[Surveillance based on molecular epidemiology for Haemophilus influenzae Isolates in Gifu Prefecture]

We analyzed Haemophilus influenzae isolates in Gifu prefecture between May 2003 and August 2003. We conducted molecular-level epidemiological studies for 313 strains using PCR to identify resistant genes in H. influenzae. Our four sets of primers are as follows: (i) p6 gene of P6 membrane protein, (ii) TEM-1 type beta-lactamase gene (bla), (iii) normal PBP 3 gene (ftsl), and (iv) mutational ftsl gene detected in beta-lactamase-nonproducing ampicillin (ABPC) resistant H. influenzae (BLNAR). H. influenzae strains were classified into 6 types based on PCR: (i) beta-lactamase-nonproducing ABPC-susceptible strains (BLNAS; n = 85) with no any resistant genes, (ii) TEM-1 type beta-lactamase-producing ABPC resistant strains (BLPAR; n = 6), (iii) beta-lactamase-nonproducing and low-level ABPC-resistant strains (Low-BLNAR; n = 77) possessing Asn-526 --> Lys-526 amino acid substitution, (iv) BLNAR strains (n = 138) possessing Asn-526 --> Lys-526 and 3 amino acids substitutions detected around the Ser-Ser-Asn conserved motif, (v) beta-lactamase-producing amoxicillin-clavulanate resistant strains (BLPACR-I; n = 3) possessing TEM-1 and Low-BLNAR resistant genes, and (vi) beta-lactamase-producing amoxicillin-clavulanate resistant strains (BLPACR-II; n = 4) possessing TEM-1 and BLNAR resistant genes. Amoxicillin (AMPC) MIC90s in Low-BLNAR was 4 microg/mL and in BLNAR was 16 microg/mL. In oral cephalosporins, cefditoren MIC90 was the most excellent with 0.5 microg/mL against BLNAR. The prevalence of H. influenzae type b isolates in Matsubara Otorhinolaryngology Clinic was 66.7%. Selection of appropriate antimicrobial agents should be performed to prevent resistant microorganisms. Also, the vaccination for H. influenzae type b would be strongly recommended in near future.

[The proper use of carbapenem examined by Monte Carlo simulation]

Monte Carlo simulation was employed for this comparative study to determine the optimal Carbapenem and its dosing strategy to cure the infections by Escherichia coli and Pseudomonas aeruginosa and to consider how the difference of each Carbapenems in dosing regimens and antibiotic activity influenced to maximize % T > MIC. This result revealed that it was important to increase a dose and a number of doses a day, in addition to great antibiotic activity for maximizing % T > MIC.

Efficacy of micafungin against deep-seated candidiasis in cyclophosphamide-induced immunosuppressed mice

OBJECTIVES

We investigated the effects of fluconazole and micafungin for the therapy of deep-seated candidiasis in a cyclophosphamide-induced immunosuppressed mouse model.

METHODS

We used the experimental model of intraperitoneal fungal abscess caused by Candida albicans, as described previously.

RESULTS AND CONCLUSIONS

Micafungin efficacy was equal to that of fluconazole in one-tenth dosage even in peritonitis. We also assessed the short-term (24 h) and long-term (8 days) therapeutic effects after the end of therapy. Although the therapeutic effect of fluconazole was similar to that of micafungin at 24 h after the end of therapy, the effect of micafungin was superior to that of fluconazole at 8 days after the end of therapy.

[The comparison of optimized pharmacodynamic dosing strategy for meropenem using Monte Carlo simulation]

Monte Carlo simulation was enmloyed to determine pharmacodynamic target attainment rates for several meropenem dosage regimens against E. coli and P. aeruginosa populations. Percent Time above MIC (% T > MIC) exposures for several meropenem dosage regimens were simulated for 10,000 subjects. Variability in pharmacokinetic parameters and MIC distributions were derived from studies in healthy volunteers and the injection antibiotics include of Meropenem susceptibility test surveillance program. The probabilities of attaining bacteriostatic responses (30% T > MIC) and bactericidal responses (50% T > MIC) exposures were high for all dosage regimens against populations of E. coli. Against P. aeruginosa, the 1000 g 3.0 infusion q8 dosage regimen provided the hightest target attainment rates. Further study of these dosage recommendations in clinical trials is suggested.

