Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integro...Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integrons and antibiotic susceptibility of clinical isolates of P. aeruginosa. Two hundred and five P. aeruginosa strains were collected from the seven general state hospitals in Turkey. They were characterized by antimicrobial susceptibility testing, screened for class 1 and class 2 integrons, and evaluated for the association between antibiotic resistance phenotypes and the presence of integrons. intI gene was amplified in 10 isolates (4.87%) by PCR and in seven isolates of them (70%) were found different gene cassettes. The aadA gene integrated into the class 1 integrons was most frequently found and it was followed by aac genes and blaOXA family genes. Sequence analysis of variable regions of the class 1 integrons showed five gene cassette arrays;aadA1(99%), aac(3)-Id(82%)-orf-aac(3”)-Ia(99%), aac(3)-Ie(83%)-blaoxa10(100%)- aadA1 (100%), aadA6(99%, 100%), aac(6’)-I(97%)-orf-aadA2(99%). No class 2 integron was detected. This study is the first multicenter study for class 1 integrons and it indicates the low rate of presence of class 1 gene cassette in P. aeruginosa.展开更多
Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of ...Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease(CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases.展开更多
Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of...Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of 281 A.baumannii clinical isolates were collected from nine diferenl state hospitals in Turkey and were confirmed as A.baumannU by conventional biochemical,API testing and bla_(-OXA-51)specific PCR.The isolates were examined by PCR for existence of class I and2 integron gene cassettes.Results:They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin(90.03%),ciprofloxacin(87.54%),cefepime and trimethoprim/sulfamethoxazole(81.13%).The lowest resistance rates was for cefotaxime(3.55%).class 1 integrons were detected in 6.4%(18/281)of A.baumannii strains and no class 2 integron was detected.The gene casselles of class 1 inlegrons AacCI-AAC(3)l-aadAI,AacCI-aadA1,AAC(3)-I,AAC(3)-I-AAC(3)-I-aadA1,TEM-1.AAC(3)-I-aadA1-AAC(3)-I-AAC(3)-I,AAC(3)-I-AAC(3)-I-AAC(3)-I-aadA1,AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I,AAC(3)-I-aadA1-AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains.The aac genes family were most frequently found integrated into the class 1 inlegrons and it was followed by aadA genes and TEM-1 genes.Conclusions:This is an extensive study on the distribulion of class 1 integron among A.baumannii in Turkey.In addition to these,two new alleles were observed.Their percentage rates of similarity to other cassettes are 95%aadA1(TK A18)and 89%,aadA 1(ANKA3).展开更多
Importance Hypervirulent variants of Klebsiella pneumoniae(hvKp)are capable of causing life-threatening pyogenic liver abscesses(PLAs),but hvKp caused PLAs was seldom reported in pediatric populations.Hence,there is a...Importance Hypervirulent variants of Klebsiella pneumoniae(hvKp)are capable of causing life-threatening pyogenic liver abscesses(PLAs),but hvKp caused PLAs was seldom reported in pediatric populations.Hence,there is an urgent need to raise our awareness of this phenomenon in pediatric populations.Objective This study aimed to report the clinical characteristics of hvKp that caused fatal PLA complicated by bacteremia in an adolescent and further identify the microbiological and genomic features of the causative strain.Methods A 14-year-old boy with diabetes mellitus was admitted to our hospital with a diagnosis of PLA complicated by bacteremia.A hypermucoviscous hvKp strain,KPN_19-106,was isolated from the drainage fluid present within the liver abscess cavity and blood.The hypermucoviscosity phenotype of the causative strain was determined by string test.Its virulence was measured using serum resistance assay and Galleria mellonella larvae-killing assay.Antimicrobial susceptibility was determined by broth microdilution method.Genetic information was obtained by whole-genome sequencing and bioinformatics analysis.Results KPN_19-106 belonged to sequence type 380 and serotype K2 and exhibited stronger serum resistance and higher in vivo lethality than the well-characterized hvKp NTUH-K2044 strain.Although KPN_19-106 is susceptible to most antibiotics,no sign of improvement was observed during treatment with such drugs.Whole-genome sequencing revealed that the isolate had integrated multiple mobile genetic elements related to virulence.Interpretation Antibiotic-susceptible hvKp can cause fatal PLA complicated by bacteremia in adolescents,with no improvement during antimicrobial therapy.The causative strain in this case had integrated multiple virulence genes and thus exhibited higher virulence both in vitro and in vivo when compared with NTUH-K2044.展开更多
