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Methicillin-resistant Staphylococcus epidermidis is an important cause of cerebrospinal fluid shunt infections and prosthetic valve endocarditis. Agar dilution miniimum inhibitory concentrations were determined for 100 strains of methicillin-resistant S. epidermidis which were isolated from clinical specimens. Vancomycin inhibited all 100 strains at s3.12 pug/ml, whereas clindamycin inhibited only 46 strains at <12.5 pg/mL. Methicillin-resistant S. epidermidis strains were resistant to achievable levels of erythromycin, with 90 strains having a minimum inhibitory concentration of 23.12 pg/ml. Of the five cephalosporins and one cephamycin tested, cefamandole was the most active in vitro, inhibiting 97 strains at S25 pug/ml. Antibiotic synergism was examined by a quantitative bacterial time-kill method. Synergism (.102 kill by the combination over the most effective single antibiotic at 24 h) was demonstrated with vancomycin (1.56 pLg/ml) plus cefamandole (6.25 pLg/ml) in 14 of 14 strains, vancomycin plus cephalothin (6.25 pLg/ml) in 14 of 14 strains, vancomycin plus rifampin (0.008 to 0.012 pg/ml) in 6 of 12 strains, rifampin plus cefamandole in 9 of 12 strains, and rifampin plus cephalothin in 10 of 12 strains. The emergence of populations of bacteria resistant to 0.2 pug of rifampin per ml developed in three offive methicillinresistant S. epidermidis strains tested. The addition of either vancomycin, cephalothin, or cefamandole to the rifampin prevented the emergence of resistance in these three strains. Clinical trials of synergistic antibiotic combination therapy for serious methicillin-resistant S. epidermidis infections are indicated.Staphylococcus epidermidis has been well established as a pathogen in the urinary tract (8), wounds (18), and, most importantly, infections involving indwelling artificial devices. S. epidermidis is the most common cause of prosthetic hip infections (10), cerebrospinal fluid shunt infections (1, 12), and prosthetic valve endocarditis (14, 15).The incidence of methicillin resistance in clinical isolates of S. epidermidis has ranged from 10% (11)

Eighty-two of 83 mental health professionals, including psychiatrists, were surveyed to determine their attitudes and behaviors toward AIDS prevention and family planning counseling with psychiatrically ill female outpatients. Nearly all reported that information should be provided on AIDS and family planning. However, they reported that they had raised topics of AIDS with only 19% of patients and family planning with only 25% of patients. This lack of communication was confirmed by patients' own reports. Factors which might relate to this lack of communication are explored.