Nasal and sinus bacteriology have been investigated in healthy controls and in patients with acute maxillary sinusitis. Comparatively few healthy noses were sterile, and in controls the nasal bacterial flora commonly consisted mainly of staphylococci and diphtheroid rods. Nasal specimens from patients with sinusitis showed most common findings to be “no growth,” pneumococci, Haemophilus influenzae and staphylococci in that order. In aspirated sinus secretions there was a predominance of pneumococci, “no growth” and Haemophilus influenzae. Other bacteria were uncommon. Staphylococci were shown conclusively to be nasal contaminants. The same organisms were found in the nasal and sinus secretions of patients with sinusitis in only 64 percent, thus indicating that nasal samples are of low predictive value in reflecting sinus flora. It can be argued that in the individual patient with sinusitis it is more reliable to base therapy on the results of previous bacteriological investigations than on the individual bacteral findings in the nose.

Paired sera from 97 patients with acute maxillary sinusitis were examined regarding antibodies to Branhamella catarrhalis. Precipitating antibodies were demonstrated in almost all sera both from patients and from healthy blood donors. Complement-fixing (CF) antibodies to B. catarrhalis were present in sera from 25 of the 97 patients and in one of 20 healthy blood donors. The titres were low and the titre changes when present were of a small magnitude. CF antibodies were most commonly demonstrated in the younger age groups. The patients with demonstrable CF antibodies to B. catarrhalis did not differ from patients without antibodies regarding radiological appearance or healing during therapy. Strains of B. catarrhalis were all rapidly killed by normal human serum but not in heated sera. The strains could not multiplicate significantly at an oxygen tension corresponding to about half the atmospheric value. The possible significance of the serological and bacteriological findings is discussed.

The diagnosis of N. gonorrhoeae infections depends upon the demonstration of the bacterium, and this is commonly done by cultivation. The laboratory diagnosis of N. gonorrhoeae was greatly facilitated by the introduction of the Thayer-Martin selective medium containing vancomycin, colistin and nystatin in its present formula (Thayer and Martin, 1966). An alternative combination of antimicrobial drugs in the selective medium, consisting of lincomycin and colistin, was proposed by Berger (1966) and Potuznik and Hausner (1969). In the bacteriological laboratory of the City of Goteborg, Sweden, about 150,000 specimens are processed each year for the cultivation of N. gonorrhoeae. This laboratory uses a modification of the Thayer-Martin medium without the addition of nystatin. Vancomycin, included in the Thayer-Martin combination of antibiotics, has been shown to inhibit the growth of certain gonococcal strains (Reyn, 1969; Cross, Hoger, Neibaur, Pasternack, and Brady, 1971). This initiated a study to investigate how common these strains were in Goteborg, and its environs, and whether they could be isolated on another medium suitable for routine use. Material and methods In October and November, 1972, a preliminary study was performed on 254 samples from 145 selected patients. The samples were cultivated both on the standard plate containing colistin and vancomycin and on the same plate without antibiotics. Samples were taken with charcoal-treated swabs and transported in a modified Stuart's medium. The plates were inoculated, the inhibitory plate first, and incubated for 40 hrs at 36°C.; gonococci were identified by their colonial and microscopic appearance, oxidase reaction, and fermentation tests. Later, a second study was performed on 1,418 samples from 609 non-selected patients. In this study urethral, cervical, and rectal swabs were obtained from the female

The occurrence of bacteria and Ureaplasma urealyticum in the upper urinary tract was studied in 50 patients operated on for renal stones. Cultures were performed on voided urine, pelvic urine obtained during surgery and the stone. The chemical composition of the stones was analysed. Twenty-six stones were of metabolic origin and 24 infection-induced, i.e. composed of struvite and/or carbonate-apatite. Ureaplasma urealyticum was cultured from the upper urinary tract in 1 patient with metabolic stones, and in 7 with infection stones. In 4 of these 7 patients no other urease-producing micro-organism was detected, suggesting that Ureaplasma urealyticum may have been associated with stone formation in these patients.

The efficacy of antimicrobial prophylaxis for recurrent urinary infection after an episode of acute febrile pyelonephritis was assessed in 27 pregnant women. Immediately following a 2-week treatment course for acute pyelonephritis, low-dose prophylaxis with a proper antimicrobial agent taken at bedtime daily was continued until 1 month after delivery. 23 women received 50 mg of nitrofurantoin, and 2 each were given 250 mg of amoxycillin and 250 mg of cephalexin, respectively. The treatment regimens were well tolerated and there were no breakthrough infections during a total of 7.8 patient-years of treatment. These results show that long-term low-dose antimicrobial prophylaxis is highly effective in this population at high risk of recurrent acute pyelonephritis.