Background: Intubated patients are particularly at risk of developing infections caused by these pathogens, specifically, P. aeruginosa and A. baumannii. In the past fifteen years, Carbapenems were known to be the dru...Background: Intubated patients are particularly at risk of developing infections caused by these pathogens, specifically, P. aeruginosa and A. baumannii. In the past fifteen years, Carbapenems were known to be the drugs of choice for these bacteria. With the increase in the use and misuse of antibiotics, these bacteria became highly resistant, and almost all available antibiotics, including Carbapenems, became inefficient. Synergistic combination therapy may be a useful strategy in slowing as well as overcoming the emergence of resistance. The aim of this study was to evaluate the anti-bacterial activity on P. aeruginosa and A. baumannii of the combination of two antibiotics: Colistin and a Carbapenem (Meropenem or Imipenem). Methods: The antibacterial activity was assessed by determining the MIC. Then, the effect of combining the antibiotics was studied using the Checkerboard Technique described by White et al., 1996. The Fractional Inhibitory Concentration (FIC) for each strain was then calculated and classified as synergy, additive, indifference or antagonism. 11 strains of A. baumannii and 11 strains of P. aeruginosa were tested in the presence of Meropenem combined with Colistin or Imipenem combined with Colistin. Results: For the combination of Meropenem and Colistin, 6 strains of A. baumannii and 3 strains of P. aeruginosa showed synergy while 5 strains of A. baumannii and 7 strains of P. aeruginosa showed additive effect, only 1 strain of P. aeruginosa showed antagonism. For Imipenem and Colistin, only 1 strain of A. baumannii and 3 strains of Pseudomonas showed synergy while 8 strains of Acinetobacter and 8 strains of Pseudomonas showed additive effect. Conclusion: The “in vitro” combination Colistin-Carbapenem is associated with an improvement in MIC. In the majority of the cases, this improvement suggests a synergistic combination or an additive effect.展开更多
AIM: To evaluate GenoT ype methicillin-resistant Staphylococcus aureus(MRSA) Direct assay and cultivation for the identification of MRSA by using mec A polymerase chain reaction(PCR) as the "gold standard" a...AIM: To evaluate GenoT ype methicillin-resistant Staphylococcus aureus(MRSA) Direct assay and cultivation for the identification of MRSA by using mec A polymerase chain reaction(PCR) as the "gold standard" assay.METHODS: In total of 61 nasal specimens from patients at the intensive care unit were studied by GenoType MRSA Direct test, conventional culture method and automated bacterial identification system. The results of Geno Type MRSA Direct assay were compared to conventional culture method the identification of MRSA and mec A gene PCR as the "gold standard" method. The sensitivity, specificity, positive predictive value and negative predictive value were calculated.RESULTS: In total, 61 specimens were studied. Fiftyfour specimens(88.5%) were negative by all three methods. Six swabs(9.8%) were found positive by GenoT ype MRSA Direct test, conventional culture method and automated bacterial identification system. The presence of mec A in these strains was confirmed by PCR. One swab sample was negative for culture meth-ods but MRSA and mecA gene were detected by GenoType MRSA Direct test and mec A PCR respectively. GenoT ype MRSA Direct test had a sensitivity of 100%(6/6) and a specificity of 100%(55/55), with a positive predictive value of 100% and a negative predictive value of 98%. Culture method of MRSA had a sensitivity of 83.3%(5/6) and a specificity of 98.2%(55/56). CONCLUSION: It was found that the GenoT ype MRSA Direct assay, which is a rapid and accurate test, is of the same sensitivity and specificity with mec A PCR. The GenoT ype MRSA Direct assay can be a better tool for rapid and accurate detection of MRSA in diagnostic laboratories.展开更多
