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Objective: To investigate the changes of serum brain natriuretic peptide (BNP), procalcitonin (PCT) and recombinant single Ig IL1 related receptor (SIGIRR) in patients with emergency abdominal infection-related sepsis and their relationship with prognosis. Methods: 318 patients with emergency abdominal infection who were received by our hospital from January 2020 to October 2023 were divided into simple infection group (n=233) and sepsis group (n=85) according to whether sepsis occurred. The baseline data and serum BNP, PCT and SIGIRR levels were compared between groups. Pearson correlation analysis was used to explore the correlation between serum indicators and clinical data. The patients in sepsis group were classified into survival group (n=56) and death group (n=29) by means of survival status within 28 days, and the baseline data, serum BNP, PCT and SIGIRR were compared. Binary logistics equation was used to analyze the related influencing factors of prognosis of patients with sepsis. ROC curve was adopted to analyze the diagnostic value of serum BNP, PCT and SIGIRR levels on prognosis of sepsis group. Results: There were significant differences in pathogen types, WBC, CRP, ALB, APACHE II score and SOFA score between simple infection group and sepsis group (P<0.05). The levels of serum BNP, PCT and SIGIRR in simple infection group were significantly lower than those in sepsis group (P<0.05). Pearson correlation analysis showed that the levels of BNP, PCT and SIGIRR in sepsis group were positively correlated with WBC, CRP, APACHE II score and SOFA score (P<0.05), and were negatively correlated with ALB (P<0.05). Among patients with sepsis, the levels of serum BNP, PCT and SIGIRR were significantly higher in death group than those in survival group(P<0.05). Binary logistics regression analysis showed that serum BNP, PCT and SIGIRR levels were associated with poor prognosis in patients with sepsis(P<0.05). ROC curve revealed that the AUCs of serum BNP, PCT, SIGIRR alone and in combination in predicting the poor prognosis in patients with sepsis were 0.876, 0.826, 0.779 and 0.976, the sensitivities were 86.21%, 82.76%, 75.86% and 96.55%, and the specificities were 75%, 75%, 71.43% and 69.64% respectively, and the combined diagnostic value was higher. Conclusion: BNP, PCT and SIGIRR have a certain correlation with patients with abdominal infection-related sepsis, and can be used as reference indicators for clinical diagnosis, treatment and prognosis evaluation. [ABSTRACT FROM AUTHOR]

Objective To investigate the therapeutic efficacy and underlying mechanism of naringin (Ng) for intestinal mucosal injury in mice with intra-abdominal infection (IAI). Methods A mouse IAI model was established by intraperitoneal injection (i.p.) of lipopolysaccharide (LPS). Sixty-four healthy male mice were randomly assigned to 4 groups (n=16): Control group (0.2 mL PBS), LPS group (LPS 10 mg/kg), Ng group (50 mg/kg Ng+10 mg/kg LPS), and BzATP group (5 mg/kg BzATP +50 mg/kg Ng+10 mg/kg LPS). Ng and BzATP were administered i.p. 1 h before modeling, while the Control group received an equivalent volume of PBS. At 24 h post-modeling, 6 mice from each group were randomly selected and sacrificed for ileum collection, and the histopathological changes in the ileal mucosa and Chiu's score were assessed using HE staining. Immunofluorescence assay was employed to investigate the expression and distribution of intestinal mucosal P2X7, pyroptosis effector protein GSDMD, and macrophage marker CD68. Western blotting was conducted to detect the expression of P2X7 and pyroptosis-related proteins NLRP3, Caspase11, GSDMD, and GSDMD-N protein in ileum tissue. ELISA was utilized to measure the contents of inflammatory factors IL-1β, IL-18, and IL-10 in the ileum. The mouse sepsis score (MSS) was recorded within 7 d. Results In comparison to the Control group, the LPS group exhibited significantly higher MSS and Chiu's scores (P < 0.05), along with inflammation-associated damage to the ileal mucosa; Immunofluorescence assay displayed consistent and intensified distribution of intestinal mucosal P2X7, GSDMD, and CD68 (P < 0.05); Levels of pro-inflammatory factors IL-1β and IL-18 were increased, while that of anti-inflammatory factor IL-10 was decreased (P < 0.05); Additionally, the protein expression of P2X7, NLRP3, Caspase11, GSDMD, and GSDMD-N in ileum tissue was increased (P < 0.05). In contrast to the LPS group, the Ng group displayed a decrease in MSS; HE staining and Chiu's scores indicated a reduction in inflammatory damage to the intestinal mucosa; Moreover, fluorescence signals for P2X7, GSDMD, and CD68 were decreased (P < 0.05). Levels of IL-1β and IL-18 were decreased (P < 0.05), while that of IL-10 was elevated (P < 0.05). The expression of P2X7, NLRP3, Caspase11, GSDMD, and GSDMD-N protein was decreased (P < 0.05). The results of the BzATP group were in contrast to those of the Ng group. Conclusion Elevoted expression of P2X7 receptor and Caspase11-mediated non-canonical pyroptosis aggravates the intestinal mucosal injury IAI mice. Ng may ameliorate the injury in IAI mice by suppressing P2X7 receptor and modulating non-canonical pyroptosis.

Abstract Citrobacter koseri (C. koseri) is a Gram-negative, motile, non-spore-forming facultative anaerobic bacillus belonging to the Enterobacteriaceae family. C. koseri typically utilizes citrate as the sole carbon source and constitutes part of the normal gastrointestinal flora in humans and animals. As an opportunistic pathogen, C. koseri infections are mainly observed in neonates, elderly individuals, and immunocompromised hosts. C. koseri has been one of the main etiological agents of neonatal meningitis and cerebral abscess. In recent years, an increasing number of cases have been reported in adults with severe infections caused by C. koseri. Here, we report for the first time a clinical case of concurrent C. koseri intra-abdominal infection in a patient with severe asthma and provide a brief review of the relevant literature. With this report, we hope to increase awareness and alertness among clinicians to the possibility of concurrent infection of gut commensal bacteria in asthmatic patients requiring long-term oral corticosteroid administration.

