High prevalence and resistance rates to antibiotics in anaerobic bacteria in specimens from patients with chronic balanitis

Aim of the study was to assess both prevalence and antibiotic resistance in anaerobic bacteria from glans penis skin of 70 adults. Strain susceptibility was determined by breakpoint susceptibility test or E test. In 9 asymptomatic, 48 untreated and 13 treated symptomatic patients, anaerobes were found in 22.2%, 70.8% and 53.3%, respectively. Gram-positive strains (GPAs) were 2.2-fold more common than Gram-negative ones. Prevalent Gram-negative (GNAs) and GPAs were Prevotella spp. and anaerobic cocci, respectively. Clostridium difficile strain was found in an untreated patient. In GNAs, resistance rates to amoxicillin, metronidazole, clindamycin, tetracycline, levofloxacin, and amoxicillin/clavulanate were 42.1, 0, 52.6, 53.3, 86.7 and 5.2%, respectively. In GPAs, the resistance rates to metronidazole, clindamycin, tetracycline, levofloxacin and amoxicillin/clavulanate were 18.2, 34.1, 52.6, 36.8 and 0%, respectively. In conclusion, anaerobes were 1.6-fold more frequent in untreated symptomatic patients compared with other patients, suggesting their participation in development of chronic balanitis. GPAs were more common than GNAs. The resistance rates to amoxicillin, clindamycin, tetracycline, and levofloxacin were high. Most active agents were metronidazole and amoxicillin/clavulanate. Resistance in anaerobes varies according to sites of specimens and years of study.     

Identification and susceptibility to antimicrobial agents of strictly anaerobic bacteria isolated from hospitalized patients

The aim of this study was to identify anaerobic strains isolated in 2001 from clinical specimens obtained from patients of Warsaw hospital and to evaluate a susceptibility of these strains to antimicrobial agents. In 2001 two hundred and twenty five clinical strains of obligate anaerobes were cultured, which were identified in the automatic ATB system (bioMérieux, France) using biochemical tests API 20 A. Drug-susceptibility of strains was determined also in ATB system with the use of ATB ANA strips. C. difficile strains were isolated on selective CCCA medium. Toxins A/B of C. difficile directly in stool specimens were detected by means of ELISA test (TechLab, USA). Fifty four strains of Gram-negative anaerobes (B. fragilis strains dominated) and 171 strains of Gram-positive anaerobes (the greatest number of strains belonged to genus Peptostreptococcus) were cultured from clinical specimens. In the cases of antibiotic-associated diarrhea 28 C. difficile strains were isolated and C. difficile toxins A/B were detected in 39 stool samples. The most active in vitro antimicrobials against Gram-negative anaerobes were metronidazole, imipenem, ticarcillin combined with clavulanic acid and piperacillin with tazobactam. Gram-positive, clinical strains of anaerobes were the most susceptible in vitro to beta-lactam antibiotics combined with beta-lactamase inhibitors (amoxicillin/clavulanate, piperacillin/tazobactam, ticarcillin/clavulanate) and imipenem.     

Anaerobic bacteria in clinical infections

The findings of 275 cultures from routine clinical specimens obtained from lesions in different sites of body, during a period of 11 months, are presented. The clinical specimens were obtained from surgical wounds, abdominal infections, orthopaedic operations, biliary tract infections and pleuropulmonary infections. The total number of positive cultures including both aerobes and anaerobes was 203 out of 275 (73.8%). Of the 38 cultures positive for anaerobes, 29 (76.3%) grew both aerobic and anaerobic bacteria, while in nine (23.7%) cultures only anaerobes were found. A total of 42 strains of anaerobic bacteria were isolated. The majority of them were found in clinical specimens obtained from abdominal infections (62%), while a low percentage (3.6%) was found in specimens from orthopaedic operations. Strains belonging to the genus Bacteroides were the most frequently isolated anaerobes, accounting for 35.7% of the total, followed by Clostridia 28.5%, Peptostreptococci 23.8% and Prevotella 12%.     

