Isolation of Enterobacter aerogenes carrying blaTEM‐1 and blaKPC‐3 genes recovered from a hospital Intensive Care Unit

Enterobacter aerogenes has recently emerged as an important hospital pathogen. In this study, we showed the emergence of E. aerogenes isolates carrying the bla_KPC gene in patients colonized by carbapenem‐resistant Klebsiella pneumoniae strains. Two multiresistant E. aerogenes isolates were recovered from bronchial aspirates of two patients hospitalized in the Intensive Care Unit at the “Santa Maria della Scaletta” Hospital, Imola. The antimicrobial susceptibility test showed the high resistance to carbapenems and double‐disk synergy test confirmed the phenotype of KPC and AmpC production. Other investigation revealed that ESBL and bla_KPC genes were carried on the conjugative pKpQIL plasmid. This is a relevant report in Italy that describes a nosocomial infection due to the production of KPC beta‐lactamases by an E. aerogenes isolate in patients previously colonized by K. pneumoniae carbapenem‐resistant. In conclusion, it's necessary a continuous monitoring of multidrug‐resistant strains for the detection of any KPC‐producing bacteria that could expand the circulation of carbapenem‐resistant pathogens.     

2013-2017年临床耐碳青霉烯类肠杆菌科细菌感染检测结果分析

目的 了解我院耐碳青霉烯类肠杆菌科细菌(carbapenem resistant Enterobacteriaceae，CRE)分布特征以及耐药特点。方法 采用Phoenix-100全自动细菌鉴定/药敏系统、联合纸片扩散法(K-B法)、改良Hodge试验及EDTA协同试验对我院2013-2017年CRE检出情况、感染特征、药敏试验及耐药性进行检测。结果 共检出CRE菌株1020株，总检出率约为5.5%，改良Hodge试验阳性率为96.6%(985/1020)。2013-2017年CRE各年检出率依次为0.8%(24/2858)、8.6%(271/3156)、5.9%(249/4205)、6.2%(245/3935)、5.4%(231/4293)；1020株CRE菌株以肺炎克雷伯菌988株(96.8%)为主，主要分离自呼吸道标本779株(76.2%)、血液标本87株(8.4%)、导管尖端45株(4.5%)，主要来自重症医学科478株(46.9%)、神经内科重症病房315株(30.8%)。药敏试验结果显示：CRE菌株对庆大霉素、阿米卡星、复方磺胺甲噁唑、多黏菌素和替加环素的耐药率分别为53.2%、39.4%、45.9%、0和0，对其他临床常用抗菌药物的耐药率均高于97.5%；对庆大霉素耐药率由80%下降至48.3%；对复方磺胺甲噁唑耐药率由33.3%上升至60.0%；对多黏菌素和替加环素一直较敏感，未发现对多黏菌素和替加环素耐药的CRE菌株。结论 CRE菌株的分离率呈现出较高水平，其中以对碳青霉烯类耐药的肺炎克雷伯菌为主。我院流行的CRE菌株主要分离自重症医学科和神经内科重症病房，应对其感染的风险因素进行调查，并有针对性的采取感染预防措施进行防控。     

连续使用卷曲霉素6个月治疗耐多药肺结核不良反应分析

卷曲霉素(Cm)是一种对结核分枝杆菌有效的多肽类抗生素[1]。根据《世界卫生组织耐药结核病防治规划指南2008紧急修订版》要求,包括卷曲霉素在内的二线注射剂的使用时间应至少6个月[2]。但国内使用卷曲霉素治疗耐药结核病疗程多在3个月以下,主要为顾忌卷曲霉素的不良反应。本研究旨在为卷曲霉素在耐药结核病治疗中的应用提供参考。     

Lipotropic capacity of raw plant-based foods: A new index that reflects their lipotrope density profile

Among all of the phytomicronutrients, lipotropes which limit excess hepatic fat deposits, have been very little studied. And yet, liver steatosis is common to several chronic diseases. Among the lipotropes, betaine, choline, myo-inositol, methionine, magnesium, niacin, pantothenic acid and folates were the ones for which sufficient data have possibly been found to allow the selection of a significant number of plant-based foods (PBFs). Our objectives were to unravel the differences or similarities in the lipotrope density (LD) profile of raw PBFs and to define an index reflecting lipotrope contents. From databases for betaine and choline contents, we selected 56 raw PBFs (38 when inositol content was taken into consideration). Lipotropic capacity (LC) was defined as the means of the 8 LD profiles, each expressed as a percentage of raw asparagus LD, which has the highest mean ranking for the 8 LDs (LC = 100). LCs ranged from 7 (grapes) to 672% (spinach), relative to asparagus LC. Among cereal, fruit, legume and seed groups, quinoa, blackberry, common bean and sesame seed had the highest levels of LC (155%, 107%, 36% and 26%, respectively). On a 100 kcal-basis, vegetables are the best sources of lipotropes, followed by cereals, fruits and legumes, then nuts and seeds. PBF LD profiles were complementary but more diversified compared to animal-based food LD profiles.     

