A case of severe pneumonia caused by multiple bacterial organisms following type B influenza virus infection

A 50-year old woman, without any underlying disease, presented with pneumonia after experiencing flu-like symptoms. Streptococcus pneumoniae was identified on admission through blood culture and urine antigen tests. Staphylococcus aureus and Streptococcus pneumoniae were present in the sputum culture. Computed tomography showed cavity development in the consolidation areas, typical of staphylococcal pneumonia. The patient was intubated and received mechanical ventilation as respiratory failure progressed. She exhibited improvement following antibiotic therapy. The change in type B influenza virus serum titer confirmed that this was a unique case of severe pneumonia caused by multiple bacterial organisms following type B influenza virus infection.

Severe Klebsiella pneumoniae pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism:A case report

BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is a clinically common Gram-negative bacillus that can cause community-and hospital-acquired infections and lead to pneumonia,liver abscesses,bloodstream infections,and other infectious diseases;however,severe pneumonia caused by hypervirulent K.pneumoniae(hv Kp)complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism is rarely seen in the clinical setting and has not been reported in the literature.CASE SUMMARY A 51-year-old man was hospitalized with fever and dyspnea.Persistent mild pain in the middle and upper abdomen began at dawn on the 3rd day following admission and developed into persistent severe pain in the left upper abdomen 8h later.Based on chest computed tomography(CT),bronchoscopy,bronchoalveolar lavage fluid metagenomic next-generation sequencing,abdominal aortic CT angiography(CTA),and culture of the superior mesenteric artery embolus,adult community-acquired severe hv Kp pneumonia complicated by acute intraabdominal multiple arterial thrombosis and bacterial embolism was diagnosed.Notably,he recovered and was discharged from the hospital after receiving effective meropenem anti-infection,endovascular contact thrombolytic,and systemic anticoagulant therapies and undergoing percutaneous thrombus aspiration.Ten days later,the patient returned to the hospital for abdominal CTA examination,which indicated blocked initial common pathway of the celiac trunk and superior mesenteric artery,and local stenosis.Therefore,celiac trunk artery stenting was performed in Chongqing Hospital,and postoperative recovery was good.CONCLUSION We report a case of hv Kp severe pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism and suggest that clinicians should consider the possibility of a Gram-negative bacillus infection and conduct effective pathogen detection in a timely fashion when managing patients with severe community-acquired pneumonia before obtaining bacteriologic and drug sensitivity results.At the same time,when patients have severe pulmonary infection complicated by severe abdominal pain,an acute mesenteric artery embolism should be considered to avoid delays in treatment.

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.

Lymphoid interstitial pneumonia—Another consideration for recurrent bacterial pneumonia in an HIV positive patient (A case report)

We present a 39-year-old female with HIV, medication non-compliance, and recurrences of bacterial pneumonia. She presented with a two-day bout of worsening shortness of breath, dyspnea and productive cough. A CT of the chest was notable for multi-lobular pneumonia. She underwent flexible bronchoscopy and biopsy which revealed lymphocytic interstitial pneumonitis. Conclusion: Recurrent bacterial pneumonia is a rare complication of lymphoid interstitial pneumonia (LIP) in HIV positive patients, and should be considered in the differential as a possible precipitator of recurrent pneumonia inan HIV positive patient.

Correlation Between the Clinical Severity, Bacterial Load, and Inflammatory Reaction in Children with Mycoplasma Pneumoniae Pneumonia

