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Consistent differences between males and females have been shown in land-based measurements of anaerobic power and capacity. However, these differences have not been investigated for a tethered 30-s maximal swimming test (TST). The purpose of this study is to explore gender differences in land and pool-based assessments of anaerobic power (Fpeak) and capacity (Fmean), as well as the influence of body composition. Thirteen males and fifteen females completed land (Wingate (WAnT)) and pool-based (TST) measures of anaerobic power and capacity previously described in the literature. Additionally, the subjects completed assessments of body composition via air displacement plethysmography. The males produced higher force than the females for Fpeak (p < 0.001) and Fmean (p = 0.008) during the TST. However, linear regression analysis determined that lean mass significantly predicted Fpeak (p = 0.002) and Fmean (p < 0.001) during the TST, while gender was no longer significant (p = 0.694 and p = 0.136, respectively). In conclusion, increases in anaerobic power and capacity (Fpeak and Fmean) may be a function of increased lean mass in males and females, warranting future research on the impact of resistance training programs on force production and swimming performance.

Objective: Intravenous immunoglobulin as an adjunctive treatment in sepsis was regarded as promising by a Cochrane meta-analysis of smaller trials. In this phase III multicenter trial, we assessed whether intravenous immunoglobulin G (ivIgG) reduced 28-day mortality and improved morbidity in patients with score-defined severe sepsis., Design: Randomized, double-blind, placebo-controlled, multicenter trial., Setting: Twenty-three medical and surgical intensive care units in university centers and large teaching hospitals., Patients: Patients (n = 653) with score-defined sepsis (sepsis score 12-27) and score-defined sepsis-induced severity of disease (Acute Physiology and Chronic Health Evaluation II score 20-35)., Interventions: Patients were assigned to receive either placebo or ivIgG (day 0, 0.6 g/kg body weight; day 1, 0.3 g/kg body weight)., Measurements and Main Results: The prospectively defined primary end point was death from any cause after 28 days. Prospectively defined secondary end points were 7-day all-cause mortality, short-term change in morbidity, and pulmonary function at day 4. Six hundred fifty-three patients from 23 active centers formed the intention-to-treat group, 624 patients the per-protocol group (placebo group, n = 303; ivIgG group, n = 321). The 28-day mortality rate was 37.3% in the placebo group and 39.3% in the ivIgG group and thus not significantly different (p = .6695). Seven-day mortality was not reduced, and 4-day pulmonary function was not improved. Drug-related adverse events were rare in both groups. Exploratory findings revealed a 3-day shortening of mechanical ventilation in the surviving patients and no effect of ivIgG on plasma levels of interleukin-6 and tumor necrosis factor receptors I and II., Conclusions: In patients with score-defined severe sepsis, ivIgG with a total dose of 0.9 g/kg body weight does not reduce mortality.

Urinary tract infections are one of the most common bacterial infectious diseases in humans. Depending on the localization and the effectiveness of pathogenetic factors, various clinical pictures (lower urinary tract infection, pyelonephritis, asymptomatic bacteriuria) have to be differentiated. There are virulence factors of microorganisms on the one hand and defense mechanisms on the other, which influence the manifestation and the course of disease. The process of bacterial attachment to the epithelial cells of the boundary layer, the internalization and invasion of bacteria could be important for acute and chronic disease. Disturbances of local defense mechanisms, such as increased urinary glucose concentration in diabetes or variations of Tamm-Horsfall protein and defensin levels, may influence the course of infection. On the basis of microbiological and laboratory findings as well as the results of clinical and ultrasound procedures, the decision on the therapeutic strategy should be made. There are different treatment recommendations for acute uncomplicated and complicated cases as well as for chronic diseases. Future investigations should focus on effective therapeutic options for special immunocompromised patients in relation to the microbiological aspects and defense mechanisms of the host.

