Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats

Background The clinical course in acute necrotizing pancreatitis is mainly determined by bacterial infection of pancreatic and peripancreatic necrosis. The effect of two antibiotic regimens for early and late treatment was investigated in the taurocholate model of necrotizing pancreatitis in the rat. Materials and methods Seventy male Wistar rats were divided into five pancreatitis groups (12 animals each) and a sham-operated group (10 animals). Pancreatitis was induced by intraductal infusion of 3% taurocholate under sterile conditions. Animals received two different antibiotic regimes (20 mg/kg imipenem or 20 mg/kg ciprofloxacin plus 20 mg/kg metronidazole) early at 2, 12, 20, and 28 h after induction of pancreatitis or late at 16 and 24 h after induction of pancreatitis or no antibiotics (control). Animals were examined after 30 h for pancreatic and extrapancreatic infection. Results Early and late antibiotic treatment with both regimes could significantly reduce pancreatic infection from 58 to 8–25%. However, extrapancreatic infection was only reduced by early antibiotic therapy. While quinolones also reduced bacterial counts in small and large bowel, imipenem did not. Conclusions In our animal model of necrotizing pancreatitis, early and late treatment with ciprofloxacin/metronidazole and imipenem reduce bacterial infection of the pancreas. Extrapancreatic infection, however, is reduced significantly only by early antibiotic treatment. The effectivity of early antibiotic treatment in the clinical setting should be subject to further investigation with improved study design and sufficient patient numbers.     

Metabolic Characterization of Nondiabetic Severely Obese Patients Undergoing Roux-en-Y Gastric Bypass: Preoperative Classification Predicts the Effects of Gastric Bypass on Insulin–Glucose Homeostasis

Introduction Obese individuals may have normal insulin–glucose homeostasis, insulin resistance, or diabetes mellitus. Whereas gastric bypass cures insulin resistance and diabetes mellitus, its effects on normal physiology have not been described. We studied insulin resistance and β-cell function for patients undergoing gastric bypass. Methods One hundred thirty-eight patients undergoing gastric bypass had fasting insulin and glucose levels drawn on days 0, 12, 40, 180, and 365. Thirty-one (22%) patients with diabetes mellitus were excluded from this analysis. Homeostatic model of assessment was used to estimate insulin resistance, insulin sensitivity, and β-cell function. Based on this model, patients were categorized as high insulin resistance if their insulin resistance was >2.3. Results Body mass index did not correlate with insulin resistance. Forty-seven (34%) patients were categorized as high insulin resistance. Correction of insulin resistance for this group occurred by 12 days postoperatively. Sixty (43%) patients were categorized as low insulin resistance. They demonstrated an increase of β-cell function by 12 days postoperatively, which returned to baseline by 6 months. At 1 year postoperatively, the low insulin resistance group had significantly higher β-cell function per degree of insulin sensitivity. Conclusions Adipose mass alone cannot explain insulin resistance. Severely obese individuals can be categorized by degree of insulin resistance, and the effect of gastric bypass depends upon this preoperative physiology.     

鲍氏不动杆菌致慢性阻塞性肺疾病患者肺部感染临床及耐药性分析

目的 探讨慢性阻塞性肺疾病(COPD)患者肺部鲍氏不动杆菌感染的临床特点和耐药情况.方法 对78例COPD患者肺部鲍氏不动杆菌感染的临床表现及药敏情况进行回顾分析.结果 药物敏感性测定提示该菌对头孢哌酮/舒巴坦耐药率最低,为14.9%,其次为亚胺培南和美罗培南,分别是24.8%和28.2%;对氨苄西林、头孢他啶,头孢吡肟、哌拉西林、左氧氟沙星、莫西沙星、阿米卡星、氨曲南和替卡西林/克拉维酸有较高耐药率,为48.5%～74.8%.结论 COPD患者肺部鲍氏不动杆菌感染与年老体弱,广谱抗菌药物及激素应用、呼吸道侵入性操作及呼吸机使用有关,临床表现无特异性,耐药严重,病死率高,应注意预防.     

Entomological survey and report of a knockdown resistance mutation in the malaria vector Anopheles gambiae from the Republic of Guinea

The purpose of our entomological survey was to estimate mosquito biodiversity, infectivity rates and insecticide resistance levels in Anopheles species in four study sites in a mining area with high malaria transmission in southeastern Guinea. Anopheles gambiae s.l. (77%) was the most common Anopheles collected followed by An. funestus (20%). The specimens of the An. gambiae complex were predominantly An. gambiae S form (97.6%) with 1.4% of An. gambiae M form found in Kérouané only, and 1% of An. arabiensis which was present in all four study sites. Anopheles gambiae S form and An. funestus were found to be infected with Plasmodium falciparum, with infectivity rates of 4.1% and 4.4% and inoculation rates of 0.60 and 0.19 infected bite/person/night, respectively. In addition, a high level (79%) of the knockdown resistance (kdr) L1014F mutation was reported in the populations of An. gambiae S form. The high malaria transmission that occurs in the prospected area of Guinea requires a long-term vector control programme. However, such a control programme will have to consider the presence of the kdr gene at a surprisingly high level within the dominant vector, which could reduce the expected impact of vector control.     

