The Nomogram model was established for the risk assessment of intestinal colonization with neonatal CRKP / 实用医学杂志

Objective To establish a Nomogram model for assessing the risk of intestinal colonization by Carbapenem-Resistant Klebsiella pneumoniae(CRKP)to determine the specific probability of colonization and adopt individualized prevention strategies for the purpose of reducing the occurrence of colonization and secondary infection of neonatal CRKP.Methods A total of 187 neonates hospitalized between January 2021 and October 2022 and diagnosed with CRKP colonization by rectal swab/fecal culture as well drug sensitivity identification 48 h after admission were assigned to the CRKP group.Another 187 neonates without non-CRKP colonization during the same period were set as the non-CRKP group.All the data of the two groups were used for a retrospective analysis.The caret package in R 4.2.1 was used to randomly divide the 374 cases into the model group and validation group at a ratio of 3∶1.Then the glmnet package in R 4.2.1 was used to conduct a LASSO regression analysis over the data from the model group to determine the predictive factors for modeling and the rms software package was used to build a Nomogram model.The pROC and rms packages in R 4.2.1 were used to examine the data,analyzing the consistency indexes(Cindex),receiver operating characteristic curves(ROC),and area under the curves(AUC)and performing the internal and external validation of the efficacy of the Nomogram model via the calibration curves.Results LASSO regression analysis determined eight predictors from the 35 factors probably affecting neonatal CRKP colonization:gender,cesarean section,breastfeeding,nasogastric tube,enema,carbapenems,probiotics,and hospital stay.The Nomogram model constructed using these eight predictors as variables could predict CRKP colonization to a moderate extent,with the area under the ROC curve of 0.835 and 0.800 in the model and validation group,respectively.The Hos-mer-Lemeshow test showed that the predicted probability was highly consistent with the actual probability(the modeling group:P = 0.678>0.05;the validation group:P = 0.208>0.05),presenting a higher degree of fitting.Conclusion The Nomogram model containing such variables as gender,cesarean section,breastfeeding,nasogastric tube,enema,carbapenems,probiotics,and hospital stay is more effective in predicting the risk of neonatal CRKP colonization.Therefore,preventive measures should be individualized based on the colonization probability predicted by the Nomogram model in order to keep neonates from CRKP colonization and reduce the incidence of secondary CRKP infections among them.

Establishment of a method for rapid detection of the minimum inhibitory concentration of imipenem in KPC-producing Klebsiella pneumoniae based on ompK36 mutation / 中华检验医学杂志

Objective:To establish a rapid method to detect the minimum inhibitory concentration (MIC) of imipenem in Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) based on ompK36 gene′s GD mutation. Methods:This was a methodological evaluation study. A total of 258 isolates of Klebsiella pneumoniae were collected from Lishui Municipal Central Hospital from March 2011 to December 2019. Porin gene ompK36 and carbapenemase genes blaKPC, blaNDM, blaIMP and blaOXA-48 were amplified by PCR and confirmed by sequencing. The MIC was detected and confirmed by microbroth dilution susceptibility test, and the corresponding patterns of genotype and MIC were constructed. Based on the patterns, a method for rapid detection of imipenem MIC by real-time fluorescence PCR (RT-PCR) was designed and established. The 159 isolates of non-repetitive Klebsiella pneumoniae collected by Lishui Disease Prevention and Control Center (CDC) from 2017 to 2019 were used for further verification. The sensitivity and specificity were calculated by fourfold table. Kappa test was used to compare the consistency between RT-PCR and microbroth dilution susceptibility test. Results:Among 258 isolates, 109 isolates did not carry carbapenemase gene, 65 isolates carried ompK36 gene GD mutation, 127 isolates carried blaKPC, 15 isolates carried blaNDM, 9 isolates carried blaIMP, and blaOXA-48 was not detected. With mircobroth dilution susceptibility test as the standard, there were 3 corresponding patterns between the drug resistance gene and the imipenem MIC of Kp: when all the 4 carbapenemase genes were negative, MIC≤1 mg/L, the sensitivity was 100% (107/107) and the specificity was 98.4% (125/127); when blaKPC was positive and ompK36 gene GD mutation was negative, 4 mg/L≤MIC≤16 mg/L, the sensitivity was 88.2% (60/68) and the specificity was 98.8% (164/166); when blaKPC and ompK36 gene GD mutation were both positive, MIC≥32 mg/L, the sensitivity was 96.6% (57/59) and the specificity was 96.6% (169/175). RT-PCR detected blaKPC, blaNDM, blaIMP, blaOXA-48 genes accurately.The RT-PCR results of ompK36 gene GD mutation in the KPC-producing isolates were 100% consistent with the sequencing results. In the 159 isolates from Lishui CDC, the sensitivity and specificity of imipenem MIC detected by RT-PCR were higher than 95% in all 3 patterns with mircobroth dilution susceptibility test as the standard, and Kappa value was 0.971. Conclusion:The RT-PCR based on ompK36 gene GD mutation was helpful to quickly determine the MIC range of imipenem in KPC-Kp.

