Klebsiella Research Articles

Distribution and drug resistance of pathogens isolated from upper and lower ureter of stone obstruction in patients with ureteral calculi

Four hundred and twenty two patients with ureteral calculi undergoing surgical treatment from January 2016 to December 2016 were enrolled in the study. Urine samples were taken from upper and lower ureter of stone obstruction, pathogen examination and drug susceptibility tests were performed. Twenty nine strains of pathogens were isolated from the upper segment of ureter with a detection rate of 6.9%; 22 strains were gram-negative bacteria (75.9%) and 3 strains were gram-positive bacteria (10.3%) and 4 strains were fungi (13.8%). Forty eight strains of pathogenic bacteria were isolated from the lower segment with a detection rate of 11.4%; 37 strains were gram-negative bacteria (77.1%), 11 strains were gram-positive bacteria (22.9%), no fungi was isolated. In 20 cases the positive results were obtained only from upper ureter urine samples, and in 39 cases the positive results were obtained only from lower segment samples. The same pathogens were detected from both upper and lower ureter of stone obstruction in 7 cases, and different pathogens were identified in 2 cases. The most common pathogens were Escherichia coli, followed by Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium. The resistance to quinolones in gram-negative bacteria was higher than that to cephalosporins. The resistance rate of Escherichia coli to cephalosporin was 36.7%-63.3%, that to ciprofloxacin and levofloxacin was 86.7%-100.0%; the resistance rate of Enterococcus to erythromycin was 100.0%. It is suggested that ureteral calculi obstruction may lead to negative culture results of conventional mid-stream urine samples. It is of clinical value to investigate the distribution and antibiotic resistance of pathogens both from upper and lower segments of ureter in patients with ureteral calculi. Key words: Ureteral calculi; Ureteral obstruction; Urinary tract infections; Drug resistance

Antibiotic prophylaxis in prostate biopsy

Prostate biopsy is nowadays one of the most frequent diagnostic procedures in urology. The incidence of bacteraemia, bacteriuria and infective complications is higher after the transrectal procedure than after the transperineal one. A survey demonstrated that 98% of the urologists in USA use antibiotics to prevent infective complications. The transrectal prostate biopsy is the only diagnostic intervention procedure in urology for which an antibiotic prophylaxis is recommended, also for low-risk patients, by the guidelines of the European Association of Urology. If the perineal route is adopted, the antibiotic prophylaxis is recommended only in high-risk patients. The patient should preferably receive an evacuative enema to achieve a rectal cleansing and to ameliorate the diagnostic accuracy of transrectal ultrasound. A survey in the US demonstrated that an evacuative enema with saline solution is adopted by more than 80% of urologists. Criteria for antibiotics choice. The majority of bacteraemias are transitory, asymptomatic and self-limiting. On the other side, bacteriuria can persist for several days. Antibiotics must achieve high drug concentrations not only in plasma and tissue but also in urine. Symptomatic infections are generally caused by E. Coli and less frequently by the Streptococcus faecalis. Nevertheless, other agents as Klebsiella and Chlostridium, although rare, might cause severe infections. Thus, prophylaxis needs antibiotics at large spectrum and a single agent may not be enough for high-risk patients. Risk determination and drug schedules. It is essential to point out the infective risk of the patient. The choice of the drug, the timing and schedule of antibiotic prophylaxis are still object of debate. Several randomized studies have been conducted with contradictory results. The antibiotic prophylaxis should be tailored according to patients? infective risk and to the procedure adopted. It is able to reduce infections rate after transrectal biopsy below 5%. The adoption of periprostatic anesthesia and the number of cores can influence the incidence of infective complications. Commonly, one-three days oral administration of fluoroquinolone is adopted. A single-dose prophylaxis can be also used with favorable results. Tolerability and route of administration should be taken into account, and also costs should be considered. Considering the low cost of antibiotics adopted as short-term prophylaxis and the high cost of the treatment of infective complications, it seems reasonable to provide antibiotics prophylaxis for all patients at high risk for infective complications and for all cases submitted to transrectal prostate biopsy.

Bacteriological Assessment of Drinking Water Supplied Inside the Government Schools of Patna District, Bihar, India

Contamination in drinking water comes in several ways in which soil and fecal contamination are major with respect to microbial agents. The aim of the study was to assess the contamination status of drinking water use by the students in government schools of Patna district, Bihar India. Total 12 samples of 9 government schools were collected aseptically in a 60ml sterile plastic container for bacteriological analysis to determine their suitability for drinking. Water samples were collected aseptically into 60ml sterile plastic container at 9 different government school campus. Twelve samples were subjected to microbiological analysis in order to evaluate the quality of potable water in circulation within the school and identify its sources of contamination. Most probable number or multiple tube tests was applied to detect the presence of coliform in a drinking water sample. Analysis was performed using culture and biological methods. Out of 12 samples, 9 samples show high MPN value. Biochemical test confirms the presence of bacteria like “staphylococcus, klebsiella, salmonella” etc, are absorbs in the water samples. This study emphasizes the need for regular monitoring of water Supply system inside schools.

