Abstract:BackgroundResistance among Klebsiella pneumoniae to most antibiotics is on the rise. Tigecycline has been considered as one of the few therapeutic options available to treat multidrug-resistant bacteria. We investigated the clinical and microbiological characteristics of tigecycline non-susceptible K. pneumoniae bacteremia.MethodsAdult patients with tigecycline non-susceptible K. pneumoniae bacteremia at a medical center in Taiwan over a 3-year period were enrolled. K. pneumoniae isolates were identified by th… Show more
“…Despite the growing clinical concerns about the increasing prevalence of tigecycline-nonsusceptible K. pneumoniae isolates, the impact and clinical characteristics of patients with tigecyclinenonsusceptible K. pneumoniae infections are rarely reported in the scientific literature (8). In our previous study, we reported the high 28-day mortality among patients with tigecycline-nonsusceptible K. pneumoniae bacteremia (8).…”
Section: Discussionmentioning
confidence: 99%
“…In our previous study, we reported the high 28-day mortality among patients with tigecycline-nonsusceptible K. pneumoniae bacteremia (8). Here, we further compared tigecycline-nonsusceptible K. pneumoniae and tigecyclinesusceptible K. pneumoniae bacteremia and demonstrated the mortality attributable to tigecycline nonsusceptibility.…”
Section: Discussionmentioning
confidence: 99%
“…Tigecycline nonsusceptibility among K. pneumoniae isolates, as reported in recent studies (6)(7)(8), is between 0 and 5.7% globally (9). Recently, we reported on the high mortality rate (28-day mortality: 38.9%) in patients with tigecycline-nonsusceptible K. pneumoniae bacteremia (8). Although tigecycline-nonsusceptible K. pneumoniae bacteremia has emerged as a critical problem, studies reporting the risk factors for such infections are limited (6,10).…”
mentioning
confidence: 94%
“…Nosocomial infections were defined as K. pneumoniae-positive isolates identified in patients more than 48 h after admission to the hospital. Healthcareassociated infections were defined as patients meeting any of the following criteria: having received intravenous therapy at home or in an outpatient clinic during the previous 30 days, having received renal dialysis in a hospital or clinic during the previous 30 days, having hospitalization for 2 or more days during the previous 90 days, or having resided in a nursing home or long-term-care facility (8). Appropriate empirical antimicrobial therapy was defined as administration of at least one antimicrobial agent to which the causative pathogen was susceptible within 24 h after the onset of bacteremia, at the approved route and dosage for the affected target organ(s).…”
A rise in tigecycline resistance in Klebsiella pneumoniae has been reported recently worldwide. We sought to identify risk factors, outcomes, and mechanisms for adult patients with tigecycline-nonsusceptible K. pneumoniae bacteremia in Taiwan. We conducted a matched case-control study (ratio of 1:1) in a medical center in Taiwan from January 2011 through June 2015. The cases were patients with tigecycline-nonsusceptible K. pneumoniae bacteremia, and the controls were patients with tigecyclinesusceptible K. pneumoniae bacteremia. Logistic regression was performed to evaluate the potential risk factors for tigecyclinenonsusceptible K. pneumoniae bacteremia. Quantitative reverse transcription-PCR was performed to analyze acrA, oqxA, ramA, rarA, and kpgA expression among these isolates. A total of 43 cases were matched with 43 controls. The 14-day mortality of patients with tigecycline-nonsusceptible K. pneumoniae bacteremia was 30.2%, and the 28-day mortality was 41.9%. The attributable mortalities of tigecycline-nonsusceptible K. pneumoniae at 14 and 28 days were 9.3 and 18.6%, respectively. Fluoroquinolone use within 30 days prior to bacteremia was the only independent risk factor for tigecycline-nonsusceptible K. pneumoniae bacteremia. The tigecycline-nonsusceptible K. pneumoniae bacteremia was mostly caused by overexpression of AcrAB and/or OqxAB efflux pumps, together with the upregulation of RamA and/or RarA, respectively. One isolate demonstrated isolated overexpression of kpgA. In conclusion, tigecycline-nonsusceptible K. pneumoniae bacteremia was associated with high mortality, and prior fluoroquinolone use was the independent risk factor for the acquisition of tigecycline-nonsusceptible K. pneumoniae. The overexpression of AcrAB and/or OqxAB contributes to tigecycline nonsusceptibility in K. pneumoniae.
