Klebsiella Research Articles

Pathogen distribution and bacterial resistance in children with severe community-acquired pneumonia

To investigate the distribution of pathogens and bacterial resistance in children with severe community-acquired pneumonia (CAP). A total of 522 children with severe CAP who were hospitalized in 2016 were enrolled as study subjects. According to their age, they were divided into infant group (402 infants aged 28 days to 1 year), young children group (73 children aged 1 to 3 years), preschool children group (35 children aged 3 to 6 years), and school-aged children group (12 children aged ≥6 years). According to the onset season, all children were divided into spring group (March to May, 120 children), summer group (June to August, 93 children), autumn group (September to November, 105 children), and winter group (December to February, 204 children). Sputum specimens from the deep airway were collected from all patients. The phoenix-100 automatic bacterial identification system was used for bacterial identification and drug sensitivity test. The direct immunofluorescence assay was used to detect seven common respiratory viruses. The quantitative real-time PCR was used to detect Mycoplasma pneumoniae (MP) and Chlamydia trachomatis (CT). Of all the 522 children with severe CAP, 419 (80.3%) were found to have pathogens, among whom 190 (45.3%) had mixed infection. A total of 681 strains of pathogens were identified, including 371 bacterial strains (54.5%), 259 viral strains (38.0%), 12 fungal strains (1.8%), 15 MP strains (2.2%), and 24 CT strains (3.5%). There were significant differences in the distribution of bacterial, viral, MP, and fungal infections between different age groups (P<0.05). There were significant differences in the incidence rate of viral infection between different season groups (P<0.05), with the highest incidence rate in winter. The drug-resistance rates of Streptococcus pneumoniae to erythromycin, tetracycline, and clindamycin reached above 85%, and the drug-resistance rates of Staphylococcus aureus to penicillin, erythromycin, and clindamycin were above 50%; they were all sensitive to vancomycin and linezolid. The drug-resistance rates of Haemophilus influenzae to cefaclor and cefuroxime were above 60%, but it was sensitive to cefotaxime. The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to ampicillin, cefotaxime, and ceftriaxone were above 60%, but they were sensitive to carbapenems and compound preparation of enzyme inhibitors. Bacteria are the main pathogens in children with severe CAP and mixed infection is prevalent. The drug-resistance rates of these pathogenic bacteria are high.

Evaluation of Antioxidant and Antimicrobial Activities of Ethanol Extracts of Three Kinds of Strawberries.

The antioxidant and antimicrobial activities of three kinds of strawberry ethanol extracts from Robus corchorifolius L. f. (RCL), Rubus parvifolius L. var. parvifolius (RPL), and Duchesnea chrysantha Miq. (DCM) were investigated. The RPL was highest (P<0.05) in phenolic, flavonoid, and anthocyanin contents. 2,2-Diphenyl-1-picrylhydrazyl and 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) radical scavenging activities of RPL and DCM extracts were higher than that of RCL (P<0.05). Hydrogen peroxide scavenging activity of RPL was high compared to DCM and RCL (P<0.05). RCL exhibited a significant (P<0.05) potent antioxidant activity in nitric oxide radical inhibition. Inhibition diameter zone (nearest mm) of extracts against the test bacteria ranged from 11.5 in RCL to 12.5 in DCM against Staphylococcus aureus, from 10.5 in RCL to 13.5 in DCM against Streptococcus pneumoniae, from 8.5 in DCM to 10.5 in RCL against Escherichia coli, and the same inhibition of 10 mm in three of the extracts against Klebsiella pneumoniae. However, there was no inhibition against fungi Aspergillus niger and Candida albicans. Three of the extracts had the same minimum inhibitory concentration values of 12.50, 12.50, and 6.25 μg/mL against S. aureus, K. pneumoniae, and S. pneumoniae, respectively. On the other hand, MIC values of 12.50, 12.50, and 6.50 μg/mL were recorded for RPL, DCM, and RCL against E. coli, respectively. The result of present study revealed that extracts from three kinds of strawberries could be potential candidates as antioxidant and antimicrobial sources for functional food industries.

