Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers.Methods:Antibiotic susceptibility testing was performed by agar diffusio...Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers.Methods:Antibiotic susceptibility testing was performed by agar diffusion and agar dilution methods,resistance genes were identified by PCR and sequencing,and molecular typing of isolates was carried out by enterobacterial repetitive intergenic consensus-PCR(ERIC-PCR).Results:Among 125 tested isolates,117(93.6% ) were multidrug-resistant.of which 94(75.2% ) were imipenem resistant.The bla_(ADC)and bla_(OXA-51-like) genes were detected in all isolates,in association with ISAba I sequence in 84% and 8% (imipenem resistant) of isolates,respectively.The bla_(OXA-23-like) and bla_(OXA-24-like)carbapenemase genes were delected in 67.02% and 20.21% of imipenem-resistant isolates,respectively.The bla_(OXA-23-like) gene is linked to ISAba1 or ISAba4 elements.The metallo-β-lactamase NDM-1 gene was found in 10(10.6% ) imipenem-resisianl strains from three hospitals,it is linked to ISAba125 clement in nine strains.Extended spectrum β-lactamases production was not detected.Imipenem and cefotaxime resistance phenolypes could not be transferred to Escherichia coli by conjugation.Outer membrane protein CarO gene was not delected in four imipenem-resisianl isolates.The aac(6')-1b.sul1,sul2,tetA and tetB genes were present in 5.31% .36.17% .77.65% .1.06% and 65.92% of strains,respectively.Class 1 integrons were detected in 23.4% strains.KRIC-PCR typing showed a genetic diversity among bla_(OXA-23-like) and bla_(OXA-24-like) positive strains,while clonality was observed among bla_(NDM-1)positives.Conclusions:This study highlighted the high prevalence of imipenem resistance in Acinetobacter baumannii in Algiers hospitals mediated mainly by bla_(OXA-23-like),bla_(OXA-24-like),and bla_(NDM-1) genes.展开更多
AIM： To reveal the expression of multidrug-resistance associated proteins： glutathione-S-transferase π（GSTπ）, P-glycoprotein（P-gp） and vault protein lung resistance protein（LRP） in retinoblastoma（RB） witho...AIM： To reveal the expression of multidrug-resistance associated proteins： glutathione-S-transferase π（GSTπ）, P-glycoprotein（P-gp） and vault protein lung resistance protein（LRP） in retinoblastoma（RB） without any conservative treatment before primary enucleation and to correlate this expression with histopathological tumor features. METHODS： A total of 42 specimens of RB undergone primary enucleation were selected for the research. Sections from the formalin-fixed, paraffin-embedded specimens were stained with HE and immunohistochemistry to detect the expression of GSTπ, P-gp and LRP.RESULTS： GSTπ was expressed in 39/42（92.86%） RBs and in 9/9（100%） well-differentiated RBs. P-gp/GSTπ was found in 30（71.42%） of 42 RBs. Totally 9（21.43%） tumors were well differentiated and 33（78.57%） were poorly differentiated. Totally 15（35.71%） eyes had optic nerve（ON） tumor invasion, 36（85.71%） had choroidal tumor invasion, and 14（33.33%） had simultaneous choroidal and ON invasion. There was no statistically significant relationship between P-gp, GSTπ, LRP positivity and the degree of ocular layer tumor invasion and ON tumor invasion（P〉0.05）. CONCLUSION： RB intrinsically expresses GSTπ, P-gp and LRP. GSTπ expression is positive in 100% welldifferentiation ones, so in which way it is correlated with differentiation. But the other two proteins expressions are not related to tumor differentiation and to the degree of tumor invasion. GSTπ may be a new target of chemotherapy in RB.展开更多
Staphylococcus aureus is major human pathogen causing large variety of infections worldwide. This study carried out to isolate S. aureus from different clinical cases, also detection of MRSA prevalence and VRSA emerge...Staphylococcus aureus is major human pathogen causing large variety of infections worldwide. This study carried out to isolate S. aureus from different clinical cases, also detection of MRSA prevalence and VRSA emergence, in addition to shedding light on strains that have to be multidrug resistance against various antibiotics, The clinical samples were collected from AI-Jumhuory Teaching Hospital patients in Mosul, isolates identification were achieved by conventional procedures including biochemical and physiological tests, and the specific latex agglutination test. The sensitivity pattern achieved by using disk diffusion technique, for MRSA and VRSA detection oxacillin-disk （1 μg） and vancomycin-disk （30 μg） were used respectively. Results revealed, among 17 S. aureus isolates, 7 （41%） were mostly isolated from patients with wound and burn infections. Isolates had high resistance rate against ampicillin （100%） and cefotaxime （81%）, and lower resistance rate against several antibiotics. MRSA was 88% of total isolates, 93.3% of MRSA were multidrug resistance to 3-9 of antibiotics. Six isolates （40%） of MRSA were VRSA. It is concluded that antibiotics other than vancomycin can be used as anti-MRSA agents after a sensitivity test to prevent the prevalence of VRSA, the major cause of this chemotherapy problems maybe irrational and indiscriminate use of broad-spectrum antibiotics.展开更多
Objective: To explore the roles of intracellular pH value (pHi) and sodium-hydrogen exchanger isoform-1 (NHE-1) in the mechanism of multidrug resistance of leukemia cells. Methods: Multidrug resistant cell line HL-60 ...Objective: To explore the roles of intracellular pH value (pHi) and sodium-hydrogen exchanger isoform-1 (NHE-1) in the mechanism of multidrug resistance of leukemia cells. Methods: Multidrug resistant cell line HL-60 induced by doxorubicin(DOX) (called as HL-60/DOX cells) and their parent cell line HL-60 were employed as experiment group and control group. The proliferation and chemosensitivity of the cells were studied by MTT assay, and the expression of multidrug resistance protein (MRP) was detected by immol/Lunocytochemistry. Meanwhile, pHi was measured by spectrofluorometery with a fluorescence dye BCECF-AM. Based on the pHi recovery curve after intracellular acid loading, the activity of NHE-1 was analyzed. The expression of NHE-1 mRNA and MRP mRNA were determined by semi-quantitative RT-PCR. Cell apoptosis was observed with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL), and apoptotic DNA was extracted and electrophoresed. Results: ① The IC 50 values for DOX, MTZ, VCR and homoharringtonine(HT), in HL-60/DOX cells were significantly higher than those in HL-60 cells (P<0.01). HL-60/DOX cells expressed abundant MRP, but HL-60 cells did not. ② pHi of HL-60/DOX cells were significantly higher than that of HL-60 cells(P<0.001). The expression and activity of NHE-1 in HL-60/DOX cells were significantly stronger than those of HL-60 cells. ③After administration of the specific NHE-1 inhibitor dimethyl amiloride (DMA) at a certain range of concentrations, compared with HL-60 cells, the rate of growth inhibition of HL-60/DOX cells increased significantly (P<0.05), the drug-sensitivity of HL-60/DOX cells was significantly sensitive (P<0.01), the expression of MRP and MRP mRNA decreased significantly (P<0.01), the apoptosis rate increased significantly (P<0.01). Conclusion: NHE-1 is involved in the drug-resistant mechanisms of multidrug-resistant HL-60 cells induced by DOX. The specific NHE-1 inhibitor DMA can partly reverse the multidrug resistance of HL-60 cells induced by DOX.展开更多
BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly lead...BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear.Clarifying this relationship may help deter-mine the prognostic significance of colonization in these patients.AIM To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODS This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center(2018-2024).Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission.Outcomes analyzed included MDRO infection during ICU stay,concordance between colonizing and infecting strains,organ support requirements,and 28-day transplant free survival.Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTS Nearly one-third(29.9%)of patients were colonized with MDROs on admission,more commonly in the acute-onchronic liver failure phenotype than those with acute decompensation(34.5 vs 10.0%,P=0.033).Although infections were established in the majority(85%)of cases,of which 17.6%due to MDROs,colonization alone did not independently predict these infections[odds ratio(OR)=2.18,P=0.383]nor influenced short-term mortality(OR=1.14,P=0.813).However,once MDRO infection occurred,an 82%concordance was observed between colonizing and infecting strains.MDRO infections,unlike colonization,significantly increased the need for organsupport interventions,including mechanical ventilation and vasopressor therapy and prolonged ICU stays.Only severity of organ dysfunction,quantified by the Sequential Organ Failure Assessment score,independently predicted 28-day mortality(OR=1.38,P=0.024).CONCLUSION MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis,particularly those with acute-on-chronic liver failure.While colonization alone does not predict infection or early mortality,its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected.Ultimately,short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.展开更多
BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli...BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,theχ2 test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.展开更多
Enterotoxigenic E.coli is one of the bacterial pathogens contributing to the global resistance crisis in public health and animal husbandry.The problem of antibiotic resistance is becoming more and more serious,and ph...Enterotoxigenic E.coli is one of the bacterial pathogens contributing to the global resistance crisis in public health and animal husbandry.The problem of antibiotic resistance is becoming more and more serious,and phage is con-sidered one of the potential alternatives to antibiotics that could be utilized to treat bacterial infections.Our study isolated and identified a lytic phage PGX1 against multidrug-resistant enterotoxigenic E.coli EC6 strain from sew-age.The phage lysis profile revealed that PGX1 exhibited a lytic effect on multidrug-resistant enterotoxigenic E.coli strains of serotype O60.Through phage whole genome sequencing and bioinformatics analysis,PGX1 was found to be the class Caudoviricetes,family Autographiviridae,genus Teseptimavirus.The length of the PGX1 genome is about 37,009 bp,containing 54 open reading frames(ORFs).Notably,phage PGX1 lacks any lysogenic-related genes or virulence genes.Furthermore,phage PGX1 demonstrates strong adaptability,tolerance,and stability in various pH(pH4-10)and temperatures(4–40°C).The in vivo and in vitro tests demonstrated that phage PGX1 significantly removes and inhibits the formation of multidrug-resistant EC6 biofilm and effectively controls the Galleria mel-lonella larvae and enterotoxigenic E.coli EC6 during mice infection.In conclusion,the above findings demonstrated that phage PGX1 may be a novel antimicrobial agent to control multidrug-resistant E.coli infections.展开更多
BACKGROUND Intensive care unit(ICU)patients are critically ill and have low immunity.They will undergo various trauma medical procedures during diagnosis and treatment.The use of high-dose hormones and broad-spectrum ...BACKGROUND Intensive care unit(ICU)patients are critically ill and have low immunity.They will undergo various trauma medical procedures during diagnosis and treatment.The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients.Therefore,it is necessary to explore the causes of nosocomial infection in ICU and provide basis for the prevention and control of nosocomial infection in ICU.AIM To explore major pathogens of nosocomial infection in ICUs,methods of detection and drug resistance trends.METHODS Risk factors of multidrug-resistant infection were analyzed to provide a basis for clinical rational use of antimicrobial drugs in the ICU.These findings were used to standardize rational use of antimicrobial agents.BD PhoenixTM100 automatic bacterial identification analyzer was used to for cell identification in specimens collected from the ICU between January 2016 and December 2019.Drug sensitivity tests were carried out and drug resistance trends were analyzed using the optical disc diffusion method.Odds ratios and corresponding 95%CI of independent variables were calculated using a logistic regression model.Backward elimination(trend=0.1)was used as an inclusion criterion for multivariate analysis.All data were analyzed using SPSS version 22.0,and P<0.05 was considered statistically significant.RESULTS We collected 2070 samples from ICU patients between January 2016 and December 2019.Sample types comprised sputum(1139 strains,55.02%),blood(521 strains,25.17%),and drainage fluid(117 strains,5.65%).A total of 1051 strains of major pathogens,including Acinetobacter baumannii,Escherichia coli(E.coli),Pseudomonas aeruginosa(P.aeruginosa),Klebsiella pneumoniae(K.pneumoniae)and Staphylococcus aureus,were detected,with a detection rate of 35.97%(378/1051).Most of these strains were resistant to antibiotics.Detection rate of E.coli was 21.79%(229/1051),and it was generally sensitive to many antimicrobial drugs.Detection rate of P.aeruginosa was 24.74%(260/1051),and showed low sensitivity to most antibiotics.Detection rate of K.pneumoniae was 9.42%(99/1051),which was generally resistant to multiple antimicrobial drugs and resistant forms.K.pneumoniae was resistant to imipenem for approximate 4 years,and showed a 19.9%(19/99)and 20.20%(20/99)rate of meropenem resistance.Logistic analysis showed that mechanical ventilation and ureteral intubation were risk factors for multidrug-resistant bacterial infections.CONCLUSION This study showed a high incidence of ICU infections.Mechanical ventilation and urine tube intubation were risk factors for infection with multidrug-resistant bacteria.展开更多
Multidrug-resistant （MDR） bacterial infection is a common complication of severe acute pancreatitis （SAP）. This study aimed to explore the association between human leukocyte antigen-antigen D-related （HLA-DR） e...Multidrug-resistant （MDR） bacterial infection is a common complication of severe acute pancreatitis （SAP）. This study aimed to explore the association between human leukocyte antigen-antigen D-related （HLA-DR） expression and multidrug-resistant infection in patients with SAP. A total of 24 SAP patients who were admitted to Nanjing Drum Tower Hospital between May 2015 and December 2016 were enrolled in the study. The percentages of CD4^＋, CD8^＋, natural killer （NK）, and HLA-DR （CD14＋） cells and the CD4^＋/CD8^＋ cell ratio on days 1, 7, 14, and 28 after admission were determined by flow cytometry. Eighteen patients presented with the symptoms of infection. Among them, 55.6% patients （10/18） developed MDR infection. The most common causative MDR organisms were Enterobacter cloacae and Acinetobacter baumannii. The CD4＋/CD8＋ cell ratio and the percentage of NK cells were similar between patients with non-MDR and patients with MDR infections. In patients without infection, the HLA-DR percentage was maintained at a high level throughout the 28 days. Compared to the patients without any infection, the HLA-DR percentage in patients with non-MDR infection was reduced on day 1 but increased and reached similar levels on day 28. In patients with MDR infection, the HLA-DR percentage remained below normal levels at all-time points. It was concluded that persistent down-regulation of HLA-DR expression is associated with MDR bacterial infection in patients with SAP.展开更多
Dear Editor： The emergence of multidrug-resistant tuberculosis （MDR-TB） is bringing new challenges. MDR-TB is caused by Mycobacterium tuberculosis （M. tuberculosis） that is resistant to isoniazid and rifampicin,...Dear Editor： The emergence of multidrug-resistant tuberculosis （MDR-TB） is bringing new challenges. MDR-TB is caused by Mycobacterium tuberculosis （M. tuberculosis） that is resistant to isoniazid and rifampicin, with or with- out resistance to other anti-tuberculosis drugs. Approximately 450,000 people developed MDR-TB worldwide in 2012 and an estimated 170,000 people died from the disease. Bacterial burden is not strictly corre- lated with disease progression, and several hallmarks of severe tuberculosis suggest that insufficiently controlled inflammation plays an important role in pathogenesis.展开更多
Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adu...Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adults with multidrug-resistant tuberculosis(MDR-TB)in China.Methods A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years.The model parameter data were synthesized from the literature,the national TB surveillance information system,and consultation with experts.The incremental cost-effectiveness ratio(ICER)of BR vs.CR was determined.Results BR(vs.CR)had a higher sputum culture conversion rate and cure rate and prevented many premature deaths(decreased by 12.8%),thereby obtaining more quality-adjusted life years(QALYs)(increased by 2.31 years).The per capita cost in BR was as high as 138,000 yuan,roughly double that of CR.The ICER for BR was 33,700 yuan/QALY,which was lower than China's 1×per capita Gross Domestic Product(GDP)in 2020(72,400 yuan).Conclusion BR is shown to be cost effective.When the unit price of Bedaquiline reaches or falls below57.21 yuan per unit,BR is expected to be the dominant strategy in China over CR.展开更多