Given the lack of defining features in the clinical manifestations and radiographic findings for children with mycoplasma pneumoniae pneumonia(MPP),quantitative polymerase chain reaction(qPCR)has become a useful diagnostic method.This study was performed to explore the relationship between the qPCR findings,clinical symptoms,and inflammatory markers in children with MPP.Four hundred children with MPP have been enrolled in this retrospective analysis.All clinical and analytical information,including mycoplasma pneumoniae(MP)PCR results,has been collected.Based on the PCR results,the patients were divided into groups with load values(copy number)<105(54 cases),2105 and<106(71 cases),2106 and<107(112 cases),>107 and<108(114 cases),and>108(49 cases).The clinical features(including symptoms and signs)and inflammatory indicators were compared among the groups.The incidence of high fever(above 39℃),thermal peak during the entire hospitalization period,fever duration,days of hospitalization,and plasma lactate dehydrogenase(LDH)levels were statistically correlated with the MP PCR load value in children with MPP.The analysis of relevance degree showed the correlative order as a thermal peak of hospitalization>duration of fever>period of hospitalization>LDH value>C-reactive protein value.The host immune response was significantly greater in the complication group than in the non-complication group.

Analysis on the Clinical Effect of Shenling Baizhu San Combined with Routine Treatment on Bacterial Pneumonia in Children

[Objectives]To explore the effect of Shenling Baizhu San combined with routine treatment on the clinical efficacy,gastrointestinal function protection,inflammatory response and immune function of children with bacterial pneumonia.[Methods]From July 2017 to January 2018,80 children with bacterial pneumonia were randomly selected and divided into observation group and control group with 40 cases in each group.The control group was treated with conventional Western medicine,while the observation group was treated with Shenling Baizhu San on the basis of conventional treatment,with a period of 10 d.Then,we compared the clinical efficacy,incidence of gastrointestinal symptoms,WBC,CRP,CD4+and CD8+levels between the two groups.[Results]The clinical efficacy of the observation group was better than that of the control group(P<0.05).After treatment,the levels of WBC and CRP in the two groups decreased,especially in the observation group(P<0.05).After treatment,the level of CD4+in both groups increased significantly,while the level of CD8+decreased significantly,and the level of CD4+in the observation group was significantly higher than that in the control group after treatment.The incidence of gastrointestinal symptoms in the observation group was significantly lower than that in the control group(P<0.01).[Conclusions]Shenling Baizhu San can obviously improve the clinical effect of bacterial pneumonia in children and has the protective effect of gastrointestinal tract,and its mechanism may be related to its anti-inflammatory and immunomodulatory effects.

Evaluating the Health Risks of Pneumonia from Airborne Bacterial Communities Using 16S rDNA Sequences of Pneumonia-related Pathogens

Objective Airborne microbial communities include a significant number of uncultured and poorly characterized bacteria.No effective method currently exists to evaluate the health risks of such complex bacterial populations,particularly for pneumonia.Methods We developed a method to evaluate risks from airborne microorganisms,guided by the principle that closer evolutionary relationships reflect similar biological characteristics,and thus used16 S rDNA sequences of 10 common pneumonia-related bacterial pathogens.We calculated a risk of breath-related(Rbr)index of airborne bacterial communities and verified effectiveness with artificial flora and a clinical project.Results We suggested applying Rbr80 to evaluate the health risks of airborne bacterial communities that comprise 80% of dominant operational taxonomic units(OTUs).The feasibility of Rbr80 was confirmed by artificial flora and by pneumonia data from a hospital.A high Rbr80 value indicated a high risk of pneumonia from airborne bacterial communities.Conclusion Rbr80 is an effective index to evaluate the pneumonia-associated risk from airborne bacteria.Values of Rbr80 greater than 15.40 are considered high risk.

Application of 16s rDNA Sequencing in the Analysis of Pathogenic Bacteria in Sputum of Severe Bacterial Pneumonia

Objective: 120 patients with severe pneumonia who were kept in the comprehensive ICU of our hospital in 2018 were selected, and 16s rDNA sequencing was performed to analyze the composition of pathogenic bacteria in the sputum of severe pneumonia. Methods: The sputum samples of patients with severe bacterial pneumonia were collected, and the diversity of pathogens in the samples was analyzed by polymerase chain reaction (PCR) amplification and high-throughput sequencing (16s rDNA PCR-DGGE). Results: Sequence showed that sputum samples contained a relatively large number of species, and there were many species that were not detected by sequencing. The dominant bacteria were Streptococcus, Sphingomonas, Corynebacterium, Denatobacteria, Aquobacteria, Acinetobacteria, Prevotella, Klebsiella, Pseudomonas, etc. Conclusion: Bacteria caused by sputum of severe bacterial pneumonia are complex and diverse, which provides new methods and ideas for individualized treatment of patients with severe pneumonia.