Changes in Five Years among Pathogens in Wound Infection and Their Susceptibility to Antimicrobials

Background: Proper knowledge about the epidemiology and changing sensitivity pattern of drug in bacterial wound infection is very important in ensuring optimum management of the wound and formulating policies in infection control. Objectives of our study was to disseminate the etiology of bacterial wound infection in two time frames (in 2016 or group A and in 2011 or group B), to provide their susceptibility pattern and to highlight the changes of susceptibility pattern in order to update information regarding antimicrobial resistance and it’s implication in wound management. Method: Bacteria isolated from wound swab, aspirates and pus samples received in year 2016 and 2011 were included in the study. Isolates were identified by conventional tests and antibiotic sensitivity was determined by disc diffusion method according to CLSI guideline. Results: Gram positive cocci are still the predominating organism in wound infection. Both Staph. aureus as well as CoNS (coagulase negative staphylococci) lead the list as pathogens of wound infection. Among Gram negative bacteria, Acinetobacter spp. and Klebsiella spp, were more common than Pseudomonas spp. in our study. Notable raise in ampicillin sensitivity is observed after 5 years among Staphylococci species. Cotrimoxazole is regaining its importance as all the isolates from wound infection have a increasing trend towards susceptibility to it in 5 years. Doxycycline also has raised activity more than 61 % on Gram positive cocci in group A or 2016. Vancomycin, linezolid for Gram positive bacteria and amikacin, meropenem, pipercillin tazobactam, and colistin for Gram negative bacteria are still useful but showing reduced sensitivity after 5 years. Amoxyclav is not very useful as a prophylactic antibiotic as only 40% pathogens were susceptible. Resistance to quinolones, cephalosporins, aminoglycosides are increasing in both Gram positive and negative bacteria with few exceptions.

Pathogens and drug susceptibility test of septic arthritis of hip in children

Objective To study the pathogens and their drug susceptibility of septic arthritis of hip in children. Methods Prior to the antibiotic treatment, pus was extracted for bacterial culture under aseptic operation. The pathogenic bacterium was identified and drug susceptibility was analyzed using a fully automated bacterial identification/drug susceptibility system. Results A total of 68 pathogens were isolated, in which 42 were Gram-positive bacteria, 23 were Gram-negative bacteria and 3 were fungi. The results showed differences in the bacterial types of hip septic arthritis in children with different ages (5 days to 13 years). For newborns (less than 1 month), the most common pathogen was Klebsiella pneumoniae; for the ages of 1 month to 13 years old, the most common pathogen was Staphylococcus aureus. The results of drug susceptibility tests showed that Gram-positive bacteria were highly susceptible to vancomycin, teicoplanin and linezolid; the resistance of Staphylococcus aureus to penicillin was up to 96%; and Klebsiella pneumoniae, Escherichia coli, Haemophilus influenzae, Enterobacter cloacae and Salmonella were highly sensitive to meropenem and imipenem. Conclusion In the antimicrobial drug treatment of children with hip septic arthritis, the etiology sample should be collected for drug susceptibility analysis. Empirical drug therapy strategy should be applied in the absence of the analysis results. Sensitive antibiotic drug therapy should be used after obtaining reliable etiological diagnosis and drug susceptibility results, and simultaneously taking the age into consideration. Key words: Children; Hip joint; Septic arthritis; Drug resistance; Antibiotic; Drug susceptibility test

SYNTHESIS AND ANTIBACTERIAL ACTIVITY OF SOME NEW SUBSTITUTED AZETIDINE DERIVATIVES

Four-membered nitrogen heterocycles such as I²-lactams and azetidines are useful substrates in organic chemistry for the design and preparation of biologically active compounds. New series of 4(3-Chloro-(Substituted-Phenyl)-4-oxoazetidine1-yl)1-phenylthiosemicaebazide derivative were synthesized by the reaction of Schiff base with 2-Chloro acetyl chloride. Synthesized compounds were evaluated for their Anti- bacterial activity against Gram positive bacteria (Bacillus Subtilis) and gram negative bacteria (Klebsiella pneumonia). In this synthesis 6 derivatives are used named as NM1, NM2, NM3, NM4, NM5 and NM6.Synthesized compounds show significant activity against bacteria strains on agar plate. Their structures were established on the basis of elemental analysis, IR and NMR spectral data. The different substituted azetidine derivatives were synthesized followed by cyclization reaction. The newly synthesized azetidine derivatives were evaluated for their antimicrobial activity. The synthesized compounds NM1 showed effective antimicrobial activity. This clearly indicates that new azetidine derivatives can be effectively synthesized by method mentioned in this study.Â

