BACKGROUND Bacterial infections(BI)negatively affect the natural course of cirrhosis.The most frequent BI are urinary tract infections(UTI),pneumonia,and spontaneousbacterial peritonitis(SBP).AIM To assess the relevan...BACKGROUND Bacterial infections(BI)negatively affect the natural course of cirrhosis.The most frequent BI are urinary tract infections(UTI),pneumonia,and spontaneousbacterial peritonitis(SBP).AIM To assess the relevance of bacterial infections beyond the commonly recognized types in patients with cirrhosis and to investigate their relationship with other clinical variables.METHODS We retrospectively analyzed patients with cirrhosis and BI treated between 2015 and 2018 at our tertiary care center.BIs were classified as typical and atypical,and clinical as well as laboratory parameters were compared between the two groups.RESULTS In a cohort of 488 patients with cirrhosis,we identified 225 typical BI(95 UTI,73 SBP,72 pulmonary infections)and 74 atypical BIs,predominantly cholangitis and soft tissue infections(21 each),followed by intra-abdominal BIs(n=9),cholecystitis(n=6),head/throat BIs(n=6),osteoarticular BIs(n=5),and endocarditis(n=3).We did not observe differences concerning age,sex,or etiology of cirrhosis in patients with typical vs atypical BI.Atypical BIs were more common in patients with more advanced cirrhosis,as evidenced by Model of End Stage Liver Disease(15.1±7.4 vs 12.9±5.1;P=0.005)and Child-Pugh scores(8.6±2.5 vs 8.0±2;P=0.05).CONCLUSION Atypical BIs in cirrhosis patients exhibit a distinct spectrum and are associated with more advanced stages of the disease.Hence,the work-up of cirrhosis patients with suspected BI requires detailed work-up to elucidate whether typical BI can be identified.展开更多
Objective:The clinical diagnostic accuracy of C-reactive protein(CRP)for bacterial infections in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is still controversial.This study evaluated its accur...Objective:The clinical diagnostic accuracy of C-reactive protein(CRP)for bacterial infections in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is still controversial.This study evaluated its accuracy through Meta-analysis.Methods:Studies on the diagnostic value of CRP for bacterial infections in AECOPD were searched form Web of Science,PubMed,Cochrane library,EMBASE,WANFANG DATA,CNKI and China Biology Medicine disc.The included studies were evaluated according to QUADAS-2 assessment tool.Stata 12.0 software was used for meta analyses to summarize the sensitivity and the specificity of the included studies,and the heterogeneity test was conducted.The symmetric receiver operating characteristic curves(SROC)was drawn and the area under the curve(AUC)was calculated,and the funnel plot was drawn to determine publication bias.Results:664 studies were initially identified,20 of which met the inclusion criteria(9 in English and 11 in Chinese).Meta-analysis results showed that the summary sensitivity and specificity of CRP in diagnosing bacterial infections in AECOPD were 0.84,95%CI(0.77-0.90)and 0.76,95%CI(0.67-0.82),respectively.The AUC of SROC was 0.87,95%CI(0.83-0.89).Conclusion:CRP has high accuracy,sensitivity and specificity in distinguishing AECOPD bacterial infections from non-bacterial infection.展开更多
AIM To determine risk factors, causative organisms and antimicrobial resistance of bacterial infections following living-donor liver transplantation(LDLT) in cirrhotic patients.METHODS This prospective study included ...AIM To determine risk factors, causative organisms and antimicrobial resistance of bacterial infections following living-donor liver transplantation(LDLT) in cirrhotic patients.METHODS This prospective study included 45 patients with hepatitis C virus-related end-stage liver disease who underwent LDLT at Ain Shams Center for Organ Transplant, Cairo, Egypt from January 2014 to November 2015. Patients were followed-up for the first 3 mo after LDLT for detection of bacterial infections. All patients were examined for the possible risk factors suggestive of acquiring infection pre-, intra-and post-operatively. Positive cultures based on clinical suspicion and patterns of antimicrobial resistance were identified. RESULTS Thirty-three patients(73.3%) suffered from bacterial infections; 21 of them had a single infection episode, and 12 had repeated infection episodes. Bile was the most common site for both single and repeated episodes of infection(28.6% and 27.8%, respectively). The most common isolated organisms were gramnegative bacteria. Acinetobacter baumannii was the most common organism isolated from both single and repeated infection episodes(19% and 33.3%, respectively), followed by Escherichia coli for repeated infections(11.1%), and Pseudomonas aeruginosa for single infections(19%). Levofloxacin showed high sensitivity against repeated infection episodes(P = 0.03). Klebsiella, Acinetobacter and Pseudomonas were multi-drug resistant(MDR). Pre-transplant hepatocellular carcinoma(HCC) and duration of drain insertion(in days) were independent risk factors for the occurrence of repeated infection episodes(P = 0.024).CONCLUSION MDR gram-negative bacterial infections are common post-LDLT. Pre-transplant HCC and duration of drain insertion were independent risk factors for the occurrence of repeated infection episodes.展开更多
Purpose:To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country,and to validate a new scorin...Purpose:To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country,and to validate a new scoring system to predict bacterial infections.Methods:This was a retrospective,single-center study among patients who were admitted via the emergency department of a public hospital.All patients who were started on antibiotics were included in the study,while patients aged<18 years were excluded.Data collected includeding patients'demographics,vital signs and basic laboratory parameters like white blood cell count and creatinine.The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values.Logistic regression was used to derive a novel early warning system for bacterial infections.The area under the receiver operating characteristic(AUROC)was computed for each scoring model.Results:In total,109 patients were included in this study.The quick sequential organ failure assessment(qSOFA),search out severity and rapid acute physiology score had the highest AUROC(≥0.89)for predicting mortality,while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC>0.85;however,these scoring systems failed to predict whether patients were truly infected.The INFECTIONS(short for impaired mental status,not conscious,fast heart rate,elevated creatinine,high temperature,on inotrope,low oxygen,high neutrophils and high sugar)model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient.Conclusions:Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department.The INFECTIONS score may help recognize patients with bacterial infections,but it should be further validated in multiple countries prior to widely use.展开更多