LASSO regression based risk prediction model establishment for Klebsiella pneumonia infection in patients with severe acute pancreatitis / 中华胰腺病杂志

Objective:To construct a risk prediction model for infection with Klebsiella pneumonia (KP) for patients with severe acute pancreatitis (SAP).Methods:Retrospective analysis was done on the clinical data of 109 SAP patients who were admitted to Shanghai General Hospital, between March 2016 and December 2021. Patients were classified into infection group ( n=25) and non-infection group ( n=84) based on the presence or absence of KP infection, and the clinical characteristics of the two groups were compared. The least absolute shrinkage and selection operator (LASSO) algorithm was used to reduce the dimension of the variables with statistical significance in univariate analysis. A nomogram prediction model was created by incorporating the optimized features from the LASSO regression model into the multivariate logistic regression analysis. Receiver operating characteristic curve (ROC) was drawn and the area under curve (AUC) was calculated; and consistency index (C-index) were used to assess the prediction model's diagnostic ability. Results:A total of 25 strains of KP were isolated from 109 patients with SAP, of which 21(84.0%) had multi-drug resistance. 20 risk factors (SOFA score, APACHEⅡ score, Ranson score, MCTSI score, mechanical ventilation time, fasting time, duration of indwelling of the peritoneal drainage tube, duration of deep vein indwelling, number of invasive procedures, without or with surgical intervention, without or with endoscopic retrograde cholangiopancreatography (ERCP), types of high-level antibiotics used, digestion disorders, abnormalities in blood coagulation, metabolic acidosis, pancreatic necrosis, intra-abdominal hemorrhage, intra-abdominal hypertension, length of ICU stay and total length of hospital stay) were found to be associated with KP infection in SAP patients by univariate analysis. The four variables (APACHEⅡ score, duration of indwelling of the peritoneal drainage tube, types of high-level antibiotics used, and total length of hospital stay) were extracted after reduced by LASSO regression. These four variables were found to be risk factors for KP infection in SAP patients by multiple logistic regression analysis (all P value <0.05). Nomogram prediction model for KP infection in SAP was established based on the four variables above. The verification results of the model showed that the C-index of the model was 0.939, and the AUC was 0.939 (95% CI 0.888-0.991), indicating that the nomogram model had relatively accurate prediction ability. Conclusions:This prediction model establishes integrated the basic clinical data of patients, which could facilitate the risk prediction for KP infection in patients with SAP and thus help to formulate better therapeutic plans for patients.

The use of biosynthesized silver nanoparticles from Klebsiella pneumonia as antioxidants and anti-bacterial agents

Aims@#This study was aimed at the biosynthesis of silver nanoparticles (AgNPs) from Klebsiella pneumonia and the evaluation of their anti-bacterial and antioxidant activities. @*Methodology and results@#Silver nitrate was used for the biosynthesis of silver-nanoparticles, and UV-visible spectrophotometer, X-ray diffraction, scanning electron microscope and Fourier transforms infrared spectroscopy were used for the characterization of AgNPs. Results showed colour changes of bacterial supernatant from pale yellow to dark brown, indicating the biosynthesis of AgNPs. The biosynthesis of AgNPs was confirmed using UV-visible spectrophotometry, which shows a strong peak at 420 nm. Infrared spectroscopy was also used, which revealed that the carboxyl and phenolic groups were coated on the surface of AgNPs. The results of the electron microscope scanning showed that AgNPs are spherical and have a size range from 35-100 nm. On the other hand, the antioxidant activity of AgNPs was done in vitro by adding the nanoparticles to the 1,1-Diphenyl-2-picrylhydrazyl (DPPH) solution. The absorbance was measured at 517 nm after 30 min in dark conditions. The results revealed a significant increase (P<0.05) in free radicals reduction at five concentrations of AgNPs (30, 60, 120, 240 and 480 µg/mL). Finally, the antibacterial activity of AgNPs against Escherichia coli and Pseudomonas aeruginosa was studied. The results revealed a significant increase (P<0.05) in the diameter of the inhibition zone of bacterial growth at 200 µg/mL AgNPs compared to the inhibition zone at 50 and 100 µg/mL AgNPs. The minimum inhibitory concentration of AgNPs was determined. It was 30 µg/mL of P. aeruginosa and 16 µg/mL of E. coli.@*Conclusion, significance and impact of study@#The preliminary study results suggest that AgNPs have anti-bacterial activity as well as the ability to inhibit free radicals, making them a potential antioxidant source. However, further research is required.

