Vancomycin-resistant enterococcal bacteremia: comparison of clinical features and outcome between Enterococcus faecium and Enterococcus faecalis.

BACKGROUND AND PURPOSE: Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens. This study was conducted to clarify the clinical features and outcome of patients with vancomycin-resistant enterococcal bacteremia. METHODS: Patients with vancomycin-resistant enterococcal bacteremia treated at a medical center in northern Taiwan between November 1998 and July 2006 were reviewed. Clinical and bacteriological characteristics of Enterococcus faecium and Enterococcus faecalis were compared. RESULTS: Twelve patients (6 males and 6 females) were included for analyses. The mean age was 69.3 years (range, 40 to 86 years), and 8 cases (66.7%) were older than 65 years. All patients had underlying disease. Two patients received total hip replacement before development of VRE bacteremia. Twelve patients had prior exposure to broad-spectrum antimicrobial therapy. Ten patients had prior intensive care unit stay and prior mechanical ventilation before VRE bacteremia. All of the patients (n = 12) had an intravascular catheter in place. Bacteremia was caused by E. faecalis in 4 patients and by E. faecium in eight. The portals of entry included urinary tract (8.3%), skin, soft tissue and bone (41.7%) and unknown sources (50.0%). E. faecium showed a higher rate of resistance to ampicillin and teicoplanin than E. faecalis (87.5% vs 0.0%, p=0.01). The 60-day mortality rate was higher in patients with E. faecium bacteremia than E. faecalis bacteremia (62.5% vs 0.0%), although statistical significance was not obtained (p=0.08). CONCLUSIONS: VRE bacteremia may have an impact on the mortality and morbidity of hospitalized patients. Patients with bacteremia caused by vancomycin-resistant E. faecium had a grave prognosis, especially immunosuppressed patients. The prudent use of antibiotics and strict enforcement of infection control may prevent further emergence and spread of VRE.     

Epidemiology of community-acquired Staphylococcus aureus bacteremia.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen which has been isolated with increasing frequency in recent decades. Community-acquired MRSA (CA-MRSA) infections have also become increasingly important in recent years. This study retrospectively analyzed the risk factors, duration of hospitalization, yearly trend and seasonal variation in prevalence, and antibiotic susceptibility of isolates of community-acquired S. aureus (CASA) bacteremia and CA-MRSA bacteremia from patients treated in a teaching hospital in northern Taiwan. A total of 104 clinical isolates of CASA bacteremia were collected between January 1999 and December 2001. Among these, 35 (33.7%) were identified as MRSA. After multivariate analysis, the independent risk factors for developing CA-MRSA bacteremia were diabetes mellitus (p=0.028), chronic obstructive lung disease (p=0.037), and renal insufficiency (p=0.041). Only 6 (17.1%) patients in the MRSA group had no identified risk factors. Most of the isolates of CA-MRSA had a high degree of resistance to most antibiotics, including clindamycin (71.4%), trimethoprim-sulfamethoxazole (65.7%), and chloramphenicol (41.2%). No major trend or seasonal variation in the prevalence was found during the study period. No difference in mortality related to resistance pattern was found. Although CA-MRSA is not the major pathogen in community-acquired bacteremia, it should be included in the differential diagnosis of Gram-positive bacterial bloodstream infection, especially in those patients with risk factors. Early empiric therapy with glycopeptides in these patients may reduce morbidity and mortality.     

Differential effects of (S)- and (R)-enantiomers of albuterol in a mouse asthma model

BACKGROUND: (R)- and (S)-Enantiomers of albuterol likely exert differential effects in patients with asthma. The (R)-enantiomer binds to the beta2-adrenergic receptor with greater affinity than the (S)-enantiomer and is responsible for albuterol's bronchodilating activity. (S)-Albuterol augments bronchospasm and has proinflammatory actions. OBJECTIVE: The study aim was to determine whether the (S)-enantiomer, in contrast to the (R)-enantiomer, has adverse effects on allergic airway inflammation and hyperresponsiveness in a mouse asthma model. METHODS: Mice sensitized to ovalbumin (OVA) intraperitoneally on days 0 and 14 were challenged with OVA intranasally on days 14, 25, and 35. On day 36, 24 hours after the final allergen challenge, the effect of the (R)- and (S)-enantiomers of albuterol (1 mg x kg(-1) x d(-1) administered by means of a miniosmotic pump from days 13-36) on airway inflammation and hyperreactivity was determined. RESULTS: In OVA-sensitized/OVA-challenged mice, (R)-albuterol significantly reduced the influx of eosinophils into the bronchoalveolar lavage fluid and airway tissue. (R)-Albuterol also significantly decreased airway goblet cell hyperplasia and mucus occlusion and levels of IL-4 in bronchoalveolar lavage fluid and OVA-specific IgE in plasma. Although (S)-albuterol significantly reduced airway eosinophil infiltration, goblet cell hyperplasia, and mucus occlusion, it increased airway edema and responsiveness to methacholine in OVA-sensitized/OVA-challenged mice. Allergen-induced airway edema and pulmonary mechanics were unaffected by (R)-albuterol. CONCLUSION: Both (R)- and (S)-enantiomers of albuterol reduce airway eosinophil trafficking and mucus hypersecretion in a mouse model of asthma. However, (S)-albuterol increases allergen-induced airway edema and hyperresponsiveness. These adverse effects of the (S)-enantiomer on lung function might limit the clinical efficacy of racemic albuterol.     

Persistent monocytosis after intravenous immunoglobulin therapy correlated with the development of coronary artery lesions in patients with Kawasaki disease.

