嗜麦芽窄食单胞菌下呼吸道感染30例临床分析

嗜麦芽窄食单胞菌 (Ｓｔｅｎｏｔｒｏｐｈｏｍｏｎａｓｍａｌｔｏｐｈｉｌｉａ ,ＳＭＡ )是革兰氏阴性需氧杆菌 ,该菌是院内感染的重要条件致病菌。对常用的抗生素具有广泛的耐药性。近年来 ,该菌感染的发生率明显增加。我们对近年来发生于我院呼吸科病房和呼吸科重症监护病房临床拟诊为嗜麦芽窄食单胞菌肺部感染的 30例患者进行分析。　　临床资料1.一般资料 :住院诊断为嗜麦芽窄食单胞菌感染患者 30例 ,男性 18例 ,女性 12例 ,年龄 2 4～ 86岁 ,平均年龄 6 2岁。均符合以下诊断标准 :( 1)发热、咳嗽、咳痰及肺部有干湿罗音。白细胞和 (或 …     

慢性阻塞性肺疾病急性加重患者肺部感染铜绿假单胞菌临床分析

目的:调查医院慢性阻塞性肺疾病急性加重(AECOPD)住院患者合并肺部铜绿假单胞菌感染的临床特点及病原菌对常用抗菌药物的耐药性,为临床诊疗与合理用药提供参考依据。方法:回顾性分析2016-01—2018-12收治的120例AECOPD合并肺部铜绿假单胞菌感染患者,按照《全国临床检验操作规程》(第4版)留取痰液标本并进行分离培养与细菌鉴定及药敏试验,比较2种形态的铜绿假单胞菌的耐药性差异。结果:年龄高、伴有基础疾病、呼吸道侵入性操作史、长期应用广谱抗菌药物、使用激素、免疫抑制剂等是AECOPD合并肺部铜绿假单胞菌感染的危险因素;药敏试验显示,铜绿假单胞菌对多黏菌素、阿米卡星、妥布霉素、庆大霉素较敏感,耐药率均<10.0%;非黏液型铜绿假单胞菌与黏液型铜绿假单胞菌对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、亚胺培南、美罗培南、环丙沙星的耐药性差异有统计学意义(P<0.05)。结论:铜绿假单胞菌是AECOPD合并肺部细菌感染最常见的病原菌,应引起高度重视。临床医生应提高标本送检率,并根据药敏结果合理选择抗菌药物治疗,防止或减缓耐药性的上升。     

合并结构性肺病的社区获得性肺部感染患者铜绿假单胞菌感染情况的Meta分析

目的采用循证医学系统分析方法分析合并结构性肺病的社区获得性肺部感染患者铜绿假单胞菌的感染情况。方法计算机检索中国学术期刊网全文数据库(CNKI)、MEDLINE及PUBMED数据库,汇总有关合并结构性肺病的社区获得性肺部感染患者与单纯社区获得性肺部感染患者铜绿假单胞菌感染情况对比的随机对照研究,应用Stata11.0软件进行Meta分析。结果共纳入3篇文献,Meta分析结果显示:合并结构性肺病的社区获得性肺部感染的患者较单纯肺部感染者铜绿假单胞菌感染率OR及95%CI为2.43(1.33,4.44)。对发表偏倚及敏感性进行分析,结果显示发表偏倚不明显,剔除任意一篇文献后结果无变化。结论合并结构性肺病的社区获得性肺部感染患者较单纯社区获得性肺部感染患者铜绿假单胞菌感染率高,临床用药应兼顾该菌。     

继发性肺结核合并肺部感染病原体分析

目的分析继发性肺结核合并肺部感染患者致病菌的菌群分布及结核患者痰菌情况。方法随机选取1996年—2007年我院确诊继发性肺结核合并肺部感染患者750例,痰培养出致病菌株或经纤支镜灌洗液、刷检培养出致病菌株进行分析。结果750例继发肺结核合并肺部感染患者,肺部感染的病原体排在前十位依次为白色念珠菌,假丝酵母菌,肺炎克雷伯菌,阴沟肠杆菌,铜绿假单胞菌,金黄色葡萄球菌,大肠埃希菌,河生、产气、聚团、生癌肠杆菌,液化、黏质、气味沙雷菌。继发肺结核合并肺部感染合并慢性阻塞性肺病(COPD)、继发肺结核合肺部感染合并糖尿病患者,除真菌为首之外,主要是铜绿假单胞菌、金黄色葡萄球菌,其次是阴沟肠杆菌、大肠埃希菌。继发肺结核合并肺部感染(无合并症)两种菌株以上感染集菌(+)75.16%,继发肺结核合并肺部感染合并糖尿病单一菌株感染,集菌(+)69%,高于其他组。结论继发肺结核合并肺部感染菌群分布与综合医院菌群分布有其本身特点,为临床提供指导意义。     