Background: Sepsis still represents a major public health issue worldwide, and the immune system plays a main role during infections; therefore, its activity is mandatory to resolve this clinical condition. In this report, we aimed to retrospectively verify in a real-life setting the possible usefulness of pentameric IgM plus antibiotics in recovering patients with sepsis after major abdominal surgery. Materials/methods: We reviewed, from January 2013 until December 2019, all adult patients admitted to the ICU for sepsis or septic shock (2) after major abdominal surgery. Among these patients, were identified those that, according to legal indication and licenses in Italy, were treated with pentameric IgM plus antibiotics (Group A) or with antibiotics alone (Group B). The following parameters were evaluated: blood gas analysis, lactate, CRP, procalcitonin, endotoxin activity, liver and renal function, coagulation and blood cell count at different time points (every 48 h for at least 7 days). Differences between groups were analyzed using Fisher's exact test or a chi-square test for categorical variables. A Mann–Whitney U test or Kruskal–Wallis test were instead been performed to compare continuous variables. Univariate and multivariate analysis were also performed. Results: Over a period of 30 months, 24 patients were enrolled in Group A and 20 patients in Group B. In those subjects, no statistical differences were found in terms of bacterial or fungal infection isolates, when detected in a blood culture test, or according to inflammatory index, a score, lactate levels and mortality rate. A 48 h response was statistically more frequent in Group B than in Group A, while no differences were found in other clinical and laboratory evaluations. Conclusions: Based on our results, the use of pentameric IgM does not seem to give any clinical advantages in preventing sepsis after major abdominal surgery. [ABSTRACT FROM AUTHOR]

Citrobacter koseri (C. koseri) is a Gram-negative, motile, non-spore-forming facultative anaerobic bacillus belonging to the Enterobacteriaceae family. C. koseri typically utilizes citrate as the sole carbon source and constitutes part of the normal gastrointestinal flora in humans and animals. As an opportunistic pathogen, C. koseri infections are mainly observed in neonates, elderly individuals, and immunocompromised hosts. C. koseri has been one of the main etiological agents of neonatal meningitis and cerebral abscess. In recent years, an increasing number of cases have been reported in adults with severe infections caused by C. koseri. Here, we report for the first time a clinical case of concurrent C. koseri intra-abdominal infection in a patient with severe asthma and provide a brief review of the relevant literature. With this report, we hope to increase awareness and alertness among clinicians to the possibility of concurrent infection of gut commensal bacteria in asthmatic patients requiring long-term oral corticosteroid administration. [ABSTRACT FROM AUTHOR]

Background: We sought to understand which factors are associated with open appendectomy as final operative approach. We hypothesize that higher American Association for the Surgery of Trauma (AAST) Emergency General Surgery (EGS) grade is associated with open appendectomy. Patients and Methods: Post hoc analysis of the Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated and Gangrenous (MUSTANG) prospective appendicitis database was performed. All adults (age >18) undergoing appendectomy were stratified by final operative approach: laparoscopic or open appendectomy (including conversion from laparoscopic). Univariable analysis was performed to compare group characteristics and outcomes, and multivariable logistic regression was performed to identify demographic, clinical, or radiologic factors associated with open appendectomy. Results: A total of 3,019 cases were analyzed. One hundred seventy-five (5.8%) patients underwent open appendectomy, including 127 converted from laparoscopic to open. The median age was 37 (25) years and 53% were male. Compared with the laparoscopic group, open appendectomy patients had more comorbidities, higher proportion of symptoms greater than 96 hours, and higher AAST EGS grade. Moreover, on intraoperative findings, the open appendectomy group had a higher incidence of perforated and gangrenous appendicitis with purulent contamination, abscess/phlegmon, and purulent abdominal/pelvic fluid. On multivariable analysis controlling for comorbidities, clinical and imaging AAST grade, duration of symptoms, and intra-operative findings, only AAST Clinical Grade 5 appendicitis was independently associated with open appendectomy (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.24–25.55; p = 0.025). Conclusions: In the setting of appendicitis, generalized peritonitis (AAST Clinical Grade 5) is independently associated with greater odds of open appendectomy. [ABSTRACT FROM AUTHOR]

Liang Zheng,1,&ast; Zhoujun Kang,1,&ast; Ru Wang,2 Meng Lv,2 Zhirui Gao,1 Haizhou Xu,1 Meitang Wang1 1Emergency Department, Changhai Hospital Affiliated to Navy Medical University, Shanghai, People’s Republic of China; 2Genoxor Medical Science and Technology Inc., Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Haizhou Xu; Meitang Wang, Emergency Department, Changhai Hospital Affiliated to Navy Medical University, Changhai Road No. 168, Yangpu District, Shanghai, 200433, People’s Republic of China, Tel +86-21-81873891, Email sealand_xu@126.com; wmt88@sina.comPurpose: Intra-abdominal infections (IAI) are gradually becoming common in the emergency department, though the incidence is low and the prognosis is fair, as the symptoms are similar to other intra-abdominal diseases, rapid and accurate diagnosis of the causative agents is essential for clinical management. This study aimed to evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) in detecting IAI in the emergency department.Patients and Methods: This was a retrospective, single-centered study including patients admitted to the emergency department from January 1st, 2021 to August 31st, 2022 with diagnosis of IAI. The comparison between mNGS and microbial culture using paracentesis fluid samples was performed to evaluate the diagnostic performance of mNGS for IAI. Meanwhile, paracentesis fluid and peripheral blood mNGS were compared to explore the sample specificity. Further, the microbial community structure of the patients with pyogenic liver abscesses (PLA) was analyzed.Results: Thirty-four IAI patients including 23 with pyogenic liver abscesses (PLA), 3 with parapancreatic abscesses, and 8 with other IAI were included in this study. Compared with the conventional microbial culture of paracentesis fluid, mNGS using paracentesis fluid detected more positive cases of IAI (93.75% vs 81.25%), and identified more species of pathogens, especially in obligate anaerobes and viral pathogens. Peripheral blood mNGS presented a relatively high consistency with the paracentesis fluid mNGS (91% mutual positive). The microbial community structure of PLA patients with diabetes is less diverse than that of those without diabetes. Patients with diabetes are at high risk of PLA caused by Klebsiella pneumonia.Conclusion: mNGS has advantages in detecting IAI in the emergency department, and peripheral blood mNGS can be a non-invasive choice for early diagnosis.Keywords: metagenomic next-generation sequencing, mNGS, abdominal infection, pyogenic liver abscesses, PLA, emergency department

In the context of rising gastric disease prevalence, acute gastric hemorrhage presents a significant clinical challenge, particularly among athletes who engage in intense physical activity. This demographic may have unique vulnerabilities due to the stress and strain of their rigorous training and performance routines. Acute gastric bleeding can arise from various sources, including gastritis from Helicobacter pylori infection, gastric ulcers, or vascular abnormalities exacerbated by lifestyle factors like excessive alcohol consumption. However, the impact of high-intensity physical exertion, common in athletes, on these conditions remains underexplored. In athletes, the management of acute gastric bleeding often involves conservative drug therapy post-hemodilation, with proton pump inhibitors like omeprazole offering both anti-inflammatory and acid-inhibiting effects. Surgical intervention is reserved for severe cases, considering the heightened risk of postoperative abdominal infections due to the stomach's unique physiology and its microbial population. This study focuses on the intestinal mucosal barrier's function postoperatively in athletes who have undergone treatment for acute gastric bleeding. We explore how intense physical activity influences intestinal mucosal integrity and its subsequent role in postoperative infection risks. The role of high-mobility group box1 (HMGB1) and the receptor for advanced glycation end products (RAGE) in this context is also examined. HMGB1, a crucial pro-inflammatory cytokine and late inflammatory mediator, and RAGE, a significant HMGB1 receptor, are believed to play pivotal roles in the inflammatory response following acute gastric bleeding. Our research aims to investigate the changes in intestinal mucosal barrier function and the levels of HMGB1 and RAGE in athletes with acute gastric bleeding. This study will provide insights into how physical stressors unique to athletes might affect postoperative outcomes, particularly infection risks. The findings could guide the development of tailored therapeutic and preventative strategies for this specific population. [ABSTRACT FROM AUTHOR]