As clinical persistence of Borrelia burgdorferi in patients with active Lyme borreliosis occurs despite obviously adequate antibiotic therapy, in vitro investigations of morphological variants and atypical forms of B. burgdorferi were undertaken. In an attempt to learn more about the variation of B. burgdorferi and the role of atypical forms in Lyme borreliosis, borreliae isolated from antibiotically treated and untreated patients with the clinical diagnosis of definite and probable Lyme borreliosis and from patient specimens contaminated with bacteria were investigated. Furthermore, the degeneration of the isolates during exposure to penicillin G in vitro was analysed. Morphological analysis by darkfield microscopy and scanning electron microscopy revealed diverse alterations. Persisters isolated from a great number of patients (60-80%) after treatment with antibiotics had an atypical form. The morphological alterations in culture with penicillin G developed gradually and increased with duration of incubation. Pleomorphism, the presence of elongated forms and spherical structures, the inability of cells to replicate, the long period of adaptation to growth in MKP-medium and the mycoplasma-like colonies after growth in solid medium (PMR agar) suggest that B. burgdorferi produce spheroplast-L-form variants. With regard to the polyphasic course of Lyme borreliosis, these forms without cell walls can be a possible reason why Borrelia survive in the organism for a long time (probably with all beta-lactam antibiotics) [corrected] and the cell-wall-dependent antibody titers disappear and emerge after reversion.

For a better understanding of the persistence of Borrelia burgdorferi sensu lato (s.l.) after antibiotic therapy the kinetics of killing B. burgdorferi s.l. under amoxicillin, doxycycline, cefotaxime, ceftriaxone, azithromycin and penicillin G were determined. The killing effect was investigated in MKP medium and human serum during a 72 h exposure to antibiotics. Twenty clinical isolates were used, including ten strains of Borrelia afzelii and ten strains of Borrelia garinii. The results show that the kinetics of killing borreliae differ from antibiotic to antibiotic. The killing rate of a given antibiotic is less dependent on the concentration of the antibiotic than on the reaction time. Furthermore, the data show that the strains of B. afzelii and B. garinii have a different reaction to antibiotics used in the treatment of Lyme borreliosis and that different reactions to given antibiotics also exist within one species. The B. garinii strains appear to be more sensitive to antibiotics used in therapy. Furthermore, the persistence of B. burgdorferi s.l. and clinical recurrences in patients despite seemingly adequate antibiotic treatment is described. The patients had clinical disease with or without diagnostic antibody titers to B. burgdorferi.

An in vitro system was developed to test the phagocytic activity of human macrophages grown from blood monocytes in the presence of the antibiotics ampicillin, tetracycline, and chloramphenicol. (3)H-labeled Listeria monocytogenes served as test organism. Subinhibitory amounts of the antibiotics enhanced the phagocytic activity significantly (P < 0.025). Macrophages pretreated with the drugs in identical concentrations showed the same phagocytic activity as control cells in the absence of the drugs. Because the drug concentrations used were similar to those that may be attained in man at certain places of inflammation, enhanced phagocytosis in the presence of antibiotics may have clinical significance.

High antibody titers against Escherichia coli were found in 100 randomly selected pregnant women by means of indirect haemagglutination (IHA). After birth, sera from the umbilical vein of the newborns were also tested. It was found that the indirect haemagglutination titers of the children were strongly influenced by the IgG which had been transferred via the placenta. Twenty-two sera of newborns showed an increased IHA-titer against E. coli, but only seven children displayed specific IgM antibodies, determined by indirect immunofluorescence. After chromatographic separation of the sera into IgG and IgM fractions, it was demonstrated that isolated antibodies of the IgG type alone can produce increased IHA titers. The assumption that the indirect haemagglutination is determined almost exclusively by antibodies of the IgG type is unfounded. Therefore, indirect haemagglutination is not suitable as a screening-test for newborns.

