Severe Klebsiella pneumoniae pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism: A case report.

BACKGROUND: Klebsiella pneumoniae (K. pneumoniae) is a clinically common Gram-negative bacillus that can cause community- and hospital-acquired infections and lead to pneumonia, liver abscesses, bloodstream infections, and other infectious diseases; however, severe pneumonia caused by hypervirulent K. pneumoniae (hvKp) complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism is rarely seen in the clinical setting and has not been reported in the literature. CASE SUMMARY: A 51-year-old man was hospitalized with fever and dyspnea. Persistent mild pain in the middle and upper abdomen began at dawn on the 3rd day following admission and developed into persistent severe pain in the left upper abdomen 8 h later. Based on chest computed tomography (CT), bronchoscopy, bronchoalveolar lavage fluid metagenomic next-generation sequencing, abdominal aortic CT angiography (CTA), and culture of the superior mesenteric artery embolus, adult community-acquired severe hvKp pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism was diagnosed. Notably, he recovered and was discharged from the hospital after receiving effective meropenem anti-infection, endovascular contact thrombolytic, and systemic anticoagulant therapies and undergoing percutaneous thrombus aspiration. Ten days later, the patient returned to the hospital for abdominal CTA examination, which indicated blocked initial common pathway of the celiac trunk and superior mesenteric artery, and local stenosis. Therefore, celiac trunk artery stenting was performed in Chongqing Hospital, and postoperative recovery was good. CONCLUSION: We report a case of hvKp severe pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism and suggest that clinicians should consider the possibility of a Gram-negative bacillus infection and conduct effective pathogen detection in a timely fashion when managing patients with severe community-acquired pneumonia before obtaining bacteriologic and drug sensitivity results. At the same time, when patients have severe pulmonary infection complicated by severe abdominal pain, an acute mesenteric artery embolism should be considered to avoid delays in treatment.

Efficacy and safety of adjunctive nebulized colistin sulfate for multidrug-resistant Gram-negative bacteria pneumonia: a retrospective comparative cohort study.

BACKGROUND: The incidence of multidrug-resistant Gram-negative bacteria (MDR-GNB) pneumonia has increased in the last decade. If antibiotics are given only through intravenous, the antibiotic concentrations in lung tissue will be insufficient. Recently, nebulized antibiotics have shown effectiveness as an adjunctive therapy with intravenous antibiotics for resistant strains. Therefore, the goal of this study was to assess the efficacy and safety of adjunctive nebulized colistin sulfate in combination with intravenous antibiotics in patients with MDR-GNB pneumonia. METHODS: A total of 203 patients who were infected with MDR-GNB pneumonia were selected. Based on whether patients received nebulized colistin sulfate, patients were divided into 2 groups: the NCIA group (nebulized colistin sulfate in combination with intravenous antibiotics) and the IA group (intravenous antibiotics without nebulized colistin sulfate). After propensity score matching (PSM) analysis, we compared the efficacy in terms of favorable clinical outcomes, the bacteria detection rate, days of hospital stay, days of intensive care unit (ICU) stay, days of mechanical ventilation (MV), antipyretic time, days of antibiotic therapy, and 28-day all-cause mortality. Safety was also compared between groups. RESULTS: A total of 116 patients met the criteria for evaluation, with 46 patients in the NCIA group and 70 patients in the IA group. After PSM, 31 patients were selected from each group. There were significant differences in favorable clinical outcomes on days 7 (67.7% vs. 32.3%, P=0.005) and 14 (71% vs. 41.9%, P=0.045) and the bacteria detection rate on days 7, 14, and the last day. There were also significant differences in days of hospital stay (17 vs. 23 days, P=0.01), antipyretic time (0.5 vs. 7.5 days, P=0.037), and days of antibiotic therapy (14 vs. 23 days, P=0.002). However, there were no significant differences in days of ICU stay, days of MV, and 28-day all-cause mortality. For nephrotoxicity, the NCIA group did not increase the risk of acute kidney injury (16.1% vs. 9.7%, P=0.707), only one patient (3.2%) in the NCIA group developed airway hyperresponsiveness (P=1.000). CONCLUSIONS: For MDR-GNB pneumonia, nebulized colistin sulfate as an adjuvant supportive treatment for intravenous antibiotics maybe can improve clinical efficacy and has high safety.