Jie Zhao,1,2 Teng Zhang,2,3 Zhe Deng,1,2 Xia Han,1,2 Tao Ma,2,3,&ast; Keliang Xie1,2,&ast; 1Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 2Tianjin Medical University, Tianjin, People’s Republic of China; 3Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tao Ma, Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People’s Republic of China, Tel +86 13702172328, Email taoma@tmu.edu.cn Keliang Xie, Department of Critical Care Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People’s Republic of China, Tel +86 15332112099, Email xiekeliang2009@hotmail.comPurpose: Intra-abdominal infection is considered the second most common cause of sepsis and results in localized or diffused inflammation of the peritoneum. The main treatment for abdominal sepsis is an emergency laparotomy for source control. However, surgical trauma also causes inflammation, and patients become susceptible to postoperative complications. Therefore, it is necessary to identify biomarkers that can be used to distinguish sepsis from abdominal infection. This prospective study investigated whether cytokine levels in the peritoneum could predict complications and indicate severity of sepsis following emergency laparotomy.Methods: We prospectively observed 97 patients with abdominal infection admitted to the Intensive Care Unit (ICU). After emergency laparotomy,SEPSIS-3 criteria were used for the diagnosis of sepsis or septic shock. Blood and peritoneal fluid samples were drawn at postoperative admission to the ICU and cytokine concentrations were measured by flow cytometry.Results: Fifty-eight postoperative patients were enrolled. We found significant elevations in the peritoneal concentrations of IL-1β, IL-6, TNF-α, IL-17, and IL-2 in patients with sepsis or septic shock compared to the patients without sepsis after surgery. Positive correlations between levels of these peritoneal cytokines with APACHE II scores were found: IL-6, in particular, had the highest correlation coefficient of 0.833. Meanwhile, IL-10 in blood, MCP-1 and IL-8 in both blood and peritoneum were simultaneously increased in patients with sepsis and septic shock, and also positively correlated with disease severity.Conclusion: The cytokine storm that occurs in the abdominal cavity after emergency laparotomy may be the main mechanism leading to sepsis. It may be valuable to measure IL-1β, IL-6, TNF-α,IL-17, IL-2, MCP-1, and IL-8 in the peritoneal fluid, combined with serum IL-10, MCP-1 and IL-8, in a panel of cytokines, to assess the severity of sepsis and predict mortality from abdominal infection after emergency laparotomy.Keywords: abdominal infection, emergency laparotomy, peritoneal cytokine, cytokine storm

Abstract Objective To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. Methods The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People’s Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. Results There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P

Background: It is recognized increasingly that common surgical infections of the peritoneal cavity may be treated with antibiotic agents alone, or source control surgery with short-course antimicrobial therapy. By extension, testable hypotheses have emerged that such infections may not actually be infectious diseases, but rather represent inflammation that can be treated successfully with neither surgery nor antibiotic agents. The aim of this review is to examine extant data to determine which of uncomplicated acute appendicitis (uAA), uncomplicated acute calculous cholecystitis (uACC), or uncomplicated mild acute diverticulitis (umAD) might be amenable to management using supportive therapy alone, consistent with the principles of antimicrobial stewardship. Methods: Review of pertinent English-language literature and expert opinion. Results: Only two small trials have examined whether uAA can be managed with observation and supportive therapy alone, one of which is underpowered and was stopped prematurely because of challenging patient recruitment. Data are insufficient to determine the safety and efficacy of non-antibiotic therapy of uAA. Uncomplicated acute calculous cholecystitis is not primarily an infectious disease; infection is a secondary phenomenon. Even when bactibilia is present, there is no high-quality evidence to suggest that mild disease should be treated with antibiotic agents. There is evidence to indicate that antibiotic prophylaxis is indicated for urgent/emergency cholecystectomy for uACC, but not in the post-operative period. Uncomplicated mild acute diverticulitis, generally Hinchey 1a or 1b in current nomenclature, does not benefit from antimicrobial agents based on multiple clinical studies. The implication is that umAD is inflammatory and not an infectious disease. Non-antimicrobial management is reasonable. Conclusions: Among the considered disease entities, the evidence is strongest that umAD is not an infectious disease and can be treated without antibiotic agents, intermediate regarding uACC, and lacking for uAA. A plausible hypothesis is that these inflammatory conditions are related to disruption of the normal microbiome, resulting in dysbiosis, which is defined as an imbalance of the natural microflora, especially of the gut, that is believed to contribute to a range of conditions of ill health. As for restorative pre- or probiotic therapy to reconstitute the microbiome, no recommendation can be made in terms of treatment, but it is not recommended for prevention of primary or recurrent disease. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. Methods: The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. Results: There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). Conclusion: Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures. [ABSTRACT FROM AUTHOR]

Background Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. Methods A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. Results No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. Conclusion Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic granulomatous disease (CGD) is an inborn error of immunity. It is characterized by recurrent bacterial or fungal infections, including infections by Burkholderia species. This is due to respiratory burst dysfunction of phagocytes. Currently, there is no report on Burkholderia contaminans (B. Contaminans) infection in children with CGD. Case presentation We present a previously healthy, 17-month-old Chinese boy infected with B. Contaminans in the intra-abdominal regions. Immunological screening, including assessment of cellular immunity and humoral immunity did not yield conclusive results. The level of nicotinamide adenine dinucleotide phosphatase (NADPH) activity was decreased and whole-exome sequencing identified a de novo mutation in the CYBB gene. Conclusions For specific pathogens such as B. Contaminans, immune assessment should be carried out even if there is no positive medical history or specificity in basic immunity screening.

Objective: To study the clinical diagnostic value of neutrophil CD64 index, PCT, and CRP in patients with acute pancreatitis with abdominal infection. Methods: A number of patients with acute pancreatitis (n = 234) participated in the study. According to the infection and health conditions, they were further divided into the non-infection group (n = 122), infection group (n = 78), and sepsis group (n = 34), and 40 healthy subjects were selected in the control group (n = 40). Expression levels of infection indexes, such as CD64 index, PCT, and CRP, were detected and compared. ROC curves were drawn to compare the efficacy of each index in the diagnosis of acute pancreatitis with abdominal infection and sepsis. The study was retrospectively registered under the China Clinical Trial Registry as a trial number ChiCTR2100054308. Results: All indexes were significantly higher in three clinical groups than the healthy control group (p < 0.05). The CD64 index, CD64 positive rate, and PCT in the infected group were significantly higher than those in the uninfected group (ALL p < 0.05). The PCT of patients infected with Gram-negative bacteria was significantly higher than that of Gram-positive bacteria-infected patients (p < 0.05). CD64 index had the best diagnostic efficiency for acute pancreatitis infection, with 82.14% sensitivity, 88.51% specificity, and 0.707 Youden indexes. The CD64 Youden index (0.780) for sepsis diagnosis was the highest, while the AUC of PCT was the highest (0.897). Conclusion: CD64 index combined with PCT has good sensitivity and specificity in diagnosing acute pancreatitis infection and sepsis. [ABSTRACT FROM AUTHOR]