Participation of gram-negative anaerobes in infections in hospitalized patients

The aim of the study was to assess the prevalence and antibiotic susceptibility profiles of strictly anaerobic Gram-negative bacteria isolated from clinical samples taken from hospitalized patients from 01.01.2007 to 31.12.2008. The specimens were cultured using media, incubated at 37 degrees C under anaerobic conditions. Biochemical identification and antibiotic susceptibility were done in an automated system ATB Expression (bioMerieux S.A, France). For selected strains of Bacteroides sp. sensitivity was determined using E-test (AB BIODISK, Sweden). Overall 1274 strains of obligate anaerobes were isolated. Gram-negative bacteria were cultured in number of 333 strains. Most frequently isolated was Bacteroides sp. (46,9%) and Prevotella sp. (29,7%). Isolated bacteria are still susceptible to imipenem (100%), metronidazole (100%) and beta-lactam antibiotics with beta-lactamase inhibitors: amoxicillin/clavulanate (97,8%) piperacillin/tazobactam (99,1%), ticarcillin/clavulanate (99,1%).     

DIAGNOSIS AND TREATMENT OF JOINT TUBERCULOSIS

Tuberculosis of the joints is not a clinical oddity and a diagnosis of tuberculous infection must be considered in all joint lesions if diagnosis is to be made early. A history of insidious onset of pain, especially if accompanied by pulmonary symptoms or a history of contact with a tuberculous person, should alert the clinician to the possibility of this diagnosis. The tuberculin test, roentgenograms, culture of aspirated fluids and biopsy, by anthrotomy or punch, continue to be the standard procedures for establishing the diagnosis. The differential diagnosis must include the entire gamut of bone and joint disease.Chemotherapy combining streptomycin and dihydrostreptomycin with isonicotinic acid hydrazid and para-aminosalicylic acid is of extreme value in the eradication of draining sinuses and in the advancement of the ideal surgical date; but general physical and mental hygiene, rest and the prevention or correction of deformities is a continuing therapeutic necessity. Fusion of the affected area is advocated in almost all lesions although there is some hope that functioning joints may be preserved with early diagnosis, conservative surgical treatment and more efficient antibiotics. A postoperative regime similar to the preoperative treatment must be continued until the stabilization is firm or until there is no evidence of activity.     

Characteristic of clinical strains of gram-negative obligate anaerobes

The aim of the study was to assess prevalence and antibiotic susceptibility profiles ofGram-negative strictly anaerobic bacteria isolated from clinical specimens taken from hospitalized patients in 2005-2006. Biochemical identification and antibiotic susceptibility were done in an automated system ATB Expression (bioMerieux sa). From 12262 specimens examined 867 strains of obligate anaerobes were isolated. Gram-negative strictly anaerobic bacteria were cultured in number of 138 strains (15,9%). All cultures were performed on Columbia agar and Schaedler agar media (bioMerieux sa) supplemented with 5% sheep blood and incubated at 37 degrees C for 48-120 h in 85% N2, 10% H2, 5% CO2. Most frequently isolated was Bacteroides spp. (41,3%). For this group beta-lactamase activity was evaluated by using nitrocefin disc test (Cefinase BBL, Becton Dickinson and Co., Cockeysville, MD, USA). Production of ESBLs was detected with the use of two disc diffusion methods: the double-disc synergy test (DDST) according to Jarlier et al. and the diagnostic disc (DD) test according to Appleton. ESBLs were produced by 5,3% strains of Bacteroides spp. For all Bacteroides spp. strains MIC values were determined by gradient diffusion method Etest (AB BIODISK, Sweden). ESBLs and MIC were performed on Wilkins-Chalgren solid medium supplemented with 5% sheep blood (Difco Lab., USA) and all plates were incubated at 35 degrees C for 48 hours in 85% N2, 10% H2, 5% CO2. Most Gram-negative obligate anaerobes isolated from clinical specimens are still susceptible to imipenem (100%), metronidazole (99,3%) and beta-lactam antibiotics with beta-lactamase inhibitors: piperacillin/tazobactam (99,3%), ticarcillin/clavulanate (99.3%), amoxicillin/clavulanate (97.8%).     