[New trends in research on group B streptococci (GBS) infections and sexual transmitted diseases]

The adherence to and invasion of A549 cells by serotype VIII GBS (group B streptococci) were significantly greater than those of serotype III GBS for both the invasive strain and vaginal isolates. Serotype III strains of GBS stimulated significantly greater tumor necrosis factor alpha (TNF-alpha), interleukin-10 (IL-10), and interleukin-12 (IL-12) production than did serotype VIII strains. Interleukin-4 (IL-4) and interleukin-8 (IL-8) production in response to serotype VIII was significantly higher than in response to serotype III. On sexual transmitted diseases, orogenital contact has been common in both commercial sex workers (CSWs) and non-CSWs in Japanese women. Therefore, chlamydial infections in pharynx have been increasing in recent days. However, the treatment against Chlamydia trachomatis in the cases of pharyngeal infections should be longer than in the cases of uterine cervical infections.

[Incidence, treatment and outcome of anaerobic bacteremia]

In this paper, we discussed the incidence and clinical significance of blood cultures positive for anaerobes. Anaerobic bacteria is uncommon, accounting for 0.5-13% of all positive cultures. The incidence depend on the institution. Recent findings of a multicenter prospective observational trials showed that in vitro activity of the agents directed at Bacteroides species reliably predicts outcome. When a positive anaerobic blood culture was noted, appropriate action must be taken, since negligence in this respect may seriously impair the outcome of patients.

Adherence to, invasion by, and cytokine production in response to serotype VIII group B Streptococci

The adherence to and invasion of the human epithelial cell line A549 by group B streptococcus (GBS) serotype VIII strains were compared with those of serotype III strains by a conventional method and the dynamic in vitro attachment and invasion system. Twenty GBS strains, including nine vaginal isolates and one invasive isolate each of serotypes III and VIII, were used in the conventional attachment and invasion assay. Adherence to and invasion of A549 cells by serotype VIII GBS strains were significantly greater (P < 0.0001) than those by serotype III strains for both the invasive strain and vaginal isolates. Cytokine production by A549 cells following stimulation with GBS serotypes III and VIII or their purified capsular polysaccharides (CPS) was measured. Serotype III strains stimulated significantly greater tumor necrosis factor alpha (TNF-alpha) (P < 0.0001) and interleukin-10 (IL-10) (P < 0.05) production than did serotype VIII strains. IL-8 production in response to serotype VIII was significantly higher (P < 0.001) than that in response to serotype III. TNF-alpha, IL-8, and IL-10 production was greater in A549 cells infected with GBS than in the untreated control cells. TNF-alpha production was significantly greater (P < 0.005) after stimulation with purified GBS serotype III CPS than after stimulation with serotype VIII CPS, a result similar to that after stimulation with whole GBS. IL-12 production by A549 cells was observed only in response to infection with GBS serotype III, resulting in the possibility of a greater TH1 response in serotype III GBS. These results suggest differences in immune responses to infection with GBS serotypes III and VIII.

[Epidemiology of Streptococcus pneumoniae isolates in Gifu Prefecture]

We analyzed Streptococcus pneumoniae isolates confirmed by direct PCR in Gifu prefecture between May 2002 and August 2002. We analyzed isolates of 254 strains from 6 hospitals to determine antibiotic susceptibility, genotype of penicillin-binding protein (PBP) genes and macrolide resistant genes, and the serotypes distribution of isolates from Matsubara Otorhinolaryngology Clinic. Isolates in which abnormal PBP genes of pbp1a, pbp2x, and pbp2b were identified by PCR were classified based on PCR results as follows; (i) penicillin-susceptible (PSSP) with 3 normal PBP genes, (ii) penicillin-intermediate (PISP) with an abnormal pbp2x, (iii) PISP with an abnormal php2b, (iv) PISP with abnormal pbp2x and pbp2b, (v) PISP with abnormal pbpla and pbp2x, (vi) penicillin-resistant (PRSP) with 3 abnormal PBP genes. The overall incidence of PRSP, PISP and PSSP was 121 (49%), 109 (42%) and 24 (9%), respectively, and there was a significant difference among some hospitals (p<0.05). However, there was no significant difference among the hospitals for the incidence of abnormal macrolide-resistant genes (mefA, ermB). Panipenem showed an excellent antimicrobial activity for injectable carbapenems against PRSP, following biapenem, imipenem, and meropenem. Cefditoren (CDTR) showed an excellent antimicrobial activity for oral cephalosporins against PRSP, following cefteram and cefcapene. Interestingly, there were 2 and 3 strains on MIC of CDTR for 8 and 4 microg/mL, respectively. The prevalent pneumococcal serotypes of isolates in Matsubara Clinic were 6 (17/55), following by 40 (8/55), 9 (6/5) and 15 (5/55). The endemic strains were observed in this study using pulsed field gel electrophoresis. These findings suggest the needs to continue the surveillance of bacterial resistance not only in the nationwide but also in the distict.