Acute Eosinophilic Pneumonia (AEP) Due to Daptomycin: Is Autoimmunity a Clinico-Pathophysiologic Bridge to AEP?

Daptomycin induced acute eosinophilic pneumonia is a rare and potentially life threatening condition characterized by rapid respiratory failure, pulmonary infiltrates and eosinophilia. Risk factors for acute eosinophilic pneumonia include smoking, environmental irritants or inhalants and certain medications such as Daptomycin [1]. In this review of literature, we aim to explore the potential triggers for developing acute eosinophilic pneumonia in patients exposed to Daptomycin. The exact immune mechanism for daptomycin induced AEP is unknown, however the current proposed mechanism describes a T helper 2 lymphocyte response to inactivated daptomycin in the pulmonary surfactant, which leads to eosinophilia. Disordered T regulatory cell function is seen in patients with certain cancers, allergies and autoimmune conditions. We propose that patients with these underlying risk factors may be at increased risk of developing AEP after becoming exposed to Daptomycin. Understanding potential risk factors is crucial for health care workers as it allows them to identify susceptible populations, explore preventative measures and treat accordingly.

Correlation of serum P2X7 receptor, CD64 and CD54 expression with infection process in children with bacterial pneumonia

Objective:To investigate the correlation of serum P2X7 receptor, CD64 and CD54 expression with infection process in children with bacterial pneumonia.Methods: A total of 164 children with bacterial pneumonia hospitalized in this hospital between June 2016 and February 2018 were selected as bacterial pneumonia group, and 100 healthy children who received vaccination in this hospital during the same period were selected as normal control group. The expression levels of P2X7 receptor, CD64 and CD54 as well as the contents of inflammatory factors, acute phase proteins and immunoglobulins in serum of the two groups were detected. Results: Immediately after admission, serum P2X7 receptor, CD64 and CD54 expression of bacterial pneumonia group were higher than those of normal control group, inflammatory cytokines TNF-α, sTREM-1, IL-2 and IL-6 contents were higher than those of normal control group, acute phase proteins 1-AGP, CRP, CP and HP contents were higher than those of normal control group, and immunoglobulins IgA, IgM and IgG contents were higher than those of normal control group;serum P2X7 receptor, CD64 and CD54 expression in children with bacterial pneumonia were positively correlated with TNF-α, sTREM-1, IL-2, IL-6, 1-AGP, CRP, CP, HP, IgA, IgM and IgG contents.Conclusion:The serum P2X7 receptor, CD64 and CD54 expression increase in children with bacterial pneumonia, and they are positively correlated with the degree of infection.

Analysis of Clinical Symptoms Improvement in Treatment of Severe Pneumonia Caused by Multi-drug Resistant Bacterial Infection by Bronchoscopy Alveolar Lavage

