| emerging antimicrobial resistance in early and late-onset neonatal sepsis. | compared to developed countries, the use of antimicrobials in egypt is less regulated and is available over the counter without the need for prescriptions. the impact of such policy on antimicrobial resistance has not been studied. this study aimed to determine the prevalence of early and late onset sepsis, and the frequency of antimicrobial resistance in a major referral neonatal intensive care unit (nicu). | 2017 | 28630687 |
| identifying spectra of activity and therapeutic niches for ceftazidime-avibactam and imipenem-relebactam against carbapenem-resistant enterobacteriaceae. | we determined imipenem, imipenem-relebactam, ceftazidime, and ceftazidime-avibactam mics against 100 cre isolates that underwent whole-genome sequencing. klebsiella pneumoniae carbapenemases (kpcs) were the most common carbapenemases. forty-six isolates carried extended-spectrum β-lactamases (esbls). with the addition of relebactam, imipenem susceptibility increased from 8% to 88%. with the addition of avibactam, ceftazidime susceptibility increased from 0% to 85%. neither imipenem-relebactam no ... | 2017 | 28630202 |
| antibiotic resistance determinants and clonal relationships among multidrug-resistant isolates of klebsiella pneumoniae. | in the present study, we performed pcr based screening to determine the presence of antibiotic resistance genes and sequencing to find mutation in qrdr region among fourteen isolates of k. pneumoniae. association analysis was conducted to detect the co-resistance among the isolates. multi-locus sequence analysis was carried out to determine the clonal relationship among them. all the k. pneumoniae isolates showed resistance to multiple antibiotics and exhibited cross-resistance to antibiotics. a ... | 2017 | 28629728 |
| molecular characterization of clinical imp-producing klebsiella pneumoniae isolates from a chinese tertiary hospital. | imp-producing klebsiella pneumoniae (impkpn) exhibits sporadic prevalence in china. the mechanisms related to the spread of impkpn remain unclear. | 2017 | 28629366 |
| resistance to colistin in klebsiella pneumoniae: a 4.0 strain? | the global rise of multidrug-resistant gram-negative bacteria represents an increasing threat to patient safety. from the first observation of a carbapenem-resistant gram-negative bacteria a global spread of extended-spectrum beta-lactamases and carbapenemases producing klebsiella pneumoniae has been observed. treatment options for multidrug-resistant k. pneumoniae are actually limited to combination therapy with some aminoglycosides, tigecycline and to older antimicrobial agents. unfortunately, ... | 2017 | 28626539 |
| acyloxyacyl hydrolase promotes the resolution of lipopolysaccharide-induced acute lung injury. | pulmonary infection is the most common risk factor for acute lung injury (ali). innate immune responses induced by microbe-associated molecular pattern (mamp) molecules are essential for lung defense but can lead to tissue injury. little is known about how mamp molecules are degraded in the lung or how mamp degradation/inactivation helps prevent or ameliorate the harmful inflammation that produces ali. acyloxyacyl hydrolase (aoah) is a host lipase that inactivates gram-negative bacterial endotox ... | 2017 | 28622363 |
| clinical features and prognostic factors of klebsiella endophthalmitis-10-year experience in an endemic region. | aimsto identify the clinical features and prognostic factors of endogenous endophthalmitis caused by klebsiella pneumoniae.methodsthis is a retrospective case series of all patients with klebsiella endophthalmitis managed from january 2006 to december 2015 by kowloon east ophthalmic service. statistical analysis involved hypothesis testing on the spss 18.0 software (spss). a significance level of p<0.05 was taken.resultsin the 10-year period, k. pneumoniae accounted for 19 out of 39 cases of end ... | 2017 | 28622312 |
| identification of pathogenic factors in klebsiella pneumoniae using impedimetric sensor equipped with biomimetic surfaces. | k.pneumoniae is an opportunistic pathogen that causes nosocomial infections, such as, pneumonia, urinary tract infections, septic shock, and gastro intestinal disease. lipopolysaccharide (lps), capsular polysaccharide, and fimbriae are recognized major virulence factors of k.pneumoniae and play key roles during early stages of infections. in this study, we functionalized the surface of gold electrode with mannose and mucin to monitor the adhesion-associated virulence factors of k.pneumoniae. the ... | 2017 | 28617330 |
| demonstration that a klebsiella pneumoniae subsp. pneumoniae isolated from an insect (nezara viridula) harbors a plasmid-borne type iv secretion system. | previously, we reported the isolation of klebsiella pneumoniae subspecies pneumoniae strain kp 5-1 from a southern green stink bug (nezara viridula) that is a significant pest of numerous economically important crops. we subsequently sequenced the strains whole genome. here, we report the presence of a functional plasmid-borne type iv secretion (tfss) system that was identified using genomic mining of the annotated genome. comparison of the kp 5-1 resident 186 kb plasmid (pkp 5-1) with nine othe ... | 2017 | 28616744 |
| serum inflammatory biomarkers and clinical outcomes of copd exacerbation caused by different pathogens. | copd exacerbation is characterized by worsening of symptoms, warranting change in treatment. systemic and airway inflammation play roles in the pathogenesis of copd exacerbation. we hypothesized whether increased serum inflammatory biomarkers are associated with the clinical outcomes of copd exacerbation caused by different infectious pathogens. | 2017 | 28615935 |
| multi-drug resistant klebsiella pneumoniae strains circulating in hospital setting: whole-genome sequencing and bayesian phylogenetic analysis for outbreak investigations. | carbapenems resistant enterobacteriaceae infections are increasing worldwide representing an emerging public health problem. the application of phylogenetic and phylodynamic analyses to bacterial whole genome sequencing (wgs) data have become essential in the epidemiological surveillance of multi-drug resistant nosocomial pathogens. between january 2012 and february 2013, twenty-one multi-drug resistant k. pneumoniae strains, were collected from patients hospitalized among different wards of the ... | 2017 | 28615687 |
| intraventricular administration of tigecycline for the treatment of multidrug-resistant bacterial meningitis after craniotomy: a case report. | intracranial infections, especially multidrug-resistant (mdr) bacterial meningitis, are one of the most severe complications after craniotomy and may greatly impact patient outcomes. | 2017 | 28614982 |
