Exopolysaccharides from Klebsiella oxytoca: anti-inflammatory activity

Abstract Exopolysaccharides (EPS) produced by Klebsiella oxytoca are of environmental, pharmaceutical, and medicinal interest. However, studies about the anti-inflammatory activity of EPS produced by this microorganism still remain limited. The aim of this study was to produce, characterize, and evaluate the anti-inflammatory activity of EPS from K. oxytoca in a pleurisy model. Colorimetric analysis revealed that precipitated crude exopolysaccharides (KEPSC) and deproteinated exopolysaccharides (KEPS) present high levels of total carbohydrates (65.57% and 62.82%, respectively). Analyses of uronic acid (7.90% in KEPSC and 6.21% in KEPS) and pyruvic acid (3.01% in KEPSC and 1.68% in KEPS) confirm that the EPS are acidic. Gas chromatography-mass spectrometry analyses demonstrated that the EPS consisted of rhamnose (29.83%), glucose (11.21%), galactose (52.45%), and mannose (6.50%). The treatment of an experimental pleurisy model in rats through subcutaneous administration of 50, 100, 200, and 400 mg/kg of KEPS decreased both the volume of inflammatory exudate and the number of leukocytes recruited to the pleural cavity. The present data showed that EPS production by K. oxytoca using the method described is easy to perform and results in a good yield. In addition, we show that KEPS exhibit anti-inflammatory activity when administered subcutaneously in rats.

A case of late-onset Klebsiella oxytoca keratitis treated with topical imipenem after deep anterior lamellar keratoplasty / Caso de ceratite de início tardio por Klebsiella oxytoca tratado com imipenem tópico após ceratoplastia lamelar anterior profunda

ABSTRACT The aim of this study was to discuss a case of late-onset Klebsiella oxytoca keratitis after deep anterior lamellar keratoplasty and its treatment. A 21-year-old female patient presented with redness and effluence in the left eye at 5 months after uncomplicated deep anterior lamellar keratoplasty surgery. In the examination, a single suture was loosened in the superior nasal region and there was an infiltration area and epithelial defect in the graft and recipient bed junction in the area of the loose suture. Topical fortified vancomycin and fortified ceftazidime treatment was started empirically hourly, but there was insufficient response. After K. Oxytoca growth in a swab and suture culture taken from the patient, fortified vancomycin was replaced with fortified imipenem. It was observed that the infiltration area rapidly regressed and the epithelial defect was closed after fortified imipenem treatment. Fortified imipenem may be considered as an alternative treatment, especially in cases in which there is no response to treatment and culture growth is detected.(AU)

RESUMO O objetivo deste estudo é discutir um caso de ceratite tardia por Klebsiella oxytoca, após ceratoplastia lamelar anterior profunda, bem como seu tratamento. Uma paciente de 21 anos apresentou vermelhidão e efluxo no olho esquerdo 5 meses após cirurgia de ceratoplastia lamelar anterior profunda sem complicações. Ao exame, havia uma única sutura solta na região nasal superior e uma área de infiltração com defeito epitelial no enxerto e na junção com o leito receptor na área da sutura solta. Iniciou-se empiricamente um tratamento tópico com vancomicina e ceftazidima fortificada de hora em hora, porém com resposta insuficiente. Após o crescimento de K. oxytoca a partir de cultura de swab e sutura retirados da paciente, a vancomicina fortificada foi substituída por imipenem fortificado. Observou-se que a área de infiltração regrediu rapidamente e que o defeito epitelial foi fechado com o tratamento com imipenem fortificado. O imipenem fortificado pode ser considerado um tratamento alternativo, especialmente nos casos sem resposta ao tratamento e detecção de crescimento na cultura.(AU)

Microbiota oral e retal de calitriquídeos (Callithrix sp) em área antropizada de Mata Atlântica, Rio de Janeiro, Brasil / [Oral and rectal microbiota of callitrichids (Callithrix sp) in an anthropized area of the Atlantic Forest in Rio de Janeiro, Brazil]