Bacteriophages or phages are viruses that infect bacteria and are increasingly used to control bacterial infections.We develop a reaction-diffusion model coupling the interactive dynamic of phages and bacteria with an...Bacteriophages or phages are viruses that infect bacteria and are increasingly used to control bacterial infections.We develop a reaction-diffusion model coupling the interactive dynamic of phages and bacteria with an epidemiological bacteria-borne disease model.For the submodel without phage absorption,the basic reproduction number Ro is computed.The disease-free equilibrium(DFE)is shown to be globally asymptotically stable whenever Ro is less than one,while a unique globally asymptotically endemic equilibrium is proven whenever Ro exceeds one.In the presence of phage absorption,the above stated classical condition based on Ro,as the average number of secondary human infections produced by susceptible/lysogen bacteria during their entire lifespan,is no longer suficient to guarantee the global stability of the DFE.We thus derive an additional threshold No,which is the average offspring number of lysogen bacteria produced by one infected human during the phage-bacteria interactions,and prove that the DFE is globally asymptotically stable whenever both Ro and No are under unity,and infections persist uniformly whenever Ro is greater than one.Finally,the discrete counterpart of the continuous partial differential equation model is derived by constructing a nonstandard finite difference scheme which is dynamically consistent.This consistency is shown by constructing suitable discrete Lyapunov functionals thanks to which the global stability results for the continuous model are replicated.This scheme is implemented in MatLab platform and used to assess the impact of spatial distribution of phages,on the dynamic of bacterial infections.展开更多
Background and Aims:Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population.The aim of this study was to assess the incidence of infections in cirrh...Background and Aims:Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population.The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections,bacteria isolated,therapeutic regimens used,and mortality.Methods:This was a retrospective chart review study,including 192 patients.All patients had a diagnosis of cirrhosis and were admitted to University Hospital.Information collected included demographics,etiology of cirrhosis,identification of bacteria from cultures,multidrug-resistant(MDR)status,antibiotics administered,intensive care unit(ICU)admission,and patient mortality.Results:Infections were present in 105(54.6%)patients,and 60(31.2%)patients had multiple infections during a hospitalization(s)for infections.A total of 201 infections were identified.Urinary tract infections(UTIs)were the most common infection(37.8%),followed by bacteremia(20.4%),pneumonia(12.9%),spontaneous bacterial peritonitis(SBP)(11.9%),abscess/cellulitis(6.0%),infectious diarrhea(6.0%),and other(5.0%).Escherichia coli was the most common bacteria isolated(13.4%),both among sensitive and MDR infections.MDR bacteria were the cause for 41.3%of all infections isolated.Fungi accounted for 9.5%of infections.21.9%of patients had decompensation from their infection(s)that required ICU care,and 14.6%of patients died during hospitalization or soon after discharge.Conclusions:The incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts(54.6%),even higher than prior studies suggest.As many of these infections are caused by MDR bacteria and fungal organisms,stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised population.However,once organism sensitivities are discovered,narrowing of antibiotic regimens must occur to maintain good antibiotic stewardship.展开更多
Objective:To ascertain the feasibility of using sustainable natural resources in maintaining disease free fish in such establishments.Methods:causative bacteria were identified by morphology and biochemical techniques...Objective:To ascertain the feasibility of using sustainable natural resources in maintaining disease free fish in such establishments.Methods:causative bacteria were identified by morphology and biochemical techniques.The antibacterial activity and disease resistant capability of mangrove plant leaf extract were investigated against fish pathogens.Results:The infected marine ornamental fishes were collected from the hatchery condition and inhibition activity at the concentration of 220,200,175 and 150μg/mL against Pseudomonas fluorescens,Pseudomonas aeruginosa,Vibrio parahaemolyticus,and Vibrio anguillarum respectively.The experimental trial reveals feeding marine ornamental fish with feed incorporated with a methanol leaf extract of Avicennia marina,increases their survival and reduces their susceptibility to infections from the isolated bacteria.Based on the in vitro assay,methanol extract of Avicennia marina was exhibited good Conclusions:The mangrove leaves have potential to control the infections caused by Pseudomonas fluorescens,Pseudomonas aeruginosa,Vibrio parahaemolyticus and Vibrio anguillarum.展开更多
Considering the WHO warning about the emergence of a’post-antibiotic’era during the 21st century in which common infections and minor injuries will have a dramatic impact on human death toll,search for new potential...Considering the WHO warning about the emergence of a’post-antibiotic’era during the 21st century in which common infections and minor injuries will have a dramatic impact on human death toll,search for new potential antibacterial drug targets became a necessary need.Targets that are extensively explored concern the modulation展开更多
Multidrug-resistant(MDR)bacterial infections exert a tremendous burden on the public health system throughout the developing and developedworld.Slowing development of novel antibiotic scaffolds,over-prescription of an...Multidrug-resistant(MDR)bacterial infections exert a tremendous burden on the public health system throughout the developing and developedworld.Slowing development of novel antibiotic scaffolds,over-prescription of antibiotics,extensive agricultural antibiotic use,and the increasingly complex hospitalized patient populations undergoing treatment,all fuel the rise of highly MDR“superbugs.”Unfortunately,host-directed therapies to boost immune resistance to infection are not currently available for treatment of MDR pathogens.Hematopoietic cells are endowed with a variety ofmechanismsto control microbial invasion.Macrophages in particular have long been appreciated as potent antimicrobial immune cells equipped with several receptors that allow for rapid recognition,phagocytosis,and killing of pathogenic microbes,coupled to secretion of immunostimulatory cytokines to further orchestrate a robust multifaceted antibacterial immune response.To investigate the utility of macrophages as a cell therapy for MDR bacterial infections,we developed a therapeutically translatable process to generate,harvest,and cryopreserve monocyte-derived macrophages(ICONIMACTM).These cells effectively killed both Gram-positive and Gram-negative MDR pathogens in vitro,and conferred protection in vivo against experimental lethal peritonitis and lung infection.Our discoveries provide a proof-of-concept for a novel immunotherapeutic approach against MDR bacterial infections,urgently needed to supplement the diminishing antibiotic pipeline.展开更多