嗜麦芽寡养单胞菌临床分布特征与耐药分析

目的了解湖州市中心医院嗜麦芽寡养单胞菌临床分布特征与耐药性。方法采用常规方法分离,用VITE-COMPACT2全自动微生物分析仪进行菌种鉴定,用K—B法进行药敏试验。结果分离到嗜麦芽寡养单胞菌810株,复方新诺明耐药菌株48株（分离率5．9％）。标本来源主要来自ICU室,其次呼吸科,大部分来自痰液标本（约占89．2％）,年龄段以中老年人比率最高。嗜麦芽寡养单胞菌对亚胺培南、美罗培南、头孢吡肟、哌拉西彬他坐巴坦、庆大霉素、妥布霉素、阿米卡星高度耐药;头孢他啶、替卡西林／克拉维酸、环丙沙星耐药率为33．7％～58．2％;头孢哌酮／舒巴坦、左氧氟沙星、米诺环素、复方新诺明耐药率低于30．0％。复方新诺明耐药菌株对头孢哌酮／舒巴坦、左氧氟沙星和米诺环素耐药率分别为60．4％、91．7％和2．0％,对其余抗菌药物耐药率达100．0％。复方新诺明耐药菌株与复方新诺明敏感菌株相比,耐药情况更严重,其中对三、四代头孢菌素、喹诺酮类耐药率显著高于复方新诺明敏感菌株（P〈0．01）;对碳青霉烯类、青霉素类、氨基糖苷类抗菌药物耐药率与复方新诺明敏感菌株相比,差异无统计学意义（P〉0．05）。结论嗜麦芽寡养单胞菌呈高度耐药,对头孢哌酮／舒巴坦、左氧氟沙星、米诺环素、复方新诺明尚敏感,但对复方新诺明耐药的嗜麦芽寡养单胞菌耐药现象更严重。应重视嗜麦芽寡养单胞菌引起的院内感染,尽量减少不必要的侵人性操作,加强抗菌药物的合理规范使用。     

ICU 应用IABP 治疗心脏外科术后患者的护理临床效应

目的:探讨应用主动脉内球囊反搏术(IABP)治疗心脏外科术后患者的护理方法与临床效果。方法:回顾性分析总结我院2008年6月～2009年12月收治的25例心脏外科术后应用主动脉内球囊反搏术患者的临床资料。结果:本组患者25例患者均无并发症发生,其中23例症状改善,2例病情恶化。护士应熟练掌握IABP机的工作原理及报警项目;应重视基础护理,密切监测生命体征及各项检查结果;早期观察和预防并发症发生。结论:在临床护理中,应组织护士学习IABP相关知识,使护士熟要掌握相关的临床护理技术,从而确保IABP良好的的治疗效果。     

Review of the morbidity of 300 free-flap donor sites

Donor-site morbidity in 300 consecutive free flaps was reviewed to identify their etiologies and potentially prevent their recurrence in future cases. An overall morbidity rate of 20 percent was seen in this series. Secondary surgical procedures specific for donor-site problems were required in 7.7 percent of patients. Major complications occurred in 2.3 percent of the donor sites. From this review it is apparent that major donor-site morbidity is uncommon and most donor-site problems could probably have been avoided. Our recommendations are as follows: closure of the donor site to avoid excessive tension must be carefully planned preoperatively, donor-site anatomy and flap elevation techniques must be precisely understood, surgical retractors must be carefully placed to avoid injury to nearby structures, the donor site should be closed immediately following pedicle division, thus minimizing wound exposures, and complete surgical hemostasis is mandatory.     

Anaerobic bacteria colonizing the lower airways in lung cancer patients

Anaerobes comprise most of the endogenous oropharyngeal microflora, and can cause infections of airways in lung cancer patients who are at high risk for respiratory tract infections. The aim of this study was to determine the frequency and species diversity of anaerobes in specimens from the lower airways of lung cancer patients. Sensitivity of the isolates to conventional antimicrobial agents used in anaerobe therapy was assessed. Respiratory secretions obtained by bronchoscopy from 30 lung cancer patients were cultured onto Wilkins-Chalgren agar in anaerobic conditions at 37°C for 72-96 hours. The isolates were identified using microtest Api 20A. The minimal inhibitory concentrations for penicillin G, amoxicillin/clavulanate, piperacillin/tazobactam, cefoxitin, imipenem, clindamycin, and metronidazole were determined by E-test. A total of 47 isolates of anaerobic bacteria were detected in 22 (73.3%) specimens. More than one species of anaerobe was found in 16 (53.3%) samples. The most frequently isolated were Actinomyces spp. and Peptostreptococcus spp., followed by Eubacterium lentum, Veillonella parvula, Prevotella spp., Bacteroides spp., Lactobacillus jensenii. Among antibiotics used in the study amoxicillin/clavulanate and imipenem were the most active in vitro (0% and 2% resistant strains, respectively). The highest resistance rate was found for penicillin G and metronidazole (36% and 38% resistant strains, respectively). The results obtained confirm the need to conduct analyses of anaerobic microflora colonizing the lower respiratory tract in patients with lung cancer to monitor potential etiologic factors of airways infections, as well as to propose efficient, empirical therapy.     