非发酵菌下呼吸道感染临床及药敏分析

非发酵菌是指一群不能利用葡萄糖或仅能以氧化形式利用葡萄糖的革兰阳性菌。其中假单胞属的铜绿假单胞菌在肺部感染中的重要性早已为人们所知。近年来，随着新型抗生素的广泛应用及细菌鉴定方法的的发展，非发酵菌群中其他细菌如不动杆菌、嗜麦芽窄食单胞菌、引起的肺部感染日渐增加．因此，有必要对本群细菌的临床及诊治手段作一回顾性分析。     

肺结核合并肺部感染铜绿假单胞菌的药敏分析

目的调查分析肺结核合并肺部感染铜绿假单胞菌的耐药性。方法在342例肺结核合并肺部感染患者中共分离出115株铜绿假单胞菌,进行细菌鉴定及药物临床分析。结果肺结核合并肺部感染患者铜绿假单胞菌的感染率为33.6%,50岁以上者PA感染率(49.1%)明显高于50岁以下者(25.7%)(P<0.05);115株铜绿假单胞菌中对头孢唑林耐药率最高(80.0%),其次为氯霉素(75.65%);对碳青霉烯类药物亚胺培南的敏感率最高(86.96%),其次为阿米卡星(68.70%)、左氧氟沙星(64.35%)和环丙沙星(61.74%)。结论肺结核病患者由于长期服药,免疫功能低下,合并感染铜绿假单胞菌易产生抗药性,用药应根据药敏结果选择合适抗生素。     

铜绿假单胞菌易引发菌血症的危险因素分析

目的研究广泛耐药铜绿假单胞菌引发菌血症的发生率及其危险因素。方法回顾性研究沈阳军区总医院2009年至2011年200例铜绿假单胞菌感染的住院患者。采用常规方法进行细菌培养、菌株鉴定及药敏检测。结果200例患者中168例感染非广泛耐药铜绿假单胞菌的患者中有8例发展为菌血症（4．8％），32例感染广泛耐药铜绿假单胞菌的患者中3例发展为菌血症（9．4％）。近期应用氟喹诺酮是产生广泛耐药铜绿假单胞菌菌血症的独立危险因素。结论广泛耐药的铜绿假单胞菌更易引发菌血症，与患者的基础疾病、氟喹诺酮的使用有关。     

急性脑卒中病人医院获得性肺部感染162例分析

目的探讨脑卒中病人医院获得性肺部感染的特点及其防治对策.方法对我院 1996年1月-2004年6月住院急性脑卒中病人中发生的医院获得性肺部感染162例进行回顾性分析.结果出血性脑卒中病人的肺部感染率高于缺血性脑卒中病人;70岁以上高龄病人感染率明显升高; 肺部感染多发生在住院2周后; 合并感染病人病死率明显升高;常见病原菌为铜绿假单孢菌、白色念珠菌、嗜麦芽窄食单孢菌、金黄色葡萄球菌等, 某些病原菌呈多重耐药性.结论对脑卒中病人, 应加强护理, 积极采取预防措施, 避免发生肺部感染;肺部感染一旦发生, 应尽量在使用抗生素前做痰培养和药敏, 以便尽早明确病原菌, 有针对性地使用敏感的抗生素.     

2008年我院呼吸科革兰阴性菌的分布及药敏分析

目的了解2008年我院呼吸病房下呼吸道感染中G-菌（革兰阴性菌）的分布及药敏试验,为合理应用抗菌药物提供依据。方法对我院呼吸病房2008年住院患者的合格呼吸道分泌物进行细菌培养,分析G-菌的体外药敏试验情况。结果共分离到363株致病菌,其中G-菌189株。常见病原菌依次为铜绿假单胞菌,肺炎克雷伯菌,大肠埃希菌,嗜麦芽窄食单胞菌。铜绿假单胞菌对阿米卡星等敏感率为61%～87%,嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明的敏感率为94.7%,肺炎克雷伯菌对亚胺培南等敏感率为61.5%～94.2%,产ESBL株的检出率为21.2%。大肠埃希菌对阿米卡星、亚胺培南的敏感率为100%,产ESBL株的检出率30%。结论下呼吸道G-菌感染中,最常见为铜绿假单胞菌。铜绿假单胞菌的治疗可选用碳青酶烯类或＋氟喹诺酮类或氨基糖苷类;复方新诺明和左氧氟沙星可作为嗜麦芽窄食单胞菌感染的首选药物;肺炎克雷伯菌、大肠埃希菌的治疗可首选碳青酶烯类或阿米卡星。     