Investigation of a suspected outbreak of carbapenem-resistant Klebsiella pneumonia infection / 上海预防医学

ObjectiveTo investigate a suspected outbreak of healthcare-associated infection （HAI） caused by carbapenem-resistant Klebsiella pneumonia （CRKP） in a secondary grade-A hospital， analyze the infection source and transmission route， and put forward corresponding preventive and control measures. MethodsEpidemiological investigation was conducted on 5 patients with CRKP infection in department of neurosurgery during December 23‒30， 2021. Specimens were collected with the environmental microbiology monitoring procedure. CRKP isolated from the environmental samples were analyzed by multilocus sequence typing （MLST） method. Comprehensive measures were taken to control the CRKP infection. ResultsThe 5 infected patients were located in 3 rooms， and all were diagnosed as HAI. The antimicrobial susceptibility testing results from the specimens of 3 CRKP infected patients were the same. Through environmental microbiology monitoring， CRKP strains were detected from the faucet handle and sink specimens in 3 rooms. The results of MLST analysis showed that the faucet handle and sink specimens in room 2 and 3 were ST11 type. The environmental specimen in room 1 was ST23 type. The suspected outbreak was effectively controlled after comprehensive interventions. ConclusionHAI suspected outbreak might be caused by the environmental contamination from the pathogens of CRKP-infected patients as well as the contaminated hands of medical staff and accompanying family members. Strengthening the publicity， education and management of medical staff and accompanying staff， early identification of infection outbreaks， and timely comprehensive control measures are the keys to controlling multidrug-resistant nosocomial infection outbreaks.

Clinical characteristics of patients with septated loculations of pyogenic liver abscesses / 中华肝胆外科杂志

Objective:To compare clinical features of patients with pyogenic liver abscesses with and without septated lobulations.Methods:Patients diagnosed to have pyogenic liver abscesses who were treated in our hospital from January 2011 to March 2021 were enrolled into this retrospective study. There were 203 males and 132 females, with age of (56±14) years old. The patients were divided into two groups by findings on computed tomography and ultrasound into the septated lobulation group ( n=68) and the non-septated lobulation group ( n=267). The clinical data of these patients were compared. Results:In the septated lobulation group, the neutrophil count was 9.17(5.97, 12.33)×10 9/L and the TBil was 17.65(11.92, 27.84) μmol/L. These were significantly higher than the corresponding figures of 7.81(5.42, 10.81)×10 9/L, 12.90(9.00, 19.68) μmol/L, respectively in the non-septated lobulation group ( P<0.05). The difference in the maximum diameters of the septated lobulation group was also significantly larger than the non-septated lobulation group ( P=0.032). Additionally, pus culture showed the proportion of Klebsiella pneumoniae positive patients in the septated lobulation group was significantly higher than that in the non-septated lobulation group [41.18% (28/68) vs. 25.84% (69/267), P=0.013]. The use of fluoroquinolones in patients in the septated lobulation group was higher than that in the non-septated lobulation group [20.59% (14/68) vs. 10.11% (27/267), χ 2=5.54, P=0.019]. Conclusion:Compared to patients without septated lobulations, those with septated lobulations had a larger diameter of abscesses, a higher positive rate of Klebsiella pneumoniae on pus culture and a higher proportion of patients receiving fluoroquinolones.

Risk factors for acquisition of ESBL-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator-associated hospital-acquired pneumonia in a tertiary care hospital in Indonesia

Aims@#This study was aimed to identify the risk factors for the acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator hospital-acquired pneumonia (NV-HAP) patients in a tertiary care hospital in Indonesia.@*Methodology and results@#A case-control study was performed between March 31, 2018, and August 31, 2019. Twenty-eight ESBL-producing E. coli and K. pneumoniae isolates and 28 susceptible strains of E. coli and K. pneumoniae obtained from NV-HAP patients were included in this study. Phenotypic screening for ESBL production was performed by the Vitek2 system and subsequently confirmed by double-disk synergy tests. The use of 3rd generation cephalosporin as initial antibiotic therapy for more than three days was the significant risk factor for the acquisition of ESBL-producing E. coli and K. pneumoniae among NV-HAP patients (odds ratio [OR] 41.827; p=0.001). The length of stay of patients with NV-HAP acquiring the ESBL strains was longer than 10 days (OR 17.334; p=0.001).@*Conclusion, significance and impact of study@#The use of 3rd generation cephalosporin as the initial antibiotic for NV-HAP should be restricted to prevent the emergence of ESBL-producing strains. Infection prevention measures are required to control the acquisition of ESBL-producing E. coli and K. pneumoniae in NV-HAP patients.