| a carbon-dot-based fluorescent nanosensor for simple visualization of bacterial nucleic acids. | a simple and facile method for sensing of nucleic acids is in great need for disease biomarker detection and diagnosis. herein, a fluorescent nanosensor utilizing carbon dot nanoparticles is introduced that form visible precipitates in the presence of target dna. carbon dot nanoparticles are fabricated by microwave pyrolysis of polyethylenimine, which emits strong photoluminescence and can form precipitates when added to target dna oligonucleotides. the precipitates can be easily visualized by u ... | 2017 | 28614623 |
| the potential of a brown microalga cultivated in high salt medium for the production of high-value compounds. | amphora sp. was isolated from the sfax solar saltern and cultivated under hypersaline conditions. it contains moderate rates of proteins, lipids, sugars, and minerals and a prominent content of bioactive compounds: polyphenols, chlorophyll a, carotenoids, and fatty acids. the analysis of fatty acids with gc/ms showed that the c16 series accounted for about 75% of amphora sp. lipids. saturated fatty acids whose palmitic acid was the most important (27.41%) represented 41.31%. amphora sp. was foun ... | 2017 | 28612024 |
| a fragment of the alarmin prothymosin α as a novel biomarker in murine models of bacteria-induced sepsis. | sepsis is a life-threatening condition that requires urgent care. thus, the identification of specific and sensitive biomarkers for its early diagnosis and management are of clinical importance. the alarmin prothymosin alpha (protα) and its decapeptide protα(100-109) are immunostimulatory peptides related to cell death. in this study, we generated bacterial models of sepsis in mice using two klebsiella pneumoniae strains (l-78 and atcc 43816) and monitored sepsis progression using protα(100-109) ... | 2017 | 28611290 |
| in vitro-in vivo discordance with humanized piperacillin-tazobactam exposures against piperacillin-tazobactam-resistant/pan-β-lactam-susceptible klebsiella pneumoniae strains. | recent findings have identified klebsiella pneumoniae strains that are pan-β-lactam susceptible (pbl-s) but piperacillin-tazobactam resistant (tzp-r) in vitro we assessed the efficacy of a humanized exposure of piperacillin-tazobactam (tzp) against 12 tzp-r/pbl-s k. pneumoniae isolates in an immunocompromised murine lung infection model. discordance between the in vitro resistance profile and the in vivo efficacy of human-simulated tzp exposures against this phenotypic profile was observed. addi ... | 2017 | 28607019 |
| alcohol-associated intestinal dysbiosis impairs pulmonary host defense against klebsiella pneumoniae. | chronic alcohol consumption perturbs the normal intestinal microbial communities (dysbiosis). to investigate the relationship between alcohol-mediated dysbiosis and pulmonary host defense we developed a fecal adoptive transfer model, which allows us to investigate the impact of alcohol-induced gut dysbiosis on host immune response to an infectious challenge at a distal organ, independent of prevailing alcohol use. male c57bl/6 mice were treated with a cocktail of antibiotics (ampicillin, gentami ... | 2017 | 28604843 |
| clinical predictors and outcomes of klebsiella pneumoniae bacteraemia in a regional hospital in hong kong. | klebsiella pneumoniae (kp) infection is associated with high morbidity and mortality. multidrug resistance, especially extended-spectrum β-lactamase (esbl) production, in kp is endemic worldwide. | 2017 | 28602703 |
| surveillance of carbapenemase-producing enterobacteriaceae in the indian ocean region between january 2010 and december 2015. | the aim of this study was to trace the emergence of carbapenemase-producing enterobacteriaceae (cpe) on reunion island, a french overseas territory well suited for the surveillance of cpe emergence in patients from the entire indian ocean region. | 2017 | 28602387 |
| an unusual case of primary hepatic lymphoma with dramatic but unsustained response to bendamustine plus rituximab and literature review. | primary hepatic lymphoma is an uncommon cause of hepatic space-occupying lesions. | 2017 | 28596829 |
| cooperative interactions between toll-like receptor 2 and toll-like receptor 4 in murine klebsiella pneumoniae infections. | klebsiella pneumoniae is an opportunistic and clinically significant emerging pathogen. we investigated the relative roles of toll-like receptor (tlr) 2 and tlr4 in initiating host defenses against k. pneumoniae. tlr2 knockout (ko), tlr4 ko, tlr2/4 double ko (dko), and wild-type (wt) mice were inoculated with k. pneumoniae. mice in each group were sacrificed after either 12 or 24h, and the lungs, liver, and blood were harvested to enumerate bacterial colony-forming units (cfu). cytokine and chem ... | 2017 | 28595383 |
| epidemiology of carbapenem-resistant klebsiella pneumoniae bloodstream infections in a chinese children's hospital: predominance of new delhi metallo-β-lactamase-1. | the spread of carbapenem-resistant klebsiella pneumoniae (crkp) has become a significant problem worldwide; however, relevant data in children are limited. we performed a retrospective study to better understand the epidemiology of crkp bloodstream infections at beijing children's hospital. a total of 164 k. pneumoniae strains were collected from blood cultures between january 2011 and september 2014, of which 52 (31.7%) were crkp strains. all 52 crkp strains were multidrug resistant; 46 (88.5%) ... | 2017 | 28594635 |
| synthesis and evaluation of antimicrobial activity of [r₄w₄k]-levofloxacin and [r₄w₄k]-levofloxacin-q conjugates. | the development of a new class of antibiotics to fight bacterial resistance is a time-consuming effort associated with high-cost and commercial risks. thus, modification, conjugation or combination of existing antibiotics to enhance their efficacy is a suitable strategy. we have previously reported that the amphiphilic cyclic peptide [r₄w₄] had antibacterial activity with a minimum inhibitory concentration (mic) of 2.97 µg/ml against methicillin-resistant staphylococcus aureus (mrsa). herein, we ... | 2017 | 28594345 |
| relationship between β-lactamase production and resistance phenotype in klebsiella pneumoniae strains. | this study was designed to evaluate the resistance phenotypes of β-lactamases-producing klebsiella pneumoniae strains. the antibiotic susceptibility and β-lactamase activity of k. pneumoniae strains, including antibiotic-sensitive k. pneumoniae (kpwt), ciprofloxacin-induced resistant k. pneumoniae (kpcip) and clinically isolated k. pneumoniae strains (kpci237, kpci263 and kpci272) were determined in the absence and presence of β-lactamase inhibitors (bli 489, sulbactam, clavulanate and tazobacta ... | 2017 | 28591808 |