Background: Genetic diversity of human immunodeficiency virus affects the treatment and the emergence of resistance. Some subtypes would develop resistance more frequently than others. The aim of this study is to dete...Background: Genetic diversity of human immunodeficiency virus affects the treatment and the emergence of resistance. Some subtypes would develop resistance more frequently than others. The aim of this study is to determine the rate of virological treatment failure and the involvement of genetic diversity and different mutations in this failure in Kinshasa. Methods: Of the 153 Antiretroviral-naive patients who were included in the cohort, 138 patients have been received for the appointment of the 6th month. Clinical parameters were recorded on individual patient charts. The determination of Viral Load (VL) was done at the Laboratory of Molecular Biology. Clinical and biological parameters of the 6th month were compared with those taken at baseline of the cohort to determine the evolution of patients under treatment. Results: At the consultation of the 6th month, 138 patients (90.2%) had returned out of the 153 included. Eighty-one (58.7%) patients were women and 57 (41.3%) men. The age of patients is between 18 and 65 with an average of 37 years. Ten deaths (6.5%) and 5 (3.3%) lost have been reported. One hundred twenty-five patients (90.5%) were in clinical stage 3 and 13 (9.5%) in clinical stage 4. The median CD4 T cells is 560 cells mm3. The median VLs of patients was 0.90 log10 RNA copies/ml. Of the 34 patients in virological failure, 8 (23.5%) are minimal failure, 23 (67.7%) in moderate failure and 3 (8.8%) in severe failure. According to the Pearson’s test, VLs at 6th months were highly correlated with that of inclusion, with V75 and K70 mutations for NRTIs, with V108 mutation for NNRTI well as the virological failure of treatment. Conclusion: Our results confirmed the hypothesis that high Viral Load at the start of the treatment is a poor prognosis for the development of therapy. Transmitted mutations are involved in treatment failure.展开更多
Purpose: To assess prevalence of and risk factors for conjunctival colonization and types of organisms among adults undergoing elective intraocular surgery. Setting: Ha’Emek Medical Center, Afula, Israel. Methods: A ...Purpose: To assess prevalence of and risk factors for conjunctival colonization and types of organisms among adults undergoing elective intraocular surgery. Setting: Ha’Emek Medical Center, Afula, Israel. Methods: A prospective study conducted in the Ophthalmology Department at Ha’Emek Medical Center, Afula, Israel between May 1, 2006 and August 31, 2007. Included were adults undergoing elective intraocular surgeries. Conjunctival cultures were obtained from the lower fornix, prior to application of prophylactic decolonization treatment and were processed using routine microbiological techniques. Demographic, socioeconomic and medical data of our patient cohort were obtained from all participants. Results: Cultures were obtained from 501 patients. (Mean age 69.7 ± 12.0 years) of whom 52.1% were females. In 208 patients (40.5%) bacteria grew in conjunctival cultures, one type in 175 (34.9%) one, and two types in 28 (5.6%). In none fungi were isolated. Coagulase negative Staphylococcus was the most frequent bacteria isolated. By multivariate analysis, significant risk factors for conjunctival bacterial colonization were spring/summer seasons (OR 1.64, CI 1.15 - 2.36, P < 0.007), and showering on the day of the operation (OR 1.73, CI 1.11 - 2.69, P < 0.01). Conclusions: In addition to previously known risk factors for conjunctival microorganism colonization, the present study found showering on the morning of the operation, possibly related to bacteria on towels or in the eyelids and lashes, and time of year (spring/summer) perhaps resulting from higher temperature and humidity related to the presence of conjunctival bacteria to be significant in adults undergoing intraocular surgery.展开更多
Prosthetic joint infection is a rare manifestation of Yersinia enterocolitica. We report a case of a patient presenting with fever and a purulent infection in his prosthetic knee joint caused by Y. enterocolitica. He ...Prosthetic joint infection is a rare manifestation of Yersinia enterocolitica. We report a case of a patient presenting with fever and a purulent infection in his prosthetic knee joint caused by Y. enterocolitica. He had been operated in 1990 for arthrosis of the right knee. Re-operation was performed in 2007 for loosening of the prosthesis. Seven months later, following progressively increasing knee pain, he became acutely febrile and a purulent knee joint infection was diagnosed. Y. enterocolitica was isolated from the joint fluid. Serum antibodies against Y. enterocolitica were also positive. He was treated with debridement, replacement of the liner component of the prosthesis and a long course of intravenous antimicrobial therapy. The infection was thought to be in a chronic suppressive state. The final outcome after all therapy was good.展开更多