Sepsis is a life-threatening dysregulated host response to infection that compromises organ health, and abdominal sepsis is a commonly presenting critical illness in intensive care units (ICU). In this study, we investigate the effect of age on clinical sepsis characteristics and innate immune cells (neutrophils and monocytes) functionality in abdominal sepsis patients. We recruited 32 patients with abdominal sepsis from the Beijing Ditan Hospital’s ICU from February 2021 to September 2021, and selected 18 healthy volunteers that were age- and sex-matched as controls for a prospective cohort study. Elderly abdominal sepsis patients (age >65 years) had the following altered characteristics compared to nonelderly patient controls: lower mean arterial pressure, monocytes percentage, and red blood cell volume distribution width (p < 0.05); higher neutrophils percentage and neutrophils-to-lymphocytes ratio (p < 0.05); significantly increased monocyte-produced reactive oxygen (p < 0.05); increases neutrophilic secretion of TNF-α, as well as lower monocytic secretion of TNF-α (p < 0.05); higher neutrophil percentage (which was significantly higher in peripheral blood than monocyte percentage). Elderly patients also had significantly increased phagocytic activity in their neutrophils and monocytes (p < 0.05), significantly reduced neutrophils-produced reactive oxygen (p < 0.001), and significantly increased TNF-α secretion by monocytes and neutrophils (p < 0.05). We found that elderly patients have decreased immune cell function and increased release of cytokines compared to younger patients, suggesting individualized treatment plans targeting the elderly septic microenvironment could help prevent organ failure in elderly septic patients and improves patient survival. [ABSTRACT FROM AUTHOR]

Solid organ transplantation (SOT) recipients have a heightened risk for infection due to prolonged immunosuppressive drug use following transplant procedures. The occurrence of post-transplant infections is influenced not only by the transplanted organ type but also by varied factors. The kidney is the most common organ in SOT, followed by the liver, heart, and lung. This review aims to provide a comprehensive overview of the current epidemiological characteristics of infections after kidney, liver, heart, and lung transplantation, focusing on bacterial, fungal, and viral infections. The incidence and infection types demonstrated significant variability across different SOTs. Furthermore, this review attempts to elucidate the clinical characteristics of infections across patients following different SOTs and contribute to the development of individualized prevention strategies according to infection incidence, ultimately enhancing the quality of life of transplant recipients., (© The Author(s) 2024. Published by Oxford University Press on behalf of Applied Microbiology International.)

Background: Diagnosing and treating abdominal infection in children remains a challenge. Nucleic acid detection, as a rapid and accurate diagnosis tool, has great significance in this field., Aim: To investigate the diagnosis and treatment of abdominal infection by nucleic acid detection and its possible correlation with psychological stress in children., Methods: A total of 50 pediatric patients diagnosed with abdominal infections between September 2020 and July 2021 were included in this study. Intra-abdominal pus samples were collected for pathogen culture, drug susceptibility testing, and broad-spectrum bacterial nucleic acid testing. Psychological stress, anxiety, depression, and coping styles were assessed using the coping with a disease (CODI) scale., Results: Based on susceptibility testing, a regimen of cefazoxime, piperacillin/tazobactam, and metronidazole or ornidazole achieved 100% effectiveness in treating appendicitis. Psychological assessments revealed a positive correlation between pressure level and both anxiety ( r = 0.324, P = 0.001) and depressive disorders ( r = 0.325, P < 0.001). Acceptance and distancing as coping strategies were negatively correlated with anxiety and depression, while negative emotional responses were strongly associated with increased anxiety ( r = 0.574, P < 0.001) and depression ( r = 0.511, P = 0.001). Coping strategies such as illusion and escape showed no significant correlation with emotional outcomes., Conclusion: Nucleic acid testing helps in the diagnosis of abdominal infections in children, and also focuses on children's mental health., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background and Aims: Skeletal muscle density (SMD) is a valuable prognostic indicator in various conditions such as cancer, liver cirrhosis. Yet, the connection between SMD and intra-abdominal infection in individuals who have suffered abdominal injuries is still unclear. The purpose of this research is to examine how well SMD can predict intra-abdominal infection in patients who have suffered abdominal trauma., Methods: Participants with abdominal injuries were included in this research from January 2015 to April 2023. Based on the sex-specific cut off values of SMD, the entire population was split into two categories. Prognostic factors were identified through logistic regression analysis. ROC was used to assess the predictive accuracy of SMD and its combinations with other biomarkers for clinical outcomes., Results: A total of 220 patients were ultimately included in the study. Patients in the group with low SMD exhibited a higher incidence of intra-abdominal infection, longer hospital stays, and increased hospital costs. In patients with abdominal trauma, low SMD was identified as a significant independent predictor of intra-abdominal infection (OR 2.397; 95 % CI 1.117-5.141, p = 0.025). Low SMD had a higher area under the curve (AUC) in ROC analysis compared to TRF, NRS2002 score, and APACHEII score for predicting intra-abdominal infection (AUC 0.70, 95 % CI 0.61-0.78, p = 0.002). Moreover, low SMD showed associations with clinical outcomes such as hospital stay length and costs (p < 0.01)., Conclusions: Low SMD is recognized as an independent risk factor for predicting intra-abdominal infections in this patient population. Notably, SMD is emerging as a novel predictor of abdominal infections in patients with abdominal trauma., Competing Interests: Conflict of interest We have no conflict of interest to declare., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective To investigate the risk factors of abdominal infection after orthotopic liver transplantation. Methods Clinical data of 284 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. All recipients were divided into the infection group (n=51) and non-infection group (n=233) according to the incidence of postoperative abdominal infection. Univariate and multivariate logistic regression analyses were used to identify the risk factors of abdominal infection. Nomogram prediction models were constructed and the prediction efficiency of these models was evaluated. The predictive value of continuous variables for abdominal infection was assessed. Results Among 284 recipients, 51 developed abdominal infection with an incidence of 18.0%. Diabetes mellitus before surgery[odds ratio (OR) 2.66，95% confidence interval (CI) 1.13-6.14，P=0.013], long operation time (OR 1.98，95%CI 1.03-3.57， P=0.038), low prognostic nutritional index (PNI) (OR 2.18，95%CI 1.06-4.44，P=0.023), high systemic immuneinflammation index (SII) (OR 2.21，95%CI 1.06-4.78，P=0.012) and high C-reactive protein/albumin ratio (CAR) (OR 1.90，95%CI 1.05-3.49，P=0.029) were independent risk factors for abdominal infection after liver transplantation. The area under curve (AUC) of nomogram model for predicting abdominal infection after liver transplantation was 0.761. The standard model yielded high consistency. CAR, PNI and SII were all predictors of abdominal infection after liver transplantation (all P<0.05), with AUC of 0.648, 0.611 and 0.648, and cut-off values of 2.75, 43.15 and 564.50, respectively. Conclusions CAR, SII and PNI are predictors of abdominal infection after liver transplantation. The nomogram model based on PNI, SII and CAR may effectively predict the incidence of abdominal infection after liver transplantation. [ABSTRACT FROM AUTHOR]

