SYNOPSIS Bacteria were isolated from 153 (47-5 %) swabs of the appendix fossa in 322 patients undergoing appendicectomy. The commonest organism was Bacteroides species found in 78 of specimens. Other Gram-negative bacilli such as Klebsiella, or Enterobacter, and Esch. coli were present in 29 and 27 % respectively. Gram-positive cocci were less frequently isolated.A positive culture was obtained more commonly in perforated appendicitis (79 %) than where chronic fibrosis, lymphoid hyperplasia, or acute appendicitis was present or when the appendix was normal. Bacteroides was isolated twice as often in perforated appendicitis.The incidence of wound infection was 19% and varied according to the state of the appendix, being 63 % in perforated appendicitis and 9 5 % where lymphoid hyperplasia was present. Bacteroides was isolated from over 90 % of the wound infections.In the patients with perforated appendicitis where effective chemotherapy was given the incidence of wound infection was 15 % whereas in untreated or inappropriately treated patients it was over 50%.The isolation of bacteroides requires special precautions to be taken both in the collection of the specimen and laboratory culture. It is important that the chemotherapy of postappendicectomy infections include an antibiotic active against bacteroides.Appendicitis is a common condition which frequently requires emergency surgery. Postoperative wound infection has been reported in up to 30% of cases (Lancet, 1971) and this incidence can be influenced by many factors, the most important being surgical skill and technique and the criteria used to define the infection. Bacteria play an important role in appendicitis and the local application of antibiotics (Forbes, 1961;Rickett and Jackson, 1969) or antiseptics (Gilmore, Martin,and Fletcher, 1973) can reduce the incidence of wound infection. Despite the large number of studies into the infective complications of appendicitis, few workers have produced a detailed description of the associated bacteriology, and anaerobic bacteria which account for over 90 % of the bacterial population of the intestine have rarely been reported. The relationship ofpreoperative bacterial flora of the peritoneal cavity surrounding the appendix to the degree of contamination is important in the development of wound infection. There is no agreement about the value of parenteral antibiotic treatment in acute appendicitis which

SummaryTalampicillin is a thiazolide carboxylic ester of ampicillin and is hydrolysed in the intestinal mucosa to release free ampicillin. The mean peak serum concentration of ampicillin occurred one hour after a dose of talampicillin and was about twice that attained by an equivalent dose of ampicillin. The presence of food in the stomach reduced and delayed the peak blood levels but did not affect the total amount of antibiotic absorbed or the urinary recovery. Talampicillin had less effect on the faecal flora in volunteers than ampicillin, and no overgrowth with Candida spp or Staphylococcus aureus was seen. Thirty-eight out of 47 urinary infections were eradicated by a seven-day course of talampicillin.

The prophylactic use of a single dose of lincomycin in 100 patients undergoing appendicectomy reduced the incidence of postoperative wound infection from 17 to 6 per cent compared with a similar group of control patients. There was no correlation with the histological finding in the appendix, but patients with perforated appendicitis were excluded from the study. Bacteriological examination of the appendix area before surgery showed that Bacteroides fragilis and Escherichia coli were the organisms most frequently isolated. The majority of wound infections were due to B. fragilis, either alone or in association with aerobic organisms, but infection due to E. coli and Staphylococcus aureus also occurred. Systemic antibiotic therapy can successfully reduce the complications following appendicectomy but it is necessary to use a compound with activity against anaerobic organisms.

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