Comparative genomics of five different resistance plasmids coexisting in a clinical multi-drug resistant Citrobacter freundii isolate.

BACKGROUND: Plasmid-mediated multi-drug resistance (MDR) has been widely found in Citro-bacter freundii. C. freundii P10159 was isolated from a human case of postoperative urinary tract infection in a Chinese teaching hospital. METHODS: The complete nucleotide sequences of five resistance plasmids pP10159-1, pP10159-2, pP10159-3, pP10159-4 and pP10159-5 from C. freundii P10159 were determined through high-throughput genome sequencing, and then compared with related plasmids sequences. Plasmid transfer, CarbaNP test of carbapenemase activity, and bacterial antimicrobial susceptibility test were performed to characterize resistance phenotypes mediated by these plasmids. RESULTS: pP10159-1 carrying blaNDM-1and pP10159-2 harboring blaIMP-4 plus qnrS1 were almost identical to IncX3 plasmid pNDM-HN380 and IncN1 plasmid pP378-IMP, respectively. The blaKPC-2-carrying plasmids pP10159-3, pHS062105-3 and pECN49-KPC were highly similar to each other, and constituted a novel group of plasmids belonging to an unknown incomparability group. The MDR plasmids pP10159-4 and pP10159-5 had the backbones highly similar to IncHI4 plasmid pNDM-CIT and type 2 IncC plasmid pR55, respectively, but their accessory resistance regions differed from pNDM-CIT and pR55, respectively. The five plasmids from the P10159 isolate contained a total of 24 different genes or gene loci, which contributed to resistance to 13 distinct antibiotic molecules or toxic compounds. CONCLUSION: This is the first report of co-occurrence of five different resistance plasmids, with determination of their complete sequences. Data presented here provide a deeper insight into co-selection and maintenance of multiple plasmids and an extremely large number of resistance genes in a single bacterial isolate.

Increasing rates of Acinetobacter baumannii infection and resistance in an oncology department.

OBJECTIVE: Acinetobacter baumannii is an opportunistic pathogen found in immunocompromised patients, especially cancer patients. This study was to investigate the clinical characteristics of cancer patients and the antimicrobial resistance of A.baumannii isolates. MATERIALS AND METHODS: Clinical isolates were collected from the oncology department of a general teaching hospital, and the clinical and demographic information of patients was obtained from the hospital's information system. Antimicrobial susceptibility was examined using the agar dilution method. Carbapenemase-encoding genes were amplified by polymerase chain reaction, and sequence types were determined by multilocus sequence typing. RESULTS: The isolation rate of A.baumannii increased annually in the oncology department. Multivariate analysis showed that only prior antibiotic use was an independent risk factor for A.baumannii infection. The use of antibiotics in A.baumannii-infected patients was significantly more frequent than in non-A.baumannii-infected patients. A.baumannii isolates were highly resistant to most tested antibiotics. The IMP-4 and VIM-2 genes were present in 6 and 2 isolates, respectively. Sixty isolates had 12 genotypes, and ST208 was the most common genotype. CONCLUSION: Our results suggest that the use of antibiotics and hospital environmental pollution may be the main causes of A. baumannii infection.

[Retrospective controlled study on early postoperative inflammatory small bowel obstruction treated with electroacupuncture and acupuncture].

OBJECTIVE: To reveal the efficacy on early postoperative inflammatory small bowel obstruction (EPISBO) treated with electroacupuncture and acupuncture separately and make the comparison of the efficacy difference. METHODS: Through retrospective analysis, 459 cases of EPISBO were divided into an electroacupuncture group (355 cases) and an acupuncture group (104 cases). Based on routine treatment, Zusanli (ST 36), Shangjuxu (ST 37), Taichong (LR 3), Gongsun (SP 4) and Xuanzhong (GB 39) were selected in either group, but stimulated with electroacupuncture and acupuncture separately, once per day, for 30 min each time. RESULTS: All of 459 cases were cured. The average days of curative achievement in electroacupuncture group were less apparently than those in acupuncture group (13.5 +/- 7.5 vs. 20.8 +/- 6.5, P < 0.05). The days of curative achievement in either group were less significantly than those treated with parenteral nutrition and medication recorded in literatures (32.0 +/- 7.0, both P < 0.05). CONCLUSION: Either electroacupuncture or acupuncture achieves a significant efficacy on EPISBO, but the efficacy of electroacupuncture is better than that of acupuncture.