PurposeSurgical site infection (SSI) remains one of the most common postoperative complications for patients with abdominal infections. This study aimed at investigating the effectiveness of high-volume normal saline (NS) irrigation in preventing postoperative SSI for patients with abdominal infections.MethodsIn this retrospective before-after clinical study, patients who underwent emergency laparotomy due to abdominal infections between Jan 2015 and Dec 2021 were included consecutively. A cohort of 207 patients with NS irrigation was compared to historical controls. A propensity score matching (PSM) with a 1:1 ratio was performed to reduce potential bias. The primary outcome was the 30-day SSI rate.ResultsIrrigation (n = 207) and control (n = 207) matched patients were statistically identical on baseline characteristics, perioperative, and intraoperative parameters. Irrigation patients had lower overall SSI rates (10.6% vs. 26.1%, p

Hao Tang, Dong Liu, Yong Guo, Huayu Zhang, Yang Li, Xiaoyu Peng, Yaoli Wang, Dongpo Jiang, Lianyang Zhang, Zhengguo Wang Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of ChinaCorrespondence: Zhengguo Wang; Lianyang Zhang Email hpzhangly@163.com; dpzhangly@163.comObjective: This study is the largest clinical study of noninvasive Abdominal wall tension (AWT) measurement with a tensiometer to date. It also initially applies a polynomial regression equation to analyze the correlation between AWT measurement and intravesical pressure (IVP) measurement and remarkably finds interesting changes between different IVP intervals and AWT.Methods: Critically ill patients who were treated in the intensive care unit (ICU) of Daping Hospital, Army Medical University, from August 30, 2018, to June 30, 2020, and met the inclusion criteria were prospectively included in this study. The patients were divided into an intra-abdominal hypertension group and a non-intra-abdominal hypertension group and an abdominal infection group and no abdominal infection group. AWT and IVP were measured at 9 points on the abdominal wall on the first day after admission to the ICU. The correlations between AWTs and IVP were analyzed, and the role of AWT in the diagnosis of complications of abdominal infection and the prediction of adverse prognosis were analyzed.Results: A total of 127 patients were included. The average AWT and IVP were 2.77± 0.38 N/mm and 12.31± 7.01 mmHg, respectively, on the first day of admission. There was a positive correlation between AWT and IVP (correlation coefficient r = 0.706, p < 0.05). The polynomial regression model was AWT= -1.616× 10− 3 IVP2 +8.323× 10− 2 IVP+2.094. The cutoff value of the sensitivity and specificity of AWT for the diagnosis of abdominal infection was 2.57 N/mm. Furthermore, AWT = 2.57 N/mm had the best diagnostic efficiency, which was better than that of IAH and lactate.Conclusion: There was a correlation between AWT and IVP. AWT measurement was helpful in the diagnosis of IAH and abdominal infection complications and can therefore serve as a new method for the clinical diagnosis of IVP and abdominal infection.Keywords: intra-abdominal hypertension, abdominal wall tension, intra-abdominal pressure, abdominal compliance, abdominal infection

Background: Chronic granulomatous disease (CGD) is an inborn error of immunity. It is characterized by recurrent bacterial or fungal infections, including infections by Burkholderia species. This is due to respiratory burst dysfunction of phagocytes. Currently, there is no report on Burkholderia contaminans (B. Contaminans) infection in children with CGD. Case presentation: We present a previously healthy, 17-month-old Chinese boy infected with B. Contaminans in the intra-abdominal regions. Immunological screening, including assessment of cellular immunity and humoral immunity did not yield conclusive results. The level of nicotinamide adenine dinucleotide phosphatase (NADPH) activity was decreased and whole-exome sequencing identified a de novo mutation in the CYBB gene. Conclusions: For specific pathogens such as B. Contaminans, immune assessment should be carried out even if there is no positive medical history or specificity in basic immunity screening. [ABSTRACT FROM AUTHOR]

Intra-abdominal infections (IAIs) are a common cause of sepsis, and frequently occur in intensive care unit (ICU) patients. IAIs include many diagnoses, including peritonitis, cholangitis, diverticulitis, pancreatitis, abdominal abscess, intestinal perforation, abdominal trauma, and pelvic inflammatory disease. IAIs are the second most common cause of infectious morbidity and mortality in the ICU after pneumonia. IAIs are also the second most common cause of sepsis in critically ill patients, and affect approximately 5% of ICU patients. Mortality with IAI in ICU patients ranges from 5 to 50%, with the wide variability related to the specific IAI present, associated patient comorbidities, severity of illness, and organ dysfunction and failures. It is important to have a comprehensive understanding of IAIs as potential causes of life-threatening infections in ICU patients to provide the best diagnostic and therapeutic care for optimal patient outcomes in the ICU. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leak is among the most dreaded complications in patients undergoing colorectal surgery. We have discovered that in rodents, collagenase-producing bacteria, particularly Enterococcus faecalis, promotes anastomotic leak by degrading healing anastomotic tissue. Yet, it is unclear if these organisms play a role in humans. Patients and Methods: Patients undergoing colorectal resection at the University of Chicago from July 2014 through June 2019 who developed a post-operative infection were stratified into infections that resulted from an anastomotic leak, a Hartmann pouch stump leak, or a deep infection without an associated staple line leak. Results: Forty-two patients had available culture data. Of these patients, 19 were found to have an anastomotic leak, 7 had a stump leak, and 16 had a deep infection that was not associated with a staple line. Enterococcus faecalis was identified in 24% of all infections and was associated with the development of anastomotic leak (p = 0.029). When the organisms were classified into their known ability to produce collagenase, 74% of patients with an anastomotic leak were colonized with collagenase-producing organisms, compared with only 28% of patients with a deep infection or stump leak (p = 0.022). Antibiotic-resistant organisms were more common in patients with anastomotic leak (p = 0.01). Conclusions: Collagenase-producing and antibiotic-resistant organisms are more prevalent in anastomotic leak infections compared with other deep or organ/space infections. This lends evidence to a bacterial driven pathogenesis of leak and suggests that targeting these organisms may be a novel strategy to reduce this complication. [ABSTRACT FROM AUTHOR]

To identify the risk factors related to the patient's 28-day mortality, we retrospectively reviewed the records of patients with intra-abdominal infections admitted to the ICU of Nanfang Hospital, Southern Medical University from 2011 to 2018. Multivariate Cox proportional hazard regression analysis was used to identify independent risk factors for mortality. Four hundred and thirty-one patients with intra-abdominal infections were analyzed in the study. The 28-day mortality stepwise increased with greater severity of disease expression: 3.5% in infected patients without sepsis, 7.6% in septic patients, and 30.9% in patients with septic shock (p < 0.001). In multivariate analysis, independent risk factors for 28-day mortality were underlying chronic diseases (adjusted HR 3.137, 95% CI 1.425–6.906), high Sequential Organ Failure Assessment (SOFA) score (adjusted HR 1.285, 95% CI 1.160–1.424), low hematocrit (adjusted HR 1.099, 95% CI 1.042–1.161), and receiving more fluid within 72 h (adjusted HR 1.028, 95% CI 1.015–1.041). Compared to the first and last 4 years, the early use of antibiotics, the optimization of IAT strategies, and the restriction of positive fluid balance were related to the decline in mortality of IAIs in the later period. Therefore, underlying chronic diseases, high SOFA score, low hematocrit, and receiving more fluid within 72 h after ICU admission were independent risk factors for patients' poor prognosis.

