Clinical signif icance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess

AIM:To investigate the clinical signifi cance of C-reactive protein (CRP) values in determining the endpoint of antibiotic treatment for liver abscess after drainage. METHODS: The endpoints of antibiotic treatment in 46 patients with pyogenic liver abscess after complete percutaneous drainage were assessed by performing a retrospective study. After complete percutaneous drainage, normal CRP values were considered as the endpoint in 18 patients (experimental group), and normal body temperature for at least 2 wk were considered as the endpoints in the other 28 patients (control group). RESULTS:The duration of antibiotic treatment after complete percutaneous drainage was 15.83 ± 6.45 d and 24.25 ± 8.18 d for the experimental and the control groups, respectively (P=0.001), being significantly shorter in the experimental group than in the control group. The recurrence rate was 0% for both groups.However, we could not obtain the follow-up data about 3 patients in the control group. CONCLUSION: CRP values can be considered as an independent factor to determine the duration of the antibiotic treatment for pyogenic liver abscess after complete percutaneous drainage.

Efficacy and Safety of Antibiotics for the Treatment of Relapsing Fever:A Systematic Review and Network Meta-analysis

Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes,for which no optimal treatment has been developed.The purposes of this study were to compare the efficacy and safety of commonly used antibiotics for the treatment of relapsing fever using a network meta-analysis approach and to explore the advantages of each drug based on the current evidence.This study examined nine published studies involving 1416 patients with relapsing fever treated with penicillin,erythromycin,tetracycline,doxycycline,minocycline or chloramphenicol.The odds ratio(OR)and 95% confidence interval(CI)were used as influence indices for discontinuous data,and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking(SUCRA)curve.The primary outcomes of this study were mortality and cure rates,and the secondary outcomes were the rates of Jarisch-Herxheimer reaction and relapse.Erythromycin(SUCRA,84.5%)was the most effective antibiotic for reducing mortality,whereas tetracycline was the most effective antibiotic for improving the cure rate(SUCRA,69.3%)and reducing the relapse rate(SUCRA,79.7%),and minocycline(SUCRA,66.4%)was the most effective antibiotic for reducing Jarisch-Herxheimer reactions.In addition,our network meta-analysis showed that tetracycline is superior to penicillin for improving the cure rate(OR,5.91;95%CI,2.21-15.81)and reducing the relapse rate(OR,0.16;95%CI,0.04-0.67).

Management of Gas Gangrene in Wenchuan Earthquake Victims

Gas gangrene is an emergency condition,which usually develops after injuries or surgery.This study was designed to investigate clinical characteristics,appropriate therapy,and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims.Data on diagnosis,treatment,and prevention of confirmed,suspected,or highly suspected gas gangrene were collected.Sixty-seven（2.41%） cases of suspected gas gangrene were found,in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens.Thereof,injury sites were mainly located on the limbs,and typical indications,including crepitation,severe localized pain,swelling,wound discoloration,dark red or black necrotic muscle,foul smell as well as different degrees of systemic toxic performance were common among them.After hospitalization,all patients were isolated and had surgery quickly to remove dead,damaged or infected tissue.The wounds were also exposed for drainage and washed or padded with 3% liquid hydrogen peroxide for disinfection before all diagnostic test results were available.Additionally,high doses of antibiotics（mainly penicillin） were given for the prevention of infection,and supportive therapy was applied for corresponding symptoms control.Among those cases,no fatality was reported.In summary,in post-disaster emergency relief,the diagnosis of gas gangrene should be primarily based on clinical manifestationswhile patient isolation,wound debridement and disinfection,as well as antibiotics treatment,is the main measures for proper treatment and control of nosocomial infection for gas gangrene.

Consensus of primary care in acute pancreatitis in Japan

The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as thediagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

Optimal length of triple therapy for H pylori eradication in a population with high prevalence of infection in Chile

AIM:To compare the efficacy of 7-d versus 14-d triple therapy for the treatment of H pylori infection in Chile,with a prevalence of 73% in general population. METHODS:H pylori-infected patients diagnosed by rapid urease test,with non-ulcer dyspepsia or peptic ulcer disease were randomized to receive omeprazole 20 mg bid,amoxicillin 1 g bid,and clarithromycin 500 mg bid for 7 (OAC7) or 14 (OAC14) d. Primary outcome was eradication rate 6 wk after the treatment. Subgroup analysis was carried out considering the eradication rate among patients with or without peptic ulcer disease and eradication rate among smokers or non-smokers. RESULTS:One hundred and thirty-one patients were randomized to OAC7 (n = 69) or OAC14 (n = 62). The overall eradication rate (intention-to-treat) was 78.3% in OAC7 and 85.5% in OAC14 groups,without a significant difference (P =0.37). No significant difference in the eradication rate was found among the patients with peptic ulcer disease (n = 31) between the OAC7 group (85.7%) and OAC14 group (87.5%). However,smokers had an obviously lower eradication rate compared to non-smokers,particularly in the OAC7 group (57.1% in smokers vs 83.6% in non-smokers; P = 0.06). Adverse effects rate were similar between both groups. CONCLUSION:Short-term efficacy of triple therapy with OAC for 7 d is comparable to 14 d in this high-prevalence population. Longer follow-up,and studies focused to some subgroups of patients (smokers and non-ulcerpatients) are necessary to support widespread use of 7-d instead of 10-14-d triple therapy in a developing country like Chile.