New versatile zincic sorbent for tobacco specific nitrosamines and lead ion capture.

New carbon-doped ferric zinc oxide sorbents were fabricated to capture the environment carcinogen tobacco specific nitrosamines (TSNA) efficiently in solution, following new adsorption model of electrostatic attraction instead of traditional geometric constraints. The influence of ferric content on the structure-property of the sorbents was systemically studied with XRD, N2 adsorption-desorption and SEM methods combined with the adsorption of TSNA in different solutions. New sorbent captured 99% of 4-methylnitrosamino-1-3-pyridyl-1-butanone (NNK) in simulated surface water and 40% of TSNA in the tobacco extract solution, more than activated carbon or zeolites. Ferric ZnO sorbent took about 15 min to reach the adsorption equilibrium in the NNK or Pb(Ⅱ) solution, faster than NaZSM-5 zeolite. Moreover, the adsorbed NNK on ferric ZnO sorbent decomposed at mild conditions for the first time, providing a new way to control environment pollution.

Efficiently capturing tobacco specific nitrosamines with Hß zeolite in solution.

The high-efficiency capture of Tobacco Specific Nitrosamines by Hß zeolite in solution is reported for the first time, along with the adsorption of 4-methylnitrosamino-1-3-pyridyl-1-butanone in aqueous solution. Different from other zeolites such as NaZSM-5, the specific pore size of Hß exerted a crucial function endowing the zeolite a higher removal of TSNA and selectivity of NNK. The adsorption thermodynamics of NNK by Hß in aqueous adsorption was fitted to Temkin adsorption model with a linearly decreasing isosteric heat of adsorption. In addition, the adsorptive capacity of Hß zeolite for NNK reached over 70 mg g-1, offering a powerful sorbent of TSNA to protect environment.

New shape-selectivity discovered on graphene-based materials in catching tobacco specific nitrosamines.

New shape-selectivity of graphene-based materials was discovered on this article. To explore the new selectivity, the structure and surface state of graphene and carbon nanotube were examined firstly, and their specific selectivity was verified and was compared with that of ZSM-5 zeolite in aqueous solutions of tobacco specific nitrosamines (TSNA) along with dyes. These two adsorbents trapped about 55% and 70% of 4-methylnitrosamino-1-3-pyridyl-1-butanone (NNK) but only 3% of N'-nitrosonornicotine (NNN) in solution, having an obvious selectivity for the former, due to its stronger interaction with graphene. NNK on graphene sheet obtained more electrons (0.015 e) and owned larger adsorption energy (15.63 kcal mol-1) than that of NNN (0.003 e, 9.19 kcal mol-1), according to theoretical calculation and FTIR results. More 95 or 136 mg g -1 acid red 88 than methyl orange was captured by graphene or carbon nanotube, demonstrating this special and abnormal selectivity again. With new selectivity, graphene showed a higher capacity (6.9%) and shorter adorption equilibrium time (5 min) for TSNA than the typical selecive sorbent ZSM-5 zeolite (1.7% and 20 min) in tobacco solution but kept the similar selctivity to NNK, paving a new way to control the carcinogens like TSNA in environment.

Creating an Optimal Microenvironment within Mesoporous Silica MCM-41 for Capture of Tobacco-Specific Nitrosamines in Solution.

To meet the requirement of capturing tobacco-specific nitrosamines (TSNA) for environment protection, a unique microenvironment was carefully created inside the channels of mesoporous silica MCM-41. In situ carbonization of template micelles at 923 K, combined with the excess aluminum used in one-pot synthesis of MCM-41, is adopted to tailor the tortuosity of mecsoporous channels, while loaded metal oxides (5 wt %) and the Al component in the framework are employed to exert the necessary electrostatic interaction toward the target carcinogens TSNA in solution. The elaborated microenvironment created in mesoporous sorbents was characterized with XRD, N2 adsorption-desorption, TEM, XPS, and TG-DSC methods. Various solutions of Burley- and Virginia-type tobaccos were used to assess the adsorption performance of new mesoporous sorbents, and the influence of the solid-to-liquid ratio, adsorption time, and loading amount of CuO on the adsorption was carefully examined. The representative sample 5%Cu/AM-10c could capture 27.2% of TSNA in Burley tobacco solution, and its capacity reached 0.3 mg g-1 in Snus tobacco extract solution, offering a promising candidate for the protection of the environment and public health.