Bacterial biofilms,especially those caused by multidrug-resistant bacteria,have emerged as one of the greatest dangers to global public health.The acceleration of antimicrobial resistance to conventional an-tibiotics ...Bacterial biofilms,especially those caused by multidrug-resistant bacteria,have emerged as one of the greatest dangers to global public health.The acceleration of antimicrobial resistance to conventional an-tibiotics and the severe lack of new drugs necessitates the development of novel agents for biofilm eradication.Photodynamic therapy(PDT)is a promising non-antibiotic method for treating bacterial infections.However,its application in biofilm eradication is hampered by the hypoxic microenvironment of biofilms and the physical protection of extracellular polymeric substances.In this study,we develop a composite nanoplatform with oxygen(O_(2))self-supplying and heat-sensitizing capabilities to improve the PDT efficacy against biofilms.CaO_(2)/ICG@PDA nanoparticles(CIP NPs)are fabricated by combining calcium peroxide(CaO_(2))with the photosensitizer indocyanine green(ICG)via electrostatic interactions,followed by coating with polydopamine(PDA).The CIP NPs can gradually generate O_(2)in response to the acidic microenvironment of the biofilm,thereby alleviating its hypoxic state.Under near-infrared(NIR)irradiation,the nanoplatform converts O_(2)into a significant amount of singlet oxygen(^(1)O_(2))and heat to eradicate biofilm.The generated heat enhances the release of O_(2),accelerates the generation of^(1)O_(2)in PDT,increases cell membrane permeability,and increases bacterial sensitivity to^(1)O_(2).This nanoplatform significantly improves the efficacy of PDT in eradicating biofilm-dwelling bacteria without fostering drug resistance.Experiments on biofilm eradication demonstrate that this nanoplatform can eradicate over 99.9999%of methicillin-resistant Staphylococcus aureus(MRSA)biofilms under 5-min NIR irradiation.Notably,these integrated advantages enable the system to promote the healing of MRSA biofilm-infected wounds with negligible toxicity in vivo,indicating great promise for overcoming the obstacles associated with bacterial biofilm eradication.展开更多
Background:Tuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment. Particularly multidrug-resistant tuberculosis is becoming a major threa...Background:Tuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment. Particularly multidrug-resistant tuberculosis is becoming a major threat to tuberculosis control programs in Ethiopia which seriously threatens the control and prevention efforts and is associated with both high death rates and treatment costs. Methods: A case-control study was conducted to assess risk factors and characteristics of MDR-TB cases at ALERT Hospital, Addis Ababa, Ethiopia, where cases were 167 MDR-TB patients, while controls were newly diagnosed and bacteriologically confirmed pulmonary TB cases of similar number, who were matched by sex and age of 5-years interval. Results: The socio-demographic characteristics of the participants indicated that majority (53.3%) were males and 46.7% females;a little over half of cases (55.1%) were in the age group 26 - 45 years, whereas 46.7% of controls were in this age group. According to the multivariable logistic regression analysis, previous history of hospital admission was the only factor that was identified as predictor which increased risk to develop MDR-TB by almost twenty times (AOR = 19.5;95% CI: 9.17 - 41.62) and P-value of <0.05. All other studied factor such as being unemployed, family size, having member of household member with TB, and history of visiting hospital in past 12 months etc., didn’t show any statistically significant association. Conclusion: The study identified previous history of hospital admission as independent predictors for the occurrence of MDR-TB, while other studied variables didn’t show any strong association. The findings added to the pool of knowledge emphasizing the need for instituting strong infection control practice at health care facilities to prevent nosocomial transmission of MDR-TB.展开更多
Objective: To investigate the antibacterial activities of crude ethanol extracts of 12 Philippine medicinal plants.Methods: Crude ethanol extracts from 12 Philippine medicinal plants were evaluated for their antibacte...Objective: To investigate the antibacterial activities of crude ethanol extracts of 12 Philippine medicinal plants.Methods: Crude ethanol extracts from 12 Philippine medicinal plants were evaluated for their antibacterial activity against methicillin-resistant Staphylococcus aureus, vancomycinresistant Enterococcus, extended spectrum β-lactamase-producing, carbapenem-resistant Enterobacteriaceae and metallo-β-lactamase-producing Pseudomonas aeruginosa and Acinetobacter baumannii. Results: The leaf extracts of Psidium guajava, Phyllanthus niruri, Ehretia microphylla and Piper betle(P. betle) showed antibacterial activity against the Gram-positive methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococcus. P. betle showed the highest antibacterial activity for these bacteria in the disk diffusion(16-33 mm inhibition diameter), minimum inhibitory concentration(19-156 μg/m L) and minimum bactericidal concentration(312 μg/m L) assays. P. betle leaf extracts only showed remarkable antibacterial activity for all the Gram-negative multidrug-resistant bacteria(extended spectrum β-lactamaseproducing, carbapenem-resistant Enterobacteriaceae and metallo-β-lactamase-producing) in the disk diffusion(17-21 mm inhibition diameter), minimum inhibitory concentration(312-625 μg/m L) and minimum bactericidal concentration(312-625 μg/m L) assays. Conclusions: P. betle had the greatest potential value against both Gram-negative and Grampositive multidrug-resistant bacteria. Favorable antagonistic activities were also exhibited by the ethanol extracts of Psidium guajava, Phyllanthus niruri and Ehretia microphylla.展开更多
Objective:To study the clinical efficacy and safety of tigecycline in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)combined with multidrug-resistant Acinetobacter baumannii infecti...Objective:To study the clinical efficacy and safety of tigecycline in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)combined with multidrug-resistant Acinetobacter baumannii infection.Methods:113 patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection were recruited between January 2021 and January 2023,and given tigecycline treatment.The total effective rate,lung function indexes,related biochemical index levels,and the incidence rate of adverse reactions were observed after the treatment.Results:After the treatment,100 patients were cured,1 case with apparent effect,2 cases were effective,10 cases were ineffective,and the total effective rate was 91.15%.The post-treatment CRP(21.22±3.35 mg/L),PCT(3.18±1.11 ng/L),CRE(76.36±9.24μmol/L),and ALT(37.76±6.99 U/L)were significantly improved as compared to the pre-treatment(P<0.05).After treatment,10 cases of vomiting(8.85%),13 cases of nausea(11.50%),4 cases of diarrhea(3.53%),1 case of abdominal pain(0.88%),and 2 cases of allergy(1.77%)were observed in 113 patients.Conclusion:Tigecycline therapy for patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection not only has significant therapeutic efficacy but also has a high degree of safety.展开更多
Traditional photosensitizers show limited singlet oxygen generation in hypoxic infection lesions,which greatly suppress their performance in antibacterial therapy.Meanwhile,there still is lack of feasible design strat...Traditional photosensitizers show limited singlet oxygen generation in hypoxic infection lesions,which greatly suppress their performance in antibacterial therapy.Meanwhile,there still is lack of feasible design strategy for developing hypoxia-overcoming photosensitizers agents.Herein,radical generation ofπ-conjugated small molecules is efficiently manipulated by an individual selenium(Se)substituent.With this strategy,the first proof-of-concept study of a Se-anchored oligo(thienyl ethynylene)(OT-Se)with high-performance superoxide radical(O_(2)^(·-))and hydroxyl radical(·OH)generation capability is present,and achieves efficient antibacterial activities towards the clinically extracted multidrug-resistant bacteria methicillin-resistant S.aureus(MRSA)and carbapenem-resistant E.coli(CREC)at sub-micromolar concentration under a low white light irradiation(30 mW/cm^(2)).The water-dispersible OT-Se shows a good bacteria-anchoring capability,biocompatibility,and complete elimination of multidrug-resistant bacteria wound infection in vivo.This work offers a strategy to boost type-I photodynamic therapy(PDT)performance for efficient antibacterial treatments,advancing the development of antibacterial agents.展开更多