A proximidade dos primatas não humanos (PNH) com o ser humano pode ser considerada um fator de risco para transmissão de bactérias entre essas duas populações. Neste estudo, foi investigada a microbiota anfibiôntica aeróbica oral e retal de calitriquídeos em um fragmento de Mata Atlântica localizado no Rio de Janeiro, Brasil, e foram realizados testes fenotípicos para detecção de bactérias multirresistentes nos isolados encontrados. Foram capturados 14 calitriquídeos e coletadas 21 amostras (14 de cavidade oral e sete de cavidade retal) em dois pontos da mata próximos às habitações humanas. As espécies mais frequentes, na cavidade oral, foram Klebsiella oxytoca (50,0%), K. pneumoniae (28,6%), Kluyvera ascorbata (21,4%) e Stenotrophomonas maltophilia (21,4%) e, na cavidade retal, K. pneumoniae (85,7%), Escherichia coli (28,6%) e Enterobacter spp. (42,9%). Todos os 48 isolados da família Enterobacteriaceae foram negativos para ESBL (betalactamase de espectro ampliado), mostrando-se não produtores da enzima nos dois métodos utilizados: disco-aproximação e método de detecção automatizado. Na pesquisa de ERC (enterobactérias resistentes a carbapenêmicos), esses mesmos isolados não apresentaram resistência aos antibióticos imipenem, meropenem e ertapenem. Todas as bactérias isoladas apresentam um potencial zoonótico, o que representa um risco à saúde pública e à conservação das espécies.(AU)

Proximity of nonhuman primates (NHP) to humans can be considered a risk factor for transmission of pathogens between these two populations. This study investigated the oral and rectal aerobic bacterial microbiota of marmosets in an anthropized area of the Atlantic Forest located in Rio de Janeiro, Brazil, and performed phenotypic tests for detection of multidrug-resistant bacteria. Twenty-one samples (14 from the oral cavity and seven from the rectum) were collected from 14 Callithrix sp. captured in two sites of the forest near human dwellings. The most frequent species identified from the oral cavity swabs were Klebsiella oxytoca (50.0%), K. pneumoniae (28.6%), Kluyvera ascorbata (21.4%) and Stenotrophomonas maltophilia (21.4%), whereas the species most commonly identified from the rectum swabs were K. pneumoniae (85.7%), Enterobacter spp. (42.9%) and Escherichia coli (28.6%). All isolates of family Enterobacteriaceae showed no extended spectrum ß-lactamase production by disk-diffusion and automated detection tests. In the search for carbapenem-resistant enterobacteriaceae these isolates presented no resistance to the imipenem, meropenem and ertapenem antibiotics. The isolate of Staphylococcus aureus was susceptible to oxacillin and the isolate of Enterococcus was susceptible to vancomycin. All isolated bacteria showed zoonotic potential, thus posing a risk to species conservation and public health.(AU)

Hydroalcoholic Extract of Eugenia uniflora as Denture Disinfectant: Antimicrobial Activity and Effect on the Physical Properties of Polymethylmethacrylate

Abstract To the moment, there is no ideal substance for home-based denture disinfection. This study assessed in vitro the antimicrobial effect of the hydroalcoholic extract of Eugenia uniflora and the effect on the physical properties of denture polymethylmethacrylate (PMMA). Candida albicans, Staphylococcus aureus, and Klebsiella oxytoca were isolated from samples of saliva collected from denture wearers. The extracts were produced in three concentrations, according to the Brazilian Pharmacopeia. One hundred eighty-eight disc-shaped specimens of thermopolymerizable PMMA were prepared and randomly allocated to five treatment groups: sterile saline solution (0.85%; control); chlorhexidine digluconate (0.2%); and hydroalcoholic extract of E. uniflora (0.2%, 0.8%, and 1.16%). The specimens were disinfected for 8 hours/day for 30 days. Adherence of microorganisms to the surface, PMMA surface roughness, and color stability were assessed. Inferential statistics were performed with one- and two-way ANOVA/Tukey test, and Kruskal Wallis, Mann-Whitney U, and paired t-tests, at α=0.05. The extract of E. uniflora at 0.2% and 1.16% reduced the microbial load of K. oxytoca, while chlorhexidine digluconate significantly reduced microbial load of all microrganisms. Microbial adherence at day 10 was reduced by all experimental substances (p<0.001). Surface roughness was not affected by the disinfecting substances (p>0.05). Nevertheless, all experimental groups produced unacceptable color change at the end of the disinfection protocol (p<0.001). The non-adherent potential against microorganisms isolated from the oral cavity confirm the potential of use of the hydroalcoholic extract of E. uniflora as a denture disinfectant. Yet, unacceptable color changes may occur, regardless of extract concentration.

