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This prospective study was to assess the efficacy of nonbismuth containing quadruple therapy as first-line H. pylori treatment and to determine the clinical factors influencing patient outcome. We enrolled 200 H. pylori-infected naïve patients. They were prescribed either a 7-day nonbismuth containing quadruple therapy group (EACM, esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, metronidazole 500 mg twice daily, and clarithromycin 500 mg twice daily) or a 7-day standard triple therapy group (EAC, esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily). Follow-up studies to assess treatment responses were carried out 8 weeks later. The eradication rates attained by EACM and EAC groups were 95.6% (95% confidence interval [CI] = 89.4%–98.3%) and 79.3% (95% CI = 70%–86.4%) in the per-protocol analysis (P < 0.001) and 88% (95% CI = 80.2%–93.0%) and 73% (95% I = 63.6%–80.3%) in the intention-to-treat analysis (P = 0.007). Clarithromycin resistance, metronidazole resistance, and dual clarithromycin and metronidazole resistances were the clinical factors influencing H. pylori eradication in EACM group. Clarithromycin resistance and dual clarithromycin and metronidazole resistances were the influential factor for EAC treatment. In conclusion, the results suggest that 7-day nonbismuth containing quadruple therapy could achieve a grade “A” report card for first-line H. pylori treatment. [ABSTRACT FROM AUTHOR]

This suggests that spleen calcification might be due to SLE-related perivascular calcification and fibrosis rather than I M. kansasii i infection. (B) Abdominal computed tomography disclosed diffusely and densely distributed coarse, round, and ovoid spleen calcifications along with microlithiasis in the spleen gl She received therapy with rifampicin, ethambutol, and azithromycin. Spleen calcifications have been found in autosplenectomy, thorium dioxide exposure-related fibrosis, tuberculosis, I Pneumocystis carinii i infection, and I Histoplasma capsulatum i infection.1 Rarely, calcification can also be associated with systemic lupus erythematosus (SLE) of the spleen.1 Herein, we present a case with a history of SLE, who was subsequently infected with I Mycobacterium kansasii i and developed diffuse spleen calcifications. [Extracted from the article]

Klebsiella pneumoniae (KP) with the hypermucoviscosity (hV) phenotype has abundant capsular polysaccharides (cPs) and usually causes an invasive syndrome. sialic acid (sia), a component of cPs in KP strains with the hV phenotype, may be anti-phagocytic. sia-binding immunoglobulin-like lectin-9 (siglec-9) act as an Mhc class-I receptor on neutrophils that recognizes sia and sends a signal to dampen inflammatory response. Three clinical KP strains with KP-M1 (hV-positive, capsular serotype K1), KP-14 (hV-negative, capsular serotype non-K1/K2), and DT-X (hV-negative, capsular serotype K1) were studied. We assessed total sia in cPs extracts using enzymatic methods and phagocytosis by neutrophils of neuraminidase-treated bacteria using flow cytometry. Neutrophil killing was evaluated in the presence and absence of antibodies against siglec-9. The concentration of sia was significantly higher in the cPs extract of KP-M1 (56.75 ± 6.75 µmole/109 cfu) than in the cPs extract of KP-14 (0.02 ± 0.01 µmole/109 cfu) and DT-X (a negligible value). The KP-M1 (compared with the KP-14 and DT-X) was more resistant to neutrophil phagocytosis. Both the hV phenotype and resistance to phagocytosis of KP-M1 were significantly decreased after sia removal with neuraminidase treatment. Fluorescence microscopy with an antibody against human siglec-9 showed attachment of KP-M1 (but were absent of KP-14 and DT-X) to the surface of neutrophils and colocalization with human siglec-9. engagement of siglec-9 via sia enhanced neutrophils killing of KP-M1 by ex vivo human neutrophils bactericidal activity assay. The result showed that sia might be a constituent of KP-M1 cPs responsible for hV, thereby contributing to anti-phagocytic activity of this pathogen. [ABSTRACT FROM AUTHOR]

Quinolone has the disadvantage of easily acquired drug resistance. It is important to prescribe it wisely for a high eradication rate. The current study aimed to determine the clinical and bacteriological factors for optimal levofloxacin-containing triple therapies in second-line H. pylori eradication. We enrolled a total of 158 H. pylori-infected patients who failed H. pylori eradication using the 7-day standard triple therapy (proton-pump inhibitor [PPI] twice daily, 500 mg clarithromycin twice daily, and 1 g amoxicillin twice daily). They were prescribed with either a 10-day (group A) or 14-day (group B) levofloxacin-containing triple therapy group (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily for 10 days) by their clinicians. Follow-up studies to assess treatment responses were carried out 8 weeks later. The eradication rates attained by groups A and B were 73.6% (95% confidence interval [CI] = 63.9–85.3%) and 90.5% (95% CI = 84.5–98.1%), respectively in the per protocol analysis (P = 0.008 in the per protocol analysis) and 67.1% (95% CI = 56.6–78.5%) and 84.8% (95% CI = 76.8–93.4%), respectively, in the intention-to-treat analysis (P = 0.009). The subgroup analysis revealed that H. pylori eradication rates for group A patients with levofloxacin-susceptible strains were 92.9% (13/14) but it dropped to 12.5% (1/8) when levofloxacin-resistant strains existed. H. pylori was eradicated among all the group B patients with levofloxacin-susceptible strains, but only half of patients with levofloxacin-resistant strains were successfully eradicated. In conclusion, this study confirms the effectiveness of 14-day treatment. Importantly, the results imply that 10-day treatment duration should be optimal if a culture can be performed to confirm the existence of susceptible strains. The duration of H. pylori eradication and levofloxacin resistance were the influencing factors for successful treatment. This study suggests that tailored levofloxacin-containing therapy should be administered only for patients with susceptible strains because it can achieve >90% success rates. [ABSTRACT FROM AUTHOR]

