ABSTRACT
Ceftazidime-resistant Enterobacter aerogenes was isolated from blood cultures of three patients with fever. DNA analysis using pulsed-field gel electrophoresis and ribosomal RNA gene restriction digest pattern analysis revealed that the strains were clonally similar to each other with a 79.3-96.0% homology. The same strain of E. aerogenes was isolated from a three-way stopcock connected to the indwelling catheter in one of the patients at a concentration of 45 cfu/mL. A similar strain was also isolated from the urine of one other patient on the same floor. The data suggest that E. aerogenes caused septicaemia via low bacterial contamination of a three-way stopcock in a peripheral drip intravenous infusion system in at least one patient, and that the outbreak of E. aerogenes infections was due to clonally-related strains.
Subject(s)
Cross Infection/etiology , DNA, Bacterial/analysis , Enterobacter aerogenes/isolation & purification , Enterobacteriaceae Infections/etiology , Ribotyping/methods , Sepsis/etiology , Adult , Electrophoresis, Gel, Pulsed-Field , Enterobacter aerogenes/drug effects , Enterobacter aerogenes/pathogenicity , Equipment Contamination , Female , Humans , Japan , Microbial Sensitivity Tests , Middle AgedABSTRACT
BACKGROUND: Clarithromycin-resistant Helicobacter pylori (CRHP) has increasingly been isolated from patients in Japan. The aim of our study was to test whether proton pump inhibitors (PPIs) and their thioether derivatives, which are secreted into the gastric mucosa, could inhibit the growth and motility (a factor in colonization) of CRHP. MATERIALS AND METHODS: CRHP was isolated from patients who had experienced gastritis or peptic ulcers in Tokyo and Niigata. Drugs and related agents tested were omeprazole, lansoprazole, rabeprazole, the thioether derivative of rabeprazole (rabeprazole-TH), clarithromycin, amoxicillin and metronidazole. The MICs of the drugs and agents for H. pylori strains were determined by the agar dilution METHOD: Bacterial swimming in a liquid layer was examined under an inverted, phase-contrast microscope. RESULTS: The PPIs and rabeprazole-TH, but not the anti-H. pylori agents, inhibited the motility of CRHP at both pH 7.4 and 6.0. The concentrations (microg/ml) necessary to inhibit 50% of the motility at pH 7.4 were 0.25-0.5, 8-32, 8-16 and 128-256 for rabeprazole-TH, rabeprazole, lansoprazole and omeprazole, respectively. Rabeprazole-TH exhibited the strongest inhibitory effect against the growth of CRPH (MIC, 0.5 microg/ml). CONCLUSION: Rabeprazole-TH, which is secreted into the gastric mucosa, had the strongest inhibitory action against both the growth and motility of CRHP, suggesting that it is a potential novel agent for CRHP eradication.
Subject(s)
Benzimidazoles/pharmacology , Clarithromycin/pharmacology , Gastritis/microbiology , Helicobacter pylori/drug effects , Proton Pump Inhibitors , Sulfides/pharmacology , 2-Pyridinylmethylsulfinylbenzimidazoles , Benzimidazoles/chemistry , Cell Division/drug effects , Dose-Response Relationship, Drug , Drug Resistance, Microbial , Helicobacter Infections/drug therapy , Humans , Japan , Movement/drug effects , Omeprazole/analogs & derivatives , Rabeprazole , Sulfides/chemistry , Treatment FailureABSTRACT
The motility of Helicobacter pylori was maximum at 37 degrees C and at pH 6. A newly developed proton pump inhibitor, rabeprazole (RPZ), and its thioether derivative (RPZ-TH) markedly inhibited the motility of H. pylori. The concentrations of the drug necessary to inhibit 50% of the motility were 0.25, 16, 16, and >64 microgram/ml for RPZ-TH, RPZ, lansoprazole, and omeprazole, respectively. No such inhibitory effects were observed with H(2) blockers or anti-H. pylori agents. The motilities of Campylobacter jejuni and C. coli-but not those of Vibrio cholerae O1 and O139, Vibrio parahaemolyticus, Salmonella enterica serovar Typhimurium, and Proteus mirabilis-were also inhibited. Prolonged incubation with RPZ or RPZ-TH inhibited bacterial growth of only H. pylori, except for a turbid colony mutant. The results indicate that RPZ and RPZ-TH have a characteristic inhibitory effect against the motility of H. pylori (spiral-shaped bacteria), which is distinguished from that against bacterial growth.
Subject(s)
Anti-Ulcer Agents/pharmacology , Benzimidazoles/pharmacology , Helicobacter pylori/drug effects , Proton Pump Inhibitors , 2-Pyridinylmethylsulfinylbenzimidazoles , Anti-Ulcer Agents/chemistry , Benzimidazoles/chemistry , Cell Division/drug effects , Helicobacter pylori/cytology , Helicobacter pylori/physiology , Humans , Hydrogen-Ion Concentration , Microbial Sensitivity Tests , Omeprazole/analogs & derivatives , Rabeprazole , Sulfides/chemistry , TemperatureABSTRACT
We report case of primary volvulus of the small intestine and review 15 cases from the Japanese literature. A 56-year-old woman, with a history of appendectomy 30 years previously, was admitted with abdominal distension and signs of peritonitis. Abdominal computed tomography (CT) demonstrated a whirl-like pattern of the mesentery, showing the tightly twisted mesentery around the point of torsion. An emergency laparotomy revealed strangulation of the small intestine, from 200 cm anal to the Treitz ligament to 5 cm oral to the terminal ileum, caused by 360 degrees clockwise torsion. There was no adhesion caused by the previous operation nor were there any congenital anomalies. The strangulated intestine was removed and jejunocolonostomy was performed. The patient was discharged from hospital on day 39 after the operation. Primary volvulus of the small intestine was reported to be rare in Japan, but the mortality was 26%. Immediate diagnosis and surgical intervention is essential to achieve a good outcome. A whirl-like pattern of the mesentery is a typical sign of this condition on CT.