Patrón sensibilidad/resistencia en los urocultivos de pacientes con I.T.U. que consultan a urgencias de adultos, Hospital de San José entre enero de 2014 y diciembre de 2014 / Pattern Sensitivity/Resistance in the Urocultives of Patients with U.T.I. who Consult Adult Urgencies, San Jose Hospital between January 2014 and December 2014

Introducción: La infección del tracto urinario (ITU) es un motivo de consulta frecuente en urgencias, siendo necesario el tratamiento antibiótico empírico antes de obtener un urocultivo. Objetivo Determinar el patrón de sensibilidad/resistencia de los gérmenes aislados en los urocultivos de pacientes que ingresan por urgencias de adultos con sintomatología sugestiva de ITU. Métodos Se realizó un estudio observacional, descriptivo de corte transversal, recolectando los datos de los urocultivos de pacientes con diagnóstico de ITU que asistieron por urgencias adultos, y cumplieron los criterios de inclusión en el año 2014. Resultados Se analizaron 133 pacientes (133 urocultivos), 50,4% mujeres, edad promedio de 64,1 años (DE 19,1). Se encontró una frecuencia mayor de ITU alta (54,9%), e ITU no complicada (54,1%), la mayoría de origen en la comunidad (95,5%). El germen más frecuentemente aislado fue E. coli (56,4%), seguido por Klebsiella oxytoca (7,1%). La resistencia de E. coli fue del 55,7% para ampicilina sulbactam, 58,2% para nitrofurantoina, 40% para quinolonas y 32% para cefazolina. En pacientes con factores de riesgo urológico se encontró una resistencia entre el 40% al 50%. Se evidenció patrón BLEA (12,9%), AMPc (20%) y KPC (1,4%). Conclusión Los uropatógenos han aumentado de forma significativa su resistencia a las diferentes familias de antibióticos, entre ellas las cefalosporinas y las quinolonas, confirmando que medicamentos como ampicilina sulbactam, nitrofurantoina, y ciprofloxacina no están indicados en el manejo empírico de ITU en nuestra institución, especialmente al presentar factores de riesgo urológicos.

Introduction Urinary tract infection (UTI) is a frequent cause for assistance to the emergency services, in most cases is necessary initiate empirical antimicrobial management while obtaining the result of the uroculture. Therefore, it is vital to know the pattern of sensitivity/resistance of the most frequent uropathogens and thus offer the best initial treatment. Objective To determine the pattern of sensitivity / resistance of isolated germs in the urine cultures of adults patients admitted to the emergency room with UTI suggestive symptoms. Methods An observational, descriptive, cross-sectional study was conducted, collecting urine culture data from patients diagnosed with UTI who were attended in adult emergencies in 2014. Results A total of 133 patients were analyzed (133 urine cultures), 50.4% were women, with average age of 64.1 years (SD 19.1). Higher frequency of high urinary tract infection was found (54.9%), and uncomplicated UTI (54.1%), most UTI originated in the community (95.5%). The most frequently isolated germ was E. coli (56.4%), followed by Klebsiella oxytoca (7.1%). The resistance of E. coli was 55.7% for ampicillin sulbactam, 58.2% for nitrofurantoin, 40% for quinolones and 32% for cefazolin. In patients with urological risk factors, resistance was found between 40% and 50%. BLEA pattern (12.9%), cAMP (20%) and KPC (1.4%) were evidenced. Conclusion Uropathogens have significantly increased their resistance to different families of antibiotics, including cephalosporins and quinolones, confirming that drugs such as ampicillin sulbactam, nitrofurantoin, and ciprofloxacin are not indicated in the empirical management of UTI in our institution, especially with the presence of urological risk factors.