COMPARATIVE ANALYSIS OF THE EFFICIENCY OF THE INTRODUCTION OF METHODS OF THE EVALUATION OF QUALITATIVE PROPERTIES OF INFECTIOUS PATHOGENS INTO CLINICAL PRACTICE

In the paper there were studied qualitative properties of the dominant nosocomial wound and respiratory pathogens (Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus) over a 3-years period of the observation in hospital emergency medical care in two ways. The first pharmacoepidemiological approach was based on the estimated consumption of the main classes of antimicrobial agents and the occurrence of resistant isolates, the second method assumes a histogram reflecting statistical distribution of values of the inhibition diameter of zone of the growth of colonies of microorganisms. Two methods were proved to reveal an unidirectional trend, but the second method allows in more details to assess the dynamics of susceptibility/resistance of microorganisms depending on the type of pathogen and localization of the infection and to construct a formulary of antimicrobial agents on the basis of the actual consumption of drugs, but also from data obtained experimentally.

Related factors of nosocomial infection in severe thoracic trauma patients after operation

Objective To investigate the related factors of nosocomial infection after severe thoracic trauma so as to provide basis and interventions for lowering nosocomial infection rate. Methods A retrospective case series study was conducted in 148 cases of severe thoracic trauma surgically treated from January 2014 to January 2016. There were 98 males and 50 females with an average age of 34.7 years. The abbreviated injury scale (AIS) was ≥ 3 points. The incidence of nosocomial infection was statistically analyzed. The possible factors related to nosocomial infection were analyzed, including age, gender, previous basic diseases, coma, blood transplantation, surgical procedure, operation time, tracheal intubation time, postoperative tracheotomy, and postoperative ICU hospitalization. Results Nosocomial infection occurred in 18 cases, with infection rate of 12.2%. There were 11 cases of pulmonary infection, four urinary tract infection, two incision infection, and one thoracic cavity infection. There were four cases (22%) of Gram-positive bacteria as pathogen, both of which were Staphylococcus aureus. A total of 12 cases (67%) were Gram-negative bacteria, among which four were infected with Klebsiella pneumonia, three with Acinetobacter baumannii, three with Pseudomonas aeruginosa, and two with Escherichia coli. Two cases were infected by fungi. The incidence of infection was correlated with the patients' age (≥60 years), previous basic disease, coma, operation methods, operation time (≥3 hours), endotracheal intubation time (≥24 hours), tracheotomy after surgery, and postoperative hospitalization duration in the ICU (P<0.05), rather than gender and blood transplantation. Conclusions The most common pathogen of nosocomial infection in severe thoracic trauma patients is Gram-negative bacteria. The older age, previous basic diseases, coma, thoracotomy, long operation time, long tracheal intubation time, tracheotomy and long ICU hospital stay are the risk factors for nosocomial infection. More attention should be paid to these risk factors in order to minimize the occurrence of postoperative hospital infection, and to reduce the harm to patients. Key words: Thoracic injuries; Surgical procedures, operative; Cross infection; Risk factors

The prevalence and drug resistance of strains isolated from cerebrospinal fluid of neurosurgery patients during period of 2011-2015