| activity of ceftazidime-avibactam against clinical isolates of klebsiella pneumoniae, including kpc-carrying isolates, endemic to new york city. | in this report, we examined the (1) activity of ceftazidime-avibactam against clinical isolates klebsiella pneumoniae, including those harboring blakpc, (2) potential mechanisms leading to reduced susceptibility, and (3) activity of ceftazidime-avibactam when combined with other agents. of 802 carbapenem-resistant isolates of k. pneumoniae gathered from new york city from 1999 to 2014, all were susceptible to ceftazidime-avibactam. minimum inhibitory concentrations (mics) were higher in isolates ... | 2017 | 28590820 |
| differential th17 response induced by the two clades of the pandemic st258 klebsiella pneumoniae clonal lineages producing kpc-type carbapenemase. | the spread of kpc-type carbapenemases is mainly attributed to the global dissemination of klebsiella pneumoniae (kp) strains belonging to the clonal group (cg) 258, including sequence type (st) 258 and other related sts. two distinct clades of cg258-kp have evolved, which differ mainly for the composition of their capsular polysaccharides, and recent studies indicate that clade 1 evolved from an ancestor of clade 2 by recombination of a genomic fragment carrying the capsular polysaccharide (cps) ... | 2017 | 28586386 |
| knowledge and attitude of physicians about antimicrobial resistance and their prescribing practices in services hospital, lahore, pakistan. | a cross sectional study was conducted in services hospital, lahore using a self administered questionnaire to test the knowledge, attitude and prescribing practices of residents and attending physicians using non-probability convenience sampling. a total of 116 questionnaires were filled (response rate=77.3%). knowledge was below average (mean score of 3.66±1.1). only 18 physicians (16%) could correctly estimate the rates of resistance of klebsiella pneumoniae and pseudomonas aeruginosa to cepha ... | 2017 | 28585611 |
| a study of 24 patients with colistin-resistant gram-negative isolates in a tertiary care hospital in south india. | as the use of colistin to treat carbapenem-resistant gram-negative infections increases, colistin resistance is being increasingly reported in indian hospitals. | 2017 | 28584435 |
| susceptibility of colistin-resistant, gram-negative bacteria to antimicrobial peptides and ceragenins. | the susceptibility of colistin-resistant clinical isolates of klebsiella pneumoniae to ceragenins and antimicrobial peptides (amps) suggests that there is little to no cross-resistance between colistin and ceragenins/amps and that lipid a modifications are found in bacteria with modest changes in susceptibility to ceragenins and with high levels of resistance to colistin. these results suggest that there are differences in the resistance mechanisms to colistin and ceragenins/amps. | 2017 | 28584137 |
| risk factors and clinical outcomes for carbapenem-resistant gram-negative late-onset sepsis in a neonatal intensive care unit. | carbapenem-resistant (cr), gram-negative (gn), late-onset sepsis (los) is a serious threat in the neonatal intensive care unit (nicu). | 2017 | 28583886 |
| synergistic activities of meropenem double and triple combinations against carbapenemase-producing enterobacteriaceae. | the increasing emergence of carbapenemase-producing enterobacteriaceae poses a considerable threat to global health as only limited treatment options are available and has therefore led to efforts to discover antibiotic combination regimens effective. the aim of this study was to evaluate in vitro synergistic activity of 10 meropenem double and triple combinations against the 5 most frequently encountered carbapenemases-producing enterobacteriaceae. broth microdilution assays showed that the mer ... | 2017 | 28583381 |
| genome watch: klebsiella pneumoniae: when a colonizer turns bad. | | 2017 | 28579608 |
| ventilator-associated pneumonia: the role of emerging diagnostic technologies. | antibiotic resistance has emerged as a key determinant of outcome in patients with serious infections along with the virulence of the underlying pathogen. within the intensive care unit (icu) setting, ventilator-associated pneumonia (vap) is a common nosocomial infection that is frequently caused by multidrug-resistant bacteria. antimicrobial resistance is a growing challenge in the care of critically ill patients. escalating rates of antibiotic resistance add substantially to the morbidity, mor ... | 2017 | 28578550 |
| draft genome sequence of a ctx-m-15-producing endophytic klebsiella pneumoniae st198 isolate from commercial lettuce. | ctx-m-15-producing klebsiella pneumoniae is one of the leading causes of hospital-acquired infections globally. in this study, we present the draft genome sequence of the first ctx-m-15-producing endophytic k. pneumoniae strain, belonging to sequence type 198 (st198) and isolated from commercial lettuce, which can be used as a reference sequence for comparative analysis with clinical and environmental strains of k. pneumoniae. | 2017 | 28576742 |
| antimicrobial resistance of klebsiella pneumoniae stool isolates circulating in kenya. | we sought to determine the genetic and phenotypic antimicrobial resistance (amr) profiles of commensal klebsiella spp. circulating in kenya by testing human stool isolates of 87 k. pneumoniae and three k. oxytoca collected at eight locations. over one-third of the isolates were resistant to ≥3 categories of antimicrobials and were considered multidrug-resistant (mdr). we then compared the resistance phenotype to the presence/absence of 238 amr genes determined by a broad-spectrum microarray and ... | 2017 | 28575064 |
| nickel sequestration by the host-defense protein human calprotectin. | the human innate immune protein calprotectin (cp, s100a8/s100a9 oligomer, calgranulin a/calgranulin b oligomer, mrp-8/mrp-14 oligomer) chelates a number of first-row transition metals, including mn(ii), fe(ii), and zn(ii), and can withhold these essential nutrients from microbes. here we elucidate the ni(ii) coordination chemistry of human cp. we present a 2.6-å crystal structure of ni(ii)- and ca(ii)-bound cp, which reveals that cp binds ni(ii) ions at both its transition-metal-binding sites: t ... | 2017 | 28573847 |
| therapeutic potentials of ethanolic extract of leaves of holarrhena floribunda (g. don) dur. and schinz (apocynaceae). | holarrhena floribunda is a plant of wide usage in the togolese folk medicine. a previous ethnobotanical survey on the latex plants of the maritime region of the country revealed that this plant was included in several recipes curing malaria and microbial infections. therefore, this study aimed to seek for the effectiveness of the ethanolic extract of the plant in the treatment of these diseases. | 2017 | 28573239 |
