Legionnaires' disease at a medical center in southern Taiwan

Background/purpose

Legionella pneumophila had been recognized as a pathogen for both healthcare-associated and community-acquired pneumonia. We aimed to evaluate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in southern Taiwan.

Multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia at a medical center in southern Taiwan.

BACKGROUND AND PURPOSE: To evaluate the significance of multidrug-resistant Acinetobacter baumannii (MDRAB)-related ventilator-associated pneumonia at a medical center in southern Taiwan. METHODS: We retrospectively reviewed the medical records of patients with MDRAB isolated from sputum and described the characteristics of these patients. Patients were divided into 2 groups according to their clinical pulmonary infection scores (CPIS), and their host factors and outcomes compared. RESULTS: In the patient group with significant MDRAB-related lung infection, Acute Physiology and Chronic Health Evaluation II scores were significantly higher than in those patients with lower CPIS scores (<6). However, the clinical outcomes, including the duration of hospitalization after isolation of MDRAB and mortality rate, were not different. CONCLUSION: Our investigation showed that significant lung infections with MDRAB isolation did not result in prolonged hospitalization or increased mortality. The initial clinical severity of the group with significant MDRAB-related lung infection was significantly greater than in the other. We propose that MDRAB-related pneumonia should be regarded as a signal of the clinical severity of the patient rather than as a prognostic factor.     

Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit.

From 16 July through 27 September 1988, seven cases of nosocomial Serratia marcescens bacteremia occurred in a cardiac care unit. In all seven case patients, S. marcescens was isolated from blood cultures. Two of the seven had other microorganisms identified in the blood culture in which S. marcescens was recovered; one had Enterobacter cloacae, and one had Klebsiella pneumoniae. A case-control study was conducted to identify risk factors for bloodstream infection. Case patients were more likely than controls to have been exposed to an intra-aortic balloon pump pressure transducer (7 of 7 versus 6 of 21; P = 0.001) and to a pulmonary arterial pressure transducer (7 of 7 versus 8 of 21; P = 0.005). Cultures of in-use and in-storage transducers revealed bacterial contamination of the pressure-sensitive membranes of the transducers. S. marcescens blood culture isolates obtained from five of the seven case patients, as well as six S. marcescens isolates from cultured transducers, belonged to serotypes Oundetermined:H1 and Oundetermined:H18. E. cloacae isolates from one case patient and from two stored and two in-use transducers had identical antimicrobial suceptibility patterns. Review of cardiac care unit disinfection practices revealed that the transducers were not processed with high-level disinfection or sterilization between patient uses. We concluded that the transducers had served as reservoirs for this outbreak of bloodstream infection. Because intra-aortic balloon pumps with pressure transducers are being used more frequently in the management of critically ill cardiac patients, their role as infectious reservoirs should be considered in the investigation of nosocomial bacteremia.     

Genitourinary tuberculosis in a medical center in southern Taiwan: an eleven-year experience.

BACKGROUND AND PURPOSE: Genitourinary tuberculosis is the second most common disease form of extrapulmonary tuberculosis. This study analyzed the clinical characteristics and outcome in 31 patients with genitourinary tuberculosis treated between 1994 and 2004 at a tertiary medical center in southern Taiwan. METHODS: Data were collected by chart review. Diagnosis was based on microbiological or histological proof plus compatible radiographic findings and clinical presentation. RESULTS: This study included 14 men (45%) and 17 women (55%). Their ages ranged from 31 to 81 years (mean, 58.1 years). Genitourinary symptoms (83.9%) were more frequent than constitutional symptoms (35.5%). Pyuria plus hematuria with sterile culture (51.6%) was the most common finding. Only 25.8% of patients had a known history of pulmonary tuberculosis. Diagnosis was based on microbiological findings in 11 patients (35.5%), and by histological findings in 20 (64.5%) patients. Intravenous pyelography revealed abnormalities in 94% of patients and renal ultrasonography in 79.2%. Imaging studies were characteristic of advanced stage in most patients. Twenty-five percent of patients were classified as having treatment failure after at least 6 months of therapy. The treatment failure rate was higher in patients with positive microbiological findings (71.4%) than in those with histological findings alone (5.9%, p=0.003). CONCLUSIONS: The high rate of treatment failure and advanced stage of disease at diagnosis are indicative of the challenge in the care of patients with genitourinary tuberculosis in Taiwan.     

Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan.

Stenotrophomonas maltophilia has become an important nosocomial pathogen in immunocompromised patients in Taiwan. Patients with underlying diseases such as diabetes, uremia, and solid malignancy are extremely vulnerable to this organism. S. maltophilia bacteremia has a mortality rate of up to 62% if appropriate antibiotics are not instituted early. Knowledge of the risk factors for infection as well as local susceptibility patterns is helpful in determining which patients should receive empirical antibiotics active against S. maltophilia. This study assessed the characteristics of 50 episodes of S. maltophilia bacteremia in 48 patients admitted between March 3, 1999 and May 21, 2003. The new fluoroquinolone levofloxacin showed promising in vitro activity against S. maltophilia in view of the increasing resistance of isolates to trimethoprim-sulfamethoxazole. For patients at risk for S. maltophilia infection, such as those receiving mechanical ventilation in the ICU or those with multiple vascular access devices, the need for antimicrobial agents to which S. maltophilia is normally sensitive should be considered in selecting empiric therapy.     

Community-acquired anaerobic bacteremia in adults: one-year experience in a medical center.

A prospective observational study was conducted to evaluate the clinical characteristics and outcome of community-acquired anaerobic bacteremia. From June 1 2001 through May 31 2002, 52 patients with community-acquired anaerobic bacteremia were enrolled at the emergency department in a teaching hospital. There were 19 patients (34%) with polymicrobial bacteremia and Escherichia coli was the most common copathogen (n = 6). Of 62 anaerobic isolates, species of the Bacteroides fragilis group were the most common isolates (n = 28, 45%), followed by Clostridium spp. (n = 11, 18%). Among the 52 patients enrolled, up to 27% had underlying malignancy and the gastrointestinal tract accounted for 48% of the sources of infection. Clinical manifestations suggesting anaerobic infections were common and three-quarters (n = 39) of 52 patients received adequate empirical antimicrobial treatment. Documentation of anaerobic bacteremia seldom influenced antimicrobial treatment. The 30-day mortality was 25%. Although univariate analysis revealed that underlying malignancy (p=0.003), leukopenia (p=0.044) and absence of fever (p=0.047) were associated with mortality, only malignancy (p=0.007) was an independent risk factor in the multivariate analysis.     

Clinical and microbiological characteristics of mycotic aneurysms in a medical center in southern Taiwan

BACKGROUND AND PURPOSE: Mycotic aneurysm poses a high risk of mortality. This study evaluated the demographic and clinical characteristics and outcomes of hospitalized patients with mycotic aneurysm. METHODS: Patients with mycotic aneurysm hospitalized between March 1996 and May 2006 at a medical center in southern Taiwan were retrospectively analyzed. RESULTS: Fifty two patients (38 men and 14 women; mean age, 64.5 +/- 15.6 years) were included. The leading underlying diseases were diabetes mellitus (40.4%), hypertension (21.2%), and renal disease and heart disease (19.2% each). The most common pathogens isolated from blood and/or resected tissue were Salmonella spp. (34.6%), Klebsiella pneumoniae (11.5%) and Staphylococcus aureus (11.5%). Mycotic aneurysms caused by Gram-negative bacilli were significantly more likely to occur in older patients (p=0.018) and at infrarenal sites (p=0.021). There were trends suggesting that mycotic aneurysms were more likely to be caused by Gram-negative bacilli in patients receiving steroid treatment and in those with underlying diabetes mellitus. Mycotic aneurysms caused by Gram-positive cocci were significantly more likely to occur in suprarenal arteries (p=0.048), especially intracranially (p=0.002), in younger patients (p=0.018) and in patients with concurrent endocarditis (p=0.008). The overall in-hospital mortality rate was 30.6%, and there was no significant difference in in-hospital mortality between mycotic aneurysms caused by Gram-negative bacilli and those due to Gram-positive cocci. CONCLUSIONS: The relationship between the anatomic site of mycotic aneurysm and the spectrum of culprit bacteria may help clinicians promptly choose appropriate antibiotic regimens on an empirical basis. Further study is required to understand better the role of K. pneumoniae in mycotic aneurysm in Taiwan.     

Risk factors for candidemia-related mortality at a medical center in central Taiwan.

