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The staphylococcal flora of the groin and perianal area was studied in 12 patients undergoing aortic grafts and 3 patients having repair of ventral abdominal hernias. A total of 892 isolates of coagulase-negative staphylococci (CNS) were identified and their antibiotic resistance determined. The species most frequently isolated were S. epidermidis and S. haemolyticus with the latter showing the highest incidence of antibiotic resistance. Five of 15 patients had CNS resistant to methicillin and gentamicin on admission. The effect of pre-operative bathing with chlorhexidine was studied in 6 patients and appeared to reduce the acquisition of multi-resistant CNS in the week after operation.

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The development and assessment of a fluorescence-labelled immunosorbent assay for the detection of antibodies to the human immunodeficiency virus is described. Test serum is incubated in microtitre wells on which antigens have been coated. If present in the test serum, antibodies to the human immunodeficiency virus bind to the solid-phase antigens. In turn the antibodies are quantified with anti-human immunoglobulin labelled with fluorescein. Positive samples produce an intense fluorescence which is measured in a spectrofluorimeter. When used to test a panel consisting of normal serum and antibody-positive serum from infected patients the assay proved to be 100% specific and to have a sensitivity of 100%. The assay has many of the advantages of micro enzyme-linked immunosorbent assays, but does not suffer from the drawbacks associated with the use of an enzyme label. It requires fewer manipulations and is quicker to carry out than an equivalent enzyme-linked test.

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In a prospective randomised trial 190 consecutive admissions undergoing emergency abdominal surgery were allocated to receive a 24-h peri-operative prophylactic regime of either cefotetan or gentamicin and tinidazole. Wound sepsis developed in 14 patients in each group and one patient in each group developed intra-abdominal abscess. Nine patients in the cefotetan group and 10 patients in the gentamicin and tinidazole group died within 1 month of surgery. The death of one patient in each group was directly related to sepsis. Sixty-five per cent of aerobes isolated at operation were sensitive to cefotetan and 62% sensitive to gentamicin. The in vitro anaerobic cover of tinidazole was complete, whereas 13% of anaerobes isolated at operation were resistant to cefotetan. Anaerobes, predominantly Bacteroides fragilis, were isolated from six of the 14 infected wounds following cefotetan prophylaxis and two of the 14 infected wounds in the gentamicin and tinidazole group. It is therefore recommended that cefotetan should be combined with a nitroimidazole in patients undergoing emergency colo-rectal procedures.

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In a 12 week period five patients developed gentamicin-resistant Pseudomonas aeruginosa infection after endoscopic retrograde cholangiopancreatography with the same endoscope. The organism was subsequently cultured from the endoscopic apparatus. The cases are discussed and the importance of adequate disinfection of endoscopes is re-iterated.

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Faecal specimens were collected at weekly intervals over the winter months from 141 new-born infants without diarrhoea. Contrary to the findings in other studies, no viruses were detected by electron micriscopy or culture in any of these specimens. Over the same period faecal specimens were collected from 84 infants up to four years of age admitted to hospital. Rotaviruses or adenoviruses were found in 48% of infants with gastroenteritis. Enteroviruses and other small round virus-like particles were found in infants both with and without gastroenteritis. No viruses or pathogenic bacteria could be found in 34% of specimens from infants with gastroenteritis.

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In an outbreak of winter vomiting disease affecting both pupils and staff in a primary school, virus-like particles were found in 7 out of 8 faecal specimens examined by electron microscopy. The particles measured 26 nm in diameter and had a buoyant density of 1-38--1-40 g/cm3 in caesium chloride. They could not be cultured in tissue-culture or organ-culture. In immune electron microscopy tests the particles appeared to differ antigenically from the Norwalk and Hawaii agents. Two out of three patients examined more than one month after their illness were still excreting the particles.

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