• Amebiasis in developed countries is mostly in returning travelers or immigrants. • Transmission occurs after ingestion of contaminated food or water. • Amebiasis could cause colitis and even liver abscess. • The variables of presentations of amebiasis makes the diagnosis very challenging. • Once a correct diagnosis is made, most patients recover fully with proper treatment. [ABSTRACT FROM AUTHOR]

Purpose: All previous studies reported the benefit of antibiotic prophylaxis in cirrhotic patients with either a mixture of nonvariceal and variceal bleeding or variceal bleeding alone. Reports on sole peptic ulcers bleeding are lacking. We aimed to assess the effect of antibiotic prophylaxis in cirrhotic patients with peptic ulcer bleeding after endoscopic interventions and the risk factors associated with recurrent bleeding. Methods: A cross-sectional retrospective chart review study was conducted on 148 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures. Patients who received prophylactic intravenous ceftriaxone were classified as group A ( n = 38) and those who did not receive antibiotics were classified as group B ( n = 110). The outcomes were prevention of infection, length of hospital stay, time of rebleeding, and death. Results: More patients suffered from recurrent bleeding and infection in group B than those in group A (28.2 vs. 5.3 %; p = 0.003, and 26.4 vs. 10.5 %; p = 0.043, respectively). The risk factors associated with recurrent bleeding were being male (OR = 3.4; p = 0.024), those with advanced stage of cirrhosis with Child-Pugh's class C (OR = 3.8; p < 0.001), and those without antibiotic prophylaxis (OR = 8.9; p = 0.003). The observed 30-day survival was virtually identical for both groups ( p = 0.279). Conclusions: Antibiotic prophylaxis in cirrhotic patients after endoscopic interventions for acute peptic ulcer hemorrhage reduced infections and decreased rebleeding. Male gender, cirrhosis Child-Pugh's class C, and no antibiotic prophylaxis were independent predictors of recurrent bleeding. Further studies should be directed to explore ways to improve the overall outcome of these patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Melioidosis has emerged as a global problem; however, few studies have specifically described the clinical characteristics and outcomes when patients with melioidosis are treated at an emergency department (ED). Purpose: The objective of this study was to examine the demographics and clinical characteristics of patients with melioidosis who visited an ED. Methods: A retrospective analysis of patients treated for melioidosis at an ED. Results: Of the 25 patients identified over 7 years, 22 patients had bacteremia, whereas diabetes mellitus was the most common underlying disease (17 patients). Acute respiratory failure requiring mechanical ventilation developed in 52% of the patients. The overall mortality rate was 40%, and death within 48 hours of presentation at the ED occurred in 24% of the patients. The most common infection site was the lungs (in 52% of patients), and 36% of the patients presented with community-acquired pneumonia (CAP) at the ED. A comparison of the CAP and non-CAP groups of patients revealed that the presence of shock upon arrival (56% vs. 0; p =0.002), total mortality (78% vs. 19%; p =0.009), and early mortality (56% vs. 6%; p =0.012) were significantly more common among the individuals who comprised the CAP group. Early mortality accounted for 60% of total deaths, and all of these patients died before final microbiologic data were available. CAP presentation (p =0.012), the presence of band-form leukocytes (p =0.001), increased serum creatinine (p =0.037), and shock on arrival (p =0.005) were significantly more common among patients with early mortality. Conclusion: Melioidosis is a devastating illness with a high rate of mortality occurring within 48 hours of presentation. Melioidosis that presents with CAP is the most severe form of the disease and is associated with greatly increased early mortality. [Copyright &y& Elsevier]

Concerns over the coronavirus disease 2019 (COVID-19) pandemic and control measures have affected the routine outpatient visits of individuals with comorbidities and their mental well-being. From October 2019 to August 2020, this cross-sectional study enrolled 135 patients who sought medical attention at a medical center in Taiwan. This period covered the early (October to December 2019), peak (January to April 2020), and late (May to August 2020) periods of the COVID-19 outbreak in Taiwan. The demographic data, social support data, activities of daily living (ADL), resilience scale scores, and mental well-being scale scores of the participants were compared. There were no statistically significant differences in the participation rate, demographic data, and social support data between the three periods. The correlation analysis confirmed significant negative relationships between the number of COVID-19 cases and outpatient department visits per month (r = −0.764, p < 0.001), emergency department visits per month (r = −0.023, p < 0.001), ADL (r = −0.257, p = 0.03), resilience scale (r = −0.390, p < 0.001), and mental well-being scale (r = −0.475, p < 0.001). In conclusion, the severity of the COVID-19 outbreak in Taiwan was associated with declines in the ADL, mental well-being, and resilience of patients who sought medical attention. [ABSTRACT FROM AUTHOR]