Enteric infections complicating ulcerative colitis

Enteric infections have previously been postulated to play a role in the pathogenesis of inflammatory bowel disease (IBD), however, little evidence exists in the etiologic role of specific enteric infections in the development of IBD. When encountered in the setting of IBD, enteric infections pose a clinical challenge in management given the competing treatment strategies for infectious conditions and autoimmune disorders. Here we present the case of a young male with enteric infections complicating a new diagnosis of IBD. Our patient's initial clinical presentation included diagnoses of Klebsiella oxytoca isolation and Clostridium difficile infection. Directed therapies to include withdrawal of antibiotics and fecal microbiota transplantation were performed without resolution of clinical symptoms. Given persistence of symptoms and active colitis, the patient was diagnosed with ulcerative colitis (UC), requiring treatments directed at severe UC to include cyclosporine therapy. The finding of multiple enteric infections in a newly presenting patient with IBD is an unexpected finding that has treatment implications.

Antibiotics-Associated Hemorrhagic Colitis Caused by Klebsiella oxytoca: Two Case Reports / 대한소아소화기영양학회지

Nowadays, Klebsiella oxytoca is described as a causative organism for antibiotic-associated hemorrhagic colitis (AAHC). Here we report two cases of pediatric AAHC, from which K. oxytoca was cultured after starting amoxicillin-clavulanate or amoxicillin treatment. The patients developed severe abdominal pain and a large amount of bloody diarrhea. K. oxytoca was obtained in intestinal fluid culture of a boy through the colonoscopy. On the other hand, colonic tissue culture and intestinal fluid culture were negative of the other patient. K. oxytoca was detected in stool culture when he was admitted. These cases showed characteristic endoscopic findings of segmental hemorrhagic colitis, and both boys recovered spontaneously within 2–3 days after they stopped taking the antibiotics. Therefore, in children who develop relatively large amount of bloody diarrhea after antibiotic treatment, we should consider AAHC caused by K. oxytoca.

Performance of MALDI Biotyper for Species Identification of Carbapenem-Resistant Enterobacteriaceae by Media Types and Incubation Time

BACKGROUND: This study was conducted to evaluate the impact of the media type used for direct identification of colonies on the surveillance culture of carbapenem-resistant Enterobacteriaceae (CRE) by matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). METHODS: CRE surveillance culture isolates were subjected to species identification using the MALDI Biotyper (Bruker Daltonics, Germany) for 2 months starting in March 2017. Four types of media were evaluated: blood agar (BA), Mueller Hinton agar (MH), MacConkey agar (Mac), and MacConkey agar containing imipenem of 1 µg/mL (IMP-Mac). CRE-like colonies on IMP-Mac and their subculture colonies on the other media were tested after overnight incubation and extended incubation for one additional day. The percent identification and score value were analyzed for each media types and incubation time when the identification was correct at the genus level. RESULTS: A total of 117 isolates were identified as 84 Klebsiella pneumoniae, 12 Escherichia coli, 9 Enterobacter cloacae, 5 Klebsiella oxytoca, 4 Enterobacter aerogenes, and 2 Raoultella ornithinolytica. The successful identification rates (SIR) for BA and MH were 98.3% and 97.4% (P=0.9), respectively, while those for Mac and IMP-Mac were 82.1% (P < 0.001) and 70.9% (P < 0.001), respectively. After extended incubation, SIRs were decreased to 96.6%, 96.6% (P=1.0), 61.5% (P < 0.001), and 58.1% (P < 0.001) on BA, MH, Mac, and IMP-Mac, respectively. The average score values were significantly lower for Mac (2.017±0.22) and IMP-Mac (1.978±0.24) than for BA (2.213±0.16) (P < 0.001). CONCLUSIONS: The low performance of the MALDI Biotyper applied directly to the colonies grown on Mac or IMP-Mac indicates that subculture on BA or MH is preferable before identification by MALDI-TOF MS.

Heterologous expression and characterization of Klebsiella oxytoca lysine decarboxylase / 生物工程学报

Cadaverine is a biogenic amine that has the potential to become an important platform chemical for the production of industrial polymers, such as polyamides and polyurethanes. We reported here a lysine decarboxylase from Klebsiella oxytoca. The lysine decarboxylase from Klebsiella oxytoca was cloned to Escherichia coli to get the strain LN18. The specific activity of the crude protein from LN18 reached 30 000 U. The molecular weight was about 80 kDa. The optimum temperature and pH of the crude protein were 55 ℃ and 5.5 respectively. The specific activity could keep over 30% at pH 8.0 compared the one at pH 5.5, much difference from Escherichia coli lysine decarboxylase CadA. Mg²⁺ was positive to the specific activity, whereas Fe²⁺, Zn²⁺ and Ca²⁺ were negative.

