BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococ...BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.展开更多
Bacteria of the human intestinal microflora have a dual role.They promote digestion and are part of a defense mechanism against pathogens.These bacteria could become potential pathogens under certain circumstances.The...Bacteria of the human intestinal microflora have a dual role.They promote digestion and are part of a defense mechanism against pathogens.These bacteria could become potential pathogens under certain circumstances.The term“bacterial translocation”describes the passage of bacteria of the gastrointestinal tract through the intestinal mucosa barrier to mesenteric lymph nodes and other organs.In some cases,the passage of bacteria and endotoxins could result in blood stream infections and in multiple organ failure.Open elective abdominal surgery more frequently results in malfunction of the intestinal barrier and subsequent bacterial translocation and blood stream infections than laparoscopic surgery.Postoperative sepsis is a common finding in patients who have undergone non-elective abdominal surgeries,including trauma patients treated with laparotomy.Postoperative sepsis is an emerging issue,as it changes the treatment plan in surgical patients and prolongs hospital stay.The association between bacterial translocation and postoperative sepsis could provide novel treatment options.展开更多
BACKGROUND: The study aims to investigate the performance of a metagenomic next-generationsequencing (NGS)-based diagnostic technique for the identifi cation of potential bacterial and viral infectionsand eff ects of ...BACKGROUND: The study aims to investigate the performance of a metagenomic next-generationsequencing (NGS)-based diagnostic technique for the identifi cation of potential bacterial and viral infectionsand eff ects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients.METHODS: A total of 74 ICU patients with sepsis who were admitted to our institution from February1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for bloodcultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded.The correlations between pathogen types and sepsis severity and survival rate were evaluated.RESULTS: NGS produced higher positive results (105 of 118;88.98%) than blood cultures(18 of 118;15.25%) over the whole study period. Concomitant viral infection correlated closelywith sepsis severity and had the negative effect on the survival of patients with sepsis. However,correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis.CONCLUSIONS: Concurrent viral load correlates closely with the severity of sepsis and thesurvival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviraldrugs combined with antibiotics may be benefi cial to ICU sepsis patients.展开更多
Bacterial infection in the first month after liver transplantation is a frequent complication that poses a serious risk for liver transplant recipients as contributes substantially to increased length of hospitalizati...Bacterial infection in the first month after liver transplantation is a frequent complication that poses a serious risk for liver transplant recipients as contributes substantially to increased length of hospitalization and hospital costs being a leading cause of death in this period. Most of these infections are caused by gramnegative bacilli, although gram-positive infections, especially Enterococcus sp. constitute an emerging infectious problem. This high rate of early postoperative infections after liver transplant has generated interest in exploring various prophylactic approaches to surmount this problem. One of these approaches is selective intestinal decontamination(SID). SID is a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. The majority of studies carried out to date have found SID to be effective in the reduction of gram-negative infection, but the effect on overall infection is limited due to a higher number of infection episodes by pathogenic enterococci and coagulase-negative staphylococci. However, difficulties in general extrapolation of the favorable results obtained in specific studies together with the potential risk of selection of multirresistant microorganisms has conditioned controversy about the routinely application of these strategies in liver transplant recipients.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
Proton pump inhibitors(PPIs) represent one of the most extensively prescribed classes of drugs in general and in patients with liver cirrhosis. Many prescriptions are made without a clear adherence to standard indicat...Proton pump inhibitors(PPIs) represent one of the most extensively prescribed classes of drugs in general and in patients with liver cirrhosis. Many prescriptions are made without a clear adherence to standard indications. As a class of ordinarily well tolerated drug, PPIs are not free of side-effects and concerns have been raised about a possible role for PPIs in predisposing patients to an increased risk of bacterial infections and sepsis. As evidences of different power are accumulating on this topic, prospective studies are needed to reach a more universal agreement, but definitely more attention is needed by prescribers in being more adherent to the few recognized indications for the use of PPIs, particularly in patients with liver cirrhosis. Otherwise, doctors could run the risk of being accused of "abused" prescription.展开更多