Percutaneous vertebroplasty has been established as a safe and effective treatment for compression fractures of osteoporotic vertebrae. Complications of vertebroplasty, such as infection or anterior cement extrusion, are rare. Herein, we report an unusual presentation in an immunocompromised patient with an insidious infection of the disk. This infection resulted in dislodgment of the cement inferiorly and a compression fracture of the adjacent vertebra 6 months after vertebroplasty. We discuss the significance of this case and compare it with 7 others found in the literature. [ABSTRACT FROM AUTHOR]

We present a patient who experienced an aortic aneurysm and a left femoral artery mycotic aneurysm, which resulted from L4-infective spondylitis via the iliopsoas compartment. This rare complication could be underdiagnosed in the absence of a more extended field of imaging view such as is provided by computed tomography. [ABSTRACT FROM AUTHOR]

Objectives: To better understand the clinical outcomes of patients with extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteraemia treated with either flomoxef or a carbapenem, and to evaluate the in vitro activities of these antibiotics against ESBL-KP.Methods: Retrospective analyses to identify risk factors for mortality in patients with flomoxef-susceptible ESBL-KP, especially addressing the therapeutic roles of flomoxef and carbapenem. In vitro activities of flomoxef and carbapenem against flomoxef-susceptible ESBL-KP isolates were evaluated by susceptibility testing and time–kill study.Results: Twenty-seven patients (flomoxef group, n = 7; carbapenem group, n = 20) were included. Clinical severity reflected by high Pitt bacteraemia score (≥6) was an independent risk factor for mortality (OR 13.43; 95% CI, 1.08–166.73; P = 0.043), while use of flomoxef or a carbapenem was not. The MICs of flomoxef and carbapenem indicated that the tested ESBL-KP were susceptible to these antibiotics regardless of the inoculum size of 105 or 107 cfu/mL. Time–kill study showed that these antibiotics (flomoxef 8 mg/L and meropenem 4 mg/L) each acted actively against and inhibited the regrowth of the tested ESBL-KP for at least 24 h.Conclusions: Flomoxef might be as clinically effective as a carbapenem in treating flomoxef-susceptible ESBL-KP bacteraemia. [ABSTRACT FROM PUBLISHER]

Klebsiella pneumoniae was recently reported to be the major pathogen causing pyogenic splenic abscess in Taiwan. To better understand the characteristics of K. pneumoniae splenic abscess, which may be helpful in alerting clinicians to this infection entity when dealing with a suspicious patient, patients hospitalized between January 1981 and December 2002 with the diagnosis of splenic abscess were included in a retrospective study. Among the 38 enrolled patients, 9 (23.7%) suffered from K. pneumoniae splenic abscess. Compared to those with non-K. pneumoniae splenic abscess, patients suffering from splenic abscess caused by K. pneumoniae had a higher prevalence of underlying diabetes mellitus (88.9% vs 37.9%; p = 0.006) and higher incidence of concomitant liver abscess (44.4% vs 0%; p [ABSTRACT FROM AUTHOR]

Timely pathogen identification in bloodstream infections is crucial for patient care. A comparison is made between positive blood culture (BC) pellets from serum separator tubes using a direct identification (DI) method and colonies on agar plates from a short-term incubation (STI) method with a matrix-assisted laser desorption/ionization Biotyper for the evaluation of 354 monomicrobial BCs. Both the DI and STI methods exhibited similar identification rates for different types of bacteria, except for Gram-positive and anaerobic bacteria. The DI method's results aligned closely with the STI method's results for Enterobacterales, glucose-non-fermenting Gram-negative bacilli (GNB), and carbapenem-resistant Enterobacterales. The DI method exhibited high concordance with the conventional method for GNB identification, achieving 88.2 and 87.5% accuracy at the genus and species levels, respectively. Compared with the STI method, the DI method showed a less successful performance for Gram-positive bacterial identification (50.5 vs. 71.3%; p < 0.01). The DI method was useful for anaerobic bacterial identification of slow-growing microorganisms without any need for colony growth, unlike in the STI method (46.7 vs. 13.3%; p = 0.04). However, both methods could not identify yeast in positive BCs. Overall, the DI method provided reliable results for GNB identification, offering many advantages over the STI method by significantly reducing the turnaround time and enabling quicker pathogen identification in positive BCs. [ABSTRACT FROM AUTHOR]

A Comparison Between Dexlansoprazole Modified Release-Based And Lansoprazole-Based Nonbismuth Quadruple (Concomitant) Therapy For First-Line Helicobacter pylori Eradication: A Prospective Randomized Trial [Corrigendum]. Infection and Drug Resistance downloaded from https://www.dovepress.com/ by 140.234.252.9 on 17-Oct-2019 Copyright of Infection & Drug Resistance is the property of Dove Medical Press Ltd and its. [Extracted from the article]