The Need for Asepsis in Local Penicillin Therapy
Authors: W. McKissock, V. Logue, I. Bartholomew
Journal: BMJ (1944)

Council on Penicillin by Prof. Florey and Brig.Cairns (1943) reveals that Gram-negative organisms have been found in the discharge from penicillin-treated wounds.In some cases such organisms as Bact.coli, Proteus vlulgaris, and Ps.pyocyaniea have been grown from the aspirate from wounds receiving local injections of penicillin solution, and in others they have been cultured from pus issuing from similar wounds before healing was complete.Often enough the presence of such organisms, either in aspirated fluid or in purulent discharge, appeared to cause no serious complication or to delay healing unduly: on page 99, for example, it is stated: "Penetrating Brain Wounds.-Thebacteriological results (Table 11) usually showed that after two days' treatment of the brain cavity with penicillin Gram-positive cocci were no longer found in the fluid sucked or discharged from the wound ; organisms of the coliform group were almost invari- ably present.In wounds which remained completely closed this state of affairs persisted until healing was complete."A further statement, on page 104, runs as follows: " For wounds more than a week old penicillin solution was usually used for 3 to 5 days.Though the end-result was satisfactory, and there was never any exacerbation of pre-existing infection as a result of closure, yet usually a sinus formed in some part of the wound and discharged pus for some days before it finally healed."Particular emphasis is laid upon Ps. pyocyanea as a common infective agent in such pus or wound aspirate in a paragraph on page 39: " In many wounds Gram-negative bacilli made their appearance during treatment.This was particularly ,so with B. pyocyanieus, which usually persisted until healing was complete"; and a more detailed description is given in the form of a brief case record (p. 102):"July 27: Operation-Free pus beneath the scalp.Brain fungus projecting through a dural opening (2 cm.diameter).Five bone chips removed from the brain to a depth of 2.5 cm.The resulting brain cavity held 5 c.cm. of penicillin solution.Scalp closed in two layers by a plastic procedure.One tube for penicillin solution; 9,000 units in six days.Bacter-iological examination showed Staphylococcus alureuts in swabs from all levels of the wound.July 29: Fluid aspirated from the wound shows in films pus cells and no organisms; on culture B. pyocyaneuts.Aug. 1: Wound edges moist at one point.On aspiration, 25 c.cm. of thin blood-stained pus (culture: ' B. coli,' B. pyocyanelus).Aug. 3: Culture of aspirated fluid-' B. coli,' B. pyocyanelus, enterococci.Aug. 11: Wound intact.To base."On the other hand, more serious results could readily be anticipated, and we find on page 100 a description of a death (ona of three in a series of 23) which is attributed to " an error of surgical technique " At operation pus (Staphylococcus aureus) and necrotic material were found beneath the healing scalp, and the bone chips were removed.He was treated by local and intravenous or intra- muscular penicillin for five days (5,000 units locally, 485,000 units parenterally).He became increasingly drowsy, and on the 10th day after operation his frontal wound was aspirated and 5 c.cm. of pus were obtained from beneath the skin.Films of this showed no organisms and culture yielded only ' B. co/i.'He died on the