肺部继发嗜麦芽窄食单胞菌感染54例临床分析

目的：探讨肺部继发嗜麦芽窄食单胞菌感染的临床特点,以防延误诊治。方法：对18例结核组,24例肿瘤组,12例误诊结核组继发嗜麦芽窄食 菌感染患者进行回顾性分析。结果：哮麦芽窄食单胞菌是一种条件致病菌,通常合并基础疾病（88．9％）机械辅助通气（14．8％）,长期使用抗生素史（90．7％）及糖皮质激素史（53．7％）等患者,其中结核组有15例患者在结核治疗过程中原有症状加重或出现新的感染症状而明确继发嗜麦芽窄食单胞菌肺部感染,临床表现咳嗽48例（88．9％）,咯痰51例（94．4％）,其中黄痰33例（61．1％）,发热49例（90．7％）,多为不规则发热,胸部X线45例（83．7％）表现下肺斑片,片絮状阴影或肺纹理粗乱等,药敏检测结果该菌具有广泛耐药性,仅对替卡西林／克拉维酸钾,复方碘胺甲恶唑,环丙沙星等敏感。结论：肺部继发嗜麦芽窄食单胞菌感染临床上不具有特征性,易造成误诊或漏诊。诊断与治疗主要通过痰细菌培养和药敏检测结果。     

Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa

STUDY OBJECTIVES: To evaluate the relationship between hospital mortality and bloodstream infections due to Staphylococcus aureus or Pseudomonas aeruginosa. DESIGN: Prospective cohort study. SETTING: A 1,400-bed, university-affiliated urban teaching hospital. PATIENTS: Between December 2001 and September 2002, 314 patients with bacteremia due to S aureus or P aeruginosa were prospectively evaluated. INTERVENTION: Prospective patient surveillance and data collection. RESULTS: Thirteen patients (4.1%) received inadequate initial antibiotic treatment. Fifty-four patients (17.2%) died during hospitalization. Hospital mortality was statistically greater for patients with bloodstream infections due to P aeruginosa (n = 49) compared to methicillin-sensitive S aureus (MSSA) [n = 117; 30.6% vs 16.2%, p = 0.036] and methicillin-resistant S aureus (MRSA) [n = 148; 30.6% vs 13.5%, p = 0.007]. Multiple logistic regression analysis identified the lack of response to initial medical treatment (adjusted odds ratio [AOR], 2.69; 95% confidence interval [CI], 1.83 to 3.94; p = 0.010) and endocarditis (AOR, 4.62; 95% CI, 2.45 to 8.73; p = 0.016) as independent determinants of hospital mortality. Patients with bloodstream infections due to P aeruginosa were statistically more likely to be nonresponders to early medical treatment compared to patients with MSSA (73.5% vs 11.1%, p < 0.001) and MRSA (73.5% vs 16.9%, p < 0.001) bloodstream infections. CONCLUSIONS: These data suggest that bloodstream infections due to P aeruginosa have a greater risk of hospital mortality compared to bloodstream infections due to S aureus despite adequate antibiotic treatment.     

Infectious complications during remission induction therapy in 577 patients with acute myeloid leukemia in the Japan Adult Leukemia Study Group studies between 1987 and 1991

