1
|
Feng J, Zhang C, Chen H, Chen Z, Chen Y, He D, Pan Q, Zhou Y, Chen Z, Zhuang X. Shen-Ling-Bai-Zhu-San Enhances the Antipneumonia Effect of Cefixime in Children by Ameliorating Gut Microflora, Inflammation, and Immune Response. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:7752426. [PMID: 36118084 PMCID: PMC9473888 DOI: 10.1155/2022/7752426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Abstract
Objective Shen-Ling-Bai-Zhu-San (SLBZS) is used for treating gastrointestinal disorders. However, the role of SLBZS in treating pneumonia in children is still unclear. Methods In this study, children (≥2 and <9 years) with pneumonia were treated with 0.1 g cefixime (cefixime group) or 0.1 g cefixime + 9 g SLBZS (SLBZS + cefixime). The drugs were administered twice daily for 10 days. The therapeutic effects of the two groups were compared. The white blood cell (WBC), neutrophil, and lymphocyte counts; neutrophil-lymphocyte ratio (NLR); serum inflammatory factor levels; and gut microflora were assessed. Results The clinical efficacy of SLBZS + cefixime treatment of pneumonia in children was higher than that of cefixime alone (93.3% vs. 86.7%). Both cefixime and SLBZS + cefixime treatments decreased the area of pulmonary inflammatory lesions, reduced white blood cell and neutrophil counts, neutrophil-lymphocyte ratio, inflammation, and increased lymphocyte count in children with pneumonia compared with those before treatment. Moreover, SLBZS enhanced the anti-inflammation and immunity-enhancing effects of cefixime in children with pneumonia. SLBZS + cefixime treatment decreased Enterobacter, Enterococcus, Bacteroides, and Fusobacterium counts and increased Bifidobacterium and Lactobacillus counts. Compared with the cefixime treatment group, the count of the six bacterial strains in the SLBZS + cefixime treatment group was closer to the normal level. Conclusion SLBZS enhanced the antipneumonia effect of cefixime in children with pneumonia by ameliorating gut microflora, inflammation, and immune response.
Collapse
Affiliation(s)
- Jinli Feng
- Emergency Department, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Cheng Zhang
- Clinical Laboratory, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Houjun Chen
- Emergency Department, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Ziliang Chen
- Emergency Department, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Yongfeng Chen
- Emergency Department, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Degen He
- Pediatrics, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Qianyi Pan
- Prevention and Health Section, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Yongmao Zhou
- Pediatrics, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Zhaoyang Chen
- Pediatrics, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| | - Xiaozheng Zhuang
- Pediatrics, Zhongshan Hospital, Guangzhou University of Chinese Medicine, Zhongshan, Guangdong 528401, China
| |
Collapse
|
2
|
Stewart AG, Paterson DL, Young B, Lye DC, Davis JS, Schneider K, Yilmaz M, Dinleyici R, Runnegar N, Henderson A, Archuleta S, Kalimuddin S, Forde BM, Chatfield MD, Bauer MJ, Lipman J, Harris-Brown T, Harris PNA. Meropenem Versus Piperacillin-Tazobactam for Definitive Treatment of Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacter spp, Citrobacter freundii, Morganella morganii, Providencia spp, or Serratia marcescens: A Pilot Multicenter Randomized Controlled Trial (MERINO-2). Open Forum Infect Dis 2021; 8:ofab387. [PMID: 34395716 PMCID: PMC8361238 DOI: 10.1093/ofid/ofab387] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Carbapenems are recommended treatment for serious infections caused by AmpC-producing gram-negative bacteria but can select for carbapenem resistance. Piperacillin-tazobactam may be a suitable alternative. Methods We enrolled adult patients with bloodstream infection due to chromosomal AmpC producers in a multicenter randomized controlled trial. Patients were assigned 1:1 to receive piperacillin-tazobactam 4.5 g every 6 hours or meropenem 1 g every 8 hours. The primary efficacy outcome was a composite of death, clinical failure, microbiological failure, and microbiological relapse at 30 days. Results Seventy-two patients underwent randomization and were included in the primary analysis population. Eleven of 38 patients (29%) randomized to piperacillin-tazobactam met the primary outcome compared with 7 of 34 patients (21%) in the meropenem group (risk difference, 8% [95% confidence interval {CI}, –12% to 28%]). Effects were consistent in an analysis of the per-protocol population. Within the subcomponents of the primary outcome, 5 of 38 (13%) experienced microbiological failure in the piperacillin-tazobactam group compared to 0 of 34 patients (0%) in the meropenem group (risk difference, 13% [95% CI, 2% to 24%]). In contrast, 0% vs 9% of microbiological relapses were seen in the piperacillin-tazobactam and meropenem arms, respectively. Susceptibility to piperacillin-tazobactam and meropenem using broth microdilution was found in 96.5% and 100% of isolates, respectively. The most common AmpC β-lactamase genes identified were blaCMY-2, blaDHA-17, blaCMH-3, and blaACT-17. No ESBL, OXA, or other carbapenemase genes were identified. Conclusions Among patients with bloodstream infection due to AmpC producers, piperacillin-tazobactam may lead to more microbiological failures, although fewer microbiological relapses were seen. Clinical Trials Registration NCT02437045.
