Changes in the patterns and microbiology of spontaneous bacterial peritonitis : analysis of 200 cirrhotic patients

BACKGROUND AND AIMS

The microbiological characteristics of spontaneous bacterial peritonitis (SBP) are changing worldwide with a shift in patterns of SBP and increasing prevalence of antibiotic-resistant bacteria. We, therefore, conducted this retrospective study aiming to characterise the current patterns and microbiology of SBP in our region.

METHODS

We performed a retrospective chart review of patients presenting with their first episodes of SBP. The demographical, clinical and laboratory parameters of all patients at first paracentesis were recorded.

RESULTS

The study included 200 cirrhotic patients with SBP. Mean age was 60.4±13.5 years and 116 (58%) patients were males. Liver cirrhosis was predominantly viral in 138 (69%) patients. Ascitic fluid cultures were positive in 103 (51.5%) patients and negative in 97 (48.5%). Ninety-eight (95.1%) patients had monomicrobial bacterial growth. The most common variants of spontaneous ascitic fluid infection were culture negative neutrocytic ascites (CNNA) in 97(48.5%) patients and SBP in 65 (32.5%) patients. E.Coli was most frequently isolated microorganism in 41 (39.8%) patients followed by staphylococcus species in 19 (18.4%) patients, Klebsiella pneumonae in 14(13.6%) patients and streptococcus species in 13 (10.7%) patients. The prevalence of extended spectrum beta-lactamases (ESBL) resistant E.Coli was 29.3%. Antibiotic resistance rate for meropenem, piperacillin\ tazobactam, ceftriaxone and ciprofloxacin was 0%, 22.0%, 29.0%, and 28.6% respectively.

CONCLUSIONS

Changes in the patterns and microbiology of SBP are evident in our region with increasing prevalence of culture negative SBP, extended spectrum beta-lactamases resistant E.Coli, and increased resistance rate to first line antibiotics. Our data argue for relying on periodic hospital based antibiotic susceptibility data whenever SBP is treated.

Evaluation of hydrophobic chitosan-based particulate formulations of porcine reproductive and respiratory syndrome virus vaccine candidate T cell antigens

PRRS control is hampered by the inadequacies of existing vaccines to combat the extreme diversity of circulating viruses. Since immune clearance of PRRSV infection may not be dependent on the development of neutralising antibodies and the identification of broadly-neutralising antibody epitopes have proven elusive, we hypothesised that conserved T cell antigens represent potential candidates for development of a novel PRRS vaccine. Previously we had identified the M and NSP5 proteins as well-conserved targets of polyfunctional CD8 and CD4 T cells. To assess their vaccine potential, peptides representing M and NSP5 were encapsulated in hydrophobically-modified chitosan particles adjuvanted by incorporation of a synthetic multi-TLR2/TLR7 agonist and coated with a model B cell PRRSV antigen. For comparison, empty particles and adjuvanted particles encapsulating inactivated PRRSV-1 were prepared. Vaccination with the particulate formulations induced antigen-specific antibody responses, which were most pronounced following booster immunisation. M and NSP5-specific CD4, but not CD8, T cell IFN-γ reactivity was measurable following the booster immunisation in a proportion of animals vaccinated with peptide-loaded particles. Upon challenge, CD4 and CD8 T cell reactivity was detected in all groups, with the greatest responses being detected in the peptide vaccinated group but with limited evidence of an enhanced control of viraemia. Analysis of the lungs during the resolution of infection showed significant M/NSP5 specific IFN-γ responses from CD8 rather than CD4 T cells. Vaccine primed CD8 T cell responses may therefore be required for protection and future work should focus on enhancing the cross-presentation of M/NSP5 to CD8 T cells.

The Non-structural Protein 5 and Matrix Protein Are Antigenic Targets of T Cell Immunity to Genotype 1 Porcine Reproductive and Respiratory Syndrome Viruses