Puerperal intrauterine infection caused by Edwardsiella tarda

Edwardsiella tarda infection is uncommon and has been reported to be associated with pet reptiles and the ingestion of raw fish. The majority of the infections occur as gastrointestinal disorders in immunocompromised hosts. We report a case of puerperal intrauterine E. tarda infection in a patient with no history of predisposing illness or of the recent ingestion of raw fish; this is the first such report. The patient complained of high fever, lower abdominal pain, and increasing amounts of malodorous genital discharge; these signs and symptoms responded well to intravenous antimicrobial chemotherapy.

In vitro and in vivo antibacterial activities of telithromycin

BACKGROUND

Telithromycin is one of the ketolides, characterised by a 3-keto group instead of L-cladinose and a C(11)-C(12) carbamate link by an alkyl chain to a pyridinum and imidazolium ring side chain. We evaluated in vitro and in vivo antibacterial activities of telithromycin against gynaecological pathogens.

METHODS

In the vitro study, the antibacterial activity of telithromycin against 180 isolates (isolated in the year 2000) of Streptococcus agalactiae (n = 33), Enterococcus faecalis (n = 22), Neisseria gonorrhoeae (n = 30), Peptostreptococcus anaerobius (n = 20), Finegoldia magna (n = 20), Bacteroides fragilis (n = 25) and Prevotella bivia (n = 30) was compared with that of erythromycin A, clarithromycin, azithromycin, ampicillin and levofloxacin. In the in vivo study, the efficacy of telithromycin was evaluated using experimental intra-abdominal abscesses in mice caused by B. fragilis (minimum inhibitory concentration of telithromycin 0.5 mg/l).

RESULTS

In the in vitro study, telithromycin inhibited more than 50% of clinical isolates of S. agalactiae, E. faecalis, N. gonorrhoeae, P. anaerobius, F. magna, B. fragilis and P. bivia at concentrations of 0.016, 0.063, 0.063, 0.032, 0.032, 0.5 and 0.25 mg/l, respectively. Telithromycin inhibited more than 90% of these clinical isolates at concentrations of 0.016, 4, 0.125, 0.063, 0.063, 4 and 1 mg/l, respectively. In the in vivo study, telithromycin inhibited abscess formation and significantly decreased viable cell counts in abscesses in comparison with the untreated group.

CONCLUSIONS

These in vitro and in vivo antibacterial activities suggest that telithromycin could be a potential candidate for the treatment of bacterial infections complicated by chlamydial infection.

Nosocomial infectious potency of imipenem-resistant Pseudomonas aeruginosa isolated from obstetric and gynecologic infections

Two hundred and eighty-two strains of Pseudomonas aeruginosa were isolated from patients at the Department of Obstetrics and Gynecology, Gifu University School of Medicine, between 1998 and 2000, and among them, 27 imipenem (IPM)-resistant strains of P. aeruginosa (27/282; 9.6%) were isolated from urine, exudate from surgical wounds, and ascites. Seven of the 27 IPM-resistant P. aeruginosa strains were positive (25.9%) for the bla (imp) gene determined by a polymerase chain reaction (PCR) method, and 4 of them were positive for the aac (6')-Ib gene. No strain of P. aeruginosa had both the bla (imp) and aac(6')-Ib genes. Pulsed-field gel electrophoresis (PFGE) patterns indicated the nosocomial spread of IPM-resistant P. aeruginosa. The presence of IPM-resistant P. aeruginosa carrying the bla (imp) gene might be implicated in possible spreading and outbreaks, and screening for bla (imp)-positive P. aeruginosa, therefore, might be necessary for protection against nosocomial infection.