Skeletal metastases and impact of anticancer and bone-targeted agents in patients with castration-resistant prostate cancer

Incidence of bone metastases is very high in advanced prostate cancer patients. Bone metastases likely have a significant impact on functional status and quality of life, not only related to pain, but also to the relevant risk of skeletal-related events. A better understanding of mechanisms associated with bone metastatic disease secondary to prostate cancer and more specifically to the cross-talk between tumor cells and bone microenvironment in metastatic progression represented the background for the development of new effective bone-targeted therapies. Furthermore, a better knowledge of biological mechanisms driving disease progression led to significant advances in the treatment of castration-resistant prostate cancer, with the development and approval of new effective drugs. Aim of this review is to outline the physiopathology of bone metastases in prostate cancer and summarize the main results of clinical trials conducted with different drugs to control morbidity induced by skeletal metastases and bone disease progression. For each agent, therapeutic effect on bone metastases has been measured in terms of pain control and/or incidence of skeletal-related events, usually defined as a composite endpoint, including the need for local treatment (radiation therapy or surgery), spinal cord compression, pathological bone fractures. In details, data obtained with chemotherapy (mitoxantrone, docetaxel, cabazitaxel), new generation hormonal agents (abiraterone, enzalutamide), radium-223, bone-targeted agents (zoledronic acid, denosumab) and with several experimental agents (cabozantinib, dasatinib, anti-endothelin and other agents) in patients with castration-resistant prostate cancer are reviewed.     

Raloxifene nanomicelles reduce the growth of castrate-resistant prostate cancer

Background: Castrate-resistant prostate cancer (CRPC) patients are characterised by a 5-year relative survival rate of ～25–33%. Recently, our laboratory encapsulated a selective oestrogen receptor modulator, raloxifene, into poly(styrene-co-maleic acid) (SMA-raloxifene), which demonstrated superior in vitro cytotoxicity compared with free drug against several CRPC cell lines.

Purpose: To validate SMA-raloxifene for the management of CRPC using a mouse xenograft model.

Methods: The internalisation and retention of micellar and free raloxifene in vitro were measured by HPLC. A PC3-CRPC xenograft model was used to compare the biodistribution of both raloxifene formulations, as well as their effect on tumour progression where mice received free raloxifene (1 or 5?mg/kg, i.v.) or SMA-raloxifene (1?mg/kg, i.v.) weekly for 4 weeks.

Results: SMA-raloxifene exhibited 75% higher intracellular content compared to free drug after 48?h in PC3 cells. Biodistribution of raloxifene was 69% higher in tumours following SMA-raloxifene compared with free raloxifene. Weekly administration of 1?mg/kg free raloxifene reduced tumour progression by 20% after 4 weeks, whereas 1?mg/kg SMA-raloxifene and 5?mg/kg free raloxifene reduced progression by 40%.

Conclusion: Encapsulation of raloxifene increased its therapeutic potential for the management of CRPC.     

深圳市龙岗区鼠伤寒沙门菌耐药性和分子分型研究

目的研究深圳市龙岗区2010~2012年腹泻病人分离株鼠伤寒沙门菌的耐药性和分子分型。方法按国标GB 4789.4-2010对腹泻标本进行分离培养和生化及血清学鉴定,确定为鼠伤寒沙门菌的菌株采用纸片扩散法（K-B法）检测对22种抗生素的敏感性,通过脉冲场凝胶电泳（PFGE）对菌株进行分子分型,限制性内切酶XbaI为首选酶,AvrⅡ为次选酶,利用BioNumerics软件对酶切电泳图谱进行同源性分析。结果共分离出48株鼠伤寒沙门菌,50%的菌株来自7岁以下儿童患者。60.0%以上的鼠伤寒沙门菌对四环素和氨苄西林耐药。有34株菌株（占70.8%）耐3种及以上药物,耐8~10种药物有11株（占22.9%）,所有菌株对头孢西丁、美罗培南、亚胺培南和左氧氟沙星均敏感,多重耐药株在该区域普遍存在。XbaⅠ酶切分成40个带型,有6个型别,各含2~3株,AvrⅡ二次酶切将其重新分成12个型,其中XAP2、XAP3型2株。结论深圳市龙岗区鼠伤寒沙门菌分离株多重耐药较为严重,婴幼儿是重点防治人群。经PFGE分型鼠伤寒沙门菌菌型较多,说明本地区存在多个不同克隆株。