Gastric perforation and tuberculous bronchoesophageal fistula(TBEF) are very rare complications of extrapulmonary tuberculosis(TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multi...Gastric perforation and tuberculous bronchoesophageal fistula(TBEF) are very rare complications of extrapulmonary tuberculosis(TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multidrug-resistant tuberculosis strain in a nonacquired immune deficiency syndrome male patient.The patient underwent total gastrectomy with Rouxen-Y end-to-side esophagojejunostomy and feeding jejunostomy during intravenous treatment with anti-TB medication, and esophageal reconstruction with colonic interposition and jejunocolostomy were performed successfully after a full course of anti-TB medication.Though recent therapies for TBEF have favored medication, patients with severe stenosis or perforation require surgery and medication with anti-TB drugs basedupon adequate culture and drug susceptibility testing.展开更多
In this research,an atmospheric-pressure air plasma is used to inactivate the multidrug-resistant Acinetobacter baumannii in liquid.The efficacy of the air plasma on bacterial deactivation and the cytobiological varia...In this research,an atmospheric-pressure air plasma is used to inactivate the multidrug-resistant Acinetobacter baumannii in liquid.The efficacy of the air plasma on bacterial deactivation and the cytobiological variations after the plasma treatment are investigated.According to colony forming units,nearly all the bacteria（6-log） are inactivated after 10 min of air plasma treatment.However,7% of the bacteria enter a viable but non-culturable state detected by the resazurin based assay during the same period of plasma exposure.Meanwhile,86% of the bacteria lose their membrane integrity in the light of SYTO 9/PI staining assay.The morphological changes in the cells are examined by scanning electron microscopy and bacteria with morphological changes are rare after plasma exposure in the liquid.The concentrations of the long-living RS,such as H2O2,NO3^- and O3,in liquid induced by plasma treatment are measured,and they increase with plasma treatment time.The changes of the intracellular ROS may be related to cell death,which may be attributed to oxidative stress and other damage effects induced by RS plasma generated in liquid.The rapid and effective bacteria inactivation may stem from the RS in the liquid generated by plasma and air plasmas may become a valuable therapy in the treatment of infected wounds.展开更多
Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done ...Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done primarily among at-risk groups. The knowledge of the true extent of the MDR-TB remains a major challenge. This study tries to determine the proportion of MDR-TB in each group of presumptive MDR-TB patients and to identify some associated factors. Methods: This is an analysis of the DRC surveillance between 2007 and 2016. The proportions were expressed in Percentage. The logistic regression permits to identify the associated factors with the RR-/MDR-TB with adjusted Odds-ratio and 95% CI. Significance defined as p ≤ 0.05. Results: Overall, 83% (5407/6512) of the MDR-TB presumptive cases had each a TB test. 86.5% (4676/5407) had each a culture and drug sensitive testing (DST) on solid medium, and 24.3% (1312/5407) had performed an Xpert MTB/RIF test. The proportion of those with at least one first-line drug resistance was 59.3% [95% CI 57.2 - 61.4] among which 50.1%, [95% CI 47.9 - 52.3] for the isoniazid, 45.6% [95% CI 43.4 - 47.8] for the rifampicin, 49.9% [95% CI 47.8 - 52.1] for ethambutol and 35.8% [95% CI 33.7 - 37.9] for streptomycin. The confirmation of MDR-TB was 42.8% [95% CI 38.4 - 47.8]. Combining both tests, the proportion of RR-/MDR-TB was 49.6% [95% CI 47.9 - 51.4] for all presumptives. This proportion was 60.0% for failures, 40.7% for relapses and 34.7% for defaulters. Associated factors with the diagnosis of MDR-TB were: aged less than 35 years;prior treatment failure;defaulters;the delay between the collection of sputum and the test completion. Conclusion: The proportion of RR-/MDR-TB among the presumptives has been higher than those estimated generally. The National tuberculosis programme (NTP) should improve patient follow-up to reduce TB treatment failures and defaulting. Moreover, while increasing the use of molecular tests, they should reduce sample delivery times when they use culture and DST concomitantly.展开更多
Objective:To systematically evaluate the risk factors for multidrug-resistant organisms(MDROs)infection in patients with diabetic foot ulcer(DFU).Methods:The quality assessment of outcome measures was performed by sea...Objective:To systematically evaluate the risk factors for multidrug-resistant organisms(MDROs)infection in patients with diabetic foot ulcer(DFU).Methods:The quality assessment of outcome measures was performed by searching the Web of Science,Embase library,PubMed,Cochrane Library databases and screening the literature on the risk factors of MDROs infection in DFU patients according to the inclusion and exclusion criteria,and meta-analysis was performed using revman5.3 analysis software.Results:13 literature was retrieved,involving in 1715 patients.A total of 15 risk factors were included in the analysis and the meta-analysis showed that Previous hospitalization(OR=2.61,95%CI[1.51,4.52],P=0.0006),Previous antibiotic use(OR=2.17,95%CI[1.24-3.78],P<0.01),Type of diabetes(OR=2.44,95%CI[1.29-4.63],P<0.01),Nature of ulcer(OR=2.16,95%CI[1.06-4.40],P=0.03),Size of ulcer(OR=2.56,95%CI[1.53-4.28],P<0.01),Osteomyelitis(OR=3.50,95%CI[2.37-5.17],P<0.01),Peripheral vascular disease(OR=2.37,95%CI[1.41-3.99],P<0.01),and Surgical treatment(OR=4.81,95%CI[2.95-7.84],P<0.01)were closely associated with MDROs infection in DFU patients.Conclusions:The risk factors of MDROs infection in patients with DFU were previous hospitalization,previous antibiotic use,type of diabetes,nature of ulcer,size of ulcer,osteomyelitis,peripheral vascular disease,and surgical treatment.This study is conducive to early detection of MDROs infection in high-risk groups and timely comprehensive treatment to delay the development of the disease.展开更多
基金supported by grants from National Fund for the Research and National Agency for the Development of Research in Health(Algeria)
文摘Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers.Methods:Antibiotic susceptibility testing was performed by agar diffusion and agar dilution methods,resistance genes were identified by PCR and sequencing,and molecular typing of isolates was carried out by enterobacterial repetitive intergenic consensus-PCR(ERIC-PCR).Results:Among 125 tested isolates,117(93.6% ) were multidrug-resistant.of which 94(75.2% ) were imipenem resistant.The bla_(ADC)and bla_(OXA-51-like) genes were detected in all isolates,in association with ISAba I sequence in 84% and 8% (imipenem resistant) of isolates,respectively.The bla_(OXA-23-like) and bla_(OXA-24-like)carbapenemase genes were delected in 67.02% and 20.21% of imipenem-resistant isolates,respectively.The bla_(OXA-23-like) gene is linked to ISAba1 or ISAba4 elements.The metallo-β-lactamase NDM-1 gene was found in 10(10.6% ) imipenem-resisianl strains from three hospitals,it is linked to ISAba125 clement in nine strains.Extended spectrum β-lactamases production was not detected.Imipenem and cefotaxime resistance phenolypes could not be transferred to Escherichia coli by conjugation.Outer membrane protein CarO gene was not delected in four imipenem-resisianl isolates.The aac(6')-1b.sul1,sul2,tetA and tetB genes were present in 5.31% .36.17% .77.65% .1.06% and 65.92% of strains,respectively.Class 1 integrons were detected in 23.4% strains.KRIC-PCR typing showed a genetic diversity among bla_(OXA-23-like) and bla_(OXA-24-like) positive strains,while clonality was observed among bla_(NDM-1)positives.Conclusions:This study highlighted the high prevalence of imipenem resistance in Acinetobacter baumannii in Algiers hospitals mediated mainly by bla_(OXA-23-like),bla_(OXA-24-like),and bla_(NDM-1) genes.