| φbo1e, a newly discovered lytic bacteriophage targeting carbapenemase-producing klebsiella pneumoniae of the pandemic clonal group 258 clade ii lineage. | the pandemic dissemination of kpc carbapenemase-producing klebsiella pneumoniae (kpc-kp) represents a major public health problem, given their extensive multidrug resistance profiles and primary role in causing healthcare-associated infections. this phenomenon has largely been contributed by strains of clonal group (cg) 258, mostly of clade ii, which in some areas represent the majority of kpc-kp isolates. here we have characterized a newly discovered lytic podoviridae, named φbo1e, targeting kp ... | 2017 | 28572684 |
| a high-throughput screening strategy to identify inhibitors of ssb protein-protein interactions in an academic screening facility. | antibiotic-resistant bacterial infections are increasingly prevalent worldwide, and there is an urgent need for novel classes of antibiotics capable of overcoming existing resistance mechanisms. one potential antibiotic target is the bacterial single-stranded dna binding protein (ssb), which serves as a hub for dna repair, recombination, and replication. eight highly conserved residues at the c-terminus of ssb use direct protein-protein interactions (ppis) to recruit more than a dozen important ... | 2017 | 28570838 |
| risk factors for recurrent carbapenem resistant klebsiella pneumoniae bloodstream infection: a prospective cohort study. | to assess risk factors for recurrent carbapenem-resistant klebsiella pneumoniae bloodstream-infection (cr-kp bsi), we performed a prospective observational cohort study of all consecutive adult patients cured of a cr-kp bsi at our hospital over a six-year period (june 2010 to june 2016). maximum follow-up per patient was 180 days from the index blood cultures (bcs). recurrent cr-kp bsi was defined as new evidence of positive bcs in patients with documented clinical response after completing a co ... | 2017 | 28567543 |
| experimental sepsis severity score associated to mortality and bacterial spreading is related to bacterial load and inflammatory profile of different tissues. | pneumonia-induced sepsis is responsible for about 50% of cases in the world. patients who develop severe sepsis and septic shock present organ dysfunction and elevated plasma cytokine levels, which may lead to death. clinical scores are important to evaluate the framework of septic patients and are used to predict the syndrome progress, prognostics, and mortality. the objective of the present study was to verify the applicability of a murine clinical score system to experimental sepsis (pneumoni ... | 2017 | 28567497 |
| structural insights into the elevator-like mechanism of the sodium/citrate symporter cits. | the sodium-dependent citrate transporter of klebsiella pneumoniae (kpcits) belongs to the 2-hydroxycarboxylate transporter (2-hct) family and allows the cell to use citrate as sole carbon and energy source in anaerobic conditions. here we present crystal structures of kpcits in citrate-bound outward-facing, citrate-bound asymmetric, and citrate-free inward-facing state. the structures reveal that the kpcits dimerization domain remains stationary throughout the transport cycle due to a hydrogen b ... | 2017 | 28566738 |
| peptide markers for rapid detection of kpc carbapenemase by lc-ms/ms. | carbapenemase producing organisms (cpos) represent an urgent public health threat, and the need for new rapid methods to detect these organisms has been widely recognized. cpos carrying the klebsiella pneumoniae carbapenemase (bla kpc ) gene have caused outbreaks globally with substantial attributable mortality. here we describe the validation of a rapid ms method for the direct detection of unique tryptic peptides of the kpc protein in clinical bacterial isolates with an isolate-to-result time ... | 2017 | 28566732 |
| phenotypic methods for screening carbapenem-resistant enterobacteriaceae and assessment of their antimicrobial susceptibility profile. | in this study, we used phenotypic methods to screen carbapenem-resistant enterobacteriaceae (cres) and evaluated their antimicrobial sensitivity profile. | 2017 | 28562752 |
| himatanthus drasticus leaves: chemical characterization and evaluation of their antimicrobial, antibiofilm, antiproliferative activities. | plant-derived products have played a fundamental role in the development of new therapeutic agents. this study aimed to analyze antimicrobial, antibiofilm, cytotoxicity and antiproliferative potentials of the extract and fractions from leaves of himatanthusdrasticus, a plant from the apocynaceae family. after harvesting, h. drasticus leaves were macerated and a hydroalcoholic extract (hdhe) and fractions were prepared. antimicrobial tests, such as agar-diffusion, minimum inhibitory concentration ... | 2017 | 28561790 |
| outbreak by hypermucoviscous klebsiella pneumoniae st11 isolates with carbapenem resistance in a tertiary hospital in china. | hypervirulent and multidrug resistant klebsiella pneumoniae strains pose a significant threat to the public health. in the present study, 21 carbapenem-resistant k. pneumoniae isolates (crkp) were determined by the string test as hypermucoviscous k. pneumoniae (hmkp), with the prevalence of 15.0% (21/140) among crkp, and 1.1% (21/1838) among all k. pneumoniae isolates. among them, 7 (33.3%), and 1 (4.76%) isolate belonged to capsular serotype k20 and k2 respectively, while 13 (61.9%, 13/21) were ... | 2017 | 28560183 |
| ceftazidime-avibactam is superior to other treatment regimens against carbapenem-resistant klebsiella pneumoniae bacteremia. | there are no data comparing outcomes of patients treated with ceftazidime-avibactam versus comparators for carbapenem-resistant enterobacteriaceae infections. at our center, ceftazidime-avibactam treatment of carbapenem-resistant klebsiella pneumoniae bacteremia was associated with higher rates of clinical success (p = 0.006) and survival (p = 0.01) than other regimens. across treatment groups, there were no differences in underlying diseases, severity of illness, source of bacteremia, or strain ... | 2017 | 28559250 |
| mortality associated with bacteremia due to colistin-resistant klebsiella pneumoniae with high-level meropenem resistance: importance of combination therapy without colistin and carbapenems. | combination therapy including colistin and a carbapenem has been found to be associated with lower mortality in the treatment of bloodstream infections (bsi) due to kpc-producing klebsiella pneumoniae when the isolates show a meropenem or imipenem mic of <16 mg/liter. however, the optimal treatment of bsi caused by colistin- and high-level carbapenem-resistant kpc-producing k. pneumoniae is unknown. a prospective cohort study including episodes of bacteremia caused by colistin-resistant and high ... | 2017 | 28559247 |