BACKGROUND AND PURPOSE: This study was conducted to investigate whether changes in the complete blood count (CBC)/differential count (DC) and C-reactive protein (CRP) were correlated to Kawasaki disease (KD) with coronary artery lesions (CALs). METHODS: A retrospective analysis was performed of all children with KD at Chang Gung Memorial Hospital at Kaohsiung from 2001 to 2006. KD patients were divided into those with and without CALs for testing of correlations with changes in CBC/DC and CRP levels. RESULTS: A total of 147 patients were enrolled for this analysis. Serial CBC/DC and CRP measurements and echocardiographic data for determination of CAL formation were obtained before and after intravenous immunoglobulin (IVIG) treatment. There were 44 (29%) KD patients having CAL formation (>3 mm in diameter of internal lumen). There was no significant difference in terms of age distribution and major diagnostic criteria between KD patients with and without CALs. Male KD patients, however, had a significantly higher rate of CAL formation (p=0.009). In multivariate logistical regression analysis, persistent monocytosis after IVIG treatment was the only factor significantly correlated to CAL formation (p=0.003). CONCLUSIONS: Of the febrile routine measurements of CBC/DC and CRP in KD, persistent monocytosis after IVIG treatment was correlated to CAL formation. Further studies to clarify the mechanism of monocytosis may help prevent the CALs of KD.     

抗T细胞单克隆抗体对再生障碍性贫血患者TNF和IL—2水平的影响

为探讨抗Ｔ淋巴细胞克隆抗体对再生障碍性贫血患者免疫功能的调节作用，采用放射免疫检测２５例ＡＡ患者ＭｃＡｂ－Ｔ治疗前后血清肿瘤坏死因子和白细胞介素－２（ＩＬ－２）水平及其中１０例周围血单个核细胞体外诱生ＴＮＦ和ＩＬ－２水平的变化。     

Crossing the barrier: Evolution and spread of a major class of mosaic pbp2x in Streptococcus pneumoniae, S. mitis and S. oralis

A paradigm for Streptococcus interspecies gene transfer is represented by the mosaic pbp genes encoding the target enzymes for beta-lactam antibiotics, the penicillin-binding proteins, in Streptococcus pneumoniae. We investigated a collection of oral streptococci from three continents by comprehensive multi-locus sequence typing analysis in order to trace the origin of a mosaic block belonging to a dominant family of mosaic pbp2x implicated in penicillin resistance of S. pneumoniae. One widespread family of mosaic pbp2x occurred in all three distinct clusters of S. pneumoniae, Streptococcus mitis and Streptococcus oralis, documenting independent inter- and intraspecies recombination events. Moreover, potential ancestor genes of this mosaic block could be identified in two penicillin-susceptible S. mitis strains from South Africa and Spain, facilitating the identification of pbp2x mutations relevant for resistance development.     

不同来源乙肝表面抗原的细胞免疫学对比研究

目的　研究不同来源乙肝表面抗原诱导CD8 抗原特异性的细胞毒T淋巴细胞反应(CTL)的差异及T细胞产生细胞因子的能力 ,从而对各种来源乙型肝炎表面抗原 (HBsAg)的免疫原性有更充分的评价。方法　不同来源HBsAg分别免疫BALB c小鼠 ,于免疫后不同时间制备脾脏单个核细胞 (MNC) ,再以相应的HBsAg体外刺激 ,酶联免疫方法 (ELISA)测定细胞因子分泌水平 ;以Na2 5 1CrO4标记靶细胞 ,测定CTL反应活性 ;应用流式细胞仪分析T细胞亚群。结果　HM HBsAg免疫小鼠 10d后的脾细胞产生IFN γ水平最高 ,而在免疫后 2 0d和 2 5d ,IL 2的水平显著高于其它各组 ,CD3 分子脾淋巴细胞显著高于其它各实验组 (P <0 .0 5) ;plasma HBsAg免疫小鼠的脾淋巴细胞产生IFN γ和IL 2水平较低 ,但在免疫 2 5d对P815 HBs的杀伤性最强 ;HM HBsAg和SSC HBsAg免疫后CD4 CD8- 脾淋巴细胞比例显著增高 (P <0 .0 5) ;CD4- CD8 细胞所占百分比各组间及与空白对照组间差异无显著性 (P >0 .0 5)。结论　不同来源HBsAg诱导的细胞免疫反应类型和程度不同     

Endometrial and subendometrial blood flow measured during early luteal phase by three-dimensional power Doppler ultrasound in excessive ovarian responders

BACKGROUND: Impaired implantation in assisted reproduction cycles with high serum estradiol (E(2)) concentrations may be related to suboptimal endometrial perfusion. Endometrial and subendometrial blood flow were compared between excessive responders (serum E(2) on the day of HCG >20 000 pmol/l) and moderate responders (E(2) < or =20 000 pmol/l). METHODS: Three-dimensional (3D) ultrasound examination with power Doppler was performed 2, 4 and 7 days after HCG in 32 patients who did not have embryo transfer in order to measure endometrial thickness, pulsatility index (PI)/resistance index (RI) of uterine vessels, and endometrial volume, vascularization index (VI)/flow index (FI)/vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS: Excessive responders tended to have lower endometrial and subendometrial VI/VFI on HCG +2 and more absent endometrial/subendometrial blood flow. They had significantly higher endometrial FI and subendometrial VFI than moderate responders on HCG +7. Only in the excessive responder group, uterine PI/RI declined significantly from HCG +2 to HCG +7 and endometrial VI/VFI increased significantly from HCG +4 to HCG +7. CONCLUSION: Changes in uterine Doppler flow indices, and endometrial and subendometrial 3D power Doppler flow indices during the early luteal phase were significantly different between moderate and excessive responders.