Objective To investigate the prevalence and drug resistance profile of the strains isolated from cerebrospinal fluid of neurosurgery patients so as to provide guidance for the prevention and treatment of intracranial infection. Methods The prevalence and drug resistance of strains isolated from cerebrospinal fluid of neurosurgery patients admitted from Jan 2011 through Dec 2015. Results A total of 1 060 strains were isolated from 23 259 CSF samples. The positive rate of culture was 4.56%. After 1 060 strains were categorized and some of the same species were eliminated, 419 strains of different species were obtained, including 103(24.6%) strains of gram-positive bacteria, 293 (69.9%) strains of gram-negative bacteria and 23 (5.5%) strains of fungus. The three leading strains isolated were Acinetobacter spp. (165 strains, 39.4%), Klebsiella pneumoniae (72 strains, 17.2%), coagulase negative staphylococcus (54 strains, 13.6%). The Acinetobacter baumannii isolates showed high resistance rate to meropenem(82.3%)and to cefoperazone sulbactam (76.4%), while the rates of drug resistance to colistin and amikacin were quite low found to be 3.1% and 29.8%, respectively. The drug resistance of Klebsiella pneumonia was serious in which the rate of drug resistance to meropenem was 72.6%, and the rate of drug resistance to cefoperazone sulbactam was 79.0%, and rates of drug resistance to colistin and Amikacin were quite low found to be 0% and 35.2%, respectively. The detection rates of MRSA, MRSE and MRSH were high found to be 76.5%, 100% and 100% respectively. Non-susceptible to vancomycin and teicoplanin strains in staphylococci species were not found. Conclusions The majority of strains isolated from the cerebrospinal fluid were gram-negative bacteria, and the detection rates of Acinetobacter and Klebsiella pneumoniae were high, and the rates of drug resistance of Acinetobacter baumannii and Klebsiella pneumoniae were high. Doctor should pay more attention to the prevalence of pathogenic strains isolated from cerebrospinal fluid and drug resistance of those strains in order to rational use of antibiotic according to the drug resistance detection. Key words: Intracranial infection; Cerebrospinal fluid; Pathogenic bacteria; Drug resistance; Antimicrobial agents

The effect of artesunate on inflammatory responses to severe pneumonia by regulating MIF in rats

Objective To study the effect of artesunate on inflammatory responses to severe pneumonia by regulating macrophage migration inhibitory factor (MIF) in rats. Methods Total of 100 SD by random(random number) assigned, 20 rats were control group, 80 SD rats with severe pneumonia were caused by Klebsiella pneumoniae, 60 SD rats were treated with different concentrations(20, 40, 80 mk/kg) of artesunate after modeling. The pathological changes of lung tissue, the level of MIF myeloperoxidase activity and inflammatory cell infiltration in lung tissue of rats were evaluated. Results After treatment with artesunate, the severity of inflammation was significantly alleviated in rats with severe pneumonia evidenced by decrease in myeloperoxidase activity [severe pneumonia: (17.5 ± 1.5)vs.treatment group: (7.5 ± 2.0) ]and reduction in inflammatory cell infiltration (severe pneumonia: 27×106vs. treatment group: 12.5×106). Similarly, the artesunate also reduced the production of inflammatory cytokines significantly in bronchoalveolar lavage fluid (IL-1 in severe pneumonia group: (1 100 ± 50) pg/ml vs. treatment group: (400 ± 60)pg/ml; IL-6 in severe pneumonia group: (700 ± 30)pg/ml vs.treatment group: ( 200 ± 40)pg/ml; IL-10 in severe pneumonia group: (500 ± 70)pg/ml vs. treatment group: (200 ± 40)pg/ml; TNF-αin severe pneumonia group: (500 ± 80)pg/ml vs.treatment group: (150 ± 50)pg/ml. In addition, artesunate inhibited the level and production of MIF, thus inhibiting the inflammatory responses mediated by MIF. Conclusions Artesunate had a protective effect on pneumonia caused by Klebsiella pneumoniae in rats via inhibiting the inflammation responses mediated by MIF. This study provided a molecular basis for newly developed drugs applied to the treatment of pneumonia caused by Klebsiella pneumoniae in rats. Key words: Artesunate; Severe pneumonia; Macrophage inhibitory factor; Interleukin; Inflammatory responses; Molecular mechanism; Immunoregulation; Animal model

Neutrophil bactericidal activity assay for detecting the virulence of hypervirulent Klebsiella pneumoniae

Objective To evaluate the feasibility of using neutrophil bactericidal activity assay for analyzing the anti-bactericidal ability of hypervirulent Klebsiella pneumoniae (hvKP) strains that harbored the virulence genes of rmpA and rmpA2 and were positive for string test. Methods A total of 150 non-duplicate blood-borne Klebsiella pneumoniae strains were collected from Zhejiang Province from January 2016 to July 2017. PCR was performed to detect carbapenem resistance genes (blaKPC, blaNDM, blaIMP-1, blaIMP-2), capsule genotypes (K1, K2, K5, K20, K54 and K57) and virulence genes (rmpA, rmpA2, iucA and iroN). Klebsiella pneumoniae strains that were positive for string test and harbored rmpA and rmpA2 genes were identified as hvKP strains, while classic Klebsiella pneumoniae (cKP) strains were negative for string test, rmpA or rmpA2 gene. Neutrophil bactericidal activity assay was performed to analyze the virulence of Klebsiella pneumoniae strains and the survival rate was determined by using the following equation: the number of colony-forming units (CFUs) in experimental group divided by the number of CFUs in control group. Results Of the 150 Klebsiella pneumoniae strains, 43.3% (65/150) harbored the rmpA2 gene and among them, strains positive for genes of rmpA, iroN and blaKPC and K2 respectively accounted for 73.8%, 80.0%, 75.4% and 40.0%. Twenty-four (36.9%) rmpA2 gene-positive strains showed positive result of string test. The survival rates of hvKP and cKP groups were respectively 0.866±0.056 and 0.368±0.058 and the difference between them was statistically significant (P<0.001). Conclusion Most of the hvKP strains that carry rmpA and rmpA2 genes and are positive for string test in Zhejiang Province survive the neutrophil treatment, which indicates that the neutrophil bactericidal activity assay is an effective and simple method for identifying the virulence of Klebsiella pneumoniae. Key words: Hypervirulent Klebsiella pneumoniae; rmpA2; String test; Neutrophil; Bactericidal activity

