Analysis of multidrug resistance in Streptococcus suis ATCC 700794 under tylosin stress.

Streptococcus suis is an important zoonotic pathogen. The massive use of tylosin and other antibiotics in swine production has led to the emergence of resistant phenotypes of S. suis. However, there are no adequate measures available to address the problem of bacterial resistance. This study involved the use of 1/4 MIC (0.125 µg/mL) of tylosin to investigate resistance-related proteins by S. suis ATCC 700794. Our results showed that 171 proteins were differentially expressed in S. suis tested with 1/4 MIC (0.125 µg/mL) of tylosin using iTRAQ-based quantitative proteomic methods. TCS, heat shock protein and elongation factors were differentially expressed at 1/4 MIC (0.125 µg/mL) of tylosin compared to non treated, control cells. Using quantitative RT-PCR analysis, we verified the relationship between the differentially expressed proteins in S. suis with different MIC values. The data showed that expression profile for elongation factor G (fusA), elongation factor Ts (tsf), elongation factor Tu (tuf), putative histidine kinase of the competence regulon, ComD (comD), putative competence-damage inducible protein (cinA) and protein GrpE (grpE), observed in tylosin-resistant S. suis, correlated with that of S. suis ATCC 700794 at 1/4 MIC (0.125 µg/mL). The MIC of tylosin-resistant showed high-level resistance in terramycin, chlortetracycline, ofloxacin and enrofloxacin. Our findings demonstrated the importance of elongation factors, TCS and heat shock protein during development of tylosin resistance in S. suis. Thus, our study will provide insight into new drug targets and help reduce bacterial multidrug resistance through development of corresponding inhibitors.

Simultaneous treatment of ureteropelvic junction obstruction complicated by renal calculi with robotic laparoscopic surgery and flexible cystoscope.

OBJECTIVE: To present our experience of combining transperitoneal robot-assisted laparoscopic pyeloplasty (RALP) and concomitant flexible cystoscope lithotomy for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session. PATIENTS AND METHODS: Between October 2014 and November 2017, RALP combined with flexible cystoscope lithotomy was performed in 16 patients with UPJO and ipsilateral renal caliceal stones. Stone location and size were preoperatively assessed. After pyelotomy with appropriate length (about 8-15 mm), a 16F flexible cystoscope through the assistant trocar or robotic trocar was introduced directly into the renal pelvis under laparoscopic vision. Holmium laser lithotripsy and pressure irrigation via a pump were used for caliceal stone removal. Subsequently, robot-assisted laparoscopic pyeloplasty was undergone in a standard fashion. RESULTS: The calculi sizes ranged from 5 to 34 mm (mean 18.6 mm) and an average of 3.4 stones per patient was removed (range 1-8 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 204.6 min and estimated blood loss was 55.6 mL. Mean hospital stay was 6.7 days (3-17). The stent was removed after 8 weeks. No major intraoperative or postoperative complications were noted during a mean follow-up of 10.4 months (range 6-27 months). CONCLUSIONS: RALP combined with flexible cystoscope lithotomy is safe and effective alternatives for the simultaneous management of UPJO complicated by renal caliceal stones.