Importance: The current lack of reliable rapid tests for distinguishing between bacterial and viral infections has contributed to antibiotic misuse.Objective: This study aimed to develop a novel biomarker assay that i...Importance: The current lack of reliable rapid tests for distinguishing between bacterial and viral infections has contributed to antibiotic misuse.Objective: This study aimed to develop a novel biomarker assay that integratesFAM89A andIFI44L measurements to assist in differentiating between bacterial and viral infections.Methods: This prospective study recruited children with febrile illness from two hospitals between July 1, 2018, and June 30, 2019. A panel of three experienced pediatricians performed reference standard diagnoses of all patients (i.e., bacterial or viral infection) using available clinical and laboratory data, including a 28-day follow-up assessment. Assay operators were blinded to the reference standard diagnoses. The expression levels ofFAM89A andIFI44L were determined by quantitative real-time polymerase chain reaction assessment.Results: Of 133 potentially eligible patients with suspected bacterial or viral infection, 35 were excluded after the application of exclusion criteria. The resulting cohort included 98 patients: 59 with viral diagnoses and 39 with bacterial diagnoses. The areas under the curve (AUCs) of diagnoses usingFAM89A andIFI44L were 0.694 [95% confidence interval (CI): 0.583-0.804] and 0.751 (95%CI: 0.651-0.851), respectively. The disease risk score (DRS) [log2(FAM89A expression) - log2(IFI44L expression)] signature achieved an improved area under the receiver operating characteristic curve (AUC, 0.825;95%CI: 0.735-0.915), compared with the AUC generated from individual host RNA. A combination of the DRS and the C-reactive protein (CRP) level achieved an AUC of 0.896 (95%CI: 0.825-0.966). Optimal cutoffs for the DRS and CRP level were -3.18 and 19.80 mg/L, respectively.Interpretation: The DRS was significantly more accurate than the CRP level in distinguishing between bacterial and viral infections;the combination of these two parameters exhibited greater sensitivity and specificity. This study provides information that could be useful for the clinical application ofFAM89A andIFI44L in terms of distinguishing between viral and bacterial infections.展开更多
Establishing a system for measuring plant health and bacterial infection is critical in agriculture.Previously,the farmers themselves,who observed them with their eyes and relied on their experience in analysis,which ...Establishing a system for measuring plant health and bacterial infection is critical in agriculture.Previously,the farmers themselves,who observed them with their eyes and relied on their experience in analysis,which could have been incorrect.Plant inspection can determine which plants reflect the quantity of green light and near-infrared using infrared light,both visible and eye using a drone.The goal of this study was to create algorithms for assessing bacterial infections in rice using images from unmanned aerial vehicles(UAVs)with an ensemble classification technique.Convolution neural networks in unmanned aerial vehi-cles image were used.To convey this interest,the rice’s health and bacterial infec-tion inside the photo were detected.The project entailed using pictures to identify bacterial illnesses in rice.The shape and distinct characteristics of each infection were observed.Rice symptoms were defined using machine learning and image processing techniques.Two steps of a convolution neural network based on an image from a UAV were used in this study to determine whether this area will be affected by bacteria.The proposed algorithms can be utilized to classify the types of rice deceases with an accuracy rate of 89.84 percent.展开更多
Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Me...Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.展开更多
Objective: To explore the risk factors of intra-abdominal bacterial infection (IAI) after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Methods: A series of 82 HCC patients who re...Objective: To explore the risk factors of intra-abdominal bacterial infection (IAI) after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Methods: A series of 82 HCC patients who received LT surgeries in our department between March 2004 and April 2010 was recruited in this study. Then we collected and analyzed the clinical data retrospectively. Statistical analysis system (SPSS) software was adopted to perform statistical analysis. Chi-square test, t-test and Wilcoxon rank sum test were used to analyze the clinical data and compute the significance of the incidences of early-stage IAI after LT for HCC patients. Binary logistic regression was performed to screen out the risk factors, and multiple logistic regression analyses were performed to compute the independent risk factors. Results: A series of 13 patients (13/82, 15.9%) had postoperative IAI. The independent risk factors of postoperative intra-abdominal bacterial infections after LT for HCC patients were preoperative anemia [Hemoglobin (HGB) 〈90 g/L] and postoperative abdominal hemorrhage (72 hours 〉400 mL), with the odds ratios at 8.121 (95% CI, 1.417 to 46.550, P=0.019) and 5.911 (95% CI, 1.112 to 31.432, P=0.037). Conclusions: Postoperative IAI after LT in patients with HCC was a common complication. Preoperative moderate to severe anemia, as well as postoperative intra-abdominal hemorrhage more than 400 mL within the first 72 hours might independently indicate high risk of IAI for these patients.展开更多
Background:The rapid antibiotics treatment targeted to a specific pathogen can improve clinical outcomes of septicemia.We aimed to evaluate the clinical characteristics and outcomes of biliary septicemia caused by cho...Background:The rapid antibiotics treatment targeted to a specific pathogen can improve clinical outcomes of septicemia.We aimed to evaluate the clinical characteristics and outcomes of biliary septicemia caused by cholangitis or cholecystitis according to causative organisms.Methods:We performed a retrospective cohort study in 151 patients diagnosed with cholangitis or cholecystitis with bacterial septicemia from January 2013 to December 2015.All patients showed clinical evidence of biliary tract infection and had blood isolates that demonstrated septicemia.Results:Gram-negative,gram-positive,and both types of bacteria caused 84.1%(127/151),13.2%(20/151),and 2.6%(4/151)episodes of septicemia,respectively.The most common infecting organisms were Escherichia coli among gram-negative bacteria and Enterococcus species(Enterococcus casseliflavus and Enterococcus faecalis)among gram-positive bacteria.There were no differences in mortality,re-admission rate,and need for emergency decompression procedures between the gram-positive and gram-negative septicemia groups.In univariate analysis,previous gastrectomy history was associated with gram-positive bacteremia.Multivariate analysis also showed that previous gastrectomy history was strongly associated with gram-positive septicemia(Odds ratio=5.47,95%CI:1.19–25.23;P=0.029).Conclusions:Previous gastrectomy history was related to biliary septicemia induced by gram-positive organisms.This information would aid the choice of empirical antibiotics.展开更多