BACKGROUND AND PURPOSE: Bloodstream infections due to Candida spp. are associated with significant mortality and morbidity. This study analysed the epidemiology and outcome of candidemia cases in a teaching hospital in central Taiwan. METHODS: We retrospectively studied the clinical characteristics and antifungal susceptibility of isolates and risk factors for mortality in 91 cases of candidemia treated from January 1, 2001 to June 30, 2003. RESULTS: The mean age of the patients was 67 years (range, 30-90 years). Three episodes (3%) were community acquired. Adequate antifungal therapy was given to 78 patients (78%). Cancer (38.5%) and diabetes mellitus (36.3%) were the 2 most common underlying diseases. The most frequent risk factors identified for candidemia were prior broad-spectrum antibiotic use (84.6%), central venous catheterization (83.5%) and Candida colonization (79.5%). The most frequent isolates were Candida albicans (64.8%) and Candida tropicalis (19.8%). All of the C. albicans and C. tropicalis isolates were sensitive to fluconazole (minimal inhibitory concentration 相似文献   

The role of Serratia marcescens porins in antibiotic resistance

The outer membrane permeability of Serratia marcescens was studied by comparing porin-deficient mutants with their parental strains. Omp1-deficient strains were selected by moxalactam resistance, whereas mutants lacking the Omp2 porin were obtained by experimental infection with the SMP2 phage, whose primary receptor is the Omp2 porin. The role of porins was demonstrated in quinolone accumulation assays, where semiquantitative differences in accumulation were observed. Permeability coefficients to cephaloridine of Omp1 mutants were determined and compared with those of the parental strain. The clinical isolates S. marcescens HCPR1 and 866 showed 30- to 200-fold reduced permeability coefficients when Omp1 porin was absent.     

Community-acquired Legionnaires' disease at a medical center in northern Taiwan

Background/purposeLegionella pneumophila had been recognized as an important pathogen for community-acquired pneumonia. We aimed to investigate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in northern Taiwan.MethodsFrom June 2012 to February 2017, a retrospective review of adult community-acquired. Legionnaires' disease at a medical center was conducted. All Legionella infections were confirmed by positive urinary Legionella antigen assay, sera indirect immunofluorescence assay, or sputum culture for Legionella. Literature review of Legionnaires' disease from Medline and PubMED websites was performed.ResultsA total of 32 cases of Legionnaires' disease were identified. Their mean age was 64.3 years, with male predominance (27 cases, 84.3%). The underlying diseases were varied and most were attributed to chronic disorders, such as diabetes mellitus (31%) and cigarette smoking (40.6%). The most common symptoms were cough (68%) and fever (59.3%). More than half of patients (18, 56.2%) with Legionnaires' disease could initially present with extrapulmonary manifestations. Sixteen (50%) patients had delay in initiation of appropriate antibiotic therapy. Patients without adequately initiation of appropriate antibiotic therapy had higher proportion (11 of 16, 68.7%) of intensive care unit admission than patients with adequate initiation (5 of 16, 31.2%). Our results inferred that a delay in treatment might result in worsening of disease severity and the need for more intensive management. Overall mortality rate was 21.8%. Development of vasopressor requirement is an independent risk factor associated with mortality.ConclusionLegionnaires' disease in Taiwan frequently present with extrapulmonary manifestations. Patients with hemodynamic instability that need vasopressor therapy associated with mortality.     

Fournier's gangrene: ten-year experience in a medical center in northern Taiwan.