Dysbiosis of gut microbiome affecting small intestine morphology and immune balance:a rhesus macaque model

There is a growing appreciation for the specific health benefits conferred by commensal microbiota on their hosts.Clinical microbiota analysis and animal studies in germ-free or antibiotic-treated mice have been crucial for improving our understanding of the role of the microbiome on the host mucosal surface;however,studies on the mechanisms involved in microbiome-host interactions remain limited to small animal models.Here,we demonstrated that rhesus monkeys under short-term broad-spectrum antibiotic treatment could be used as a model to study the gut mucosal host-microbiome niche and immune balance with steady health status.Results showed that the diversity and community structure of the gut commensal bacteria in rhesus monkeys were both disrupted after antibiotic treatment.Furthermore,the 16S rDNA amplicon sequencing results indicated that Escherichia-Shigella were predominant in stool samples 9 d of treatment,and the abundances of bacterial functional genes and predicted KEGG pathways were significantly changed.In addition to inducing aberrant morphology of small intestinal villi,the depletion of gut commensal bacteria led to increased proportions of CD3+T,CD4+T,and CD16+NK cells in peripheral blood mononuclear cells(PBMCs),but decreased numbers of Treg and CD20+B cells.The transcriptome of PBMCs from antibiotic-treated monkeys showed that the immune balance was affected by modulation of the expression of many functional genes,including IL-13,VCAM1,and LGR4.

Bone infection site targeting nanoparticle-antibiotics delivery vehicle to enhance treatment efficacy of orthopedic implant related infection

Orthopedic implants account for 99%of orthopedic surgeries,however,orthopedic implant-related infection is one of the most serious complications owing to the potential for limb-threatening sequelae and mortality.Current antibiotic treatments still lack the capacity to target bone infection sites,thereby resulting in unsatisfactory therapeutic effects.Here,the bone infection site targeting efficacy of D6 and UBI29-41 peptides was investigated,and bone-and-bacteria dual-targeted nanoparticles(NPs)with D6 and UBI29-41 peptides were first fabricated to target bone infection site and control the release of vancomycin in bone infection site.The results of this study demonstrated that the bone-and-bacteria dual-targeted mesoporous silica NPs exhibit excellent bone and bacteria targeting efficacy,excellent biocompatibility and effective antibacterial properties in vitro.Furthermore,in a rat model of orthopedic implant-related infection with methicillin-resistant Staphylococcus aureus,the growth of bacteria was evidently inhibited without cytotoxicity,thus realizing the early treatment of implant-related infection.Hence,the bone-and-bacteria dual-targeted molecule-modified NPs may target bacteria-infected bone sites and act as ideal candidates for the therapy of orthopedic implant-related infections.

Preparation of Bi_(2)O_(3)/BiOI Step-scheme Heterojunction Photocatalysts and Their Degradation Mechanism of Methylene Blue

Bi_(2)O_(3)/BiOI step-scheme(S-scheme) heterojunction photocatalyst was synthesized by green calcination method, its degradation ability of methylene blue was investigated, and the photocatalytic performance of the Bi_(2)O_(3)/BiOI heterojunction, Bi_(2)O_(3) and BiOI was compared. The structure and morphology of the samples were characterized by X-ray diffraction(XRD), field emission scanning electron microscopy(FESEM), and UV-vis diffuse reflection spectrum (UV-vis DRS). The degradation rate of methylene blue was analysised by spectrophotometry, and the calculation result showed that the degradation rate of methylene blue was 97.8% in 150 minutes. The first order kinetic rate constant of 10%Bi_(2)O_(3)/BiOI is 0.021 8 min^(-1), which are2.37 and 2.68 times of BiOI(0.009 18 min^(-1)) and Bi_(2)O_(3) (0.008 03 min^(-1)) respectively. The calculation result shows that the work function of Bi_(2)O_(3) and BiOI are 3.0 e V and 6.0 e V, respectively, by density functional theory(DFT). When this S-scheme heterojunction is used as a photocatalyst, the weaker electrons in the conduction band of BiOI will be combined with the weaker holes in the Bi_(2)O_(3) valence band under combined effect with built-in electric field and band bending, which will retain stronger photoelectrons and holes between Bi_(2)O_(3) and BiOI. This may be the internal reason for the efficient degradation of tetracycline by Bi_(2)O_(3)/BiOI S-scheme heterostructures.