<strong>Introduction</strong><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">According to Mali’s National ...<strong>Introduction</strong><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">According to Mali’s National Immunization Center, the</span><span style="font-family:""> <i><span style="font-family:Verdana;">Hae</span><span style="font-family:Verdana;">mophilus influenzae</span></i><span style="font-family:Verdana;"> b (Hib) vaccine coverage rate was 90% in 2015. Our</span><span style="font-family:Verdana;"> work aimed to study invasive bacterial infections due to </span><i><span style="font-family:Verdana;">Haemophilus influenzae</span></i><span style="font-family:Verdana;"> type b in children aged 0</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">- 15 years hospitalized in the pediatrics department </span><span style="font-family:Verdana;">of the UH-GT</span></span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">We carried out a retrospective descriptive study</span><span style="font-family:""><span style="font-family:Verdana;"> from January 2017 to December 2018 (</span><i><span style="font-family:Verdana;">i</span></i><span style="font-family:Verdana;">.</span><i><span style="font-family:Verdana;">e</span></i><span style="font-family:Verdana;">. 2 years) among children aged 0</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">15 years and hospitalized for </span><i><span style="font-family:Verdana;">Haemophilus influenzae</span></i><span style="font-family:Verdana;"> type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid).</span></span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:""><span style="font-family:Verdana;">Thirty-three cases of Hib infections were collected giving a </span><span style="font-family:Verdana;">frequency of 0.2% and the age group 3 months to 3 years was the most</span><span style="font-family:Verdana;"> affected (72.73%).</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">Children who received no vaccine accounted for 21.21%.</span><span style="font-family:""> </span><span style="font-family:Verdana;">The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the </span><span style="font-family:Verdana;">bacterium</span><span style="font-family:""> </span><span style="font-family:Verdana;">in 100% of cases, against 72.72% in the blood culture</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Meningitis </span><span style="font-family:Verdana;">was the most frequent pathology (78.79%) and the lethality was high</span><span style="font-family:Verdana;"> (21.21%).</span></span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Despite the introduction of the Hib vaccine in the routine</span><span style="font-family:Verdana;"> immunization program in Mali, Hib infections remain with a high lethality linked to meningitis</span><span style="font-family:Verdana;">.</span>展开更多
BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatiti...BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatitis B virus decompensated cirrhosis(HBV-DC)remains to be investigated.AIM To investigate the impact of BI on the outcomes of the patients with HBV-DC admitted into the hospital with or without ACLF.METHODS This retrospective study included patients with HBV-DC admitted to two tertiary centers in China.In-hospital overall survival,90-d transplant-free survival,5-year post-discharge survival,and cumulative incidence of ACLF were evaluated.Risk factors for death were analyzed considering liver transplantation as a competing event.RESULTS A total of 1281 hospitalized HBV-DC patients were included;284 had ACLF at admission.The overall prevalence of BI was 28.1%.The patients with BI had a significantly lower in-hospital survival and transplant-free 90-d survival than those without,in both the patients admitted with and without ACLF.The presence of BI significantly increased the risk of developing ACLF[subdistribution hazard ratio(sHR)=2.52,95%CI:1.75-3.61,P<0.001]in the patients without ACLF.In the patients discharged alive,those who had an episode of BI had a significantly lower 5-year transplant-free survival.BI was an independent risk factor for death in the patients admitted without ACLF(sHR=3.28,95%CI:1.93-5.57),while in ACLF admissions,the presence of pneumonia,but not other type of BI,independently increased the risk of death(sHR=1.87,95%CI:1.24-2.82).CONCLUSION BI triggers ACLF in patients with HBV-DC and significantly impairs short-term survival.HBV-DC patients should be monitored carefully for the development of BI,especially pneumonia,to avoid an adverse outcome.展开更多
AIM To investigate whether the use of proton pump inhibitors(PPIs) increases the incidence of spontaneous bacterial peritonitis(SBP) in patients with cirrhosis and ascites.METHODS An historical cohort study was carrie...AIM To investigate whether the use of proton pump inhibitors(PPIs) increases the incidence of spontaneous bacterial peritonitis(SBP) in patients with cirrhosis and ascites.METHODS An historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm3 without evidence of an intraabdominal, surgically treatable source of infection.RESULTS Of 738 cirrhotic patients, 582(58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection(36.2%) and alcohol abuse(25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299(51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP(22.5%). Among 107 non-users of PPIs, 23 developed SBP(21.5%)(HR = 1.44, 95%CI: 0.85-2.47, P = 0.176). The median follow-up time of patients using PPI was 27 mo vs 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh(CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo(Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP(58.4% vs 62.7% respectively, P = 0.66). For patients with SBP, survival at 60 mo was 55.1%, vs 61.7% in patients without SBP(P = 0.34). CONCLUSION In conclusion, the rate of SBP was not significantly different in users or non-users of PPIs in this cohort of cirrhotic with ascites.展开更多
Background:Multimorbidity of intestinal cancer(IC),type 2 diabetes(T2D)and obesity is a complex set of diseases,affected by environmental and genetic risk factors.High-fat diet(HFD)and oral bacterial infection play im...Background:Multimorbidity of intestinal cancer(IC),type 2 diabetes(T2D)and obesity is a complex set of diseases,affected by environmental and genetic risk factors.High-fat diet(HFD)and oral bacterial infection play important roles in the etiology of these diseases through inflammation and various biological mechanisms.Methods:To study the complexity of this multimorbidity,we used the collaborative cross(CC)mouse genetics reference population.We aimed to study the multimorbidity of IC,T2D,and obesity using CC lines,measuring their responses to HFD and oral bacterial infection.The study used 63 mice of both sexes generated from two CC lines(IL557 and IL711).For 12 weeks,experimental mice were maintained on specific dietary regimes combined with co-infection with oral bacteria Porphyromonas gingivalis and Fusobacterium nucleatum,while control groups were not infected.Body weight(BW)and results of a intraperitoneal glucose tolerance test(IPGTT)were recorded at the end of 12 weeks,after which length and size of the intestines were assessed for polyp counts.Results:Polyp counts ranged between 2 and 10 per CC line.The combination of HFD and infection significantly reduced(P<.01)the colon polyp size of IL557 females to 2.5 cm 2,compared to the other groups.Comparing BW gain,IL557 males on HFD gained 18 g,while the females gained 10 g under the same conditions and showed the highest area under curve(AUC)values of 40000-45000(min mg/dL)in the IPGTT.Conclusion:The results show that mice from different genetic backgrounds respond differently to a high fat diet and oral infection in terms of polyp development and glucose tolerance,and this effect is gender related.展开更多
BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure(ACLF).AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and ...BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure(ACLF).AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency.METHODS This was a retrospective study.Procalcitonin(PCT),white blood cells(WBC),proportion of neutrophils(N%),and C-reactive protein(CRP)were examined.Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve(ROC)analysis was used to evaluate the diagnostic value of different indices.RESULTS This study included 386 patients with ACLF,169(43.78%)of whom had bacterial infection on admission.The area under the ROC(AUROC)of PCT,CRP,WBC and N%for the diagnosis of bacterial infection ranged from 0.637 to 0.692,with no significant difference between them.Logistic regression showed that only N%,PCT,and CRP could independently predict infection.A novel scoring system(infection score)comprised of N%,PCT and CRP was developed.The AUROC of the infection score was 0.740,which was significantly higher than that for the other four indices(infection score vs N%,PCT,CRP,and WBC,P=0.0056,0.0001,0.0483 and 0.0008,respectively).The best cutoff point for the infection score was 4 points,with a sensitivity of 78.05%,a specificity of 55.29%,a positive predictive value of 57.91%and a negative predictive value of 76.16%.CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.展开更多
文摘BACKGROUND Bacterial infections(BI)negatively affect the natural course of cirrhosis.The most frequent BI are urinary tract infections(UTI),pneumonia,and spontaneousbacterial peritonitis(SBP).AIM To assess the relevance of bacterial infections beyond the commonly recognized types in patients with cirrhosis and to investigate their relationship with other clinical variables.METHODS We retrospectively analyzed patients with cirrhosis and BI treated between 2015 and 2018 at our tertiary care center.BIs were classified as typical and atypical,and clinical as well as laboratory parameters were compared between the two groups.RESULTS In a cohort of 488 patients with cirrhosis,we identified 225 typical BI(95 UTI,73 SBP,72 pulmonary infections)and 74 atypical BIs,predominantly cholangitis and soft tissue infections(21 each),followed by intra-abdominal BIs(n=9),cholecystitis(n=6),head/throat BIs(n=6),osteoarticular BIs(n=5),and endocarditis(n=3).We did not observe differences concerning age,sex,or etiology of cirrhosis in patients with typical vs atypical BI.Atypical BIs were more common in patients with more advanced cirrhosis,as evidenced by Model of End Stage Liver Disease(15.1±7.4 vs 12.9±5.1;P=0.005)and Child-Pugh scores(8.6±2.5 vs 8.0±2;P=0.05).CONCLUSION Atypical BIs in cirrhosis patients exhibit a distinct spectrum and are associated with more advanced stages of the disease.Hence,the work-up of cirrhosis patients with suspected BI requires detailed work-up to elucidate whether typical BI can be identified.
文摘Objective:The clinical diagnostic accuracy of C-reactive protein(CRP)for bacterial infections in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is still controversial.This study evaluated its accuracy through Meta-analysis.Methods:Studies on the diagnostic value of CRP for bacterial infections in AECOPD were searched form Web of Science,PubMed,Cochrane library,EMBASE,WANFANG DATA,CNKI and China Biology Medicine disc.The included studies were evaluated according to QUADAS-2 assessment tool.Stata 12.0 software was used for meta analyses to summarize the sensitivity and the specificity of the included studies,and the heterogeneity test was conducted.The symmetric receiver operating characteristic curves(SROC)was drawn and the area under the curve(AUC)was calculated,and the funnel plot was drawn to determine publication bias.Results:664 studies were initially identified,20 of which met the inclusion criteria(9 in English and 11 in Chinese).Meta-analysis results showed that the summary sensitivity and specificity of CRP in diagnosing bacterial infections in AECOPD were 0.84,95%CI(0.77-0.90)and 0.76,95%CI(0.67-0.82),respectively.The AUC of SROC was 0.87,95%CI(0.83-0.89).Conclusion:CRP has high accuracy,sensitivity and specificity in distinguishing AECOPD bacterial infections from non-bacterial infection.
文摘AIM To determine risk factors, causative organisms and antimicrobial resistance of bacterial infections following living-donor liver transplantation(LDLT) in cirrhotic patients.METHODS This prospective study included 45 patients with hepatitis C virus-related end-stage liver disease who underwent LDLT at Ain Shams Center for Organ Transplant, Cairo, Egypt from January 2014 to November 2015. Patients were followed-up for the first 3 mo after LDLT for detection of bacterial infections. All patients were examined for the possible risk factors suggestive of acquiring infection pre-, intra-and post-operatively. Positive cultures based on clinical suspicion and patterns of antimicrobial resistance were identified. RESULTS Thirty-three patients(73.3%) suffered from bacterial infections; 21 of them had a single infection episode, and 12 had repeated infection episodes. Bile was the most common site for both single and repeated episodes of infection(28.6% and 27.8%, respectively). The most common isolated organisms were gramnegative bacteria. Acinetobacter baumannii was the most common organism isolated from both single and repeated infection episodes(19% and 33.3%, respectively), followed by Escherichia coli for repeated infections(11.1%), and Pseudomonas aeruginosa for single infections(19%). Levofloxacin showed high sensitivity against repeated infection episodes(P = 0.03). Klebsiella, Acinetobacter and Pseudomonas were multi-drug resistant(MDR). Pre-transplant hepatocellular carcinoma(HCC) and duration of drain insertion(in days) were independent risk factors for the occurrence of repeated infection episodes(P = 0.024).CONCLUSION MDR gram-negative bacterial infections are common post-LDLT. Pre-transplant HCC and duration of drain insertion were independent risk factors for the occurrence of repeated infection episodes.
文摘Purpose:To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country,and to validate a new scoring system to predict bacterial infections.Methods:This was a retrospective,single-center study among patients who were admitted via the emergency department of a public hospital.All patients who were started on antibiotics were included in the study,while patients aged<18 years were excluded.Data collected includeding patients'demographics,vital signs and basic laboratory parameters like white blood cell count and creatinine.The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values.Logistic regression was used to derive a novel early warning system for bacterial infections.The area under the receiver operating characteristic(AUROC)was computed for each scoring model.Results:In total,109 patients were included in this study.The quick sequential organ failure assessment(qSOFA),search out severity and rapid acute physiology score had the highest AUROC(≥0.89)for predicting mortality,while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC>0.85;however,these scoring systems failed to predict whether patients were truly infected.The INFECTIONS(short for impaired mental status,not conscious,fast heart rate,elevated creatinine,high temperature,on inotrope,low oxygen,high neutrophils and high sugar)model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient.Conclusions:Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department.The INFECTIONS score may help recognize patients with bacterial infections,but it should be further validated in multiple countries prior to widely use.
基金The second author(B.T.),acknowledges the support of the University of Pretoria Senior Postdoctoral Program Grant(2018-2020).
