ABSTRACT
A strain of an Enterobacter sp. with reduced susceptibility to imipenem, which produced a plasmid-mediated class A carbapenem-hydrolyzing enzyme, KPC-2 beta-lactamase, was isolated from a patient with sepsis at a Boston hospital. This is the first report of the production of a plasmid-encoded KPC-2 beta-lactamase by an Enterobacter sp.
Subject(s)
Carbapenems/metabolism , Enterobacter/enzymology , Enterobacter/genetics , Plasmids/genetics , beta-Lactamases/genetics , beta-Lactamases/metabolism , DNA, Bacterial/genetics , Drug Resistance, Bacterial , Enterobacteriaceae Infections/microbiology , Escherichia coli/genetics , Humans , Microbial Sensitivity Tests , Phenotype , RNA, Ribosomal, 16S/geneticsABSTRACT
We performed an open-label, prospective, pilot study of interferon (IFN)-alpha 2a treatment for 6 weeks in 16 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). All patients had failed to improve or relapsed after treatment with at least one conventional therapy (steroids, IV gamma globulin, or plasma exchange). Assessment included MRC strength score, leg sensory score, grip dynanometry, Rankin disability score, electrodiagnostic studies, and serum concentration of tumor necrosis factor-alpha. Nine (56%) improved after IFN-alpha therapy. Mean MRC score increased by 4.2 points (p = 0.01), and mean sensory score improved by 2.3 points (p = 0.02). Five patients improved five or more points on the MRC score, nine had slight improvement or were unchanged, and two worsened. We conclude that IFN-alpha may be effective in some patients with CIDP who relapse or fail to respond to conventional immunomodulating therapy.
Subject(s)
Demyelinating Diseases/therapy , Interferon-alpha/therapeutic use , Polyneuropathies/therapy , Adult , Aged , Chronic Disease , Female , Follow-Up Studies , Humans , Immunoglobulins, Intravenous/therapeutic use , Interferon alpha-2 , Male , Middle Aged , Pilot Projects , Prospective Studies , Recombinant ProteinsSubject(s)
Antibodies, Monoclonal/therapeutic use , Endotoxins/immunology , Sepsis/therapy , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/pharmacology , Antibodies, Monoclonal, Humanized , Double-Blind Method , Endotoxins/chemistry , Endotoxins/metabolism , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/immunology , Gram-Negative Bacteria/metabolism , Humans , Sepsis/etiology , Sepsis/immunology , United States , United States Food and Drug AdministrationABSTRACT
Septic shock is the leading cause of death in critical care units. New research in the management of septic shock is focused on the use of immune-based therapy such as antiendotoxin monoclonal antibodies. The object of this therapy is to neutralize endotoxin and prevent the progression of the pathophysiologic events of sepsis. To date, the promise of this therapy has not been realized, but hopefully, ongoing research will provide optimism for treatment of this syndrome. Two agents, E5 and HA-1A, are discussed.
