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107 stool specimens from not hospitalized individuals and 69 stool specimens from 61 hospitalized patients (Internal Medicine) were examined for C. difficile and toxin B. Included were 42 specimens of 33 female patients of the department of maxillo-facial surgery, receiving prophylactic clindamycin and 7 samples from the ward staff. From the samples of the first group, C. difficile was isolated in one case (0.93%), whereas 8 out of 61 internal patients (13%) were positive for C. difficile by culture and/or toxin test. In 12 out of 33 surgical patients (36%), C. difficile and/or toxin could be detected in the stool. Examination of the ward staff was negative. Environmental samplings on the ward, comprehending 246 contact cultures, resulted in the isolation of C. difficile from 25 plates (10.1%). The majority of the patients showed no symptoms or slight diarrhea. Only 5 patients required vancomycin therapy. Frequency and clinical significance of C. difficile isolation is discussed under these aspects.

To assess the activity of enoxacin, clindamycin and metronidazole, MICs of clinical isolates of saccharolytic intestinal Bacteroides spp. were determined, using the agar dilution method according to NCCLS guidelines. Checkerboard titrations of enoxacin-metronidazole and enoxacin-clindamycin were done on Wilkins-Chalgren agar; inoculation, incubation and reading of plates were as for determination of MICs. Metronidazole MIC 90s for Bacteroides fragilis (23 strains) and Bacteroides thetaiotaomicron (23 strains) were 0.5 mg/l, clindamycin MIC 90 for B. fragilis was 1 mg/l, and for B. thetaiotaomicron 8 mg/l, whereas enoxacin MIC 90 values were 16 mg/l and 64 mg/l, respectively. The evaluation of the inhibitory effects of the combination enoxacin-metronidazole for B. fragilis showed additional effects in eleven strains, indifference in seven strains and antagonism in one. The figures for B. thetaiotaomicron showed addition in five strains, indifference in 17 strains, antagonism in one. For B. fragilis the combination enoxacin-clindamycin showed addition in ten strains, indifference in six, and antagonism in one; for B. thetaiotaomicron synergism in one strain, addition in four strains, indifference in 17 strains. In conclusion, the absence of antagonism and the overall preponderance of additional and indifferent effects warrant the use of enoxacin in combination with metronidazole or clindamycin in clinical trials of treatment of anaerobic-aerobic mixed infections.

Warm and cold water as well as water from wash basin drains and faucet aerators was examined to determine the number of viable and dead bacteria by culture and by staining and to establish the spectrum of species with special consideration of Legionella pneumophila. The relation between the number of Legionella pneumophila, the temperature, and the iron content of the water was determined in three separate warm water systems. High colony counts (up to 8.9 X 10(5) colony-forming units), were detected in both warm and cold water at certain sampling sites. The most prevalent genera were Pseudomonas, Bacillus, Flavobacterium, Acinetobacter, and Moraxella. Legionella pneumophila was found in every building in 35 of 150 warm samples and in 1 of 43 cold water samples. The highest water temperature of a sample containing Legionella pneumophila was 64 degrees C. The correlation between high colony counts and the occurrence of Legionella pneumophila in the samples was not significant. High iron concentrations, however, appear to have a positive effect on the growth of Legionella pneumophila.

Susceptibility of anaerobic clinical isolates from the United States, Canada, and Germany to sulbactam/ampicillin (1 + 2) (SBT/AMP), ampicillin alone (AMP), and cefoxitin (CFX) was determined with a standard agar dilution test. The isolates included 192 strains of Bacteroides fragilis, 132 strains of other Bacteroides spp., and 19 strains of Clostridium spp. Against all species tested, SBT/AMP was more active than AMP or CFX. Results obtained by a new model of associative susceptibility testing indicated that susceptibility testing of single pathogens from polymicrobial infections is not necessarily reflective of the susceptibility of the pathogens at the site of infection. The results suggest that sulbactam is effective in associations of pathogens producing beta-lactamases of Richmond-Sykes types II-V and beta-lactamases of anaerobic bacteria.