文摘Bacteriophages or phages are viruses that infect bacteria and are increasingly used to control bacterial infections.We develop a reaction-diffusion model coupling the interactive dynamic of phages and bacteria with an epidemiological bacteria-borne disease model.For the submodel without phage absorption,the basic reproduction number Ro is computed.The disease-free equilibrium(DFE)is shown to be globally asymptotically stable whenever Ro is less than one,while a unique globally asymptotically endemic equilibrium is proven whenever Ro exceeds one.In the presence of phage absorption,the above stated classical condition based on Ro,as the average number of secondary human infections produced by susceptible/lysogen bacteria during their entire lifespan,is no longer suficient to guarantee the global stability of the DFE.We thus derive an additional threshold No,which is the average offspring number of lysogen bacteria produced by one infected human during the phage-bacteria interactions,and prove that the DFE is globally asymptotically stable whenever both Ro and No are under unity,and infections persist uniformly whenever Ro is greater than one.Finally,the discrete counterpart of the continuous partial differential equation model is derived by constructing a nonstandard finite difference scheme which is dynamically consistent.This consistency is shown by constructing suitable discrete Lyapunov functionals thanks to which the global stability results for the continuous model are replicated.This scheme is implemented in MatLab platform and used to assess the impact of spatial distribution of phages,on the dynamic of bacterial infections.
文摘Background and Aims:Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population.The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections,bacteria isolated,therapeutic regimens used,and mortality.Methods:This was a retrospective chart review study,including 192 patients.All patients had a diagnosis of cirrhosis and were admitted to University Hospital.Information collected included demographics,etiology of cirrhosis,identification of bacteria from cultures,multidrug-resistant(MDR)status,antibiotics administered,intensive care unit(ICU)admission,and patient mortality.Results:Infections were present in 105(54.6%)patients,and 60(31.2%)patients had multiple infections during a hospitalization(s)for infections.A total of 201 infections were identified.Urinary tract infections(UTIs)were the most common infection(37.8%),followed by bacteremia(20.4%),pneumonia(12.9%),spontaneous bacterial peritonitis(SBP)(11.9%),abscess/cellulitis(6.0%),infectious diarrhea(6.0%),and other(5.0%).Escherichia coli was the most common bacteria isolated(13.4%),both among sensitive and MDR infections.MDR bacteria were the cause for 41.3%of all infections isolated.Fungi accounted for 9.5%of infections.21.9%of patients had decompensation from their infection(s)that required ICU care,and 14.6%of patients died during hospitalization or soon after discharge.Conclusions:The incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts(54.6%),even higher than prior studies suggest.As many of these infections are caused by MDR bacteria and fungal organisms,stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised population.However,once organism sensitivities are discovered,narrowing of antibiotic regimens must occur to maintain good antibiotic stewardship.
基金Supported by University Grants Commission(UGC),New Delhi for providing the financial assistance.Reference No.U.G.C.No.33-384/2007(SR).
文摘Objective:To ascertain the feasibility of using sustainable natural resources in maintaining disease free fish in such establishments.Methods:causative bacteria were identified by morphology and biochemical techniques.The antibacterial activity and disease resistant capability of mangrove plant leaf extract were investigated against fish pathogens.Results:The infected marine ornamental fishes were collected from the hatchery condition and inhibition activity at the concentration of 220,200,175 and 150μg/mL against Pseudomonas fluorescens,Pseudomonas aeruginosa,Vibrio parahaemolyticus,and Vibrio anguillarum respectively.The experimental trial reveals feeding marine ornamental fish with feed incorporated with a methanol leaf extract of Avicennia marina,increases their survival and reduces their susceptibility to infections from the isolated bacteria.Based on the in vitro assay,methanol extract of Avicennia marina was exhibited good Conclusions:The mangrove leaves have potential to control the infections caused by Pseudomonas fluorescens,Pseudomonas aeruginosa,Vibrio parahaemolyticus and Vibrio anguillarum.
文摘Considering the WHO warning about the emergence of a’post-antibiotic’era during the 21st century in which common infections and minor injuries will have a dramatic impact on human death toll,search for new potential antibacterial drug targets became a necessary need.Targets that are extensively explored concern the modulation
文摘Multidrug-resistant(MDR)bacterial infections exert a tremendous burden on the public health system throughout the developing and developedworld.Slowing development of novel antibiotic scaffolds,over-prescription of antibiotics,extensive agricultural antibiotic use,and the increasingly complex hospitalized patient populations undergoing treatment,all fuel the rise of highly MDR“superbugs.”Unfortunately,host-directed therapies to boost immune resistance to infection are not currently available for treatment of MDR pathogens.Hematopoietic cells are endowed with a variety ofmechanismsto control microbial invasion.Macrophages in particular have long been appreciated as potent antimicrobial immune cells equipped with several receptors that allow for rapid recognition,phagocytosis,and killing of pathogenic microbes,coupled to secretion of immunostimulatory cytokines to further orchestrate a robust multifaceted antibacterial immune response.To investigate the utility of macrophages as a cell therapy for MDR bacterial infections,we developed a therapeutically translatable process to generate,harvest,and cryopreserve monocyte-derived macrophages(ICONIMACTM).These cells effectively killed both Gram-positive and Gram-negative MDR pathogens in vitro,and conferred protection in vivo against experimental lethal peritonitis and lung infection.Our discoveries provide a proof-of-concept for a novel immunotherapeutic approach against MDR bacterial infections,urgently needed to supplement the diminishing antibiotic pipeline.
基金This study was supported by the Special Fund of the National Science and Technology Major Project of China(No. 2018ZX10305409)Beijing Hospital Authority "Dengfeng" Talent Training Plan(DFL 20181201)Sanming Project of Medicine in Shenzhen(SZSM201512030)
文摘Importance: The current lack of reliable rapid tests for distinguishing between bacterial and viral infections has contributed to antibiotic misuse.Objective: This study aimed to develop a novel biomarker assay that integratesFAM89A andIFI44L measurements to assist in differentiating between bacterial and viral infections.Methods: This prospective study recruited children with febrile illness from two hospitals between July 1, 2018, and June 30, 2019. A panel of three experienced pediatricians performed reference standard diagnoses of all patients (i.e., bacterial or viral infection) using available clinical and laboratory data, including a 28-day follow-up assessment. Assay operators were blinded to the reference standard diagnoses. The expression levels ofFAM89A andIFI44L were determined by quantitative real-time polymerase chain reaction assessment.Results: Of 133 potentially eligible patients with suspected bacterial or viral infection, 35 were excluded after the application of exclusion criteria. The resulting cohort included 98 patients: 59 with viral diagnoses and 39 with bacterial diagnoses. The areas under the curve (AUCs) of diagnoses usingFAM89A andIFI44L were 0.694 [95% confidence interval (CI): 0.583-0.804] and 0.751 (95%CI: 0.651-0.851), respectively. The disease risk score (DRS) [log2(FAM89A expression) - log2(IFI44L expression)] signature achieved an improved area under the receiver operating characteristic curve (AUC, 0.825;95%CI: 0.735-0.915), compared with the AUC generated from individual host RNA. A combination of the DRS and the C-reactive protein (CRP) level achieved an AUC of 0.896 (95%CI: 0.825-0.966). Optimal cutoffs for the DRS and CRP level were -3.18 and 19.80 mg/L, respectively.Interpretation: The DRS was significantly more accurate than the CRP level in distinguishing between bacterial and viral infections;the combination of these two parameters exhibited greater sensitivity and specificity. This study provides information that could be useful for the clinical application ofFAM89A andIFI44L in terms of distinguishing between viral and bacterial infections.
