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BACTEROIDES IN THE BLOOD
377 TABLE II-LYMPHOCYTES FROM PATIENT WITH
"
STROKE
"
on a plate containing 0-2 .g. of benzylpenicillin per ml. and streaked with Sarcina lutea. The zone of growth around the disc measures penicillinase activity. The plate is incubated aerobically so that filtration to remove viable bacteroides from the broth is unnecessary. Our findings have been confirmed with strains sent from other laboratories and confirm those of Garrod. 14 Since we note a close correlation between penicillinase activity and relative penicillin resistance, we strongly suspect that penicillinase may be responsible for this resistance.
University Hospital, Street, Diego, California 92103, U.S.A. 225 West Dickinson
San
ABRAHAM I. BRAUDE.
ANTIBIOTIC TREATMENT FOR PYOGENIC HAND INFECTIONS
*
P<
0001.
t P < 0’005-0,001. t Column loaded with control tissue-culture preparation in which measles virus grown.
P<0.001.
result of 3-7% as compared with 11-0% from 0-2 million cells which had never been through the column, E.F.sensitised cells were also retained in some degree by the measles column, a significant reduction of result occurring when 0-75 and 0-05 million cells were tested. Failure to hold back cells sensitised to thyroid " (Fl-E-F3 thyroglobulin+L.A.T.S.) shows the specificity of the reaction. It can be concluded that lymphocytes which have become sensitised to E.F. in either multiple sclerosis or stroke bind strongly to E.F., and also in lesser degree to measles. If such lymphocytes are filtered out with measles, then some which are sensitised to E.F. are also removed. There is thus direct evidence that E.F. and measles share
antigens. It would be of the greatest interest to subject the fractions prepared by Salmi et awl. to this type of study. We are grateful to Mr E. A. Caspary for carrying out the determinations in the tables, which are abstracted from a widerranging study. The cytopherometers used were provided by the N.E. Multiple Sclerosis Society and the Multiple Sclerosis Research Fund Limited. J. McD. is supported by the N.E. British Empire Cancer Campaign. Medical Research Council, Demyelinating Diseases Unit, Newcastle General Hospital,
Westgate Road, Newcastle upon Tyne NE4 6BE.
SIR,-We wish to support the observation of Mr Nicholls (Feb. 3, p. 225) that Staphylococcus aureus strains resistant to penicillin are the most frequent pathogens isolated from purulent lesions of the hand. We have studied the bacteriology of soft-tissue infections in a single general practice for twelve months. Skin swabs were taken from 70 patients, of which 34 were from superficial infections such as impetigo, infected eczema, or herpes, and 36 were deeper infections such as boils, cellulitis, wounds, paronychia, and gravitational ulcers. All swabs were taken before starting antibiotics. Surgical drainage was not performed. Pathogens were isolated from 58 swabs (83%); there were 53 isolates of Staph. aureus, of which 34% were sensitive to penicillin, 77% were sensitive to tetracycline, and 96% were sensitive to erythromycin. Strains of p-hasmolytic streptococci were isolated 11 times; all were sensitive to penicillin and erythromycin, and 64% were sensitive to tetracycline. One strain of Proteus mirabilis was isolated. These results substantiate the observation of increasing resistance of Staph. aureus to penicillin, both in hospital and in general practice. The rarity of gram-negative pathogens in our series may be due to the lack of previous antibiotic treatment. We have’found more frequent resistance of Staph. aureus to tetracycline (23% in our series compared to 5% in Mr Nicholls’s series) and suggest that erythromycin be considered in general practice as an alternative oral antibiotic to tetracycline for treating softtissue infections. B. T. B. MANNERS P. R. GROB G. P. J. BEYNON F. J. GIBBS.
Devonshire House, Station Road,
Addlestone, Surrey.
E. J. FIELD J. R. MCDERMOTT.
SIR,-Ishould like to commend Mr Nicholls’s reserva(Feb. 3, p. 225) about the use of tetracycline in infancy for the treatment of hand infections, but would tions
BACTEROIDES IN THE BLOOD
SIR,-Contrary to the letter (Jan. 20, p. 147) by Dr Okubadejo and others, we confirm your comment that Bacteroides fragilis does produce {3-lactamase. We have tested over 300 strains of B. fragilis isolated from blood and other specimens at our hospital and found good penicillinase activity in over 90% of strains by our method. 122 The method of Anderson and Datta,13 which Okubadejo et al. tried to adapt to B. fragilis, is technically unsatisfactory for bacteroides penicillinase. We find that penicillinase is best demonstrated in B. fragilis by allowing a heavily inoculated 24-hour thioglycollate-broth culture to
stand
an
filter-paper
additional 18 hours at room temperature. A disc is then dipped into the broth and placed
11. Field, E. J., Caspary, E. A., Hall, R., Clark, F. Lancet, 1970, i, 1144. 12. Pinkus, G., Veto, G., Braude, A. I. J. Bact. 1968, 96, 1437. 13. Anderson, E. S., Datta, N. Lancet, 1965, i, 407.
caveat to include children of up to eight There are few or no indications for the use of tetracycline in childhood.
broaden the years.
The Children’s Hospital, Western Bank, Sheffield S10 2TH.
F. HARRIS.
SIR,-Mr Nicholls (Feb. 3,
p. 225) suggests " that when antibiotic is indicated in the management of hand infections before culture reports become available, tetracycline is to be preferred to penicillin ". However, a more significant decision is whether to prescribe antibiotics at all for hand infections yielding pus. My paper 15 of fifteen years ago cited by Mr Nicholls was entitled Dispensability of an
14. 15.
Garrod, L. P. Br. med. J. 1955, ii, Anderson, J. ibid. 1958, ii, 1569.