Severe COVID-19-associated sepsis is different from classical sepsis induced by pulmonary infection with carbapenem-resistant klebsiella pneumonia (CrKP) / 中华创伤杂志(英文版)

PURPOSE@#COVID-19 is also referred to as a typical viral septic pulmonary infection by 2019-nCoV. However, little is known regarding its characteristics in terms of systemic inflammation and organ injury, especially compared with classical bacterial sepsis. This article aims to investigate the clinical characteristics and prognosis between COVID-19-associated sepsis and classic bacterial-induced sepsis.@*METHODS@#In this retrospective cohort study, septic patients with COVID-19 in the intensive care unit (ICU) of a government-designed therapy center in Shenzhen, China between January 14, 2020 and March 10, 2020, and septic patients induced by carbapenem-resistant klebsiella pneumonia (CrKP) admitted to the ICU of the Second People's Hospital of Shenzhen, China between January 1, 2014 and October 30, 2019 were enrolled. Demographic and clinical parameters including comorbidities, critical illness scores, treatment, and laboratory data, as well as prognosis were compared between the two groups. Risk factors for mortality and survival rate were analyzed using multivariable logistic regression and survival curve, respectively.@*RESULTS@#A total of 107 patients with COVID-19 and 63 patients with CrKP were enrolled. A direct comparison between the two groups demonstrated more serious degrees of primary lung injury following 2019-nCoV infection (indicated by lower PaO@*CONCLUSION@#Critical COVID-19 shares clinical characteristics with classical bacterial sepsis, but the degree of systemic inflammatory response, secondary organ damage and mortality rate are less severe. However, following 2019-nCoV infection, the level of immunosuppression may be increased and thus induce in more death at the later stage of patients' hospitalstay.

Absceso hepático, bacteriemia y meningoencefalitis por Klebsiella pneumoniae hipervirulenta en el curso de infección por SARS - CoV2. Reporte de caso

Klebsiella pneumoniae es miembro de la familia de enterobacterias, es un patógeno oportunista que afecta a las personas con compromiso inmune, y es causa de infecciones nosocomiales. Los serotipos capsulares K1 y K2 de Klebsiella pneumoniae tienen la característica de hipermucoviscosa, que es considerada una cepa hipervirulenta. Se presenta el caso de una mujer con absceso hepático, bacteriemia y meningoencefalitis por Klebsiella pneumoniae hipervirulenta, en el curso de una infección por SARS - COV2, quien requirió soporte ventilatorio, vasopresor, tratamiento antibiótico y drenaje percutáneo del absceso en la Unidad de cuidados intensivos del Hospital Cayetano Heredia, logrando sobrevivencia y alta hospitalaria. Este caso nos permite resaltar la presencia de la cepa hipervirulenta de Klebsiella pneumoniae en nuestro país, lo cual nos permitirá realizar una evaluación integral oportuna y tratamiento precoz.

SUMMARY Klebsiella pneumoniae is a member of the family of Enterobacteriaceae, it is an opportunistic pathogen that affects people with immune compromise, and it is the cause of nosocomial infections. The capsular serotypes K1 and K2 of Klebsiella pneumoniae have the characteristic of hypermucoviscosa, which is considered a hypervirulent strain. We present the case of a female patient with liver abscess, bacteremia and hypervirulent Klebsiella pneumoniae meningoencephalitis, in the course of a SARS - CoV2 infection, who required ventilatory support, vasopressor, antibiotic treatment and percutaneous drainage of the abscess in the intensive care unit (ICU) of the Hospital Cayetano Heredia, achieving survival and hospital discharge. This case allows us to highlight the presence of the hypervirulent strain of Klebsiella pneumoniae in our country, which will allow us to carry out a timely comprehensive evaluation and early treatment.