BACKGROUND AND PURPOSE: Fournier's gangrene is a life-threatening infection. The mortality is still high despite the rapid advancement of modern intensive care and surgical technique. In this study, we present our institution's recent experience with a large series of patients with Fournier's gangrene. METHODS: A retrospective chart review was performed including 44 consecutive patients with Fournier's gangrene over a 10-year period. RESULTS: The 44 cases comprised 39 males and 5 females, with a mean age of 55.5 years. The mean duration of hospitalization was 27.9 days. Overall mortality was 22.7%. Diabetes mellitus, hypertension, chronic liver disease, liver cirrhosis and chronic renal insufficiency were the 5 leading predisposing factors. Liver cirrhosis was highly related to mortality (p=0.009). The etiologic origin of the gangrene was colorectal, urological and dermatological in 52.3%, 25.0%, and 11.4% of patients, respectively. The most common isolated pathogens were Escherichia coli, Bacteroides fragilis, Klebsiella pneumoniae, Enterococcus spp., and Proteus mirabilis. There were a total of 74 debridements. Other related surgical procedures were reconstruction surgery (n = 18), colostomy (2), cystostomy (1), vasectomy (1), orchiectomy (1) and penectomy (1). Major complications of Fournier's gangrene, including respiratory failure, renal failure, septic shock, hepatic failure and disseminated intravascular coagulopathy, were significantly to mortality (p<0.05). CONCLUSIONS: Early diagnosis, intensive medical care (aggressive resuscitation and broad-spectrum antibiotics), and prompt and repeated surgical intervention are the mainstays of treatment. Liver cirrhosis in particular is a poor prognostic factor. Reconstructive surgery should also be a consideration once the acute condition has improved. Patients with comorbid condition, serious infection, and major complications should be treated carefully and aggressively.     

Identification of capsular antigens in Serratia marcescens.

Previous studies with 31 strains of Serratia marcescens, including 28 reference O-serotype strains, have indicated that 19 of them have an acidic polysaccharide which copurifies with lipopolysaccharide during phenol-water extraction. Polysaccharide in crude extracts from 18 of the 19 strains was precipitated with Cetavlon (hexadecyltrimethyl ammonium bromide), and capsules were demonstrated around these 18 strains by Indian ink exclusion zones. Capsule-antibody binding by the Quellung reaction suggested that the acidic polysaccharide formed the capsule around the bacterial cells. Anticapsular (anti-K) antibody was detected in reference O antisera which had been prepared against boiled whole cells. Cross-titration and absorption studies revealed 14 different K antigens among these strains.     

Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic.

BACKGROUND AND PURPOSE: This study investigated the clinical manifestations and risk factors for dengue fever (DF) and dengue hemorrhagic fever (DHF) and disease severity during the 2002 outbreak in the Kaohsiung area. METHODS: We analyzed the clinical characteristics of 644 patients with virologically or serologically positive results for dengue virus at Kaohsiung Medical University Hospital from January 1 to December 31, 2002. RESULTS: The case rate peaked in November. The male-to-female ratio was 1:1.2 and the mean age was 47.5 +/- 17.9 years (range, 7 months to 88 years). The criteria for DHF were fulfilled in 232 cases, including 12 cases of dengue shock syndrome (DSS). The most common symptoms were fever (96.1%), myalgia (68.5%), headache (55.4%), and skin rash (53.7%). Hemorrhagic manifestations were noted in 73.0% of patients. The mean age of patients with DHF/DSS was 53.6 +/- 16.3 years, and the highest incidence occurred in those aged 60-69 years (27.2%). Significant risk factors for DHF/DSS were age >65 years, diabetes mellitus, hypertension, and uremia. Gallbladder wall thickening was found in 64.7% of DHF cases who underwent abdominal ultrasound examination. 164 of the 232 DHF cases (71%) were discharged without a diagnosis of DHF. The number of DHF cases identified by our study was nearly equal to that reported through the established passive surveillance system (232 cases vs 242). CONCLUSIONS: DHF was under-reported in hospital, suggesting that continuous surveillance and education for clinicians in the recognition of DHF, especially in elderly patients and those with chronic pre-existing comorbidities, is needed.     

Epidemic outbreak of Serratia marcescens infection in a cardiac surgery unit.

Between 2 February and 16 April 1985, an outbreak of Serratia marcescens infection involving 10 male patients occurred in a cardiac surgery unit. All the patients had surgical wound infection, five also had osteomyelitis (four sternal, one costal), and another had peritonitis secondary to peritoneal dialysis. Three patients had concomitant bacteremia. All Serratia strains isolated produced a cherry-red pigment, and all had the same biochemical and antibiotic susceptibility pattern. An intensive search for the origin of the outbreak was initially unsuccessful, and it proved impossible to isolate S. marcescens from cultures of numerous samples taken from hospital personnel and from the environment. The fact that all patients were male and had been shaved for surgery by the same team of barbers led us to investigate the shaving procedures. We finally isolated a strain of pigmented S. marcescens, corresponding to that involved in the outbreak, from samples taken from the hands and equipment of the barbers. After suitable action had been taken, the epidemic terminated.