Objective:To explore the effects of bronchoscopy alveolar lavage in the treatment of severe pneumonia caused by multiple drug bacterial infection.Methods:A total of 84 patients with severe pneumonia infected by multi-drug resistant bacteria were randomly selected from Kunming Second People's Hospital,which is our hospital from January 2019 to December 2020 for this research.They were divided into a reference group and a study group using a digital table method,with 42 cases in each group.The reference group was given the routine treatment,the research group performed bronchoscopy alveolar lavage on this basis to observe the curative effect.Results:Before treatment,there was no significant difference in serum factor indexes and blood gas analysis indexes between the two groups of patients,P>0.05.After treatment,the time of fever,cough,moist rales disappearing and infection control time in the study group were shorter than those in the reference group,P<0.05.Serum tumor necrosis factorα(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)levels were lower than the reference group,and the arterial partial pressure of oxygen(PO2)and oxygen saturation(SO2)were both lower than the reference group,P<0.05.The effective rate of the treatment in the study group was higher than that in the reference group,P<0.05.Conclusion:Bronchoscopic alveolar lavage treatment can effectively improve the clinical symptoms of patients with severe pneumonia caused by multi-drug resistant bacterial infection,and the effects are significant.

Klebsiella pneumoniae infections after liver transplantation:Drug resistance and distribution of pathogens,risk factors,and influence on outcomes

BACKGROUND Liver transplantation(LT)is the only curative treatment for end-stage liver disease.However,LT recipients are susceptible to infection,which is the leading cause of early mortality after LT.Klebsiella pneumoniae infections(KPIs)in the bloodstream are common in LT recipients.We hypothesized that KPIs and carbapenemresistant Klebsiella pneumoniae(CRKP)infections may affect the outcomes of LT recipients.AIM To assess KPI incidence,timing,distribution,drug resistance,and risk factors following LT and its association with outcomes.METHODS This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University,a tertiary hospital,from January 2015 to January 2023.We investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression analysis.RESULTS KPI incidence was 7.9%(n=32),with lung/thoracic cavity the most frequent site of infection;the median time from LT to KPI onset was 7.5 d.Of 44 Klebsiella pneumoniae isolates,43(97.7%)and 34(77.3%)were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline,respectively;>70%were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin.Female sex[odds ratio(OR)=2.827,95%confidence interval(CI):1.256-6.364;P=0.012],pre-LT diabetes(OR=2.794,95%CI:1.070-7.294;P=0.036),day 1 post-LT alanine aminotransferase(ALT)levels≥1500 U/L(OR=3.645,95%CI:1.671-7.950;P=0.001),and post-LT urethral catheter duration over 4 d(OR=2.266,95%CI:1.016-5.054;P=0.046)were risk factors for KPI.CRKP infections,but not KPIs,were risk factors for 6-month all-cause mortality post-LT.CONCLUSION KPIs occur frequently and rapidly after LT.Risk factors include female sex,pre-LT diabetes,increased post-LT ALT levels,and urethral catheter duration.CRKP infections,and not KPIs,affect mortality.

Serum inflammatory markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for mycoplasma severity

BACKGROUND Mycoplasma pneumoniae pneumonia(MPP)significantly impacts pediatric health,necessitating markers for early severe disease identification.AIM To investigate the correlation between serum inflammatory marker and the severity of MPP in children.METHODS A prospective study was carried out from January 2023 to November 2023.A total of 160 children with MPP who underwent treatment were selected:80 had severe MPP and 80 had mild MPP.Clinical and laboratory data were collected at the time of hospital admission and during hospitalization.Receiver operating characteristic curves were utilized to assess the diagnostic and prognostic for severe MPP.RESULTS Fever duration and length of hospitalization in pediatric patients with severe MPP exceeded those with mild MPP.The incidence of pleural effusion,lung consolidation,and bronchopneumonia on imaging was markedly elevated in the severe MPP cohort compared to the mild MPP cohort.In contrast to the mild cohort,there was a notable increase in C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate,lactic dehydrogenase,D-dimer,and inflammatory cytokines[interleukin(IL)-6,IL-8,IL-10 and tumor necrosis factor(TNF)-α]in the severe MPP group were significantly higher.CONCLUSION Serum inflammatory markers(CRP,PCT,IL-6,D-dimer,IL-10 and TNF-α)were considered as predictors in children with severe MPP.

Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria

BACKGROUND Multidrug-resistant Gram-negative bacteria,exacerbated by excessive use of antimicrobials and immunosuppressants,are a major health threat.AIM To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia,and to provide theoretical reference for clinical diagnosis and treatment.METHODS This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022.After bacteriological culture,the patients'airway secretions were collected to confirm the presence of Gram-negative bacilli.The patients were divided into the experimental and control groups according to the medication used.The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous,nebulization,or intravenous combined with nebulization,with a daily dosage of 1.5–3.0 million units.The control group consisted of 26 patients who received standard dosages of other antibiotics(including sulbactam sodium for injection,cefoperazone sodium sulbactam for injection,tigecycline,meropenem,or vaborbactam).RESULTS Of the 28 patients included in the research group,26 patients showed improvement,treatment was ineffective for two patients,and one patient died,with the treatment efficacy rate of 92.82%.Of the 26 patients in the control group,18 patients improved,treatment was ineffective for eight patients,and two patients died,with the treatment efficacy rate of 54.9%;significant difference was observed between the two groups(P<0.05).The levels of white blood cell(WBC),procalcitonin(PCT),and C-reactive protein(CRP)in both groups were significantly lower after treatment than before treatment(P<0.05),and the levels of WBC,PCT,and CRP in the research group were significantly lower than those in the control group(P<0.05).Compared with before treatment,there were no significant changes in aspartate aminotransferase,creatinine,and glomerular filtration rate in both groups,while total bilirubin and alanine aminotransferase decreased after treatment(P<0.05)with no difference between the groups.In patients with good clinical outcomes,the sequential organ failure assessment(SOFA)score was low when treated with inhaled polymyxin sulfate,and specific antibiotic treatment did not improve the outcome.Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.CONCLUSION Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable.Moreover,the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions,providing new ideas for clinical administration.

Clinical characteristics of community-acquired pneumonia in children caused by mycoplasma pneumoniae with or without myocardial damage:A single-center retrospective study

BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.

Initial clinical evaluation of chest digital tomosynthesis in adult patients with COVID-19 pneumonia

To the Editor:The coronavirus disease 2019(COVID-19)pandemic has caused a significant global health crisis,led to staggering mortality rates,and imposed a substantial economic burden.[1]Pneumonia is the leading cause of mortality in patients with COVID-19.During outbreak peaks,the surge in patients severely strained healthcare systems,highlighting the need for rapid and cost-effective screening methods.Although chest X-ray(CXR)is affordable and convenient,its low sensitivity limits its effectiveness for detecting lung abnormalities.Computed tomography(CT)is considered the gold standard for diagnosing pneumonia,including COVID-19 pneumonia,but it exposes patients to high doses of radiation(3-7 mSv)far exceeding the annual threshold of 1 mSv recommended by the World Health Organization.Even low-dose CT delivers an average effective dose of 1.6 mSv,adding to the patient’s radiation burden.

Chinese herbal medicine combined with Western medicine for Mycoplasma pneumoniae pneumonia in children:An overview of systematic reviews

Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Methods:SRs of randomized controlled trials were searched using PubMed,the Cochrane Library,Embase,the Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,and the SinoMed Database.SRs on the use of CHM alone or in combination with Western medications for MPP in children were included.The study compared the effects of Western medicine alone with those of CHM.The evidence quality using the A Measurement Tool to Assess Systematic Reviews(AMSTAR)2,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020,and the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)criteria.The primary indicators were the total effective rate,fever subsidence time,and cough disappearance time.The secondary outcomes were pulmonary rale disappearance time,average hospitalization time,lung X-ray infiltrate disappearance time,immunological indices,and inflammatory cytokine levels.Results:Twelve relevant SRs were included;75%(9/12)were assessed as very low quality,and 25%(3/12)Were rated as low quality using the AMSTAR 2 criteria.According to the PRISMA 2020 checklist,the average SR score was 20.3 out of a 27 point maximum.In all SRs,CHM demonstrated improvement in symptoms and signs among children with MPP.The evidence quality using the GRADE criteria ranged from"very low"(>50%)to"moderate"(<5%).The most common downgrading factor was imprecision,followed by publication bias and inconsistency.Conclusion:This overview highlights the limited quality of the methodology and evidence of the included SRs.Although the included studies showed the beneficial effects of CHM on MPP in children,it was difficult to draw firm conclusions owing to methodological flaws.