Detection of Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital in South India

Introduction: Carbapenems are a class of ?lactam antibiotics with a broad spectrum of activity and greatest potency against Gram positive and Gram negative bacteria and their use has markedly increased in the past few decades. The development of carbapenem resistance has now become a grave concern in the treatment of diseases.Materials and Methods: The study was a laboratory based cross sectional study done with the main aim to detect the presence of carbapenem resistance among E. coli and K. pneumoniae isolates. A total of 550 samples (pus, urine, sputum, etc) were subjected to culture. The antibiotic susceptibility for various antibiotics was studied by Kirby Bauers Disk Diffusion Test. Carbapenem resistance and Metallo-betalacatamase (MBL) production was detected using Modified Hodge Test and EDTA Disk Synergy Test respectively.Result: A total of 129 isolates (43%) were meropenem resistant out of which 42 isolates (14%) were MBL producing. Carbapenase production was noted in 42.1% of E.coliand45.8% of K. pneumoniae. Twelve percent of the E. coli and 20.8% of the K. pneumoniae were found to have prevalence of MBL producers respectively.Conclusion: High incidence of carbapenem resistance and MBL producers was noted in the isolates. Given the emerging pattern of resistance to these third line antimicrobials and limited new molecules it is imperative to frame a new antibiotic policy and its strict implementation.

Relationship between blaSHVGenes in Klebsiella pneumoniae

Seventy-five Klebsiella pneumonia isolates were identified according to their cultural characteristics and by Vitek2 system. Both genomic and plasmid DNA of the isolates were extracted. Polymerase Chain Reaction (PCR) was performed for detection of SHV-1 gene in the plasmid DNA and SHV-12 gene in the genomic DNA of the isolates. SHV-1 found in the plasmid DNA of 28% of the isolates, while 52% of the isolates contained SHV-12 in their genomic DNA. Only 20% of the isolates carry both genes together

Microbial Estimation and Characterization of Wastewater and Sludge in Awka Metropolis, Nigeria

This study focuses on the estimation and characterization of microorganisms isolated from wastewater and sludge in Awka metropolis, Nigeria. The samples were collected randomly from four (A, B, C and D) respective areas, analyzed microbiologically by homogenizing the samples under aseptic conditions to obtain a homogenous mixture, the isolation techniques used was pour plate methods as described by Cheesbrough, (2010); Joanne et al, (2011); APHA, (1989). The samples were diluted serially, inoculated on to MacConkey agar and Sabouraud Dextrose agar media each and microorganisms were isolated; wastewater had a range from 44 to 100 colonies and total of 284 (71 ± 24.30), CFU / ml (10-4) of 1.0 × 107 to 8.0 × 106 with total count of 19.4 (4.85 ± 2.96) × 106, while sludge was ranges from 60 to 120 colonies with a total of 358 (89.5 ± 29), CFU / ml (10-4) ranged from 1.0 × 107 to 7.0 × 106 with total count of 15.2 (3.8 ± 3.1) × 106. The colony and the morphology of the isolates were recorded, the bacterial isolates were characterized by motility tests, Gram staining and identified by biochemical tests. The fungal isolates were microscopically examined using a wet mount procedure. From the results obtained 8 bacterial and 7 fungal isolates were identified from both the wastewater and the sludge; Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Klebsiella pneumonia, Micrococcus leteus, Enterococcus faecalis, Serratia mercescens and Yersinia enterocolitica. Acrophialophora fusispora, Epicoccum Purpurascens, Rhizopus microsporus, Exophiala spinifera, Cladosporium cladosporiodes, Aspergillus niger and Phaeoacremonium parasiticum. Results also showed that staphylococcus aureus have the highest percentage of occurrence in wastewater, while in sludge Micrococcus species have the highest percentage of occurrence.

Antimicrobial resistance of gram-negative bacilli isolated from 14 teaching hospitals across China in 2016

