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39 children with prolonged nasopharyngeal carriage (48-328 days) of intermediately to highly penicillin-resistant pneumococci (PRP) were treated for 7 days with rifampicin in combination with amoxicillin (n = 18) erythromycin (n = 17) or clindamycin (n = 4), according to resistance pattern. In all children, except for 1 carrying a rifampicin-resistant strain, control cultures from the nasopharynx 1-2 weeks after the last antibiotic dosage, yielded no growth of PRP. In 2 brothers, PRP with the same serogroup and resistance pattern were found in nasopharynx 10 weeks after the antibiotic treatment. These preliminary findings indicate that antibiotic regimens including rifampicin are effective in eradicating nasopharyngeal carriage, but reappearance of the same strain may occur after several weeks. Such treatments should be given with caution due to the risk of selecting rifampicin-resistant strains. Further controlled studies are needed to determine the optimal combination of antibiotics and appropriate duration of therapy.

Septicemia is a rare but serious complication of infection with Yersinia enterocolitica (Y.e.). Seven cases of Y.e. septicemia are presented. Five of the patients had no underlying disease predisposing to septicemia. Five patients displayed recurrent episodes of septicemia, despite treatment with recommended doses of antibiotics to which the isolates were sensitive in vitro. One patient developed endocarditis which required surgical replacement of the aortic valve. Other clinical manifestations were arthritis, diverticulitis and pulmonary abscesses. The outcome was fatal to 3 elderly patients. The serological response to Y.e. was followed by tube agglutination and a diffusion-in-gel enzyme-linked immunosorbent assay. One patient, with a benign course of illness, had transient elevated Y.e. antibody titres, while the 3 cases with a protracted disease showed sustained antibody responses for 6-18 months. Blood isolates of Y.e. had ordinary virulence characteristics identical to fecal isolates and produced extracellular beta-lactamase. All isolates were sensitive in vitro to trimethoprim-sulfamethoxazole, mecillinam, piperacillin, cefotaxime, ceftazidime, chloramphenicol and gentamicin. The lowest MIC values were recorded for mecillinam. Full synergistic activity was demonstrated when mecillinam was combined with trimethoprim-sulfamethoxazole, cefuroxime or rifampicin.

152 women were cultured for group B streptococci (GBS) weekly from the 37th week of gestation and at admission to hospital for delivery. Matched rectal, urethral and urine specimens were collected for study (mean 4 times). In the 37th week of gestation, 33 women (22%) harboured GBS in rectal specimens, 28 women (18%) in urethral specimens, 16 women (11%) in urine specimens, and 37 women (24%) in at least one of the 3 specimens. All cultures considered, a total of 46 women (30%) yielded GBS in at least one culture. In the 37th week of gestation, women subsequently found to be GBS colonized at labour (positive in at least one site) had a higher rate of positive cultures in rectal specimens (77%) than in either urethral (67%) or urine specimens (41%). Chronic GBS carriage was more frequent in rectum than in urethra or urine. The results of the present investigation support the gastrointestinal tract as being the predominant source of GBS.

Women (1 268) attending a gynaecological clinic or a venereal disease clinic had positive cultures of group B streptococci from urethra in 27.8% and from rectum in 29.4%. The colonization rate was highest in patients from the venereal disease clinic (p less than 0.001). In a study of 405 of the females at different parts of the menstrual cycle group B streptococci were detected during the last half of the cycle in specimens from cervix in 18%, from urethra in 29% (p less than 0.005), and from rectum in 35% (p less than 0.001). The correlation between contraceptive methods and isolation of group B streptococci was investigated for 435 women. Females with intrauterine devices but not those using oral contraceptives had a significantly increased colonization rate genitally. The colonization rate of group B streptococci was also studied in 271 women using sanitary tampons and 129 women using sanitary towel. Those using tampons were significantly more often colonized. Cultures for Neisseria gonorrhoeae were performed from 380 patients but no correlation between N. gonorrhoeae and group B streptococci was found. The study supports the view that rectum and not the genito-urinary tract is the main reservoir of group B streptococci in females, that genital colonization mainly represents contamination from the gastrointestinal flora and sexual transmission is only one of many factors influencing the colonization rate.

Of 858 pregnant women studied in matched rectal, urethral and urine cultured specimens, 186 (22%) were found to be colonized by group B streptococci (GBS). GBS were detected significantly more often in rectal specimens (159) than in urethral specimens (108) or in urine specimens (64). This is supporting evidence for the gastrointestinal tract as the main habitat of GBS. Of 1786 women whose urine was sampled at delivery, GBS were isolated from 128 (7%), in 22 of whom (1% of the total) GBS were present in quantities greater than or equal to 10(4) colony forming units (cfu)/ml urine. Neonates born to women with greater than or equal to 10(4) cfu GBS/ml urine were apparently at greater risk for neonatal infection, as they were more commonly and more heavily colonized than were the newborns of women with lower quantities of GBS in urine, or if positive urethral or rectal specimens were considered. The incidence of preterm delivery or obstetric infection was not higher among women in whom GBS were isolated in specimens from any of the 3 sites; foetal distress was more common among their children, but not neonatal respiratory or infectious diseases of which the incidence was low and difficult to assess statistically.

The relationship between significant bacteriuria (SB), i.e. 2 subsequent voided urine specimens with greater than or equal to 10(5) colony forming units (CFU)/ml, and the occurrence of bacteria in the urinary bladder detected by bladder punction, was investigated in asymptomatic pregnant women. From 30 (70%) of the 43 women with SB studied, bacteria were isolated from the urinary bladder. The same bacteria were found in the bladders of all 21 women with Escherichia coli, the one with Klebsiella pneumoniae, and the one with Staphylococcus saprophyticus in midstream urine. Six of 10 patients with group B streptococci (GBS), 1 of 4 patients with Streptococcus faecalis, and none of 5 patients with Staphylococcus epidermidis in voided specimens had bacteria in the aspirated urine. Serotype III was isolated from 8/10 patients with SB caused by GBS. One child born to a woman with GBS SB but no bacteria in the urinary bladder, got early onset septicaemia. The poor predictive value of SB with GBS, S. faecalis and S. epidermidis necessitates the increased use of bladder puncture for diagnosis of true asymptomatic bacteriuria (AB), i.e. AB with bacteria in the urinary bladder. SB with GBS even without bacteria in the urinary bladder, may constitute a threat to the baby's health.