Significance of recurrent positive blood cultures in patients with bacteremia and endocarditis during therapy with penicillin

American

Federation

20 to 90 per cent of that of gramicidin. The hemolytic activity of the various gramicidin derivatives in isobacteriostatic concentrations was 7 to 20 per cent of that of the starting material. Both human and bovine plasma had an inhibitory effect on hemolytic and bacteriostatic activities of gramicidin and its derivatives. This effect is predominantly due to the globulin fraction IV-I; crystalline bovine albumin did not reduce the bacteriostatic and hemolytic properties of gramicidin and its derivatives. SIGNIFICANCX BLOOD

OF

RECURRENT

CULTURES

IN

POSITIVE

PATIENTS

WITH

BACTEREMIA AND ENDOCARDITIS DURING THERAPY

WITH PENICILLIN. Harold L. M.D., Harry F. Dowling, M.D. and Jay A. Robinson, M.D., Washington, D. C. (From the Department of Medi-

Hirsh,

cine,

Georgetown

University,

School

of

Medicine.) Although resistance to penicillin has been induced in strains of penicillin-sensitive bacteria in vitro, there are few reports on increased resistance in vivo during treatment. Of fifty-five patients with endocarditis and bacteremia treated with penicillin eleven had a recurrence of a positive blood culture during therapy. In each instance the causative organisms were found to be more resistant to penicillin. In seven patients, two with staphylococcic bacteremia, three with staphylococcic endocarditis and two with Streptococcus viridans endocarditis, this was accompanied by a return of symptoms of active infection. The increase ranged from 4- to 204%fold. Three strains exhibited increases on one occasion, one on two, one on three and two on four occasions. The blood penicillin concentrations were determined in six patients after the appearance of organisms with increased resistance. Since it is established that in patients with endocarditis blood levels four to eight times the in vitro sensitivity of the causative organisms are required, none of these patients can be considered as having had an adequate level. The dose was increased in all the patients and recovery followed in four, one died of overwhelming infection, another was ultimately cured with streptomycin and another died of debility with no evidence of active infection. In the other four patients, one each with staphylococcic and Str. viridans endocarditis and two with staphylococcic bacAMERICAN

JOURNAL

OF

MEDICINE

for Clinical

Research

317

teremia, the bacteriologic findings were not accompanied by symptoms of active infection. The increases ranged from 2- to 4-fold. Adequate blood concentrations of penicillin were found in the two patients in whom they were determined. The dose of penicillin was continued and the patients recovered. The significance of these bacteriologic findings is discussed. It has been observed that an occasional organism will manifest as much as an g-fold change in sensitivity to penicillin spontaneously or as a result of the inaccuracy of the method. It is believed, however, that the increases in resistance to penicillin observed in the seven patients represent true changes in penicillin sensitivity. The significance of the increased resistance in the other four patients is unknown. STREPTOMYCIN IN THE TREATMENT OF PER-

L. Kahn, M.D. and Lewis W. Wannamaker, M.D., Durham, North Carolina. (From the Department of MediTUSSIS. Jerome

cine,

Duke

University.)

One hundred twenty-nine patients with pertussis were treated with streptomycin at the Willard Parker Hospital in New York City; one hundred of these were infants under one year of age. On admission, eight patients were classified as mild, ninety-six as moderate and twenty-five as severe. Streptomycin was administered by one of three routes; (1) as an aerosol, (2) intramuscularly or (3) as nose drops. Aerosol treatments were given to young infants by means of a small plastic oxygen hood. Eight patients who were considered critically ill were given hyperimmune human pertussis serum in addition to the streptomycin. There were five deaths. In the remaining patients the subsequent clinical course was judged to be good in ninetyfive, fair in twenty-seven and poor in two. Skin tests employing lyophilized pertussis agglutinogen were done on 123 patients. A positive reaction was obtained in eighty-two patients (66 per cent). EFFECT

OF

SYMPATHECTOMY

ON

BLOOD

VOLUME IN HYPERTENSIVE PATIENTS. H. 5’. Mayerson, M.D. and W. D. Davis, M.D., New Orleans, Louisiana. (From the Department School Clinic.)

of Physiology, of

Medicine

Tulane and

University, the

Ochsner