The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019(COVID-19)during the pandemic.Candidemia was the most frequently re...The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019(COVID-19)during the pandemic.Candidemia was the most frequently reported invasive fungal co-infection.The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients.Additionally,Candida invasive infections in COVID-19 patients were more often linked to invasive procedures(e.g.,invasive mechanical ventilation or renal replacement therapy)during the intensive care stay and the severity of illness rather than more“classic”risk factors present in patients without COVID-19(e.g.,underlying diseases and prior hospitalization).Moreover,apart from the increased incidence of candidemia during the pandemic,a worrying rise in fluconazole-resistant strains was reported,including a rise in the multidrug-resistant Candida auris.Regarding outcomes,the development of invasive Candida co-infection had a negative impact,increasing morbidity and mortality compared to non-co-infected COVID-19 patients.In this narrative review,we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp.in critically ill COVID-19 patients.展开更多
Background:The aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life.Methods:We conducted a monocentric transversal pilot study on healthy ch...Background:The aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life.Methods:We conducted a monocentric transversal pilot study on healthy children younger than 6 months in order to define the oropharyngeal carriage rate.Participants were recruited between December 2013 and September 2015 among children without symptoms or signs of invasive infections.Results:We demonstrated an oropharyngeal carriage rate of 0.67% in children younger than 6 months.Due to the really low carriage rate,it was not possible to draw statistically significant conclusion about any other characteristic of our population.Conclusions:The present study suggests that the oropharyngeal carriage of Kingella kingae among a Swiss population of healthy infants younger than 6 months is exceptional.The scarcity of colonization and disease in the early months of life suggests thus that defense against mucosai carriage and invasive infection is above all provided by vertically acquired immunity.Limited exposure of the neonates due to limited social contacts may also represent another factor avoiding neonates'mucosal Kingella kingae carriage.展开更多
Carbapenem-resistant Enterobacteriaceae(CRE)have spread worldwide as a global threat and CRE infection is associated with a significant mortality.However,data on epidemiology and treatment of CRE infection in children...Carbapenem-resistant Enterobacteriaceae(CRE)have spread worldwide as a global threat and CRE infection is associated with a significant mortality.However,data on epidemiology and treatment of CRE infection in children are comparatively lacking.[1]Therefore,we retrospectively conducted a matched case-control study to summarize the epidemiological characteristics,risk factors,treatment,and outcomes of nosocomial CRE infections in a children patient population,and also to identify the antimicrobial resistance and resistance genotyping of CRE isolates.展开更多
Dear Editor,Arboviruses of medical importance are maintained in nature in enzootic cycles between haematogenous vectors and susceptible vertebrate hosts(Huang et al.,2019).The rapid increase in human populations aroun...Dear Editor,Arboviruses of medical importance are maintained in nature in enzootic cycles between haematogenous vectors and susceptible vertebrate hosts(Huang et al.,2019).The rapid increase in human populations around the globe and the associated urbanization are creating irreversible damage to the ecosystem,giving rise to many problems including emergence and intensification of the vector borne diseases(Sutherst,2004).Among vector borne diseases,mosquito-borne arboviruses including dengue virus(DENV),West Nile virus(WNV),Japanese Encephalitis virus(JEV)and Zika virus(ZIKV)are rapidly emerging in the affected regions of the world(Palmer et al.,2011).展开更多
ABSTRACT Introduction:Antimicrobial resistance has become a major public health threat globally.The prevalence of multidrug-resistant(MDR)bacterial infections increased substantially among inpatients under 18 years of...ABSTRACT Introduction:Antimicrobial resistance has become a major public health threat globally.The prevalence of multidrug-resistant(MDR)bacterial infections increased substantially among inpatients under 18 years of age in recent years.In Zhejiang Province,China,the trends of drug-resistance in non-adult patients from 2014 to 2019 were monitored,aiming to determine the variation patterns and epidemiological features of MDR strains.展开更多
基金supported by Recep Tayyip Erdogan University Research Fund Grants BAP-2013.102.03.12 and BAP-2013.102.03.13.
