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A comparison was made of the in-use performance of an in-house broth blood culture in a general hospital during 8 mths in 1988 with that of a commercial biphasic culture (BCB system, Roche Products Pty Ltd, Sydney) for the corresponding period in 1989. The clinical services and the number of blood samples tested were comparable. The yields of organisms after 48 hrs incubation were similar in both systems. Staphylococcus aureus showed up 3 times as often after 24 hrs incubation in the conventional system as in the BCB system. Agitation of the BCB facilitated macroscopic detection of growth in the initial 24 hrs incubation.

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Laboratory procedures for isolating the causative microbe from infected effluent in continuous ambulatory peritoneal dialysis (CAPD) are still being refined. Our recovery rate from culturing centrifuged deposits of 10 mL of fluid averaged 55% for leukocytotic fluids from 1986 to 1989, a little lower than the published reports using blood culture methods. A combined use of spun deposit and blood culture broth should improve the yield without excessive cost in time and labor. Gram staining was worthwhile only for leukocytotic fluids.

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Pulmonary actinomycosis is an uncommon infection whose diagnosis is often delayed as clinically the disease may mimic tuberculosis or cancer. It is rare in children. We present the first report from Australasia of a case of Actinomyces meyeri pneumonitis in a 13-year-old boy.

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In 1 year there were 135 episodes of septicaemia in a large referral hospital serving a population of 400,000 people. Of these, 52 were hospital-acquired giving a nosocomial septicaemia rate of 2.08 per 1000 admissions. The mortality rate rose with the number of antibiotics used; from 15% in those receiving one drug to 50% in those receiving three. A wide variety of organisms were encountered, the largest group being Staphylococcus aureus, 12 episodes; and Escherichia coli, nine episodes. Staphylococcus epidermis was pathogenic in seven patients with one death. A review of possible aetiological factors showed that 28 episodes occurred postoperatively with surgery considered directly responsible in 20. Intravenous cannulae were in place in 39 patients at the time of development of infection; they were causal in at least five; with two deaths. Urinary catheters were in situ in 14 patients and causal in at least six, with two deaths. Immunosuppression by drugs carried a worse prognosis than when infection occurred in patients with immunosuppressive disease.

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Over a three-year period, 6102 blood cultures were performed in a large general hospital. Each year, septicaemia was diagnosed in about 0.5% of patients. Detailed examination of one-year records showed that the largest proportion was from the surgical wards, followed by the emergency admitting ward, with smaller numbers from the adult medical, renal and paediatric areas. The organism most frequently responsible was Staphylococcus aureus followed by Escherichia coli. The mortality rate rose from 16% in those treated with one antibiotic, to 58% in those given three or more. Nosocomial infections accounted for 39% of all episodes, with a mortality rate of 29%. At least five cases of these, with two deaths, were attributable to intravenous cannulae. Neutropenia and concurrent immunosuppressive drug therapy were associated with a worse prognosis, but the body temperature and leucocyte count had no prognostic significance.

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Inshore sea waters harbour a variety of halophilic bacteria which increase in the warmer seasons. Ten Vibrio alginolyticus, 3 V. parahaemolyticus and 3 lactose-fermenting (L +) strains of vibrio were isolated in 3 yr from wound and ear infections, salpingitis and sputum in 2 coastal towns; 14 isolations were in summer. Clinically the cases resembled ordinary pyogenic infections. The API 20E kit and determination of NaCl tolerance permitted identification of the strains with reasonable confidence. Only a few characteristics were essential for presumptive identification.

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Bordetella bronchicanis is a common respiratory tract commensal of mammals. Rarely it causes whooping cough in children. Compromised adults in hospitals may be colonised, and one terminal pneumonia is on record. The fatal pneumonia of a malnourished alcoholic described here was contracted at home.

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Mebendazole, a new broad-spectrum oral anthelmintic for nematodes, was given to patients harboring whipworm in a hospital for the mentally retarded. A three-day regimen (100 mg twice a day) dewormed 75% of the subjects, a five-day regimen cured 95%. The remaining patients excreted strikingly lesser amounts of the parasites' eggs after therapy. No untoward effects were noted clinically. It is the drug of choice in mixed worm infestations.

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In the original Petroff procedure sputum is digested with NaOH and the centrifuged deposit neutralized with HCl before culturing. A modification in which digestion is arrested by dilution with water and the sediment is seeded on buffered media is simpler, quicker, safer and in our hands seems to give a greater number of positive smears and cultures for mycobacteria with less overgrowth by contaminants. The usefulness of regular smear examinations for excluding tuberculosis in nonspecific chest complaints is questioned.

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A fatal case of melioidosis, thought to be the third recorded from New South Wales, is presented. Infection probably occurred in Queensland. The patients presented with a subcutaneous abscess complicated by pyaemia, extensive lung involvement and septicaemic shock. The diagnosis was bacteriologically confirmed shortly before death, by isolation of Pseudomonas pseudomallei from blood, pus swabs and tracheal aspirates. There is a need for greater awareness of this disease in persons who have resided in South-East Asia and in North-Eastern Australia.

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