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Die Entwicklung und Ausbreitung von Antibiotikaresistenzen in Bakterien stellt ein immer größer werdendes Problem in Human- und Veterinärmedizin dar. Eine Abschätzung der Resistenzlage, auch in Tieren welche engen Kontakt zum Halter haben, ist aus mehrerlei Hinsicht von Bedeutung. Sie ermöglicht sowohl eine Behandlung der Tiere im Krankheitsfall, als auch die Abschätzung einer eventuellen Gefährdung für den Menschen. Die vorliegenden Studien haben im Rahmen des BfT-GermVet gezeigt, dass die Resistenzraten in aus erkrankten Hobbytieren isolierten E. coli im allgemeinen niedriger sind als die vergleichbarer Isolate aus Menschen. Für Enterobacteriacea der Genera Proteus und Klebsiella sind allgemein höhere Resistenzraten bekannt. Hier zeigten sich in der vorliegenden Studie dennoch niedrigere Werte als in der Humanmedizin, mit der Ausnahme der Resistenzraten gegenüber Fluorchinolonen. Gegenüber diesem Wirkstoff wiesen Klebsiella spp. und Proteus spp. mit bis zu 29 % resistenter Isolate höhere Raten auf als in der Humanmedizin berichtet wurden, E. coli war jedoch deutlich sensibler. Die große Bedeutung der Fluorchinolone gab auch Anlass zum Aktivitätsvergleich verschiedener Fluorchinolone in vitro, um Fehldiagnosen in der Resistenztestung gegenüber diesen Wirkstoffen zu minimieren. Dieser Vergleich zeigte zum Teil deutliche Unterschiede, wobei zusätzlich Variationen zwischen den verschiedenen Bakterienspezies beobachtet werden konnten. Eine Festlegung einer Stellvertretersubstanz für Fluorchinolone ist also abzulehnen. Die hier durchgeführten Studien sind nur eine erste Erhebung der Resistenzsituation in pathogenen Bakterien von Hobbytieren in Deutschland. Um Veränderungen in der Antibiotikaempfindlichkeit dieser Bakterien sehen zu können, möglichst noch bevor sie sich in den Resistenzraten niederschlagen, ist jedoch eine weitere regelmäßige Untersuchung notwendig. Durch die Übernahme in das GERM-Vet Progamm ist diese Beobachtung für einige der untersuchten Kategorien gewährleistet, so daß in Zukunft auch die Entwicklung der Antibiotikaresistenz in Bakterien von Hunden, Katzen und Pferden in Deutschland exakt verfolgt werden kann., Development and spread of bacteria resistant to antimicrobial agents is a major concern to human and veterinary health. Estimation of the resistance situation especially in animals with close contact to their owners is thereby of great importance. On one hand it allows a propper therapy of diseased animals; on the other hand it also gives us the opportunity to estimate a possible hazzard to human health. The present part of the BfT-GermVet study shows that percentages of resistant bacteria from animals are generally lower than those of comparable isolates from humans. Enterobacteriaceae from the genera Proteus and Klebsiella are known to contribute to high percentages of resitant isolates. The present study though shows lower percentages than those known from human medicine with exception of those for Fluoroquinolones. Here percentages of Klebsiella spp. and Proteus spp. with up to 29 % were notably higher than those from humans, while those for E. coli-isolates were notably lower. The important role of Fluoroquinolones also generated the idea to compare the in vitro activity of different Fluoroquinolones in order to minimize false diagnoses in the detection of antimicrobial resistance against these agents. This comparison shows clear differences between the agents, with additional variations between the different bacterial species. The determination of a single Fluoroquinolone as a representative for the whole family is thereby not acceptable. The present studies are only cornerstones in the monitoring of antimicrobial resistance in pathogenic bacteria from companion animals in Germany. Further investigations of these bacteria are needed to show changes in their antimicrobial susceptibility before they have to be classified as resistant. A first step already taken is the inclusion in the GERM-Vet Program. This ensures detailed observations of pathogenic bacteria from dogs, cats and horses in Germany.