Cistite enfisematosa em paciente idosa após cirurgia / Emphysematous cystitis in an elderly female patient after surgery / Cistitis enfisematosa en paciente anciana después de una cirugía

Objetivo: Relatar o caso de uma paciente não diabética com cistite enfisematosa. Descrição do caso: A seguinte descrição foi aprovada pelo CEP da UNIPAMPA conforme parecer n° 3.459.252. Paciente feminina, 82 anos, não diabética, que havia realizado procedimento cirúrgico. Achados em exames de imagem associados à cultura e exames laboratoriais direcionaram o diagnóstico para cistite enfisematosa. Foi realizado manejo conservador com antibioticoterapia com boa evolução. Conclusão: A cistite enfisematosa é um diagnóstico diferencial que requer alto nível de suspeição em pacientes não diabéticos, sendo o uso de métodos de imagem essencial para a sua realização.(AU)

Objectives: To report the case of a non-diabetic patient with emphysematous cystitis. Case description: The following description was approved by the REC from UNIPAMPA registered under the n° 3.459.252. Non-diabetic, 82 year-old female patient, who had undergone a surgical procedure. Findings in image tests associated with culture and laboratory tests directed her diagnosis to emphysematous cystitis. Conservative management was carried out and the patient was discharged after seven days of antibiotic therapy. Conclusion: Emphysematous cystitis is a differential diagnosis that requires a high level of clinical suspicion in non-diabetic patients and the use of imaging methods is essential for its achievement.(AU)

Objetivos: Reportar el caso de una paciente no diabética con cistitis enfisematosa. Descripción del caso: La siguiente descripción fue aprobada por el CEI de la UNIPAMPA según parecer n° 3.459.252. Paciente femenina de ochenta y dos años, no diabética, que había realizado un procedimiento quirúrgico. Evidencias encontradas en los exámenes de imagen asociados a cultivos y exámenes de laboratorio direccionaron el diagnóstico a Cistitis enfisematosa. Fue realizado el manejo conservador con antibioticoterapia con buena evolución. Conclusión: Cistitis enfisematosa es un diagnóstico diferencial que requiere un alto nivel de sospecha clínica en pacientes no diabéticos, siendo el uso de métodos de imagen esencial para su realización.(AU)

The efficacy and safety of ceftazidime/avibactam therapy on carbapenem-resistant Enterobacteriaceae infections: a Meta-analysis / 药学实践杂志

Objective To systematically evaluate the efficacy and safety of ceftazidime/avibactam(CAZ/AVI) in the treatment of carbapenem-resistant Enterobacteriaceae(CRE) or carbapenem-resistance Klebsiella pneumonia (CRKP), and to provide evidence-cased reference for clinic therapy. Methods A comprehensive literature search from PubMed, Embase, the Cochrane Library, CBM, CNKI and VIP database was conducted for the CAZ/AVI therapy on CRE/CRKP infections published before May.2020. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. The results were analyzed by RevMan 5.3 statistical software. Results Five studies in English involving 392 patients were included for the analysis. In terms of effectiveness, the results showed CAZ/AVI group significantly increased the clinical cure rate[OR=3.57, 95% CI (2.03, 6.26), P<0.00001] compared with the control group. Also CAZ/AVI group significantly decreased the 28/30 day all-cause mortality [OR=0.27, 95% CI (0.14, 0.50), P<0.0001]. There were no significant difference between the two groups in the clinical remission rate [OR=1.92, 95% CI (0.93, 3.97), P=0.08] and the infection recurrence rate [OR=0.44, 95% CI (0.11, 1.85), P=0.26]. In terms of safety, the incidence of adverse events in CAZ/AVI group were lower than those in control group [OR=0.29, 95% CI (0.10, 0.80), P=0.02]. There was no significant difference between two groups in the incidence of serious adverse events[OR=0.33, 95% CI (0.09, 1.19), P=0.09]. Conclusion The current evidence shows that CAZ/AVI therapy has advantage in survival rate for the treatment of CRE/CRKP infections without increase of SAEs. Limited by the quality and quantity of the included studies, the above conclusions need to be verified with more high-quality RCTs.

Antibacterial treatment scheme and risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae / 中国综合临床