Removal of potassium chloride by nanofiltration from ion-exchanged solution containing potassium clavulanate

In this study, nanofiltration with NF200 membrane was employed to remove KCl from ion-exchanged solutions containing potassium clavulanate. The pore radius of NF200 membrane was estimated to be around 0.39 nm. The effects of operating pressure on separation performance were investigated in a range of 100–400 psig. The influences of cross-flow velocity (0.14–0.70 cm/s), temperature (4–25 °C), and feed composition were also investigated. In all experiments, clavulanate rejection showed high levels from 0.91 to 0.99, while chloride rejection ranged from 0.06 to 0.54. In a case at an operating pressure of 50 psig and 25 °C, as much as 94% of clavulanate was retained while 94% of chloride was removed, indicating that NF200 membrane was a suitable choice for selectively removing KCl. NF200 membrane also showed a stable performance in the operational stability test with an ion-exchanged solution obtained by treating actual fermentation broth.     

非闭塞性肠系膜缺血致肠坏死的临床分析(附11例报道)

目的:探讨非闭塞性肠系膜缺血所致肠坏死的临床表现和结局。方法:回顾性总结青岛大学附属医院11例非闭塞性肠系膜缺血所致肠坏死的病例,评估分析其临床表现、实验室检查、腹部CT影像和手术过程。结果:所有病人均在全麻下行剖腹探查术,实施肠管切除术并一期吻合术或肠造口术,7例病人恢复良好,2例住院期间死亡,2例放弃治疗回家后死亡。结论:非闭塞性肠系膜缺血临床罕见,术前难以诊断,具有较高的病死率,血管造影可以作为NOMI早期诊断及治疗的有效手段,对于怀疑有肠坏死发生的患者需及早行手术治疗。     

Probing active site chemistry in SHV beta-lactamase variants at Ambler position 244. Understanding unique properties of inhibitor resistance

Inhibitor-resistant class A beta-lactamases are an emerging threat to the use of beta-lactam/beta-lactamase inhibitor combinations (e.g. amoxicillin/clavulanate) in the treatment of serious bacterial infections. In the TEM family of Class A beta-lactamases, single amino acid substitutions at Arg-244 confer resistance to clavulanate inactivation. To understand the amino acid sequence requirements in class A beta-lactamases that confer resistance to clavulanate, we performed site-saturation mutagenesis of Arg-244 in SHV-1, a related class A beta-lactamase found in Klebsiella pneumoniae. Twelve SHV enzymes with amino acid substitutions at Arg-244 resulted in significant increases in minimal inhibitory concentrations to ampicillin/clavulanate when expressed in Escherichia coli. Kinetic analyses of SHV-1, R244S, R244Q, R244L, and R244E beta-lactamases revealed that the main determinant of clavulanate resistance was reduced inhibitor affinity. In contrast to studies in the highly similar TEM enzyme, we observed increases in clavulanate k(inact) for all mutants. Electrospray ionization mass spectrometry of clavulanate inhibited SHV-1 and R244S showed nearly identical mass adducts, arguing against a difference in the inactivation mechanism. Testing a wide range of substrates with C3-4 carboxylates in different stereochemical orientations, we observed impaired affinity for all substrates among inhibitor resistant variants. Lastly, we synthesized two boronic acid transition state analogs that mimic cephalothin and found substitutions at Arg-244 markedly affect both the affinity and kinetics of binding to the chiral, deacylation transition state inhibitor. These data define a role for Arg-244 in substrate and inhibitor binding in the SHV beta-lactamase.     

NONCARDIAC SURGERY COMBINED WITH CORONARY ARTERY BYPASS

The coexistence of coronary artery disease with noncardiac disease often leads to a dilemma in planning therapeutic procedures. This problem is especially difficult in the presence of accelerated angina or left coronary artery stenosis. A series of 17 patients is presented in which coronary artery bypass grafts were combined with noncardiac operations without mortality or significant morbidity. An illustrative case report shows the interrelated nature of the coexisting disorders. The conclusion of this study is that, at times, various surgical procedures should be combined with coronary artery bypass grafting for a smoother, less complicated recovery. However, there are no hard and fast rules dictating combined procedures; each operation must be planned according to the existing conditions and needs of the individual patient.     

