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Multidrug-resistant Pseudomonas aeruginosa, which was only susceptible to colistin, was isolated from the urine of a patient with pyelonephritis. The isolates were confirmed as class A Extended-spectrum-β-lactamase-producing isolates. A blaBEL allele was detected by multiplex polymerase chain reaction. The organisms were identified as ST235, serotype O11. Chinese herbal decoction was orally administered. The patient returned 8 days later with relief of symptoms. No P. aeruginosa was isolated from two urine samples taken after 1 week and 2 weeks from the end of herbal therapy. The case supports the notion that these Chinese herbs are useful in treating pyelonephritis caused by multidrug-resistant P. aeruginosa. Chinese herbal medicine has allowed another choice of treatment. [ABSTRACT FROM AUTHOR]

Background: Clinical isolates of herb-resistant uropathogenic E. coli were isolated. It was possible that the virulence genotypes and phylogenetic background of E. coli differed between Chinese herb-resistant E. coli and -susceptible isolates. For this purpose, the prevalence of virulence factors (VFs) and phylogenetic background, with regard to Chinese herb resistance, among E. coli strains causing acute pyelonephritis from China were investigated., Materials and Methods: E. coli isolates from patients with acute pyelonephritis were used in this study. Standard disc diffusion methodology was used to test the susceptibility of Chinese herbal concoction against E. coli strains. Multiplex PCR amplifications employed three markers (chuA, yjaA, and TSPE4.C2) to classify E. coli isolates into one of four phylogenetic groups (group A, B1, B2, or D). The isolates were also tested for 14 virulence-associated traits (VFs) of uropathogenic E. coli., Results: A total of 115 E. coli strains were isolated. 79 (68.7%) were susceptible and 36 (31.3%) were resistant to the herbal concoction. 20.9% of the isolates encoded three or more of VFs for which they were screened, with 13.9% in susceptible isolates and 36.1% in resistant isolates. The key VFs (fyuA and/or iutA siderophores) present in >80% of isolates. The papA and papC adhesins were detected in the majority of resistant isolates (72.2% and 63.9% respectively). 78.5% of susceptible isolates belong to phylogenetic groups A, while 83.3% of resistant isolates belong to group B2., Conclusion: PapA and papC are significant VFs with an essential role in contributing to Chinese herb-resistance. Chinese herb-resistance is associated with a shift towards more virulent strains and B2 phylogenetic group.

Background: In order to define the virulence factors between Chinese herb-resistant uropathogenic E. coli and susceptible strains, the UPEC isolates were classified into two groups according to its resistance to Chinese herbs., Materials and Methods: The susceptibility profile of strains was determined by disk diffusion method. PCR systems were used to detect genes encoding papC, Aer, hly and cnf1. Isolated human urothelial cells were incubated in vitro and investigated with light microscope immunohistochemistry. Adhesion of E. coli to urothelial cells was studied in vitro., Results: The results showed that, among the 105 UPEC isolates, 18 were resistant to the herbal concoction. Cnf1 and papC occurred in ≥66.7%, of herb-resistant isolates, while, hly and Aer occurred in 22.2% and 27.8% of strains respectively. Only one gene (Cnf1) occurred in >40%, of Herb-susceptible isolates. Other genes were also found in susceptible isolates: papC (20.7%), hly (11.5%), and Aer (6.9%). Light microscopy and immunochemical investigations demonstrated the normal pelvic transitional epithelial cells cultured. The adherence of strains in both groups increased in 30 min., and reached its peak at 60, (Susceptible E. coli) or 120 min., (Resistant E. coli). The adhesion of the susceptible bacteria to human uroepithelial cells was significantly lower compared with that of the resistant E. coli (p<0.05)., Conclusion: These findings revealed that, Chinese herb-resistant uropathogenic E. coli isolates that are hemolytic, and have Aer, papC, hly, Cnf1 genes are more able to be uropathogenic and adherent.

A 48-year-old asian man was admitted to hospital for the consideration of hemodialysis (HD). An adequate site was decided on for the AVF after Doppler ultrasonography examination of radial artery and cephalic vein. The AVF was formed under local anaesthetic at his right wrist. When seen at the clinic appointment one month later, the AVF was not working. The subsequent Doppler ultrasonography examination revealed two straight shunts at draining vein. The failure of AVF is due to impaired outflow following reduction of the resistance between draining vein and peripheral venous system.

