are treated at the Harriet Lane Home in Baltimore. Even in areas of high socioeconomic status, severe epidemics of diarrhea continue to occur in nurseries for newborn infants. The epidemiology and prevention of such outbreaks will be discussed, since specific antibacterial therapy represents a significant part of recommended prophylactic measures. Diagnosis Diarrhea may be defined as an increase in the volume of stools. However, the diagnosis of diarrheal disease cannot be made precisely, particularly

Metastatic endophthalmitis as a complication of meningococcic meningitis.

Metastatic endophthalmitis was observed as a complication in 2 out of 68 patients with meningococcic meningitis during the period from 1952 to 1955. The rarity of its occurrence and the successful outcome of these cases stimulated this report. A review of the literature revealed that the complication of metastatic endophthalmitis occurred in approximately 5% of the cases in epidemics of meningitis before the era of specific serum and antibacterial therapy.* Prior to this era the end-results of endophthalmitis were vitreous abscess, the formation of a cyclitic membrane, retinal detachment, and the eventual loss of the eye in many cases. Since the advent of specific antibacterial therapy, endophthalmitis, as well as meningococcic meningitis, has been markedly reduced. Successful therapy of this complication using local penicillin by ionophoresis and systemic sulfonamide was reported by Dunnington and Krause.† The present report concerns the treatment of two cases of meningococcic endophthalmitis with massive systemic