基金Supported by the National Natural Science Foundation of China(No.30371515)
文摘AIM： To reveal the expression of multidrug-resistance associated proteins： glutathione-S-transferase π（GSTπ）, P-glycoprotein（P-gp） and vault protein lung resistance protein（LRP） in retinoblastoma（RB） without any conservative treatment before primary enucleation and to correlate this expression with histopathological tumor features. METHODS： A total of 42 specimens of RB undergone primary enucleation were selected for the research. Sections from the formalin-fixed, paraffin-embedded specimens were stained with HE and immunohistochemistry to detect the expression of GSTπ, P-gp and LRP.RESULTS： GSTπ was expressed in 39/42（92.86%） RBs and in 9/9（100%） well-differentiated RBs. P-gp/GSTπ was found in 30（71.42%） of 42 RBs. Totally 9（21.43%） tumors were well differentiated and 33（78.57%） were poorly differentiated. Totally 15（35.71%） eyes had optic nerve（ON） tumor invasion, 36（85.71%） had choroidal tumor invasion, and 14（33.33%） had simultaneous choroidal and ON invasion. There was no statistically significant relationship between P-gp, GSTπ, LRP positivity and the degree of ocular layer tumor invasion and ON tumor invasion（P〉0.05）. CONCLUSION： RB intrinsically expresses GSTπ, P-gp and LRP. GSTπ expression is positive in 100% welldifferentiation ones, so in which way it is correlated with differentiation. But the other two proteins expressions are not related to tumor differentiation and to the degree of tumor invasion. GSTπ may be a new target of chemotherapy in RB.
文摘Staphylococcus aureus is major human pathogen causing large variety of infections worldwide. This study carried out to isolate S. aureus from different clinical cases, also detection of MRSA prevalence and VRSA emergence, in addition to shedding light on strains that have to be multidrug resistance against various antibiotics, The clinical samples were collected from AI-Jumhuory Teaching Hospital patients in Mosul, isolates identification were achieved by conventional procedures including biochemical and physiological tests, and the specific latex agglutination test. The sensitivity pattern achieved by using disk diffusion technique, for MRSA and VRSA detection oxacillin-disk （1 μg） and vancomycin-disk （30 μg） were used respectively. Results revealed, among 17 S. aureus isolates, 7 （41%） were mostly isolated from patients with wound and burn infections. Isolates had high resistance rate against ampicillin （100%） and cefotaxime （81%）, and lower resistance rate against several antibiotics. MRSA was 88% of total isolates, 93.3% of MRSA were multidrug resistance to 3-9 of antibiotics. Six isolates （40%） of MRSA were VRSA. It is concluded that antibiotics other than vancomycin can be used as anti-MRSA agents after a sensitivity test to prevent the prevalence of VRSA, the major cause of this chemotherapy problems maybe irrational and indiscriminate use of broad-spectrum antibiotics.
文摘Objective: To explore the roles of intracellular pH value (pHi) and sodium-hydrogen exchanger isoform-1 (NHE-1) in the mechanism of multidrug resistance of leukemia cells. Methods: Multidrug resistant cell line HL-60 induced by doxorubicin(DOX) (called as HL-60/DOX cells) and their parent cell line HL-60 were employed as experiment group and control group. The proliferation and chemosensitivity of the cells were studied by MTT assay, and the expression of multidrug resistance protein (MRP) was detected by immol/Lunocytochemistry. Meanwhile, pHi was measured by spectrofluorometery with a fluorescence dye BCECF-AM. Based on the pHi recovery curve after intracellular acid loading, the activity of NHE-1 was analyzed. The expression of NHE-1 mRNA and MRP mRNA were determined by semi-quantitative RT-PCR. Cell apoptosis was observed with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL), and apoptotic DNA was extracted and electrophoresed. Results: ① The IC 50 values for DOX, MTZ, VCR and homoharringtonine(HT), in HL-60/DOX cells were significantly higher than those in HL-60 cells (P<0.01). HL-60/DOX cells expressed abundant MRP, but HL-60 cells did not. ② pHi of HL-60/DOX cells were significantly higher than that of HL-60 cells(P<0.001). The expression and activity of NHE-1 in HL-60/DOX cells were significantly stronger than those of HL-60 cells. ③After administration of the specific NHE-1 inhibitor dimethyl amiloride (DMA) at a certain range of concentrations, compared with HL-60 cells, the rate of growth inhibition of HL-60/DOX cells increased significantly (P<0.05), the drug-sensitivity of HL-60/DOX cells was significantly sensitive (P<0.01), the expression of MRP and MRP mRNA decreased significantly (P<0.01), the apoptosis rate increased significantly (P<0.01). Conclusion: NHE-1 is involved in the drug-resistant mechanisms of multidrug-resistant HL-60 cells induced by DOX. The specific NHE-1 inhibitor DMA can partly reverse the multidrug resistance of HL-60 cells induced by DOX.
基金approved by the Institutional Review Board of the University Hospital Centre Zagreb(Approval No:02/013 AG).