Objective:To investigate the relationship between antibacterial treatment scheme and prognosis, and to analyze the mortality risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:A retrospective case-control study was conducted. The CRKP isolated from clinical venous blood samples in the First Medical Center, Chinese PLA General Hospital between January 1, 2013 and December 31, 2018(not included from January 1, 2016 to December 31, 2017) was collected. According to relevant standards, a total of 50 patients with bloodstream infection with CRKP were included. The patients were divided into death (19 cases) or survival (31 cases) group according to their hospitalization outcomes, and clinical data and antibacterial treatment scheme after infection were collected. The clinical features of the two groups and the correlation between different antibacterial treatment regimens and prognosis were compared. Logistics regression model was used to analyze the risk factors for death in CRKP-infected patients.Results:The all-cause mortality rate of patients with CRKP bloodstream infection during hospitalization was 38%(19/50). The age ((66.89±18.13) vs. (55.06±14.39) years old, t=2.555, P=0.014), charlson's comorbidity index ((6.11±2.87) vs. (3.19±1.97), t=4.256, P<0.001) of the death group was higher than that of the survival group. The proportion of patients with chronic obstructive pulmonary disease (42.1%(8/19) vs. 3.2%(1/31), χ2=9.574, P=0.002), Charlson's comorbidity index ≥5 (68.4%(13/19) vs. 22.6%(7/31), χ2=10.314, P=0.001), septic shock (36.8%(7/19) vs. 6.5%(2/31), χ2=5.456, P=0.020), source of lung infection (36.8%(7/19) vs. 9.7%(3/31), χ2=3.868, P=0.049) was higher in death group than those in survival group. Kaplan-meier survival curve showed that the 30-day mortality of appropriate targeted treatment was lower than that of inappropriate targeted treatment ( χ2=8.138, P=0.004). Multivariate analysis showed that septic shock ( OR=56.363, 95% CI: 4.309-737.273, P=0.002) and charlson's comorbidity index ≥5 ( OR=18.605,95% CI: 1.813-190.896, P=0.014) were independent risk factors for mortality in patients with bloodstream CRKP infection. Conclusion:Appropriate targeted therapy can reduce 30-day mortality in patients with CRKP bloodstream infection. In order to reduce the risk of mortality, we should prevent the occurrence of septic shock and strengthen the diagnosis and treatment of patients with Chalson's comorbidity index ≥5.

Value Addition on Trend of Pneumonia Disease in India- The Current Update

Pneumonia continues to be the leading infectious cause of death among children under the age of five worldwide. Diagnosis of this disease is primarily dependent on physical examination, clinical history,and radiographic studies. Microbiological studies of the lower respiratory tract secretions have proven to be futile, however, sputum gram staining and culturing methods often aid in the diagnosis and management of these infections. Aspiration pneumonia often occurs in a community setting and primarily involves anaerobes like Staphylococcus aureus or gram-negative rods such as Klebsiella pneumonia, and other Enterobacteriaceae and Pseudomonas species. The total number of cases taken in the study of acute pneumonia was22 (15 male subjects and 7 female subjects). Biochemical tests were conducted for identifying different organisms present in the samples collected from patients suffering from acute pneumonia.Distribution of bacteria in the case of acute pneumonia was as follows: Staphylococcus aureus was recorded to be the highest (36.36%) followed by Streptococcus pneumonia (18.18%) and Klebsiella pneumonia (18.18%), Pseudomonas pneumonia (13.63%), Haemophilus influenza(9.09%) and lastly Chlamydia pneumonia(4.45%). A maximum number of laboratories proven acute pneumonia cases (36.36%) belonged to 61-70 years. The distribution of cases was marginally more in urban areas (63.63%). By occupation largest group (36.36%) was of others in case of acute pneumonia were as farmers, housewivesand others were the largest groups (22.73%) each. The microbial etiology derived from the present study found that Klebsiella pneumoniawas an independent risk factor for mortality in severe community-acquired pneumonia. Moreover, two important findings were drawn from this study. K. pneumoniawas identified as the causative pathogen in 22% of cases, second to S. pneumonia

Bhringraj Derived Phytochemicals against Pneumonia

Phytochemicals from Bhringaraj plant extract are traditionally used to cure Pneumonia. It is caused by Klebsiella pneumonia. Molecular docking method applied using “Biovia Discovery Studio”. “High positive values of -CDOCKER energy and -CDOCKER interaction energy” suggested that glutamic acid can effectively deactivate the dehydrogenase enzyme, thereby interrupting the life cycle of the organism

Changes of distribution and antimicrobial resistance of klebsiella pneumoniae in Shandong Provincial Hospital from 2015 to 2017 / 中国小儿急救医学