| mcr-1-producing klebsiella pneumoniae outbreak in china. | | 2017 | 28555574 |
| total synthesis and pharmacological investigation of cordyheptapeptide a. | the present investigation reports the synthesis of a phenylalanine-rich n-methylated cyclopeptide, cordyheptapeptide a (8), previously isolated from the insect pathogenic fungus cordyceps sp. bcc 1788, accomplished through the coupling of n-methylated tetrapeptide and tripeptide fragments followed by cyclization of the linear heptapeptide unit. structure elucidation of the newly synthesized cyclopolypeptide was performed by means of ft-ir, ¹h-nmr, (13)c-nmr, and fast atom bombardment mass spectr ... | 2017 | 28554994 |
| decrease of ceftriaxone susceptibility in klebsiella pneumoniae according to biofilm maturation. | | 2017 | 28552832 |
| antimicrobial activity evaluation and comparison of methods of susceptibility for klebsiella pneumoniae carbapenemase (kpc)-producing enterobacter spp. isolates. | the production of kpc (klebsiella pneumoniae carbapenemase) is the major mechanism of resistance to carbapenem agents in enterobacterias. in this context, forty kpc-producing enterobacter spp. clinical isolates were studied. it was evaluated the activity of antimicrobial agents: polymyxin b, tigecycline, ertapenem, imipenem and meropenem, and was performed a comparison of the methodologies used to determine the susceptibility: broth microdilution, etest(®) (biomérieux), vitek 2(®) automated syst ... | 2017 | 28552659 |
| metabolic engineering of klebsiella pneumoniae j2b for the production of 1,3-propanediol from glucose. | the production of 1,3-propanediol (1,3-pdo) from glucose was investigated using klebsiella pneumoniae j2b, which converts glycerol to 1,3-pdo and synthesize an essential coenzyme b12. in order to connect the glycolytic pathway with the pathway of 1,3-pdo synthesis from glycerol, i.e., to directly produce diol from glucose, glycerol-3-phosphate dehydrogenase and glycerol-3-phosphate phosphatase from saccharomyces cerevisiae were overexpressed. additionally, the effect of expression levels and the ... | 2017 | 28549809 |
| carbapenem-resistant klebsiella pneumoniae in barbados: driving change in practice at the national level. | carbapenem-resistant klebsiella pneumoniae (crkp) is of growing concern globally. the risk for transmission of antimicrobial resistant organisms across several continents to the caribbean is a real one given its tourism industry. after a cluster of cases of crkp were detected, several studies detailed in this report were initiated to better characterize the problem. | 2017 | 28542162 |
| analysis of risk factors of peripherally inserted central catheter induced catheter-related infection in patients with leukemia. | peripherally inserted central catheter (picc) is commonly used in nursing for patients with leukemia. the purpose of this study was to investigate the risk factors of catheter-related infection (cri) in patients with leukemia and to provide some nursing strategies based on the results. | 2017 | 28540264 |
| activity of minocycline against klebsiella pneumoniae carbapenemase (kpc)-producing enterobacteriaceae clinical isolates, with comparison to doxycycline and tigecycline. | we examined the in vitro activity of minocycline against 103 klebsiella pneumoniae carbapenemase (kpc)-producing enterobacteriaceae isolates and found approximately half had susceptible (26%) or intermediate (26%) mics. for a subset of 35 isolates, susceptibility was highest to tigecycline (71% fda vs. 20% eucast) followed by minocycline (14%) and then doxycycline (6%). | 2017 | 28535946 |
| clonal replacement of epidemic kpc-producing klebsiella pneumoniae in a hospital in china. | klebsiella pneumoniae is a frequent nosocomial pathogen causing difficult-to-treat infections worldwide. the prevalence of klebsiella pneumoniae carbapenemase (kpc)-producing klebsiella pneumoniae (kpc-kp) is increasing in china. the aim of this study was to investigate the molecular epidemiology of kpc-kp in a nosocomial outbreak. | 2017 | 28535790 |
| tail tubular protein a: a dual-function tail protein of klebsiella pneumoniae bacteriophage kp32. | tail tubular protein a (ttpa) is a structural tail protein of klebsiella pneumoniae bacteriophage kp32, and is responsible for adhering the bacteriophage to host cells. for the first time, we found that ttpa also exhibits lytic activity towards capsular exopolysaccharide (eps) of the multiresistant clinical strain of klebsiella pneumoniae, pcm2713, and thus should be regarded as a dual-function macromolecule that exhibits both structural and enzymatic actions. here, we present our crystallograph ... | 2017 | 28533535 |
| clonal dissemination of oxa-232 carbapenemase-producing klebsiella pneumoniae in neonates. | five oxa-232 carbapenemase-producing klebsiella pneumoniae isolates, belonging to the pandemic clone sequence type 15 (st15), were isolated from neonates and coproduced blactx-m-15 and blashv-1 genes. all isolates were resistant to ertapenem (mics of >32 μg/ml) and meropenem (mics of 4 to 8 μg/ml) and susceptible or intermediate to imipenem (mics of 1 to 2 μg/ml). the blaoxa-232 gene was located on a cole-type transformable plasmid of 6,141 bp. to the best of our knowledge, this is the first rep ... | 2017 | 28533245 |
| roles of ramr and tet(a) mutations in conferring tigecycline resistance in carbapenem-resistant klebsiella pneumoniae clinical isolates. | tigecycline is regarded as a last-resort treatment for carbapenem-resistant klebsiella pneumoniae (crkp) infections, but increasing numbers of tigecycline-resistant k. pneumoniae isolates have been reported. the tigecycline resistance mechanisms in crkp are undetermined. this study aimed to elucidate the mechanisms underlying tigecycline resistance in 16 tigecycline- and carbapenem-resistant k. pneumoniae (tcrkp) isolates. mutations in tigecycline resistance determinant genes [ramr, acrr, oqxr, ... | 2017 | 28533243 |
| first report of oxa-181 and ndm-1 from a clinical klebsiella pneumoniae isolate from nigeria. | | 2017 | 28526566 |
| klebsiella pneumoniae: a major worldwide source and shuttle for antibiotic resistance. | klebsiella pneumoniae is an important multidrug-resistant (mdr) pathogen affecting humans and a major source for hospital infections associated with high morbidity and mortality due to limited treatment options. we summarize the wide resistome of this pathogen, which encompasses plentiful chromosomal and plasmid-encoded antibiotic resistance genes (args). under antibiotic selective pressure, k. pneumoniae continuously accumulates args, by de novo mutations, and via acquisition of plasmids and tr ... | 2017 | 28521338 |