文摘BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear.Clarifying this relationship may help deter-mine the prognostic significance of colonization in these patients.AIM To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODS This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center(2018-2024).Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission.Outcomes analyzed included MDRO infection during ICU stay,concordance between colonizing and infecting strains,organ support requirements,and 28-day transplant free survival.Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTS Nearly one-third(29.9%)of patients were colonized with MDROs on admission,more commonly in the acute-onchronic liver failure phenotype than those with acute decompensation(34.5 vs 10.0%,P=0.033).Although infections were established in the majority(85%)of cases,of which 17.6%due to MDROs,colonization alone did not independently predict these infections[odds ratio(OR)=2.18,P=0.383]nor influenced short-term mortality(OR=1.14,P=0.813).However,once MDRO infection occurred,an 82%concordance was observed between colonizing and infecting strains.MDRO infections,unlike colonization,significantly increased the need for organsupport interventions,including mechanical ventilation and vasopressor therapy and prolonged ICU stays.Only severity of organ dysfunction,quantified by the Sequential Organ Failure Assessment score,independently predicted 28-day mortality(OR=1.38,P=0.024).CONCLUSION MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis,particularly those with acute-on-chronic liver failure.While colonization alone does not predict infection or early mortality,its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected.Ultimately,short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.
文摘BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,theχ2 test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.
基金supported by grants from the National Program on Key Research Project of China[2022YFD1800800,2021YFD1800300]the Yingzi Tech&Huazhong Agricultural University Intelligent Research Institute of Food Health[No.IRIFH202209,No.IRIFH202301]The National Program on Key Research Project of China,2022YFD1800800,Ping Qian,2021YFD1800300,Ping Qian,The Yingzi Tech&Huazhong Agricultural University Intelligent Research Institute of Food Health,IRIFH202209,Ping Qian,IRIFH202301,Ping Qian.
文摘Enterotoxigenic E.coli is one of the bacterial pathogens contributing to the global resistance crisis in public health and animal husbandry.The problem of antibiotic resistance is becoming more and more serious,and phage is con-sidered one of the potential alternatives to antibiotics that could be utilized to treat bacterial infections.Our study isolated and identified a lytic phage PGX1 against multidrug-resistant enterotoxigenic E.coli EC6 strain from sew-age.The phage lysis profile revealed that PGX1 exhibited a lytic effect on multidrug-resistant enterotoxigenic E.coli strains of serotype O60.Through phage whole genome sequencing and bioinformatics analysis,PGX1 was found to be the class Caudoviricetes,family Autographiviridae,genus Teseptimavirus.The length of the PGX1 genome is about 37,009 bp,containing 54 open reading frames(ORFs).Notably,phage PGX1 lacks any lysogenic-related genes or virulence genes.Furthermore,phage PGX1 demonstrates strong adaptability,tolerance,and stability in various pH(pH4-10)and temperatures(4–40°C).The in vivo and in vitro tests demonstrated that phage PGX1 significantly removes and inhibits the formation of multidrug-resistant EC6 biofilm and effectively controls the Galleria mel-lonella larvae and enterotoxigenic E.coli EC6 during mice infection.In conclusion,the above findings demonstrated that phage PGX1 may be a novel antimicrobial agent to control multidrug-resistant E.coli infections.
基金Supported by Drug resistance trend analysis and prevention and control of main pathogens in tertiary hospitals of Hebei Provincial Department of health,No.20210845Analysis of drug and drug resistance trend and prevention and control of pathogens in major general hospitals of Baoding science and technology support plan project,No.17zf79.
文摘BACKGROUND Intensive care unit(ICU)patients are critically ill and have low immunity.They will undergo various trauma medical procedures during diagnosis and treatment.The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients.Therefore,it is necessary to explore the causes of nosocomial infection in ICU and provide basis for the prevention and control of nosocomial infection in ICU.AIM To explore major pathogens of nosocomial infection in ICUs,methods of detection and drug resistance trends.METHODS Risk factors of multidrug-resistant infection were analyzed to provide a basis for clinical rational use of antimicrobial drugs in the ICU.These findings were used to standardize rational use of antimicrobial agents.BD PhoenixTM100 automatic bacterial identification analyzer was used to for cell identification in specimens collected from the ICU between January 2016 and December 2019.Drug sensitivity tests were carried out and drug resistance trends were analyzed using the optical disc diffusion method.Odds ratios and corresponding 95%CI of independent variables were calculated using a logistic regression model.Backward elimination(trend=0.1)was used as an inclusion criterion for multivariate analysis.All data were analyzed using SPSS version 22.0,and P<0.05 was considered statistically significant.RESULTS We collected 2070 samples from ICU patients between January 2016 and December 2019.Sample types comprised sputum(1139 strains,55.02%),blood(521 strains,25.17%),and drainage fluid(117 strains,5.65%).A total of 1051 strains of major pathogens,including Acinetobacter baumannii,Escherichia coli(E.coli),Pseudomonas aeruginosa(P.aeruginosa),Klebsiella pneumoniae(K.pneumoniae)and Staphylococcus aureus,were detected,with a detection rate of 35.97%(378/1051).Most of these strains were resistant to antibiotics.Detection rate of E.coli was 21.79%(229/1051),and it was generally sensitive to many antimicrobial drugs.Detection rate of P.aeruginosa was 24.74%(260/1051),and showed low sensitivity to most antibiotics.Detection rate of K.pneumoniae was 9.42%(99/1051),which was generally resistant to multiple antimicrobial drugs and resistant forms.K.pneumoniae was resistant to imipenem for approximate 4 years,and showed a 19.9%(19/99)and 20.20%(20/99)rate of meropenem resistance.Logistic analysis showed that mechanical ventilation and ureteral intubation were risk factors for multidrug-resistant bacterial infections.CONCLUSION This study showed a high incidence of ICU infections.Mechanical ventilation and urine tube intubation were risk factors for infection with multidrug-resistant bacteria.
基金This work was supported by the National Natural Science Foundation of China （No. 81701953）.
文摘Multidrug-resistant （MDR） bacterial infection is a common complication of severe acute pancreatitis （SAP）. This study aimed to explore the association between human leukocyte antigen-antigen D-related （HLA-DR） expression and multidrug-resistant infection in patients with SAP. A total of 24 SAP patients who were admitted to Nanjing Drum Tower Hospital between May 2015 and December 2016 were enrolled in the study. The percentages of CD4^＋, CD8^＋, natural killer （NK）, and HLA-DR （CD14＋） cells and the CD4^＋/CD8^＋ cell ratio on days 1, 7, 14, and 28 after admission were determined by flow cytometry. Eighteen patients presented with the symptoms of infection. Among them, 55.6% patients （10/18） developed MDR infection. The most common causative MDR organisms were Enterobacter cloacae and Acinetobacter baumannii. The CD4＋/CD8＋ cell ratio and the percentage of NK cells were similar between patients with non-MDR and patients with MDR infections. In patients without infection, the HLA-DR percentage was maintained at a high level throughout the 28 days. Compared to the patients without any infection, the HLA-DR percentage in patients with non-MDR infection was reduced on day 1 but increased and reached similar levels on day 28. In patients with MDR infection, the HLA-DR percentage remained below normal levels at all-time points. It was concluded that persistent down-regulation of HLA-DR expression is associated with MDR bacterial infection in patients with SAP.
文摘Dear Editor： The emergence of multidrug-resistant tuberculosis （MDR-TB） is bringing new challenges. MDR-TB is caused by Mycobacterium tuberculosis （M. tuberculosis） that is resistant to isoniazid and rifampicin, with or with- out resistance to other anti-tuberculosis drugs. Approximately 450,000 people developed MDR-TB worldwide in 2012 and an estimated 170,000 people died from the disease. Bacterial burden is not strictly corre- lated with disease progression, and several hallmarks of severe tuberculosis suggest that insufficiently controlled inflammation plays an important role in pathogenesis.
