Post-appendectomy pelvic abscess with extended-spectrum beta-lactamase producing Escherichia coli : A case report and review of literature

BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that catalyse the degradation of the betalactam ring of penicillins and cephalosporins(but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBLEnterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United States.CASE SUMMARY The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words "appendiceal abscesses" and "ESBL Escherichia coli(E. coli)" revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis whodeveloped a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for postappendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.CONCLUSION Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.

Comparative Study of Three β Lactamase Test Methods in <i>Staphylococcus</i>aureus Isolated from Two Nepalese Hospitals

Background: β lactamase is a plasmid-encoded enzyme that hydrolyzes β lactam ring of β lactam antibiotics rendering them ineffective. These enzymes, produced by Staphylococcus aureus along with many other organisms, have hindered the use of many useful and once life-saving β lactam antibiotics from clinical practice. Methods: This study was aimed to compare three test methods-chromogenic, acidimetric and iodometric-for the detection of β lactamase enzyme produced by 404 nosocomial induced S. aureus isolated from two Nepali hospitals, Kathmandu based hospital (KBH) and Lalitpur based Hospital (LBH). The study was carried out following standard methodology during November 2007 to June 2009 in the Department of Microbiology, Institute of Medicine, Kathmandu, Nepal. Sensitivity, specificity, efficiency, positive predictive value, and negative predictive values of the tests were calculated taking penicillin resistance and sensitivity as the standard. Results: Chromogenic method was found to be the most sensitive (98.93%) and efficient (98.51%) test and had a high positive predictive value (99.46%). Sensitivity (98.4%) and efficiency (98.27%) of iodometric method was found to be comparable to chromogenic test;its specificity (96.55 %) and positive predictive value (99.73%) were the highest among the 3 tests. Acidimetric test was the least sensitive (97.33%) and efficient (96.78%). Of note, the sensitivity and specificity of these test methods have been compromised due to the negativity of few penicillin resistant isolates and positivity of some penicillin sensitive isolates, respectively. Conclusion: Chromogenic method was found comparatively to be the best test method for the detection of β lactamase production. However, in contrast to the other two test methods whose reagents can be locally and economically prepared, chromogenic test’s use has been impeded by its cost and unavailability in the local Nepali market.

Molecular Characterization and Correlation with β-lactam Resistance of Streptococcus pneumonia Isolates in Hangzhou,China

Penicillin-binding proteins（PBPs） are the target of β-lactam antibiotics（the major treatment for Streptococcus pneumoniae infections）,and mutations in PBPs are considered as a primary mechanism for the development of β-lactam resistance in S.pneumoniae.This study was conducted to investigate the mutations in the PBPs of clinical S.pneumoniae isolates in Hangzhou,China,in correlation with β-lactam resistance.Results showed that 19 F was the predominant serotype（7/27） and 14 of the S.pneumoniae isolates were resistant to both penicillin G and cephalosporin.Genotyping results suggested that β-lactam-resistant isolates primarily exhibited single-site mutations in both the STMK and SRNVP motifs of pbp1 a in combination with double-site mutations in the STMK motif of pbp2 x,which might be the primary mechanisms underlying the β-lactam resistance of the isolates in this study.

Construction of the Skeleton of Phthalascidin, Mechanism of the Formation of the Key Tricyclic Lactam Intermediate

The mechanism of the formation of a key tricyclic lactam intermediate 3 was studied. It was found that the E-form compound 3 was transformed from the Z-form compound 4. The formation of 4 was a kinetically controlled process while the formation of 3 was a thermodynamically favorable one. A possible mechanism was given in this paper.

Lactam Triterpenoids from the Bark of Toona sinensis

Three new limonoid-type triterpenoids,namely toonasins A–C(1–3)with a rare lactam E ring,along with six known compounds(4–9)were isolated from the barks of Toona sinensis.The structures of new compounds were elucidated by interpretation of spectroscopic data,and the relative configuration of compound 1 was further characterized by X-ray crystallographic analyses.The isolated compounds were evaluated for their cytotoxic activities against five human tumor cell lines(HL-60,SMMC-7721,A-549,MCF-7 and SW480),and compounds 3 and 5 showed weak cytotoxicities.

Synthesis and Crystal Structure of α-( N-Protected a mino)β-lactam Derivative of 1 ,5-Benzothiazepine

The crystal of the title compound C, C 30 H 30 N 2O 3S has been prepared by reaction of 1,5 benzothiazepine with N protected glycine and determined by X ray single crystal diffraction. Crystal data: M r =498.62, triclinic with P 1 space group, a=10.880(2), b=13.955(3), c=9.537(2), α=99.34(3)°, β=110.43(3)°, γ=88 56(3)°, V=1338.2(5) 3, F(000)=528, λ (Mo Kα)=0.71073, Z=2, D c =1 237g/cm 3, μ =0.154mm -1 . Final R=0.0453, wR =0.1256 for 3491 observed reflections 〔 I>2σ(I) 〕. Structure analysis reveals that the substituents at C(23) and C(7) in four membered ring are located on the same side. The conformation of seven membered ring is chair like.