Infectious diseases become one of the leading causes of human death. Traditional treatment based on classical antibiotics could not provide enough antibacterial activity to combat bacterial infections due to low bioav...Infectious diseases become one of the leading causes of human death. Traditional treatment based on classical antibiotics could not provide enough antibacterial activity to combat bacterial infections due to low bioavailability, even leading to antibiotic resistance. In recent years, biomimetic delivery systems have been developed to improve drug therapy for various diseases, such as malignant tumor and cardiovascular disease. In this work, we designed virus-inspired nanodrugs(VNDs) through co-assembly of amphiphilic lipopeptide dendrons and poly(lactic-co-glycolic acid) polymers for high-efficiency antibiotic delivery. These VNDs had well-defined and stable nanostructures for tetracycline encapsulation and delivery. The VNDs were capable of promoting antibiotic internalization and enhancing their antibacterial effects against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus. Additionally, no obvious cytotoxicity of VNDs was observed to human cell lines. This work successfully demonstrated the virus-mimetic nanoparticles served as promising and applicable antibiotic delivery platform for antibacterial treatment.展开更多
The gut microbiome is recognized as a key modulator of sepsis development.However,the contribution of the gut mycobiome to sepsis development is still not fully understood.Here,we demonstrated that the level of Candid...The gut microbiome is recognized as a key modulator of sepsis development.However,the contribution of the gut mycobiome to sepsis development is still not fully understood.Here,we demonstrated that the level of Candida albicans was markedly decreased in patients with bacterial sepsis,and the supernatant of Candida albicans culture significantly decreased the bacterial load and improved sepsis symptoms in both cecum ligation and puncture(CLP)-challenged mice and Escherichia coli-challenged pigs.Integrative metabolomics and the genetic engineering of fungi revealed that Candida albicans-derived phenylpyruvate(PPA)enhanced the bactericidal activity of macrophages and reduced organ damage during sepsis.Mechanistically,PPA directly binds to sirtuin 2(SIRT2)and increases reactive oxygen species(ROS)production for eventual bacterial clearance.Importantly,PPA enhanced the bacterial clearance capacity of macrophages in sepsis patients and was inversely correlated with the severity of sepsis in patients.Our findings highlight the crucial contribution of commensal fungi to bacterial disease modulation and expand our understanding of the host-mycobiome interaction during sepsis development.展开更多
OBJECTIVE: To review the distribution and trends of bacterial culture specimens in Beijing Institute of Ophthalmology. METHODS: A retrospective analysis of the bacterial culture-positive rate, the distribution of gram...OBJECTIVE: To review the distribution and trends of bacterial culture specimens in Beijing Institute of Ophthalmology. METHODS: A retrospective analysis of the bacterial culture-positive rate, the distribution of gram' s stain, and the distribution and change of isolates was performed on 4705 specimens during a 10-year period (1989- 1998). RESULTS: Positive cultures numbered 1339 of the 4705 specimens, with a positive rate of 28.6%. Gram-positive cocci constituted 55.6% of the total isolates, followed by gram-positive bacilli 13.1% . Gram-negative cocci accounted for 2.8%, and gram-negative bacilli 28.5% . In the positive bacteria cultures, coagulase-negative Staphylococcus (mainly Staphylococcous epidermidis) was the most common isolate (25.3%), and followed by Pseudomonas 18.8%, Micrococcus 11.7%, Cotynbaccterium 10.1%, and Staphylococcus aureus 8.2% . During the 10-year period, the overall frequency of gram-positive cocci appeared to increase with time while the frequency of gram-negative bacilli decreased. CONCLUSIONS: Gram-positive cocci and gram-negative bacilli are still the predominant pathogens of ocular infection in northern China. The frequency of the former increases annually whereas that of the latter decreases. It is important to comprehend the distribution and trends of ocular pathogenic bacteria for the diagnosis, prevention and treatment of bacterial infectious ocular disease.展开更多
基金Supported by the Scientific Research Project from the Health Commission of Mianyang City,No.201903.