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2016 across China. Methods About 1 394 consecutive and non-repetitive gram-negative bacilli were isolated from 14 teaching hospitals from March to August in 2016 across China. All of these isolates were sent to the central laboratory for reidentification and susceptibility testing. The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method. The data were analyzed by using WHONET-5.6 software. Results The activity of antimicrobial agents against Enterobacteriaceae was as follows in descending order of susceptible rate: meropenem (95.2%, 891/936), amikacin (94.6%, 885/936), ertapenem (92.1%, 862/936), piperacillin/tazobactam (88.1%, 825/936), imipenem (88.0%, 823/936), cefoperazone-sulbactam (83.1%, 778/936), cefepime (72.2%, 676/936), cefiazidime (72.2%, 676/936), levofloxacin(68.8%, 644/936), ciprofloxacin (63.2%, 592/936), minocyline (62.9%, 589/936), cefiriaxone (54.9%, 514/936), cefotaxime (54.0%, 505/936), cefoxitin (44.3%, 415/936). The sensitivities of E. coli to carbapenems, amikacin, piperacillin-tazobactam, polymyxin B and cefoperazone-sulbactam were over 80%. The more sensitive antibiotic to Klebsiella pneumoniae was polymyxin B (99.0%), followed by amikacin (84.9%), meropenem (84.4%) and imipenem (82.0%). The prevalence of extended-spectrum β-lactamase was 62.8%(137/218)in Escherichia coli and 28.3%(58/205)in Klebsiella pneumonia. The activity of antimicrobial agents against E. cloacae, E. aerogenes and Citrobacter freundii was as follows in descending order of susceptible rate: meropenem (97.0%-98.5%), amikacin (95.8%-98.3% ), imipenem (94.5%-97.5% ), polymyxin B (96.4%-100%), cefoperazone-sulbactam (76.5%-90.0%), ertapenem (73.3%-90.1%), piperacillin/tazobactam (82.4%-88.3%). The most active agents against Pseudomonas aeruginosa were polymyxinB (100%), followed by amikacin (89.3%) and ciprofloxacin (82.4%). The most active agents against Acinetobacter baumannii were polymyxinB (100%). The sensitivities of Acinetobacter baumannii to meropenem, imipenem, minocycline and cefoperazone-sulbactam were 20.3%(39/202), 19.3%(41/202), 66.3%(134/202) and 24.8%(50/202), respectively. Conclusions Carbapenems remain high sensitive against Enterobacteriaceae.Controlling carbapenem resistant Klebsiella pneumoniae is urgent. Drug antimicrobial resistance in A. baumanni is a still serious problem.(Chin J Lab Med, 2017, 40: 614-622) Key words: Gram-negative bacteria; Drug resistance, bacterial; Microbial sensitivity tests

The Report of Causative Organisms in Peritonitis from the Database of Peritoneal Dialysis in Thailand Excelprogram

The peritonitis (PN) is one important clinical outcome which should be monitored by peritoneal dialysis units. To report the types of pathogens isolated from patients with peritoneal dialysis who had peritonitis. We have developed a web-based program named the Database of Peritoneal dialysis in the EXcel (DPEX). It is a program for peritoneal dialysis units to use for monitoring clinical outcomes of patients with peritoneal dialysis (PD) for continuous quality improvement. We have analyzed the data of PD patients with peritonitis during November, 2007 to September, 2015.The causative organisms were classified by cultures. The 2 month outcomes of PN consisted of the continuation of PD, technique failure or mortality rates were evaluated. The technique failure was defined as catheter removal and/or a shift to permanent hemodialysis. There were 1,300 (51.9%) males and 1,207 (48.1%)females .The mean (SD) age when PD was initiated was 54.1 (15.2) [95%CI 53.5-54.7] years. Patients with diabetes numbered 1,367 (54.5%). Patients were categorized with education levels as illiterate, primary school, secondary school, university and unknown were 728 (29%), 1,288 (51.4%), 354 (14.1%), 63 (2.5%), and 74 (3%), respectively. Universal health coverage scheme covered 2,341 (93.4%) of the cases. The numbers of gram positive, gram negative, culture negative, fungal, mycobacterial and polymicrobial PN were 1,332 (31.8%), 1,179 (28.1%), 1,498 (35.7%), 141 (3.4%), 25 (0.6%), and 15 (0.4%), respectively. The most common gram positive pathogens were Staphylococcus spp (coagulase negative and coagulase positive, not including S.aureus) 339 (25.5%) followed by Streptococcal spp. 288 (21.6%). Also, Staphylococcus aureusspp was identified in216 (16.2%). The most common gram negative pathogens were E.coli429 (36.4%) followed by Klebsiella spp. 196 (16.6%), and P.aeruginosa 142 (12.0%). The patients who continued PD, had technique failure and mortality at2,079 (82.9%), 233 (9.3%) and 178 (7.1%), respectively. There were 17 (0.7%) cases that could not be evaluated as they were transferred to other PD centers. The numbers of culture negative PN were high. Most patients who contracted PN were able to continue with PD.

