scholarly journals Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

2017 ◽  
Vol 11 (09) ◽  
pp. 672-678
Author(s):  
Xiumei Xiao ◽  
Bei Yao ◽  
Qingtao Zhou ◽  
Jie Zhang
Keyword(s):  
Klebsiella Pneumoniae ◽  
Virulence Factor ◽  
Medical Records ◽  
Capsular Polysaccharide ◽  
Body Fluids ◽  
Microbiological Characteristics ◽  
Group 2 ◽  
Challenging Situation ◽  
Sequence Types ◽  
Group 1

Introduction: Reports of hypermucoviscous Klebsiella pneumoniae (hvKP) isolated from fluids other than blood or abscess are rare. The aim of the study was to compare clinical and microbiological characteristics of hvKP found in blood or abscess fluid with those isolated from other loci. Methodology: A total of 24 non-repetitive hvKP isolates were collected from January 2013 to June 2014 from patients with hvKP infections. There were 15 in Group 1 (fluid other than blood or abscess) and 9 in Group 2 (blood or abscess fluid). Medical records of all patients were reviewed. Capsular polysaccharide (CPS) typing, virulence factor determination, and multilocus sequence typing (MLST) of hvKP isolates were performed. Results: Seventeen sequence types (STs) and 6 capsular serotypes were identified. Type K2CC65 was most commonly identified in Group 1 and type K2CC86 in Group 2. Deletion of pLVPK-derived loci were found in K2 and non-K1/K2 hvKP strains. Two virulent genes, fimH and ycfM, were identified more frequently in Group 2 than in Group 1. There was no difference in the frequency of other virulent genes or serotypes in the two groups. Two imipenem resistant hvKP isolates (cr-hvKP) were found in non-blood or abscess samples. Conclusions: hvKP isolated from different body fluids had similar clinical and microbiological characteristics. cr-hvKP identified in non-blood or abscess samples should raise our attention to the challenging situation and management of hvKP infection.

Safety and Immunogenicity of PRP-T Combined with DTP: Excretion of Capsular Polysaccharide and Antibody Response in the Immediate Post-Vaccination Period

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 522-527
Author(s):  
Melanie A. Miller ◽  
Carlton K. Meschievitz ◽  
Gerard A. Ballanco ◽  
Robert S. Daum
Keyword(s):  
Tetanus Toxoid ◽  
Capsular Polysaccharide ◽  
Oral Polio Vaccine ◽  
Haemophilus Influenzae Type ◽  
Type B ◽  
Polio Vaccine ◽  
Group 3 ◽  
Group 2 ◽  
Change In Mean ◽  
Group 1

Objective. To evaluate whether combining Haemophilus influenzae type b capsular polysaccharide covalently linked to tetanus toxoid (PRP-T) and diphtheria-tetanus-pertussis (DTP) in one syringe produced a vaccine that was safe and immunogenic. Design. Randomized clinical trial. Setting. Suburban New Orleans pediatric population. Participants. Convenience sample of 150 healthy infants. Methods. Enrollees were randomized to receive DTP and PRP-T in one injection (Group 1), DTP and PRP-T separately (Group 2), or DTP and H influenzae type b capsular saccharide coupled to a nontoxic variant of diphtheria toxin, CRM197, (HbOC) separately (Group 3) at 2, 4, and 6 months of age. All infants received oral polio vaccine at 2 and 4 months of age. Parents were instructed to record side effects on a standardized form after each vaccine administration. Blood was drawn before each immunization and at 7 months of age; an additional blood and a urine specimen was obtained 2 to 3 days after one of the vaccination visits. Serum was assayed for H influenzae anticapsular antibody (anti-PRP), anti-pertussis toxoid, anti-fimbrial hemagglutinins, anti-diphtheria and anti-tetanus toxoid antibodies, and antibody to polio viruses. Urine was assayed for H influenzae type b capsular polysaccharide. Results. The rate of occurrence of fever did not differ significantly between groups. Local swelling and erythema occurred more often at the administration site in Group 1 infants than at the DTP administration sites of infants in Groups 2 and 3 after the first and second vaccinations. The mean concentration of all antibodies we assayed did not differ significantly when Group 1 and 2 infants were compared. HbOC recipients (Group 3) had lower mean anti-H influenzae anticapsular antibody and higher mean anti-diphtheria and anti-tetanus antibody concentrations after two and three doses compared with Group 1 and Group 2 infants. No group had a significant change in mean anti-PRP antibody concentration 2 to 3 days after vaccination with any dose. After vaccination, antigenuria occurred less frequently in Group 1 infants (54%, 78%, and 72% in Groups 1, 2, and 3, respectively, P < .01). Conclusions. Combining PRP-T and DTP produced a combination vaccine associated with a slight increase in the rate of erythema and swelling but with similar immunogenicity of the vaccine components and oral polio vaccine.