The porcine reproductive and respiratory syndrome virus (PRRSV) is the cause of one of the most economically important diseases affecting swine worldwide. Efforts to develop a next-generation vaccine have largely focused on envelope glycoproteins to target virus-neutralizing antibody responses. However, these approaches have failed to demonstrate the necessary efficacy to progress toward market. T cells are crucial to the control of many viruses through cytolysis and cytokine secretion. Since control of PRRSV infection is not dependent on the development of neutralizing antibodies, it has been proposed that T cell-mediated immunity plays a key role. Therefore, we hypothesized that conserved T cell antigens represent prime candidates for the development a novel PRRS vaccine. Antigens were identified by screening a proteome-wide synthetic peptide library with T cells from cohorts of pigs rendered immune by experimental infections with a closely related (subtype 1) or divergent (subtype 3) PRRSV-1 strain. Dominant T cell IFN-γ responses were directed against the non-structural protein 5 (NSP5), and to a lesser extent, the matrix (M) protein. The majority of NSP5-specific CD8 T cells and M-specific CD4 T cells expressed a putative effector memory phenotype and were polyfunctional as assessed by coexpression of TNF-α and mobilization of the cytotoxic degranulation marker CD107a. Both antigens were generally well conserved among strains of both PRRSV genotypes. Thus, M and NSP5 represent attractive vaccine candidate T cell antigens, which should be evaluated further in the context of PRRSV vaccine development.

Comparison between killed and living probiotic usage versus placebo for the prevention of necrotizing enterocolitis and sepsis in neonates

The aim of the study is to compare the role of killed (KP) Lactobacillus acidophilus with living (LP) in reducing incidence of sepsis (NS) and necrotizing enterocolitis (NEC) in neonates. Randomized double blind placebo study, included 150 neonates admitted to NICU at day 1, sixty received oral (LP) and 60 received (KP) and 30 received placebo. One gram of stools was collected on admission, at day 7, at end of the study, as well as on suspected NEC or NS and was sent for culture.

RESULTS

LP and KP were preventive factors for NEC with absolute risk reduction (AAR) 16, 15%, respectively and 18% for NS compared to placebo. Incidence of NEC and NS did not differ significantly between neonates supplemented with LP and those with KP. Preterm neonates supplemented with KP showed significantly lower incidence of NEC compared to placebo, while incidence of NS showed no significant difference between both groups. There is significant reduction in NS and NEC among neonates with positive Lactobacillus colonization of gut compared to those none colonized at day 7 (27.9 vs. 85.9%, 0 vs. 7.8%) and at day 14 (48.7 vs. 91.7% for NS and 0 vs. 20.8% for NEC). Overall comparison between the three groups showed statistical significant reduction in the incidence of NEC. Present conclusions are that early gut colonization with beneficial bacteria lowers the incidence of NEC and NS. KP retained similar benefits to live bacteria.

Synthesis and antidiabetic activity of some sulfonylurea derivatives of 3,5-disubstituted pyrazoles

Two series of 3,5-disubstituted pyrazolesulfonylurea derivatives were prepared and evaluated as hypoglycemic agents. Preliminary biological testing revealed that the new compounds possess potent hypoglycemic activity.

Synthesis and antidiabetic activity of some sulfonylurea derivatives of 3,4,5-trisubstituted pyrazoles

Three series of 3,4,5-trisubstituted pyrazolesulfonylurea derivatives were prepared and evaluated as hypoglycemic agents. Preliminary biological testing revealed that the new compounds possess moderate hypoglycemic activity.

Synthesis of some substituted pyrazole-3-carboxylic acids with possible hypoglycemic and antimicrobial activity

Condensation of delta-unsaturated 1.3-diketoesters (1) with 4-substituted arylhydrazines (2) or benzenesulphonyl-hydrazine (8) led to 1-aryl-3-ethoxycarbonyl-5-[alpha-substituted styryl]-pyrazoles (3), and 1-benzenesulphonyl-3-ethoxycarbonyl-5-styryl pyrazole (9). Potassium permanganate oxidation of 3 gave 5-acetyl (or benzoyl)-1-aryl-3-ethoxycarbonyl pyrazoles (6) which on hydrolysis gave the corresponding carboxylic acids (7). Hydrolysis of 3 gave the corresponding acids 4 which on treatment with thionyl chloride followed by ammonia afforded the corresponding carboxamides 5.

The scope of the reactions of hydrazines and hydrazones. Part 4: Trisubstituted pyrazoles of possible hypoglycemic and antibacterial activity

Condensation of ethyl 2,4-dioxo-6-phenyl hex-5-enoate (1) with 4-substituted sulphamyl phenylhydrazines (2) led to 1-aryl-3-ethoxycarbonyl-5-styrylpyrazoles (3) which on hydrolysis gave 1-aryl-5-styrylpyrazole-3-carboxylic acids (4) and upon permanganate oxidation gave 1-aryl-3-ethoxycarbonylpyrazole-5-carboxylic acids (5). Similar condensation of hydralazine (6) with (1) gave the corresponding pyrazole (7) which on hydrolysis gave the acid 8.