文摘Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integrons and antibiotic susceptibility of clinical isolates of P. aeruginosa. Two hundred and five P. aeruginosa strains were collected from the seven general state hospitals in Turkey. They were characterized by antimicrobial susceptibility testing, screened for class 1 and class 2 integrons, and evaluated for the association between antibiotic resistance phenotypes and the presence of integrons. intI gene was amplified in 10 isolates (4.87%) by PCR and in seven isolates of them (70%) were found different gene cassettes. The aadA gene integrated into the class 1 integrons was most frequently found and it was followed by aac genes and blaOXA family genes. Sequence analysis of variable regions of the class 1 integrons showed five gene cassette arrays;aadA1(99%), aac(3)-Id(82%)-orf-aac(3”)-Ia(99%), aac(3)-Ie(83%)-blaoxa10(100%)- aadA1 (100%), aadA6(99%, 100%), aac(6’)-I(97%)-orf-aadA2(99%). No class 2 integron was detected. This study is the first multicenter study for class 1 integrons and it indicates the low rate of presence of class 1 gene cassette in P. aeruginosa.
文摘Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease(CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases.
基金Supported by Recep Tayyip Erdogan University(Grant No.BAP2012.102.03.4.and BAP-2013.102.03.4)
文摘Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of 281 A.baumannii clinical isolates were collected from nine diferenl state hospitals in Turkey and were confirmed as A.baumannU by conventional biochemical,API testing and bla_(-OXA-51)specific PCR.The isolates were examined by PCR for existence of class I and2 integron gene cassettes.Results:They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin(90.03%),ciprofloxacin(87.54%),cefepime and trimethoprim/sulfamethoxazole(81.13%).The lowest resistance rates was for cefotaxime(3.55%).class 1 integrons were detected in 6.4%(18/281)of A.baumannii strains and no class 2 integron was detected.The gene casselles of class 1 inlegrons AacCI-AAC(3)l-aadAI,AacCI-aadA1,AAC(3)-I,AAC(3)-I-AAC(3)-I-aadA1,TEM-1.AAC(3)-I-aadA1-AAC(3)-I-AAC(3)-I,AAC(3)-I-AAC(3)-I-AAC(3)-I-aadA1,AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I,AAC(3)-I-aadA1-AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains.The aac genes family were most frequently found integrated into the class 1 inlegrons and it was followed by aadA genes and TEM-1 genes.Conclusions:This is an extensive study on the distribulion of class 1 integron among A.baumannii in Turkey.In addition to these,two new alleles were observed.Their percentage rates of similarity to other cassettes are 95%aadA1(TK A18)and 89%,aadA 1(ANKA3).
基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(grant number ZYLX201813).