This study describes the bacteriological and mycological investigation of 212 ear swab samples of dogs with an otitis externa. 11 samples were sterile. Malassezia pachydermatis could be cultivated in 72.1% of all samples, in 21.9% of these cases in pure culture. In 27.9% of all samples only bacteria were found. Coagulase-positive haemolytic Staphylococcus and Malassezia pachydermatis were isolated together in 31.8% of all ear swab samples. Pseudomonas aeruginosa could be detected in 22.9%, haemolytic Streptococcus in 8.0%. The evaluation of antibiograms showed little resistance of staphylococcus to most common antibiotics or chemotherapeutics respectively, but the growth of Pseudomonas aeruginosa and especially Proteus spec. was only inhibited by a few substances.

This paper describes the technique to reconstruct the genitals after an episode of Fournier's gangrene using the rectus abdominis muscle flap. A 44-year-old diabetic man felt ill with a Fournier's gangrene following inguinal herniotomia. The infection could be treated by aggressive débridement and by muscle flap coverage. Then we reconstructed the genitalia.

To explain hospital acquired urinary tract infections in a Urological Clinic, 3691 case histories were evaluated. About 15% of iatrogenic infections were found, among them 7% bacteremias and 0.9% of cases with urosepsis. Autoinfection and intermittent infections should be differentiated. The iatrogenic infection can be prevented by avoiding certain diagnostic and operative interventions, observation of asepsis and exact indication, the autoinfection and intermittend infection by shortening the period of hospitalization. The observed different risk of infection of individual organ systems had its origin, not in a low defense potency but in the operative technique used.

Many infections of the urinary tract, especially after surgical treatment are nosocomial infections. The etiological bacteria could only be found in the urine of the infected patients and in the faecal flora of nearly 40% of all stationary patients. The so called "problem bacteria": Klebsiella, Proteus rettgeri, pseudomonas showed increasing drug resistance during the observed period between 1972-1975. The bacteria isolated from the faecal flora also showed multiple drug resistance. Thus we concluded that the antibiotic regime in these patients is very important for the selection and the increase of the problem bacteria both in urine and in the faecal flora.

The in vitro sensitivity of tetracycline and doxycycline is compared. Streptococcus and staphylococcus are more sensitive to doxycycline whereas pseudomonas and proteus spec. are more sensitive to tetracycline.

The various types of bacterial resistance (natural species resistance, chromosomal and plasmidic resistance) and their mechanisms are described. Thereafter, a survey on the resistance is given using investigations from different sources. The distribution of resistant strains dependent on the geographical location and the situation of the patients (ambulatory--hospitalized) is described, and the development of resistant strains in dependance of time is analyzed. Finally, the phenomena of resistance against aminoglycoside and beta-lactam antibiotics are explained in more detail.

Combination effects of mecillinam + ampicillin and mecillinam + cefazolin were investigated by the cross diffusion test and by the kinetics of bactericidal action. Synergism was found by cross diffusion in about 50% of strains of E. coli, Klebsiella and Proteus. Sensitivity against ampicillin was correlated with synergism. In mecillinam-resistant strains, synergism is usually absent. The combination of ampicillin or cefazolin with mecillinam leads to bactericidal acceleration; the effects are comparable to those of the combination with gentamycin. Mecillinam seems to be a clinically promising agent for combination chemotherapy. A simple test for synergism is desirable.

Two sets of group of 50 women were examined and compared to find out if the introduction of continuous intra-uterine catheter during labour increased infection. Amniotic fluid was withdrawn from both groups and examined. Also a catheter was introduced into the amniotic sac of one group and after 2 and 5 hours amniotic fluid was also withdrawn from both groups and examined. Inhaled amniotic fluid from the infant was also withdrawn and bacteriologically examined both quantitatively and qualitatively. The examination proved that there was no significant increase in the infection of the test group and the control group. Also there were no complications observed on the mother and child after delivery.

