in Seattle, on a standardized single-disk method for antibiotic susceptibility testing ".. . consolidate(s) and update(s) previous descriptions of the method and provide(s) a concise outline for its performance and interpretation." Clinical microbiologists were relieved that finally a disk diffusion method had been standardized, could be used with ease, and provided reliable results as compared with minimum inhibitory concentration tests. The pivotal role of Hans Ericsson's theoretical and practical studies (H. Ericsson and G. Svartz-Malmberg, Antibiot. Chemother. 6:41-74, 1959), as well as earlier reports by some of the authors of the publications cited, must be mentioned as a matter of fairness. Most of the recommendations given are still valid today even though some of the antimicrobial agents are obsolete, new ones have been added, some zone sizes had to be modified, and new media were designed for Haemophilus influenzae and Neisseria gonorrhoeae. Recommendations of the National Committee for Clinical Laboratory Standards continue to be based on this publication; the "Kirby-Bauer" method is, among the many disk methods used in other countries, still the one that has been researched most thoroughly and updated continuously.

We reevaluated conventional criteria for diagnosing coliform infection of the lower urinary tract in symptomatic women by obtaining cultures of the urethra, vagina, midstream urine, and bladder urine. The traditional diagnostic criterion, greater than or equal to 10(5) bacteria per milliliter of midstream urine, identified only 51 per cent of women whose bladder urine contained coliformis. We found the best diagnostic criterion to be greater than or equal to 10(2) bacteria per milliliter (sensitivity, 0.95; specificity, 0.85). Although isolation of less than 10(5) coliforms per milliliter of midstream urine has had a low predictive value of previous studies of asymptomatic women, the predictive value of the criterion of greater than or equal to 10(2) per milliliter was high (0.88) among symptomatic women the prevalence of coliform infection exceeded 50 per cent. In view of these findings, clinicians and microbiologists should alter their approach to the diagnosis and treatment of women with acute symptomatic coliform infection of the lower urinary tract.

To determine the cause of the acute urethral syndrome, we studied 59 women with dysuria and frequent urination without "significant bacteriuria" (defined as greater than or equal to 10(5) organisms per milliliter), 35 women with typical cystitis and 66 women with no symptoms of urinary-tract infection. Although none of the 59 women with urethral syndrome had greater than 3.4 x 10(4) bacteria per milliliter in either of two successive midstream urine specimens, samples of bladder urine obtained by suprapubic aspiration or catheterization from 24 women contained coliforms, and samples from three contained Staphylococcus saprophyticus; all but one of these 27 women also had pyuria. Of the 32 women with sterile bladder urine, 10 of 16 with pyuria and one of 16 without pyuria were infected with Chlamydia trachomatis (P = 0.002). Chlamydial infection was found in 11 of 42 women with urethral syndrome and pyuria, in three of 66 without symptoms, and in one of 35 with cystitis (P less than 0.01 when the group with urethral syndrome is compared with either of the other groups). Thus, 42 of 59 women with urethral syndrome had abnormal pyuria and 37 of these 42 were infected with coliforms, S. saprophyticus, or C. trachomatis, whereas few women without pyuria had demonstrable infection. Bacteriuria of greater than or equal to 10(5) per milliliter may be an insensitive diagnostic criterion when applied to symptomatic lower-urinary-tract infection.

Chlamydia trachomatis was isolated from the urethra from 48 (42 per cent) of 113 men with non-gonococcal urethritis (NGU), four (7 per cent) of 58 without overt urethritis, and 13 (19 per cent) of 69 with gonorrhea. Postgonococcal urethritis (PGU) developed in 11 of 11 men who had C. trum antibody to C. trachomatisis developed. The immunotype specificity of chlamydial antibody corresponded to the immunotype isolated. Among culture-negative patients. chlamydial antibody prevalence correlated with the number of past sex partners and with previous NGU. Herpesvirus hominis, cytomegalovirus, T-mycoplasma, Mycoplasma hominis, other bacteria, and Trichomonas vaginalis were not implicated in NGU or PGU. Thus, the cause of chlamydia-negative NGU and PGU remains obscure. Endocervical chlamydia were found in sex partners of 15 of 22 NGU patients with and two of 24 without urethral chlamydial infection (p smaller than 0.001). Tetracycline treatment of both sex partners appears advisable.

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Escherichia coli is an ubiquitous microorganism which is found in the gastrointestinal tract of every individual, where it usually forms a part of the normal gut flora. Extensive epidemiological, clinical, and bacteriological observations have documented the pathogenic significance of certain serological strains of E. coli in infantile diarrhea. However, although they are frequently isolated in infected sites closely related to the gastrointestinal tract, such as the appendix, gall bladder, and peritoneal cavity, little is known about the serological specificity of coliform bacteria in non-enteric infections, particularly those involving the urinary tract. Ewing (1) has emphasized that complete serological typing of E. coli should provide accurate information concerning the incidence of specific strains associated with disease and permit evaluation of nosocomial spread.The concept that some strains of gram-negative organisms may be associated with infection more often than others is not new. Kauffman (2) advanced the hypothesis that certain coliform serotypes are more prevalent in appendicitis, and he also noted that strains of certain serological groups were more frequently isolated from the urine than from feces. Others have reported that strains of certain serological groups are more commonly isolated from infected sites than from fecal specimens (3). Vahlne (4) and Sjdstedt (5) that the majority of non-enteric E. coli infections are caused by strains of a few specific serological groups, but did not support the idea that specific strains have a marked predilection for renal tissue (7). This report is an extension of these original observations and offers additional evidence that certain serological groups of E. coli are responsible for the majority of non-enteric infections because of their increased prevalence in the environment. METHODS OrganismsThe organisms included in this study were obtained from the following sources: 1) Five hundred and twentytwo strains of E. coli were isolated from patients with non-enteric infections hospitalized at King County Hospital (KCH) and University of Washington Hospital (UW) in Seattle, Johns Hopkins Hospital (JH) in Baltimore, and Salt Lake General Hospital (SL) in Salt Lake City. The isolates obtained from KCH were from consecutive patients in whom E. coli was of known pathogenic significance (292 strains from 276 patients). The majority of strains was of urinary origin. 2) Eighty-seven strains were cultured from urine samples of consecutive catheterized pregnant women with low bacterial counts (< 1,000 bacilli per ml). These were considered to represent urethral contamination. 3) Thirty-five strains were isolated from consecutive untreated patients hospitalized with overt urinary tract infections characterized by significant bacteriuria (100,000 bacilli per ml), from whom simultaneous stool specimens were obtained by rectal swab. Bacteriology A modified method of Edwards and Ewing (8) was used for group differentiation of Enterobacteriaceae by biochemical tests. All ...

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