Efficacy of Oral Ofloxacin and Ciprofloxacin. Cross-over Study. The efficacy of the 4-quinolones ciprofloxacin (CPX) and ofloxacin (OFX) was studied in a cross-over study. Twenty out-patients with cystic fibrosis and chronic colonization of the respiratory tract with Pseudomonas aeruginosa were treated for ten days with OFX, then another ten days with CPX, and vice versa. Drug concentrations in serum and sputum were assayed. The patients' clinical and laboratory parameters were monitored. The side-effects that appeared did not require interrupting treatment. The serum and sputum concentrations were found to be above the minimal inhibitory concentration. Although P. aeruginosa was not eliminated by the therapy, two-thirds of the patients showed improvement during the infection that could be observed clinically and in laboratory measurements. Oral treatment with OFX and CPX is efficacious.

Recent investigations of several authors on portal venous and systemic endotoxemia in healthy adults have shown that endotoxins absorbed from the intestinal mucosa are found in portal venous blood, cleared by the RES of the liver and usually cannot be determined in peripheral blood. In patients with liver disease, however, there was often a reduced endotoxin clearance with spillover of endotoxin resulting in systemic endotoxemia. Among the complications of systemic endotoxemia, hepatocytotoxicity, pyrogen reaction, disseminated intravascular coagulation, impaired renal function, and endotoxic shock are most hazardous. In addition, O-antibody titers and lipid-A-antibody titers were found to be higher in patients with liver disease and in patients with Crohn's disease than in control groups. The investigations indicate that intestinal endotoxins are of importance in the pathogenesis of liver disease and of Crohn's disease and that reduction of intestinal endotoxins by antibiotics may be of value in the therapy of these diseases.

Adhesion of a 3H-thymidine-labeled reference strain of enterococci to epithelial cells of buccal mucosa from 20 young female patients with rec. UTI (aged 3 to 15 years) and 19 urologically healthy girls was investigated. Bacterial attachment in children with rec. UTI was significantly higher statistically than in the healthy control group and did not show any alteration when tested separately during acute UTI (14 cases) and infection-free intervals (17 cases). There was no difference in adherence between patients with rec. UTI connected with diverse anomalies of the urinary tract (12 girls) and UTI patients without anomalies (8 girls). Within the patient group 3 cases under antimicrobial prophylaxis with co-trimoxazole showed bacterial adhesion similar to that in healthy controls. Our examination results lead to the assumption that attachment of enterococci to buccal epithelial cells can be used as a diagnostic criterion for rec. UTI.

Antibodies were measured in 172 unselected neonates against mixed polyvalent antigens derived from E. COLI, Klebsiella, Ps. aeruginosa and Proteus spp. respectively, using a modification of the indirect haemagglutination technique according to Neter. 120 of these neonates with no evidence of infection served as controls. 6 out of 8 children with proven E. coli septicaemia had either raised titres or significant rises in titre. Five further neonates with septicaemia, four due to Klebsiella and one to Pseudomonas, had pathologically raised titres as well. 8 out of 12 neonates with clinically suspected septicaemia in whom no pathogen was isolated from the blood or cerebrospinal fluid had raised antibody titres. Following premature rupture of the membranes 2 out of 3 neonates who subsequently developed proven E. coli septicaemia had raised antibody titres against E. coli even on the first day of life. These results suggest that the measurement of antibody titres can be a valuable aid to the diagnosis of neonatal septicaemia.

About 5% of all patients fall ill with anosocomial infection, i.e. one acquired in hospital. Among the principal causes of this are therapeutic measures which lead to an increased exposure of patients to organisms (soiled artificial respiration equipment, venous catheters, urinary catheters etc.) and to a raised disposition in the patients due to reduction of endogenous defense (cytostatic therapy, corticoids irradiation, operations etc.). Cross infections are largely transmitted on the hands of doctors and nursing personnel. The detection, prevention and control of hospial infections by specially trained personnel (hospital infection officers, specialist hygiene nurses, hospital hygiene committees) is absolutely necessary and justified for economic reasons alone.

