RESUMEN
The whole-genome sequencing of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains is required for investigating the molecular epidemiology because of their diverse molecular types across geographical regions. CRKP strains were collected from a tertiary hospital in Southeastern China from January 2017 to December 2020. Following species identification, drug susceptibility phenotypes were determined based on minimum inhibitory concentrations using the VITEK 2 Compact system. In addition, whole-genome sequencing was performed to identify the resistance genes and high virulence genes (rmpA, rmpA2, iucA, iroB, and peg-344). Finally, a phylogenetic tree was constructed based on the core genes. Forty CRKP strains were identified, and 25% of the involved patients (nâ =â 10) died during hospitalization. The dominant sequence type (ST) was ST11 (65%), followed by ST290 (nâ =â 4, 10%) and a novel ST (nâ =â 4, assigned as ST6242, 10%). CRKP strains with this new ST were resistant to amikacin but susceptible to sulfamethoxazole-trimethoprim, and the phylogenetic tree indicated that they were derived from ST11 strains. All ST6242 strains were classified as the hypervirulent type (positive for rmpA, rmpA2, iucA, and peg-344). CRKP strains with this novel ST harbored highly virulent genes and a unique resistance phenotype. Thus, they should be epidemiologically monitored.
Asunto(s)
Infecciones por Klebsiella , Klebsiella pneumoniae , Pruebas de Sensibilidad Microbiana , Centros de Atención Terciaria , Secuenciación Completa del Genoma , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/patogenicidad , China/epidemiología , Masculino , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Secuenciación Completa del Genoma/métodos , Femenino , Persona de Mediana Edad , Anciano , Antibacterianos/farmacología , Filogenia , Enterobacteriaceae Resistentes a los Carbapenémicos/genética , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Carbapenémicos/farmacología , Virulencia/genética , Adulto , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Urinary tract infections (UTI) is a prevalent condition in those with diabetes, and in severe cases, it may escalate to sepsis. Therefore, it is important to analyze the risk variables associated with sepsis in diabetes individuals with UTI. METHODS: This research was a retrospective cross-sectional analysis. From January 2011 to June 2022, a group of individuals with diabetes were identified as having UTI at a tertiary hospital situated in Southeastern China. Patient data, including information on urine culture, was collected retrospectively from a clinical record database. The participants were categorized into the sepsis and non-sepsis groups. The risk variables were derived using both uni-and multiple- variable regression analysis. RESULTS: The research included 1919 patients, of whom 1106 cases (57.63%) had positive urine cultures. In total, 445 blood culture samples were tested, identifying 186 positive cases (41.80%). The prevalence of bacteria in urine and blood samples was highest for Escherichia coli and Klebsiella pneumoniae, respectively. Moreover, 268 individuals (13.97%) exhibited sepsis. The regression analysis indicated a positive correlation between sepsis and albumin (ALB)<34.35 g/L, C-reactive protein (CRP)>55.84 mg/L and white blood cell count (WBC) >8.485 X 109/L in diabetic cases with UTIs. By integrating the three aforementioned parameters, the area under the receiver operating characteristic curve was 0.809. CONCLUSIONS: The early detection of sepsis in diabetic individuals with UTI may be achieved using a comprehensive analysis of CRP, WBC, and ALB test findings.