文摘Importance Hypervirulent variants of Klebsiella pneumoniae(hvKp)are capable of causing life-threatening pyogenic liver abscesses(PLAs),but hvKp caused PLAs was seldom reported in pediatric populations.Hence,there is an urgent need to raise our awareness of this phenomenon in pediatric populations.Objective This study aimed to report the clinical characteristics of hvKp that caused fatal PLA complicated by bacteremia in an adolescent and further identify the microbiological and genomic features of the causative strain.Methods A 14-year-old boy with diabetes mellitus was admitted to our hospital with a diagnosis of PLA complicated by bacteremia.A hypermucoviscous hvKp strain,KPN_19-106,was isolated from the drainage fluid present within the liver abscess cavity and blood.The hypermucoviscosity phenotype of the causative strain was determined by string test.Its virulence was measured using serum resistance assay and Galleria mellonella larvae-killing assay.Antimicrobial susceptibility was determined by broth microdilution method.Genetic information was obtained by whole-genome sequencing and bioinformatics analysis.Results KPN_19-106 belonged to sequence type 380 and serotype K2 and exhibited stronger serum resistance and higher in vivo lethality than the well-characterized hvKp NTUH-K2044 strain.Although KPN_19-106 is susceptible to most antibiotics,no sign of improvement was observed during treatment with such drugs.Whole-genome sequencing revealed that the isolate had integrated multiple mobile genetic elements related to virulence.Interpretation Antibiotic-susceptible hvKp can cause fatal PLA complicated by bacteremia in adolescents,with no improvement during antimicrobial therapy.The causative strain in this case had integrated multiple virulence genes and thus exhibited higher virulence both in vitro and in vivo when compared with NTUH-K2044.
文摘Background: Intubated patients are particularly at risk of developing infections caused by these pathogens, specifically, P. aeruginosa and A. baumannii. In the past fifteen years, Carbapenems were known to be the drugs of choice for these bacteria. With the increase in the use and misuse of antibiotics, these bacteria became highly resistant, and almost all available antibiotics, including Carbapenems, became inefficient. Synergistic combination therapy may be a useful strategy in slowing as well as overcoming the emergence of resistance. The aim of this study was to evaluate the anti-bacterial activity on P. aeruginosa and A. baumannii of the combination of two antibiotics: Colistin and a Carbapenem (Meropenem or Imipenem). Methods: The antibacterial activity was assessed by determining the MIC. Then, the effect of combining the antibiotics was studied using the Checkerboard Technique described by White et al., 1996. The Fractional Inhibitory Concentration (FIC) for each strain was then calculated and classified as synergy, additive, indifference or antagonism. 11 strains of A. baumannii and 11 strains of P. aeruginosa were tested in the presence of Meropenem combined with Colistin or Imipenem combined with Colistin. Results: For the combination of Meropenem and Colistin, 6 strains of A. baumannii and 3 strains of P. aeruginosa showed synergy while 5 strains of A. baumannii and 7 strains of P. aeruginosa showed additive effect, only 1 strain of P. aeruginosa showed antagonism. For Imipenem and Colistin, only 1 strain of A. baumannii and 3 strains of Pseudomonas showed synergy while 8 strains of Acinetobacter and 8 strains of Pseudomonas showed additive effect. Conclusion: The “in vitro” combination Colistin-Carbapenem is associated with an improvement in MIC. In the majority of the cases, this improvement suggests a synergistic combination or an additive effect.
文摘AIM: To evaluate GenoT ype methicillin-resistant Staphylococcus aureus(MRSA) Direct assay and cultivation for the identification of MRSA by using mec A polymerase chain reaction(PCR) as the "gold standard" assay.METHODS: In total of 61 nasal specimens from patients at the intensive care unit were studied by GenoType MRSA Direct test, conventional culture method and automated bacterial identification system. The results of Geno Type MRSA Direct assay were compared to conventional culture method the identification of MRSA and mec A gene PCR as the "gold standard" method. The sensitivity, specificity, positive predictive value and negative predictive value were calculated.RESULTS: In total, 61 specimens were studied. Fiftyfour specimens(88.5%) were negative by all three methods. Six swabs(9.8%) were found positive by GenoT ype MRSA Direct test, conventional culture method and automated bacterial identification system. The presence of mec A in these strains was confirmed by PCR. One swab sample was negative for culture meth-ods but MRSA and mecA gene were detected by GenoType MRSA Direct test and mec A PCR respectively. GenoT ype MRSA Direct test had a sensitivity of 100%(6/6) and a specificity of 100%(55/55), with a positive predictive value of 100% and a negative predictive value of 98%. Culture method of MRSA had a sensitivity of 83.3%(5/6) and a specificity of 98.2%(55/56). CONCLUSION: It was found that the GenoT ype MRSA Direct assay, which is a rapid and accurate test, is of the same sensitivity and specificity with mec A PCR. The GenoT ype MRSA Direct assay can be a better tool for rapid and accurate detection of MRSA in diagnostic laboratories.