Lipid A is the toxic component of endotoxin in gram-negative bacteria. Antibodies to lipid A are not usually found in healthy persons (or only at a low titer) without a corresponding history of infection. Even gram-negative septicemia is found to be accompanied by only low titers. A completely different situation is seen in patients with chronic or recurrent infections due to Enterobacteriaceae and other gram-negative bacteria. Here it is notable that the antibody titer varies with the type of disorder (e. g. cystitis and pyelonephritis). A severe would infection, e. g. due to Pseudomonas aeruginosa, also leads to measurable lipid A antibody titers. Varying antibody titers can be observed in cystic fibrosis, Crohn's disease, and severe surgical infections. One can conclude that a significantly elevated antibody titer develops during an extensive tissue involvement of long duration and indeed is caused by tissue inhibition by endotoxin. Based on clinical experience, it can be assumed that lipid A antibodies present in the body have a protective effect in septic shock.

The protective effect of high-titer anti-lipid A hyperimmune globulin with respect to the course of the disease and the mortality rate was studied in patients with septicemia verified by positive blood cultures. Six patients were treated with anti-lipid A in an open study. Dramatic improvement in fever curves and clinical condition in some of the patients encouraged us to start a randomized double blind study. So far, 17 patients have entered the study, 16 of whom were evaluable. Immediately after a positive blood culture was found, patients received either high doses of anti-lipid A or placebo (saline solution) on two subsequent days. Before and after each infusion blood samples were taken in order to assess serum bactericidal activity and anti-lipid A titers. Because of the still small numbers of patients the results of both studies were summarized. In all patients treated with anti-lipid A clear-cut increases in anti-lipid A titers were shown. Patients with repeated gram-negative infections showed higher median anti-lipid A titers than patients without such a history. The patients treated with anti-lipid A immune globulin ran a significantly milder course than the placebo group. The severe signs of septic shock were reversed in seven of 15 patients on anti-lipid A compared to two of seven patients treated with placebo. In the anti-lipid A-treated group, three of 15 patients died, and in the placebo group two of seven. This difference is not statistically significant.

Today, however aminoglycosides are nearly indispensable owing to their broad antibacterial spectrum and genuine bactericidal effect as well as the possible synergic effect with beta-lactam preparations. The new cephalosporins are distinguished by a high beta-lactam stability and are active against the majority of pathogens causing nosocomial infections. An exceptional position is held by cefotaxim with its generally outstanding antibacterial potency, and by cefoxitin with its activity against Bacteroides fragilis. The ureidopenicillin azlocillin is superior to the Pseudomonas penicillins so far used. It acts against enterococci and H. influenzae as reliably as does mezlocillin.

The protective effect of high-titer anti-lipid A hyperimmune globulin with respect to the course of the disease and the mortality rate was studied in patients with septicemia verified by positive blood cultures. Six patients were treated with anti-lipid A in an open study. Dramatic improvement in fever curves and clinical condition in some of the patients encouraged us to start a randomized double blind study. So far, 17 patients have entered the study, 16 of whom were evaluable. Immediately after a positive blood culture was found, patients received either high doses of anti-lipid A or placebo (saline solution) on two subsequent days. Before and after each infusion blood samples were taken in order to assess serum bactericidal activity and anti-lipid A titers. Because of the still small numbers of patients the results of both studies were summarized. In all patients treated with anti-lipid A clear-cut increases in anti-lipid A titers were shown. Patients with repeated gram-negative infections showed higher median anti-lipid A titers than patients without such a history. The patients treated with anti-lipid A immune globulin ran a significantly milder course than the placebo group. The severe signs of septic shock were reversed in seven of 15 patients on anti-lipid A compared to two of seven patients treated with placebo. In the anti-lipid A-treated group, three of 15 patients died, and in the placebo group two of seven. This difference is not statistically significant.

The present paper reviews the risk of infection with particular reference to cystometry. Cystomanometric studies were performed in 71 children with chronic recurrent urinary tract infections and 40 children with neurogenic micturition disorders with meningomyelocele. Our results show that short-term catheterization in cystometry leads to a considerable risk of infection. In 10% of the cystometries children developed new infections. The infection risk decidedly depends less on the nature of the intervention than on the individual disposition. Antibiotic therapy seems to have little influence on the risk of infection.

