SUMMARYThe fluorescent antibody technique was used to investigate an epidemic of Klebsiella infection in a urological ward and to trace the probable source to a contaminated sink in the treatment room. It was also shown that cross infections by particular capsular types were very common within each ward. Certain types of Klebsiella occurred in cut-flower water but could not be associated with the types infecting the patients.Antibiotic resistance patterns within one capsular type were found to vary whether the type was from different sources in one patient or from different patients in the same ward. One capsular type was observed to develop resistance to increasing numbers of antibiotics over a 3-year period. This was probably due to the acquisition of R-plasmids. There also appeared to be a relation between capsular type and the site of infection.The frequency of Klebsiella infections in the urological wards dropped significantly after up-grading the treatment room, improving catheter storage and reducing ampicillin use.
A NEW series of 1,8 naphthyridine derivatives with antibacterial properties has been synthesised recently at the Sterling-Winthrop Research Institute (Lesher et al., 1962). Extensive chemotherapeutic studies have revealed that one of these, l-ethyl-7-methyl-l,8-naphthyridine-4one-3-carboxylic acid (Negram or nalidixic acid), has a high order of activity against Gram-negative bacteria both in vitro and in vivo (Deitz, Froelich, and Bailey, personal communication). Toxicological, pharmacological, and biochemical investigations have established that the drug is safe for human clinical trials (McChesney et al., 1964), while administration to volunteers for up to six months has confirmed that the substance is generally well tolerated in daily doses of up to 8 g. per day (Stough, personal communication).Recently the results of a trial of the drug in hospital practice has been reported (Swinney and Lishman, 1963). In view of these good results and the overall promise of Negram, we have undertaken a trial of this drug in the treatment of urinary infections under conditions obtaining in general practice. It was hoped also that the investigation would reveal the pattern of urinary infection as seen in general practice in South-West London and Surrey during the summer of 1962.
EXPERIXENT AL FiltrationSeveral attempts were made to filter the infective agent through Berkefeldt V and Pasteur-Chamberland L, filters. Fresh four-day-old rabbit skin leeions ground with sand were either suspended in distilled water, suspended in normal d i n e , digegted with trypsin and suspended in normal saline, or digeeted with succus entericus and suspended in normal dine.All auspensions were lightly centrifuged at 3000 r.p.m. for 5 min. to remove gross particles and adjueted to pH 7.4 before filtration. The efficiency of all
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