ABSTRACT
Donor-derived infections with multidrug-resistant gram-negative bacteria are associated with poor outcomes, in part because of limited treatment options. Here, we describe a case of donor-derived, disseminated infection with colistin-resistant, carbapenemase-producing Klebsiella pneumoniae in a liver transplant recipient that was cured with addition of intravenous fosfomycin to a multidrug regimen, in conjunction with aggressive surgical source control. Intravenous fosfomycin represents a promising adjunctive agent for use in treatment of extensively drug-resistant infections in immunocompromised hosts.
Subject(s)
Allografts/microbiology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Multiple, Bacterial , Fibrosis/surgery , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/physiology , Liver Transplantation/adverse effects , Aged , Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis , Bacterial Proteins/metabolism , Colistin/administration & dosage , Colistin/therapeutic use , Drug Therapy, Combination/methods , Female , Fosfomycin/administration & dosage , Fosfomycin/therapeutic use , Humans , Klebsiella Infections/etiology , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests , Minocycline/administration & dosage , Minocycline/analogs & derivatives , Minocycline/therapeutic use , Tigecycline , beta-Lactamases/metabolismABSTRACT
This study presents a computational fluid dynamics modeling approach to investigate the nucleation in the water-sulfuric acid system in a flow tube. On the basis of an existing experimental setup (Brus, D.; Hyvärinen, A.-P.; Viisanen, Y.; Kulmala, M.; Lihavainen, H. Atmos. Chem. Phys. 2010, 10, 2631-2641), we first establish the effect of convection on the flow profile. We then proceed to simulate nucleation for relative humidities of 10, 30, and 50% and for sulfuric acid concentration between 10(9) to 3 x 10(10) cm(-3). We describe the nucleation zone in detail and determine how flow rate and relative humidity affect its characteristics. Experimental nucleation rates are compared to rates gained from classical binary and kinetic nucleation theory as well as cluster activation theory. For low RH values, kinetic theory yields the best agreement with experimental results while binary nucleation best reproduces the experimental nucleation behavior at 50% relative humidity. Particle growth is modeled for an example case at 50% relative humidity. The final simulated diameter is very close to the experimental result.
Subject(s)
Computer Simulation , Models, Chemical , Sulfuric Acids/chemistry , Water/chemistry , Humidity , KineticsSubject(s)
Brain/pathology , Brain/physiopathology , Cardiolipins/metabolism , Cholesterol/metabolism , Dementia/cerebrospinal fluid , Dementia/microbiology , Neurosyphilis/cerebrospinal fluid , Phosphatidylcholines/metabolism , Adult , Atrophy/cerebrospinal fluid , Atrophy/diagnosis , Atrophy/microbiology , Brain/microbiology , Cardiolipins/analysis , Cholesterol/analysis , Dementia/diagnosis , Disease Progression , False Negative Reactions , Hallucinations/cerebrospinal fluid , Hallucinations/microbiology , Humans , Injections, Intravenous , Magnetic Resonance Imaging , Male , Memory Disorders/cerebrospinal fluid , Memory Disorders/microbiology , Motor Skills Disorders/cerebrospinal fluid , Motor Skills Disorders/microbiology , Neurocognitive Disorders/cerebrospinal fluid , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/microbiology , Neurosyphilis/diagnosis , Penicillins/administration & dosage , Personality Disorders/cerebrospinal fluid , Personality Disorders/diagnosis , Personality Disorders/microbiology , Phosphatidylcholines/analysis , Speech Disorders/cerebrospinal fluid , Speech Disorders/microbiology , Temporal Lobe/microbiology , Temporal Lobe/pathology , Temporal Lobe/physiopathology , Treatment Outcome , Treponema pallidum/physiologyABSTRACT
Two cases of culture-negative endocarditis with cocci seen in valve vegetations are presented. The organisms were identified by molecular analysis using broad-range PCR primers complementary to the 16S rRNA gene, sequencing, and database search using BLAST software. The results and utility of this method are discussed.