| microbial competition in environmental nosocomial reservoirs and diffusion capacity of oxa48-klebsiella pneumoniae: potential impact on patients and possible control methods. | we have found clusters of klebsiella pneumoniae with oxa48-carbepenemase cases in some hospital rooms, and decided to investigate whether bathroom siphons could be a reservoir for oxa48 bacteria, as occurs with k. oxytoca with other types of carbepenemases. | 2017 | 28515629 |
| respiratory multiplex polymerase chain reaction: an important diagnostic tool in immunocompromised patients. | viruses and atypical pathogens can cause significant respiratory illness in immunocompromised patients. multiplex polymerase chain reaction (mpcr) has improved the diagnostic yield of pathogens, and it is easier to identify the co-infections also. the present study was done to evaluate the performance of mpcr on bronchoalveolar lavage (bal) samples in immunocompromised patients. | 2017 | 28515602 |
| angiotensin-converting enzyme enhances the oxidative response and bactericidal activity of neutrophils. | angiotensin-converting enzyme (ace) inhibitors are widely used to reduce blood pressure. here, we examined if an ace is important for the antibacterial effectiveness of neutrophils. ace knockout mice or mice treated with an ace inhibitor were more susceptible to bacterial infection by methicillin-resistant staphylococcus aureus (mrsa). in contrast, mice overexpressing ace in neutrophils (neu(ace) mice) have increased resistance to mrsa and better in vitro killing of mrsa, pseudomonas aeruginosa, ... | 2017 | 28515091 |
| oral gentamicin therapy for carbapenem-resistant klebsiella pneumoniae gut colonization in hematologic patients: a single center experience. | the mortality for carbapenem-resistant klebsiella pneumoniae (kpc-kp) infection ranges from 18 to 48% depending on the type of therapy. mortality rates in hematologic patients are even higher, up to 85%. gut decontamination with oral gentamicin might be an option to avoid a subsequent kpc-kp infection in colonized patients. we treated 14 hematologic patients with oral gentamicin, 80 mg four times daily, for 7 to 25 days in order to eradicate kpc-kp from the gut, starting oral gentamicin therapy ... | 2017 | 28513809 |
| documentation of ethnomedicinal information and antimicrobial validation of thespesia populnea used by yanadi tribe of ganugapenta village, chittoor district, andhra pradesh, india. | this study aimed to document the traditional knowledge of medicinal plants and antimicrobial validation of thespesia populnea used by yanadi tribe of chittoor district, andhra pradesh, india. | 2017 | 28512597 |
| population genomic analysis of 1,777 extended-spectrum beta-lactamase-producing klebsiella pneumoniae isolates, houston, texas: unexpected abundance of clonal group 307. | klebsiella pneumoniae is a major human pathogen responsible for high morbidity and mortality rates. the emergence and spread of strains resistant to multiple antimicrobial agents and documented large nosocomial outbreaks are especially concerning. to develop new therapeutic strategies for k. pneumoniae, it is imperative to understand the population genomic structure of strains causing human infections. to address this knowledge gap, we sequenced the genomes of 1,777 extended-spectrum beta-lactam ... | 2017 | 28512093 |
| rapid susceptibility profiling of carbapenem-resistant klebsiella pneumoniae. | the expanding global distribution of multi-resistant klebsiella pneumoniae demands faster antimicrobial susceptibility testing (ast) to guide antibiotic treatment. current asts rely on time-consuming differentiation of resistance and susceptibility after initial isolation of bacteria from a clinical specimen. here we describe a flow cytometry workflow to determine carbapenem susceptibility from bacterial cell characteristics in an international k. pneumoniae isolate collection (n = 48), with a r ... | 2017 | 28507322 |
| colistin resistance in carbapenem-resistant klebsiella pneumoniae mediated by chromosomal integration of plasmid dna. | here we describe the spread of colistin resistance in clinical isolates of carbapenem-resistant klebsiella pneumoniae in medellín, colombia. among 32 isolates collected between 2012 and 2014, 24 showed genetic alterations in mgrb nineteen isolates belonged to sequence type 512 (st512) (or its single locus variant [slv]) and harbored an 8.1-kb hsdmsr insertion corresponding to iskpn25, indicating a clonal expansion of the resistant strain. the insertion region showed 100% identity to several plas ... | 2017 | 28507118 |
| efficacy and pharmacokinetics of the combination of op0595 and cefepime in a mouse model of pneumonia caused by extended-spectrum-beta-lactamase-producing klebsiella pneumoniae. | op0595 (rg6080) is a novel diazabicyclooctane that inhibits class a and c serine beta-lactamases. although the combination of op0595 and cefepime (fep) showed good in vitro activity against extended-spectrum-beta-lactamase (esbl)-producing pathogens, the effect of the combination therapy against severe infections, such as pneumonia or bacteremia, remains unknown in vivo in this study, we investigated the efficacy and pharmacokinetics of the combination therapy of op0595 and fep in a mouse model ... | 2017 | 28507106 |
| prevalence of acquired carbapenemase genes in klebsiella pneumoniae by multiplex pcr in isfahan. | multi-drug resistant klebsiella pneumoniae has been considered as a serious global threat. this study was done to investigate carbapenemase producing genomes among k. pneumoniae isolates in isfahan, central iran. | 2017 | 28503496 |
| liposome loaded phage cocktail: enhanced therapeutic potential in resolving klebsiella pneumoniae mediated burn wound infections. | klebsiella pneumoniae is one of the predominant pathogens in burn wound infections, and prevalence of multidrug resistant strains has further complicated the situation. an increased interest in phage therapy as a means of combating infection has been accruing in recent years. in order to overcome the drawbacks associated with phage therapy, the present study was conducted to evaluate the potential of liposomes as a delivery vehicle for phage in the treatment of burn wound infection. | 2017 | 28502784 |
| changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single-centre prospective cohort study. | to analyse trends in the aetiology, treatment and outcomes of bloodstream infection (bsi) within the first year post-transplant over the last 10-year period, we prospectively recorded all episodes of bsi occurring in solid organ transplant (sot) recipients during the first year post-transplant from 2007 to 2016. trends of factors were analysed by 2-year periods. of 475 consecutive episodes of bsi, 218 occurred within a year of sot in 178 sot recipients. gram-positive bsi decreased over time (40. ... | 2017 | 28500792 |
