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Current Infectious Disease Reports Mar 2017The increase in drug-resistant community-acquired pneumonia (CAP) is an important problem all over the world. This article explores the current state of antimicrobial... (Review)
Review
PURPOSE OF REVIEW
The increase in drug-resistant community-acquired pneumonia (CAP) is an important problem all over the world. This article explores the current state of antimicrobial resistance of different bacteria that cause CAP and also assesses risk factors to identify those pathogens.
RECENT FINDINGS
In the last two decades, it has been documented that there is a significant increase in drug-resistant Streptococcus pneumoniae and other bacteria causing CAP. The most important risk factors are overuse of antibiotics, prior hospitalization, and lung comorbidities. The direct consequences can be severe, including prolonged stays in hospital, increased costs, and morbi-mortality. However, drug-resistant CAP declined after the introduction of the pneumococcal conjugate vaccine. This review found an increase in resistance to the antibiotics used in CAP, and the risk factor can be used for identifying patients with drug-resistant CAP and initiate appropriate treatment. Judicious use of antibiotics and the development of effective new vaccines are needed.
PubMed: 28251510
DOI: 10.1007/s11908-017-0565-x -
Antimicrobial Agents and Chemotherapy Oct 2020Four isolates and one isolate were obtained from urine samples of five patients in 2018 in Japan. All of the isolates were resistant to imipenem and meropenem, and...
Four isolates and one isolate were obtained from urine samples of five patients in 2018 in Japan. All of the isolates were resistant to imipenem and meropenem, and three were highly resistant to both carbapenems, with MICs of 512 μg/ml. The three highly carbapenem-resistant isolates harbored , encoding a variant of IMP-1 metallo-β-lactamase with two amino acid substitutions (Val67Phe and Phe87Val), and the other two harbored and , respectively. Whole-genome sequencing revealed that an isolate harbored two copies of on the chromosome and that the other four harbored a copy of or in a plasmid. Expression of conferred carbapenem resistance in Recombinant IMP-70 and an IMP-1 variant with Val67Phe but without Phe87Val had significant higher hydrolytic activities against meropenem than recombinant IMP-1, indicating that an amino acid substitution of Val67Phe affects increased activities against meropenem in IMP-70. These results suggest that spp. become more highly resistant to carbapenems by acquisition of two copies of or by mutation of genes with amino acid substitutions, such as .
Topics: Humans; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Japan; Microbial Sensitivity Tests; Providencia
PubMed: 32816727
DOI: 10.1128/AAC.00382-20 -
MSphere Mar 2024Members of , although typically opportunistic, can cause severe infections in immunocompromised hosts. Recent advances in genome sequencing provide an opportunity for...
UNLABELLED
Members of , although typically opportunistic, can cause severe infections in immunocompromised hosts. Recent advances in genome sequencing provide an opportunity for more precise study of this genus. In this study, we first identified and characterized a novel species named sp. nov. It has ≤88.23% average nucleotide identity (ANI) and ≤31.8% DNA-DNA hybridization (dDDH) values with all known species, which fall significantly below the species-defining thresholds. Interestingly, we found that and actually fall under the same species, evidenced by an ANI of 98.59% and a dDDH value of 90.4%. By fusing ANI with phylogeny, we have reclassified 545 genomes within this genus into 20 species, including seven unnamed taxa (provisionally titled Taxon 1-7), which can be further subdivided into 23 lineages. Pangenomic analysis identified 1,550 genus-core genes in , with coenzymes being the predominant category at 10.56%, suggesting significant intermediate metabolism activity. Resistance analysis revealed that most lineages of the genus (82.61%, 19/23) carry a high number of antibiotic-resistance genes (ARGs) and display diverse resistance profiles. Notably, the majority of ARGs are located on plasmids, underscoring the significant role of plasmids in the resistance evolution within this genus. Three species or lineages (, Taxon 3, and L12) that possess the highest number of carbapenem-resistance genes suggest their potential influence on clinical treatment. These findings underscore the need for continued surveillance and study of this genus, particularly due to their role in harboring antibiotic-resistance genes.