文摘BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.
文摘Bacteria of the human intestinal microflora have a dual role.They promote digestion and are part of a defense mechanism against pathogens.These bacteria could become potential pathogens under certain circumstances.The term“bacterial translocation”describes the passage of bacteria of the gastrointestinal tract through the intestinal mucosa barrier to mesenteric lymph nodes and other organs.In some cases,the passage of bacteria and endotoxins could result in blood stream infections and in multiple organ failure.Open elective abdominal surgery more frequently results in malfunction of the intestinal barrier and subsequent bacterial translocation and blood stream infections than laparoscopic surgery.Postoperative sepsis is a common finding in patients who have undergone non-elective abdominal surgeries,including trauma patients treated with laparotomy.Postoperative sepsis is an emerging issue,as it changes the treatment plan in surgical patients and prolongs hospital stay.The association between bacterial translocation and postoperative sepsis could provide novel treatment options.
基金supported by grants from Scienceand Technology Committee of Shanghai (18411951400)KeyClinical Medical Specialties Project in Shanghai Pudong NewArea (PWZzk2017-22)+1 种基金Science and Technology Action Plan(19495810200)Leading Talent Project in Shanghai Pudong NewArea Health System (PWRl2018-08).
文摘BACKGROUND: The study aims to investigate the performance of a metagenomic next-generationsequencing (NGS)-based diagnostic technique for the identifi cation of potential bacterial and viral infectionsand eff ects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients.METHODS: A total of 74 ICU patients with sepsis who were admitted to our institution from February1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for bloodcultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded.The correlations between pathogen types and sepsis severity and survival rate were evaluated.RESULTS: NGS produced higher positive results (105 of 118;88.98%) than blood cultures(18 of 118;15.25%) over the whole study period. Concomitant viral infection correlated closelywith sepsis severity and had the negative effect on the survival of patients with sepsis. However,correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis.CONCLUSIONS: Concurrent viral load correlates closely with the severity of sepsis and thesurvival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviraldrugs combined with antibiotics may be benefi cial to ICU sepsis patients.
文摘Bacterial infection in the first month after liver transplantation is a frequent complication that poses a serious risk for liver transplant recipients as contributes substantially to increased length of hospitalization and hospital costs being a leading cause of death in this period. Most of these infections are caused by gramnegative bacilli, although gram-positive infections, especially Enterococcus sp. constitute an emerging infectious problem. This high rate of early postoperative infections after liver transplant has generated interest in exploring various prophylactic approaches to surmount this problem. One of these approaches is selective intestinal decontamination(SID). SID is a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. The majority of studies carried out to date have found SID to be effective in the reduction of gram-negative infection, but the effect on overall infection is limited due to a higher number of infection episodes by pathogenic enterococci and coagulase-negative staphylococci. However, difficulties in general extrapolation of the favorable results obtained in specific studies together with the potential risk of selection of multirresistant microorganisms has conditioned controversy about the routinely application of these strategies in liver transplant recipients.
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Proton pump inhibitors(PPIs) represent one of the most extensively prescribed classes of drugs in general and in patients with liver cirrhosis. Many prescriptions are made without a clear adherence to standard indications. As a class of ordinarily well tolerated drug, PPIs are not free of side-effects and concerns have been raised about a possible role for PPIs in predisposing patients to an increased risk of bacterial infections and sepsis. As evidences of different power are accumulating on this topic, prospective studies are needed to reach a more universal agreement, but definitely more attention is needed by prescribers in being more adherent to the few recognized indications for the use of PPIs, particularly in patients with liver cirrhosis. Otherwise, doctors could run the risk of being accused of "abused" prescription.
