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1.
Wan-Lin Tsai Chih-Hsin Hung Hui-An Chen Jiun-Ling Wang I-Fei Huang Yee-Hsuan Chiou Yao-Shen Chen Susan Shin-Jung Lee Wan-Yu Hung Ming-Fang Cheng 《Journal of microbiology, immunology, and infection》2018,51(6):723-731
Background/Purpose
The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is increasing worldwide. This study investigated the clinical features and bacteriology of pediatric patients with ESBL-producing E. coli bacteremia and compared their characteristics with those of adult patients.Methods
Clinical and laboratory data from all of the 41 patients aged ≤18 years diagnosed with E. coli bacteremia were collected over 5 years. Patients aged >18 years diagnosed with E. coli bacteremia, matched 1:1 for calendar time, were enrolled as the adult group. All E. coli isolates were tested for their blaCTX-M group and sequence type 131 (ST131). A novel seven-single nucleotide polymorphism-based clonotyping test was applied to detect the septatypes of each isolate.Results
In the adult group, patients with ESBL-producing E. coli bacteremia had more previous hospitalizations and antimicrobial agent use than did those with non-ESBL-producing E. coli bacteremia, but these differences were not found in pediatric group. In the pediatric group, the proportion of isolates producing CTX-M group 9 was higher than that in the adult group (85.7% vs. 42.9%; p < 0.05). Among both groups, there were more E. coli ST131 in ESBL isolates in than there were non-ESBL isolates. The distribution of septatypes was more homogenous in ESBL-producing E. coli among the pediatric patients than among the adult patients.Conclusion
ST131 was the major clone causing E. coli bacteremia in both pediatric and adult populations. The pediatric population demonstrated a higher number of isolates producing CTX-M group 9 with more homogenous septatypes compared with the adult population. 相似文献2.
Chun-Hsiang Chiu Ying-Chuan Wang Kuo-Ming Yeh Jung-Chung Lin L.K. Siu Feng-Yee Chang 《Journal of microbiology, immunology, and infection》2018,51(1):64-69
Background/Purpose
Although the prevalence of pneumonia or other extrapulmonary infections is higher in people with alcoholism or acute alcohol intoxication, the possible relationship of acute alcohol intoxication to phagocytic function has not been investigated. Our aim was to determine whether acute alcohol intoxication suppresses phagocytic function in human neutrophils.Methods
Twenty healthy individuals were enrolled for isolating neutrophils to evaluate the neutrophil phagocytic function at different alcohol concentrations. Klebsiella pneumoniae was isolated from clinical specimens of liver abscesses. The rate of K. pneumonia phagocytosis (K2 and non-K1/K2 isolates) by neutrophils was determined using flow cytometry and compared among the nine groups with different alcohol concentrations.Results
The rate of phagocytic uptake decreased significantly with increasing alcohol concentration in both the K2 and non-K1/K2 K. pneumonia groups (r = ?0.866, p = 0.03 vs. r = ?0.975, p < 0.001). Moreover, the percentage of K. pneumoniae ingested by neutrophils decreased with age.Conclusion
The ability of neutrophils to phagocytose virulent K2 K. pneumoniae was suppressed by ethanol at high concentrations. This finding may account for the higher prevalence of pneumonia or other extrapulmonary infection in people with acute alcohol intoxication. 相似文献3.
