Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: A matched case–control study

BackgroundInfections due to carbapenem-resistant Enterobacteriaceae have been the emerging problem worldwide. This primary object of this study was to understand the risk factors and clinical outcomes of carbapenem-nonsusceptible Escherichia coli (CNSEc) bacteremia.MethodsWe conducted a matched case–control study in a 3,715-bed tertiary care medical center in northern Taiwan. The controls were selected among patients with carbapenem-susceptible E coli and were matched with CNSEc for bacteremia.ResultsFifty-one patients were included in this study (17 cases and 34 controls). Bivariate analysis showed that prior exposure to carbapenems (p<0.001), stay in intensive care units (p=0.016), placement of central venous catheters (p=0.001), chronic liver diseases (p<0.001), uremia with regular dialysis (p=0.004), and mechanical ventilation (p=0.004) were associated with CNSEc bacteremia. Multivariate analysis revealed that prior exposure to carbapenems [odds ratio (OR), 29.17; 95% confidence interval (CI), 1.76–484.70; p=0.019], uremia with regular dialysis (OR, 98.58; 95% CI, 4.02–999; p=0.005) and chronic liver diseases (OR, 27.86; 95% CI, 2.31–335.83; p=0.009) were independent risk factors for CNSEc bacteremia. Compared with carbapenem-susceptible E coli group, CNSEc group had a longer hospital stay (68.4 days vs. 35.8 days; p=0.04) and a higher disease severity, as indicated by a Pittsburgh bacteremia score greater than or equal to 4 (5.6% vs. 2.5%; p=0.015). Patients with CNSEc bacteremia had a higher overall in-hospital mortality rate (94.12% vs. 50.00%; p=0.002), but there was no difference in the 28-day mortality between these two groups.ConclusionsCNSEc bacteremia would lead to a poor outcome among patients with prior exposure to carbapenems, chronic liver disease, and uremia with regular dialysis

Relationship of teicoplanin MICs to treatment failure in teicoplanin-treated patients with methicillin-resistant Staphylococcus aureus pneumonia

Background/PurposeThe objective of this study was to determine the predictive value of teicoplanin minimal inhibitory concentrations (MICs) for treatment failure among patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.MethodsIn this study, all patients with ≥1 tracheal aspirates or sputum cultures positive for MRSA admitted to the hospital between April 2011 and September 2011 were reviewed. We enrolled patients who are ≥18 years of age, with a diagnosis of pneumonia, and with a receipt of teicoplanin therapy throughout the course. The relationship between teicoplanin Etest MICs and treatment outcomes of MRSA pneumonia was analyzed to identify the breakpoint of teicoplanin MICs influencing treatment outcomes.ResultsOf the 80 patients enrolled, 31 had a lower teicoplanin MIC level (<2.0 mg/L) and 49 had a higher MIC level (≥2.0 mg/L) for MRSA. The lower MIC group had a higher clinical resolution rate in 14 days [24 (77.4%) vs. 23 (46.9%), p = 0.007] and a lower treatment failure rate at the end of teicoplanin treatment [4 (12.9%) vs. 18 (36.7%), p = 0.020]. A comparison between the treatment success and failure groups showed that the former had a longer duration of teicoplanin use (18.76 ± 10.34vs.12.41 ± 5.65 days; p = 0.014). Results of a multivariate analysis showed that teicoplanin MICs ≥ 2.0 mg/Land shorter duration of teicoplanin therapy were independent risk factors for treatment failure.ConclusionA higher teicoplanin MIC value (≥2.0 mg/L) may predict the treatment failure among patients with teicoplanin-treated MRSA pneumonia

Outcomes and characteristics of ertapenem-nonsusceptible Klebsiella pneumoniae bacteremia at a university hospital in Northern Taiwan: A matched case-control study