Homeostatic Problems in General Surgery

For electrolyte problems that arise during surgical procedures, the surgeon must be versed in the physiologic function of the organs that play vital roles in homeostasis. Pulmonary and renal evaluation before operation can give forewarning of potential dangers. Hyperaldosteronism, a disease entity influencing electrolytic changes and causing other pathophysiological effects, should be understood by the surgeon. Not only should he understand the causes of dehydration, hyperhydration, metabolic and respiratory acidosis and metabolic and respiratory alkalosis, he should also be able to recognize their deleterious effects clinically, know how to make use of adequate laboratory procedures to substantiate a diagnosis and determine the effect of treatment.The effect of water deficit and water excess, and of deficits and excesses of such ions as sodium, potassium, calcium, carbon dioxide and bicarbonate on the renal, cardiac, pulmonary and neuromuscular systems must be considered.Tetany before or after operation challenges a surgeon''s diagnostic acuity. Relying on laboratory tests only, without correlating the results with history and clinical features, may lead to errors in the administration of electrolytic fluids.     

Sterility in unsterilized surgical adhesive tape

Providing a barrier to infectious organisms, sterile surgical adhesive tape has been used to close wounds for almost 20 years. The possibility that prepackaged unsterilized tape could be used for similar purposes is suggested by this study. Samples (480) were taken from 120 rolls that had been left in plastic surgical suite cabinets for 2 weeks. Aerobes and anaerobes were evaluated using tryptic soy agar with 5% sheep blood, while yeast and fungi were checked with Sabouraud dextrose agar. Sterility of sticky and smooth inner surfaces is shown to be a significant finding (p less than 0.01). It is concluded that prepackaged unsterilized surgical adhesive tape can be used to approximate wound edges without being a source of contamination (the sterile tape is 5600 percent more expensive). Wound closure in this manner would benefit the patient in the field, in the emergency room, or in third world countries where the supply of sterile tape is limited.     

Sepsis after autologous fat grafting

Autologous fat grafting is an increasingly popular technique, with numerous examples of excellent results. Adherence to key principles, including sterile technique and low-volume injection throughout layers of tissue, appears to be critical to obtaining good results. Reports of adverse outcomes are infrequent, but several case reports document both infectious and aesthetic complications. This case report represents an extreme complication, including abscess formation, life-threatening sepsis, and residual deformity. It serves as yet another reminder that early adoption of surgical procedures by those without a sound understanding of the underlying principles and techniques can have disastrous consequences. Furthermore, physicians operating on any patient must understand the potential for complications and be able to manage these appropriately when they occur.     

APPLICATIONS FOR BACTERIAL MEMBRANE FRACTIONS IN STERILE PHARMACEUTICAL QUALITY CONTROL

The commercially available bacterial membrane preparation Oxyrase was examined for use in quality control laboratory procedures for culturing anaerobic microorganisms, and as a media additive for parenteral product filling line validation by media fill to detect anaerobes. Comparison studies between Oxyrase products and conventional anaerobic culturing methods were performed. The results from the studies showed Oxyrase for Broth to be effective in promoting the growth of anaerobes in nonprereduced media not normally used for anaerobic cultivation.     

Unsuspected Carcinoma Found Histologically After Minor Anorectal Operations

The unsatisfactory results of radical operations in advanced anal cancer could be bettered by earlier diagnosis of the malignant lesion. The possibility of cancer should always be kept in mind when treating any of the common chronic anal diseases. Preliminary biopsy studies should be done more frequently if suspicious lesions are present and all tissues removed during minor anorectal operations should always be examined by a pathologist. Each surgical specimen should be labeled to show the site from which it was removed. Follow-up care of the patient would be simplified if the exact site of cancer origin could be identified.A recent ten-year survey of minor anorectal surgical procedures at the University of California Medical Center showed clinically unsuspected anal cancer found in 2 per cent of cases on tissue examination by the pathologist. The cancers were generally early and of the keratinizing squamous cell and nonkeratinizing varieties.     

Treatment of malignant pain of the head and neck

The treatment of pain due to malignancy in the head and neck is difficult, and the pain doctor must take a special responsibility in selecting the appropriate treatment. Specialized and often combined surgical procedures may still offer the best chance of relief, particularly when tumours involve the paranasal sinuses and the petrous bone. Peripheral and central destructive procedures can prove effective, and perhaps thalamotomy is deserving of greater usage. Chronic intrathecal analgesic administration can undoubtedly prove effective, and while the unwanted features may yet have to be established, it provides a welcome additional option in the management of pain in this difficult area.