基金supported by National Natural Science Foundation of China (NSFC, Nos. 91956105, 22077028 and 32000995)China National Postdoctoral Program for Innovative Talents(No. BX20200124)+2 种基金China Postdoctoral Science Foundation (No.2020M682544)the Fundamental Research Funds for the Central University (No. 531118010440)Major Research Projects (No.531118100003) from Hunan University。
文摘Infectious diseases become one of the leading causes of human death. Traditional treatment based on classical antibiotics could not provide enough antibacterial activity to combat bacterial infections due to low bioavailability, even leading to antibiotic resistance. In recent years, biomimetic delivery systems have been developed to improve drug therapy for various diseases, such as malignant tumor and cardiovascular disease. In this work, we designed virus-inspired nanodrugs(VNDs) through co-assembly of amphiphilic lipopeptide dendrons and poly(lactic-co-glycolic acid) polymers for high-efficiency antibiotic delivery. These VNDs had well-defined and stable nanostructures for tetracycline encapsulation and delivery. The VNDs were capable of promoting antibiotic internalization and enhancing their antibacterial effects against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus. Additionally, no obvious cytotoxicity of VNDs was observed to human cell lines. This work successfully demonstrated the virus-mimetic nanoparticles served as promising and applicable antibiotic delivery platform for antibacterial treatment.
基金supported by the National Natural Science Foundation of China(32271230 and 32071124)to PCthe NIH Grant(P30DK120515)to BS+4 种基金the National Natural Science Foundation of China(82270581)to YCthe National Key R&D Project of China(2018YFC0115301)the National Natural Science Foundation of China(81974070)the Shenzhen Science and Technology Program(JCYJ20210324131010027)the Research Foundation of Shenzhen Hospital of Southern Medical University(PT2018GZR10)to WG.
文摘The gut microbiome is recognized as a key modulator of sepsis development.However,the contribution of the gut mycobiome to sepsis development is still not fully understood.Here,we demonstrated that the level of Candida albicans was markedly decreased in patients with bacterial sepsis,and the supernatant of Candida albicans culture significantly decreased the bacterial load and improved sepsis symptoms in both cecum ligation and puncture(CLP)-challenged mice and Escherichia coli-challenged pigs.Integrative metabolomics and the genetic engineering of fungi revealed that Candida albicans-derived phenylpyruvate(PPA)enhanced the bactericidal activity of macrophages and reduced organ damage during sepsis.Mechanistically,PPA directly binds to sirtuin 2(SIRT2)and increases reactive oxygen species(ROS)production for eventual bacterial clearance.Importantly,PPA enhanced the bacterial clearance capacity of macrophages in sepsis patients and was inversely correlated with the severity of sepsis in patients.Our findings highlight the crucial contribution of commensal fungi to bacterial disease modulation and expand our understanding of the host-mycobiome interaction during sepsis development.
文摘OBJECTIVE: To review the distribution and trends of bacterial culture specimens in Beijing Institute of Ophthalmology. METHODS: A retrospective analysis of the bacterial culture-positive rate, the distribution of gram' s stain, and the distribution and change of isolates was performed on 4705 specimens during a 10-year period (1989- 1998). RESULTS: Positive cultures numbered 1339 of the 4705 specimens, with a positive rate of 28.6%. Gram-positive cocci constituted 55.6% of the total isolates, followed by gram-positive bacilli 13.1% . Gram-negative cocci accounted for 2.8%, and gram-negative bacilli 28.5% . In the positive bacteria cultures, coagulase-negative Staphylococcus (mainly Staphylococcous epidermidis) was the most common isolate (25.3%), and followed by Pseudomonas 18.8%, Micrococcus 11.7%, Cotynbaccterium 10.1%, and Staphylococcus aureus 8.2% . During the 10-year period, the overall frequency of gram-positive cocci appeared to increase with time while the frequency of gram-negative bacilli decreased. CONCLUSIONS: Gram-positive cocci and gram-negative bacilli are still the predominant pathogens of ocular infection in northern China. The frequency of the former increases annually whereas that of the latter decreases. It is important to comprehend the distribution and trends of ocular pathogenic bacteria for the diagnosis, prevention and treatment of bacterial infectious ocular disease.