Objective To investigate the antimicrobial resistance and distribution of klebsiella pneu‐moniae in Shandong Provincial Hospital and to provide a reference for clinical treatment. Methods The specimens collected in our hospital from January 1,2015 to December 31,2017 were cultured. The drug sensi‐tivity test was carried out according to the unified scheme by paper diffusion method or automated instrument method. The results were interpreted according to the CLSI 2014 M100‐S24,and the data were analyzed by using WHONET5. 6 software. Results From 2015 to 2017,a total of 79 615 specimens were sent to the hos‐pital for bacterial culture,and 2 159 strains of klebsiella pneumoniae (non‐repeat bacteria) were isolated,with a separation rate of 9. 87%, 9. 23% and 9. 98%, respectively. The detection rates of extended spectrum β‐lactamase(ESBLs)‐producing klebsiella pneumoniae strains were 37. 97%,43. 57% and 40. 87% respec‐tively. The specimens were mainly separated from sputum,blood,urine,skin soft tissue,ascites and cerebro‐spinal fluid. Except for the slight decrease in ESBLs‐producing rate of klebsiella pneumoniae in sputum cul‐ture specimens in 2017,other specimens showed an increasing trend year by year,especially in blood culture specimens. The ESBLs production rate of klebsiella pneumoniae increased from 24. 53% in 2015 to 55. 00%in 2017. The drug resistance rate of ESBLs‐producing strains to various antibacterial drugs was significantly higher than that of non‐ESBLs producing strains. ESBLs‐producing klebsiella pneumoniae had a high drug re‐sistance rate to most antibiotics,and it was most sensitive to carbapenems,with drug resistance rates lower than 17%. However,the rate of carbapenem‐resistant showed a rapid rise. Conclusion Klebsiella pneumoni‐ae is a common pathogenic bacteria in clinical practice, and the drug resistance rate of ESBLs producing strains is high. Strengthening the monitoring of bacterial resistance and infection control measures are very important for the effective treatment of bacterial infection.

Animal models of Klebsiella Pneumonia infection and their applications in anti-infection of Chinese traditional medicine / 国际检验医学杂志

Klebsiella pneumoniae is one of the most common bacteria in nosocomial infections, and the second pathogen in bloodstream infections and urinary tract infections.In recent years, the emergence of Carbapenem-Resistant Klebsiella Pneumonia has become the focus in the field of anti-infection.At present, the treatment of Carbapenem-Resistant Klebsiella Pneumonia is mainly combined drug use, but which exists possible drawbacks including many side effects, higher cost, and more serious drug resistance and so on.With the increasing attention of the therapeutic effect, Chinese traditional medicine begins to come into researchers′sight as an alternative therapy or combination of traditional Chinese and Western medicine.Therefore, animal models used to evaluate the efficacy of drugs have been attracted wide attention.This article reviews animal models of Klebsiella Pneumonia infection and their applications in anti-infection of Chinese traditional medicine.

The Septic Knee Arthritis Caused by Klebsiella pneumoniae in a Patient with Type 2 Diabetes Mellitus and Osteoarthritis of the Knee / 대한정형외과학회잡지

Klebsiella pneumoniae causes that liver abscess mostly, also spread to pneumonia, meningitis, urinary tract infections. Septic arthritis caused by K. pneumoniae is a quite rare and has not been reported in Korea. Therefore, the authors report a case of the septic arthritis in the knee joint caused by K. pneumoniae in a patient with type 2 diabetes mellitus and osteoarthritis of the knee that successfully treated by early detection and arthroscopic synovectomy.

Resistencia a colistín mediado por el gen mcr-1 identificado en cepas de Escherichia coli y Klebsiella pneumoniae: primeros reportes en el Perú / Resistance to colistin mediated by the mcr-1 gene identified in strains of Escherichia coli and Klebsiella pneumoniae: first reports in Peru

Introducción. Ante la aparición de reportes de la presencia del gen mcr-1 y su posible diseminación por plásmidos en los países de la región y dado que este gen confiere resistencia a colistín, fármaco que es la última línea de tratamiento contra bacterias multirresistentes, es importante conocer su presencia en nuestro país en microorganismos que lo expresen. Métodos. Se realizó un estudio descriptivo y transversal. Se incluyeron microorganismos aislados de urocultivos de pacientes ambulatorios de un centro de salud privado en Lima, Perú, en agosto del año 2017. De 326 urocultivos positivos se seleccionaron 10 aislamientos entre cepas de Escherichia coli y Klebsiella pneumoniae que presentaron concentración mínima inhibitoria ≥ 4µg/ mL (interpretado como resistente para colistín) por el sistema automatizado Microscan Walkaway 96 plus. Se utilizaron los siguientes métodos: colistín agar spot, predifusión con tabletas de colistín, microdilución en caldo colistin y PCR para el gen mcr-1. Resultados. Se determinó que 7 aislamientos, todas Escherichia coli, expresaron la presencia del gen mcr-1 por PCR, el cual confiere resistencia plasmídica a polipéptidos. De las cepas restantes, dos Escherichia coli y una Klebsiella pneumoniae, resultaron positivos para resistencia a colistín en las pruebas fenotípicas pero no en la PCR para gen mcr-1 lo cual sugiere un mecanismo de resistencia a colistín no asociado a gen mcr-1. Conclusiones. Se obtuvieron 7 aislamientos de Escherichia coli resistentes a colistín y con expresión del gen mcr-1.

