The authors review 23 cases of hospital-acquired meningitis occurring over a 15 year period in neurosurgical patients. Factors associated with the development of meningitis include recent craniotomy, cerebrospinal fluid leak, the presence of ventricular or lumbar drainage tubes, and skull fracture. Four cases were caused by Staphylococcus epidermidis; one of these patients died. In 19 cases, Gram-negative enteric bacteria were the etiologic agents, most commonly members of the Klebsiella-Enterobacter-Serratia group. Eleven of these patients died. The particular antibiotic or group of antibiotics used and the route of administration made no difference in the outcome of Gram-negative bacillary meningitis.

A major common-source, foodborne epidemic of typhoid fever occurred in San Antonio, Tex, in the fall of 1981, involving 80 verified cases. We summarize the clinical course of our 34 patients who had a nonspecific symptom complex that included at the initial examination fever (32 patients, 93%), headache (19 patients, 57%), diarrhea (11 patients, 33%), and anorexia (ten patients, 30%). The most common initial diagnoses were urinary tract and upper respiratory tract infections. The subsequent isolation of Salmonella typhi from blood cultures was usually unexpected. Physical findings were different from two previous series originating in the United States. Hepatomegaly was noted in only 7% (two patients), splenomegaly was noted in 13% (four patients), and rose spots were noted in 5% (two patients) of the patients. Liver function test results, however, were abnormal in 32 (95%) of the 34 patients (mean SGOT, 155 IU/mL). Typhoid fever, as seen in this outbreak, was notable for its nonspecific and mild manifestation and uniformly favorable outcome.

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A nine-test system using multiple-inoculation agar plates for biotyping of Escherichia coli is described. Testing of 959 strains resulted in 78 biotypes. On repeated testing, 96% of 182 strains had identical biotypes or differed by only one test. This system provides satisfactory differentiation among strains and is reproducible. Precise standardization of inoculum size is not required. Multiple inoculation allows time and cost-efficient testing of large numbers of strains.

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