Chia-Ying Liu Chih-Cheng Lai Hsiu-Tzy Chiang Min-Chi Lu Ling-Fang Wang Tsai-Ling Tsai Mei-Yu Kang Yi-Ni Jan Yi-Ting Lo Wen-Chien Ko Shu-Hui Tseng Chun-Ming Lee Po-Ren Hsueh 《Journal of microbiology, immunology, and infection》2019,52(1):62-74
Background/purpose
This study investigated the distribution and persistence of multidrug resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and multidrug-resistant Acinetobacter baumannii (MDRAB) in six long-term care facilities (LTCFs).Methods
We investigated the distribution of MDROs in residents of six LTCFs and their environments from January to December 2016 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples from the residents every three months. Multilocus sequence typing (MLST) was conducted, and genes for panton-valentine leukocidin (PVL) from MRSA isolates were determined.Results
A total of 521 samples were positive for MDROs, and MRSA was the most common organism (65.1%), followed by MDRAB (11.3%), carbapenem-resistant Klebsiella pneumoniae (11.1%), carbapenem-resistant Escherichia coli (4.6%), and carbapenem-resistant P. aeruginosa (2.1%, n = 11). By a linear regression model, positive MRSA isolates from the environment were found to be statistically significant and associated with the number of colonized LTCF residents (p = 0.01), while the timing of the surveillance culture was not (p = 0.227). The main MLST types associated with PVL-production were sequence type (ST) 59, (40.0%, 24/60), ST30 (21.4%, 3/14), ST8 (87.5%, 14/16), and ST45 (3.6%, 1/28). The susceptibility rates of tetracycline (96.7%), trimethoprim-sulfamethoxazole (96.7%), and ciprofloxacin (81.7%) were statistically significant and higher in MRSA ST59, compared to the rates in MRSA ST45 isolates.Conclusions
MRSA was the most commonly colonized MDRO, both in the LTCF residents and in the environment, followed by MDRAB and carbapenem-resistant K. pneumoniae. 相似文献4.
Yu-Tsung Huang Ju-Ying Jiang Meng-Shiuan Hsu Hsin-Sui Hsu Chun-Hsing Liao Po-Ren Hsueh 《Journal of microbiology, immunology, and infection》2018,51(4):510-518
Background/purpose
Pyogenic liver abscess (PLA) and bacteremia caused by Klebsiella pneumoniae is a common complication among patients with diabetes mellitus (DM). The aim of this study is to investigate the prevalence of rectal carriage and serotype distribution of K. pneumoniae amongst DM patients and their clinical relevance.Methods
We prospectively collected rectal swabs for K. pneumoniae culture in asymptomatic DM patients from March 2008 to June 2009. Seven capsular serotypes that were commonly associated with PLA were determined by capsular polysaccharide synthesis (cps) genotyping. Microbiologically confirmed bacterial infections were evaluated 1 and 5 years after initial enrolment of the patients.Results
A total of 100 male and 62 female patients (mean age, 56.6 years) were enrolled. Of these, 77 (47.5%) had rectal K. pneumoniae colonization. Colonizers were older than non-colonizers (p = 0.03). Sex, fasting blood glucose, and initial HbA1C were not statistically different (p = 0.26, 0.18, and 0.31, respectively). Among the 65 available isolates, 22 (33.8%) belonged to the seven main serotypes. During the 5-year's follow-up, 21 patients developed microbiologically documented bacterial infections but none of them developed PLA and bacteremia. Risk factors for bacterial infection within 5 years included initial glycosylated hemoglobin (HbA1C) > 10% or first-year average HbA1C > 10%.Conclusion
Although nearly half of asymptomatic DM patients had rectal carriage of K. pneumoniae and one-third of them colonized by isolates belonging to the seven serotypes related to PLA, none of them subsequently developed PLA and colonized patients did not have higher risk of microbiologically confirmed bacterial infections. 相似文献5.
Shih-Wen Ting Chen-Hsiang Lee Jien-Wei Liu 《Journal of microbiology, immunology, and infection》2018,51(5):621-628
Background/purpose
A substantial number of carbapenem-resistant Gram-negative bacilli (CR GNB) have been identified among the etiologic multidrug-resistant GNB in healthcare-associated infections. For achieving a better therapeutic outcome by minimizing inappropriate empirical antibiotic treatment before blood culture and susceptibility testing results are available, it is very important to identify patients who are at risk for the development of CR GNB bacteremia.Methods
Retrospective analysis of propensity-score matched (PSM) adult patients with CR GNB bacteremia (PSM-group 1 [n = 95]) and those with non-CR GNB bacteremia (PSM-group 2 [n = 190]).Results
PSM-group 1 was found to a significantly longer length of hospital stay (27 vs. 18 days; p < 0.001) after emerging GNB bacteremia and a higher 30-day all-cause mortality rate (27.4% vs. 5.8%; p < 0.001), when compared with PSM-2 group. Independent risk factors for the acquisition of CR GNB bacteremia were previous exposure to an antipseudomonal penicillin (odds ratio [OR] = 3.58; 95% confidence interval [CI] = 1.30–9.90), an antipseudomonal cephalosporin (OR = 3.49; 95% CI = 1.09–11.24), and a carbapenem (OR = 3.60; 95% CI = 1.37–9.47), and longer length of hospital stay before the development of GNB bacteremia (OR = 1.03; 95% CI = 1.01–1.05).Conclusion
Risk factors for acquisition of CR GNB bacteremia identified in this study each may serve as a reminder alerting clinicians to hospitalized patients at risk for CR GNB bacteremia requiring appropriate antibiotic coverage, and in these circumstances, combined antibiotics may be used until antimicrobial de-escalation/adjustment is clearly indicated by the subsequently identified pathogenic GNB and its susceptibility profile. 相似文献6.
