Aims-To determine if erythromycin given from birth reduces the inflammatory response and the incidence and severity of chronic lung disease. Methods-Seventy five infants less than 30 weeks of gestation and ventilated from birth for lung disease were randomly assigned to receive erythromycin intravenously for 7 days or to no treatment. Ureaplasma urealyticum was detected in tracheal secretions by culture and polymerase chain reaction. DiVerential cell counts were obtained from bronchoalveolar lavage fluid collected daily for 5 days and concentrations of the cytokines interluekins IL-1 and IL-8, and tumour necrosis factor (TNF-) were measured. Chronic lung disease (CLD) was defined as oxygen dependency at 36 weeks of gestation. Results-Nine infants (13%) were positive for U urealyticum. The inflammatory cytokines in the lungs increased over the first 5 days of life in all babies, but no association was found between their concentrations and the development of CLD. Those treated with erythromycin showed no significant diVerences from the nontreated group in the diVerential cell counts or concentrations of the cytokines. The two groups had a similar incidence of CLD. Babies infected with U urealyticum did not have a more pronounced cytokine response than those without infection. Chorioamnionitis was associated with significantly higher concentrations of IL-1 and IL-8 on admission: these babies had less severe acute lung disease and developed significantly less CLD. Conclusions-U urealyticum in the trachea was not associated with an increased inflammatory response in preterm infants. Erythromycin did not reduce the incidence or severity of CLD. (Arch Dis Child Fetal Neonatal Ed 1998;78:F10-F14)

A case of Gemella morbillorum endocarditis Sir, We report a case of Gemella morbillorum endocarditis. A 75-year-old man was admitted to hospital for investigation of weight loss and lassitude of two months duration. He had a history of rhematic fever as a child. Examination revealed a temperature of 38.5'C, mild ankle oedema and a pansystolic murmur radiating to the axilla. There were no other signs of endocarditis. He had a haemoglobin of 9.3 g/dl, white cell count of 9.7 x 109/l and an erythrocyte sedimentation rate of48 mm/h. An echocardiogram revealed mitral valve vegetations with regurgitation. A diagnosis ofendocarditis was made, three sets of blood cultures were taken and he was started on benzylpenicillin 1.2 g iv 4 hourly and gentamicin 80 mg iv 12 hourly. His temperature returned to normal after 24 hours. At 48 hours all three sets of blood cultures grew G morbillorum (confirmed by the Streptococcal Reference Laboratory). The organism proved sensitive to penicillin on disc testing but failed to survive subculture for further sensitivity studies. After 24 days of benzylpenicillin a bright red maculopapular rash appeared over the patient's trunk and legs and a leucopenia of 1.8 x 109/1 was noted. This was consistent with an allergic reaction and treatment was stopped. His temperature rose to 39°C within 48 hours. Further cultures were taken and he was given teicoplanin. After the first dose of this he became dizzy, wheezy and breathless. His blood pressure fell to 90/60 mmHg. He was given iv hydrocortisone, chlorpheniramine and salbutamol. In view of his reaction to teicoplanin we decided not to risk treatment with vancomycin and opted instead for rifampicin 600 mg orally 12 hourly and erythromycin 500 mg orally 6 hourly. The organism had appeared sensitive to both these drugs on disc testing. The

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Polymerase chain reaction (PCR) amplification of the urease genes of Ureuplusmu ureulyticurn was compared with culture for detection of the organism in 100 endotracheal aspirates from 54 ventilated preterm infants. Ninety specimens gave negative results by both culture and PCR and three specimens gave positive results by both culture and PCR. Six specimens were negative by culture but positive by PCR. The one specimen positive by culture and negative by PCR was interpreted as a false-positive culture result. Overall agreement between results obtained by culture and PCR was 93%. PCR is a sensitive and reliable method for the detection of U. ureulyticum in neonatal endotracheal secretions. Detection by PCR (1-2 days) is more rapid than culture (2-5 days) and this will be important if early therapeutic intervention is shown to be effective.

In a prospective cohort study in a tertiary referral neonatal intensive care unit, the endotracheal secretions of 40 consecutively intubated newborn infants, less than 31 weeks' gestation, were examined weekly for the genital mycoplasmas and all other common bacterial pathogens. Fifteen (37%) infants were positive for Ureaplasma urealyticum and/or Mycoplasma hominis. There were no differences in gestation, birthweight, use of surfactant, or time on ventilator between the culture-positive and negative babies. Thirteen (87%) of the culture-positive group developed chronic lung disease (CLD) compared with 11 (41%) of the negative group (p = 0.0196). Of those culture-positive, 37% were not identified on the first specimen taken at the time of admission. These data suggest a significant association between infection with the urogenital mycoplasma and CLD and also stress the need for repeated cultures to identify these organisms.