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A total of 300 patients undergoing various types of urological procedures was studied for incidence of bacteremia. An osmotically stabilized anaerobic broth with sodium polyanethol sulfonate (Liquoid) yielded more positive blood cultures than any other culture system and was also the best system by far for recovery of anaerobes. The membrane filter showed faster growth and, therefore, facilitated faster identification of the infecting organism. There was a 31% incidence of bacteremia in the patients having transurethral resection of the prostate, 17% in the cystoscopy group, 24% in the urethral dilation group, and 8% in the urethral catheterization group. The organisms found most frequently isolated in blood cultures were enterococci and Klebsiella pneumoniae. Notable were a relatively large number of anaerobes and two protoplasts. The major source of the bacteremia was previous urinary tract infection, but evidence is presented which indicates that the prostate gland and the normal urethral flora are other significant sources.

Metronidazole, a systemic trichomonicide which has been used extensively since 1960, has recently been shown to be active against various anaerobic bacteria in vitro and in experimental infections. In the present study, metronidazole showed significant activity against virtually all of 54 strains of anaerobic and microaerophilic bacteria tested, including Bacteroides fragilis. Since this organism is the anaerobe most commonly isolated from human infections and has demonstrated significant resistance to many antimicrobial agents, metronidazole may prove to be very useful. Our initial clinical evaluation of metronidazole in human anaerobic infections is presented. Because of metronidazole's in vitro activity, its low incidence of toxic reactions, and this initial favorable clinical trial, the drug deserves further evaluation in the management of anaerobic infections.

Anaerobic bacteria predominate in the normal human fecal flora, out-numbering aerobes at least 100 to one. The two most prevalent organisms are Bacteroides fragilis and Bifidobacterium. Ileostomy flora is, on the other hand, chiefly aerobic and the total count is lower (10(8) per ml of fluid, compared to 10(10) per gram for feces). In normal people, small bowel bacterial counts are generally 10(5) per ml or less. The upper small bowel consists primarily of Gram-positive aerobes in small numbers. In the terminal ileum, counts are higher and aerobes and anaerobes are present in equal numbers. In the presence of acute obstruction and certain bowel stasis or other syndromes, the small bowel flora may become relatively profuse and fecal in type. The stomach normally has less than 10(3) organisms per ml but counts are higher in gastric samples with pH above 4.0. Intestinal bacteria are important in such processes as conversion of bilirubin to urobilinogen, supply of vitamin K to the host, defense against infection, bile acid deconjugation and conversion, infections related to the bowel, the malabsorption of blind loop and other bacterial overgrowth syndromes, and hepatic coma.

The bile tests for characterizing gram-negative anaerobic bacilli were reevaluated in prereduced anaerobically sterilized peptone-yeast-glucose broth, in thioglycollate broth, and on blood agar plates. Blood agar plates were unsatisfactory. The combination of 20% bile with 0.1% desoxycholate inhibited Fusobacterium, Bacteroides melaninogenicus, and B. oralis and sometimes Sphaerophorus necrophorus, but not B. fragilis or other Sphaerophorus species studied. Ten per cent bile with 0.05% desoxycholate was less satisfactory. There was no significant difference between fresh and commercial powdered bile. Desoxycholate (0.1% in thioglycollate broth) inhibited B. fragilis, Fusobacterium, B. melaninogenicus, B. oralis, and S. necrophorus, but not S. varius or S. mortiferus/S. ridiculosus. The bile and desoxycholate tests are simple to perform and helpful for characterization and classification of gram-negative anaerobic bacilli.

A method for identification of gram-negative anaerobic bacilli is described. Based on differences in susceptibility to paper discs containing 10 mug of colistin, 60 mug of erythromycin, 1,000 mug of kanamycin, 1,000 mug of neomycin, 2 units of penicillin, and 15 mug of rifampin, these bacteria may be placed into five groups. Other tests such as colony morphology, production of pigment, growth in bile, esculin hydrolysis, and reaction on egg yolk-agar may be used for further identification. The susceptibility tests are rapid and simple to perform and are helpful in characterizing gram-negative anaerobic bacilli. They are not intended for use in predicting clinical effectiveness of the drugs utilized.

A double-closured method introduced for Hungate tubes eliminates clamps or special racks to hold the rubber stoppers in place while the tubes are being processed. The system prevents stoppers from being dislodged by gas-producing anaerobes and keeps the stoppers sterile so that the closed system of transfer can be conveniently utilized. Open and closed systems for handling a gas-producing anaerobe were compared. Ten tubes containing Clostridium perfringens were opened; the organism was detected in the air by use of an impingement collector. The gloved hand of the operator also revealed the test organism. A similar trial with culture material removed by the closed system (syringe transfer) resulted in no detectable contamination of the environment.