Background and purposeCarbapenem-resistant Klebsiella pneumoniae is an emerging problem worldwide. The object of this study was to investigate the risk factors, characteristics and outcomes of ertapenem-nonsusceptible K pneumoniae (ENSKp) bacteremia.MethodsWe conducted a 1:2 ratio matched case-control study. The controls were randomly selected among patients with ertapenem-susceptible K pneumoniae (ESKp) bacteremia and were matched with ENSKp cases for bacteremia.ResultsSeventy-five patients were included in this study (25 cases and 50 controls). Bivariate analysis showed that prior exposure to either β-Lactam/β-Lactam-lactamase inhibitors (p = 0.008) or 4th generation cephalosporins (p < 0.001), chronic obstructive pulmonary disease (COPD) (p = 0.001), acute renal failure (p = 0.021), chronic kidney disease without dialysis (p = 0.021), recent hospital stay (p = 0.016), intensive care unit stay (p = 0.002), mechanical ventilation (p = 0.003), central venous catheter placement (p = 0.016), Foley indwelling (p = 0.022), polymicrobial bacteremia (p = 0.003) and higher Pittsburgh bacteremia score (p < 0.001) were associated with ENSKp bacteremia. The multivariate analysis showed that prior exposure to 4th generation cephalosporins (odds ratio [OR], 28.05; 95% confidence interval [CI], 2.92–269.85; p = 0.004), COPD (OR, 21.38; 95% CI, 2.95–154.92; p = 0.002) and higher Pittsburgh bacteremia score (OR, 1.35; 95% CI, 1.10–1.66; p = 0.004) were independent factors for ENSKp bacteremia. ENSKp bacteremia had a higher 14-day mortality rate than ESKp bacteremia (44.0% vs. 22.0%; p = 0.049). The overall in-hospital mortality rates for these two groups were 60.0% and 40.0% respectively (p = 0.102).ConclusionENSKp bacteremia had a poor outcome and the risk factors were prior exposure of 4th generation cephalosporins, COPD and higher Pittsburgh bacteremia score. Antibiotic stewardship may be the solution for the preventive strategy

Recent Advances in Tungsten-Oxide-Based Materials and Their Applications

Among several active photothermal nanomaterials, tungsten-oxide-based materials have received considerable attention recently because of their ability to absorb near-infrared (NIR) light and their efficient light-to-heat conversion properties. In addition, tungsten-oxide-based materials have an unusual oxygen defect structure and strong local surface plasma resonance (LSPR), which offers strong photoabsorption in a broad wavelength range of the NIR region. In the past, several light-absorbing nanomaterials such as noble metals, polymeric materials, and other inorganic nanomaterials were of interest for their use in photothermal therapy for cancer treatment. In this study, we review the synthesis, properties, and applications of tungsten-oxide-based nanomaterials as a new type of photothermal material. The basic ideas behind photothermal nanomaterial development as well as the factors that influence their structural designs are also discussed in this study. In addition, recent progress in various fields such as NIR light-shielding, pyroelectric, water evaporation, photocatalysis, gas sensors, and energy-related applications for WO3−x- and MxWO3-based nanomaterials (including their hybrids) are highlighted. Finally, this review presents promising insights into this rapidly growing field that may inspire additional research leading to practical applications

Menelloides C and D, New Sesquiterpenoids from the Gorgonian Coral Menella sp

Two new metabolites, including a lindenane-type sesquiterpenoid, menelloide C (1), and a germacrane-type sesquiterpenoid, menelloide D (2), were isolated from a Formosan gorgonian coral identified as Menella sp. The structures of 1 and 2 were established by spectroscopic methods and 2 displayed a weak inhibitory effect on the release of elastase by human neutrophils

Nardosinane-Type Sesquiterpenoids from the Formosan Soft Coral Paralemnalia thyrsoides

Five new nardosinane-type sesquiterpenoids, paralemnolins Q–U (1–5), along with three known compounds (6–8), were isolated from the Formosan soft coral Paralemnalia thyrsoides. The structures of new metabolites were elucidated on the basis of extensive spectroscopic methods, and the absolute configuration of 1 was determined by the application of Mosher’s method on 1. Among these metabolites, 1 and 3 are rarely found nardosinane-type sesquiterpenoids, possessing novel polycyclic structures. Compounds 1, 3, 6 and 7 were found to possess neuroprotective activity

Terpenoids from the Octocorals Menella sp. (Plexauridae) and Lobophytum crassum (Alcyonacea)

A new germacrane-type sesquiterpenoid, menelloide E (1), and a new cembrane-type diterpenoid, lobocrassin F (2), were isolated from the octocorals Menella sp. and Lobophytum crassum, respectively. The structures of terpenoids 1 and 2 were determined by spectroscopic and chemical methods and compound 2 was found to display a significant inhibitory effect on the release of elastase by human neutrophils

Refractive Index and Dispersion Measurement Principle with Polarization Change in Total Internal Reflection

Refractive index measurements have been an important task for a long time because that index plays an essential role in describing the optical properties of a material. Many methods have been developed to perform that task. Some of them use interferometry to achieve high precision. However, these configurations are complicated. Some measure the critical angle using simple structures, but their accuracy is unsatisfactory because it is difficult to judge the exact critical angle with intensity variations. Here, we propose several new schemes based on measuring the polarization change in the total internal reflection. The proposed method has the merits of simple structure and easy incident angle determination that gives the maximum phase change. Additionally, it is possible to find the material dispersion by measuring the wavelength dependence of the polarization ellipticity. Some useful formulas relating the refractive index to the maximum phase change are obtained. This work can provide valuable alternatives for refractive index measurement