The efficacy of single or double-antibiotic regimen for the treatment of complicated appendicitis in children

Objective To evaluate the efficacy of single or double-antibiotic regimen for the treatment of complicated appendicitis in children, with the purpose to guide the rational use of antibiotics in clinic. Methods Six hundred and sixty-three patients with acute appendicitis admitted to the department of pediatric surgery in Jinhua Municipal Central Hospital between March 2011 and February 2015.One hundred and seventy-two of 663 patients with complicated appendicitis which confirmed by intra-operative macroscopic or post-operative pathological examination were eligible for the study.These patients were divided into two groups based on the regimen of their postoperative antibiotics: single or double-antibiotic regimen(treatment group, n=66); triple antibiotics regimen(control group, n=106). Demographic data, blood routine test and C-response protein(CRP), length of hospital stay, postoperative complications and duration of antibiotic treatment were recorded and statistically analyzed. Results There was no difference between the treatment group and control group with respect to age distribution, blood routine examination and CRP, length of hospital stay, duration of antibiotic treatment or postoperative complications.Although the number of patients changed of antibiotics on the basis of bacterial culture of pyogenic fluids in treatment group were more frequently than those in the control group(7/66 vs.1/106), the therapeutic effective rate of changed of antibiotics was 100% in both two groups.The culture positive rate of peritoneal fluids was 72.09% (124/172), the most common pathogens were escherichia coli(80.15%, 105/131), pseudomonas aeruginosa(5.34%, 7/131)and klebsiella pneumonia (3.05%, 4/131). The results of bacterial culture of peogenic fluids showed no difference in both two groups. Conclusion Children with complicated appendicitis can be managed effectively with single or double broad-spectrum antibiotics after appendectomy, and it may be beneficial to guide the rational use of antibiotics and decrease the irrational use of multi-antibiotics combination in clinic. Key words: Children; Appendicitis; Complicated; Antibiotic drug; Therapy

Metabolic Engineering of Klebsiella pneumoniae for the Production of Poly(3-Hydroxypropionate) from Glycerol

Metabolic Engineering of Klebsiella pneumoniae for the Production of Poly(3-Hydroxypropionate) from Glycerol

Co-relation of estrous cycle phases with uterine bacterial and fungal flora in non-pregnant female laboratory rabbits.

This study was designed to investigate the relationship between the estrous cycle phases with uterine bacterial and fungal flora in non-pregnant female rabbits. Thirty laboratory mature multiparous rabbits were used for this purpose. Samples from uterine lavage for culture of bacteria and fungi were collected at different stages of estrous cycle (based on vaginal cytology), and histopathological observations were evaluated based on the scoring system used for defining the infection of the uterus. Various types of bacteria and fungi were isolated from rabbits at all stages of estrous cycle. The widest variety of bacteria and fungi was isolated at Di-estrous stage and the lowest variety was detected at estrous stage. Klebsiella oxytoca as well as yeast have been isolated at all stages of estrous cycle. This study showed that infection with K. oxytoca and yeast had no relationship with different stages of estrous cycle but other bacteria and fungus were associated with one or more stages of the estrous cycle in rabbits.

Clinical characteristics of bacterial liver abscess in patients with type 2 diabetes mellitus

Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without type 2 diabetes mellitus, in order to guide clinical diagnosis and treatment. Methods The clinical data of 110 patients with bacterial liver abscess at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Among them, 45 cases with type 2 diabetes mellitus and 65 cases without type 2 diabetes mellitus were included in the study. The demographic data, clinical signs and symptoms, laboratory findings, pathogenic results, imaging findings, treatment and prognosis were compared between the two groups. Differences among the quantitative data with normal distribution were compared using t test, while count data were compared with χ2 test or Fisher exact test. Multivariate Logistic regression was used to determine the prognostic risk factors of two groups. Results Fever as initial symptom in diabetic group and non-diabetic group were 37 cases and 40 cases, respectively, while abdominal pain presented in 7 cases and 22 cases of the two groups, respectively, both with statistically significant difference (χ2=5.417 and 4.582, respectively, both P<0.05). As for laboratory examination, neutrophil counts in the two groups were (12.87±8.83)×109/L and (10.24±4.86)×109/L, respectively, the percentages of neutrophils were 0.841±0.077 and 0.799±0.103, respectively, albumin levels were (28.36±4.65) g/L and (30.67±6.16) g/L, respectively, with statistically significant difference (t=2.010, 2.317 and -2.265, respectively, all P<0.05). Patients with elevated blood urea nitrogen in the two groups were 13 cases and 8 cases, respectively, patients with elevated creatinine were 9 cases and 4 cases, respectively, with statistically significant difference (χ2=4.733 and 4.892, respectively, both P<0.05). In diabetic group, pus culture was positive in 13 out of 19 cases, and blood culture was positive in 7 out of 21 cases. In non-diabetic group, pus culture was positive in 9 out of 13 cases, and blood culture was positive in 6 out of 25 cases. The positive rates of Klebsiella pneumoniae in the two groups were 37.5% (15/40) and 15.8% (6/38) , respectively, with statistically significant difference (χ2=4.669, P=0.031). The effective rates of the two groups with glycemic control were 84.4% (38/45) and 84.6% (55/65), respectively, and the mortality rates of the two groups were 2.2% (1/45) and 1.5% (1/65), respectively. Multivariate Logistic regression showed that multiple abscess (OR=34.61, 95% CI: 1.601-748.457, P=0.024) was prognostic risk factor and invasive intervention (OR=0.028, 95%CI: 0.001-0.984, P=0.049) was protective factor in the diabetes mellitus group. Hypoalbuminemia (OR=14.793, 95% CI: 1.605-136.322, P=0.017) and the history of abdominal surgery within two years (OR=7.624, 95% CI: 1.294-44.913, P=0.025) were prognostic risk factors in the non-diabetic group. Conclusions Patients with bacterial liver abscess showing symptoms of severe infection in diabetic group are more frequently than patients in non-diabetic group. Klebsiella pneumoniae infection rate is also higher in diabetic group. Patients with bacterial liver abscess and diabetes mellitus should receive antibiotic treatment combined with invasive therapy in time. Key words: Bacterial liver abscess; Diabetes mellitus; Clinical characteristics; Therapy; Prognosis

Study on the resistance genes of carbapenem-resistant Enterobacteriaceae collected from 5 hospitals in Northeast China

Objective To investigate the antibiotic resistance and resistance genes of carbapenem-resistant Enterobacteriaceaes (CRE) isolated from 5 hospitals in Northeast China. Methods This study collected 85 CRE isolates during January 2013 to June 2015 from five hospitals in Northeast China. Drug sensitivities of 14 antimicrobial agents were determined by the broth microdilution method. The phenotypes of carbapenemases were screened by modified Hodge test and EDTA test respectively. The genotypes of carbapenemases and other extended spectrum β-lactamases (ESBL) were detected by PCR gene amplification and DNA sequencing method. Using the PCR result as gold standard, the performances of other two carbapenemase detection methods were evaluated. Results Among the 85 CRE strains collected in this study, Klebsiella pneumoniae was the most frequently isolated species (61/85, 71.8%). The results of antimicrobial agent sensitivity showed that the 85 CRE strains had resistance rate of cephalosporin and β-lactams/enzyme inhibitor (piperacillin-tazobactam) over 80.0%. The resistance rate of carbapenem was high, with ertapenem 100.0% (85/85), meropenem 65.9% (56/85), imipenem 71.8% (61/85). There were 36 isolates resistant to both meropenem and imipenem. For fluoroquinolones, the resistance rates of levofloxacin and ciprofloxacin were 72.9% (62/85) and 65.9% (56/85), respectively. The resistance rate to fosfomycin and amikacin were 65.0% (55/85) and 54.1% (46/85), respectively. The resistance rate of colistin (21.2%, 18/85) and tigecycline (20.5%, 17/85) were low. Forty-nine strains were modified Hodge test positive and 12 strains were EDTA test positive. By PCR gene amplification and DNA sequencing method, 64 strains carried carbapenemase-encoding genes, of which KPC-2 was the main type (53/85, 62.4%), followed by IMP-4 (10/85, 11.8%), NDM-5 (7/85, 8.2%) and NDM-6 (1/85, 1.2%). At the same time, 85 CRE isolates had the ESBL gene detection and 47 isolates were CTX-M type ESBLs (47/85, 55.3%), with no TEM or SHV type. Conclusions Klebsiella pneumoniae is the majority of CRE strains from 5 large hospitals in Northeastern China. The CRE strains are resistant to most of antimicrobials. Most carbapenemases-producing isolates have the KPC-2 type. Nearly half of the carbapenemase-producing strains also carry ESBL genes, which makes the resistance mechanisms more complicated. Key words: Enterobacteriaceae; Carbapenemase; Extended-spectrum β-lactamases