Collapse
Affiliation(s)
- Adam G Stewart
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Barnaby Young
- National Centre for Infectious Disease, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Disease, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joshua S Davis
- Infectious Disease Department, John Hunter Hospital, Newcastle, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Kellie Schneider
- Infectious Disease Department, John Hunter Hospital, Newcastle, Australia
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol, Turkey
| | - Rumeysa Dinleyici
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol, Turkey
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Andrew Henderson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Sophia Archuleta
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore
| | - Brian M Forde
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia.,Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Australia
| | - Mark D Chatfield
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Michelle J Bauer
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Jeffrey Lipman
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Scientific Consultant, Nimes University Hospital, University of Montpellier, Nimes, France
| | | | - Patrick N A Harris
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | |
Collapse
|
3
|
Zou H, Jia X, He X, Su Y, Zhou L, Shen Y, Sheng C, Liao A, Li C, Li Q. Emerging Threat of Multidrug Resistant Pathogens From Neonatal Sepsis. Front Cell Infect Microbiol 2021; 11:694093. [PMID: 34322398 PMCID: PMC8312093 DOI: 10.3389/fcimb.2021.694093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Multidrug-resistant (MDR) pathogens are responsible for a substantial burden of morbidity and mortality from neonatal sepsis; however, data on these sepsis-related pathogens among hospitalized neonates in China are not well characterized. In this study, a total of 240 strains were isolated from four Women and Children's hospitals in Southwest China between 2014 and 2019. Of these included pathogens, 104 (43.33%) were gram-positive bacteria, 129 (53.75%) were gram-negative bacteria, and 7 (2.92%) were fungi. Escherichia coli (E. coli, 34.01%) and Klebsiella pneumoniae (K. pneumoniae, 15.35%) were the main pathogen of neonate bacteremia. ST167 were the most prevalent STs in E. coli and ST11 in K. pneumoniae. Our study found that E. coli (62.71%) was the predominate pathogen of early-onset sepsis, among which 64.86% were MDR. Late-onset sepsis was mainly caused by K. pneumoniae (28.31%) and E. coli (24.78%), with showing that 78.33% of these pathogens were MDR. Notably, the prevalence of EO/LO pathogens were quite different from Indian and south of China. Moreover, we found that bla CTX-M (42.06%) was most dominant resistant genes with about a third isolates (31.09%) were positive for bla CTX-M-15. All the carbapenem-resistant K. pneumoniae were positive for NDM-1. Moreover, late-onset sepsis and antibiotic exposure were significantly associated with MDR infection. Emerging multi-resistant pathogens of sepsis posts a serious threat to neonatal outcomes and emphasizes an urgent need to control their further spread.
Collapse
Affiliation(s)
- Hua Zou
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaojiong Jia
- Department of Laboratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao He
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Su
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ligang Zhou
- Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Shen
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Chenglin Sheng
- Department of Laboratory Medicine, Wan Zhou Health Center for Women and Children, Chongqing, China
| | - Ang Liao
- Department of Laboratory Medicine, Yong Chuan Health Center for Women and Children, Chongqing, China
| | - Chunli Li
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Qiuhong Li
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| |
Collapse
|
4
|
Drozdinsky G, Neuberger A, Rakedzon S, Nelgas O, Cohen Y, Rudich N, Mushinsky L, Ben-Zvi H, Paul M, Yahav D. Treatment of Bacteremia Caused by Enterobacter spp.: Should the Potential for AmpC Induction Dictate Therapy? A Retrospective Study. Microb Drug Resist 2020; 27:410-414. [PMID: 32808858 DOI: 10.1089/mdr.2020.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Carbapenems are considered treatment of choice for bacteremia caused by potential AmpC-producing bacteria, including Enterobacter spp. We aimed to compare mortality following carbapenem vs. alternative antibiotics for the treatment of Enterobacter spp. bacteremia. Patients and Methods: We conducted a retrospective study in two centers in Israel. We included hospitalized patients with Enterobacter bacteremia treated with third-generation cephalosporins (3GC), piperacillin/tazobactam, quinolones, or carbapenem monotherapy as the main antibiotic in the first week of treatment, between 2010 and 2017. Cefepime was excluded due to nonavailability during study years. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses were conducted, introducing the main antibiotic as an independent variable. Results: Two hundred seventy-seven consecutive patients were included in the analyses. Of these, 73 were treated with 3GC, 39 with piperacillin/tazobactam, 104 with quinolones, and 61 with carbapenems. All-cause 30-day mortality was 16% (45 patients). The type of antibiotics was not significantly associated with mortality on univariate or multivariate analyses. With carbapenems as reference, adjusted odds ratios (ORs) for mortality were 0.708, 95% confidence interval (CI) 0.231-2.176 with 3GC; OR 1.172, 95% CI 0.388-3.537 with piperacillin/tazobactam; and OR 0.586, 95% CI 0.229-1.4 with quinolones. The main antibiotic was not associated with repeated growth of Entrobacter spp. in blood cultures or other clinical specimens. Resistance development was observed with 3GC and piperacillin/tazobactam. Conclusions: Carbapenem treatment was not advantageous to alternative antibiotics, including 3GC, among patients with Enterobacter spp. bacteremia in an observational study.
Collapse
Affiliation(s)
- Genady Drozdinsky
- Medicine E, Rabin Medical Center, Beilinson Hospital, Peta-Tikva, Israel
| | - Ami Neuberger
- Infectious Disease Division, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Stav Rakedzon
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ortal Nelgas
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yonat Cohen
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nurith Rudich
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Liza Mushinsky
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Haim Ben-Zvi
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Mical Paul
- Infectious Disease Division, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Beilinson Hospital, Peta-Tikva, Israel
| |
Collapse
|