Lower abdominal pain is a common complaint for patients presenting for evaluation in the emergency department. Among other life-threatening complications, acute appendicitis needs to be ruled out in the case of right-lower quadrant pain (RLQ). Sigmoid perforation caused by an ingested foreign body is an uncommon cause of RLQ pain. This report presents the case of an otherwise healthy, 29-year-old male who presented to the emergency department with RLQ pain. His initial evaluation raised concern for acute appendicitis. However, during his exploratory laparoscopy, he was found to have a perforated sigmoid colon due to a skewer stick; the patient had no recollection of having ingested any foreign body. This paper highlights the importance of considering the possibility of sigmoid perforation by an ingested foreign body as a possible cause of RLQ pain. The article also reviews the most common causes of ingested foreign bodies, their potential complications and management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Devanathan et al.)

Objective To explore the effective management of post-operation infections through clinical pharmacists participating in the treatment of a gastric cancer patient with post operation abdominal infection and cellulitis. Methods Clinical pharmacists provided an rational anti-infective treatment plan with the combination of pharmacy and clinical practice, conducted medication education for the patient, and participated in the process of pharmacy care for the patient. Results Physicians modified the medication plan according to the recommendations from the clinical pharmacists. The patient ’s infection was effectively controlled and the symptoms were alleviated. Conclusion With their professional knowledge, clinical pharmacists can select the best antibacterial drug regimen for the treatment of post-operation infections and provide patients with optimal pharmaceutical care. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical diagnostic value of neutrophil CD64 index, PCT, and CRP in patients with acute pancreatitis with abdominal infection. Methods: A number of patients with acute pancreatitis (n = 234) participated in the study. According to the infection and health conditions, they were further divided into the non-infection group (n = 122), infection group (n = 78), and sepsis group (n = 34), and 40 healthy subjects were selected in the control group (n = 40). Expression levels of infection indexes, such as CD64 index, PCT, and CRP, were detected and compared. ROC curves were drawn to compare the efficacy of each index in the diagnosis of acute pancreatitis with abdominal infection and sepsis. The study was retrospectively registered under the China Clinical Trial Registry as a trial number ChiCTR2100054308. Results: All indexes were significantly higher in three clinical groups than the healthy control group (p < 0.05). The CD64 index, CD64 positive rate, and PCT in the infected group were significantly higher than those in the uninfected group (ALL p < 0.05). The PCT of patients infected with Gram-negative bacteria was significantly higher than that of Gram-positive bacteria-infected patients (p < 0.05). CD64 index had the best diagnostic efficiency for acute pancreatitis infection, with 82.14% sensitivity, 88.51% specificity, and 0.707 Youden indexes. The CD64 Youden index (0.780) for sepsis diagnosis was the highest, while the AUC of PCT was the highest (0.897). Conclusion: CD64 index combined with PCT has good sensitivity and specificity in diagnosing acute pancreatitis infection and sepsis.

Abstract Background Evidence suggests that early adaptive responses of hepatic mitochondria occur in experimentally induced sepsis. Little is known about both colonic mitochondrial function during abdominal infection and long-term changes in mitochondrial function under inflammatory conditions. We hypothesize that hepatic and colonic mitochondrial oxygen consumption changes time-dependently after sterile laparotomy and in the course of abdominal infection. The aim of the present study was to investigate the hepatic and colonic mitochondrial respiration after sterile laparotomy and abdominal infection over up to 96 h. Methods After approval of the local Animal Care and Use Committee, 95 Wistar rats were randomized into 8 groups (n = 11–12): 1–4 sham (laparotomy only) and 5–8 colon ascendens stent peritonitis (CASP). Healthy, unoperated animals served as controls (n = 9). The mitochondrial respiration in colon and liver homogenates was assessed 24, 48, 72, and 96 h after surgery. Mitochondrial oxygen consumption was determined using a Clark-type electrode. State 2 (oxygen consumption in the presence of the substrates for complexes I and II) and state 3 respiration (ADP dependent) were assessed. The respiratory control ratio (RCR state 3/state 2) and ADP/O ratio (ADP added/oxygen consumed) were calculated for both complexes. Data are presented as means ± SD, two-way ANOVA followed by Tukey’s post hoc test. Results Hepatic RCR was initially (after 24 h) elevated in both operated groups; after 48 h only, the septic group was elevated compared to controls. In CASP groups, the hepatic ADP/O ratio for complex I was elevated after 24 h (vs. controls) and after 48 h (vs. sham) but declined after 72 h (vs. controls). The ADP/O ratio for complex II stayed unchanged over the time period until 96 h. The colonic RCR and ADP/O did not change over time after sham or CASP operation. Conclusion Hepatic, but not colonic, mitochondrial respiration is increased in the initial phase (until 48 h) and normalizes in the longer course of time (until 96 h) of abdominal infection.

Objective　 To provide the certain guidance for the accurate treatment of patients with abdominal infection by observing the changes of the difference between HCT and ALB in the treatment of patients with abdominal infection. Methods　 A total of 106 patients with various abdominal infection treated in the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2018 were selected and divided into 7 groups （n = 106） according to the operation time： preoperative， postoperative 12 h， postoperative 1 day， postoperative 2 days， postoperative 7 days， postoperative 14 days and postoperative 21 days. Gender and age of patients were recorded. The hematocrit and plasma albumin of patients at each time point above were collected， and the HCT-ALB difference was calculated. According to the clinical outcome， they were divided into the postoperative improvement group and the death group. The difference of HCT，ALB and HCT-ALB in each group was compared. Results　 Compared with those before the surgery， HCT and ALB decreased and HCT-ALB increased 12 h， 1 day，2 days and 7 days after the surgery （P < 0.05）. Compared with those before the operation， HCT and ALB decreased 14 days after the operation （P < 0.05），but there was no significant difference in HCT-ALB （P > 0.05）. Compared with the improved group， the age of patients in the death group increased （ P < 0.05）， and the preoperative HCT-ALB increased （P < 0.05）. Conclusion　 Capillary leakage is aggravated in patients with celiac infection after the surgical treatment， and the pathological process lasts for more than 7 days， and the capillaries of the dead are more leaky. [ABSTRACT FROM AUTHOR]