Analysis of distribution and drug resistance of pathogenic bacteria in 83 neonatal septicemia

Objective To study the distribution and drug resistance of pathogens in neonatal septicemia in order to provide clinical guidance for antibiotic usage. Methods This retrospective study analyzed blood culture and clinical data from 83 confirmed neonatal septicemia patients and the blood collection cultures were analyzed. Results A total of 84 strains were isolated from 83 cases of blood specimens, Gram positive bacteria, Gram negative bacteria and fungi were 38(45.2%), 41(48.8%), 5(6.0%), respectively.Gram positive bacteria was mainly coagulase negative staphylococcus and staphylococcus aureus, which were 13(15.5%) and 8(9.5%) respectively.Gram negative bacteria was mainly Escherichia coli and Klebsiella pneumonia, which were 25(29.8%) and 9(10.7%) respectively.Gram positive bacteria were found high resistance to penicillin G, amoxicillin clavulanate potassium, oxacillin and clindamycin, from 34.2% to 73.7%, but they were sensitive to vancomycin, teicoplanin and linezolid.Gram negative bacteria were found high resistance to ampicillin(82.9%), the constituent ratio of the extended spectrum βlactamases(ESBLs) was 34.1%, carbapenem resistant strains was not found.All fungi were sensitive to azoles. Conclusion Gram negative bacteria are the major pathogens in neonatal septicemia, with high infection rate of Escherichia coli and high constituent ratio of the ESBLs, and antimicrobial agents should be chosen according to blood culture and antimicrobial susceptibility results. Key words: Neonatal; Septicemia; Pathogens; Drug resistance

Frequency of Multi Drug Resistant Nosocomial Pathogens in Intensive Care Units of a Tertiary Care Hospital in Karachi

Objective: To evaluate occurrence of nosocomial infections and antibiotic susceptibility patterns of bacterial pathogens isolated from Intensive Care Units (IC-Us) in a tertiary care hospital of Karachi-Pakistan. Methods and Results : One thousand and fifty clinical isolates were identified following standard protocols. Their antibiograms were evaluated and a clinical correlation was made to measure their pathogenic status and method of acquisition of infection. Fifty-six percent isolates were identified as Acinetobacter baumannii, 13.2% as Pseudomonas aeruginosa, 11.2% as Staphylococcus aureus (MRSA), 8.8% as Klebsiella pneumoniae, 4.1 % as Vancomycin resistant Enterococci (VRE), 2.7% as Escherichia coli (ESBL), 1.2% as Klebsiella spp, 1.1% as coagulase negative staphylococcus, 0.7% as Salmonella typhi and 0.2% as salmonella spp. All the isolates exhibited different resistance patterns against conventional antibiotics. Majority of them were Multi Drug Resistant (MDR). Conclusions : In this study, Acinetobacter baumanniiisolates revealed a pathogenic potential of around 56% were identified by antimicrobial susceptibility patterns. In our study, majority of Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Vancomycin resistant Enterococci, E.coli, and Klebsiella spp were found to be multi drug resistant. High antimicrobial resistance in the ICU is an alarming situation, and calls for imperative measures leading to careful selection/use of antimicrobials while treating different infections. This study is expected to help infection control agencies to take robust steps to control nosocomial infections in developing countries.