Studies were conducted into the quantitative composition of the gastro-intestinal flora of 30 naturally raised piglets in four age groups. The gastro-intestinal tract was found to be "flooded" by Escherichia coli, Clostridium perfringens, micrococci, streptococci, proteus, and lactobacteria over the first hours after birth. Development of the intestinal flora was complete at the age of four days. The groups of germs recordable from naturally and artificially raised piglets were, basically, the same. Piglets, consequently, have no specific "lactoflora".

After description of the most important properties of fosfomycin including pharmacokinetics, antibacterial activity and hitherto got clinical experiences the determinations of the resistance on frequent clinical pathogenic agents are reported. They were performed in the diffusion test in a platelet content of 20 micrograms with admixture of glucose-6-phosphate. High sensitivity rates showed E. coli, P. mirabilis, hemophiliacs and above all Staph. aureus, but also a large part of the Klebsiella and the Pseudomonas strains could be classified as sensitive. Streptococci, pneumococci and enterococci mostly proved as resistant. Thus, in an oral therapy the spectre is smaller than in a highly dosed parenteral supply. Nevertheless, fosfomycin in the two forms of application is to be regarded as an enrichment of the therapeutic possibilities and further should be tested clinically.

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.

Liver biopsies and serum samples were collected after intravenous application of 2 g cephradin (n = 13) or 2 g cephacetril (n = 11) during surgery. There was no difference in the serum levels of cephradin and cephacetril. 30 min. after i.v. application of cephradin the liver tissue concentration was 72.62 mcg/g. 30 min. after i.v. cephacetril the liver tissue concentration was 5.83 mcg/g. The quotient of liver tissue concentration to serum concentration for cephradin was between 0.36 and 0.83, and for cephacetril between 0.02 and 0.16. The excretion of cephradin and cephacetril in human bile was studied by collecting bile samples from the common bile duct via T-tube drainage (n = 17). Cholecystomized patients were given 2 g of antibiotics intravenously. Serum levels of cephradin were 263 mcg/ml 5 min after application, and 22 mcg/ml after 240 min. Serum levels of cephradin were 263 mcg/ml 5 min after application, and 22 mcg/ml after 240 min. Serum levels of cephacetril were 193 mcg/ml 5 min after application, and 27 mcg/ml after 240 min. The highest levels of cephradin in the bile were found 75 min after injection at a concentration of 86.4 mcg/ml; the highest level for cephacetril was 21.8 mcg/ml at 15 min. In patients with hyperbilirubinaemia cephradin reached a mean maximum concentration of 29.6 mcg/ml in bile samples, in comparison to 117.4 mcg/ml in normal patients, while no difference was seen with cephacetril. After intravenous administration of 2 g cephradin biliary concentration are achieved which may be sufficiently high to be effective not only against the very sensitive gram-positive organisms, but also against most strains of E. coli, Klebsiella and indol-negative Proteus. Cephradin is effective in the treatment of cholangitis and intrahepatic abscesses, as was observed in 18 patients. A free bile-flow is essential.

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.

In a comparison of the antibacterial in-vitro activity of sisomicin, gentamicin, and tobramycine, sisomicin showed a higher activity against E. coli, indole-positive Proteus spp. and organisms of the Klebsiella-Enterobacter-Serratia group, whereas tobramycine was superior against Pseudomonas spp. However, the differences in activity between sisomicin and gentamicin were only within one step of dilution which is hardly sufficient to guarantee a basic superiority of one or the other preparation for clinical purposes. In 12 healthy probands serum levels and renal elimination of sisomicin and gentamicin after a single intramuscular injection of 1 mg/kg body weight were investigated in a randomised change-over trial. With corresponding serum levels, almost identical elimination half-lives of 109 and 111 minutes, and recovery values of 84 and 88.4%, respectively, there were no significant differences in the pharmacokinetics of sisomicin and gentamicin. Thus in the antibacterial treatment of gentamicin-sensitive gram-negative organisms sisomicin presents an equally good alternative. With organisms only moderately sensitive or resistant to gentamicin, sisomicin, tobramycine and amikacin should be additionally tested.