| examining the efficacy of intravenous administration of predatory bacteria in rats. | the proteobacteria bdellovibrio bacteriovorus and micavibrio aeruginosavorus are obligate predators of gram-negative bacteria, and have been proposed to be used to treat multidrug-resistant bacterial infections. the ability of predatory bacteria to reduce bacterial burden in vivo within the lungs of rats has been demonstrated, but it was unknown if predatory bacteria can attenuate systemic bacterial burden administered intravenously. in this study, we first assessed the safety of intravenous ino ... | 2017 | 28500337 |
| complete genome sequence of a novel multidrug-resistant klebsiella pneumoniae phage, vb_kpn_ime260. | klebsiella pneumoniae is the most common clinically important opportunistic bacterial pathogen and its infection is often iatrogenic. its drug resistance poses a grave threat to public health. the genomic data reported here comprise an important resource for research on phage therapy in the control of drug-resistant bacteria. | 2017 | 28495757 |
| hypervirulent klebsiella pneumoniae in california sea lions ( zalophus californianus): pathologic findings in natural infections. | tissues of stranded california sea lions ( zalophus californianus) naturally infected with a hyperviruluent strain of klebsiella pneumoniae were examined by histopathology and immunohistochemistry against the k. pneumoniae k2 capsular antigen. in 7 of 8 animals, there was severe purulent bronchopneumonia, sometimes complicated by fibrinonecrotizing pleuritis with pyothorax. in affected areas of lung, large numbers of degenerate neutrophils and macrophages were admixed with rare large extracellul ... | 2017 | 28494709 |
| coagulation factor xi improves host defence during murine pneumonia-derived sepsis independent of factor xii activation. | bacterial pneumonia, the most common cause of sepsis, is associated with activation of coagulation. factor xi (fxi), the key component of the intrinsic pathway, can be activated via factor xii (fxii), part of the contact system, or via thrombin. to determine whether intrinsic coagulation is involved in host defence during pneumonia and whether this is dependent on fxii activation, we infected in parallel wild-type (wt), fxi knockout (ko) and fxii ko mice with two different clinically relevant pa ... | 2017 | 28492700 |
| identification of d-galactan-iii as part of the lipopolysaccharide of klebsiella pneumoniae serotype o1. | klebsiella pneumoniae is a gram-negative, ubiquitous bacterium capable of causing severe nosocomial infections in individuals with impaired immune system. emerging multi-drug resistant strains of this species and particularly carbapenem-resistant strains pose an urgent threat to public health. the lipopolysaccharide (lps) o-antigen is the main surface antigen. it contributes to the virulence of this species and determines the o-serotype of k. pneumoniae isolates. among the nine main o-serotypes ... | 2017 | 28487676 |
| diversity-oriented sustainable synthesis of antimicrobial spiropyrrolidine/thiapyrrolizidine oxindole derivatives: new ligands for a metallo-β-lactamase from klebsiella pneumonia. | a simple, environmentally benign and highly proficient microwave assisted one-pot approach for the synthesis of antimicrobial spiropyrrolidine/thiapyrrolizidine oxindole derivatives is reported assembling two pharmacophoric moieties (1,3-indanedione and pyrrolidine/thiapyrrolizidine) in a single molecular framework via three-component 1,3-dipolar cycloaddition reaction of substituted isatin, sarcosine/1,3-thiazoles-4-carboxylic acid and knoevenagel adduct (2-cyano-3-phenyl-acrylic acid ethyl est ... | 2017 | 28487071 |
| molecular characterization of carbapenem- resistant enterobacteriaceae yields increasing rates of ndm-1 carbapenemases and colistin resistance in an oxa-48- endemic area. | we aimed to characterize carbapenem-resistant isolates in a tertiary hospital in istanbul, turkey, high-prevelance area for oxa-48 producers. about 76 enterobacteriaceae clinical isolates were included. carbapenemase production was detected by carbapenem inactivation method and carbapenemase genes were investigated by pcr. the clonal relationships were evaluated by ap-pcr. nineteen klebsiella pneumoniae isolates were colistin resistant. about 75 isolates yielded carbapenemase by cim. 52 oxa-48, ... | 2017 | 28486840 |
| evolution and dissemination of the klebsiella pneumoniae clonal group 258 throughout israeli post-acute care hospitals, 2008-13. | the kpc-producing klebsiella pneumoniae (kpc-kp) clonal group (cg) 258 has disseminated throughout israeli post-acute care hospitals (pachs). the objectives of the study were (i) to describe the evolution and (ii) to understand the dissemination modes of cg 258 in the pach system in israel. | 2017 | 28486697 |
| epidemiological typing of multidrug-resistant klebsiella pneumoniae, which causes paediatric ventilator-associated pneumonia in egypt. | multidrug-resistant klebsiella pneumoniae is a common nosocomial pathogen that plays an important role in ventilator-associated pneumonia (vap). this study aimed to define the clonal relatedness of k. pneumoniae strains isolated from paediatric vap in addition to those isolated from environmental samples. | 2017 | 28485710 |
| detection of a ctx-m group 2 beta-lactamase gene in a klebsiella pneumoniae isolate from a tertiary care hospital, trinidad and tobago. | identification of the prevalence and spread of esbl-mediated antibiotic resistance is essential especially in the hospital setting. it is for this reason, more and more studies are highlighting the importance of complementing phenotypic esbl-detection techniques with molecular techniques in order to understand the basis and extent of this form of resistance among clinically evolved bacterial populations, especially those belonging to the enterobacteriaceae family. however, in trinidad and tobago ... | 2017 | 28482925 |
| high prevalence of multi-drug resistant klebsiella pneumoniae in a tertiary teaching hospital in western kenya. | klebsiella pneumoniae is a gram negative enterobacteriaciae commonly associated with nosocomial infections. multidrug resistant strains are increasingly being reported with corresponding increase in morbidity and mortality. the study outlines the epidemiology and antibiotic resistance pattern of k. pneumonia over a 10 year period in moi teaching and referral hospital, eldoret, kenya. | 2016 | 28480442 |
| high burden of carbapenem-resistant enterobacteriaceae (cre) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting. | infections by multidrug-resistant gram-negative bacteria (mdr-gnb) have been continuously growing and pose challenge to health institution globally. carbapenem-resistant enterobacteriacea (cre) was identified as one of the mdr-gnb which has limited treatment options and higher mortality compared to those of sensitive strains. we report an increased burden of cre fecal carriage at a hospital in the north-eastern region of malaysia. | 2017 | 28473912 |
