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This review describes Semmelweis' achievement 150 years ago. User acceptability of hand disinfectants has been improved, but Semmelweis' observation that handwashing, in contrast to hygienic hand disinfection, is not always sufficiently effective, is not yet generally acknowledged, and the compliance of medical personnel to the rules of hand hygiene still remains an educational problem to be solved.

Amoxicillin is one of the most active antimicrobials against Helicobacter pylori in vitro, with a minimum inhibitory concentration (MIC) ofor = 0.01-0.1 mg/l. Thus far, neither primary nor secondary resistant strains have been found. Amoxicillin, which has a bactericidal effect on H. pylori, but is less inhibitory in the stationary growth phase and against cell-adherent or slowly growing H. pylori, probably has both topical and systemic activity. It is fairly acid stable and is less affected by gastric acidity than macrolides. Nevertheless, its activity in vivo is considerably enhanced when it is given concomitantly with proton pump inhibitors. Several amoxicillin-containing treatment regimes have yielded H. pylori eradication rates ofor = 90%. Of particular interest are 1-week treatment regimens containing amoxicillin + clarithromycin + omeprazole, or amoxicillin + metronidazole + omeprazole, as well as a 1-h topical therapy developed in Japan.

During the last years the appearance of radiopaque concrements in the maxillary sinus was reported. These could be identified as root-filling material for teeth of the upper jaw containing zinc oxide. This suggested that excess root-filling material containing zinc oxide in the maxillary sinus could favour the development of a local, non-invasive aspergillosis. Therefore, we tested Aspergillus fumigatus, A. flavus, A. terreus, A. nidulans and A. niveus for the influence of zinc oxide. Cza-pek-Dox agar was inoculated with the six different Aspergillus strains. Circular cavities stamped into the agar's center of each plate were filled with aliquots of the dilutions of a geometric series of zinc oxide dissolved in 0,1n H2SO4. All plates were then incubated for seven days at 37 degrees C. Readings were taken on the 3rd, the 5th and the 7th day. It became obvious that solved zinc oxide promotes the growth of all the tested Aspergillus species. This influence diminished with decreasing concentration. This effect could be observed on all days of measurement. Only A. niger showed an attenuated dependence, probably due to the a priori high growth rate of this species on Czapek-Dox agar. It is concluded that overfilling of maxillary teeth with a zinc oxide containing root filling material favours the development of local aspergillosis.

In order to investigate a presumed association of certain anamnestic data with Chlamydia trachomatis infection of infertile women, appropriate specimens were examined from 100 patients of an infertility clinic. PCR and nucleic acid hybridization were positive in 5% of the patients, corresponding in both tests; IgG was found in 31% and IgA in 5% of patients. The prevalence was highest in the age-group of 26-35 years (21 of 55) and higher in patients who had been trying to conceive for2 years (12 of 37) as than those tryingor = 2 years (3 of 13). The proportion of IgG-positive women was significantly (p = 0.03) smaller in Turkish patients (3 of 22) than in those of other origin (11 of 33 from former Yugoslavia and 15 of 39 Austrian women). The prevalence was higher in patients with reported pelvic inflammatory disease (11 of 30) as compared to patients without (15 of 50). With a pathological state of the Fallopian tubes the prevalence was 12 of 25, with normal tubes 6 of 18 (p0.05). Thus, there seem to exist anamnestic hints as to chlamydial infections. Because of their high prevalence in patients with sterility we recommend screening for chlamydial infection prior to undertaking any invasive diagnostic procedure of the Fallopian tubes.