Bogusław Buszewski Viorica Railean-Plugaru Paweł Pomastowski Katarzyna Rafińska Malgorzata Szultka-Mlynska Patrycja Golinska Magdalena Wypij Dariusz Laskowski Hanna Dahm 《Journal of microbiology, immunology, and infection》2018,51(1):45-54
Background/Purpose
In this study, an acidophilic actinobacteria strain was used as a novel reducing agent for a single-step synthesis of nanostructure silver particles. We used a Streptacidiphilus durhamensis HGG16n isolate for efficient synthesis of bioactive silver nanoparticles [bio(AgNPs)] in an inexpensive, eco-friendly, and nontoxic manner. The obtained bio(AgNPs) exhibited unique physicochemical and biochemical properties.Methods
Structural, morphological, and optical properties of the synthesized biocolloids were characterized by spectroscopy, dynamic light scattering, and electron microscopy approaches. The antimicrobial activity was evaluated using the well- and disc-diffusion methods.Results
The obtained crystalline structure and stable biosynthesized silver nanoparticles ranged in size from 8 nm to 48 nm and were mostly spherical in shape. Antimicrobial assays of the silver nanoparticles against pathogenic bacteria showed the highest antimicrobial activity against Pseudomonas aeruginosa, Staphylococcus aureus, and Proteus mirabilis, followed by Escherichia coli, Klebsiella pneumoniae, and Bacillus subtilis. Moreover, the synergistic effect of bio(AgNPs) with various commercially available antibiotics was also evaluated.Conclusion
These results provide insight into the development of new antimicrobial agents along with synergistic enhancement of the antibacterial mechanism against clinical bacteria. 相似文献7.
Hung-Jen Tang Chi-Chung Chen Chih-Cheng Lai Chun-Cheng Zhang Tzu-Chieh Weng Yu-Hsin Chiu Han-Siong Toh Shyh-Ren Chiang Wen-Liang Yu Wen-Chien Ko Yin-Ching Chuang 《Journal of microbiology, immunology, and infection》2018,51(1):76-81
Background/purpose
The aim of this study is to investigate the role of tigecycline in Vibrio vulnificus infection.Methods
Eight randomly selected clinical V. vulnificus isolates were studied to obtain the minimal inhibitory concentrations (MICs) of minocycline, cefotaxime, and tigecycline, and the time–kill curves of tigecycline alone or in combination with other drugs. A peritonitis mouse model was used for the evaluation of the therapeutic efficacy of tigecycline alone or cefotaxime in combination with minocycline or tigecycline.Results
The MIC of minocycline, cefotaxime, and tigecycline for eight clinical V. vulnificus isolates was 0.06–0.12 μg/mL, 0.03–0.06 μg/mL, and 0.03–0.06 μg/mL, respectively. In time–killing studies, at the concentration of 1 × MIC, the inhibitory effect of tigecycline persisted for 24 hours in five of eight isolates. With 2 × MIC and trough level, the inhibitory effect was noted in all isolates for 24 hours. With the combination of minocycline plus cefotaxime and tigecycline plus cefotaxime at 1/2 × MIC, the bactericidal effect was noted in 25% and 62.5% of eight isolates and synergism in 50% and 75% of isolates. With a low (1.25 × 105 CFU/mL) inoculum, all infected mice survived with tigecycline alone, tigecycline plus cefotaxime, or minocycline plus cefotaxime on the 14th day. At the inoculum of 1.25 × 106 CFU, the survival rate was 33.3% on the 14th day in the tigecycline plus cefotaxime-treated group, but none of the mice treated by tigecycline alone or minocycline plus cefotaxime survived (33.3% vs. 0%, p = 0.01 by Fisher's exact test).Conclusion
Our in vitro combination and animal studies indicate that tigecycline could be an option for the treatment of invasive V. vulnificus infections. 相似文献8.