基金funded by King Mongkut’s University of Technology North Bangkok(Contract no.KMUTNB-63-KNOW-044).
文摘Establishing a system for measuring plant health and bacterial infection is critical in agriculture.Previously,the farmers themselves,who observed them with their eyes and relied on their experience in analysis,which could have been incorrect.Plant inspection can determine which plants reflect the quantity of green light and near-infrared using infrared light,both visible and eye using a drone.The goal of this study was to create algorithms for assessing bacterial infections in rice using images from unmanned aerial vehicles(UAVs)with an ensemble classification technique.Convolution neural networks in unmanned aerial vehi-cles image were used.To convey this interest,the rice’s health and bacterial infec-tion inside the photo were detected.The project entailed using pictures to identify bacterial illnesses in rice.The shape and distinct characteristics of each infection were observed.Rice symptoms were defined using machine learning and image processing techniques.Two steps of a convolution neural network based on an image from a UAV were used in this study to determine whether this area will be affected by bacteria.The proposed algorithms can be utilized to classify the types of rice deceases with an accuracy rate of 89.84 percent.
基金This study was supported by a grant from the National Natural Science Foundation of China(81870457).
文摘Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.
基金funded by a new round of the ShanghaiHealth System outstanding young talent training plan (XYQ2011030)
文摘Objective: To explore the risk factors of intra-abdominal bacterial infection (IAI) after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Methods: A series of 82 HCC patients who received LT surgeries in our department between March 2004 and April 2010 was recruited in this study. Then we collected and analyzed the clinical data retrospectively. Statistical analysis system (SPSS) software was adopted to perform statistical analysis. Chi-square test, t-test and Wilcoxon rank sum test were used to analyze the clinical data and compute the significance of the incidences of early-stage IAI after LT for HCC patients. Binary logistic regression was performed to screen out the risk factors, and multiple logistic regression analyses were performed to compute the independent risk factors. Results: A series of 13 patients (13/82, 15.9%) had postoperative IAI. The independent risk factors of postoperative intra-abdominal bacterial infections after LT for HCC patients were preoperative anemia [Hemoglobin (HGB) 〈90 g/L] and postoperative abdominal hemorrhage (72 hours 〉400 mL), with the odds ratios at 8.121 (95% CI, 1.417 to 46.550, P=0.019) and 5.911 (95% CI, 1.112 to 31.432, P=0.037). Conclusions: Postoperative IAI after LT in patients with HCC was a common complication. Preoperative moderate to severe anemia, as well as postoperative intra-abdominal hemorrhage more than 400 mL within the first 72 hours might independently indicate high risk of IAI for these patients.
文摘Background:The rapid antibiotics treatment targeted to a specific pathogen can improve clinical outcomes of septicemia.We aimed to evaluate the clinical characteristics and outcomes of biliary septicemia caused by cholangitis or cholecystitis according to causative organisms.Methods:We performed a retrospective cohort study in 151 patients diagnosed with cholangitis or cholecystitis with bacterial septicemia from January 2013 to December 2015.All patients showed clinical evidence of biliary tract infection and had blood isolates that demonstrated septicemia.Results:Gram-negative,gram-positive,and both types of bacteria caused 84.1%(127/151),13.2%(20/151),and 2.6%(4/151)episodes of septicemia,respectively.The most common infecting organisms were Escherichia coli among gram-negative bacteria and Enterococcus species(Enterococcus casseliflavus and Enterococcus faecalis)among gram-positive bacteria.There were no differences in mortality,re-admission rate,and need for emergency decompression procedures between the gram-positive and gram-negative septicemia groups.In univariate analysis,previous gastrectomy history was associated with gram-positive bacteremia.Multivariate analysis also showed that previous gastrectomy history was strongly associated with gram-positive septicemia(Odds ratio=5.47,95%CI:1.19–25.23;P=0.029).Conclusions:Previous gastrectomy history was related to biliary septicemia induced by gram-positive organisms.This information would aid the choice of empirical antibiotics.