Influence of a probiotic mixture on antibiotic induced microbiota disturbances

AIM: To study the effect of probiotic consumption on the faecal microbiota during and after antibiotic exposure.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing:A single-center study

BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%.Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic.People avoided going to the hospital for fear of being infected.Different countries have different epidemic prevention measures that result in different treatment outcomes.The Chinese government also published some temporary measures in order to prevent the outbreak.AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed.Cases were grouped according to admission year.The demographic characteristics,present illnesses,medical history,symptoms and signs,comorbidities,blood test results,imaging data,appendix pathology,and treatment details were compared.RESULTS Overall,74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019,whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020.Fever,thick appendix,nonsurgical management,and uncomplicated appendicitis(simple or supportive appendicitis)were more common in group 2020(P<0.05).Among the nonsurgical management cases,the neutrophil percentage,neutrophil-tolymphocyte ratio,and recurrence rate were higher in group 2020(P<0.05).Among surgically managed cases,there were more cases with gastrointestinal symptoms,peritonitis,ascites in the image,and intraoperative adhesion or ascites in group 2020(P<0.05).The white blood cell count,time from diagnosis to surgery,surgical time,and intraoperative blood loss were higher in group 2020(P<0.05).CONCLUSION During the COVID-19 pandemic,patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment.For patients who underwent surgical management,the operation was delayed and more difficult during the pandemic.Nevertheless,the hospital stay and the incidence of postsurgical complications did not change.

A combined evaluation of the characteristics and antibiotic resistance induction potential of antibiotic wastewater during the treatment process

Antibiotic wastewater contains a variety of pollutant stressors that can induce and promote antibiotic resistance(AR)when released into the environment.Although these substances are mostly in concentrations lower than those known to induce AR individually,it is possible that antibiotic wastewater discharge might still promote the AR transmission risk via additive or synergistic effects.However,the comprehensive effect of antibiotic wastewater on AR development has rarely been evaluated,and its treatment efficiency remains unknown.Here,samples were collected from different stages of a cephalosporin production wastewater treatment plant,and the potential AR induction effect of their chemical mixtures was explored through the exposure of the antibiotic-sensitive Escherichia coli K12 strain.Incubation with raw cephalosporin production wastewater significantly promoted mutation rates(3.6×10^(3)-9.3×10^(3)-fold)and minimum inhibition concentrations(6.0-6.7-fold)of E.coli against ampicillin and chloramphenicol.This may be attributed to the inhibition effect and oxidative stress of cephalosporin wastewater on E.coli.The AR induction effect of cephalosporin wastewater decreased after the coagulation sedimentation treatment and was completely removed after the full treatment process.A Pearson correlation analysis revealed that the reduction in the AR induction effect had a strong positive correlation with the removal of organics and biological toxicity.This indicates that the antibiotic wastewater treatment had a collaborative processing effect of conventional pollutants,toxicity,and the AR induction effect.This study illustrates the potential AR transmission risk of antibiotic wastewater and highlights the need for its adequate treatment.

DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA:SURVEY CONDUCTED IN SOME REGIONS OF CHINA

Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia （CAP） in recent years. We also investigated the procedure of diagnosis us well as the empirical treatment for this disease in OPD （ outpatient department） of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfiUed the questionnaires and information sheets in each center. After that, data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities （ 77. 3% ）, most of those who had medical insurance. Most CAP patients had productive cough （81.1% ）, and 76. 7% and 18. 2 % CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP （43. 2% ）. Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP （ 51.1% ） with oral taken as the main method for drug using （66. 3% ）. Conclusion This survey provides a key point of empirical therapy in China. The procedure for diagnosing us well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.

Algae-mediated antibiotic wastewater treatment:A critical review

The existence of continually increasing concentrations of antibiotics in the environment is a serious potential hazard due to their toxicity and persistence.Unfortunately,conventional treatment techniques,such as those utilized in wastewater treatment plants,are not efficient for the treatment of wastewater containing antibiotic.Recently,algae-based technologies have been found to be a sustainable and promising technique for antibiotic removal.Therefore,this review aims to provide a critical summary of algae-based technologies and their important role in antibiotic wastewater treatment.Algal removal mechanisms including bioadsorption,bioaccumulation,and biodegradation are discussed in detail,with using algae-bacteria consortia for antibiotic treatment,integration of algae with other microorganisms(fungi and multiple algal species),hybrid algae-based treatment and constructed wetlands,and the factors affecting algal antibiotic degradation comprehensively described and assessed.In addition,the use of algae as a precursor for the production of biochar is highlighted,along with the modification of biochar with other materials to improve its antibiotic removal capacity and hybrid algae-based treatment with advanced oxidation processes.Furthermore,recent novel approaches for enhancing antibiotic removal,such as the use of genetic engineering to enhance the antibiotic degradation capacity of algae and the integration of algal antibiotic removal with bioelectrochemical systems are discussed.Finally,some based on the critical review,key future research perspectives are proposed.Overall,this review systematically presents the current progress in algae-mediated antibiotic removal technologies,providing some novel insights for improved alleviation of antibiotic pollution in aquatic environments。

