Paisley, John

The value of a routine 48-h anaerobic subculture of blood cultures was assessed in our laboratory over a 4-month period. Excluding presumed contaminants, anaerobes represented 51 (6.9%) of the total number of 734 positive cultures. Sixteen isolates (all Bacteroides ) from six patients were detected by the anaerobic subculture. All but one of these were also detected macroscopically. Excluding the one isolate, the routine anaerobic subculture hastened the identification of anaerobic organisms by only 1 day in two patients. We conclude that a routine anaerobic subculture is not indicated for the detection of anaerobic bacteremia.

The effect of combinations of gentamicin with trimethoprim or sulfamethoxazole-trimethoprim against clinical isolates of Escherichia coli (11 strains) and Klebsiella pneumoniae (12 strains) was examined by using a microdilution checkerboard technique. All isolates were susceptible to each antimicrobial agent. Synergism, defined as at least a 2-log 2 -dilution lowering of the minimal inhibitory concentration of either antibiotic in the combination compared with the minimal inhibitory concentration of the antibiotic alone, was observed with 15 of 23 (65%) isolates tested against trimethoprim and gentamicin and 14 of 23 (61%) isolates tested against sulfamethoxazole-trimethoprim and gentamicin. A 3-log 2 -dilution lowering of the minimal inhibitory concentration of either antibiotic was observed in 7 of 23 (30%) trimethoprim and gentamicin trials and 3 of 23 (13%) sulfamethoxazole-trimethoprim and gentamicin trials. Antagonism was observed in 3 of 46 combination trials and only with strains of K. pneumoniae .

Fifty-one clinical isolates of ticarcillin-resistant, gram-negative bacilli were tested for susceptibility to combinations of ticarcillin and clavulanic acid (BRL 14151), a potent beta-lactamase inhibitor. Minimal inhibitory concentrations (MICs) were measured by a microdilution method, and minimal bactericidal concentrations for selected strains were measured by the broth dilution method. Ticarcillin MICs were ≥128 μg/ml for all and ≥512 μg/ml for 38 (75%) of the strains. Thirty-nine strains of Enterobacteriaceae tested included Escherichia coli (14), Klebsiella pneumoniae (16), Citrobacter sp. (3), Enterobacter sp. (3), Salmonella enteritidis (1), Serratia marcescens (1), and Proteus mirabilis (1). Ticarcillin MICs for 34 strains (88%) were lowered at least threefold by the addition of 1.0 μg of clavulanic acid per ml. Against 33 strains (85%), the MICs were 64 μg or less per ml in the presence of 5 μg of clavulanic acid per ml. In contrast, the MICs for seven of eight strains of Pseudomonas aeruginosa were unaffected by the addition of up to 10 μg of clavulanic acid per ml. Ticarcillin with 5 μg of clavulanic acid per ml was bactericidal against ticarcillin-resistant (MIC ≥ 2,048 μg/ml) E. coli, K. pneumoniae, Enterobacter , and P. mirabilis .