Assuming a local weakness in the defence system to be responsible for chronic, recurrent infection of the urinary tract in young girls, we made 86 determinations of the bacterial periurethral flora from 70 female patients aged between five and eleven years. Within three patient groups (urologically healthy, temporarily free from infection, currently suffering an acute attack of chronic, recurrent urinary tract infection), we found gram-negative bacteria in 1/20 of the healthy children, in 1/2 of those temporarily free from infection and in all children suffering an acute attack. Enterococci (the accompanying flora) was found in 1/20, 1/2 of the children respectively. In both cases, the differences were significant (chi 2-Test, p less than 0.01). In comparison to healthy children, the more children, in 1/2 of those temporarily free from infection and in all children suffering an acute attack. Enterococci (the accompanying flora) was found in 1/20, 1/2 of the children respectively. In both cases, the differences were significant (chi 2-Test, p less than 0.01). In comparison to healthy children, the more children, in 1/2 of those temporarily free from infection and in all children suffering an acute attack. Enterococci (the accompanying flora) was found in 1/20, 1/2 of the children respectively. In both cases, the differences were significant (chi 2-Test, p less than 0.01). In comparison to healthy children, the more frequent colonization of children who were not currently infected, but who were prone to infection, was seen particularly as an indication of an intermittent local weakness in the defence system, possibly occurring when a defence mechanism occasionally falls short of a threshold level, thus allowing an infection to set in.

Lipid A is the toxic component of endotoxin in gram-negative bacteria. Antibodies to lipid A are not usually found in healthy persons (or only at a low titer) without a corresponding history of infection. Even gram-negative septicemia is found to be accompanied by only low titers. A completely different situation is seen in patients with chronic or recurrent infections due to Enterobacteriaceae and other gram-negative bacteria. Here it is notable that the antibody titer varies with the type of disorder (e.g. cystitis and pyelonephritis). A severe wound infection, e.g. due to Pseudomonas aeruginosa, also leads to measurable lipid A antibody titers. Varying antibody titers can be observed in cystic fibrosis, Crohn's disease, and severe surgical infections. One can conclude that a significantly elevated antibody titer develops during an extensive tissue involvement of long duration and indeed is caused by tissue inhibition by endotoxin. Based on clinical experience, it can be assumed that lipid A antibodies present in the body have a protective effect in septic shock.

In 18 patients with Crohn's disease, 28 patients with ulcerative colitis, 24 patients with acute enteritis and in 68 healthy adults lipid A antibody titers were determined by the passive hemolysis test. In addition O antibody titers to polyvalent Escherichia coli, Klebsiella, Proteus and Pseudomonas aeruginosa antigens were measured by indirect hemagglutination. The patients with Crohn's disease showed a statistically significant elevation of the lipid A antibody titers compared with each of the three other groups investigated. The O antibody titers for the four polyvalent antigens were higher in the patients with Crohn's disease than in the other groups. The results indicate that Enterobacteriaceae are involved in the pathogenesis of Crohn's disease. Thus, long-term treatment with wide spectrum antibiotics seems to be justified. The determination of lipid A antibody titers may be useful in differentiating between Crohn's disease and ulcerative colitis on diagnosis.

To determine whether sera containing high titers of lipid A antibody may be applicable at effective doses in treating patients with septicemia, a pharmacokinetic study was performed in seven patients aged 24 to 73 years with gram-negative septicemia and various underlying diseases, one of whom received a placebo, and in one patient without infection. In this study, we attempted to determine the effective dosage, the number of infusions and appropriate administration interval for the prevention and treatment of endotoxin shock. Blood samples from each patient were tested for lipid A antibodies before and at regular intervals after administration using an enzyme-linked immunosorbent assay (ELISA). Selected, pooled human immunoglobulin preparations containing high titers (expressed as exponents of 10) of IgG (titer = 3-4) and IgM (titer = 2-4) lipid A antibodies were administered first at a dosage of 8 ml/kg body weight. After administration, the mean lipid A antibody titer increased from 0.4 to 2.3 for IgG and from 2 to 2.4 for IgM. The initial increase was followed by a drop in titer within 24 h, which was perhaps due to antibody consumption. Following the second administration (24 h after the first) of only 4 ml/kg body weight, the mean IgG and IgM titers increased to 2.4 and 3.3, respectively, and dropped slower. A notable increase in circulating lipid A antibody titers was achieved, and four of six treated patients recovered from the sepsis. The two patients who died entered the study in a pre-terminal state. These studies encouraged us to initiate a randomized, double-blind controlled study.