文摘Background: Genetic diversity of human immunodeficiency virus affects the treatment and the emergence of resistance. Some subtypes would develop resistance more frequently than others. The aim of this study is to determine the rate of virological treatment failure and the involvement of genetic diversity and different mutations in this failure in Kinshasa. Methods: Of the 153 Antiretroviral-naive patients who were included in the cohort, 138 patients have been received for the appointment of the 6th month. Clinical parameters were recorded on individual patient charts. The determination of Viral Load (VL) was done at the Laboratory of Molecular Biology. Clinical and biological parameters of the 6th month were compared with those taken at baseline of the cohort to determine the evolution of patients under treatment. Results: At the consultation of the 6th month, 138 patients (90.2%) had returned out of the 153 included. Eighty-one (58.7%) patients were women and 57 (41.3%) men. The age of patients is between 18 and 65 with an average of 37 years. Ten deaths (6.5%) and 5 (3.3%) lost have been reported. One hundred twenty-five patients (90.5%) were in clinical stage 3 and 13 (9.5%) in clinical stage 4. The median CD4 T cells is 560 cells mm3. The median VLs of patients was 0.90 log10 RNA copies/ml. Of the 34 patients in virological failure, 8 (23.5%) are minimal failure, 23 (67.7%) in moderate failure and 3 (8.8%) in severe failure. According to the Pearson’s test, VLs at 6th months were highly correlated with that of inclusion, with V75 and K70 mutations for NRTIs, with V108 mutation for NNRTI well as the virological failure of treatment. Conclusion: Our results confirmed the hypothesis that high Viral Load at the start of the treatment is a poor prognosis for the development of therapy. Transmitted mutations are involved in treatment failure.
文摘Purpose: To assess prevalence of and risk factors for conjunctival colonization and types of organisms among adults undergoing elective intraocular surgery. Setting: Ha’Emek Medical Center, Afula, Israel. Methods: A prospective study conducted in the Ophthalmology Department at Ha’Emek Medical Center, Afula, Israel between May 1, 2006 and August 31, 2007. Included were adults undergoing elective intraocular surgeries. Conjunctival cultures were obtained from the lower fornix, prior to application of prophylactic decolonization treatment and were processed using routine microbiological techniques. Demographic, socioeconomic and medical data of our patient cohort were obtained from all participants. Results: Cultures were obtained from 501 patients. (Mean age 69.7 ± 12.0 years) of whom 52.1% were females. In 208 patients (40.5%) bacteria grew in conjunctival cultures, one type in 175 (34.9%) one, and two types in 28 (5.6%). In none fungi were isolated. Coagulase negative Staphylococcus was the most frequent bacteria isolated. By multivariate analysis, significant risk factors for conjunctival bacterial colonization were spring/summer seasons (OR 1.64, CI 1.15 - 2.36, P < 0.007), and showering on the day of the operation (OR 1.73, CI 1.11 - 2.69, P < 0.01). Conclusions: In addition to previously known risk factors for conjunctival microorganism colonization, the present study found showering on the morning of the operation, possibly related to bacteria on towels or in the eyelids and lashes, and time of year (spring/summer) perhaps resulting from higher temperature and humidity related to the presence of conjunctival bacteria to be significant in adults undergoing intraocular surgery.
基金supported by the Turku University Hospital and the Anne and Rauno Puolimatka Foundation.