Prevalence of colistin-resistance gene mcr-1 in patients with bloodstream infection in 23 hospitals of Zhejiang Province

Objective To investigate the prevalence of colistin resistance and mcr-1 gene in patients with bloodstream infection caused by Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) in Zhejiang Province. Methods A total of 869 clinical strains of the Enterobacteriaceae family, including 611 E.coli and 258 K.pneumonia strains, were isolated from patients with bloodstream infection(BSI) in Zhejiang Province from March 2014 to April 2015. Broth microdilution method and PCR were respectively performed to detect colistin resistance and mcr-1 gene in those stains. Susceptibilities of mcr-1-positive strains to other antibiotics were assessed by E-test. Pulsed-field gel electrophoresis(PFGE) and multilocus sequence typing (MLST) were used for molecular typing. Location of mcr-1 gene was determined by analysis of PFGE profiles of S1-digested genomic DNA and Southern blot hybridization. Plasmid transfer to E.coli recipients was investigated using filter mating test. Clinical data of the patients infected with mcr-1-positive strains was collected and analyzed. Results The minimum inhibitory concentration (MIC) values of colistin to the 869 Enterobacteriaceae strains ranged from ≤0.06 μg/ml to 16 μg/ml. Six (0.69%) E.coli strains were identified to be colistin-resistant and mcr-1-positive and the MIC values against them ranged from 8 μg/ml to 16 μg/ml. No colistin-resistant or mcr-1-positive K.pneumonia strain was identified. All mcr-1-positive strains were susceptible to carbapenems and most of them (83.33%, 5/6) were susceptible to tigecycline and β-lactamase inhibitor combinations tested in this study. The six mcr-1-positive strains were of different sequence types (STs) and the mcr-1 genes carried by them located on three types of plasmids with the sizes of 33 kb, 61 kb and 244.4 kb. Conclusion The prevalence of mcr-1 gene in E.coli and K.pneumonia strains isolated from patients with BSI in Zhejiang Province was relatively low, only accounting for 0.69% of all isolated Enterobacteriaceae strains.Those strains carrying mcr-1 gene showed low drug resistance to colistin. The mcr-1-positive strains were usually non-pathogenic clones and remained susceptible to many antimicrobial agents, which was conducive to favorable outcomes. In order to clarify the clinical impact of this novel resistance gene on public health, further studies should be conducted. Key words: Bloodstream infection; Colistin resistance; mcr-1 gene

The clinical features of 93 bacterial liver abscess cases

Objective To investigate the clinical features of patients with bacterial liver abscess. Methods The clinical data of patients with liver abscess during January 2014 to December 2016 were retrospectively analyzed. Results There were 93 cases enrolled, 26.88% were accompanied by diabetes mellitus (DM), 60.22% were accompanied liver, gall bladder, pancreas diseases or had history of liver, bile duct or gastrointestinal surgery. The most common symptoms were fever (94.62%) and gastrointestinal symptoms (50.54%), while 15.05% for shock; 91.40% were single abscess, and 73.12% were in the right lobe. The white blood cell count (WBC), neutrophil (N), hypersensitive C-reactive protein (hsCRP), procalcitonin (PCT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were elevated in 60.22%, 65.59%, 97.85%, 82.93% (34/41), 47.31%, and 46.24% of patients, respectively. 12/62 (19.35%) were positive by blood culture and 32/54 (59.26%) were positive by pyogenic fluids or bile culture, the top two pathogenic bacteria were Klebsiella pneumonia (52.27%) and Escherichia coli (27.27%). Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were between 0-25 points, 72.04% cases were (0-10) points, 26.88% case were (11-20) points and one patient was more than 20 points. Among the 93 cases, 82.79% were underwent antibacterial by carbapenem, penicillin enzyme compound preparation or combined with levofloxacin, and 45.16% were underwent liver puncture of drainage treatment. A percentage (96.77%) of patients was cured or recovered. Conclusions Biliary retrograde infection is the main cause of hepatic abscess. In the early experiential antibacterial therapy, the first-line choices of antibiotics are those effective to extended spectrum β-lactamase (ESBL) positive enterobacteriaceae bacteria. Liver puncture of drainage treatment may be effective and safety. APACHE Ⅱ score may be useful to assess the prognosis of live abscess. Key words: Liver abscess, pyogenic/DI/TH

