Abstract Objectives : To investigate the possibility of identifying DNA hypermethylation in the circulation of prostate cancer patients. Methods : Plasma DNA samples were extracted from 36 prostate ...cancer patients and 27 benign prostate hyperplasia (BPH) cases. After extensive methylation-sensitive restriction enzyme digestion, the DNA samples were subjected to the real-time quantitative PCR amplification. Dissociation curve analysis was applied to determine if hypermethylation occurred in the promoter region flanking the GSTP1 gene, a well-documented epigenetic event among prostate cancer cells, in these plasma DNA samples. Results : 11 of 36 prostate cancer patients showed positive peak pattern, indicating methylation changes occurred. Concordant data were obtained from the corresponding paraffin-embedded tissue samples available from the Tumor Bank. Twenty-five of the 27 BPH cases showed negative results, suggesting no methylation changes happened in the CpG islands in these cases. Conclusions : We have successfully identified prostate cancer genome hypermethylation in the peripheral circulation in prostate cancer patients with this protocol. This method can effectively distinguish BPH from prostate neoplasm. Although a larger number of samples are necessary to validate the capability of the protocol in practice, using plasma DNA sample is an ideal non-invasive approach for prostate neoplasm detection.
Objectives: The aim of the study was to characterize the genetic basis of β-lactam resistance developed in clinical isolates of Klebsiella pneumoniae after exposure to cefuroxime. Methods: Clinical ...features of two episodes of liver abscess caused by K. pneumoniae in a diabetic patient were reported. Four isolates (KP1/KP2 and KP3/KP4) of K. pneumoniae were recovered from cultures of blood/pus in the first and second episodes, respectively. Laboratory investigation of the K. pneumoniae isolates included genotyping by PFGE, resistance gene analysis by PCR amplification and DNA sequencing, and outer membrane protein analysis by SDS–PAGE. Results: KP3 and KP4 were recovered after a 21 day cefuroxime therapy and demonstrated identical genotypes to that of KP1 and KP2. However, compared with KP1 and KP2, emerging resistance to piperacillin, cefalotin, cefuroxime and cefoxitin was observed. The other antibiotics tested, except ampicillin, retained the same effectiveness against the four isolates, although increases (4- to 8-fold) in the MICs of cefotaxime, ceftriaxone, ceftazidime, cefepime, flomoxef and aztreonam were observed in KP3 and KP4. None of the isolates produced extended-spectrum β-lactamases or plasmid-mediated AmpC β-lactamases. Deficiency in the expression of an outer membrane protein (OmpK35) was observed in the cefuroxime-resistant isolates, KP3 and KP4. Conclusions: The increased resistance to cephalosporins in these clinical isolates of K. pneumoniae after exposure to cefuroxime might be related to the loss of OmpK35.
In Taiwan, beginning in 2013, the 13-valent pneumococcal conjugate vaccine (PCV13) was provided free of charge to children 2-5 years of age. In 2014, this was extended to children 1-5 years old. ...During 2012-2014, 953 cases of culture-confirmed pneumococcal disease (CCPD), including 104 invasive pneumococcal disease (IPD), were prospectively identified and analyzed at a 3,700-bed hospital in Taiwan. From 2012 to 2014, the incidence per 10,000 admissions decreased from 26.7 to 20.4 for CCPD (P < 0.001) and from 3.2 to 1.9 for IPD (P < 0.05). Significant reduction of PCV13 serotypes was firstly noted in children in 2013 and extended to both paediatric and adult populations in 2014. Simultaneously, the incidence per 10,000 admissions of non-PCV13 serotypes increased from 6.1 in 2012 to 9.3 in 2014 (P < 0.005). The most prevalent non-PCV13 serotypes were 15A, 15B, and 23A, each containing a predominant clone, ST63(15A), ST83(15B), and ST338(23A). From 2012 to 2014, isolates with penicillin minimum inhibitory concentrations >2 mg/L decreased from 27.8% to 8.1% (P < 0.001) among all isolates. PCV13 immunization in young children demonstrated an early protective effect in all ages. However, in the elderly, the effect was compromised by an emergence of non-PCV13 serotypes.
Tularemia is a zoonotic infection seen primarily in the Northern Hemisphere. It is caused by the bacteria Francisella tularensis. Although the ulceroglandular form of the disease is the more common ...manifestation of infection, F tularensis is known to cause pneumonia. F tularensis has two predominant subspecies, namely subsp. tularensis (type A) and subsp. holarctica (type B). Type B tularemia is considered to be much less virulent than type A and barely caused lethal disease and pneumonia.We reported a case with a 68-year-old man immune-compromised patient diagnosed with bacteremic pneumonia engendered by type B tularemia with initial presentation of high fever, pneumonia with pleural effusion; the diagnosis was performed using 16S rRNA gene sequence analysis. The patient's fever, pneumonia, and pleural effusion were resolved with appropriate antibiotics for tularemia. This case involving severe bacteremic pneumonia in an immune-compromised patient is rare.This case suggests that low virulence F tularensis should be included in the differential diagnoses of bacteremic pneumonia for endemic tularemia.