The Effective Catalyst (Cobalt Salt/Lewis Acid) for Beckmann Rearrangement of Cycloalkanone Oximes to Lactams under Mild Conditions

The Beckmann rearrangement of cyclohexanone oxime was achieved by the combined use of cobalt salt and Lewis acids co-catalysts (each 10 mol%). Various combinations of cobalt salts and Lewis acids gave lactams in a satisfactory yield under mild conditions. This method makes it possible to reduce undesirable byproducts.

Synthesis and Steric Structure of β-Lactam Derivatives of 2,4-Diaryl-2,3-dihydro-1,5-benzothiazepines

This paper reports the primary results of the study on β-lactam derivatives of 2,4-diaryl-2, 3-di hydro-1, 5 -benzothiazepines. Five titie compounds have been synthesized, and their configUration and conformation were detendned by X-ray crystallographic analysis.

Synthesis, Crystal Structure and Antitumor Activities of 2-Acyl-β-lactam-2-carboxamides

A series of 2-acyl-β-lactam-2-carboxamides was prepared through a tandem Ugi 4 CC/SN cyclization of bromoacetic acid, primary amine, arylglyoxal, and isocyanide. All of them were characterized by NMR, IR, MS and elemental analysis. Meanwhile, the single crystal of compound 5 a, C_(19)H_(25)ClN_2 O_3, was also obtained and determined by X-ray crystallography. Crystal data: triclinic system, space group P_1, a = 8.1318(15), b = 11.931(2), c = 12.027(2) ?, α = 67.361(3)°, β = 73.009(3)°, γ = 85.663(3)°, V = 1029.1(3) ?3, Z = 2, F(000) = 388, Dc = 1.178 g/cm3, μ = 0.204 mm^(-1), R = 0.0786 and w R = 0.2212 for 3585 independent reflections(Rint = 0.0214) and 2960 observed ones(I > 2σ(I)). Intermolecular N–H···O stacking interactions contributed to the stability of the structure. The antitumor abilities of 5 were analyzed with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazo-liumbromide(MTT) standard method; 5 c stood out as the most potent showing an IC_(50) of 1.70 μmol/L against human tumor cell lines(HepG2).

Synthesis of Some New Spiro <i>β</i>-Lactams and Thiazolidinones Compounds Containing Sulfur Incorporating Quinon Compounds

A series of spiro, β-Lactams, and thiazolidinones incorporating compounds 4 have been synthesized by cycloaddition reaction of, chloroacetyl chloride and mercaptoacetic acid with the synthesized Shiff,s bases 5a-c to give new spiro β- Lactam 6a-c and spiro thiazolidinone 7a-c the cycloaddition were characterized by spectral data including HNMR, 13C-NMR, IR and elemental analysis.

探讨肺炎克雷伯菌临床感染的护理方式及对β-lactams药物耐药性的主决定因素

目的:研究探讨肺炎克雷伯菌(本文以下使用英文简称"KNP")临床感染的护理方式及对药物耐药性的主决定因素。方法:2011年1月～2013年1月,于我院共选择110例患者作为研究对象。首先对患者实施积极的护理干预,以防止院内感染。之后对患者送检物实施β-lactams的活性测定以及细胞膜的通透性测定。结果:和敏感菌株比较,泛耐药菌株以及多重耐药的菌株β-内酰胺酶(本文以下使用英文简称"β-lactamase")的活性显著增多,差异具有统计学意义(P<0.05)。泛耐药菌株以及多重耐药的菌株两者的外膜的通透性相对于敏感菌株而言,具有显著的阻碍作用,差异具有统计学意义(P<0.05)。结论:合理护理,可有效防止医院院内感染。且β-lactamase的活性以及细胞外膜的通透性是KNP对β-lactams耐药性的主决定性因素,对抗生素药物的筛选具有一定的指导意义。

Novel Method for the Enantioselective Synthesis of β-Lactams

A novel method for the enantioselective synthesis of β-lactams is described in this study. 2,3-Dihydrobenzooxazin-4-one derived from salicylamide and L-menthone was used as the chiral auxiliary, which reacted with a-bromo-acyl bromides in the presence of pyridine to give carboximides 2. The stereo-controlled Reformatsky-type reactions of carboximides with imines yielded the corresponding trans β-lactams with high enantioselectivities（e.e. 75%-86%） and high chemical yields（63%-85%）, meanwhile, the chiral auxiliary dihydrobenzooxazin-4-one was released and recovered.