Distribution of pathogenic bacteria and drug sensitivity analysis on urinary tract infection

Objective To analyze the distribution and drug sensitivity of pathogenic bacteria in urinary tract infection, and to provide evidences for rational use of antibiotics in clinic. Methods The data from 3 677 midstream urine specimens for bacterial culture were retrospectively analyzed.VITEK-2Compact was used to identify bacteria and test drug sensitivity.And WHONET5.6 was used to statistically analyze the data. Results Of 649 strains of pathogenic bacteria from urinary tract infection patients, there were 439 strains of gram-negative bacteria, accounted for 67.6%, among which there were 301 (46.4%) strains of Escherichia coli, and 74 (11.4%) strains of Klebsiella pneumoniae; there were 121 strains of gram-positive cocci, accounted for 18.7%, among which there were 97(14.9%) strains of Enterococcus, and 22 (3.4%) strains of Staphylococcus; there were 89 strains of fungi, accounted for 13.7%.According to drug susceptibility, the sensitive rates of Escherichia coli and Klebsiella pneumoniae to imipenem, cefotetan, piperacillin-tazobactam and amikacin were all over 87.0%.The drug sensitivity of Enterococcus to vancomycin and linezolid were both 100.0%.As to drug resistance to other drugs, Enterococcus faecium was higher than Enterococcus faecalis. Conclusion Escherichia coli is the primary pathogenic bacteria of urinary tract infection.Every bacteria strain has a high drug resistance.In clinic, hospital should perform urine bacterial culture and drug sensitivity tests timely, and use antibiotics rationally in order to reduce the production and growth of drug-resistant bacteria. Key words: Urinary Tract Infection; Bacteriology; Microbial sensitivitytests

The clinical features of 19 endogenous endophthalmitis cases

Objective To investigate the etiological features and visual outcomes of endogenous endophthalmitis (EE). Methods A retrospective consecutive case series of 19 patients (23 eyes) presenting with presumed EE from 2009 to 2016 in the Ophthalmology Department of Zhongshan Hospital and Huashan Hospital, Fudan University were included. Patients′ medical history (main risk factors), microbial culture results, treatment regimen and visual outcomes were evaluated. Results In total, 19 patients (23 eyes) were identified, including 7 female (8 eyes) and 12 male (15 eyes). Mean age was 54.0±17.9, ranging from 24 to 85. Most patients had severe underlying diseases, mainly diabetic mellitus (9/19) and liver abscess (8/19). Twenty vitreous samples from 17 cases were cultured, and 12 eyes from 10 cases were positive with a positive rate of 12/20. Fifteen cases had blood or body fluids cultures and 10 were positive, with the positivity rate of 10/15. Candida albicans (5/6) was the most common pathogen isolated in fungal endophthalmitis, and Klebsiella pneumonia (7/13) was the most common pathogen in bacterial endophthalmitis. Patients mainly received vitrectomy, intravitreal injection, and systemic/local antibiotic therapy. Only five eyes had improved visual acuities, and 6 eyes were enucleated or eviscerated.Among the 10 eyes from 8 cases who were treated within one week after onset, 5 eyes from 3 cases (5/10) had improved visual acuities; one eye from one case had no visual improvement; four eyes from four cases had no light perception or enucleated. No improved visual acuity occurred in patients who were treated after one week. Conclusions Although the incidence is low, EE has poor visual outcomes. Timely diagnosis and treatment may be helpful to maximize the recovery of vision. Key words: Endogenous endophthalmitis; Bacterial; Fungi; Prognosis

Apple, Guava and Pineapple Fruit Extracts as Antimicrobial Agents against Pathogenic Bacteria