Jen-Jia Yang Jann-Tay Wang Aristine Cheng Yu-Chung Chuang Wang-Huei Sheng 《Journal of microbiology, immunology, and infection》2018,51(5):681-687
Background
Suppression of intestinal flora by broad-spectrum antimicrobial agents facilitated risk of colonization or infection with resistant pathogen. We aimed to investigate the changes in bowel carriage of target resistant microorganisms (TRO) among patients treated with three different classes of Pseudomonas-sparing broad-spectrum antimicrobial agents (ertapenem, moxifloxacin and flomoxef) with anaerobic coverage. Risk factors for developing colonization of TRO were also analyzed.Methods
We prospectively enrolled the adult hospitalized patients (>20 years old) who were indicated for at least 7-day course with either of ertapenem, moxifloxacin or flomoxef. Rectal swabs were performed for the patients who received at least 1-day course of study antibiotics during the treatment duration. The TROs included Pseudomonas aeruginosa, Enterobacteriaceae, and Acinetobacter baumannii. MacConkey agars with study antibiotics were used to isolate the TROs and evaluate the antimicrobial resistance.Results
The mean age of our study population was 61.6 years, and 58.8% were males. The rates of rectal colonization for Pseudomonas aeruginosa was similar among the study medications (ertapenem 13.2%, flomoxef 20%, moxifloxacin 14.3%, p = 0.809). Compared with ertapenem, flomoxef (odds ratio [OR], 4.30; 95% confidence interval [95% CI], 1.28–14.48, p = 0.019) and moxifloxacin (OR, 6.95; 95% CI, 1.36–35.52, p = 0.019) had higher risk for colonization of ertapenem-resistant Escherichia coli colonization.Conclusion
The patients who received treatment of ertapenem may have a lower risk of rectal colonization for ertapenem resistant Escherichia coli than those who received flomoxef or moxifloxacin. The rate of Pseudomonas colonization did not differ between the three study Pseudomonas-sparing agents. 相似文献9.
F. El Garch M. Sauget D. Hocquet D. LeChaudee F. Woehrle X. Bertrand 《Clinical microbiology and infection》2017,23(1):51.e1-51.e4
Objectives
In November 2015, a plasmid-mediated colistin resistance, MCR-1, was described in animals, food and humans in China, and it was considered as a potential emerging threat to public health. Therefore, we screened for the mcr-1 gene a European collection of colistin-resistant Escherichia coli (n = 218) and Salmonella spp. (n = 74) isolated from diseased food-producing animals between 2004 and 2014 and characterized the mcr-1-positive clones.Methods
Screening for mcr-1 gene was performed by PCR on isolates for which inhibition diameter was <15 mm around a 50 μg disk of colistin. Positive E. coli isolates were then characterized by phylogrouping, multilocus sequence typing and pulsed-field gel electrophoresis typing. Antibiotic susceptibility was determined by disk diffusion testing or by broth microdilution.Results
Among the collection, 42 E. coli and three Salmonella spp. were positive for mcr-1, with continuous detection since 2004 mainly from bovine and swine digestive infections. Most of the mcr-1-positive strains were resistant to amoxicillin and cotrimoxazole but remained susceptible to cephalosporins, carbapenems and piperacillin/tazobactam. All but one isolate were resistant to colistin, with a minimum inhibitory concentration of >2 mg/L. Most of the mcr-1-positive E. coli belonged to the phylogroup A with two prevalent clonal complexes, CC10 and CC165, in which sequence type 10 and sequence type 100 were overrepresented and pulsed-field gel electrophoresis typing revealed a high diversity of pulsotypes.Conclusions
MCR-1 was detected yearly in European food-producing animal since 2004 with a high diversity of pulsotypes supporting the dissemination of mcr-1 via plasmids. 相似文献10.