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

2020 ◽  
Author(s):  
Meltem Bor ◽  
Ozkan Ilhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistant ◽  
Group 2 ◽  
Antifungal Use ◽  
Group 1

Abstract Aim The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP). Material and methods This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors. Results A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality. Conclusion Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.

Iliac Fascia Compartment Block and Analgesic Consumption in Patients Operated on for Hip Fracture

2017 ◽  
Vol 19 (5) ◽  
pp. 0-0 ◽  
Author(s):  
Mateusz Klukowski ◽  
Rafał Kowalczyk ◽  
Grzegorz Górniewski ◽  
Paweł Łęgosz ◽  
Marek Janiak ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Medical Records ◽  
Ultrasound Guidance ◽  
Postoperative Mortality ◽  
Early Mobilization ◽  
Femur Fractures ◽  
Study Results ◽  
Group 2 ◽  
Fascia Iliaca Compartment Block ◽  
Group 1

Background. Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe­sio­logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal­gesia is necessary to achieve this goal. Material and methods. A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re­ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was per­formed under ultrasound guidance, and systemic analgesics were administered according to a standardized pro­to­col. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study. Results. Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB. Conclusion. The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.

Analysis of the Incidence and Characteristics of Venoocclusive Disease (VOD) of the Liver in Pediatric Hematopoietic Progenitor Cell Transplant (HPCT) Patients with Heparin Alone Vs. Heparin and Ursodiol Prophylaxis at the Medical College of Wisconsin.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4306-4306
Author(s):  
Julie-An Talano ◽  
Jessica Brown ◽  
Jennifer McArthur ◽  
Mollie Mulberry ◽  
Daniel Eastwood ◽  
...  
Keyword(s):  
Medical Records ◽  
Low Dose ◽  
Pediatric Patients ◽  
Hematologic Malignancy ◽  
Post Transplant ◽  
Dose Heparin ◽  
Group I ◽  
Group 2 ◽  
Low Dose Heparin ◽  
Group 1

Abstract Abstract 4306 VOD is a serious and potentially life-threatening complication of HPCT as a result of liver injury from the effect of chemotherapy and/or radiation. The reported incidence rate in pediatric HPCT patients varies widely from 5% to 40%. Previous studies have shown the beneficial effects of post-transplant pharmacological therapies such as ursodeoxyholic acid (ursodiol), heparin, and defibrotide at preventing VOD. However, the combined effect of heparin and ursodiol prophylaxis in preventing VOD in pediatric patients has yet to be determined. This study evaluated retrospectively whether there was a benefit of such combined therapy in pediatric HPCT patients. Our center adopted as standard practice for all HPCT patients the initiation of low dose heparin at 4 units/kg/hour with the commencement of conditioning for HPCT until day +28 post transplant. In 2003, we combined ursodiol 10 mg/kg TID to start with HPCT conditioning and to continue until day + 100 post transplant with low dose heparin through day + 28 for all pediatric HPCT patients. We performed a retrospective chart review and compared the characteristics and the incidence of VOD in patients who underwent transplantation from 1996-2002 and received heparin alone compared to 2003-2008 when the patients received the combination of heparin and ursodiol prophylaxis. Patients were identified through medical records with the ICD diagnosis of VOD. The medical records were reviewed and those patients who did not meet the Baltimore criteria for the diagnosis of VOD were excluded. Only patients who developed VOD with their first transplants were included. Group I = Heparin (216) Group II = Heparin + Ursodiol (220) Allogeneic 187 (86.5%) 160 (72.7%) Autologous 29 (13.5%) 60 (27.3%) Median Age 9 yrs 8 yrs Male 123 (57%) 135 (62%) Female 93 (43%) 85 (38%) Non-malignant 34 (15.7%) 50 (22.8%) Hematologic malignancy 143 (66.2%) 109 (49.5%) Non-hematologic malignancy 39 (18.1%) 61 (27.7%) # VOD 13 5 The 100 day incidence of VOD was 0.0605 (SE 0.01618) in group 1 and 0.0227 (SE 0.01002) in group 2. The difference is 0.0377 (SE 0.0190) and based on a standard normal distribution with a p = 0.0473. The estimated risk of VOD for patients receiving Heparin + Ursodiol is 0.94 (risk or hazard ratio) that of the risk with Heparin alone, with a 95% confidence interval of (0.918, 0.960). This represents about a 6% reduction in risk for those receiving Heparin + Ursodiol. The day 100 survival in the VOD patients was 6 out of 13 in group 1 and 3 out of 5 in group 2. In conclusion, low dose heparin and ursodiol prophylaxis appears to be an effective strategy in VOD prevention in pediatric patients. The combination appeared to be more effective than heparin alone. However, this study is limited in that it is retrospective in nature. Disclosures: Off Label Use: heparin and ursodiol as VOD prophylaxis.