“…Despite the growing clinical concerns about the increasing prevalence of tigecycline-nonsusceptible K. pneumoniae isolates, the impact and clinical characteristics of patients with tigecyclinenonsusceptible K. pneumoniae infections are rarely reported in the scientific literature (8). In our previous study, we reported the high 28-day mortality among patients with tigecycline-nonsusceptible K. pneumoniae bacteremia (8).…”
Section: Discussionmentioning
confidence: 99%
“…In our previous study, we reported the high 28-day mortality among patients with tigecycline-nonsusceptible K. pneumoniae bacteremia (8). Here, we further compared tigecycline-nonsusceptible K. pneumoniae and tigecyclinesusceptible K. pneumoniae bacteremia and demonstrated the mortality attributable to tigecycline nonsusceptibility.…”
Section: Discussionmentioning
confidence: 99%
“…Tigecycline nonsusceptibility among K. pneumoniae isolates, as reported in recent studies (6)(7)(8), is between 0 and 5.7% globally (9). Recently, we reported on the high mortality rate (28-day mortality: 38.9%) in patients with tigecycline-nonsusceptible K. pneumoniae bacteremia (8). Although tigecycline-nonsusceptible K. pneumoniae bacteremia has emerged as a critical problem, studies reporting the risk factors for such infections are limited (6,10).…”
mentioning
confidence: 94%
“…Nosocomial infections were defined as K. pneumoniae-positive isolates identified in patients more than 48 h after admission to the hospital. Healthcareassociated infections were defined as patients meeting any of the following criteria: having received intravenous therapy at home or in an outpatient clinic during the previous 30 days, having received renal dialysis in a hospital or clinic during the previous 30 days, having hospitalization for 2 or more days during the previous 90 days, or having resided in a nursing home or long-term-care facility (8). Appropriate empirical antimicrobial therapy was defined as administration of at least one antimicrobial agent to which the causative pathogen was susceptible within 24 h after the onset of bacteremia, at the approved route and dosage for the affected target organ(s).…”
A rise in tigecycline resistance in Klebsiella pneumoniae has been reported recently worldwide. We sought to identify risk factors, outcomes, and mechanisms for adult patients with tigecycline-nonsusceptible K. pneumoniae bacteremia in Taiwan. We conducted a matched case-control study (ratio of 1:1) in a medical center in Taiwan from January 2011 through June 2015. The cases were patients with tigecycline-nonsusceptible K. pneumoniae bacteremia, and the controls were patients with tigecyclinesusceptible K. pneumoniae bacteremia. Logistic regression was performed to evaluate the potential risk factors for tigecyclinenonsusceptible K. pneumoniae bacteremia. Quantitative reverse transcription-PCR was performed to analyze acrA, oqxA, ramA, rarA, and kpgA expression among these isolates. A total of 43 cases were matched with 43 controls. The 14-day mortality of patients with tigecycline-nonsusceptible K. pneumoniae bacteremia was 30.2%, and the 28-day mortality was 41.9%. The attributable mortalities of tigecycline-nonsusceptible K. pneumoniae at 14 and 28 days were 9.3 and 18.6%, respectively. Fluoroquinolone use within 30 days prior to bacteremia was the only independent risk factor for tigecycline-nonsusceptible K. pneumoniae bacteremia. The tigecycline-nonsusceptible K. pneumoniae bacteremia was mostly caused by overexpression of AcrAB and/or OqxAB efflux pumps, together with the upregulation of RamA and/or RarA, respectively. One isolate demonstrated isolated overexpression of kpgA. In conclusion, tigecycline-nonsusceptible K. pneumoniae bacteremia was associated with high mortality, and prior fluoroquinolone use was the independent risk factor for the acquisition of tigecycline-nonsusceptible K. pneumoniae. The overexpression of AcrAB and/or OqxAB contributes to tigecycline nonsusceptibility in K. pneumoniae.
“…It is assumed that similar conditions prompt spherule development in vivo , but there is also evidence that contact with neutrophils can stimulate arthroconidia to spherule conversion [39]. In chronic coccidioidal lung cavities, where there are no neutrophils, one can sometimes see reversion to hyphal forms that contain swellings that appear to be abortive attempts to make spherules [40]. 10.1080/21505594.2018.1509667-F0002Figure 2.Mycelia containing arthroconidia and a mature spherule with endospores.…”
Coccidioides immitis and C. posadasii are two highly pathogenic dimorphic fungal species that are endemic in the arid areas of the new world, including the region from west Texas to southern and central California in the USA that cause coccidioidomycosis (also known as Valley Fever). In highly endemic regions such as southern Arizona, up to 50% of long term residents have been infected. New information about fungal population genetics, ecology, epidemiology, and host-pathogen interactions is becoming available. However, our understanding of some aspects of coccidioidomycosis is still incomplete, including the extent of genetic variability of the fungus, the genes involved in virulence, and how the changes in gene expression during the organism’s dimorphic life cycle are related to the transformation from a free-living mold to a parasitic spherule. Unfortunately, efforts to develop an effective subunit vaccine have not yet been productive, although two potential live fungus vaccines have been developed.
Tuberculosis (TB) and Human Immunodeficiency virus (HIV) coinfection continues to be a very serious health concern globally. Even though TB is treatable, it remains among the leading cause of death especially among HIV‐infected individuals. Although the emergence of antiretroviral therapy (ART) has positively impacted the treatment of HIV, it is a major risk factor for developing active TB disease. The treatment of HIV and TB coinfection is associated with many challenges, one of which is the requirement of treatment with multiple medications for an extended period which is faced by all infected individuals across every age group, however, some of the challenges are peculiar to a specific age range. This review provides a comprehensive analysis of HIV and TB co‐infection among persons within different age brackets and the characteristics of both diseases, their current treatment guidelines, the challenges they pose, and their impact on global health are examined and reported herein.
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