SUMMARY.The development of the bacterial flora of neonates during the first week of life was studied in 23 babies. Specimens of meconium or faeces were collected and swabs taken from the umbilicus and mouth on days 1, 2, 3 and 6. The bacteria present were isolated on a variety of plain and selective media. The predominant faecal organisms by the end of the first week were anaerobes. Bifidobacteria were isolated from all the neonates and bacteroides and clostridia were isolated from 78.3%. Bifidobacteria and bacteroides were present in large numbers; other species were isolated in smaller numbers. Enterococci were isolated from all neonates, enterobacteria from 82.6%, anaerobic cocci from 52.2%, and streptococci and staphylococci from 34.8% each.Staphylococcus aureus was the predominant species isolated from the umbilicus; it was isolated from 21.7% of neonates on the first day rising to 87.0% by the sixth day and represented 49% of isolates from this site. S. albus, streptococci, enterococci and Escherichia coli were each isolated from a few neonates.Viridans streptococci (3 1 -4% of isolates) and Streptococcus salivarius (251%) were the commonest species recovered from the mouth. They were present from 8 h after birth; S. albus and Neisseria spp. were isolated later on the first day, and anaerobic species of Veillonella and Bijidobacterium appeared on the second day. INTRODUCTIONThe normal fetus is sterile until shortly before birth, as long as the amniotic membrane remains intact. After birth, the neonate rapidly acquires commensal bacteria that colonise the skin and mucous membranes. The host defence mechanisms are not well developed at this stage and some commensals may become opportunist pathogens, particularly in compromised neonates who must remain in hospital for the treatment of congenital abnormalities.The gastrointestinal 'tract is colonised soon after birth, mainly by facultative bacteria. Mata, Mejicanos and Jimenez (1 972), Bullen, Tearle and Willis (1 976) and Long and Swenson (1977) have shown that anaerobes colonise the neonatal gastrointestinal tract during the first week of life and are greater in number and variety than aerobes or facultative species. Subsequently, only ~ ~~

Summary. From December 1989 to May 1990,3 15 faecal samples from children under 5 years old with diarrhoea (215) and without diarrhoea (100) seen at paediatric clinics were investigated for bacterial, viral and parasitic enteropathogens. Standard and recently described methods were used for the investigations, which revealed that 74.9 YO of children with diarrhoea were infected with enteropathogens compared with 28 YO of controls. In the diarrhoeal group, 59.1 YO had a bacterial, 26.5 O/ O a viral and 2.3 YO a parasitic aetiology. Rotavirus was the pathogen most frequently detected, accounting for 22.3 YO of positive findings in the group with diarrhoea versus 9 YO in the control group. Other important agents were : enterotoxigenic Escherichia coli (ETEC) (14.4 versus 6 YO), enteropathogenic E. coli (EPEC) (10-7 versus 5 YO), enteroadherent E.coli (EAEC) (9.3 versus 4 YO), enterohaemorrhagic E. coli (EHEC) (5.1 versus 3 YO) and Salmonella spp. (3.3 versus 1 YO). The following enteropathogens were detected exclusively in the diarrhoeal stools : Shigella spp. (5.1 YO), Yersinia enterocolitica (0-9 YO), Aeromonas hydrophila (1.4 YO), Entamoeba histolytica (0.5 YO), Giardia lamblia (0.5 YO), Trichomonas hominis (0-5) and Trichuris trichiura (0.9 YO). The detection rates of rotavirus, EPEC and EAEC were much greater in the diarrhoeal than in the control patients. No Vibrio cholerae, enteroinvasive E. coli (EIEC), Plesiomonas spp. or Cryptosporidum spp. were detected in this study. Our data suggest that both the traditional and newly recognised diarrhoeal agents are important causes of diarrhoea in the children under 5 years old in Lagos, Nigeria.

SUMMARYThe sequential acquisition of bacterial flora by premature neonates was studied during a 10 month period. Mean gestational age of the babies was 29-01 weeks and the mean birth weight was 1P728 kg. Escherichia coli and group B streptococci (GBS) colonized the umbilicus of 7 and 6 babies respectively, out of 23 studied, on the first day of life. E. coli and staphylococci were the predominant flora on the 6th day and they colonized 12 and 13 respectively. The oral flora was predominantly Gram-positive cocci, mainly Streptoccocus salivarius which was isolated from 17 out of 22 babies on the 6th day, viridians streptococci were isolated from 14 babies, Staphylococcus albus from 16 babies and group D streptococci from 11 babies. Candida spp. also colonized the oral cavities of 17 out of 22 babies on the 6th day. At the end of the first week of life, the faecal flora was predominantly anaerobic represented by Bifidobacterium spp., Bacterioides spp. and Clostridium spp. The commonest facultative faecal flora were E. coli, which was isolated from all the babies, and Strept. faecalis isolated from 20 babies. Early gut colonization by GBS, Bacteroides spp. and Clostridium spp. was noticed in more babies delivered vaginally than by caesarean section where colonization by these bacteria was relatively delayed. The use of prophylactic penicillin plus gentamicin in the special neonatal unit probably prevented systemic spread of any of the potential opportunistic pathogens during the study.

The development of resistance is a compelling reason for reviewing administration of antibiotics. Recently, most Acinetobacter infections are caused by multidrug-resistant (MDR) strains which have necessitated the use of tigecycline or colistin. This study was undertaken to determine the susceptibility of Acinetobacter spp. to these and other drugs. A total of 250 Acinetobacter isolates were collected from the 8 government hospitals over a period of 6 months. Susceptibility to 18 antibiotics, including tigecycline and colistin, was investigated by determining their minimum inhibitory concentrations using E test. Of the 250 isolates, 13.6% and 12% were resistant to tigecycline and colistin. A total of 25.2% and 37.2% were resistant to imipenem and meropenem, respectively. Of the 250 isolates 88.4% were MDR. This relatively high prevalence of tigecycline and colistin-resistant isolates indicates an emerging therapeutic problem which may severely compromise the treatment of MDR Acinetobacter spp. infections in Kuwait.

Three distinct clones of CRAB were isolated, providing evidence of a high diversity of carbapenemases among our geographically related isolates.