文摘<strong>Introduction</strong><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">According to Mali’s National Immunization Center, the</span><span style="font-family:""> <i><span style="font-family:Verdana;">Hae</span><span style="font-family:Verdana;">mophilus influenzae</span></i><span style="font-family:Verdana;"> b (Hib) vaccine coverage rate was 90% in 2015. Our</span><span style="font-family:Verdana;"> work aimed to study invasive bacterial infections due to </span><i><span style="font-family:Verdana;">Haemophilus influenzae</span></i><span style="font-family:Verdana;"> type b in children aged 0</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">- 15 years hospitalized in the pediatrics department </span><span style="font-family:Verdana;">of the UH-GT</span></span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">We carried out a retrospective descriptive study</span><span style="font-family:""><span style="font-family:Verdana;"> from January 2017 to December 2018 (</span><i><span style="font-family:Verdana;">i</span></i><span style="font-family:Verdana;">.</span><i><span style="font-family:Verdana;">e</span></i><span style="font-family:Verdana;">. 2 years) among children aged 0</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">15 years and hospitalized for </span><i><span style="font-family:Verdana;">Haemophilus influenzae</span></i><span style="font-family:Verdana;"> type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid).</span></span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:""><span style="font-family:Verdana;">Thirty-three cases of Hib infections were collected giving a </span><span style="font-family:Verdana;">frequency of 0.2% and the age group 3 months to 3 years was the most</span><span style="font-family:Verdana;"> affected (72.73%).</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">Children who received no vaccine accounted for 21.21%.</span><span style="font-family:""> </span><span style="font-family:Verdana;">The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the </span><span style="font-family:Verdana;">bacterium</span><span style="font-family:""> </span><span style="font-family:Verdana;">in 100% of cases, against 72.72% in the blood culture</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Meningitis </span><span style="font-family:Verdana;">was the most frequent pathology (78.79%) and the lethality was high</span><span style="font-family:Verdana;"> (21.21%).</span></span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Despite the introduction of the Hib vaccine in the routine</span><span style="font-family:Verdana;"> immunization program in Mali, Hib infections remain with a high lethality linked to meningitis</span><span style="font-family:Verdana;">.</span>
基金Supported by the National Natural Science Foundation of China,No.81570535 and No.81770587Key Projects in the National Science and Technology Pillar Program during the Thirteenth Five-year Plan Period,No.2017ZX10203201-008,No.2018ZX09206005-003,and 2017ZX10202202-005-004+4 种基金the Shanghai Three-Year Plan of the Clinical Skills and Innovations,No.16CR1002Athe Shanghai Municipal Key Clinical Specialty,No.shslczdzk01103the Shanghai Three-Year Plan of the Key Subjects Construction in Public Health-Infectious Diseases and Pathogenic Microorganism,No.15GWZK0102the Suzhou Expert Team of Clinical Medicine,No.SZYJTD201717the Joint Research Initiative-Shanghai Jiao Tong University School of Medicine,No.YW20190002
文摘BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatitis B virus decompensated cirrhosis(HBV-DC)remains to be investigated.AIM To investigate the impact of BI on the outcomes of the patients with HBV-DC admitted into the hospital with or without ACLF.METHODS This retrospective study included patients with HBV-DC admitted to two tertiary centers in China.In-hospital overall survival,90-d transplant-free survival,5-year post-discharge survival,and cumulative incidence of ACLF were evaluated.Risk factors for death were analyzed considering liver transplantation as a competing event.RESULTS A total of 1281 hospitalized HBV-DC patients were included;284 had ACLF at admission.The overall prevalence of BI was 28.1%.The patients with BI had a significantly lower in-hospital survival and transplant-free 90-d survival than those without,in both the patients admitted with and without ACLF.The presence of BI significantly increased the risk of developing ACLF[subdistribution hazard ratio(sHR)=2.52,95%CI:1.75-3.61,P<0.001]in the patients without ACLF.In the patients discharged alive,those who had an episode of BI had a significantly lower 5-year transplant-free survival.BI was an independent risk factor for death in the patients admitted without ACLF(sHR=3.28,95%CI:1.93-5.57),while in ACLF admissions,the presence of pneumonia,but not other type of BI,independently increased the risk of death(sHR=1.87,95%CI:1.24-2.82).CONCLUSION BI triggers ACLF in patients with HBV-DC and significantly impairs short-term survival.HBV-DC patients should be monitored carefully for the development of BI,especially pneumonia,to avoid an adverse outcome.
文摘AIM To investigate whether the use of proton pump inhibitors(PPIs) increases the incidence of spontaneous bacterial peritonitis(SBP) in patients with cirrhosis and ascites.METHODS An historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm3 without evidence of an intraabdominal, surgically treatable source of infection.RESULTS Of 738 cirrhotic patients, 582(58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection(36.2%) and alcohol abuse(25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299(51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP(22.5%). Among 107 non-users of PPIs, 23 developed SBP(21.5%)(HR = 1.44, 95%CI: 0.85-2.47, P = 0.176). The median follow-up time of patients using PPI was 27 mo vs 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh(CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo(Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP(58.4% vs 62.7% respectively, P = 0.66). For patients with SBP, survival at 60 mo was 55.1%, vs 61.7% in patients without SBP(P = 0.34). CONCLUSION In conclusion, the rate of SBP was not significantly different in users or non-users of PPIs in this cohort of cirrhotic with ascites.
文摘Background:Multimorbidity of intestinal cancer(IC),type 2 diabetes(T2D)and obesity is a complex set of diseases,affected by environmental and genetic risk factors.High-fat diet(HFD)and oral bacterial infection play important roles in the etiology of these diseases through inflammation and various biological mechanisms.Methods:To study the complexity of this multimorbidity,we used the collaborative cross(CC)mouse genetics reference population.We aimed to study the multimorbidity of IC,T2D,and obesity using CC lines,measuring their responses to HFD and oral bacterial infection.The study used 63 mice of both sexes generated from two CC lines(IL557 and IL711).For 12 weeks,experimental mice were maintained on specific dietary regimes combined with co-infection with oral bacteria Porphyromonas gingivalis and Fusobacterium nucleatum,while control groups were not infected.Body weight(BW)and results of a intraperitoneal glucose tolerance test(IPGTT)were recorded at the end of 12 weeks,after which length and size of the intestines were assessed for polyp counts.Results:Polyp counts ranged between 2 and 10 per CC line.The combination of HFD and infection significantly reduced(P<.01)the colon polyp size of IL557 females to 2.5 cm 2,compared to the other groups.Comparing BW gain,IL557 males on HFD gained 18 g,while the females gained 10 g under the same conditions and showed the highest area under curve(AUC)values of 40000-45000(min mg/dL)in the IPGTT.Conclusion:The results show that mice from different genetic backgrounds respond differently to a high fat diet and oral infection in terms of polyp development and glucose tolerance,and this effect is gender related.
基金Supported by the Chinese National Science and Technology Projects,No.2017ZX10202201.
文摘BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure(ACLF).AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency.METHODS This was a retrospective study.Procalcitonin(PCT),white blood cells(WBC),proportion of neutrophils(N%),and C-reactive protein(CRP)were examined.Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve(ROC)analysis was used to evaluate the diagnostic value of different indices.RESULTS This study included 386 patients with ACLF,169(43.78%)of whom had bacterial infection on admission.The area under the ROC(AUROC)of PCT,CRP,WBC and N%for the diagnosis of bacterial infection ranged from 0.637 to 0.692,with no significant difference between them.Logistic regression showed that only N%,PCT,and CRP could independently predict infection.A novel scoring system(infection score)comprised of N%,PCT and CRP was developed.The AUROC of the infection score was 0.740,which was significantly higher than that for the other four indices(infection score vs N%,PCT,CRP,and WBC,P=0.0056,0.0001,0.0483 and 0.0008,respectively).The best cutoff point for the infection score was 4 points,with a sensitivity of 78.05%,a specificity of 55.29%,a positive predictive value of 57.91%and a negative predictive value of 76.16%.CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.