Rituximab Does Not Prevent Relapse in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3318-3318
Author(s):  
Goyal Jatinder ◽  
Jose L. O. Lima ◽  
Jill Adamski ◽  
Marisa Marques
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Medical Records ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Delayed Response ◽  
Thrombocytopenic Purpura ◽  
Group 2 ◽  
Group 1

Abstract Abstract 3318 Objective: In the last decade, rituximab has been added to therapeutic plasma exchange (TPE) to treat patients with thrombotic thrombocytopenic purpura (TTP) who appear resistant to TPE. We sought to determine first if rituximab prevented TTP relapse. In addition, if relapse has occurred, we compared the rates of relapse of patients treated with TPE alone with those treated with a combination of TPE and rituximab. Methods: We retrospectively reviewed the medical records of all adult patients treated for TTP between 2003 and 2008 at our institution. TTP was defined as thrombocytopenia, hemolytic anemia and ADAMTS13 activity less than 10% due to an inhibitor. None of the patients had congenital TTP. Patient demographics, laboratory data, treatment characteristics and follow up details were collected from their electronic and apheresis' medical records. Kaplan-Meier curves were drawn for survival and Cox proportional hazards models were applied to look for independent predictors of relapse-free survival (RFS). Results: A total of 20 patients underwent TPE only (Group 1) as compared to 18 patients who also received rituximab during admission with TTP (Group 2). Table 1 shows that both groups were balanced at baseline for demographic and laboratory data. However, patients in group 2 had longer duration of hospital stay (p<0.0001), underwent more TPE procedures (p<0.0001) and took longer to achieve remission (p<0.0001). The mean follow up in group 1 was 77.5 (±22.4) months and in group 2 was 68.6 (±28.5) months. At follow-up, 5 patients from group 1 relapsed (25%) as compared with 6 patients from group 2 (35%) (p=0.50). The 1-year, 3-year and 5-year RFS rates were 95%, 85% and 74% for group 1, and 94%, 76% and 71%, respectively, for group 2 (p=0.53 using log rank test). On univariate analysis, only age at the time of treatment (p=0.05) and duration of follow-up after treatment (p=0.03) were predictors of relapse. However, on multivariate analysis, no independent predictors of relapse were identified. Conclusion: Rituximab does not prevent or reduce rates of relapse when used with TPE in patients with TTP. Since rituximab was added to patients later in their TPE course due to delayed response to treatment, it may yet have a role in decreasing the number of TPEs needed to achieve a response if it were started earlier during hospitalization for TTP. Disclosures: No relevant conflicts of interest to declare.