文摘Prosthetic joint infection is a rare manifestation of Yersinia enterocolitica. We report a case of a patient presenting with fever and a purulent infection in his prosthetic knee joint caused by Y. enterocolitica. He had been operated in 1990 for arthrosis of the right knee. Re-operation was performed in 2007 for loosening of the prosthesis. Seven months later, following progressively increasing knee pain, he became acutely febrile and a purulent knee joint infection was diagnosed. Y. enterocolitica was isolated from the joint fluid. Serum antibodies against Y. enterocolitica were also positive. He was treated with debridement, replacement of the liner component of the prosthesis and a long course of intravenous antimicrobial therapy. The infection was thought to be in a chronic suppressive state. The final outcome after all therapy was good.
文摘The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019(COVID-19)during the pandemic.Candidemia was the most frequently reported invasive fungal co-infection.The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients.Additionally,Candida invasive infections in COVID-19 patients were more often linked to invasive procedures(e.g.,invasive mechanical ventilation or renal replacement therapy)during the intensive care stay and the severity of illness rather than more“classic”risk factors present in patients without COVID-19(e.g.,underlying diseases and prior hospitalization).Moreover,apart from the increased incidence of candidemia during the pandemic,a worrying rise in fluconazole-resistant strains was reported,including a rise in the multidrug-resistant Candida auris.Regarding outcomes,the development of invasive Candida co-infection had a negative impact,increasing morbidity and mortality compared to non-co-infected COVID-19 patients.In this narrative review,we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp.in critically ill COVID-19 patients.
文摘Background:The aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life.Methods:We conducted a monocentric transversal pilot study on healthy children younger than 6 months in order to define the oropharyngeal carriage rate.Participants were recruited between December 2013 and September 2015 among children without symptoms or signs of invasive infections.Results:We demonstrated an oropharyngeal carriage rate of 0.67% in children younger than 6 months.Due to the really low carriage rate,it was not possible to draw statistically significant conclusion about any other characteristic of our population.Conclusions:The present study suggests that the oropharyngeal carriage of Kingella kingae among a Swiss population of healthy infants younger than 6 months is exceptional.The scarcity of colonization and disease in the early months of life suggests thus that defense against mucosai carriage and invasive infection is above all provided by vertically acquired immunity.Limited exposure of the neonates due to limited social contacts may also represent another factor avoiding neonates'mucosal Kingella kingae carriage.
文摘Carbapenem-resistant Enterobacteriaceae(CRE)have spread worldwide as a global threat and CRE infection is associated with a significant mortality.However,data on epidemiology and treatment of CRE infection in children are comparatively lacking.[1]Therefore,we retrospectively conducted a matched case-control study to summarize the epidemiological characteristics,risk factors,treatment,and outcomes of nosocomial CRE infections in a children patient population,and also to identify the antimicrobial resistance and resistance genotyping of CRE isolates.
基金The study was exempted from ethical approval by the Institutional Review Board of Aga Khan University(Ref#2019-0488-2928).
文摘Dear Editor,Arboviruses of medical importance are maintained in nature in enzootic cycles between haematogenous vectors and susceptible vertebrate hosts(Huang et al.,2019).The rapid increase in human populations around the globe and the associated urbanization are creating irreversible damage to the ecosystem,giving rise to many problems including emergence and intensification of the vector borne diseases(Sutherst,2004).Among vector borne diseases,mosquito-borne arboviruses including dengue virus(DENV),West Nile virus(WNV),Japanese Encephalitis virus(JEV)and Zika virus(ZIKV)are rapidly emerging in the affected regions of the world(Palmer et al.,2011).
文摘ABSTRACT Introduction:Antimicrobial resistance has become a major public health threat globally.The prevalence of multidrug-resistant(MDR)bacterial infections increased substantially among inpatients under 18 years of age in recent years.In Zhejiang Province,China,the trends of drug-resistance in non-adult patients from 2014 to 2019 were monitored,aiming to determine the variation patterns and epidemiological features of MDR strains.
