BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that ...BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that catalyse the degradation of the betalactam ring of penicillins and cephalosporins(but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBLEnterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United States.CASE SUMMARY The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words "appendiceal abscesses" and "ESBL Escherichia coli(E. coli)" revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis whodeveloped a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for postappendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.CONCLUSION Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.展开更多
Background The extended-spectrum beta-lactamase （ESBL）-producing Klebsiella pneumoniae has increasingly become a major contributor to nosocomial infections and can exhibit multiple antibiotic resistance.Previous stu...Background The extended-spectrum beta-lactamase （ESBL）-producing Klebsiella pneumoniae has increasingly become a major contributor to nosocomial infections and can exhibit multiple antibiotic resistance.Previous studies have focused on the resistance genes in ESBL-producing strains,and the resistance-associated genetic environment of non-ESBL-producing strains has been ignored until now.Here,we investigated the occurrence and characteristics of non-ESBL-producing K.pneumoniae,which potentially carries unexpressed resistance genes.Methods K.pneumoniae strains were collected from five medical institutions in China from February 2010 to August 2013.The VITEK-2 ESBL detection system was used as a primary screen to identify the ESBL-producing phenotype,and the three primary types of ESBL-associated genes （CTX,SHV,and TEM） were detected by polymerase chain reaction （PCR） to confirm the strains presenting with a non-ESBL-producing phenotype.mRNA expression in the non-ESBL-producing strains was further screened by reverse-transcription PCR （RT-PCR） to validate their transcriptional efficiency.Results Out of 224 clinically isolated antibiotic-sensitive K.pneumoniae strains with a non-ESBL-producing phenotype,5 （2.2％） were identified to carry inactivated ESBL blaSHV genes with intact upstream promoter regions and resistance gene sequences.Interestingly,three of the five antibiotic-sensitive K.pneumoniae strains containing ESBL blaSHV genes still exhibited mRNA transcription of blasHv,while the other two exhibited no mRNA transcription.Conclusion These findings suggest that inactivated ESBL genes exist in non-ESBL-producing antibiotic-sensitive K.pneumoniae strains,which have the potential to transform the strain into an ESBL phenotype if an inappropriate application or overdose of antibiotics is implemented during clinical management.展开更多
目的:评估β-内酰胺类与氟喹诺酮类抗菌药物治疗成人社区获得性肺炎(community-acquired pneumonia,CAP)的有效性与经济性,为临床合理用药提供依据。方法:回顾性分析2023年7月至2024年6月安徽医科大学第一附属医院北区呼吸与危重症医学...目的:评估β-内酰胺类与氟喹诺酮类抗菌药物治疗成人社区获得性肺炎(community-acquired pneumonia,CAP)的有效性与经济性,为临床合理用药提供依据。方法:回顾性分析2023年7月至2024年6月安徽医科大学第一附属医院北区呼吸与危重症医学科757例CAP患者病历。按治疗方案分为β-内酰胺类组(A组,382例)和氟喹诺酮类组(B组,375例)。采用倾向性评分匹配控制混杂因素,匹配后每组各171例。有效性分析采用Cox比例风险回归模型及亚组分析;经济性评价通过TreeAge Pro 2022构建决策树模型进行成本—效果分析,并进行敏感性分析验证稳健性。结果:A组有效率为84.80%(145/171),B组为86.55%(148/171)。Cox回归显示B组临床有效率高于A组(HR=1.42,95%CI:1.10~1.84,P=0.01)。亚组分析提示年龄与治疗措施存在交互作用(P<0.01)。在≥65岁人群中两组疗效差异无统计学意义(HR=0.91,P=0.76),而在<65岁人群中B组更具统计学意义上的优势(HR=1.81,P<0.01)。经济性分析显示,B组期望成本为300.89元,低于A组的1221.62元;增量成本效果比为–3392.89元/QALD,低于意愿支付阈值。敏感性分析结果一致。结论:氟喹诺酮类抗菌药物治疗CAP在整体人群(尤其<65岁患者)中临床有效率更高且更具经济性,可作为特定人群的理想选择。展开更多
文摘BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that catalyse the degradation of the betalactam ring of penicillins and cephalosporins(but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBLEnterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United States.CASE SUMMARY The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words "appendiceal abscesses" and "ESBL Escherichia coli(E. coli)" revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis whodeveloped a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for postappendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.CONCLUSION Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.
文摘Background The extended-spectrum beta-lactamase （ESBL）-producing Klebsiella pneumoniae has increasingly become a major contributor to nosocomial infections and can exhibit multiple antibiotic resistance.Previous studies have focused on the resistance genes in ESBL-producing strains,and the resistance-associated genetic environment of non-ESBL-producing strains has been ignored until now.Here,we investigated the occurrence and characteristics of non-ESBL-producing K.pneumoniae,which potentially carries unexpressed resistance genes.Methods K.pneumoniae strains were collected from five medical institutions in China from February 2010 to August 2013.The VITEK-2 ESBL detection system was used as a primary screen to identify the ESBL-producing phenotype,and the three primary types of ESBL-associated genes （CTX,SHV,and TEM） were detected by polymerase chain reaction （PCR） to confirm the strains presenting with a non-ESBL-producing phenotype.mRNA expression in the non-ESBL-producing strains was further screened by reverse-transcription PCR （RT-PCR） to validate their transcriptional efficiency.Results Out of 224 clinically isolated antibiotic-sensitive K.pneumoniae strains with a non-ESBL-producing phenotype,5 （2.2％） were identified to carry inactivated ESBL blaSHV genes with intact upstream promoter regions and resistance gene sequences.Interestingly,three of the five antibiotic-sensitive K.pneumoniae strains containing ESBL blaSHV genes still exhibited mRNA transcription of blasHv,while the other two exhibited no mRNA transcription.Conclusion These findings suggest that inactivated ESBL genes exist in non-ESBL-producing antibiotic-sensitive K.pneumoniae strains,which have the potential to transform the strain into an ESBL phenotype if an inappropriate application or overdose of antibiotics is implemented during clinical management.
文摘目的:评估β-内酰胺类与氟喹诺酮类抗菌药物治疗成人社区获得性肺炎(community-acquired pneumonia,CAP)的有效性与经济性,为临床合理用药提供依据。方法:回顾性分析2023年7月至2024年6月安徽医科大学第一附属医院北区呼吸与危重症医学科757例CAP患者病历。按治疗方案分为β-内酰胺类组(A组,382例)和氟喹诺酮类组(B组,375例)。采用倾向性评分匹配控制混杂因素,匹配后每组各171例。有效性分析采用Cox比例风险回归模型及亚组分析;经济性评价通过TreeAge Pro 2022构建决策树模型进行成本—效果分析,并进行敏感性分析验证稳健性。结果:A组有效率为84.80%(145/171),B组为86.55%(148/171)。Cox回归显示B组临床有效率高于A组(HR=1.42,95%CI:1.10~1.84,P=0.01)。亚组分析提示年龄与治疗措施存在交互作用(P<0.01)。在≥65岁人群中两组疗效差异无统计学意义(HR=0.91,P=0.76),而在<65岁人群中B组更具统计学意义上的优势(HR=1.81,P<0.01)。经济性分析显示,B组期望成本为300.89元,低于A组的1221.62元;增量成本效果比为–3392.89元/QALD,低于意愿支付阈值。敏感性分析结果一致。结论:氟喹诺酮类抗菌药物治疗CAP在整体人群(尤其<65岁患者)中临床有效率更高且更具经济性,可作为特定人群的理想选择。