Antimicrobial peptides (AMPs) potentially serve as ideal antimicrobial agents for the treatment of polymicrobial abdominal infections due to their broad-spectrum antimicrobial activity and excellent biocompatibility. However, the balance of chain length, positive charges, and hydrophobicity on the antimicrobial activity of AMPs are still far from being optimal. Herein, a series of AMPs ([KX] n -NH 2 , X = Ile, Leu or Phe, n = 3, 4, 5, or 6) with varied charges and hydrophobicity for the treatment of polymicrobial abdominal infections are designed. Specifically, [KI] 4 -NH 2 peptide exhibits the best in vitro antimicrobial activity against Gram-positive and -negative bacteria, as well as fungal strains. Based on the good cell biocompatibility, [KI] 4 -NH 2 peptide is found to have negligible in vivo toxicity at the dosage of up to 28 mg kg -1 . Furthermore, great in vivo therapeutic efficacy of [KI] 4 -NH 2 peptide against S. typhimurium is demonstrated in the mice abdominal infection model. The design of short sequence of antimicrobial peptides with a charge/hydrophobicity balanced structures provides a simple and efficient strategy for potential clinical applications of antimicrobial peptide-based biomaterials in a variety of bacterial infection diseases., (© 2023 Wiley‐VCH GmbH.)

The increasing prevalence of bacterial multidrug antibiotic resistance has led to a serious threat to public health, emphasizing the urgent need for alternative antibacterial therapeutics. Lytic phages, a class of viruses that selectively infect and kill bacteria, offer promising potential as alternatives to antibiotics. However, injectable carriers with a desired release profile remain to be developed to deliver them to infection sites. To address this challenge, phage-loaded microparticles (Phage-MPs) have been developed to deliver phages to the infection site and release phages for an optimal therapeutic effect. The Phage-MPs are synthesized by allowing phages to be electrostatically attached onto the porous polyethylenimine-modified silk fibroin microparticles (SF-MPs). The high specific surface area of SF-MPs allows them to efficiently load phages, reaching about 1.25 × 10 10 pfu per mg of microparticles. The Phage-MPs could release phages in a controlled manner to achieve potent antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA). Unlike the diffuse biodistribution of free phages post-intraperitoneal injection, Phage-MPs could continuously release phages to effectively boost the local phage concentration at the bacterial infection site after they are intraperitoneally injected into an abdominal MRSA-infected mouse model. In a mouse abdominal MRSA infection model, Phage-MPs significantly reduce the bacterial load in major organs, achieving an efficient therapeutic effect. Furthermore, Phage-MPs demonstrate outstanding biocompatibility both in vitro and in vivo. Overall, our research lays the foundation for a new generation of phage-based therapies to combat antibiotic-resistant bacterial infections.

Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response

Objective: To investigate the quality of life of patients with severe acute pancreatitis (SAP), and to analyze the influencing factors of SAP complicated with abdominal infection. 136 patients with SAP in our hospital from January 2017 to December 2019 were selected and included in the study group. Another 90 volunteers who had physical examination in our hospital at the same time were selected as the control group. The patients in the study group were divided into infection group (n=48) and non infection group (n=88) according to the abdominal infection situation. Quality of life survey (SF-36) was used to evaluate the quality of life of the control group and the study group. The influencing factors of SAP complicated with abdominal infection were analyzed by univariate and multivariate logistic regression. The scores of social function, energy, physiological function, emotional function, physiological function, general health condition, physical pain and mental health of the study group were lower than those of the control group (P<0.05). Univariate analysis showed that mechanical ventilation time, multiple organ dysfunction syndrome, diabetes mellitus, hypoxemia, intestinal dysfunction time, renal failure, Acute physiology and chronic health status score II (APACHE Ⅱ) were associated with SAP complicated with abdominal infection (P<0.05), but not with gender, age, type of disease, etiology and respiratory failure (P>0.05). Multivariate Logistic regression analysis showed that multiple organ dysfunction syndrome, mechanical ventilation time≥ 10 h, intestinal dysfunction time≥ 4 d, renal failure, hypoxemia, APACHE Ⅱ>11 points were independent risk factors of SAP complicated with abdominal infection (P<0.05). Compared with healthy patients, patients with SAP have a lower quality of life and required continuous health intervention outside the hospital. In addition, SAP complicated with abdominal infection is associated with many factors, which should be paid attention to clinically and relevant countermeasures should be taken actively to improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

This study was conducted in the Al Batool Teaching Hospital in Ba'aqubah in Diyala city, from August 2019 to December 2019. In children under 10 years patients suffering from diarrhea with different gastrointestinal complaints, Stool samples were collected from each patients use for microscopic examination and Culture and sensitivity test. Diarrheal diseases are major problem of developing countries. Though precise data on childhood mortality associated with diarrheal diseases in Iraq is not available, it has been estimated that approximately 25% of child death are associated with diarrheal disease, particularly acute diarrhea. The purpose of this study was to detect causative agent of acute diarrhea in children less than 10 years of age. With the study of sensitivity to certain antibiotics. Bacterial pathogen infected cases 30 (60%) male and 20(40%) female, among the total enrolled cases the Escherichia coli was 30(60%), Klebsiella species was 17(34%) and kluyvera ascorbate species was 3 (6%). also the study detected that bacterial infection was found to be of highest percentage, 26(52%) in the age group less than 1 year, The least infection2 (4%) was found in group between 7-8. There were no detectable cases of bacterial infection among the age group of 9-10 years in this study. Amikacin showed efficacy in 26(96.6%) isolates of E.coli species, also showed efficacy in 16(94.1%) isolate of Klebsiella spp. Amikacin, cefepime, meropenem, gantamicin showed efficacy in 3(100%) isolate of Kluyvera ascorbate. [ABSTRACT FROM AUTHOR]

