Fimbriation, hemagglutination and adherence properties were studied in two strains of S. marcescens (ATCC 43820 and 43821) isolated from the urine of two hospitalized patients in two different hospitals. Studies were performed using electron microscopy (EM), fimbrial purification, recombinant DNA and hemagglutination techniques, hydrophobicity and tests of adherence to uroepithelial cells, catheters and glass. In EM, fimbriae of these two strains showed an inner channel and were 11 nm. thick and 0.76-1.08 microns long. Original strains and the clone GH42-pSF192 (recombinant DNA prepared using E. coli GH42 as recipient and the cosmid SuperCos 1 as a vector) versus negative control (E. coli GH42-SuperCos 1) showed mannose-resistant hemagglutination of tanned erythrocytes and yeast, high hydrophobicity (55.4 and 49.6% at 37C versus 22.8%) and high adherence to borosilicate glass (313,000 and 168,000 CFU/cm.2 versus 17,000 CFU/cm.2), catheters (4.7 x 10(6) and 1.0 x 10(6) CFU/cm.2 versus 3.9 x 10(4) CFU/cm.2) and uroepithelial cells (adherence indexes of 3.82 and 3.29 versus 1.25). The properties of the fimbriae studied were different from those previously described in the genus Serratia, and they were designated as MR/T.

The pharmacokinetics of ticarcillin and clavulanic acid were studied by blood and urine assay methods in 25 patients divided into five groups with varying degrees of renal insufficiency i.e. mild, moderate and severe renal insufficiency, almost anuric patients and those requiring haemodialysis (groups A to E). A single dose of 5.2 g Timentin (5.0 g ticarcillin and 200 mg clavulanic acid) was administered intravenously by infusion over 30 min. The average elimination half-life (T1/2) of ticarcillin increased from 0.95 h in patients with creatinine clearance (Clcr) of 80 ml/min to 1.8, 4.4, 6.9 and 11.2 h respectively in mild, moderate and severe renal insufficiency and in almost anuric patients. The T1/2 values for clavulanic acid were 0.75, 0.9, 2.0, 2.5 and 4.8 h in the same groups. The area under concentration-time curve (AUC) for ticarcillin increased from 787 to 2839 mg/l/h and for clavulanic acid from 12.8 to 29 mg/l/h when group mean values from patients with mild and severe renal insufficiency were compared. The plasma clearance (Clpl) of clavulanic acid was in all groups greater than that of ticarcillin i.e. 166 and 100 ml/min vs. 79.2 and 25.0 ml/min when comparing mean values from groups with mild and severe renal insufficiency respectively. The plasma clearance ratio clavulanic acid/ticarcillin increased proportionally to the degree of renal insufficiency from a value of 1.5 in normal subjects to between 3.3 and 3.8 in more advanced cases.(ABSTRACT TRUNCATED AT 250 WORDS)

SUMMARY Candidiasis affecting the urinary bladder is relatively common. Some of the reasons that favour the increasing incidence of this mycosis are:(a) The indiscriminate use of broad‐spectrum antibiotics.(b) The presence of a larger number of patients with lowered biological resistance due to the disease itself or its treatment.(c) Instrumental manipulation, favouring the contamination of vital organs. Vesical candidiasis does not carry the dangers of renal localisation, but produces uncomfortable symptoms, resistant to usual antibiotic therapy and in some cases necessitating surgical intervention. Also spread by the ascending route may promote renal candidiasis. Vesical lavage with Amphotericin B solution is easy to perform, highly effective and produces no toxicity.

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