Objectives
Higher vancomycin MIC values (≥1.5 mg/L via Etest) may be associated with vancomycin treatment failure among patients with serious methicillin-resistant Staphylococcus aureus (MRSA) ...infections. As there were limited similar data for teicoplanin, this retrospective cohort study intended to determine the predictive value of teicoplanin MICs for treatment failure among patients with MRSA bacteraemia.
Patients and methods
All patients with at least one blood culture positive for MRSA admitted to the hospital between January 2010 and January 2011 were reviewed. Patients with an age ≥18 years and receipt of teicoplanin therapy throughout the course or receipt of <72 h of vancomycin therapy and then teicoplanin for >3 days were enrolled. Teicoplanin Etest® MICs and treatment outcomes for MRSA bacteraemia were reviewed to identify the breakpoint of teicoplanin MICs influencing treatment outcomes.
Results
Of the 101 patients enrolled, 56 had a lower teicoplanin MIC (≤1.5 mg/L) for MRSA and 45 had a higher MIC (>1.5 mg/L) for MRSA. A lower teicoplanin MIC was associated with a favourable outcome 37 (66.1%) versus 13 (28.9%); P < 0.001 and a lower rate of bloodstream infection-related mortality 15 (26.8%) versus 22 (48.9%); P = 0.022. Patients with chronic obstructive pulmonary disease, bacteraemic pneumonia or higher Pittsburgh bacteraemia score had an unfavourable outcome (P = 0.028, 0.022 and <0.001, respectively). Multivariate analysis showed that teicoplanin MIC >1.5 mg/L, higher Pittsburgh bacteraemia score and bacteraemic pneumonia were independent risk factors for unfavourable outcome.
Conclusions
A higher teicoplanin MIC value (>1.5 mg/L) may predict an unfavourable outcome and higher mortality rate among teicoplanin-treated MRSA bacteraemic patients.
Abstract Thirsty-six binary toxin producers were detected with 2 genotypes ( cdtA+ and cdtB+ ) among 265 Clostridium difficile isolates by multiplex PCR. The rate of accurate differentiation between ...these 2 genotypes was 100% by 6-peak cluster analysis of spectra generated by Bruker Biotyper matrix-assisted laser desorption ionization/time-of-flight mass spectrometry.
Salmonella enterica
serotype choleraesuis is a cause of serious systemic infections. Data from a surveillance system in Taiwan document the rapid emergence of fluoroquinolone resistance in this ...serotype. The rate of resistance has reached 60 percent. Molecular typing indicates that the source of the resistant isolates is likely to be herds of swine raised for food.
Salmonellosis is an important public health problem throughout the world.
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Although most salmonella infections are self-limiting, serious sequelae, including systemic infection and death, can occur.
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Among more than 2000 salmonella serotypes,
Salmonella enterica
serotype choleraesuis has a high predilection for causing systemic infection in humans.
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S. enterica
serotype choleraesuis usually causes bacteremia and metastatic focal infections that require parenteral antimicrobial therapy.
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Appropriate drugs include ampicillin, trimethoprim–sulfamethoxazole, and chloramphenicol; however, resistance to these agents is increasing in many areas of the world.
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Fluoroquinolones and the third-generation cephalosporins are recommended for use in areas where there are resistant organisms. . . .
Abstract Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have been increasing in recent years, posing a threat to public health worldwide. The susceptibility to ...eight antimicrobial agents of 35 clinical A. baumannii isolates from Taiwan was tested. Isolates were examined by polymerase chain reaction (PCR) and sequencing for β-lactamase genes and mutations in the gyrA and parC genes. Expression of AdeB, an efflux pump protein, was evaluated by real-time quantitative PCR. The level of adeB expression correlated with resistance to ciprofloxacin and ampicillin/sulbactam in A. baumannii isolates. Almost all isolates with full resistance to ciprofloxacin had both high adeB expression and point mutations in parC and gyrA , but 4 intermediate-resistant isolates had only high adeB expression without point mutations in gyrA or parC , in contrast to 18 susceptible isolates with low adeB expression and without mutations in gyrA or parC . Sixteen isolates (45.7%) carrying a type 1 integron were MDR as well as being more resistant to imipenem, amikacin, gentamicin, ceftazidime or cefepime than those without the integron. The class 1 integron in A. baumannii carried different resistance gene cassettes, including 5′CS- blaIMP-1 – aadA4 –3′CS, 5′CS– aacA4 – aadA1 –3′CS and 5′CS– aacC1 – aadA1 –3′CS. In conclusion, expression of the adeB gene was associated with resistance to ciprofloxacin and ampicillin/sulbactam in A. baumannii . Multiple mutations in gyrA and parC also played a role in ciprofloxacin resistance. The major metallo-β-lactamase contributing to imipenem resistance in A. baumannii in Taiwan was blaIMP-1 , which was carried by the class 1 integron. The class 1 integron was associated with the MDR phenotype in A. baumannii.
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