The Japan Adult Leukemia Study Group analyzed infectious episodes in 577 patients with acute myeloid leukemia during remission induction therapy between 1987 and 1991. 542 patients (93.9%) experienced at least one infectious episode, 121 (21.0%) had microbiologically documented infection; there was clinically documented infection in 184 (31.9%) and unexplained fever in 237 (41.1%). Among 121 microbiologically documented infections, bacteremia/fungemia was observed in 68, pneumonia in 33, and other types of infections in 20. Among the bacteremia/fungemia, gram-negative bacteria accounted for 41.2% (Pseudomonas aeruginosa was the most common), gram-positive bacteria for 39.7%, fungi for 16.2% (Candida spp. being most frequent), and polymicrobial for 2.9%. The most frequent isolates among pneumonia were Pseudomonas aeruginosa and Aspergillus. A total of 70 patients (12.1%) died during remission induction. Mortality of 68 patients with bacteremia/fungemia was 26.5%; in these patients, mortality with concomitant pneumonia increased to 41.4%; without pneumonia, mortality was 15.4% (P < 0.05). Mortality according to the isolated microbes was 17.2% for gram-negative bacteria, 25% for gram-positive bacteria, and 54.5% for fungi. Mortality of 113 patients with pneumonia (33 microbiologically documented and 80 clinically documented), 20 with other microbiologically documented infections, 104 with other clinically documented infections, and 237 with unexplained fever was 25.7%, 5.0%, 5.8%, and 5.1%, respectively.     

Epidemiology of nosocomial pneumonia in infants after cardiac surgery

BACKGROUND: The pattern of nosocomial pneumonia (NP) in infants in a pediatric surgical ICU after cardiac surgery may differ from that seen in adult ICUs. STUDY OBJECTIVES: The primary aim of this study was to describe the epidemiology of NP in infants after cardiac surgery and, secondarily, to describe the changes of the distribution and antibiotic resistance of the pathogen during the last 3 years. METHODS: Data were collected between June 1999 and June 2002 from 311 consecutive infants who underwent open-heart surgery in our hospital. We retrospectively analyzed the distribution and antibiotic resistance pattern of all the pathogenic microbial isolates cultured from lower respiratory tract aspirations. RESULTS: Of 311 infants, 67 patients (21.5%) acquired NP after cardiac surgery. The incidence of NP was more frequently associated with complex congenital heart defect (CHD) compared to simple CHD (43% vs 15.9%, chi(2) = 22.47, p < 0.0001). The proportion of late-onset NP was higher in patients with complex CHD (chi(2) = 6.02, p = 0.014). A total of 79 pathogenic microbial strains were isolated. Gram-negative bacilli (GNB) were the most frequent isolates (68 isolates, 86.1%), followed by fungi (6 isolates, 7.6%) and Gram-positive cocci (5 isolates, 6.3%). The main GNB were Acinetobacter baumanii (11 isolates, 13.9%), Pseudomonas aeruginosa (10 isolates, 12.7%); other commonly seen GNB were Flavobacterium meningosepticum (7 isolates, 8.9%), Klebsiella pneumoniae (7 isolates, 8.9%), Escherichia coli (6 isolates, 7.6%), and Xanthomonas maltophilia (5 isolates, 6.2%). The most commonly seen Gram-positive cocci were Staphylococcus aureus (2 isolates, 2.5%) and Staphylococcus epidermidis (2 isolates, 2.5%). The frequent fungi were Candida albicans (5 isolates, 6.3%). Most GNB were sensitive to cefoperazone-sulbactum, piperacillin-tazobactam, imipenem, ciprofloxacin, amikacin. The bacteria producing extended spectrum beta-lactamases were mainly from K pneumoniae and E coli; the susceptibility of ESBL-producing strains to imipenem was 100%. There were one case of methicillin-resistant S aureus (MRSA) and 1 case of methicillin-resistant S epidermidis; their susceptibility to vancomycin, gentamycin, and ciprofloxacin were 100%. From 1999 to 2002 in infants with NP after open-heart surgery, there was a trend of increasing frequency of multiresistant GNB such as A baumanii, P aeruginosa, and K pneumoniae. However, no remarkable changes of distribution were found in Gram-positive cocci and fungi in the 3-year period. Early onset episodes of NP were frequently caused by Haemophilus influenzae, methicillin-sensitive S aureus, and other susceptible Enterobacteriaceae. Conversely, in patients who acquired late-onset NP, P aeruginosa, A baumannii, other multiresistant GNB, MRSA, and fungi were the predominant organisms. CONCLUSIONS: The pattern of pathogens and their antibiotic-resistance patterns in NP in infants after cardiac surgery had not shown an increasing prevalence of Gram-positive pathogens as reported by several adult ICUs. GNB still remained the most common pathogens during the last 3 years in our hospital. There was a trend of increasing antibiotic resistance in these isolates.     