IMPORTANCE
The genus, known to harbor opportunistic pathogens, has been a subject of interest due to its potential to cause severe infections, particularly in vulnerable individuals. Our research offers groundbreaking insights into this genus, unveiling a novel species, sp. nov., and highlighting the need for a re-evaluation of existing classifications. Our comprehensive genomic assessment offers a detailed classification of 545 genomes into distinct species and lineages, revealing the rich biodiversity and intricate species diversity within the genus. The substantial presence of antibiotic-resistance genes in the genus underscores potential challenges for public health and clinical treatments. Our study highlights the pressing need for increased surveillance and research, enriching our understanding of antibiotic resistance in this realm.
Topics: Humans; Providencia; Plasmids; Anti-Bacterial Agents; Genomics; DNA
PubMed: 38412041
DOI: 10.1128/msphere.00731-23 -
Hand Clinics Nov 2020An unstable and osteoarthritic distal radioulnar joint presents with considerable functional impairment, pain, and weakness in gripping manipulation of objects. A wide... (Review)
Review
An unstable and osteoarthritic distal radioulnar joint presents with considerable functional impairment, pain, and weakness in gripping manipulation of objects. A wide variety of surgical alternatives have been described to address these concerns. Resection arthroplasties include different types of distal ulna resection and soft tissue procedures; good overall results have been described for these types of procedures, although they have shown limitations in achieving and maintaining pain relief and stability, especially in more active patients. Since the late 1980s, partial and total joint arthroplasties have emerged as good alternatives for treatment in young and more active patients.
Topics: Arthritis; Arthroplasty; Arthroplasty, Replacement; Humans; Joint Instability; Wrist Joint
PubMed: 33040964
DOI: 10.1016/j.hcl.2020.07.008 -
Arquivos Brasileiros de Cardiologia 2024
PubMed: 38477765
DOI: 10.36660/abc.20230834 -
Biomedica : Revista Del Instituto... May 2020San Andrés and Providencia are Colombian islands in the Caribbean Sea. San Andrés has 68,283 inhabitants and has registered cases of leprosy in immigrants from...
San Andrés and Providencia are Colombian islands in the Caribbean Sea. San Andrés has 68,283 inhabitants and has registered cases of leprosy in immigrants from continental Colombia. Providencia has 5,037 inhabitants and historically health programs did not have records of the disease, but in 2009 two cases of multibacillary histoid leprosy were confirmed and, subsequently, another two, which represents a prevalence of 8 cases per 10,000 inhabitants and places the island as a hyperendemic site for leprosy. Initially, a 14-year-old girl with histoid leprosy was diagnosed and, exploring this case, her father was diagnosed with the same clinical form of leprosy. Recently, a new intrafamilial patient with multibacillary leprosy and an extrafamilial case of a girl with undetermined leprosy were detected. The objective of this study was to present to the scientific community and the public health officers these clinical cases and to draw the attention of the sanitary authorities on the necessity of establishing continuous programs of leprosy epidemiological surveillance on the island using the new tools available in the Programa de Control de la Lepra (Leprosy Control Program).
Topics: Adolescent; Colombia; Female; Humans; Leprosy; Male; Middle Aged
PubMed: 32463605
DOI: 10.7705/biomedica.4974 -
The Journal of Emergency Medicine Mar 2022The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to...
BACKGROUND
The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH.
OBJECTIVE
Our aim was to determine whether higher urine pH in the emergency department is associated with nitrofurantoin resistance.
METHODS
A single health system database of emergency department patients aged 18 years and older who received urinalysis between April 18, 2014, and March 7, 2017, was examined using χ test and multivariable regression analysis.
RESULTS
Of 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p < 0.001). The Proteeae species represented 4.4% of urine samples at pH 5-7, 24.4% at pH 8-9, and 40.0% at pH 9. At urine pH 5-7, 80.4% of urine samples were sensitive to nitrofurantoin; however, this percentage decreased to 66.1% for urine pH 8-9 and 54.6% for urine pH 9. Nitrofurantoin had the highest OR (2.10, 95% CI 1.85-2.39) among cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole for bacteriuria sensitive to those antibiotics at urine pH 5-7. At urine pH 8-9 and 9, nitrofurantoin had the lowest OR among the antibiotics: 0.48 (95% CI 0.42-0.54) and 0.31 (95% CI 0.24-0.40), respectively (p < 0.001 for both).
CONCLUSIONS
Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance.