Up to now, pulsed field gel electrophoresis (PFGE) has been used successfully for the analysis of the chains of infection of multiresistant staphylococci, enterococci and other germs involved in hospitalism. The purpose of this study was to find out whether yeast isolates from mothers and those from their newborns differed in genotypes. In this investigation, 103 parturient mothers and their children were examined for colonization by yeasts in sampling the vaginal secret at delivery and by taking swabs from the oral mucosa and the anus of the children on the third day after parturition. The samples were cultured on Sabouraud glucose agar and incubated for 48 hrs at 37 degrees C. The differentiation of the isolates was done biochemically by means of the VITEK-AMS system and morphologically on rice-extract agar. Subsequently DNA-fingerprinting analysis was carried out. In 6 cases we could prove the presence of Candida spp. in the mothers as well as in their children. In all cases the strains from mother and child showed the same banding pattern. Likewise, the strains isolated out of the vaginal secretion and the vaginal epithelium of individual women were identical. The differences observed between strains isolated from various women were of low or medium degree. This shows the PFGE to be an efficient procedure to demonstrate the relation of strains derived from mothers and their newborns.

The immunoglobulin G antibody response to Helicobacter pylori was assessed in 78 patients with non-ulcer dyspepsia using five different antigen preparations. All patients were endoscoped and biopsied. The H pylori state was determined histologically on at least two endoscopic biopsy specimens using a modified Giemsa stain. The ultracentrifuged cell sonicate, acid glycine extract, and 120 kilodalton protein antigens were specific in diagnosing infection (95-98%), but had only moderate sensitivity (70-84%). By mixing either of the two complex antigens with the 120 kilodalton protein, the sensitivity of the test was increased to 97% without affecting the high specificity. The combination of ultracentrifuged sonicate or acid glycine extract with the 120 kilodalton protein therefore seems to be superior to the individual antigen preparations and is particularly suitable for the serodiagnosis of H pylori infection.

The detection of antibodies specific for Helicobacter (Campylobacter) pylori is gaining importance for the diagnosis of chronic gastritis associated with this pathogen [12,14]. Compared with invasive diagnostic methods or breath tests, serodiagnosis is much easier to perform, cheaper, and, above all, less stressful to the patient. Furthermore, for the purpose of studying the efficacy of therapeutic regimens, it appears well suited for monitoring the colonization of the gastric mucosa with H. pylori (Fig. 1). This is advantageous since in studies such as these frequent endoscopies are necessary over a long period, which is expensive and not a factor conducive to patient compliance. Of course, biopsy speciriens would still be indispensable for cultivation of the pathogen, typing, and sensitivity testing, as well as for histological check-up, but the frequency of taking them could Possibly be significantly reduced.

In a prospective, randomized, double-blind, placebo-controlled study involving 27 surgical units in six European countries, the effect of preoperative whole-body bathing on two occasions with a detergent containing chlorhexidine (CHX+) on the incidence of wound infection in elective, clean surgery was compared with two bathings with a detergent without chlorhexidine (CHX-). In the CHX+ group 2.62% of 1413 patients and in the CHX- group 2.36% of 1400 patients subsequently became infected. The infection rate in the CHX+ group was 1.11 times that in the CHX- group with 95% confidence limits ranging between 0.69 and 1.82. Consequently, bathing patients twice preoperatively with chlorhexidine-detergent did not reduce the incidence of infection of clean wounds.

The data on blood culture isolates for 1983 and January - July 1984 reported by the Antibiotic Study Group of South Africa have been analysed to determine national and regional prevalences of different micro-organisms and resistance to certain antibiotics. Although there are significant differences in isolation frequencies between the various centres, overall the five most frequent isolates are Staphylococcus aureus (1983 - 15%; 1984 - 14%), Escherichia coli (13%), Klebsiella spp. (11%; 10%), Streptococcus pneumoniae (9%), and Salmonella typhi (7%; 13%). Staph. aureus ranks first in most centres for 1983 but is displaced in some in 1984 by enteric Gram-negative bacilli. In Durban S. typhi is the most common isolate for the entire period. Methicillin resistance among Staph. aureus is common (approximately 30% overall), especially in the Transvaal. Gentamicin resistance among certain Gram-negative bacilli is a problem in many centres and is especially disturbing in the case of Klebsiella spp., of which over 30% of total isolates are resistant. Ampicillin resistance for Haemophilus influenzae varies from nil to over 30% in different centres, and penicillin-resistant pneumococci are still encountered (nil to over 10%).