P. Espinal E. Nucleo M. Caltagirone V. Mattioni Marchetti M.R. Fernandes V. Biscaro R. Rigoli A. Carattoli R. Migliavacca L. Villa 《Clinical microbiology and infection》2019,25(3):385.e1-385.e5
Objectives
Genomic characterization of the internationally spread sequence type (ST) 16 carbapenem-resistant Klebsiella pneumoniae.Methods
The complete genomes of three carbapenem producing ST16 K. pneumoniae from Italian patients were analysed by single-nucleotide polymorphism-based phylogeny, core genome multilocus sequence typing, resistance, plasmid, and virulence content and compared with ten genomes of ST16 strains isolated in other countries. Plasmids carrying blaNDM-1 or blaOXA-232 carbapenemase genes were assembled and sequences were analysed.Results
The internationally spread ST16 K. pneumoniae clone showed variability in terms of distribution of NDM-1 and OXA-232 type carbapenemases. In some ST16 strains, up to six plasmids can be simultaneously present in the same cell, including ColE-like plasmids carrying blaOXA-232 and IncF plasmids carrying blaNDM-1. The differences observed in plasmid, resistance, and virulence content and core genome suggested that there is not a unique, highly conserved ST16 clone, but instead different variants of this lineage circulate worldwide.Conclusions
The ST16 K. pneumoniae clone has spread worldwide and may become a high-risk clone. 相似文献11.
G. Chapelet A. S. Boureau A. Dylis G. Herbreteau S. Corvec E. Batard G. Berrut L. de Decker 《European journal of clinical microbiology & infectious diseases》2017,36(12):2417-2422
Previous studies have shown controversial results of factors associated with short-term mortality in patients with extended-spectrum beta-lactamase (ESBL)-producing E. coli bacteremia and no research has investigated the impact of the geriatric assessment criteria on short-term mortality. Our objective was to determine whether dementia and walking ability are associated with 30-day mortality in patients with ESBL-producing E. coli bacteremia. All blood bottle cultures, analyzed from January 2008 to April 2015, in the Bacteriology Department of a 2,600-bed, university-affiliated center, Nantes, France, were retrospectively extracted. Factors associated with short-term mortality in patients with ESBL-producing E. coli bacteremia: 140 patients with an ESBL-producing E. coli bloodstream infection were included; 22 (15.7%) patients died within 30 days following the first positive blood bottle culture of ESBL-producing E.coli. In multivariate analysis, a reduced ability to walk (OR = 0.30; p = 0.021), presence of dementia (OR = 54.51; p = 0.040), a high Sepsis-related Organ Failure Assessment (SOFA) score (OR = 1.69; p < 0.001), presence of neutropenia (OR = 12.94; p = 0.049), and presence of a urinary tract infection (OR = 0.07; p = 0.036), were associated with 30-day mortality. Our findings provide new data showing an independent association between 30-day mortality with dementia and reduced walking ability, in patients with ESBL-producing E. coli bacteremia. These criteria should be considered in the therapeutic management of patients with ESBL-producing E. coli bacteremia. 相似文献
12.
M.R. Haverkate T.N. Platteel A.C. Fluit J.W. Cohen Stuart M.A. Leverstein-van Hall S.F.T. Thijsen J. Scharringa R.C. Kloosterman M.J.M. Bonten M.C.J. Bootsma 《Clinical microbiology and infection》2017,23(1):46.e1-46.e7
Objectives
Patients can acquire extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization, and colonized patients may transmit these bacteria after discharge, most likely to household contacts. In this study, ESBL transmission was quantified in households.Methods
Faecal samples were longitudinally collected from hospitalized patients colonized with ESBL-producing bacteria and from their household members during hospitalization of the index patient and at 3, 6, 12 and 18 months. A mathematical household model was developed, which allowed for person-to-person transmission, acquisition from other sources (background transmission), and losing carriage. Next, a deterministic population model with a household structure was created, informed by parameter values found in the household model.Results
In all, 74 index patients and 84 household members were included. In more than half of the household members ESBL-producing bacteria were demonstrated at some time during follow up. Person-to-person transmission occurred at a rate of 0.0053/colonized person/day (0.0025–0.011), background transmission at 0.00015/day (95% CI 0.00002–0.00039), and decolonization at 0.0026/day (0.0016–0.0040) for index patients and 0.0090/day (0.0046–0.018) for household members. The estimated probability of transmission from an index patient to a household contact was 67% and 37% vice versa.Conclusion
There is frequent transmission of ESBL-producing bacteria in households, which may contribute to the observed endemicity of ESBL carriage in the Netherlands. However, the population model suggests that there is not a single dominant acquisition route in the community. 相似文献13.