基金supported by The National 13th Five-year Mega-Scientific Projects of Infectious Diseases in China[Grant Number:2017ZX10201302001004]。
文摘Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adults with multidrug-resistant tuberculosis(MDR-TB)in China.Methods A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years.The model parameter data were synthesized from the literature,the national TB surveillance information system,and consultation with experts.The incremental cost-effectiveness ratio(ICER)of BR vs.CR was determined.Results BR(vs.CR)had a higher sputum culture conversion rate and cure rate and prevented many premature deaths(decreased by 12.8%),thereby obtaining more quality-adjusted life years(QALYs)(increased by 2.31 years).The per capita cost in BR was as high as 138,000 yuan,roughly double that of CR.The ICER for BR was 33,700 yuan/QALY,which was lower than China's 1×per capita Gross Domestic Product(GDP)in 2020(72,400 yuan).Conclusion BR is shown to be cost effective.When the unit price of Bedaquiline reaches or falls below57.21 yuan per unit,BR is expected to be the dominant strategy in China over CR.
基金supported by the National Natural Science Foundation of China(No.22175125)the Natural Science Foundation of the Jiangsu Higher Education Institutions of China(No.21KJA150008)the Key Laboratory of Polymeric Materials De-sign and Synthesis for Biomedical Function,Soochow University,and the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD).
文摘Bacterial biofilms,especially those caused by multidrug-resistant bacteria,have emerged as one of the greatest dangers to global public health.The acceleration of antimicrobial resistance to conventional an-tibiotics and the severe lack of new drugs necessitates the development of novel agents for biofilm eradication.Photodynamic therapy(PDT)is a promising non-antibiotic method for treating bacterial infections.However,its application in biofilm eradication is hampered by the hypoxic microenvironment of biofilms and the physical protection of extracellular polymeric substances.In this study,we develop a composite nanoplatform with oxygen(O_(2))self-supplying and heat-sensitizing capabilities to improve the PDT efficacy against biofilms.CaO_(2)/ICG@PDA nanoparticles(CIP NPs)are fabricated by combining calcium peroxide(CaO_(2))with the photosensitizer indocyanine green(ICG)via electrostatic interactions,followed by coating with polydopamine(PDA).The CIP NPs can gradually generate O_(2)in response to the acidic microenvironment of the biofilm,thereby alleviating its hypoxic state.Under near-infrared(NIR)irradiation,the nanoplatform converts O_(2)into a significant amount of singlet oxygen(^(1)O_(2))and heat to eradicate biofilm.The generated heat enhances the release of O_(2),accelerates the generation of^(1)O_(2)in PDT,increases cell membrane permeability,and increases bacterial sensitivity to^(1)O_(2).This nanoplatform significantly improves the efficacy of PDT in eradicating biofilm-dwelling bacteria without fostering drug resistance.Experiments on biofilm eradication demonstrate that this nanoplatform can eradicate over 99.9999%of methicillin-resistant Staphylococcus aureus(MRSA)biofilms under 5-min NIR irradiation.Notably,these integrated advantages enable the system to promote the healing of MRSA biofilm-infected wounds with negligible toxicity in vivo,indicating great promise for overcoming the obstacles associated with bacterial biofilm eradication.
文摘Background:Tuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment. Particularly multidrug-resistant tuberculosis is becoming a major threat to tuberculosis control programs in Ethiopia which seriously threatens the control and prevention efforts and is associated with both high death rates and treatment costs. Methods: A case-control study was conducted to assess risk factors and characteristics of MDR-TB cases at ALERT Hospital, Addis Ababa, Ethiopia, where cases were 167 MDR-TB patients, while controls were newly diagnosed and bacteriologically confirmed pulmonary TB cases of similar number, who were matched by sex and age of 5-years interval. Results: The socio-demographic characteristics of the participants indicated that majority (53.3%) were males and 46.7% females;a little over half of cases (55.1%) were in the age group 26 - 45 years, whereas 46.7% of controls were in this age group. According to the multivariable logistic regression analysis, previous history of hospital admission was the only factor that was identified as predictor which increased risk to develop MDR-TB by almost twenty times (AOR = 19.5;95% CI: 9.17 - 41.62) and P-value of <0.05. All other studied factor such as being unemployed, family size, having member of household member with TB, and history of visiting hospital in past 12 months etc., didn’t show any statistically significant association. Conclusion: The study identified previous history of hospital admission as independent predictors for the occurrence of MDR-TB, while other studied variables didn’t show any strong association. The findings added to the pool of knowledge emphasizing the need for instituting strong infection control practice at health care facilities to prevent nosocomial transmission of MDR-TB.
基金Supported by Philippine Council for Health Research and Development of the Department of Science and Technology(Grant No.2015PHD1)
文摘Objective: To investigate the antibacterial activities of crude ethanol extracts of 12 Philippine medicinal plants.Methods: Crude ethanol extracts from 12 Philippine medicinal plants were evaluated for their antibacterial activity against methicillin-resistant Staphylococcus aureus, vancomycinresistant Enterococcus, extended spectrum β-lactamase-producing, carbapenem-resistant Enterobacteriaceae and metallo-β-lactamase-producing Pseudomonas aeruginosa and Acinetobacter baumannii. Results: The leaf extracts of Psidium guajava, Phyllanthus niruri, Ehretia microphylla and Piper betle(P. betle) showed antibacterial activity against the Gram-positive methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococcus. P. betle showed the highest antibacterial activity for these bacteria in the disk diffusion(16-33 mm inhibition diameter), minimum inhibitory concentration(19-156 μg/m L) and minimum bactericidal concentration(312 μg/m L) assays. P. betle leaf extracts only showed remarkable antibacterial activity for all the Gram-negative multidrug-resistant bacteria(extended spectrum β-lactamaseproducing, carbapenem-resistant Enterobacteriaceae and metallo-β-lactamase-producing) in the disk diffusion(17-21 mm inhibition diameter), minimum inhibitory concentration(312-625 μg/m L) and minimum bactericidal concentration(312-625 μg/m L) assays. Conclusions: P. betle had the greatest potential value against both Gram-negative and Grampositive multidrug-resistant bacteria. Favorable antagonistic activities were also exhibited by the ethanol extracts of Psidium guajava, Phyllanthus niruri and Ehretia microphylla.
文摘Objective:To study the clinical efficacy and safety of tigecycline in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)combined with multidrug-resistant Acinetobacter baumannii infection.Methods:113 patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection were recruited between January 2021 and January 2023,and given tigecycline treatment.The total effective rate,lung function indexes,related biochemical index levels,and the incidence rate of adverse reactions were observed after the treatment.Results:After the treatment,100 patients were cured,1 case with apparent effect,2 cases were effective,10 cases were ineffective,and the total effective rate was 91.15%.The post-treatment CRP(21.22±3.35 mg/L),PCT(3.18±1.11 ng/L),CRE(76.36±9.24μmol/L),and ALT(37.76±6.99 U/L)were significantly improved as compared to the pre-treatment(P<0.05).After treatment,10 cases of vomiting(8.85%),13 cases of nausea(11.50%),4 cases of diarrhea(3.53%),1 case of abdominal pain(0.88%),and 2 cases of allergy(1.77%)were observed in 113 patients.Conclusion:Tigecycline therapy for patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection not only has significant therapeutic efficacy but also has a high degree of safety.