Topics: Anti-Bacterial Agents; Bacteriuria; Emergency Service, Hospital; Female; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Urinary Tract Infections
PubMed: 35000812
DOI: 10.1016/j.jemermed.2021.10.022 -
Microbiology Spectrum Aug 2022Although the prevalence of carbapenem-resistant Enterobacterales remains low in Japan, these bacteria are a growing problem worldwide, owing to their multidrug...
Although the prevalence of carbapenem-resistant Enterobacterales remains low in Japan, these bacteria are a growing problem worldwide, owing to their multidrug resistance phenotype. We isolated a multidrug-resistant Providencia rettgeri strain, NR1418, harboring a rare variant, , a novel variant, designated , and . This strain is resistant to β-lactams, amikacin, levofloxacin, and colistin. Genomic analysis revealed that NR1418 carries two plasmids, designated pNR1418-1 and pNR1418-2. The pNR1418-1 plasmid harbors , , and , while the pNR1418-2 plasmid harbors , which is located in a class 1 integron. Both plasmids exhibit high similarities with the plasmid of the isolate BML2526, which also harbors and was identified in the same region of Japan as NR1418 at a different point in time. This indicates the possibility of the emergence and evolution of IMP-70-producing and suggests that the plasmid of BML2526 may have occurred following recombination of the two plasmids harbored by NR1418. Further, and were found on unique plasmids, indicating that they likely evolved through mutations and recombination. Although Providencia rettgeri is an opportunistic pathogen, its intrinsic resistance to colistin and tigecycline makes the treatment of carbapenem-resistant challenging. We isolated a multidrug-resistant strain which harbored a rare variant, , a novel variant, , and from a urinary sample obtained in Osaka, Japan. We investigated its genetic structure and evaluated the evolution of the plasmids carrying these genes. We show that , , and are present on unique plasmids and that they have high similarities to the plasmid of another IMP-70-producing isolate that was identified as being from the same location. The evolution of plasmids through mutations and recombination may play a role in the development and spread of multidrug resistance.
Topics: Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Colistin; Microbial Sensitivity Tests; Plasmids; Providencia
PubMed: 35862988
DOI: 10.1128/spectrum.01204-22 -
Foot and Ankle Clinics Dec 2020There is no consensus on whether the deltoid ligament must be repaired in ankle fractures. Recent studies have shown better early radiologic results when the deltoid... (Review)
Review
There is no consensus on whether the deltoid ligament must be repaired in ankle fractures. Recent studies have shown better early radiologic results when the deltoid ligament is repaired, but no differences in long term functional outcomes. However, there is evidence suggesting that patients with high fibular fractures or injuries with concomitant syndesmotic instability may benefit from repair. The authors recommend repairing the deltoid ligament complex in bimalleolar equivalent fractures associated with syndesmotic or gross multiligamentous instability as well as in heavier patients with greater mechanical requirements.
Topics: Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Humans; Ligaments; Ligaments, Articular; Treatment Outcome
PubMed: 33543718
DOI: 10.1016/j.fcl.2020.08.009 -
Communications Biology Apr 2022Bacterial homologous lysine and arginine decarboxylases play major roles in the acid stress response, physiology, antibiotic resistance and virulence. The Escherichia...
Bacterial homologous lysine and arginine decarboxylases play major roles in the acid stress response, physiology, antibiotic resistance and virulence. The Escherichia coli enzymes are considered as their archetypes. Whereas acid stress triggers polymerisation of the E. coli lysine decarboxylase LdcI, such behaviour has not been observed for the arginine decarboxylase Adc. Here we show that the Adc from a multidrug-resistant human pathogen Providencia stuartii massively polymerises into filaments whose cryo-EM structure reveals pronounced differences between Adc and LdcI assembly mechanisms. While the structural determinants of Adc polymerisation are conserved only in certain Providencia and Burkholderia species, acid stress-induced polymerisation of LdcI appears general for enterobacteria. Analysis of the expression, activity and oligomerisation of the P. stuartii Adc further highlights the distinct properties of this unusual protein and lays a platform for future investigation of the role of supramolecular assembly in the superfamily or arginine and lysine decarboxylases.
Topics: Carboxy-Lyases; Escherichia coli; Providencia
PubMed: 35383285
DOI: 10.1038/s42003-022-03276-1