THE CLINICAL IMPORTANCE OF GRAM-POSITIVE ANAEROBIC COCCI ISOLATED AT ST-BARTHOLOMEWS-HOSPITAL, LONDON, IN 1987

The clinical importance of the gram-positive anaerobic cocci (GPAC) is olated in 1987 at St Bartholomew's Hospital, London, is assessed. Of a bout 800 anaerobic isolates, 209 (27%) were GPAC, of which 67 (32%) we re from abscesses and 22 (11%) were in pure growth. Four species compr ised 77% of the 168 isolates available for study: Peptostreptococcus m agnus (55 isolates, 33%), P. micros (23, 14%), P. asaccharolyticus (24 , 14%) and P. anaerobius (27, 16%). Different species were associated with different sites, from P. magnus (usually skin-associated sites; n ormally cultured with aerobes, infrequently with other anaerobes), P. asaccharolyticus (distributed widely) and P. anaerobius (usually genit ourinary and gastrointestinal; always below the diaphragm) to P. micro s (always deep sites with other anaerobes). P. magnus was isolated fro m 15 abscesses and was obtained in pure culture from 11 specimens, six of them abscesses developing from infected sebaceous cysts. P. micros was usually isolated from soft tissue abscesses, never from the skin, and with a characteristic mixed flora consisting of ''Streptococcus m illeri'' and anaerobic gram-negative rods. P. heliotrinreducens was a rare isolate from similar specimens. P. asaccharolyticus was cultured from a wide variety of sites, typically mixed with both aerobes and an aerobes, and frequently from abscesses. Most isolates of P. anaerobius came from gastrointestinal or female genitourinary specimens, never f rom above the diaphragm and rarely from the skin; cultures were usuall y heavily mixed. Isolates of P. vaginalis and the ''bGAL'' group made up 11% of strains and were usually cultured from superficial sites, P. vaginalis often from post-operative wound infections with Staphylococ cus aureus. There were only two isolates of P. hydrogenalis, three of P. tetradius and none of P. barnesae, P. prevotii, P. lacrimalis, P. l actolyticus, P. productus or Peptococcus niger. GPAC are a heterogeneo us group associated with a wide variety of infections, particularly ab scesses, and are frequently isolated in pure culture. They deserve fur ther study.