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Since 1989 the reporting of chlamydia infections is regulated by the Contagious Diseases Act, which stipulates that a physician who detects chlamydia is obliged to trace the patient's sexual partner(s). Up to 1994 the annual decrease in the number of chlamydia cases was 20 percent, which did not meet the goal stipulated by the County Council. A questionnaire study was carried out concerning diagnosis, treatment and public health intervention in chlamydia patients seen by general and private practitioners. While the clinical management was seen to adhere to the recommendations of the National Board of Health, adequate tracing of sexual contacts was not carried out in 20-45 per cent of the cases. In a major urban area, such as the County of Stockholm, referral of all chlamydia cases to specialist clinics could possibly improve not only the care of the patients but also the success rate in reaching their sex partners.

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Serratia marcescens is a Gram negative rod which for a century and a half was considered a harmless saphrophyte. However, medical technology and the use of antibacterial agents have created ecological niches for this bacterium, which is now a medical problem. The bacterium is encountered in connection with contact lens keratitis, often associated with contaminated contact lens solutions. The concentrations of chlorhexidin and thiomersal required in contact lens solution to suppress the bacterium have been proved toxic to the eye. Modern contact lens solutions with biguanids have rapid killing kinetics, while in solutions with polyquaternium S. marcescens can survive in reduced numbers for up to 72 hours. The adherence of a specific isolate of Serratia to hydrogel lenses increased with decreased water content of the lenses. However, there has been no correlation between hydrophobicity markers or hemagglutinins and adherence to contact lenses or urinary tract epithelium. When handling medical plastic devices, such as contact lenses, strictly enforced hygiene remains the most important method to combat environmental bacteria such as Serratia marcescens.

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Samples of five different solutions for disinfection of soft contact lenses were experimentally inoculated with a strain of Pseudomonas aeruginosa or Serratia marcescens. No bacteria could be detected after one hour in solutions with biguanids, while they survived in reduced number up to 72 h in solutions with polyquaternium as active substance. However, prolonged survival after one week could not be detected. Lenses treated with polyquaternium based contact lens disinfectant solutions overnight may still harbour bacteria, which might increase the risk for bacterial complications, such as keratitis.

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The adherence of 4 isolates of Serratia marcescens, 1 isolate of Serratia liquefaciens, 1 of Pseudomonas aeruginosa, and 2 of Staphylococcus epidermidis to blood transfusion sets (CPD-SAGMAN) consisting of bags and connecting tubing was tested. All strains adhered well to the connecting tubes (polyvinyl chloride) from the transfusion sets from 3 manufacturers. Three isolates from a Swedish outbreak of septicaemia associated with contaminated blood bags showed greater adherence than an isolate from a urinary tract infection. There was no significant adherence of S. marcescens to the blood bags. In general, there were no significant differences in the adherence of a given isolate to the plastics from different manufacturers. Appropriate hygienic procedures for the production of transfusion sets appear to be of greater importance than differences in the plastic material as regards the incidence of transfusion-related bacteremia.

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The capacity of 59 isolates of Serratia marcescens, obtained from urinary tract infections, wounds, and contact lenses or their paraphernalia, to agglutinate erythrocytes from different animal species was tested. Three main patterns were found: mannose-sensitive agglutination of guinea-pig, fowl or horse erythrocyte; mannose-resistant agglutination of chicken or pigeon erythrocytes alone or in combination with mannose-sensitive agglutination; and no agglutination. Hemagglutination capacity was associated with isolates from urinary tract infection, but not with isolates associated with contact lenses. Adherence to human urinary tract epithelium did not correlate with the hemagglutination patterns nor with the origin of the isolates. Some strains of different hemagglutination pattern were selected for the study of hydrophobicity and adherence to contact lens polymers. Hydrophobicity, as determined by degree of partition in hexadecane and water (BATH-values), correlated neither with degree of adherence to contact lens polymers nor with the hemagglutination pattern. For a representative strain there was an excellent correlation (r2 = 0.98) between adherence and the water content (hydrophobicity) of the lens polymers. These results suggest that, as with tissues, other factors interact with hydrophobicity in causing adherence to plastics.

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In recent decades, Serratia marcescens has been established as a cause of infections difficult to treat, and several outbreaks of nosocomial infections have been reported, mostly from the USA. However, serratia infections affecting bones and joints are very rare; only a few such cases have previously been reported from Europe. We report 7 patients with orthopaedic infections by S. marcescens chiefly of nosocomial origin where previous antibiotic therapy apparently was a predisposing factor. The clinical course was generally protracted, often requiring repeated surgical interventions. Also, in some cases adequate therapy was considerably delayed as serratia was considered to be a nonpathogenic saprophyte. Multiresistance to antibiotics was a major clinical problem. However, the third generation cephalosporins are often effective against serratia and the aminoglycosides can thus be avoided. The increased use of prophylactic antibiotic therapy in orthopaedic surgery may bring about an increase in the incidence of infections by multiresistant microorganisms in orthopaedic wards.

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Twenty-four different brands of contact lens solutions were experimentally inoculated with strains of S. marcescens, S. liquefaciens and E. coli. Only flexol and hexidin could sufficiently suppress the growth of Serratia strains. If a soaking agent is to be effective in suppressing S. marcescens it must have a chlorhexidine concentration of at least 50 micrograms/ml and a thiomersal concentration of 10 micrograms/ml.

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A pigment-producing strain of Serratia rubidaea was isolated from two consecutive cultures from a sponge of silastic foam used as a dressing for chronic crural ulcers. The bacterium caused a red discolouration of the sponge and the surrounding part of the leg. The silastic sponge creates a new type of environment for microorganisms. The growth of previously rare bacteria such as S. rubidaea may be favoured by conditions within the sponge.

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