I-Ling Chen Chen-Hsiang Lee Li-Hsiang Su Yu-Chin Lily Wang Jien-Wei Liu 《Journal of microbiology, immunology, and infection》2018,51(1):55-63
Background/purpose
The long-term effects of antimicrobial-stewardship programs in the intensive care units (ICUs) have not been adequately examined. We evaluated the impact of an online comprehensive antimicrobial stewardship program (OCASP) on the outcomes of patients in 200-bed medical/surgical ICUs over the course of 11 years.Methods
We analyzed the records of adult patients admitted to ICUs during the 5 years before (n = 27,499) and the 6 years after (n = 33,834) implementation of an OCASP. Antimicrobial consumption, expenditures, duration of treatment, incidence of healthcare-associated infections (HAIs), prevalence of HAIs caused by antimicrobial-resistant strains, and crude or sepsis-related mortality of patients were analyzed. Segmented regression analyses of interrupted time series were used to assess the significance of changes in antimicrobial use.Results
Compared to the patients in the pre-OCASP period, the patients in the post-OCASP period were older, had greater disease severity, longer ICU stays, and were more likely to receive antimicrobials, but had lower antimicrobial expenditures and crude and sepsis-related mortality. The trend of overall antimicrobial use [slope of defined daily dose/1000 patient-days vs. time) increased significantly before OCASP implementation (p < 0.001), but decreased significantly after implementation (p < 0.01). The administration duration of all classes of antibiotics were significantly shorter (p < 0.001) and the incidences of HAIs were significantly lower (p < 0.001) after implementation. However, there was an increase in the proportion of HAIs caused by carbapenem-resistant Acinetobacter baumannii relative to all A. baumannii infections.Conclusion
Implementation of an OCASP in the ICUs reduced antimicrobial consumption and expenditures, but did not compromise healthcare quality. 相似文献14.
Hong-Yi Lee Yu-Chia Hsieh Ching-Chuan Liu Yi-Chuan Huang Kuang-Yi Chang Hsin Chi Luan-Yin Chang Yhu-Chering Huang Li-Min Huang 《Journal of microbiology, immunology, and infection》2018,51(2):199-206
Background
In Taiwan, the age group with the greatest incidence of invasive pneumococcal disease is 2–5 years of age, which is different from other countries. This study was conducted to identify risk factors and different 13-valent pneumococcal conjugate vaccine (PCV13) schedules associated with vaccine-type invasive pneumococcal pneumonia (IPP) despite prior vaccination.Methods
A case–control study was conducted prospectively between August 2012 and December 2015 at five participating medical centers. The study enrolled children <15 years of age who were admitted to one of the five medical centers for CAP. Blood samples and acute-phase serum specimens were collected and Streptococcus pneumoniae was identified by using a real-time polymerase-chain-reaction (RT-PCR) assay targeting the lytA gene.Results
A total of 25 children diagnosed with vaccine-type IPP and 124 controls were enrolled. Vaccine-type IPP occurred in 6 (28.6%), 14 (24.1%), and 5 (7.1%) children receiving vaccines on a not-age-appropriate schedule (n = 21), primary infant schedule (n = 58), and toddler catch-up schedule (n = 70) (P = 0.008), respectively. Of 25 children, the mean age at disease onset was 36 ± 11 months; serotype 19A was responsible for 84% (21/25).Conclusion
After adjustment for confounding factors, the risk of vaccine-type IPP was significantly higher among children receiving vaccines on a not-age-appropriate schedule, or on a primary infant schedule, compared with children receiving vaccines on a toddler catch-up schedule. Duration of vaccine immunity should be investigated to direct strategies for maintaining individual and population immunity against pneumococcal disease. 相似文献15.