Prevention of ventilator-associated pneumonia with inhaled antibiotics

The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated patients.Recent high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).

Impact of Genetic Diversity of Uropathogenic Escherichia coli and Klebsiella pneumoniae Strains on the Dissemination of Extended Spectrum Beta-Lactam Resistance Genes in Côte d’Ivoire

The increase and spread of bacterial resistance to extended-spectrum beta-lactam antibiotics are reported in many infections and are a real public health problem worldwide. Drug pressure is a factor that favors the emergence of a population of better adapted bacteria. However, there is no literature highlighting the genetic diversity and evolutionary structure of E. coli and K. pneumoniae in an environment with high selection pressure in Côte d’Ivoire. The objective of this study was to evaluate the genetic diversity of E. coli and K. pneumoniae strains circulating at the HKB Hospital in Abobo and at the Daloa Regional Hospital and its impact on the dissemination of extended spectrum beta-lactam resistance genes. A total of 39 strains isolated from the urinary tract of infected patients, including 30 strains of E. coli and 9 strains of K. pneumoniae were studied. A total of 39 strains isolated from the urinary tract of infected patients, including 30 strains of E. coli and 9 strains of K. pneumoniae were studied. From genomic DNA extracts, ESBL resistance genes were amplified by PCR and sequenced, in addition to genetic typing by ERIC-PCR. The data obtained were submitted to genetic and bioinformatics analyses. The results have shown a genetic diversity important in E. coli and K. pneumoniae with diversity indexs (SID) ranging from 0.5 to 0.77. The genetic structure of the bacterial species studied has shown a clonal distribution of strains with clones expressing TEM-9 and CTX-M-15 variants. Also, this clonal structure was correlated with the spread of resistance genes in E. coli and K. pneumoniae. The spread of resistant clones is a factor that might limit the fight against antibiotic resistance.

Plasma Metabonomics of Human Adenovirus-infected Patients with Pneumonia and Upper Respiratory Tract Infection

Objective Human adenovirus(HAdV)infection is common and can develop to serious conditions with high mortality,yet the mechanism of HAdV infection remains unclear.In the present study,the serum metabolite profiles of HAdV-7-infected patients with pneumonia or upper respiratory tract infection(URTI)were explored.Methods In total,35 patients were enrolled in the study following an outbreak of HAdV-7 in the army,of whom 14 had pneumonia and 21 had URTI.Blood samples were collected at the acute stage and at the recovery stage and were analyzed by untargeted metabolomics.Results Over 90% of the differential metabolites identified between the pneumonia patients and URTI patients were lipids and lipid-like molecules,including glycerophospholipids,fatty acyls,and sphingolipids.The metabolic pathways that were significantly enriched were primarily the lipid metabolism pathways,including sphingolipid metabolism,glycerophospholipid metabolism,and linoleic acid metabolism.The sphingolipid metabolism was identified as a significantly differential pathway between the pneumonia patients and URTI patients and between the acute and recovery stages for the pneumonia patients,but not between the acute and recovery stages for the URTI patients.Ceramide and lactosylceramide,involved in sphingolipid metabolism,were significantly higher in the pneumonia patients than in the URTI patients with good discrimination abilities[area under curve(AUC)0.742 and 0.716,respectively;combination AUC 0.801].Conclusion Our results suggested that HAdV modulated lipid metabolism for both the patients with URTI and pneumonia,especially the sphingolipid metabolism involving ceramide and lactosylceramide,which might thus be a potential intervention target in the treatment of HAdV infection.