Potential virulence of Klebsiella sp. isolates from enteral diets

We aimed to evaluate the potential virulence of Klebsiellaisolates from enteral diets in hospitals, to support nosocomial infection control measures, especially among critical-care patients. Phenotypic determination of virulence factors, such as capsular expression on the external membrane, production of aerobactin siderophore, synthesis of capsular polysaccharide, hemolytic and phospholipase activity, and resistance to antibiotics, which are used therapeutically, were investigated in strains ofKlebsiella pneumoniae and K. oxytoca. Modular industrialized enteral diets (30 samples) as used in two public hospitals were analyzed, and Klebsiella isolates were obtained from six (20%) of them. The hypermucoviscous phenotype was observed in one of the K. pneumoniae isolates (6.7%). Capsular serotypes K1 to K6 were present, namely K5 and K4. Under the conditions of this study, no aerobactin production, hemolytic activity or lecithinase activity was observed in the isolates. All isolates were resistant to amoxicillin and ampicillin and sensitive to cefetamet, imipenem, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim. Most K. pneumoniae isolates (6/7, 85.7%) from hospital B presented with a higher frequency of resistance to the antibiotics tested in this study, and multiple resistance to at least four antibiotics (3/8; 37.5%) compared with isolates from Hospital A. The variations observed in the antibiotic resistance profiles allowed us to classify theKlebsiella isolates as eight antibiotypes. No production of broad-spectrum β-lactamases was observed among the isolates. Our data favor the hypothesis that Klebsiella isolates from enteral diets are potential pathogens for nosocomial infections.

Incidencia y etiología de la bacteriemia asociada al uso de catéteres venosos centrales en una unidad de cuidados intensivos pediátricos / Incidence and etiology of bacteremia associated with the use of central venous catheters in a pediatric intensive care unit

Las infecciones intrahospitalarias determinan un aumento en la morbimortalidad de los pacientes. La infección asociada al uso de catéteres intravenosos es la más frecuente en las unidades de cuidado intensivos. Objetivo: determinar la incidencia y etiología de bacteriemia asociada al uso de catéteres venosos centrales en la Unidad de Cuidados Intensivos de Niños (UCIN) del Centro Hospitalario Pereira Rossell. Material y método: se realizó un estudio descriptivo observacional entre el 1 de diciembre de 2009 hasta el 1 de julio de 2010. Se incluyeron todos los pacientes hospitalizados en UCIN, que cumplieran con la definición de paciente de Unidad de Cuidado Intensivo del National Nosocomial Infections Surveillance (NNIS) y que portaran un catéter venoso central. La fuente de recolección de datos fueron las historias clínicas. Resultados: se incluyeron 94 niños con vías centrales, un total de 109 vías, 988 días de cateterización. Se identificaron cinco casos de bacteriemias asociadas al catéter, una densidad de incidencia de bacteriemia asociada al catéter de 5.06 casos por cada 1000 días de cateterización. Los gérmenes aislados fueron Staphylococcus coagulasa negativo, Staphylococcus aureus, Klebsiella oxytoca, Enterobacter cloacae y Candida albicans. En todos los casos el tiempo de positivización diferencial del hemocultivo obtenido del catéter venoso fue menor a 2 horas frente al obtenido por punción periférica. Conclusiones: el valor hallado de incidencia de infección asociada al uso de catéter fue elevado y es necesario implementar medidas destinadas a disminuirla...