Yetunde A. Kuyinu Babatunde A. Odugbemi Shukrat O. Salisu-Olatunji Funmilade O. Adepoju Olumuyiwa O. Odusanya 《Journal of the National Medical Association》2018,110(1):88-91
Background
Nigeria is one of the ten countries with the highest tuberculosis (TB) burden globally and is experiencing an increasing incidence of drug resistance. This study aimed to determine the prevalence of mycobacterium tuberculosis and rifampicin resistance (DR-TB) among patients screened at the TB clinic of a tertiary institution in Lagos, South-West, Nigeria.Methods
A review of records of 840 patients with suspected drug-resistant TB was carried out from Gene Xpert test clinic register at a tertiary health facility from November 2013 to April 2015. The Data was analyzed with SPSS version 20, Chi square test was used to determine association between DR-TB and the factors examined and the level of significance was set at P < 0.05.Results
MTB detection among all screened suspects was 43.3%. The prevalence of rifampicin resistance was 17.6% among patients that were investigated for DR-TB and this occurred more in the working age group (15-54 years) with male to female ratio of 1.8:1. However, only history of close contact with known DR-TB patient was associated with DR-TB (P < 0.01).Conclusion
The burden of DR-TB may be higher than previously thought. Drug resistance testing should be made more available to detect cases and thus control the emerging problem. 相似文献16.
Ruei-Hsin Chang Tsolmon Nyamsuren Sarvesh Gyawali Szu-Chieh Fu Yi-Wen Huang Rui-Ting Hu Sien-Sing Yang 《中华民国医用超音波学会杂志》2017,25(3):161-166
Background
Histological improvement and regression of liver fibrosis after long-term use of nucleos(t)ides analogues (NUCs) have been documented. The aim of the present investigation was to evaluate the usefulness of traditional sonography to detect hepatic and splenic changes during NUC therapy in chronic hepatitis B (CHB) patients.Methods
A total of 181 CHB patients receiving NUC treatment were enrolled in this study. The study population was divided into three groups: 72 cirrhotic, 58 noncirrhotic CHB, and 51 nonreplicative hepatitis B virus carriers. All patients had blood chemistries taken and sonography at baseline and during the NUC treatment period. The changes in liver size, liver edge, spleen size, platelet count, and platelet count/spleen diameter (PC/SD) ratio were compared among the three groups of patients.Results
CHB Patients with and without cirrhosis have improved clinical features during NUC therapy with lower aspartate aminotransferase, alanine aminotransferase, international normalized ratio, hepatitis B virus DNA, and spleen size and higher platelet, liver edge, liver size, and PC/SD ratio compared with the baseline data (p < 0.05). The differences in liver edge, liver size, spleen size, and PC/SD ratio are higher in the cirrhosis group than in the noncirrhotic group (p < 0.001). A decrease in spleen size exhibited a linear relationship with treatment duration (R2 = 0.905).Conclusions
Traditional sonography is helpful to monitor changes in liver fibrosis of CHB patients under NUC therapy. 相似文献17.
Wei-Shuo Chang Mao-Wang Ho Po-Chang Lin Cheng-Mao Ho Chia-Hui Chou Min-Chi Lu Yen-Jen Chen Hsien-Te Chen Jen-Hsien Wang Chih-Yu Chi 《Journal of microbiology, immunology, and infection》2018,51(2):235-242
Background
In Taiwan, studies about hematogenous pyogenic vertebral osteomyelitis (HPVO) are limited. We conducted a retrospective study to evaluate the clinical presentations, treatment, and outcomes of patients with the diagnosis of HPVO.Method
This 12.5-year retrospective study included patients with a diagnosis of HPVO. Medical records of all HPVO patients were thoroughly reviewed and their clinical data were analyzed by the SPSS software.Result
414 HPVO cases were included and the mean age was 61.6 ± 13.4 years. The mean duration of symptoms was 29 ± 35.3 days and pain over the affected site was reported by most patients (86.0%). Gram-positive bacteria, especially Staphylococcus aureus (162/399 = 40.6%), were the main HPVO pathogens. Escherichia coli (42/399 = 10.5%) was the most common gram-negative isolate. Surgery was performed in 68.8% of cases and the mean duration of total antibiotic treatment was 104.7 ± 77.7 days. All-cause mortality and recurrence rates were 6.3% and 18.8%, respectively. In multivariate analysis, polymicrobial infection (OR: 4.154, 95% CI: 1.039–16.604, p = 0.044), multiple vertebral body involvement (OR: 2.202, 95% CI: 1.088–4.457, p = 0.028), abscess formation treated with antibiotics alone (OR: 2.912, 95% CI: 1.064–7.966, p = 0.037), and the duration of antimicrobial treatment less than 4 weeks (OR: 3.737, 95% CI: 1.195–11.683, p = 0.023) were associated with HPVO recurrence.Conclusion
In Taiwan, HPVO mainly affected the elderly and S. aureus remained the most common HPVO pathogen. In patients with risk factors associated with HPVO recurrence, a longer duration (≥6 weeks) of antimicrobial therapy is suggested. 相似文献18.