Penetration of oral telithromycin into female genital tissues

To estimate the potential efficacy of telithromycin in the treatment of gynecological infections, a pharmacokinetic study was conducted in 13 Japanese subjects. Telithromycin was administered orally, at a dose of 600 mg, to patients undergoing hysterectomy, 3.0 to 7.5 h prior to the hysterectomy. At surgical operation, cubital venous blood, uterine arterial blood, vaginal cervix uteri (portio vaginalis), supravaginal uterine cervix, uterine endometrium, uterine myometrium, oviduct, and ovary specimens were collected separately. The blood and tissue concentrations of telithromycin were measured with a bioassay, using Micrococcus luteus ATCC 9361 as the test organism. The concentrations of telithromycin in these tissues and their proportions in relation to that in cubital venous blood (in parentheses) were as follows: cubital venous blood, 0.119 to 1.270 mg/l; uterine arterial blood, 0.111 to 1.230 mg/l; vaginal cervix uteri (portio vaginalis), 0.356 to 1.850 mg/kg (1.324 to 5.640), supravaginal uterine cervix, 0.376 to 4.520 mg/kg (1.108 to 16.807), uterine endometrium, 0.234 to 5.300 mg/kg (0.975 to 12.185), uterine myometrium, 0.309 to 5.050 mg/kg (1.288 to 19.832), oviduct, 0.375 to 5.550 mg/kg (1.563 to 10.000); and ovary, 0.495 to 5.250 mg/kg (1.835 to 6.851). From these results, it was concluded that the concentrations of telithromycin in female genital tissues are generally higher than those in blood. Taking the antimicrobial spectrum of telithromycin into consideration, it was suggested that telithromycin could potentially be a good candidate for the treatment of gynecological infections, including cases associated with sexually transmitted diseases.

Clinical efficacy of clarithromycin against uterine cervical and pharyngeal Chlamydia trachomatis and the sensitivity of polymerase chain reaction to detect C. trachomatis at various time points after treatment

The detection and eradication of pharyngeal Chlamydia trachomatis in patients with chlamydial uterine cervicitis (commercial sex workers and others) were investigated. Pharyngeal C. trachomatis was detected in 75.0% of the commercial sex workers and in 21.9% of the other subjects. All the pharyngeal C. trachomatis-positive patients had a past history of orogenital contact. Chlamydial infection was treated with clarithromycin for 7 or 14 days. The presence of C. trachomatis was determined by polymerase chain reaction (PCR) on days 8, 15, and 22 after completion of the treatment. In the 7-day treatment group, the eradication rate of pharyngeal C. trachomatis was 53.3%, 56.7%, and 60.0% on days 8, 15, and 22, respectively, after completion of the treatment, while the eradication rate of cervical C. trachomatis was 83.3%, 96.7%, and 100% on days 8, 15, and 22, respectively. The eradication rate of pharyngeal C. trachomatis in the 7-day treatment was significantly lower than that of cervical C. trachomatis, while there was no significant difference in the 14-day treatment. The eradication rate of pharyngeal C. trachomatis in the 14-day treatment was significantly higher than that in the 7-day treatment. Since the DNA of dead organisms may be detected because of high PCR sensitivity, appropriate therapeutic judgment by PCR could be done around day 22 after completion of the treatment.

Tuboovarian abscess caused by Candida glabrata in a febrile neutropenic patient

Deep-seated Candida infections are strongly associated with mortality and morbidity of patients, and need early diagnosis. The frequency of deep-seated fungal infection has recently been growing. We encountered a tuboovarian abscess caused by Candida glabrata after chemotherapy with an anticancer drug, methotrexate, in a febrile neutropenic patient. The susceptibilities to fluconazole and amphotericin B were 16 and 0.5 micro g/ml, respectively. Although combination therapy of fluconazole and amphotericin B was effective, left salpingectomy was laparoscopically performed because the left adnexal tumor continued to exist asymptomatically after 1 month.

Pharmacokinetics of single-dose intravenous ciprofloxacin in blood and ascites of patients with pelvic peritonitis

To estimate the efficacy of ciprofloxacin in the treatment of pelvic peritonitis, a pharmacokinetic study was conducted in four Japanese subjects. Ciprofloxacin was administered intravenously at a dose of 300 mg for 1 h to patients with pelvic peritonitis. Ascites was collected by culdocentesis. The concentrations of ciprofloxacin in blood and ascites were measured by a bioassay, using Escherichia coli Kp as the test organism and heart infusion agar as the medium. The ciprofloxacin concentration in ascites ranged from 3.01 to 9.41 microg/ml. The values for the arithmetic mean of ascites/serum ranged from 4.01 to 19.37, which showed that the penetration of ciprofloxacin was higher in ascites than in serum. The concentrations of ciprofloxacin are generally higher in ascites than in blood. Taking the antimicrobial spectrum of ciprofloxacin and the causative organisms of pelvic peritonitis into account, intravenous ciprofloxacin could be a good candidate for use in the treatment of pelvic peritonitis from the point of view of pharmacokinetics.