Introduction. Given the appearance of reports of the presence of the mcr-1 gene and its possible dissemination by plasmids in the countries of the region and given that this gene confers resistance to colistin, the drug that is the last line of treatment against multiresistant bacteria, it is important to know its presence in our country in microorganisms that express it. Methods. Descriptive and cross-sectional study was carried out. Microorganisms isolated from urine culture of outpatients from a private health center in Lima, Peru, were included in august 2017. Out of 326 positive urine cultures, 10 isolates were selected between strains of Escherichia coli and Klebsiella pneumoniae that had a minimum inhibitory concentration ≥4µg/mL (interpreted as resistant for colistín) by the automated system Microscan Walkaway 96 plus. The following methods were used: colistin agar spot, prediffusion with colistin tablets, microdilution in colistin broth and PCR for the mcr-1 gene. Results. It was determined that 7 isolates, all Escherichia coli, expressed the presence of the mcr-1 gene by PCR, which confers plasmid resistance to polypeptides. Of the remaining strains, two Escherichia coli and one Klebsiella pneumoniae, were positive for resistance to colistin in the phenotypic tests but not in the PCR for mcr-1 gene, which suggests a mechanism of colistin resistance not associated with the mcr-1 gene. Conclusions. Seven isolates of Escherichia coli resistant to colistin and with expression of the mcr-1 gene were obtained.

Establishment of a mouse model of pneumonia with an isolated epidemic ST23 Klebsiella pneumonia strain / 中华微生物学和免疫学杂志

Objective To establish a mouse model of pneumonia with C57BL/6 and MyD88KO mice after infection with an isolated ST23 Klebsiella pneumonia (KP) strain, which was an epidemic strain and identified by multilocus sequence typing (MLST). Methods Fifty C57BL/6 mice were randomly di-vided into three groups:KP infection,control and immunosuppressive groups. Thirty MyD88KO mice were divided into KP infection and control groups. All mice in the KP infection groups were infected with 50 μl of ST23 KP strain through nasal dripping. Equal volume of PBS was used to set up the control groups. Mice in the immunosuppressive group were first injected with cyclophosphamide for three days and then infected with equal volume of ST23 KP strains through nasal dripping. Clinical signs and survival curves during KP infec-tion were monitored. Moreover,pulmonary bacterial loads and histopathological changes in the KP-infected mice were detected at different time points. Results ST23 KP-infected C57BL/6 mice showed inflammatory cell infiltration in lung tissues on the 10th day and remained alive on the 21st day. All ST23 KP-infected MyD88KO mice died on the 5th day with severe histopathological damage in lung tissues. C57BL/6 mice that pretreated with cyclophosphamide had similar symptoms with MyD88KO mice after infection and died on the 5th day. Some critical inflammatory mediators such as TNF-a,nitric oxide synthase 1 (NOS1) and NF-κBp65 were up-regulated in lung tissues of mice after KP infection. No inflammatory syndromes were found in the mice of PBS control groups. Conclusion This study suggests that the mouse model of pneumonia is successfully established with KP strain. It will help researchers to study the characteristics and pathogenesis of ST23 KP strain-induced pneumonia and to seek safe treatments in the future.

Characterization of Klebsiella pneumoniae associated with cattle infections in southwest China using multi-locus sequence typing (MLST), antibiotic resistance and virulence-associated gene profile analysis

Abstract Klebsiella pneumoniae is important human and animal pathogen that causes a wide spectrum of infections. In this study, isolates from cattle nasal swabs samples were identified by 16S rRNA, and to evaluate the antimicrobial susceptibility, virulence gene carrying levels, and multilocus sequence typing of K. pneumoniae isolates. 33 isolates of K. pneumoniae were isolated and identified in 213 nasal swabs samples, of which 12 were hypervirulent K. pneumoniae strains. Extended Spectrum Beta-Lactamases genes were found in 93.4% of the strains. Of which, TEM was the most prevalent (93.4%), followed by CTX-M and SHV were 57.6% and 39.4%, respectively. A main mutation pattern of quinoloneresistance-determining region, Thr83-Ieu and Asp87-Asn in gyrA and Ser87-Ile in parC, was detected in 33 K. pneumoniae isolates. All the isolates harbored at least two virulence factor genes, with ureA (97.0%) and wabG (91.0%) exhibiting high carriage rates in 33 K. pneumoniae isolates. MLST revealed 7 sequence types, of which 3 STs (2541, 2581 and 2844) were newly assigned. Using eBURST, ST2844 and ST2541 were assigned to new clonal complex 2844. Our study provides evidence and biological characteristics of K. pneumoniae isolates from cattle upper respiratory tract in Southwest China.