Asunto(s)
Sepsis , Infecciones Urinarias , Humanos , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiología , Infecciones Urinarias/epidemiología , Masculino , Femenino , Sepsis/complicaciones , Sepsis/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Estudios Transversales , Factores de Riesgo , China/epidemiología , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Diabetes Mellitus/epidemiología , Adulto , Klebsiella pneumoniae/aislamiento & purificación , Recuento de Leucocitos , Complicaciones de la Diabetes/microbiología , Complicaciones de la Diabetes/epidemiologíaRESUMEN
A 82-year-old man was admitted to hospital with fever, unresponsiveness, elevated hypersensitive C-reactive protein and neutrophile granulocyte. Ceftriaxone was administrated by intravenous dripping in the emergency room, but the effect was not satisfactory. Following his admission to the ward, cefoperazone sulbactam were given. Elizabethkingia meningoseptica was identified by blood culture and further confirmed by 16S rRNA sequencing. The lumbar puncture showed that cerebrospinal fluid pressure was 80 mmH2O (1 mmH2O=0.0098 kPa) and biochemical results were normal. After 11 days of cefoperazone sulbactam treatment, the patient was discharged with negative blood culture. The hypersensitive C-reactive protein and neutrophile granulocyte had also declined. The patient received levofloxacin tablets for anti-infection treatment for 14 d after discharge. No signs of infection were observed in three months' following up.
Asunto(s)
Infecciones por Flavobacteriaceae , Sepsis , Masculino , Humanos , Anciano de 80 o más Años , Proteína C-Reactiva , Cefoperazona/uso terapéutico , Infecciones por Flavobacteriaceae/diagnóstico , Infecciones por Flavobacteriaceae/tratamiento farmacológico , ARN Ribosómico 16S , Sulbactam/uso terapéuticoRESUMEN
Pasteurella multocida is an opportunistic pathogen. Previously reported infections associated with P. multocida have often been linked to contact with cats, dogs, and other animals. Cases of systemic multiple-site infections following P. multocida infection are rare. This case study presents a 49-year-old middle-aged man with post-hepatitis B cirrhosis and no history of animal contact. The patient was admitted with symptoms of fever accompanied by diarrhea, abdominal distension, and cough. Blood tests showed elevated levels of CRP, PCT, and IL-6, and blood culture revealed the growth of P. multocida. CT scans revealed a large amount of abdominal effusion, a small amount of pleural effusion, and pulmonary infection foci. The patient's condition improved after successive administration of ceftriaxone and levofloxacin to fight the infection, and abdominal puncture and drainage. Multiple-site infections caused by P. multocida are rarely encountered in patients with liver cirrhosis but without animal contact, which could be regarded as serious conditions warranting careful attention in terms of clinical diagnosis and treatment.
Asunto(s)
Enfermedades Transmisibles , Infecciones por Pasteurella , Pasteurella multocida , Peritonitis , Neumonía , Sepsis , Masculino , Persona de Mediana Edad , Humanos , Animales , Gatos , Perros , Infecciones por Pasteurella/complicaciones , Infecciones por Pasteurella/diagnóstico , Infecciones por Pasteurella/tratamiento farmacológico , Cirrosis Hepática/complicaciones , Sepsis/complicaciones , Neumonía/complicacionesRESUMEN
OBJECTIVE: Escherichia coli (E. coli) is the most common opportunistic clinical micro-organism with high drug resistance. This study aimed to analyse the resistance pattern of E. coli according to patient age and clinical sample type. DESIGN AND SETTING: This retrospective observational study was conducted in a tertiary hospital in southeastern China. PARTICIPANTS: E. coli strains were isolated from blood, urine and sputum of infected inpatients. The patients were divided into four age groups: children (0-14 years old, including neonatal and non-neonatal groups), youths (15-40 years old), middle-aged (41-60 years old) and old (>60 years old). RESULTS: A total of 7165 E. coli strains were collected from all samples. Compared with urine and blood isolates, more sputum isolates were resistant against 12 tested antibiotics. Furthermore, urine isolates were more resistant to levofloxacin than sputum and blood isolates. Although the patients' age was not associated with resistance rates of E. coli strains isolated from blood, a larger proportion of urine-derived strains from youths were resistant to sulfamethoxazole-trimethoprim and piperacillin-tazobactam than those from old people. The sputum strains from the elderly were more resistant to most of the tested antibiotics compared with sputum strains isolated from children. CONCLUSIONS: The resistance profile of E. coli is different among age groups and specimen sources and should be considered during E. coli infection treatment.