Practical Experience of Thromboprophylaxis After Lower Limb Replacement – Rivaroxaban Versus Enoxaparin

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4369-4369
Author(s):  
Kyoung Ha Kim ◽  
Nam Seok Ham ◽  
Yang Ki Kim ◽  
Hyung Suk Choi ◽  
You Sung Suh ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Medical Records ◽  
Efficacy And Safety ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis ◽  
Replacement Arthroplasty ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Abstract Abstract 4369 BACKGROUND Since October 2010, rivaroxaban has been approved by Korean government to be covered by national health insurance reimbursement system as thromboprophylaxis after total hip arthroplasty and total knee arthroplasty. However, there is no available data on outcomes of rivaroxaban as thromboprophylaxis in Korea. We performed a retrospective study to compare the efficacy and safety of venous thromboembolism prophylaxis with enoxaparin or rivaroxaban in 195 consecutive patients undergoing major orthopaedic surgery at our center. METHODS This study retrospectively reviewed the medical records of the 195 patients who underwent a total hip replacement arthroplasty or total knee replacement arthroplasty and received thromboprophoylaxis with enoxaparin or rivaroxaban at Soonchunhyang University Hospital between March 2009 and May 2012. Each patient's medical records included information on age, sex, comorbidities (active malignant disease, renal insufficiency), treatment details (type of surgery, type of anesthesia, duration of surgery,), duration of prophylaxis, efficacy (death, pulmonary embolism, deep vein thrombosis), safety (major bleeding, cerebrovascular accident), cause of drug interruption. RESULTS Of 195 patients, 129 patients received thromboprophylaxis with enoxaparin (group 1; our hospital standard since March 2009), 66 received rivaroxaban (group 2; our hospital standard since February 2011). Symptomatic venous thromboembolism was found in 0.7 % of patients in the group 1 (1/129 patients) compared to 1.5 % of group 2 (1/66 patients; p=0.627). No significant differences in the rates of symptomatic VTE were found. However, patients with received rivaroxaban had significantly more rates of major bleeding (0 in group 1 vs 3% (2/66 patients) in group 2; p=0.047). Although group 1 patients were planed receiving thromboprophylaxis with rivaroxaban from day one post operatively, mean time from the end of surgery to first rivaroxaban intatake was 4.2 days. CONCLUSIONS Despite lower compliance in rivaroxaban group, venous thromboembolism prophylaxis with rivaroxaban is not inferior to prophylaxis with enoxaparin with regard to the prevention of symptomatic venous thromboembolisms. But, more bleeding complications and wound problems revealed in rivaroxaban group. Further studies and experiences are needed to assess the efficacy and safety of rivaroxaban in clinical practice. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Changes in the Trend in Bladder Emptying Methods in Patients With Spinal Cord Injury: A 20-Year Single-Center Retrospective Study

2020 ◽  
Vol 44 (3) ◽  
pp. 228-237
Author(s):  
Sang-Wook Oh ◽  
Joo Hwan Jung ◽  
In Kyoung Cho ◽  
Hye Jin Lee ◽  
Seung Hyun Kwon ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Medical Records ◽  
Spinal Injury ◽  
Intermittent Catheterization ◽  
Bladder Emptying ◽  
The Past ◽  
Cord Injury ◽  
Group 2 ◽  
Group 1

Objective To review trends in bladder emptying methods over a 20-year period in patients with spinal cord injury (SCI) by severity according to the American Spinal Injury Association impairment scale (AIS).Methods Medical records of patients with SCI from 1994 to 1998 (group 1) and from 2012 to 2016 (group 2) were retrospectively reviewed. We classified bladder emptying methods according to the International Spinal Cord dataset. We grouped patients with normal voiding, bladder reflex triggering, and bladder expression as those using voiding without catheter.Results A total of 667 patients were included in the analysis. The proportion of patients using voiding without catheter and intermittent catheterization decreased from 67.0% to 30.0% and increased from 26.8% to 54.8%, respectively. In patients with AIS-A and AIS-B, the proportion of patients with intermittent catheterization increased from 32.8% to 73.3%. In patients with AIS-D, the proportion of patients using voiding without catheter and intermittent catheterization decreased from 88.5% to 68.9% and increased from 11.5% to 26.8%, respectively. In group 2, among 111 patients with AIS-D using voiding without catheter at admission, 8 (7.2%) switched to intermittent catheterization at discharge due to decreased bladder volume, increased post-voiding residual urine, or incontinence.Conclusion Over the past 20 years, trends in bladder emptying methods in patients with SCI changed from voiding without catheter to intermittent catheterization in Korea. This was especially prominent in patients with AIS-A, AIS-B, and AIS-C. Even in patients with AIS-D, the use of intermittent catheterization at hospital discharge increased.