Analysis of pathogenic bacteria and drug resistance in 102 children with bone and joint purulent infection

Objective To summarize the bacterial types and drug resistance of children with bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College in recent 9 years, so as to provide reference for rational use of antibiotics in clinics. Methods A retrospective study was performed on the clinical data of 102 children with hematogenous bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College from January 2008 to October 2016, in which there were 57 boys and 45 girls with a mean age 5.5 years old(from 10 days to 14 years old), among which 38 cases were acute osteomyelitis, 30 cases were pyogenic arthritis, 27 cases were chronic osteomyelitis, and 7 cases were arthritis with hematogenous osteomyelitis.The results of blood culture, pus culture and antibiotic sensitivity test results were analyzed and summarized. Results The results of blood culture or pus culture in 102 cases were all infected by single bacteria, including 89 cases of staphylococcus aureus(SA), accounting for 87.30%, 3 cases (2.94%) of micrococcus scarlatinae, 2 cases (1.96%) of klebsiella pneumoniae, 2 cases (1.96%) of staphylococcus haemolyticus, and 1 case (0.98%) of methicillin-resistant staphylococcus epidermidis, streptococcus pneumoniae, streptococcus mitis, enterococcus hirae, enterobacter cloacae and pseudomonas aeruginosa, respectively.The resistance rate of SA to penicillin was 92.1%, but to Lincomycin, Erythromycin, Cefoxitin and Tetracycline it was more than 50.0%, and to Sulfamethoxazole, Gentamicin and Rifampicin it was quite low, and the resistant strains to Linezolid, Quinupristin/Dafoe Putin, Mo Xisha star, Tigecycline, Vancomycin, Levofloxacin, Nitrofurazone were no found.There were not multi drug resistant strains to be found except in the 45 cases of methicillin-resistant staphylococcus aureus(MRSA)and 1 case of methicillin-resistant staphylococcus epidermidis. Conclusion SA is the main pathogenic bacteria of bone and joint purulent infection in children in the local area. The resistant rate of penicillin and the detection rate of MRSA are high in the hematogenous osteoarticular infections caused by SA, but no vancomycin resistant cases were found. Key words: Bone and joint; Infection; Pathogenic bacteria; Drug resistance

Prevalence of Plasmid-Mediated Quinolones Resistance among Klebsiella pneumoniae Strains Isolated from Hospitals in Borujerd, Iran

Prevalence of Plasmid-Mediated Quinolones Resistance among Klebsiella pneumoniae Strains Isolated from Hospitals in Borujerd, Iran

Risk factors analysis and nursing intervention of multidrug-resistant organism infection in patients of traditional Chinese medicine hospital

Objective To discuss the risk factors and nursing intervention of multidrug-resistant organism (MDRO) infection in patients of traditional Chinese medicine hospital (TCM). Methods By investigating the patients admitted to Beijing Xuan Wu Hospital of Traditional Chinese medicine from June 2015 to June 2016, 756 patients of them who were confirmed with clinical diagnosis of infection and pathogen detection with positive, which were divided into MDRO group including 97cases and non-MDRO group including 659 cases, then the pathogens of MRDO infection species and distributionwere counted, and analyzed risk factors for infection. Results A total of 756 cases were detected positive strains 816 strains, including 611 strains of monitoring target strains, 116 strains of MRDO. The top three were methicillin-resistant staphylococcus aurous 30.17%(35/116), Pseudomonas aeruginosa 18.97% (22/116) and Klebsiella pneumonia 18.10% (21/116). Single factor analysis results showed that the patients' age, hospitalization days, the history of other hospital admission, invasive procedure, basic chronic disease (diabetes, cerebrovascular disease, lung disease) and combined use of antibiotics were MDRO infection risk factors (χ2=9.470-198.609, P < 0.01); multivariate Logistic regression analysis showed that the independent risk factors of MDRO infection were the history of other hospital admission (OR=2.085, 95%CI1.040-4.179), invasive procedure (OR=3.063,95%CI1.526-6.150), diabetes (OR=2.037,95%CI1.070-3.877), cerebrovascular disease (OR=4.349,95%CI 2.035-9.293)and combined use of antibiotics (OR=18.723,95%CI9.202-38.094). Conclusions Patients of TCM have many characteristics, such as with more basic diseases, longer length of stay, elder and so on. So we should be alert to the risk of MDRO infection and take nursing interventions to prevent and strengthen the isolation prevention. Key words: Risk factors; Traditional Chinese medicine hospital; Multidrug-resistant organism; Nursing care

Prevalence of plasmid-mediated quinolone resistance genes in Klebsiella pneumoniae strains in pediatrics in China