Introducing the authors report on cases of scombroid poisoning episodes in food serving establishments. These cases were related to the formation of histamine in tuna meat due to Proteus morganii although the meat was sound when taken from cans. It is demonstrated experimentally (Table 1) and shown in a critical literature review (Table 2) that among Proteus species Proteus morganii is the only species being able of producing histamine levels high enough to cause food poisoning in humans. Multiplication and histamine formation by Proteus morganii at different temperatures show (Fig. 1 and 2) that the concentration of histamine increases rapidly once the formation has started and the level of 1000 mg/kg considered as critical may be exceeded within a short period of time. These results confirm our observations obtained during epidemiological studies of food poisoning cases that improper handling and storage of tuna meat from cans at food serving establishments may bear the risk of causing scombroid poisoning. It should be emphasized that certain cultures of Proteus morganii are able to form histamine at levels of more than 1000 mg/kg even at a temperature of 7 degree C although prolonged incubation is necessary (Fig. 1). This fact should be taken into consideration in the evaluation of results when a prolonged period of time has elapsed between sampling or consumption of the suspect food and its examination.

Swabs were taken from 100 patients suffering from chronic otitis media or mastoiditis before operation to identify bacteria and their sensitivity to antibiotics. Recommendations are made concerning local or general preoperative treatment.

In patients with prostatovesiculitis the qualitative proof of microorganisms from experiment or ejaculate has only an insignificant diagnostic value on account of the lacking possibility of the recognition of contamination germs, It may be concluded to a prostatitis caused by bacteria, when the number of germs established in the exprimate is unequivocally larger than this one in the middle stream urine. In order to use successfully also the differences of the number of germs of ejaculate and middle stream urine for the differentiation between bacterial contamination and prostatovesiculitis, it must be presumed that bacteria of the physiological flora of the urethra may be cultivated in about the same quantity by investigations of the ejaculate as well as of the middle stream urine. Of 100 males without inflammatory disease in the region of the urogenital tract, therefore, middle stream urine and ejaculate or exprimate-containing urine were examined bacteriologically. Hereby was recognized that the number of germs in the different ejaculte specimens of healthy men considerably varied in comparison to the middle stream urine or the exprimate-containing urine and, consequently, is scarcely taken into consideration as diagnostic criterion for the prostatovesiculitis.

Mice are protected against lethal doses of Salmonella typhi-murium by vaccination with ATA extracted from Providencia. No protective effect is observed when the S. typhi-murium strains are enterotoxigenic. Thus protection is antibacterial, but not antitoxic.

In all parts of the hospitals examined results were found, which demonstrated, in part considerable, gaps in the hygienic systems. Therefore the enforcement of the following measures must be emphatically postulated: - Development of hospital hygiene plans by competent experts in cooperation with the doctors and nurses in charge. - Foundation of commissions for hygiene, who are responsible for preventive measures and for the establishment of a survey of hospital infections. - Delegation of the internal control of hospital hygiene to a person experienced in that field without other functions. - Renovation of supplementation of the technical hygienical facilities especially in old hospitals.

Technology, evidence as well as indications and contraindications of the suprapubic bladder puncture are shown from a gynecological and obstetrical point of view. The bacteriological result of urine obtained by puncture from 476 women has been compared with that obtained subsequently by midstream voiding. It was proved statistically that bladder puncture yielded less positive results than midstream voiding. In 8.4 per cent of the cases there was a positive voided midstream urine culture with pathogenic bacteria while the samples of bladder puncture were sterile, thus 29.2 per cent of the positive voided midstream urine cultures proving to be "false-positive" concerning an infection of the bladder and of the upper urinary tract. The frequency of pathogenic bacteria, "apathogenic" bacteria and mixed cultures is given, divided into conforming and nonconforming culture results of puncture and midstream urines.