Risk factors of septic shock in patients with hematologic malignancies and Pseudomonas infections

Pseudomonas is a clinically significant and opportunist pathogen, usually associated in causing high mortality nosocomial infections. The aim of this study was to determine the risk factors associated with septic shock in patients diagnosed with hematologic malignancies and Pseudomonas infections. A total of 80 Pseudomonas isolates (77 Pseudomonas aeruginosa) were collected from 66 patients aged 2-64 years: 52 with acute leukemia (79%), 7 with lymphoma (10.5%), and 7 with other hematologic disorders (10.5%), between 2001 and 2009. The median age of the patients was 30 years. Isolates were collected mostly from bloodstreams (45%) and skin lesions (31.5%). The median time for microbiologic documentation was 8 days (range 0-35 days) from onset of neutropenia. At least 11 patients (16.6%) had recurrent (≥2) infections. The clinical symptoms observed were skin lesions (34%), diarrhea (20%), isolated fever (18%), and respiratory symptoms (14%). The isolates tested were found resistant to piperacillin/tazobactam (43%), ceftazidime (31%), imipenem-cilastatin (26%), ciprofloxacin (25%), and amikacin (26%). Septic shock occurred in 16.2% of episodes (13/80). Crude mortality due to septic shock occurred in 19.6% of patients (13/66). The median time for response to antibiotic therapy in the remaining 80.4% of patients (53/66) was 2.5 days. Univariate analysis revealed that factors associated with septic shock were: fever for ≥3 days in patients on antibiotic therapy (P = 0.019), serum lactate >5 mmol (P = 0.05), hemoglobin level <50 g/l (P = 0.042), hypoproteinemia <50 g/l (P = 0.01), procalcitonin >10 ng/ml (P = 0.031), and hypophosphatemia (P = 0.001). Multivariate analysis revealed that hypophosphatemia (P = 0.018), hypoproteinemia (P = 0.028), and high serum lactate (P = 0.012) are significant factors, independently associated with increased risk of septic shock in patients with hematologic malignancies and Pseudomonas infections.     

Antimicrobial therapy of febrile complications after high-dose chemo-/radiotherapy and autologous hematopoietic stem cell transplantation--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Infectious complications occur in 60-100% of patients following high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (HSCT), and are commonly caused by Gram-negative aerobic bacteria (such as Pseudomonas aeruginosa and enterobacteriacea e) and Gram-positive cocci (such as enterococci, streptococci and staphylococci), which should be covered by empiric first-line antibiotic therapy. Less frequently, infections are caused by fungi and anaerobic bacteria, and initial therapy does not necessarily have to cover coagulase-negative staphylococci, oxacillin-resistant S. aureus (MRSA), anaerobic bacteria and fungi. Patients who already receive antibiotics and develop pulmonary infiltrates should immediately be treated with systemic antifungals. Patients with fever and diarrhea or other signs and symptoms of gastrointestinal or perianal infection should be treated with antibiotics covering anaerobic bacteria and enterococci. Clinically stable patients with skin infections or central venous catheter-related infections can be treated with standard empiric antibiotic therapy including a beta-lactam active against Pseudomonas aeruginosa with or without an aminoglycoside, and should only receive glycopeptides if they do not respond to first-line therapy within 72 hours, become clinically unstable, have severe mucositis, or when resistance against the empiric antibiotics is demonstrated. Recombinant hematopoietic growth factors should not be added routinely but may be considered in life-threatening situations such as invasive pulmonary mycoses or sepsis.     

Factors affecting the incidence of Stenotrophomonas maltophilia isolation in cystic fibrosis