Objective: To analyze the common pathogenic bacteria and drug resistance of patients with abdominal infection after colorectal cancer surgery, and to explore the risk factors and the effect on the prognosis of patients. Methods: A retrospective study was conducted on 225 patients who underwent radical operation for colorectal cancer from January 2012 to January 2015. According to the occurrence of abdominal infection after operation, the patients were divided into infection group (31 cases) and uninfected group (194 cases). The suspected infected patients were identified by pathogen culture and drug sensitivity test, and the risk factors of abdominal infection after radical operation for colorectal cancer were analyzed. The mortality, progression-free survival (PFS) and recurrence rates were compared between the two groups. Results: The incidence of abdominal infection with patients after colorectal cancer surgery was 13.77%. A total of 67 strains of strains detected, gram negative bacteria had the highest detection rate, followed by gram-positive bacteria and fungi. Escherichia coli was sensitive to imipenem and the drug resistance rate was 0% . Klebsiella pneumoniae was sensitive to imipenem, Amikacin and tobramycin, and the drug resistance rates were 0%. Pseudomonas aeruginosa was sensitive to tobramycin, and the drug resistance rate was 11.11% . Staphylococcus epidermidis was more sensitive to levofloxacin, tobramycin, ciprofloxacin and imipenem, and the drug resistance rates were 0%, 0%, 12.50% and 12.50% respectively. Single factor analysis showed that abdominal infection after colorectal cancer surgery was related to preoperative hemoglobin level, preoperative serum albumin level, diabetes mellitus, TNM stage, Dukes stage, operation type, operation time, intraoperative bleeding, viscera resection, postoperative stoma, anastomotic fistula and postoperative drainage tube retention time (P<0.05). Multiple Logistic regression analysis showed that combined diabetes mellitus, combined visceral resection, preoperative serum albumin level<35 g/L, operation time>160 min, postoperative stoma, anastomotic fistula and postoperative drainage tube retention time≥ 11d were the independent risk factors of abdominal infection after colorectal cancer surgery (P<0.05). Compared with the uninfected group, the 3-year mortality and recurrence rate of the infected group was higher, and PFS was significantly shortened (P<0.05). Conclusion: Abdominal infection after colorectal cancer surgery is affected by many factors, with high infection rate and poor prognosis. The infection pathogenic bacteria are mainly gram-negative bacteria, and the antibiotics have certain resistance. Preventive measures should be taken for patients with diabetes mellitus, low preoperative serum albumin level,intraoperative combined visceral resection, long operation time, postoperative stoma, anastomotic fistula and long postoperative drainage tube retention time to prevent post-operative infection, and imipenem and tobramycin can be used to prevent and treat peritoneal infection caused by drug-resistant bacteria after radical resection of colorectal cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk factors of abdominal infection after pancreaticoduodenectomy and analyze its etiological characteristics and drug sensitivity test. Methods: The clinical data of 60 cases undergoing pancreaticoduodenectomy in the 967th Hospital of the PLA Joint Logistics Support Force from January 2016 to December 2018 were retrospectively analyzed, the risk factors for postoperative abdominal infection were analyzed. The distribution and drug resistance of pathogenic bacteria in patients with postoperative abdominal infection were analyzed according to the results of bacterial culture and drug sensitivity test. Results: Univariate analysis showed that intraoperative blood transfusion, pulmonary infection, biliary fistula and pancreatic fistula were all related to the occurrence of abdominal infection (P<0.05). Multivariate Logistic regression analysis showed that intraoperative blood transfusion greater than 1000 mL, pulmonary infection, biliary fistula and pancreatic fistula were risk factors for abdominal infection after pancreaticoduodenectomy (P<0.05). A total of 54 strains were cultured in the peritoneal drainage fluid of 20 patients with postoperative abdominal infection. Among them, 23 strains (42.59%), 28 strains (51.85%) and 3 strains (5.56%) were Gram-positive bacteria. The main Gram-positive bacteria (Enterococcus faecalis, Staphylococcus epidermidis) were less sensitive to ciprofloxacin and erythromycin, all were below 17.00%, the sensitivity rates to linezolid and vancomycin were 100.00%. The main Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae) less sensitive to ceftazidime, cefazolin and piperacillin, all were below or equal to 25.00%, the susceptibility rates to gentamicin and imipenem were higher, all were higher or equal to 80.00%. Conclusion: Excessive blood transfusion during operation and occurrence of pulmonary infection, biliary fistula and pancreatic fistula are risk factors for abdominal infection after pancreaticoduodenectomy. Antibiotics should be use targetedly in clinic according to the results of drug sensitivity test. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore clinical characteristics, prevention and treatment of advanced infection as a complication of ventriculoperitoneal (VP) shunt. MethodsThe clinical data of 4 patients with hydrocephalus underwent VP shunt admitted in Peking Union Medical College Hospital were analyzed retrospectively. Results3 cases of abdominal infection and 1 of multisystemic infection were presented, all of which were patients developing hydrocephalus after neurosurgery. 2 of them were cases of adhesive intestinal obstruction and intracranial infection, 1 case was multiple abdominal abscesses, while the other one was a case of intracranial infection combined with urinary tract infection and pulmonary infection. These 4 patients were treated effectively by shunt removal and intravenous administration of antibiotics and there was no relapse during the 6-month follow-up. ConclusionsVP-shunt related advanced infection has non-specific clinical manifestations and is often associated with intracranial infection. Staphylococcus is one of the major pathogens. Shunt removal or externalization and systematic antibiotics treatment is usually required. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the entry points and methods of pharmaceutical care for patients with abdominal infection after biliary tract surgery by clinical pharmacists, so as to provide references for the comprehensive analysis and treatment of postoperative secondary infections. METHODS: Clinical pharmacists participated in the whole course of treatment on a patient with abdominal infection after biliary tract surgery, learned about the underlying disease, clinical symptoms, laboratory test results and medication history of patients, analyzed the pathogenic bacteria of postoperative infection and assisted clinicians in formulating individualized therapeutic regimen with the combination of high risk factors of abdominal infection. RESULTS: Through comprehensive analysis, it was concluded that the pathogenic bacteria induced abdominal infection were mainly Pseudomonas aeruginosa, anaerobic bacteria and enterococcus, which can be effectively covered by cefoperazone sulbactam, ornidazole and linezolid, so that the infection was controlled in time. CONCLUSION: Clinical pharmacists have applied pharmaceutical knowledge and clinical experience to participate in the formulating of anti-infective individualized therapeutic regimen on providing effective pharmaceutical services for patients and medical staff. [ABSTRACT FROM AUTHOR]

Abstract Carbapenem resistant Klebsiella pneumoniae (CRKP) nosocomial infection increased rapidly in recent years. By far, the anti-infection drugs for CRKP infection are limited. Tigecycline is one of the last resort treatments for CRKP infections. In this study, curative effect of tigecycline therapy was monitored in a 59-year-old male patient infected with KPC-producing K. pneumoniae. Consecutive clonal consistent K. pneumoniae isolates were cultured during tigecycline treatment. Whole genome sequencing of the isolates was performed, and bioinformatics analysis was further performed. Five isolates, four of which were susceptible and one resistant were collected. All of the isolates belong to Sequence Type 11 (ST11), and harbouring 11 gene sequences relevant to antibiotic resistance including bla KPC-2. One amino acid substitution V57L in rpsJ was identified in the tigecycline resistant isolates. Subsequent transformation experiment confirmed the contribution of the rpsJ variant (V57L) to reduced tigecycline susceptibility. To our knowledge, this study is the first report to provide direct in vivo evidence that evolution in the rpsJ gene can lead to tigecycline resistance in patients infected with KPC-producing K. pneumoniae during tigecycline treatment. This finding serves as a therapeutic warning as the rpsJ gene is on the chromosome of CRKP strains. Under selective pressure from tigecycline, the rpsJ mutation may occur and lead to tigecycline resistant. Highlights • Curative effect of tigecycline therapy was monitored in a 59-year-old male patient infected with KPC-producing K. pneumoniae. • This study provides direct in vivo evidence that evolution in the rpsJ gene can lead to tigecycline resistance. • This finding serves as a therapeutic warning that the rpsJ mutation may occur under selective pressure from tigecycline. [ABSTRACT FROM AUTHOR]