RESUMO
The main aim of this study was to understand the relationship between the drug-resistant characteristics of Klebsiella pneumoniae and CTX-M-type extended spectrum ß-lactamases (ESBLs), and to detect the distributions of CTX-M-type ESBLs in clinically isolated strains. CTX-M ESBL genes isolated from the clinical samples were amplified by polymerase chain reaction and identified by sequence analysis; the antibiotic susceptibility of the samples was determined using the Kirby-Bauer disc-diffusion method. One hundred and five strains among the 246 isolated strains of K. pneumoniae tested positive for ESBL production (42.68%); 92 of these produced CTX-M ESBLs. Of the 92 CTX-M ESBL strains, 81 produced CTX-M-1 ESBLs and 11 produced CTX-M-25 ESBLs. Fifty-seven of the CTX-M-1 ESBL- and six of the CTX-M-25 ESBL-producing bacteria had CTX-M ESBL genes that coexisted in the plasmid and chromosome. The Kirby-Bauer antibiotic susceptibility method revealed that CTX-M ESBL-positive strains showed a higher rate of resistance to cefazolin, cefoxitin, cefuroxime, ceftazidime, cefotaxime, aztreonam, levofloxacin, and cotrimoxazole, compared to the CTX-M ESBL-negative strains (P < 0.05). The CTX-M ESBL genes were commonly observed in the K. pneumoniae isolated from respiratory tract samples; these were significantly associated with the drug-resistant characteristics of K. pneumoniae to ß-lactam antibiotics.
Assuntos
Farmacorresistência Bacteriana , Klebsiella pneumoniae/enzimologia , Mucosa Respiratória/microbiologia , beta-Lactamases/genética , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificaçãoRESUMO
We used a meta-analysis approach to investigate the association between proton pump inhibitor (PPI) use and risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. We searched Ovid Medline, Embase, and the Cochrane Library to identify eligible studies. We included studies that compared cirrhotic patients who did or did not use PPIs. The primary outcome was SBP, and the secondary outcome was overall bacterial infection. Results were pooled using random-effect models. This process led to identification of 12 journal articles and 5 conference abstracts. The pooled data showed that PPI use in patients with cirrhosis and ascites was significantly associated with an increased risk of SBP [odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.46-3.23; P < 0.05; I2 = 85.6%] and overall risk of bacterial infection (OR = 1.98; 95%CI = 1.36-2.87; P < 0.05; I2 = 0). Subgroup analysis revealed that journal articles and studies reporting adjusted effect estimates demonstrated that PPI users had a significantly increased risk of SBP (OR = 2.13; 95%CI = 1.61-2.82; P < 0.05; I2 = 29.4%; and OR = 1.98; 95%CI = 1.42-2.77; P < 0.05; I2 = 67%, respectively). In conclusion, PPI use increased the risk of SBP and overall bacterial infection in patients with cirrhosis and ascites. PPIs should be administered after careful assessment of the indications in cirrhotic patients. Future well-designed prospective studies are warranted to clarify the dose relationships and to compare infection risks associated with different classes of PPIs.
Assuntos
Infecções Bacterianas/induzido quimicamente , Infecções Bacterianas/complicações , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/complicações , Peritonite/induzido quimicamente , Peritonite/complicações , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Relação Dose-Resposta a Droga , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) were evaluated using ultrafast magnetic resonance imaging (UMRI) while asleep and awake to analyze tongue changes. The upper airway of 21 OSAHS patients and 20 normal controls were examined during sleep using UMRI. A series of midline sagittal images of the upper airway were obtained to measure dynamic changes in tongue size and the distance from the tongue to the x-axis (an extended line from the anterior nasal spine to posterior nasal spine) and the y-axis (a perpendicular line from the center of the pituitary to the x-axis). The maximum and minimum sagittal diameters of the tongue were shorter in the OSAHS group than in the control group (P<0.01) while awake, whereas the difference between the maximum and minimum vertical diameters of the tongue and the upper and central part of tongue between the posterior border and the retropharyngeal wall were greater (P<0.05). During sleep, the maximum values and differences between the maximum and minimum tongue sizes in the OSAHS group were larger than in the control group (P<0.05), whereas the minimum values were lower than in the control group (P<0.01). Tongue size significantly differs between OSAHS patients and normal controls during sleep. The tongue tends to move downward during OSAHS, which may be attributed to increased upper airway resistance.
Assuntos
Imageamento por Ressonância Magnética/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Língua/fisiopatologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Polissonografia , Radiografia , Apneia Obstrutiva do Sono/diagnóstico por imagem , Língua/diagnóstico por imagemRESUMO
Apnea and the respiratory cycle are dynamic processes in obstructive sleep apnea-hypopnea (OSAH), which occur only during sleep. Our study aimed to observe the dynamic changes in the soft palate and the uvula during wakefulness and sleep using ultrafast magnetic resonance imaging (UMRI) to provide reference data for the pathogenesis and treatment of OSAH. The dynamic changes in the soft palate and uvular tip of 15 male patients (average age: 50.43 ± 9.82 years) with OSAH were evaluated using UMRI of the upper airway while asleep and awake after 1 night of sleep deprivation. A series of midline sagittal images of the upper airway were obtained. The distance from the center of the soft palate to the x-axis (an extended line from the anterior nasal spine to the posterior nasal spine), from the uvular tip to the x-axis, from the center of the soft palate to the y-axis (a perpendicular line from the center of the pituitary to the x-axis), and from the uvular tip to the y-axis (designated as PX, UX, PY, and UY, respectively) were measured during sleep and wakefulness. The minimum PX, PY, UX, and UY were shorter during sleep than during wakefulness, whereas the maxima were longer during sleep (P < 0.01), the differences between the maximum and minimum PX, PY, UX, and UY were larger during sleep (P < 0.01). The upward, downward, forward, and backward ranges of movement of the soft palate and the uvular tip were larger during sleep in OSAH patients. This increased compliance may trigger each airway obstructive event.