2003-2005年积水潭医院烧伤感染常见细菌及耐药性分析

目的 了解笔者单位近期的烧伤感染细菌分布及耐药情况。方法 收集2003年1月-2005年12月从笔者单位492例烧伤住院患者创面分泌物、静脉导管、血液、尿液、粪等标本分离而得的菌株，对其菌种分布特点及耐药性进行分析。结果 送检标本中革兰阴性菌多于革兰阳性菌。革兰阳性菌292株，分离率最高者为金黄色葡萄球菌（16．7％），其中甲氧西林耐药金黄色葡萄球菌在金黄色葡萄球菌中占82．5％；革兰阴性菌372株，分离率较高的分别为铜绿假单胞菌（12．5％）、大肠埃希菌（11．1％）。3年中大肠埃希菌和肺炎克雷伯菌对超广谱β内酰胺酶的耐药率分别为60．8％和42．9％。结论 笔者单位烧伤病区细菌耐药问题严重，仍需不断监测病区菌种变化及药物敏感情况，以有效地控制细菌感染和耐药菌株的播散。     

Effect of a minor vitamin A deficiency on the course of infection with <Emphasis Type="Italic">Ascaridia galli</Emphasis> (Schrank, 1788) and the resistance of chickens

Summary The effect of vitamin A deficiency was studied in chickens infected with 500 Ascaridia galli eggs and controls. Diet 1 (deficient, 500 IU vitamin A or 172 μg retinol acetate per kg diet), Diet 2 (deficient, 1000 IU vitamin A or 344 μg retinol acetate per kg diet) and Diet 3 (sufficient, 1500 IU vitamin A or 516 μg retinol acetate per kg diet) were assigned to 46 chickens each. Clinical signs, weight gains, livers’ weights, vitamin A levels, worm burdens and parasite eggs’ excretions were recorded. Infected chickens had lower weight gains than the controls fed alike. Chickens given Diet 1 stored lesser vitamin A in liver than those fed Diet 3. Although worm counts in the 3 groups did not differ significantly, chickens fed Diet 1 excreted more A. galli eggs than those fed the 2 other diets. Female worms harboured by chickens fed Diet 1 had higher fecundity at week 5 pi than those of chickens fed Diet 2. Results indicated that Vitamin A is important for poultry in the moderation of the infection with A. galli.     

葡萄球菌的分离鉴定及药敏分析

目的：了解不同种类葡萄球菌在本院临床标本中的感染情况及耐药性，为临床治疗和控制此类感染提供参考。方法：采用VITEK-AMS GPI卡进行鉴定，纸片扩散法(NCCLS)及GPS卡进行药敏实验、β内酰胺酶测定和MRS检测，并结合临床资料进行分析。结果：总共3753株感染菌中822株为葡萄球菌(21．90％)，其中金黄色葡萄球菌(SA)322株(39．17％)，凝固酶阴性葡萄球菌(CNS)500株(60．83％)。SA中293株(90．99％)产生β内酰胺酶，苯唑西林耐药者(MRSA)183株(56．83％)；CNS中450株(90．00％)产生β内酰胺酶，苯唑西林耐药的凝固酶阴性葡萄球菌(MRCNS)350株(70．00％)。结论：葡萄球菌特别是凝固酶阴性葡萄球菌是临床感染的主要致病菌之一；万古霉素是有效治疗苯唑西林耐药的葡萄球菌(MRS)的唯一可选药物；合理使用抗生素对治疗和控制感染至关重要。     

新生儿脐炎85例脐部分泌物细菌学分析

目的：了解新生儿脐部感染细菌学状况，为临床提供预防及治疗参考。方法：调查我院1997年1月－2002年6月收治的有完善细菌学资料的新生儿脐炎85例，对所获得的98例致病菌的种类及药敏状况进行分析。结果：社会获得性感染主要致病菌为G^ 球菌（70．5％），金黄色葡萄球菌占比例较高。医院感染主要致病菌为C^-杆菌（51．4％），以大肠埃希菌占比例较高。两类感染所分离的细菌均具有多重耐药性，但对氨基糖苷类及喹诺酮类耐药率较低，其次是第三代头孢菌素类抗生素。结论：临床对新生儿脐部感染，特别是有严重感染中毒症状时，应首先考虑使用第三代头孢菌素类抗生素。     

Absence of structural alterations of the multidrug resistance genes in transitional cell carcinoma

Summary Tumor DNA from 27 patients with treated or untreated transitional cell carcinomas of the urinary tract was screened for genomic alterations of the multidrug resistance genes in order to determine whether structural changes of these genes are important in primary urothelial tumors. None of the tumors showed evidence of amplification or rearrangements of either mdr1 or mdr2. The lack of amplification or rearrangements observed in these tumors suggests that structural alterations of the mdr1 and mdr2 genes are not important mediators of drug resistance in TCC.Supported in part by grant CA-34775 from the National Institutes of Health and by a grant from the Heckscher Foundation for ChildrenDr. Klein is a fellow of the American Cancer Society