| klebsiella pneumoniae septicaemia in preweaned pigs. | this article has been prepared by susanna williamson and colleagues of the apha pig expert group. | 2017 | 28473488 |
| disease surveillance in england and wales, april 2017. | ▪ current and emerging issues: update on schmallenberg virus▪ highlights from the scanning surveillance network▪ update on international disease threats▪ focus on klebsiella pneumoniae septicaemia in preweaned pigsthese are among matters discussed in the animal and plant health agency's (apha's) disease surveillance report for april 2017. | 2017 | 28473487 |
| synergistic activity of synthetic n-terminal peptide of human lactoferrin in combination with various antibiotics against carbapenem-resistant klebsiella pneumoniae strains. | the spread of multi-drug resistant (mdr) klebsiella pneumoniae strains producing carbapenemases points to a pressing need for new antibacterial agents. to this end, the in-vitro antibacterial activity of a synthetic n-terminal peptide of human lactoferrin, further referred to as hlf1-11, was evaluated against k. pneumoniae strains harboring different carbapenemase genes (i.e. oxa-48, kpc-2, kpc-3, vim-1), with different susceptibility to colistin and other antibiotics, alone or in combination wi ... | 2017 | 28470337 |
| neonatal sepsis in a nigerian private tertiary hospital: bacterial isolates, risk factors, and antibiotic susceptibility patterns. | neonatal sepsis is an important cause of morbidity and mortality in the pediatric age group in spite of several attempts at mitigating its effects. this article determines the prevalence of neonatal sepsis and the pathogens responsible for sepsis as well as risk factors and outcome at the babcock university teaching hospital. | 2017 | 28469117 |
| anti-lps antibodies protect against klebsiella pneumoniae by empowering neutrophil-mediated clearance without neutralizing tlr4. | initial promising results with immune sera guided early human mab approaches against gram-negative sepsis to an lps neutralization mechanism, but these efforts failed in human clinical trials. emergence of multidrug resistance has renewed interest in pathogen-specific mabs. we utilized a pair of antibodies targeting klebsiella pneumoniae lps, one that both neutralizes lps/tlr4 signaling and mediates opsonophagocytic killing (opk) (54h7) and one that only promotes opk (kpe33), to better understan ... | 2017 | 28469079 |
| knowledge, behaviour and microbial load of workers handling dental solid waste in a public health service in brazil. | healthcare wastes are those generated inside healthcare services, including dental clinics. workers coming into close proximity to hazardous healthcare waste are potentially at risk. in an attempt to assess the knowledge and attitudes of workers dealing with infectious waste, a questionnaire was administered. the biological risk was investigated by evaluating the microbial load and screening some clinically relevant micro-organisms in the nasal mucosa, hands and coats of these workers. the resul ... | 2017 | 28464731 |
| [kpc-producing klebsiella pneumoniae colonization at a university hospital]. | a surveillance study was conducted at a university hospital in buenos aires city aimed to assess the rates of colonization with carbapenemase-producing strains of klebsiella pneumoniae, which are bacteria of utmost epidemiological importance. to this end, rectal swabs collected from all inpatients were cultured for the presence of these bacteria. two point prevalence surveys showed high prevalence rates (up to 25%). the following variables were evaluated in all inpatients: place of origin (home ... | 2017 | 28463215 |
| honeycomb liver abscess. | | 2017 | 28462151 |
| impaired inhibition by avibactam and resistance to the ceftazidime-avibactam combination due to the d(179)y substitution in the kpc-2 β-lactamase. | the ceftazidime-avibactam antibiotic combination was recently shown to be at risk for the emergence of resistance under treatment. to gain insight into the underlying mechanism, we have analyzed the catalytic properties of a klebsiella pneumoniae carbapenemase type 2 (kpc-2) β-lactamase harboring the d(179)y substitution. we show that impaired inhibition by avibactam combined with significant residual activity for ceftazidime hydrolysis accounts for the resistance. in contrast, the d(179)y subst ... | 2017 | 28461318 |
| ndm-5 and oxa-181 beta-lactamases, a significant threat continues to spread in the americas. | among gram-negative bacteria, carbapenem-resistant infections pose a serious and life-threatening challenge. here, the crackle network reports a sentinel detection and characterization of a carbapenem-resistant klebsiella pneumoniae st147 isolate harboring blandm-5 and blaoxa-181 from a young man who underwent abdominal surgery in india. blandm-5 was located on an incfii plasmid of ≈90 kb, whereas blaoxa-181 was chromosomally encoded. resistome and genome analysis demonstrated multiple copies of ... | 2017 | 28461314 |
| [a dead case of severe community-acquired pneumonia caused by highly pathogenic klebsiella pneumoniae]. | | 2017 | 28459411 |
| emergence and nosocomial spread of carbapenem-resistant oxa-232-producing klebsiella pneumoniae in brunei darussalam. | carbapenem-resistant enterobacteriaceae (cre) are identified as a major global health concern. the success of cre is facilitated by the emergence, acquisition and spread of successful clones carrying plasmid-encoded resistance genes. in this study, an outbreak of carbapenem-resistant klebsiella pneumoniae (crkp) infections in patients hospitalised in brunei darussalam was investigated. | 2017 | 28458051 |
| early rehospitalization post-kidney transplant due to infectious complications: can we predict the patients at risk? | rehospitalization early post-kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. the aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post-kidney tr ... | 2017 | 28457394 |
| carbapenem-resistant klebsiella pneumoniae infections early after liver transplantation: a single-center experience. | the aims of this study were to define in a cohort of 310 liver transplant recipients, the incidence of post-liver transplantation (lt) non-carbapenem-resistant klebsiella pneumoniae (crkp) and crkp infections, pre- and post-lt crkp colonization, crkp-associated mortality, and risk factors for non-crkp and crkp infections. every patient was screened for crkp immediately before and after lt. the 6-month survival rate was 95%. fifty-two patients became infected (16.5%): 8 by crkp (2.5%) and 44 (14% ... | 2017 | 28457370 |