Photocatalytic fuel cell for simultaneous antibiotic wastewater treatment and electricity production by anatase TiO_(2) nanoparticles anchored on Ni foam

Photocatalytic fuel cell (PFC) holds great potential for the sustainable production of electricity and degradation of organic pollutants for solving global energy and environmental problems.However,the efficient photodegradation of organic dyes and antibiotic drugs,such as ciprofloxacin (CIP) and methylene blue(MB),remains challenging.Aiming at improving the separation efficiency of hole and electron for electricity generation in the PFC system,TiO_(2)-NPs@NF-x photoanode was fabricated by a cost-effective and laborsaving hydrothermal approach.The as-fabricated photoanode demonstrated abundant active sites,enhanced light harvesting capacity and photogenerated charge carrier separation.At a CIP-HCl concentration of 10 mg/L and p H value of about 7,85%of CIP-HCl can be efficiently removed after 3 h irradiation by 300 W Xe lamp.TiO_(2)-NPs@NF-20 photoelectrode based PFC system exhibited an impressed ability to simultaneously degrade ciprofloxacin and generate electricity under light irradiation with an open circuit voltage of 1.021 V,short circuit current density and maximum power density of 2.4 mA/cm^(2),0.357 mW/cm^(2),respectively.This work provided a cost-effective method for the treatment of organic waste and generation of electrical power.

Infections in Alcoholic Hepatitis

Severe alcoholic hepatitis (sAH) is defined by a modified discriminant function ≥32 or model for end-stage liver disease (MELD) >20. Patients with sAH are in an immu-nocompromised state attributed to cirrhosis-related immu-noparesis and corticosteroid use. Individuals with sAH often develop severe infections that adversely impact short-term prognosis. Currently, the corticosteroid prednisolone is the only treatment with proven efficacy in sAH;however, the combination of corticosteroid treatment and altered host defense in sAH has been thought to increase the risk of acquiring of bacterial, opportunistic fungal, and viral infec-tions. Newer studies have shown that corticosteroids do not increase occurrence of infections in those with sAH;unfor-tunately, the lack of response to corticosteroids may instead predispose to infection development. Prompt and appropri-ate antibiotic treatment is therefore essential to improving patient outcomes. This review highlights common infections and risk factors in patients with sAH. Additionally, current diagnostic, therapeutic, and prophylactic strategies in these patients are discussed.

Selective and stable elimination of endosymbionts from multiple-infected whitefly Bemisia tabaci by feeding on a cotton plant cultured in antibiotic solutions

The maternally heritable endosymbiont provides many ecosystem functions.Antibiotic elimination of a specific symbiont and establishment of experimental host lines lacking certain symbionts enable the roles of a given symbiont to be explored.The whitefly Bemisia tabaci(Gennadius)in China harbors obligate symbiont Portiera infecting each in-dividual,as well as facultative symbionts,such as Hamiltonella,Rickettsia and Cardinium,with co-infections occurring relatively frequently.So far no studies have evaluated the selectivity and efficacy of a specific symbiont elimination using antibiotics in whiteflies co-infected with different symbionts.Furthermore,no success has been achieved in estab-lishing certain symbiont-free B.tabaci lines.In this study,we treated Hamiltonella infected B.tabaci line,Hamiltonella-Rickettsia-co infected line and Hamiltonella-Cardinium co-infected line by feeding B.tabaci adults with cotton plants cultured in water containing ri-fampicin,ampicillin or a mixture of them,aiming to selectively curing symbiont infections and establishing stable symbiont-free lines.We found ampicillin selectively eliminated Cardinium without afecting Portiera,Hamiltonella and Rickettsia,although they coex-isted in the same host body.Meanwhile,all of the symbionts considered in our study can be removed by rifampicin.The reduction of facultative symbionts occurred at a much quicker pace than obligate symbiont Portiera during rifampicin treatment.Also,we measured the stability of symbiont elimination in whitefly successive generations and established Rickettsia-infected and Cardinium-infected lines which are absent in natural populations.Our results provide new protocols for selective elimination of symbionts co-existing in a host and establishment of different symbiont-infected host lines.