Nineteen patients previously treated unsuccessfully, usually with bactericidal antibiotics, received large doses (average: 15-20 mg/kg/day) of oral doxycycline (Vibramycin) after suitable testing for resistance. The good therapeutic results -- complete cure in eleven cases, great improvement in one, doubtful response to doxycycline in four, three failures -- justifies the observation that high oral doses of doxycycline can be considered as an important addition to the possibilities for treatment of endocarditis.

Within 3 years 2546 nosocomial infections were registered among 18 897 hospitalised patients of a gynaecological-obstetric university hospital, Results were obtained in a prospective study on the use of nurses specially trained in hygiene. The incidence of nosocomial infections was 13.5% including predominantly asymptomatic bacteriurias and 3.9% without bacteriurias. It was higher after major surgical intervention and lowest in pregnant women, postnatal patients, vaginal deliveries and minor operations. Bacteriurias were the most common infection in all patient groups. They made up 71% of the total, followed by postoperative pelvic infections (7.3%), phlebitis at the site of infusion (6.5%) and abdominal wound infection (4.2%). During the control programme, introduction and reinforcement of various hygienic measures and continuous instruction and control of the wards and treatment rooms by the specially trained nurses the incidence of all nosocomial infections decreased by 48.1% and of urinary tract infections by 42.7%.

Bacterial meningitis should in principle be easily accessible to chemotherapy. The results of treatment cannot, however, be regarded at all optimistically although in recent years the therapy has brought an improvement in prognosis. Astonishingly, the therapeutic recommendations in common use even today are already 20 years old, so that the more favorable treatment results must be attributed to an earlier and more accurate diagnosis. The neurological damage following survival of meningitis is considerable, in particular, capacity to remember and powers of concentration remain impaired. Examination of these patients before school and observation during their schooldays is therefore essential.

In addition to an innate functional dysmaturity of the neonate's immune system, operation, anaesthesia, and intensive care measures can significantly worsen this physiological immune deficiency. Given the fact that antimicrobial therapy as well as progress in intensive care of infected operated neonates and prematures did not significantly decrease the high mortality rate in this patient age group we began performing fresh-blood exchange transfusions as supportive immunotherapy in the treatment of neonatal septicaemia. Since indication for exchange transfusion has been adopted as early as septicaemia was suspected only 46% of the operated neonates (13 out of 28) died of their infection, compared to 82% of the patients (23 out of 28) who did not undergo exchange transfusion.

From the studies of Westenfelder et al. and our own studies of the presence of lipid A antibodies in the upper and lower urinary tract infections, it can be concluded that chronic pyelonephritis is a lipid A induced disease. This hypothesis is based on the distinct statistically different antibody production in upper urinary tract infection in contrast to lower urinary tract infection, the persistence of lipid A in renal tissue, as well as the induction of lipid A nephritis in puppies. These observations should be considered in future studies to proceed in the clarification of these diseases.

There are two main periods of manifestation of anaerobic infections in childhood. In the neonatal period anaerobic septicaemia is usually mild with a lower mortality rate, but has essentially the same causes as aerobic septicaemia (premature rupture of the membranes, amniotic infection syndrome after ascending infection). The latter cases comprise about 10% of aerobic septicaemias. Later in childhood, the pathogenesis of anaerobic infections is similar to that in adulthood. Anaerobic infections occur after surgery, particularly of the abdominal region, in malignancies, immunodeficiency and aspiration. With the exception of Bacteroides fragilis, most anaerobes are sensitive to penicillin. A high percentage of clinically important anaerobes are sensitive to clindamycin, chloramphenicol and metronidazole.