We have used reduced doses of Chinese herbs for estimation of urinary tract infections (UTIs) patients with stable impairment of renal function. A total of 33 adult female patients with moderately impaired renal function and symptomatic UTIs were included in this study. Urine cultures were carried out. Patients were monitored clinically and with various laboratory tests. Chinese herbal concoction divided by milligrams of creatinine per 100 ml were orally administrated for ten days. Three patients were excluded from final analysis. Most of the patients responded symptomatically to treatment. Chinese herbs eradicated the primary pathogen in 68.7% of the patients at the day 10 of treatment. Two patients relapsed (one had abbreviated courses of therapy) 6 to 8 days posttreatment. Organisms which recurred included Escherichia coli and Pseudomonas aeruginosa. Bacterial reinfections occurred 5 to 8 days posttreatment in four patients. Adverse reactions observed among the 30 patients were rare. Nausea (6.67%) and mild elevation of hepatic enzymes (3.33%) were probably drug related. Nausea disappeared when the therapy ended. Elevated hepatic enzymes resumed at the 2-week follow-up. Two patients demonstrated slight increases in serum creatinine on day 10 of treatment. One patient had a 12.5% elevation over baseline and the other had a 13.0% elevation. Serum creatinine values had improved in these two patients at 4-week follow-up. Chinese herbal medicine was effective and safe in the treatment of UTIs with renal insufficiency.

The aim of this study is to evaluate Chinese herbs' efficacy on adhesive properties of Escherichia coli (E. coli). The effects of Chinese herbal solution on the hemagglutination and adhesion by E. coli strain were studied. E. coli C16 was isolated from a patient with urinary tract infection. The MIC value of herbal solution for the E. coli C16 was 0.1g/ml. The MBC value was 0.2g/ml. The effects of herbal solution on the hemagglutination abilities of E. coli C16 were dependent on the herbal solution used. The strain C16 lost half of its hemagglutination abilities when the herbal solution concentration was at MIC (0.05g/ml). Herbal solution decreased the adherence of strain C16 in a dose-dependent way. The numbers of adherent bacteria were reduced to 45% of the control values after growth with herbal solution at MIC. The results show that anti-adhesion is one mode of action for Chinese herbs used against pathogens.

We assessed the effects of Chinese herbs on the uncomplicated urinary tract infections (UTIs) in women caused by fluoroquinolone-resistant strains. A total of 56 pre-menopausal women with uncomplicated UTIs caused by fluoroquinolone-resistant strains were included. Urine cultures were carried out. All organisms were proved to be fluoroquinolone-resistant at baseline. The patients were orally administrated Chinese herbal concoction for ten days. Chinese herbal concoction eradicated the primary pathogen in 71.4% of the patients at the 1-week follow-up. Among the 20 patients who had bacteriologic failures in the Day 5 of treatment, 2 developed superinfection. Of the failures in the group, Proteus mirabilis, Staphylococcus epidermidis and Providencia rettgeri were implicated in 50.0%, 50.0% and 100.0% of the failures, respectively. The clinical outcomes were also good, with cure or improvement for more than 80% of all subjects. About 14% of the study subjects reported at least one potential adverse event. The adverse events most frequently reported were nausea and diarrhea. All patients tolerated the symptoms. The adverse reactions did not prevail after discontinuation of the medication. Chinese herbal therapy may be an acceptable alternative for the treatment of uncomplicated UTIs caused by fluoroquinolone-resistant uropathogens.

The aim of the study is to evaluate the efficacy of Chinese herbs (Angelica sinensis, Ligusticum wallichii, Salvia miltiorrhiza, Rhizoma dioscoreae, Rhodiola crenilata, Astragalus membranaceus and Angelica sinensis) on adenine-induced chronic renal failure in rats. 30 age-matched male Wistar rats were divided into three groups. Rats in group A (n = 10), B (n = 10) and C (n = 10) were fed a standard laboratory chow and allowed tap water ad libitum. In group B and C, renal failure was induced by the administration of a diet containing 0.75% adenine for 28 days which began at day 0. Rats in group C were given Chinese herbs (40 ml/kg with drug concentration 1.75 g/ml) beginning at day 0. Urine albumin, blood urea nitrogen (BUN) and creatinine were determined at days 0, 14 and 28. At day 28, the animals were killed and their kidneys removed for light microscope evaluation. Body weight in Group B decreased more significantly than that in Group C (p = 0.032) at day 28. The rats in group B demonstrated more severe proteinuria and higher Serum creatinine and BUN levels than group C at day 14 and day 28 (P < 0.05, 0.01). All rats given adenine developed marked structural renal damage involving the tubule and interstitium. The values were much less severe in group C than those in group B. In adenine-induced chronic renal failure rats, the protective effects of these Chinese herbs were of a significant nature. Our results do support the notion that these Chinese herbs are useful in deferring the advance of chronic renal failure. We recommend Chinese herbs as a beneficial treatment for pre-end stage chronic renal failure.