1529.
"
STROKE
"
on a plate containing 0-2 .g. of benzylpenicillin per ml. and streaked with Sarcina lutea. The zone of growth around the disc measures penicillinase activity. The plate is incubated aerobically so that filtration to remove viable bacteroides from the broth is unnecessary. Our findings have been confirmed with strains sent from other laboratories and confirm those of Garrod. 14 Since we note a close correlation between penicillinase activity and relative penicillin resistance, we strongly suspect that penicillinase may be responsible for this resistance.
University Hospital, Street, Diego, California 92103, U.S.A. 225 West Dickinson
San
ABRAHAM I. BRAUDE.
ANTIBIOTIC TREATMENT FOR PYOGENIC HAND INFECTIONS
*
P<
0001.
t P < 0’005-0,001. t Column loaded with control tissue-culture preparation in which measles virus grown.
P<0.001.
result of 3-7% as compared with 11-0% from 0-2 million cells which had never been through the column, E.F.sensitised cells were also retained in some degree by the measles column, a significant reduction of result occurring when 0-75 and 0-05 million cells were tested. Failure to hold back cells sensitised to thyroid " (Fl-E-F3 thyroglobulin+L.A.T.S.) shows the specificity of the reaction. It can be concluded that lymphocytes which have become sensitised to E.F. in either multiple sclerosis or stroke bind strongly to E.F., and also in lesser degree to measles. If such lymphocytes are filtered out with measles, then some which are sensitised to E.F. are also removed. There is thus direct evidence that E.F. and measles share
antigens. It would be of the greatest interest to subject the fractions prepared by Salmi et awl. to this type of study. We are grateful to Mr E. A. Caspary for carrying out the determinations in the tables, which are abstracted from a widerranging study. The cytopherometers used were provided by the N.E. Multiple Sclerosis Society and the Multiple Sclerosis Research Fund Limited. J. McD. is supported by the N.E. British Empire Cancer Campaign. Medical Research Council, Demyelinating Diseases Unit, Newcastle General Hospital,
Westgate Road, Newcastle upon Tyne NE4 6BE.
SIR,-We wish to support the observation of Mr Nicholls (Feb. 3, p. 225) that Staphylococcus aureus strains resistant to penicillin are the most frequent pathogens isolated from purulent lesions of the hand. We have studied the bacteriology of soft-tissue infections in a single general practice for twelve months. Skin swabs were taken from 70 patients, of which 34 were from superficial infections such as impetigo, infected eczema, or herpes, and 36 were deeper infections such as boils, cellulitis, wounds, paronychia, and gravitational ulcers. All swabs were taken before starting antibiotics. Surgical drainage was not performed. Pathogens were isolated from 58 swabs (83%); there were 53 isolates of Staph. aureus, of which 34% were sensitive to penicillin, 77% were sensitive to tetracycline, and 96% were sensitive to erythromycin. Strains of p-hasmolytic streptococci were isolated 11 times; all were sensitive to penicillin and erythromycin, and 64% were sensitive to tetracycline. One strain of Proteus mirabilis was isolated. These results substantiate the observation of increasing resistance of Staph. aureus to penicillin, both in hospital and in general practice. The rarity of gram-negative pathogens in our series may be due to the lack of previous antibiotic treatment. We have’found more frequent resistance of Staph. aureus to tetracycline (23% in our series compared to 5% in Mr Nicholls’s series) and suggest that erythromycin be considered in general practice as an alternative oral antibiotic to tetracycline for treating softtissue infections. B. T. B. MANNERS P. R. GROB G. P. J. BEYNON F. J. GIBBS.
Devonshire House, Station Road,
Addlestone, Surrey.
E. J. FIELD J. R. MCDERMOTT.
SIR,-Ishould like to commend Mr Nicholls’s reserva(Feb. 3, p. 225) about the use of tetracycline in infancy for the treatment of hand infections, but would tions
BACTEROIDES IN THE BLOOD
SIR,-Contrary to the letter (Jan. 20, p. 147) by Dr Okubadejo and others, we confirm your comment that Bacteroides fragilis does produce {3-lactamase. We have tested over 300 strains of B. fragilis isolated from blood and other specimens at our hospital and found good penicillinase activity in over 90% of strains by our method. 122 The method of Anderson and Datta,13 which Okubadejo et al. tried to adapt to B. fragilis, is technically unsatisfactory for bacteroides penicillinase. We find that penicillinase is best demonstrated in B. fragilis by allowing a heavily inoculated 24-hour thioglycollate-broth culture to
stand
an
filter-paper
additional 18 hours at room temperature. A disc is then dipped into the broth and placed
11. Field, E. J., Caspary, E. A., Hall, R., Clark, F. Lancet, 1970, i, 1144. 12. Pinkus, G., Veto, G., Braude, A. I. J. Bact. 1968, 96, 1437. 13. Anderson, E. S., Datta, N. Lancet, 1965, i, 407.
caveat to include children of up to eight There are few or no indications for the use of tetracycline in childhood.
broaden the years.
The Children’s Hospital, Western Bank, Sheffield S10 2TH.
F. HARRIS.
SIR,-Mr Nicholls (Feb. 3,
p. 225) suggests " that when antibiotic is indicated in the management of hand infections before culture reports become available, tetracycline is to be preferred to penicillin ". However, a more significant decision is whether to prescribe antibiotics at all for hand infections yielding pus. My paper 15 of fifteen years ago cited by Mr Nicholls was entitled Dispensability of an
14. 15.
Garrod, L. P. Br. med. J. 1955, ii, Anderson, J. ibid. 1958, ii, 1569.
1529.