This investigation was conducted to compare the antimicrobial properties of alcohol fruit extracts from Apple (Malus pumila), Guava (Psidium guajava), and Pineapple (Ananas comosus) against eight bacteria: Staphylococcus aureus, Enteroaggregative E.coli (EAEC), Enterotoxigenic E.coli (ETEC), Enterobacter cloacae, Shigella flexineri, Enterococcus faecalis, Klebsiella, and Pseudomonas aeruginosa. All the fruits were bought fresh from the market, cut into small cubes, and sun dried to a crisp over 4-5 days. After being blended to a fine powder, 75g of each powder was passed through a Soxhlet apparatus containing 250 ml of 99% ethanol to obtain a crude extract. This process was repeated with 250 ml of methanol to obtain a methanolic crude extract. The antimicrobial properties of the extracts were tested using agar well diffusion, Norfloxacin used as positive control and water as negative control. The inhibition zones from each extract were measured and an activity index was calculated from the mean zone sizes. All fruits showed some degree of antimicrobial properties with the highest activity index (2.6) being from Pineapple ethanolic and methanolic extracts against EAEC. Both Apple ethanolic and methanolic extracts showed activity only against Staph. aureus and EAEC. Guava extracts were effective against all the strains except for ETEC. Pineapple extracts were strongly active against all the bacteria. The methanolic extracts of Apple and Guava showed slightly larger zones compared to their ethanolic extracts. For Pineapple, inhibition zones from the ethanolic extracts were slightly larger. The results of this investigation show great promise for potential antimicrobial drugs.

Antimicrobial activity ofTriclosancoated sutures in vitro

Introduction: Surgical site infections (S.S.I.) are most often due to the organisms present as indigenous flora and are a common problem in most of the hospitals. One of the risk factor is the presence of foreign material which includes suture. The use of antimicrobial coated sutures with the sustained action can be a useful supplement to the aseptic technique. Materials and methods: Randomly selected strains of MRSA, MRSE, Enterococcus, E.coli, Klebsiella & Pseudomonas species isolated from clinical samples in our laboratory were tested against the Triclosan coated and non-coated sutures commercially available. Result: Zone of inhibition was found with Triclosan coated suture and no zone of inhibition found with non coated sutures. Conclusion- Usage of sutures coated with antimicrobial agents like Triclosan can reduce the rates of surgical site infection.

Endocarditis due to Multidrug-Resistant Klebsiella pneumoniae -KPC

Infective endocarditis (IE) is defined as a microbial infection of the cardiac endothelium, commonly involving, but not limited to, the cardiac valves. This pathology could lead to dire complications, carrying a high morbidity and a 6-month mortality of 25%. Its incidence increases proportionally with age and presents with a bimodal distribution and a frequency of 1/100,000 in young adults and 10/100,000 in patients older than 75 years. IE can be classified as native valve endocarditis or prosthetic valve endocarditis, with the former having higher incidence rates. Additionally, IE can be named as either right-sided or left- sided endocarditis, with each one displaying unique clinical features. We report a case of a 42-year-old Hispanic male patient with a medical history of intravenous drug abuser (IVDA), hepatitis C (HCV) and chronic alcohol abuse that arrived at the emergency room with an unquantified fever, myalgia and nausea for 4 days before admission. Patient was admitted to the medicine ward with a diagnosis of fever of unknown origin, hypernatremia and dehydration. Patient was initially treated with vancomycin and cefepime and hydration but after 72 h patient persisted with fever (average 38.8 °C), developed a rash on the palms of the hands and the soles of the feet and a new 2/6 murmur was noticed at the mitral area. Blood culture recovered multidrug-resistant Klebsiella pneumoniae with Klebsiella pneumoniae carbapenemase (KPC), and therapy was switched to polymyxin B and high-dose extended-infusion meropenem for 42 days. The patient improved and underwent valve replacement 8 weeks after discharge. IE must remain high on the differential diagnosis in every patient with fever of unknown origin. The physical exam must also remain as the cornerstone for diagnosis, as in this patient, where the development of a new hand rash and a new murmur altered the diagnosis, prognosis and management. IE poses a high mortality rate from common pathogens and is a difficult pathology to handle. The management of endocarditis due to a KPC is a real challenge in view of limited data and limited antibiotic options. J Med Cases. 2017;8(10):318-321 doi: https://doi.org/10.14740/jmc2912w