基金financially supported by the National Natural Science Foundation of China(Nos.82125022,82072383,31800833,21977081,52173135 and 22207024)Zhejiang Provincial Natural Science of Foundation of China(No.LZ19H180001)+1 种基金Wenzhou Medical University(No.KYYW201901)University of Chinese Academy of Science(Nos.WIBEZD2017001-03 and WIUCASYJ2020001)。
文摘Traditional photosensitizers show limited singlet oxygen generation in hypoxic infection lesions,which greatly suppress their performance in antibacterial therapy.Meanwhile,there still is lack of feasible design strategy for developing hypoxia-overcoming photosensitizers agents.Herein,radical generation ofπ-conjugated small molecules is efficiently manipulated by an individual selenium(Se)substituent.With this strategy,the first proof-of-concept study of a Se-anchored oligo(thienyl ethynylene)(OT-Se)with high-performance superoxide radical(O_(2)^(·-))and hydroxyl radical(·OH)generation capability is present,and achieves efficient antibacterial activities towards the clinically extracted multidrug-resistant bacteria methicillin-resistant S.aureus(MRSA)and carbapenem-resistant E.coli(CREC)at sub-micromolar concentration under a low white light irradiation(30 mW/cm^(2)).The water-dispersible OT-Se shows a good bacteria-anchoring capability,biocompatibility,and complete elimination of multidrug-resistant bacteria wound infection in vivo.This work offers a strategy to boost type-I photodynamic therapy(PDT)performance for efficient antibacterial treatments,advancing the development of antibacterial agents.
文摘Gastric perforation and tuberculous bronchoesophageal fistula(TBEF) are very rare complications of extrapulmonary tuberculosis(TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multidrug-resistant tuberculosis strain in a nonacquired immune deficiency syndrome male patient.The patient underwent total gastrectomy with Rouxen-Y end-to-side esophagojejunostomy and feeding jejunostomy during intravenous treatment with anti-TB medication, and esophageal reconstruction with colonic interposition and jejunocolostomy were performed successfully after a full course of anti-TB medication.Though recent therapies for TBEF have favored medication, patients with severe stenosis or perforation require surgery and medication with anti-TB drugs basedupon adequate culture and drug susceptibility testing.
基金supported by the Spark Program of the second Affiliated Hospital of Anhui Medical University (Grant No.2015hhjh04)National Natural Science Foundation of China under Grant No.51777206+6 种基金Natural Science Foundation of Anhui Province (Grant No.1708085MA13 and No.1708085MB47)Science Foundation of Institute of Plasma Physics,Chinese Academy of Sciences under Grant (No.DSJJ-14-YY02)City University of Hong Kong Applied Research Grant (ARG) (No.9667144)Hong Kong Research Grants Council (RGC) General Research Funds (GRF) (No.City U 11301215)Doctoral Fund of Ministry of Education of China (No.2017M612058)Specialized Research Fund for the Doctoral Program of Hefei University of Technology (No.JZ2016HGBZ0768)Foundation of Anhui Province Key Laboratory of Medical Physics and Technology (Grant No.LMPT2017Y7BP0U1581)
文摘In this research,an atmospheric-pressure air plasma is used to inactivate the multidrug-resistant Acinetobacter baumannii in liquid.The efficacy of the air plasma on bacterial deactivation and the cytobiological variations after the plasma treatment are investigated.According to colony forming units,nearly all the bacteria（6-log） are inactivated after 10 min of air plasma treatment.However,7% of the bacteria enter a viable but non-culturable state detected by the resazurin based assay during the same period of plasma exposure.Meanwhile,86% of the bacteria lose their membrane integrity in the light of SYTO 9/PI staining assay.The morphological changes in the cells are examined by scanning electron microscopy and bacteria with morphological changes are rare after plasma exposure in the liquid.The concentrations of the long-living RS,such as H2O2,NO3^- and O3,in liquid induced by plasma treatment are measured,and they increase with plasma treatment time.The changes of the intracellular ROS may be related to cell death,which may be attributed to oxidative stress and other damage effects induced by RS plasma generated in liquid.The rapid and effective bacteria inactivation may stem from the RS in the liquid generated by plasma and air plasmas may become a valuable therapy in the treatment of infected wounds.
文摘Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done primarily among at-risk groups. The knowledge of the true extent of the MDR-TB remains a major challenge. This study tries to determine the proportion of MDR-TB in each group of presumptive MDR-TB patients and to identify some associated factors. Methods: This is an analysis of the DRC surveillance between 2007 and 2016. The proportions were expressed in Percentage. The logistic regression permits to identify the associated factors with the RR-/MDR-TB with adjusted Odds-ratio and 95% CI. Significance defined as p ≤ 0.05. Results: Overall, 83% (5407/6512) of the MDR-TB presumptive cases had each a TB test. 86.5% (4676/5407) had each a culture and drug sensitive testing (DST) on solid medium, and 24.3% (1312/5407) had performed an Xpert MTB/RIF test. The proportion of those with at least one first-line drug resistance was 59.3% [95% CI 57.2 - 61.4] among which 50.1%, [95% CI 47.9 - 52.3] for the isoniazid, 45.6% [95% CI 43.4 - 47.8] for the rifampicin, 49.9% [95% CI 47.8 - 52.1] for ethambutol and 35.8% [95% CI 33.7 - 37.9] for streptomycin. The confirmation of MDR-TB was 42.8% [95% CI 38.4 - 47.8]. Combining both tests, the proportion of RR-/MDR-TB was 49.6% [95% CI 47.9 - 51.4] for all presumptives. This proportion was 60.0% for failures, 40.7% for relapses and 34.7% for defaulters. Associated factors with the diagnosis of MDR-TB were: aged less than 35 years;prior treatment failure;defaulters;the delay between the collection of sputum and the test completion. Conclusion: The proportion of RR-/MDR-TB among the presumptives has been higher than those estimated generally. The National tuberculosis programme (NTP) should improve patient follow-up to reduce TB treatment failures and defaulting. Moreover, while increasing the use of molecular tests, they should reduce sample delivery times when they use culture and DST concomitantly.
基金National Natural Science Foundation of China(81973614)。
文摘Objective:To systematically evaluate the risk factors for multidrug-resistant organisms(MDROs)infection in patients with diabetic foot ulcer(DFU).Methods:The quality assessment of outcome measures was performed by searching the Web of Science,Embase library,PubMed,Cochrane Library databases and screening the literature on the risk factors of MDROs infection in DFU patients according to the inclusion and exclusion criteria,and meta-analysis was performed using revman5.3 analysis software.Results:13 literature was retrieved,involving in 1715 patients.A total of 15 risk factors were included in the analysis and the meta-analysis showed that Previous hospitalization(OR=2.61,95%CI[1.51,4.52],P=0.0006),Previous antibiotic use(OR=2.17,95%CI[1.24-3.78],P<0.01),Type of diabetes(OR=2.44,95%CI[1.29-4.63],P<0.01),Nature of ulcer(OR=2.16,95%CI[1.06-4.40],P=0.03),Size of ulcer(OR=2.56,95%CI[1.53-4.28],P<0.01),Osteomyelitis(OR=3.50,95%CI[2.37-5.17],P<0.01),Peripheral vascular disease(OR=2.37,95%CI[1.41-3.99],P<0.01),and Surgical treatment(OR=4.81,95%CI[2.95-7.84],P<0.01)were closely associated with MDROs infection in DFU patients.Conclusions:The risk factors of MDROs infection in patients with DFU were previous hospitalization,previous antibiotic use,type of diabetes,nature of ulcer,size of ulcer,osteomyelitis,peripheral vascular disease,and surgical treatment.This study is conducive to early detection of MDROs infection in high-risk groups and timely comprehensive treatment to delay the development of the disease.