[Investigation on administration method of carbapenems]

Seventy-two women diagnosed as parametritis were enrolled in this study and examined on the effective administration method of carbapenems, imipenem/cilastatin (IPM/CS), panipenem/betamipron (PAPM/BP) and meropenem (MEPM). The total dosage of each carbapenem was 1.5 g/day, and administration frequency was twice a day (0.75 g x 2) or three times a day (0.5 g x 3). We reviewed the highest body temperature, white blood cell count and CRP value, before treatment and the fourth day after the start of treatment. Three times a day method was statistically superior to twice a day method in the highest body temperature, and CRP value. When we use carbapenem antimicrobial agents, the basis of PK/PD of time above MIC would lead to the increasing clinical effects.

Effect of ravuconazole, a new triazole antifungal, in a rat intraabdominal abscess model

BACKGROUND

Ravuconazole (BMS-207147) is a long-lasting triazole antifungal agent active against a broad spectrum of fungal pathogens including non-albicans Candida, Aspergillus, Cryptococcus and key dermatophytic fungi.

METHODS

The efficacy of ravuconazole was evaluated using an experimental intraabdominal abscess model in rats caused by Candida albicans (E81022). Two hundred milligrams of cyclophosphamide per kilogram was injected intraperitoneally into 40 rats. Four days (96 h) after the injection of cyclophosphamide, a mixture of C. albicans and autoclaved rat cecal contents [C. albicans 1.7 x 10(8) colony-forming units/rat] was inoculated into the peritoneal cavity. The rats were divided into four groups: ravuconazole treated, fluconazole treated, itraconazole treated and untreated. Each antifungal was given orally at a dose of 10 mg/kg twice a day for 5 days. On the day after the last administration, the rats were dissected and the viable fungi in the abscesses were determined. The number of C. albicans in each abscess was determined by a quantitative culture technique.

RESULTS

Ravuconazole inhibited abscess formation and significantly decreased the viable cell counts in abscesses in comparison with the untreated group. It's efficacy was at least equivalent to fluconazole and itraconazole against this pathogen. The rank order of potency (inhibition) was ravuconazole > itraconazole > fluconazole.

CONCLUSION

Taking into consideration the antifungal spectrum of ravuconazole, which includes non-albicans Candida as well as C. albicans and Aspergillus, it is suggested that ravuconazole would be a good agent for the treatment of fungal peritonitis.

[The frequency of Streptococcus pneumoniae strains and sensitivity surveillance for several antibiotics in Gifu Prefecture]

The frequency and the antibacterial sensitivity of Streptococcus pneumoniae strains isolated from 6 key hospitals (in 5 areas) and 1 otorhinolaryngology clinic in Gifu Prefecture from February to March, 1999, were investigated with several antibiotics. A total of 128 strains of Streptococcus pneumoniae were isolated throughout the study: 47 strains (36.7%) of penicillin-susceptible S. pneumoniae (PSSP), 51 strains (39.8%) of penicillin-intermediate S. pneumoniae (PISP), and 30 strains (23.4%) of penicillin-resistant S. pneumoniae (PRSP); the resistant bacteria being relatively prominent. In these hospitals, PSSP was isolated by 38.8% in all the key hospitals and by 30% in the otolaryngology clinic with almost no discernible difference. PISP was isolated by 63.3%, higher in the otolaryngology clinic and PRSP by 28.6%, higher in the key hospitals conversely. The MIC90s in PISP and PRSP were determined with the antibiotics. In result, only cefditoren (CDTR) showed favorable antibacterial activities with the MIC90 of 0.78 microgram/ml among penicillins or oral cephems. The MIC90s of carbapenems such as imipenem (IPM), meropenem (MEPM), and panipenem (PAPM) were less than 0.39 microgram/ml; particularly, PAPM showed the highest antibacterial activities. Among new quinolones such as tosufloxacin (TFLX), levofloxacin (LVFX), sparfloxacin (SPFX), and ciprofloxacin (CPFX), TFLX showed the highest antibacterial activities with the MIC90 of 0.39 microgram/ml. Other agents showed very low antibacterial activities as the MIC90s were 25 micrograms/ml in minocycline (MINO) and more than 100 micrograms/ml in clarithromycin (CAM) and clindamycin (CLDM).

