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The minimum inhibitory concentrations (MIC) of ciprofloxacin were determined for 441 uropathogens from patients with complicated and/or hospital acquired urinary tract infections (UTI). None of the Enterobacteriaceae was resistant (MIC > or = 4 mg/l), but 21.7% of enterococci, 28.3% of Pseudomonas spp. and 38.5% of staphylococci were. Subtyping of the strains revealed that with staphylococci there was no clonal spread of resistant strains. In the case of enterococci and Pseudomonas spp., however, cross infections played a major role (46% and 40% respectively). In a retrospective analysis of 370 UTI episodes caused by Pseudomonas aeruginosa (74), enterococci (185) or staphylococci (111) there was no difference between sensitive and resistant strains with respect to clinical aspects and rates of elimination by appropriate anti-bacterial therapy. The rates of spontaneous disappearance without antibacterial therapy ranged from 28% in the case of P. aeruginosa up to 63% in the case of coagulase-negative staphylococci. This implies that especially in UTI caused by gram-positive cocci an indication for antibacterial therapy should be weighted thoroughly and fluoroquinolones should only be used in accordance with sensitivity testing.

The minimum duration of continuous amphotericin B irrigation (50 mg/liter/day) required to clear the candida colonizing the urinary bladder was investigated. Eleven in vitro experiments revealed a consistent candidicidal effect within 48 hours with 25 and 5 mg/l of amphotericin B concentrations attainable in the bladder. Hospitalized nursing home patients with candiduria were treated with two-day irrigation according to the protocol. The protocol consists of the use of a newly inserted catheter for the irrigation, subsequent washout of the residual drug, and immediate sampling of urine for microscopic examination and culture after the procedure. In 47 of 65 (72.3%) cases yeast was cleared. In the remaining 18 the candida persisted. Of the latter, ten received additional irrigation for an average of 7.3 days (range: 4-12 days). In all ten cases funguria continued. Two-day irrigation saves time and expense, and is as effective as the five-day procedure in eradicating the yeast on bladder mucosa. Because of the relatively short irrigation time, the protocol may be useful in clinical evaluation of the site of urinary candidiasis.