Objective To investigate the prevalence of plasmid-mediated quinolone resistance (PMQR) genes among clinical isolates of Klebsiella pneumoniae (K.pneumoniae) in pediatrics. Methods A total of 131 non-duplicate clinical isolates of K. pneumoniae were collected in the Affiliated Children′s Hospital of Capital Institute of Pediatrics from 2010 to 2012. PMQR genes [qnrA, qnrB, qnrS, aac(6′)-Ⅰb-cr and qepA], mutations in the quinolone resistance-determining region (QRDR) and extended spectrum β-lactamases (ESBLs) genes in those strains were analyzed by PCR. Minimum inhibitory concentrations (MIC) of different antibiotics against those K. pneumoniae strains were determined by broth microdilution method and E-test according to the guidelines issued by the Clinical and Laboratory Standards Institute (CLSI). Transferability of the PMQR genes was examined by conjugation test with the sodiumazide-resistant Escherichia coli J53. Results Among the 131 isolates, 9.92% were resistant to quinolone and 30.5% were positive for PMQR genes, including 6.87% harboring qnrB gene, 22.9% harboring qnrS gene and 4.58% harboring aac(6′)-Ⅰb-cr gene. Neither qnrA-positive nor qepA-positive strain was detected. Among these PMQR genes-positive isolates, 90% were ESBLs-producing strains and two presented mutations in gyrA and parC genes. Conjugation test showed that these PMQR genes could be transferred horizontally and the ciprofloxacin resistance increased 2 to 32 folds in transconjugants. Conclusion This study indicates that the PMQR gene-carrying rate is high in K. pneumoniae strains isolated in paediatrics in China. Most of the PMQR gene-positive strains are also ESBLs-producing strains. The PMQR genes could be transferred horizontally in bacteria. Key words: Klebsiella pneumoniae; PMQR; ESBLs

Bacteriological analysis and treatment strategy in patients with biliary sepsis

Objectives To access the bacteriology in patients with sepsis due to biliary tract infection to provide a basis for empirical selection of proper antibiotic treatment. Methods This is a single-center retrospective study on 214 patients with biliary tract infection admitted from August 2014 to July 2016 to the surgical intensive care units (ICU) of The First Affiliated Hospital of Sun Yat-sen University. To study the demographic information, sequential organ failure assessment (SOFA), usage of antibiotics before ICU and duration of ICU were analyzed. Bile, peritoneal drainage and blood samples were collected. Results 47 septic shock patients and 25 septic patients due to biliary tract infection were enrolled in the trial. The two groups (the shock group vs. the sepsis group) had a significant difference in the duration of ICU stay [(6.4±4.6) d vs. (2.3±1.8) d, P<0.05]. 48 strains of pathogens were isolated from the bile samples. The major pathogens were Escherichia coli (E. coli) (n=23, 47.9%), Enterococcus faecalis (n=8, 16.7%) and Enterococcus faecium (n=2, 4.2%). 80 strains of pathogens were isolated from the peritoneal drainage culture samples. E. coli, pseudomonas aeruginosa, and Klebsiella pneumoniae ranked the top 3 species, accounting for 26.3%, 11.3% and 7.5%, respectively. The sensitivity of E. coli isolated from bile to amikacin, imipenem and panipenem were all over 90.0%. Conclusions E. coli was the principal gram-negative bacterium in biliary infection induced sepsis. Early administration of carbapenemes may reduce the occurrence of septic shock in these patients. Key words: Antibiotics; Biliary tract infection; Sepsis; Bacteriological analysis

Flora indígena de cucarachas (Dictyoptera: Blattidae y Blattellidae): un análisis bacteriológico y ultraestructural

Intradomiciliary cockroaches ( Periplaneta americana Linnaeus 1753), P. australasiae Fabricius 1775), and Blattella germanica Linnaeus 1767) were collected in a Day Care Center (CEN-CINAI) and four foodstores of the Central Market, San Jose, Costa Rica. Enterobacter aerogenes, E. agglomerans, E. gergoviae, Citrobacter freundi, Klebsiella pneumoniae, K. oxytoca, Hafnia alvei, and Pseudomonas sp. were isolated from bodywash of the insects and from their intestinal contents. Scanning electron microscopy observations of the body and negative staining specimens of intestinal contents and ultrathin sections of intestine show abundant morphotypes of bacteriae, include bacilli and curve-shaped rods, some of them with periplasmic fibers.