[ study of the effect of silver nanoparticles on extended spectrum beta-lactamase producing Klebsiella strains]

Wide use of beta-lactam antibiotics increases bacterial resistance to these groups of antibiotics in pathogen bacteria through production of beta-lactamase enzyme. The present study was carried out with the aim of evaluating the isolation of ESBL producing Klebsiella spp. in clinical specimens and investigating the effect of silver nanoparticles on them. A total of 61 clinical Klebsiella isolates were examined in terms of production of extended spectrum beta-lactamase [ESBL] through disk diffusion method using the antibiotics cefixime, ceftriaxone, ceftazidime, as well as beta-lactamase inhibitor clavulanic acid, and the antibiotics' minimal inhibitory concentration [MIC] values were determined by agar dilution method. Then, ESBL production was examined using standard ESBL disk for detection of deta-lactamase through DDT [double disk approximation test] method. Subsequently, the effect of different concentrations of nanosilver solution on isolated bacteria was studied. Student t-test was used for analysis of the data. Out of 61 multidrug resistant Klebsiella isolates, 51 [60.83%] Klebsiella pneumonea and 10 [39.16%] Klebsiella oxytoca were recognized. All samples were demonstrated to be positive in double disk method for proving ESBL production, and were sensitive to the nanosilver solution with a concentration of 500ppm. The obtained findings showed that increase in the concentration of nanosilver solutions had a direct correlation with inhibition zone diameter of ESBL producing Klebsiella spp in vitro and in completely aseptic condition. If it is proved that nanosilver solutions are non-toxic in vivo, they could be used as a new effective alternative to antibiotics

Predictors of Mortality in Patients Treated in an Emergency Department for Necrotizing Fasciitis

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.

Predictors of Mortality in Patients Treated in an Emergency Department for Necrotizing Fasciitis

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.

Clinical Manifestations of Hospitalized Children Due to Varicella-Zoster Virus Infection / 소아감염

PURPOSE: This study was performed to describe the clinical manifestations of hospitalized children due to varicella-zoster virus (VZV) infection. METHODS: This study included 40 children who were hospitalized for varicella or herpes zoster at Seoul National University Children's Hospital, 2009-2012. Diagnosis of VZV infection was confirmed by VZV PCR or culture from vesicular fluid. Medical records were reviewed to collect clinical features and outcome, antiviral treatment, history of varicella vaccination, and underlying diseases. RESULTS: Sixteen patients with varicella and 24 patients with herpes zoster were included. Their median age was 10.5 years (16 days-19 years). Thirty-five (87.5%) patients had underlying diseases. Among 24 patients with herpes zoster, 11 patients had previous history of varicella and 1 had herpes zoster. Twenty patients (50%) had a history of varicella vaccination, and 19 immunocompromised patients had VZV infection despite of vaccination. Most (95%) patients were treated by intravenous or oral acyclovir, and no treatment failure of intravenous acyclovir was found. The median duration of fever was 4.4 days (1-10 days), and that of antiviral treatment was 12 days (7-23 days) in immunocompromised patients. Immunocompromised patients received longer duration of antiviral treatment than imunocompetent patients (P=0.014). Eleven (27.5%) immunocompromised patients had postherpetic neuralgia, 2 (5%) had proven co-infection by Streptococcus pyogenes and Klebsiella oxytoca, and 1 (2.5%) complicated with pneumonia. CONCLUSION: Immunocompromised children require longer duration of treatment and are at risk of severe complication associated with VZV infection. Early initiation of antiviral therapy and close monitoring are necessary for those in immunocpompromised conditions.

Effect of acetic acid, furfural and 5-hydroxymethylfurfural on production of 2,3-butanediol by Klebsiella oxytoca / 生物工程学报

To get the tolerability and consumption of Klebsiella oxytoca on major inhibitors in lignocelluloses hydrolysate, we studied the effect of acetic acid, furfural and 5-hydroxymethylfurfural on production of 2,3-butanediol by Klebsiella oxytoca. The metabolites of furfural and 5-hydroxymethylfurfural were measured. The results show that when acetic acid, furfural and 5-hydroxymethylfurfural was individually added, tolerance threshold for Klebsiella oxytoca was 30 g/L, 4 g/L and 5 g/L, respectively. Acetic acid was likely used as substrate to produce 2,3-butanediol. The yield of 2,3-butanediol increased when acetic acid concentration was lower than 30 g/L. In the fermentation, more than 70% 5-hydroxymethylfurfural was converted to 2,5-furandimethanol. All furfural and the rest of 5-hydroxymethylfurfural were metabolized by Klebsiella oxytoca. It showed that in the detoxification process of 2,3-butanediol production using lignocelluloses hydrolysate, furfural should be given priority to remove and a certain concentration of acetic acid is not need to removal.