Background
The clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma (COPD-BA) have not been discussed thoroughly.Objective
To reveal the clinical features of patients with COPD-BA, to evaluate the risk factors of COPD-BA, and to provide suggestions for COPD individualized therapy.Methods
A retrospective observational study was performed. A total of 182 patients with COPD (90 with COPD-BA and 92 with pure COPD) were recruited in the study. Information on the following items was collected: demographics, clinical manifestations, complications, laboratory findings, other histories, and inpatient treatments during exacerbation.Results
A total of 182 patients were diagnosed with COPD, with 90 (49.45%) being classified as having COPD-BA. Patients with COPD-BA were more likely to be female (P = .004) and experienced more severe respiratory exacerbations (P = .04) despite being younger (P = .008). Those patients at onset of recurrent cough and sputum production were younger (P = .001). Significantly, a positive asthmatic family history (P = .03) was observed. Patients with COPD-BA usually had higher level of total serum IgE (although no differences were observed), had higher positive rates of the serum specific IgE (P = .004), and were more like to have an allergic history (P = .003). Allergic factor was the risk factor of COPD-BA (odds ratio, 4.477). During hospitalization, patients with COPD-BA tended to be treated with systemic corticosteroids (P = .008).Conclusion
Patients with COPD-BA were characterized by persistent airflow limitation with unique clinical features. Allergic factor was associated with the presence of asthmatic characteristics in patients with COPD. When hospitalized for exacerbation, the individualized therapy for COPD-BA might include the use of corticosteroids systemically. 相似文献19.
Objectives
The mcr-1 gene is the first reported plasmid-mediated colistin resistance gene. It has caused worldwide concern about the colistin resistance in Gram-negative bacteria. The aim of this research was to study the impact of mcr-1 on the selection of high-level colistin resistance (HLCR) mutations in Escherichia coli and Klebsiella pneumoniae.Methods
We detected the HLCR mutation rates of Enterobacteriaceae strains (K. pneumoniae XH209, KP10, and E. coli Q3, ATCC 25922) and their transformants harbouring the mcr-1 gene. Further analysis of the HLCR mutants was conducted by sequencing, plasmid elimination experiment, and real-time quantitative PCR.Results
For XH209, mean mutation rate of XH209-pMCR was 1.7 (95% confidence interval (CI) 0.76–2.54) × 10?8, while XH209 and XH209-pCR2.1 showed mutation rates of 2.0 (95% CI, 1.32–2.67) × 10?8 and 2.3 (95% CI 1.47–3.13) × 10?8. For KP10 and its derived strains KP10-pCR2.1, KP10-pMCR, the mutation rates were 3.5 (95% CI 0.77–6.13) × 10?8, 4.8 (95% CI 0.69–8.94) × 10?8 and 4.2 (95% CI 0.95–7.54) × 10?8 respectively. The mutation rates of E. coli strains Q3-pMCR and ATCC25922-pMCR were 3.4 (95% CI 0.19–7.47) × 10?8 and 1.54 (95% CI 0.27–2.8) × 10?9, which were significantly higher than their corresponding non-mcr-1-carrying strains (p < 0.05).Conclusions
Beside the knowledge that mcr-1 mediates low-level colistin resistance, this gene also facilitates selection of HLCR mutants in E. coli, but does not affect K. pneumoniae. 相似文献20.
Li-Hsin Tsao Chih-Yi Hsin Hsin-Yi Liu Han-Chuan Chuang Li-Yuan Chen Yuarn-Jang Lee 《Journal of microbiology, immunology, and infection》2018,51(3):359-366