Treatment of delayed deep infection after spinal fixation

Objective To explore the efficacy of early aggressive debridement with implant retention, primary wound closure, closed suction drain without irrigation and antibiotic therapy for the treatment of delayed deep infection after spinal fixation. Methods 4 057 patients were underwent dorsal spinal fixation from January 2010 to June 2014. Among them, 42 cases of delayed deep infection after operation were included in the study. There were 25 males and 17 females, with an average age of 68.6±8.1 years (ranged from 53 to 83 years). The diagnosis of delayed deep infection was based on the time of onset, clinical symptoms and signs, imaging and laboratory findings. Surgical debridement was performed immediately after diagnosis of infection. In addition, devitalized and necrotic tissue and biofilms which adhered to the surface of the implant were removed meticulously and thoroughly. Primary wound closure was performed in each patient, and closed suction drains were maintained for about 7-10 d without irrigation. Routine sensitive antimicrobial drugs was applied for 3 months after operation. Results 42 cases were all followed up for 24 to 72 months with an average of 46 months. Among the 42 infected patients, 3 patients were underwent posterior cervical spine surgery and 39 patients were underwent posterior lumbar spine surgery. There were 13 cases of staphylococcus aureus infection, 7 cases of escherichia coli infection, 3 cases of ESBL escherichia coli infection, 3 cases of enterobacter cloacae infection, 2 cases of MRSA, 2 cases of acinetobacter baumannii infection, 2 cases of klebsiella pneumoniae infection, 1 case in enterococcus faecium and pseudomonas aeruginosa and staphylococcus haemolyticus, respectively. There were still 7 patients with negative bacterial culture. 41 cases retained their implant, whereas 1 staphylococcus aureus infection patient had the implants removed because of loosening during debridement. Nevertheless, primary wound healing was found in all patients, and stitches were removed 2 to 3 weeks after debridement. Infections were effectively controlled with no recurrence of infection during the follow-up. The average erythrocyte sedimentation rate was (65.76±20.08) mm/h preoperative, (41.43±14.65) mm/h 1 month postoperative, (10.81±2.72) mm/h 6 months postoperative, and (8.10±5.46) mm/h 12 months postoperative, respectively, the differences were statistically significant. The average C reactive protein was (40.55±16.91) mg/L preoperative, (6.50±2.46) mg/L 1 month postoperative, (4.31±1.26) mg/L 6 months postoperative, and (3.83±1.50) mg/L 12 months postoperative, respectively, the differences were statistically significant. The average procalcitonin was (0.47±0.28) ng/ml preoperative, (0.08±0.06) ng/ml 1 month postoperative, (0.06±0.03) ng/ml 6 months postoperative, and (0.05±0.00) ng/ml 12 months postoperative, respectively, and the differences were statistically significant. Conclusion A timely diagnosis, aggressive and meticulous debridement, high vacuum closed-suction drain, routine and adequate use of antibacterial agents are keys to successfully resolving infection and maintaining implant retention in the treatment of delayed deep infection after spinal fixation. Key words: Infection; Reoperation; Debridement

Técnicas para el aislamiento, identificación y caracterización molecular de cepas de Ralstonia solanacearum relacionadas a Moko del plátano

&lt;p&gt;&lt;em&gt;Ralstonia solanacearum&lt;/em&gt; es uno de los fitopatógenos más destructivos en la agricultura; en el cultivo de plátano la raza 2 causa la enfermedad denominada Moko del plátano, la cual en México está restringida a algunas áreas y provoca pérdidas cuando ocurren brotes epidémicos. La raza 2 comprende subgrupos (secuevares), los cuales usualmente son identificados mediante PCR de tipo Multiplex. El aislamiento de &lt;em&gt;R. solanacearum&lt;/em&gt; es usualmente difícil, aún sobre medios semiselectivos, debido a su crecimiento lento y a la frecuente contaminación con bacterias &lt;em&gt;Pseudomonas&lt;/em&gt;,&lt;em&gt; Klebsiella &lt;/em&gt;y&lt;em&gt; Erwinia&lt;/em&gt;,&lt;em&gt; &lt;/em&gt;que presentan fenotipos similares&lt;em&gt;. &lt;/em&gt;En este trabajo se presenta una estrategia que facilita el aislamiento, identificación y clasificación de &lt;em&gt;R. solanacearum&lt;/em&gt; raza 2. El protocolo comprende inmunodiagnóstico del material vegetal sospechoso, confirmación mediante PCR, aislamiento sobre medios semiselectivos SMSA y B-King, y genotipificación de los secuevares mediante reacciones de PCR sencillas, específicas. En el presente trabajo se aislaron 25 cepas de muestras obtenidas del estado de Tabasco, las cuales genotipificaron en el secuevar 6. Su previa genotipificación mediante Multiplex fue confusa, lo que evidencia que ese ensayo puede llevar a conclusiones erróneas. Por lo tanto no es válido proponer divergencia genética y emergencia de nuevas cepas con base en su resultado, como se ha hecho en algunos reportes recientes.&lt;/p&gt;