Resistance to Beta Lactam Antibiotics of <i>Pseudomonas aeruginosa</i>Isolated in Community Infections within HIV Infected Persons in Lomé-Togo

Objective: Describe resistance to beta lactam antibiotics of Pseudomonas aeruginosa in community infection within HIV-1 infected persons. Methods: We have studied prospectively from June 15th to December 31st 2013 inthe Clinic Hotel-Dieu and NGO VISA of Lomé, adult HIV-1 infected patients under anti retroviral therapy combining tenofovir, lamivudine and efavirenz for at least one year. The technique of agar diffusion susceptibility using discs of Ticarcillin + clavulanic acid is used to study the β-lactamase production. The diagnosis of species was performed by the chloroform test and the test for sensitivity to kanamycin and colistin. Results: Thirty five strains of Pseudomonas aeruginosa were obtained. The T-lymphocytes CD4 mediane was 575 cells/mm3 of blood. Urine represented 15 cases, skin abscesses 11 cases, externa suppurate otitis 7 cases and vaginal swab for 2 cases. The phenotypes were: wild phenotypes 23 cases (65.7%), resistant phenotypes 12 cases. Among resistant phenotypes, 4 were complex phenotype;5 were ESBL phenotypes;2 were hyper productive cephalosporinases phenotypes and 1 was a specific phenotype with impermeability to imipenem. Conclusion: The acquisition of resistance of Pseudomonas aeruginosa to beta lactam antibiotics in community infections among HIV-1 infected person incentives controls and promotes the rational use of antibiotics.

The Triangle-relationship of β-lactam Antitiotics

The geometric parameters for D-Ala-D-Ala are optimized by MM, the most and next two stable conformations are obtained. According to the interaction model with target emzyme suggested by us, the traingle-relationship of it is obtained. This triangle-relationship could be found in the pharmaceuticals belong to different classes of β-actams also.

Highly Stereoselective Synthesis of trans-3-Chloro-β-lactams from Imines and Mixed Chloroacetyl and Nitroacetyl Chlorides

A series of trans-3-chloro-β-lactams was synthesized stereospecifically from imines and chloroacetyl chloride or a mixture of chloroacetyl chloride and nitroacetyl chloride, prepared from vinylidene chloride and a mixture of concentrated nitric acid and sulfuric acid, in the presence of triethylamine. The reaction of vinylidene chloride and the mixed acid was investigated. The formation mechanism of chloroacetyl chloride and nitroacetyl chloride and their reaction process with imines were proposed.

Synthesis and Crystal Structure of an (N-Protected amino)-β-lactam Derivative of 1,5-Benzothiazepine

The title compound -(N-protected amino)--lactam (C36H33N2O5ClS), derivative of 1,5-benzothiazepine, was prepared by the reaction of 1,5-benzothiazepine 1 with (4R)- phenyloxazolidylacetyl chloride and characteized by X-ray diffraction analysis. The title compound crystallizes in orthorhombic system, space group P212121 with a=12.293(2), b=26.026(5), c=10.146(2)? V=3246.1?, Z=4, Dc=1.312g/cm3, Mr=641.15, F(000)=1344, μ= 0.228 mm1. The final R=0.0597 and wR=0.1165 for 3226 observed reflections with I ≥ 2?I). The crystal structure shows that the 4-phenyloxazolidyl and phenyl attached to C(8) and C(9) are in cis positions, and no trans product was discovered. So the cyclization to -lactam is stereospecific.

Synthesis and Stereostructure of New β-Lactam Derivatives of1,5-Benzothiazepines

Reaction of 1,5-benzothiazepine with N-protected glycine gives new a-amino-β-lactamderivatives of 1.5-benzothiazepine. The configuration and conformation of the products wereconfirmed by x-ray diffraction. The result further reveals that the reaction of 1.5-benzothiazepineswith derivatives of carboxylic acid stereospecific.

Synthesis and Steric Structure of 1, 5-Benzothiazepine-Phenyl-β-Lactams

1, 5-Benzothiazepines 1 react with phenylacetyl chloride to give the title compounds.The structures of these new compounds were confirmed by elemental analysis, ~1H NMR, ^(13)C NMRand MS spectroscopy, and their configuration (the mutual positions of the substituents relative to theβ-lactam ring) and conformation of the compounds were determined by X-ray crystal analysis.

Aztreonam Cell Mediated Hypersensitivity Cross Reactivity with Beta Lactam Antibiotics: The Possibility That It Exists

A 61-year-old female with past medical history of maculopapular rash reaction to ciprofloxacin and amoxicillin being treated for diverticulitis develops the same rash with administration of piperacillin/tazobactam and aztreonam. A diffuse maculopapular rash developed after the administration of piperacillin. It resolved with discontinuation of the drug and the patient was switched to aztreonam and a very similar rash developed subsequently. In a review of the literature, there are no documented cases of a patient with an allergy to both aztreonam and piperacillin/tazobactam despite in vivo cross-reactivity. Unfortunately, there are no standardized allergy tests for aztreonam or piperacillin. This case, however, does offer the possibility that aztreonam may not always be the right alternative to persons with beta-lactam antibiotic allergies.