scholarly journals Comparison of outcomes of thrombocytopenic and non-thrombocytopenic culture proven neonatal sepsis

2021 ◽  
Vol 8 (3) ◽  
pp. 512
Author(s):  
Saumil M. Patel ◽  
Kinjal Patel ◽  
Karan Patel ◽  
Rekha Thaddanee
Keyword(s):  
Klebsiella Pneumoniae ◽  
Neonatal Mortality ◽  
Neonatal Sepsis ◽  
Blood Cultures ◽  
Klebsiella Pneumonia ◽  
Specific Marker ◽  
Significant Difference ◽  
Group 2 ◽  
Micro Organisms ◽  
Group 1

Background: Due to high incidence of sepsis as a main cause of neonatal mortality, early detection and proper treatment are important in reducing neonatal mortality. Thrombocytopenia is a common hematological problem encountered during neonatal period, particularly in neonatal sepsis. This study was done to know the incidence of thrombocytopenia in neonatal sepsis and to compare clinical outcome in patients with thrombocytopenic and non-thrombocytopenic neonatal sepsis.Methods: This was a prospective study carried out at neonatal intensive care unit of a tertiary care teaching hospital of western Gujarat, India, from October 2018 to August 2020. 2739 neonates were admitted with probable sepsis during study period. 299 neonates with positive blood cultures were recruited for the study. They were divided into two groups; group-1 had patients with thrombocytopenia, while group-2 included patients without thrombocytopenia. Severity of thrombocytopenia was assessed in group-1. Micro-organisms isolated and outcome of sepsis were compared in both the groups. Results: There were 208 neonates in group-1 (thrombocytopenic) and 91 in group-2 (non-thrombocytopenic). There was no significant difference in demographic profiles of neonates in both groups. Klebsiella pneumonia was the most common organism isolated from 79 patients of group-1 and 19 patients of group-2 (p=0.033). Coagulase negative Staphylococci and Candida were the second and third most common micro-organisms isolated from 30.2% and 15.1% of blood cultures respectively. In group-1, 85 (40.8%), 72 (34.6%) and 51 (24.5%) neonates had severe, moderate and mild thrombocytopenia respectively. Klebsiella pneumoniae (45.9%) was the commonest organism isolated in severe thrombocytopenic neonates, followed by Candia (22.4%) and Enterococcus (14.1%).Conclusions: Thrombocytopenia is a specific marker of neonatal sepsis. The platelet count is a simple test that facilitates diagnostic orientation and the establishment of an early empirical treatment. Klebsiella pneumoniae was the commonest organism isolated in severe thrombocytopenic neonates.

scholarly journals Multiplex PCR for Identification of Two Capsular Types in Epidemic KPC-Producing Klebsiella pneumoniae Sequence Type 258 Strains

2014 ◽  
Vol 58 (7) ◽  
pp. 4196-4199 ◽  
Author(s):  
Liang Chen ◽  
Kalyan D. Chavda ◽  
Jacqueline Findlay ◽  
Gisele Peirano ◽  
Katie Hopkins ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Multiplex Pcr ◽  
Capsular Polysaccharide ◽  
Sequence Type ◽  
Pcr Assay ◽  
Content Type ◽  
Multiplex Pcr Assay ◽  
Polysaccharide Synthesis ◽  
Sequence Types

ABSTRACTWe developed a multiplex PCR assay capable of identifying two capsular polysaccharide synthesis sequence types (sequence type 258 [ST258]cps-1andcps-2) in epidemicKlebsiella pneumoniaeST258 strains. The assay performed with excellent sensitivity (100%) and specificity (100%) for identifyingcpstypes in 60 ST258K. pneumoniaesequenced isolates. The screening of 419 ST258 clonal isolates revealed a significant association betweencpstype andK. pneumoniaecarbapenemase (KPC) variant:cps-1is largely associated with KPC-2, whilecps-2is primarily associated with KPC-3.

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