Effects of fluconazole on viable cell count in experimental intraperitoneal Candida abscesses

We investigated the effects of fluconazole in experimental intraperitoneal Candida abscesses in neutropenic mice treated with cyclophosphamide to assess a clinically appropriate method for the application of fluconazole in fungal infections in patients with neutropenia. The efficacy of fluconazole in fungal infection was investigated in treatments started immediately after Candida albicans inoculation and before C. albicans inoculation (preventive use of fluconazole). In this intraabdominal fungal abscess model, it was confirmed that fungi in already formed abscess were not reduced in number by fluconazole, even when those fungi were susceptible to fluconazole. Fluconazole was effective with both administration methods. We conclude from this study that the effect of the preventive use of fluconazole was equivalent to the effect when treatment was started immediately after fungal inoculation.

In vitro and in vivo antibacterial activities of a new injectable carbapenem, S-4661, against gynaecological pathogens

Carbapenems are often used to treat infections in obstetrics and gynaecology because of their activity against anaerobes. S-4661, a new injectable carbapenem antibiotic, has favourable pharmacokinetic properties and is not hydrolysed by dehydropeptidase I. We investigated the in vitro and in vivo antibacterial activities of S-4661 against strains of Streptococcus agalactiae, Escherichia coli, Peptostreptococcus magnus, Bacteroides fragilis and Prevotella bivia, which are major pathogens in the fields of obstetrics and gynaecology. The MIC(50) and MIC(90) of S-4661 for these strains were 0.25 and 1 mg/L, respectively. The in vivo efficacy of S-4661 was evaluated in a rat model of intrauterine infection, namely pyometra caused by E. coli and B. fragilis. The accumulation of neutrophils in the uterus in the S-4661-treated group was less marked and the number of bacteria significantly lower than those in the untreated group. These results suggest that S-4661 may be useful for treating polymicrobial infections in the fields of obstetrics and gynaecology.

In vitro antifungal activity of FK463, a new water-soluble echinocandin-like lipopeptide

The antifungal activity of FK463 against 72 recent clinical isolates of Candida albicans (24), Candida glabrata (17), Candida tropicalis (11), Candida krusei (8) and Candida parapsilosis (12) was compared with those of amphotericin B, fluconazole and itraconazole by means of a broth microdilution method specified by the National Committee for Clinical Laboratory Standards (NCCLS) document M27-A. The lowest drug concentration at which 90% of the population was inhibited (MIC(90)) of FK463 against C. albicans, C. glabrata, C. tropicalis, C. krusei and C. parapsilosis was 0.0156, 0. 0156, 0.0313, 0.125 and 1 mg/L, respectively. FK463 exhibited broad-spectrum activity against clinically important Candida spp. (MIC range < or =0.0039-2 mg/L), and its MICs for such fungi were lower than those of other antifungal agents tested. The minimum fungicidal concentrations for Candida spp. did not differ by more than two-fold from the MICs. Results from pre-clinical evaluations performed to date indicate that FK463 should be a potent parenteral antifungal agent.

Vaginal microflora in healthy women with Gardnerella vaginalis

In order to find the vaginal prevalence of Gardnerella vaginalis in a normal female population, we determined the incidence of G. vaginalis in relation to that of other bacterial genera and species in the vagina. Two-hundred and thirty-nine healthy women were the subjects of this study. Vaginal discharge was collected and bacteriological studies were performed. The mean total aerobe count in the G. vaginalis-positive group was 9.02 log10 colony-forming units (CFU)/g, which was significantly higher (P < 0.0001) than that (6.80 log10 CFU/g) in the G. vaginalis-negative group. In contrast, there was no difference in the mean total anaerobe count between the two groups of subjects (8.82 and 8.24 log10 CFU/g, respectively in the case of including Lactobacillus species count). Also, the mean pH level of vaginal secretion in the G. vaginalis-positive group was 4.58, which was significantly higher (P < 0.005) than that (4.10) in the G. vaginalis-negative group. Aerobes were isolated at equal incidence in the two groups. Anaerobes were isolated at a significantly higher rate in the G. vaginalis-positive group (P < 0.005) than in the G. vaginalis-negative group. The mean count of Lactobacillus species was significantly higher (P < 0.0001) in the G. vaginalis-negative group than in the positive counterpart (7.02 vs 8.66). Elevation of vaginal pH, an increase in the anaerobe count, and decreases in the Lactobacillus species count could be good predictors of the prevalence of bacterial vaginosis in healthy women.