STUDY OBJECTIVES: To identify factors predisposing cystic fibrosis (CF) patients to Stenotrophomonas maltophilia infection and to determine whether coinfection with S maltophilia affects the clinical response to therapy with tobramycin solution for inhalation (TSI), 300 mg bid. DESIGN: Retrospective review of data collected from two identical, 6-month, randomized, placebo-controlled trials. SETTING: Sixty-nine CF centers in the United States. INTERVENTIONS: Active drug administration of 300 mg TSI. PATIENTS: Five hundred twenty CF patients with chronic Pseudomonas aeruginosa endobronchial infections. MEASUREMENTS AND RESULTS: A logistic regression analysis identified factors contributing to increased S maltophilia isolation frequency. In this multivariate analysis, the only significant predictors of S maltophilia isolation during the last month of the trial were the concomitant use of oral quinolones (primarily ciprofloxacin; p = 0.0015) and S maltophilia isolation prior to treatment (p < 0.0001). Treatment group, gender, age, use of systemic or inhaled steroids, use of oral sulfonamide, IV cephalosporins, or penicillin antibiotics, baseline FEV(1) percent predicted, and pretreatment Aspergillus isolation were not significant predictors of subsequent S maltophilia infection. In addition, S maltophilia-positive culture frequency was compared to the change in pulmonary function. Patients who either never had culture results positive for S maltophilia or who were positive at <25% of observations had greater clinical response to TSI at the final study visit compared to patients who were positive at > or = 25% of observations. CONCLUSIONS: TSI therapy did not result in a greater risk for isolation of S maltophilia than standard care alone. In contrast, oral quinolone antibiotic use during the trial was associated with a 2.7-fold increased risk of having a culture positive for S maltophilia (p = 0.0015). The use of TSI to suppress P aeruginosa resulted in improved lung function, regardless of S maltophilia culture frequency. However, improvement was not as great among patients who were persistently coinfected with S maltophilia.     

Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies.

Predisposing factors, clinical characteristics, and antimicrobial treatment of 37 hematology patients with Stenotrophomonas maltophilia bacteremia who were seen at the department of hematology of the University La Sapienza (Rome) from 1987 to 1996 were evaluated. The results were compared with a control group of patients with Pseudomonas aeruginosa bacteremia. Profound neutropenia was more prolonged in the S. maltophilia group (P=.025), severe cellulitis occurred only in S. maltophilia-infected patients (11 [30%]; P=.0002), and the bacteremia presented as breakthrough infection in 56% of the cases due to S. maltophilia (vs. only 24% of those due to P. aeruginosa; P=.002). Acute mortality rates associated with S. maltophilia and P. aeruginosa bacteremia were 24% and 21%, respectively. In both groups, profound neutropenia and hypotension at the onset of bacteremia, duration of profound neutropenia during bacteremia, severity-of-illness score > or =4, and inappropriate antibacterial treatment were factors significantly associated with death. Most S. maltophilia isolates were resistant to aminoglycosides, beta-lactams, and ciprofloxacin. Cotrimoxazole and ticarcillin-clavulanic acid showed borderline activity. Prompt administration of in vitro-active antibiotics may improve the prognosis of S. maltophilia bacteremia, especially for immunocompromised patients, and novel drug combinations are needed for the treatment of severe infections.     

Methicillin-resistant Staphylococcus aureus: the other emerging resistant gram-positive coccus among liver transplant recipients.

We undertook a study of the characteristics and clinical impact of infections due to methicillin-resistant Staphylococcus aureus (MRSA) after liver transplantation. Of 165 patients who received liver transplants at our institution from 1990 through 1998, 38 (23%) developed MRSA infections. The predominant sources of infection were vascular catheters (39%; n=15), wound (18%; n=7), abdomen (18%; n=7), and lung (13%; n=5). A significant increase in MRSA infections (as a percentage of transplant patients infected per year) occurred over time (P=.0001). This increase was greater among intensive care unit patients (P=.001) than among nonintensive care unit hospital patients (P=.17). Cytomegalovirus seronegativity (P=.01) and primary cytomegalovirus infection were significantly associated with MRSA infections (P=.005). Thirty-day mortality among patients with MRSA infections was 21% (8/38). Mortality was 86% in patients with bacteremic MRSA pneumonia or abdominal infection and 6% in those with catheter-related bacteremia (P=.004). Thus the incidence of MRSA infection has increased exponentially among our liver transplant recipients since 1990. These infections have unique risk factors, time of onset, and a significant difference in site-specific mortality; deep-seated bacteremic infections, in particular, portend a grave outcome.     

Infections caused by Pseudomonas maltophilia. Expanding clinical spectrum

Pseudomonas maltophilia (Xanthomonas maltophilia) is a frequently isolated commensal that is gaining increasing recognition as an opportunistic pathogen in debilitated hosts. We report three unusual infections due to P maltophilia that illustrate the ability of the organism to cause life-threatening illness. We describe a case of postoperative meningitis, a case of recurrent bacteremia complicated by ecthyma gangrenosum, and a case of native valve endocarditis in a drug addict. Because of frequent isolation from noninfected sites, the pathogenic potential of P maltophilia may be overlooked. The notable resistance of this organism is commonly used beta-lactam and aminoglycoside antibiotics may complicate therapy.