The bacterial flora of the preputial space of 210 healthy males (43 children aged between 2 and 11 years, 137 males between 12 and 60 years and 30 men over 60 years) was determined by smears and cultueres from glans penis, sulcus coronarius and the adjacent prepuce. The results were grouped according to various criteria, e.g. glans covered or uncovered and age of males. Differences in the distribution of germs could be found in relationship to age. In the case of an uncovered glans penis the presence of microbial flora corresponds to the grampositive saprophytic bacteria in areas rich in sebaceous glands. In the case of a covered glans the density of microorganisms increases. Prevalent are gramnegative anaerobes, especially Bacterioides melaninogenicus, also enterococci, enterobacteria and coagulase-positive staphylococci.

Bacteriological investigation of possible cornea donors' conjunctiva and aqueous humor were performed. The results show the importance of antibiotic prophylaxis before keratoplasty.

In 650 cases for the purpose of a methodical comparison was examined urine got by paracentesis of the bladder and midstream urine. The most important results were: 1. Urine got by paracentesis of the bladder was infected in 30.9%, midstream urine in 51.7%. 2. Further 39.4% of the samples of midstream urine were poor in germs; in 2.3% these findings corresponded to an infection. 3. Only 69.7% of the kinds of germs and 38.8% of the numbers of germs were identical. 4. 28.4% of the samples of midstream urine with a significant bacteriuria and 60.6% of those ones in the region of suspicion showed sterility in the corresponding urine got by paracentesis of the bladder. 5. On the other hand 30.8% of the infected urine got by paracentesis of the bladder did not reveal a significant bacteriuria in the midstream urine. These results confirm the relevance of the quickly performable and complicationless suprapubic paracentesis of the bladder as diagnostic method. It should more be taken into consideration in clinic and outpatient department.

In 14 out of 43 Klebsiella pneumoniae strains (33%) the combination cephacetril-colistin showed a synergistic, in 11 strains (25%) an additive effect. In Proteus strains no synergistic action was found. The combination was more likely to be synergistic or additive in strains requiring higher minimal inhibitory concentrations of cephacetril and colistin. Most highly resistant Klebsiella pneumoniae strains were synergistically inhibited by concentrations of both drugs, which can easily be obtained in serum by usual clinical doses.

As exemplified by a test preparation, methods for assessing the effect of hand disinfection on the resident flora are put up for discussion. The test of a method for hand disinfection must make allowance for conditions prevailing in practice. Accordingly, the following steps should be taken into consideration: A. Single use 1. Immediate disinfecting effect 2. Duration of the disinfecting effect B. Repeated use 3. Course of the initial colony count 4. Immediate disinfecting effect 5. Behaviour of colony count after interruption of the disinfecting method applied. For the purpose of comparing the total count, as with all other disinfecting methods, the colony count must be determined by fractional collection methods; to this end, Traub's procedure may be modified, possibly using the plastic bag method described by Gaschen. A careful statistical evaluation with appropriate transformation of the results is indispensable.

The penicillin beta-lactamase (PBL) activity of the clinical isolates was measured at the same time by colorimetric microtitration, the iodometric method and chromatographic analysis. The minimal inhibitory concentration (MIC) of ampicillin (Ap) was determined for each isolate, the character of the coupled resistances, their frequency and distribution in the PBL producing and PBL-negative strains were also investigated. It was found that 1. the MIC value was 100 microgram/ml in 87.5 per cent of the Penicillin (P) and Ap resistant clinical isolates, 2. PBL was produced by 55--75 per cent of the P and Ap resistant strains depending on the species of the bacteria, 3. less than 50 per cent of the E. coli isolates produced PBL; in the case of other species this value was higher, about 65--70 per cent, 4. resistance to Su, SM, Tc, Nm and Cm was most frequently coupled to Ap and P resistance, 5. the distribution curve representing the number of the coupled resistance to the Ap and P shows a peak with 6 coupled antibiotics in the PBL-negative strains and 2 peaks in the PBL-producing strains.