Actividad antibacteriana de extracto de hojas de Melia azedarach L / Antibacterial activity of leaf extract Melia azedarach L

El trabajo tuvo como objetivo evaluar la actividad antibacteriana de extractos de hojas de Melia azedarach L. sobre seis bacterias patógenas. Inicialmente mediante extracción por el método Soxhlet se obtuvo extracto total en etanol y a partir de éste se prepararon fracciones líquido-líquido con éter de petróleo y acetato de etilo. El extracto total y las dos fracciones fueron diluidos a diferentes concentraciones (ppm) para evaluar in vitro su actividad antibacteriana. Las bacterias de mayor susceptibilidad fueron las patógenas de humanos Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa y Klebsiella oxytoca, en relación a la fitopatógena Burkholderia glumae quien mostró resistencia a todos los tratamientos. Las bacterias patógenas fueron más susceptibles a la fracción éter de petróleo a concentración mínima de 25 ppm. El screen fitoquímico de la planta indicó presencia de metabolitos secundarios tipo alcaloides, terpenos/esteroles, saponinas, taninos y antocianinas. Estos resultados evidencian el posible uso de M. azederach como alternativa de control biológico sobre las bacterias analizadas.

The work was objective to evaluate the antibacterial activity of extracts from leaves of Melia azedarach (L) on six pathogenic bacteria. Total ethanol extract was obtained initially by extraction with method Soxhlet and from this prepared liquid-liquid fractions with petroleum ether and ethyl acetate. The total extract and the two fractions were diluted at different concentrations (ppm) to evaluate its antibacterial activity in vitro. More susceptible bacteria were the pathogenic human Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa and Klebsiella oxytoca, in relation to the plant pathogen Burkholderia glumae who showed resistance to all treatments. Pathogenic bacteria were more susceptible to the fraction of petroleum ether to the minimum concentration of 25 ppm. Screen plant phytochemical indicated presence of secondary metabolites type alkaloids, terpenes/sterols, saponins, tannins and anthocyanins. These results demonstrate the potential use of M. azederach as biological control alternatively on analysed bacterial.

Isolation of the Causative Microorganism and Antimicrobial Susceptibility of Impetigo / 대한피부과학회지

BACKGROUND: Impetigo is a common bacterial infection caused by Staphylococcus aureus, and group A beta-hemolytic Streptococcus or both. Recently, S. aureus has been reported as the most frequently isolated pathogen of impetigo and the incidence of methicillin-resistant S. aureus (MRSA) among patients with impetigo has increased. OBJECTIVE: To investigate the predominant microorganism and the antibiotic susceptibility of the impetigo causative pathogen. METHODS: Bacterial culture and antimicrobial susceptibility testing were performed in patients with impetigo from June 2006 to May 2012. RESULTS: Of 164 patients, bacteria were cultured from 139 patients. Among them, S. aureus was isolated from 114 (82%) patients. The others were Acinetobacter baumannii, Enterobactercloacae, Enterococcus species, Enterococcus faecium, Enterococcus faecalis, Klebsiella oxytoca, and Candida albicans. The resistance rates of S. aureus against antibiotics were as follows: penicillin, 95.6%; erythromycin, 43.9%; fusidicacid, 38.1%; clindamycin, 24.5%; gentamycin, 21%; tetracycline, 12.3%; trimethoprim-sulfamethoxazole, 0.9%; ciprofloxacin, 0%; habekacin, 0%; linezolid, 0%; teicoplanin, 0%; and vancomycin, 0%. Thirty-four (29.8%) S. aureus isolates were MRSA, and the prevalence of MRSA increased during the 6-year period. CONCLUSION: The most predominant pathogen in impetigo was S. aureus, which was sensitive to ciprofloxacin, habekacin, linezolid, trimethoprim-sulfamethoxazole, teicoplanin, and vancomycin. An increase in the prevalence of MRSA was observed during the 6-year period, and the effective antibiotics for MRSA were trimethoprim-sulfamethoxazole, teicoplanin and vancomycin.