Follow-up blood cultures add little value in the management of bacteremic urinary tract infections.

The need for mandatory confirmation of negative conversion in bacteremic urinary tract infection (UTI) has not been adequately addressed, even though follow-up blood cultures (FUBCs) are still prescribed liberally. The purpose of this study was to identify possible risk factors associated with positive FUBCs. We retrospectively collected data on adult cases of bacteremic UTI with at least one FUBC. Patients were divided into the negative FUBCs and the positive FUBC group, and data of both groups were compared. Of 306 cases of bacteremic UTI, 251 had a negative result from an FUBC and 55 had a positive result. Diabetes mellitus, malignancy, complicated UTI, and initial intensive care unit (ICU) admission were significantly more common in the positive FUBC group than in the negative group (all-P < 0.05). Time to defervescence was significantly longer in the positive FUBC group than in the negative group (52.2 h vs. 25.3 h, P < 0.05). A multivariate analysis showed that malignancy, initial ICU admission, CRP > 16 (mg/dL), and a time to defervescence of more than 48 h were significant factors associated with a positive FUBC. No subsequent cases of bacteremia developed in patients without risk factors associated with a positive FUBC. In bacteremic UTIs, patients with positive FUBCs usually present with higher initial inflammatory markers, longer time to defervescence, more frequent ICU admission rates, and an elevated chance of having cancer. More careful clinical assessment before drawing FUBCs would reduce costs and inconvenience to patients.

A Case of Multiple Cardiovascular and Tracheal Anomalies Presented with Wolff-Parkinson-White Syndrome in a Middle-aged Adult.

Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. A 56-year-old man with no previous medical history was admitted due to recurrent wide QRS complex tachycardia with hemodynamic collapse. A chest radiograph showed dextrocardia. After synchronized cardioversion, an electrocardiogram revealed Wolff-Parkinson-White (WPW) syndrome. Persistent left SVC, PA sling, and right tracheal bronchus were also detected by a chest computed tomography (CT) scan. He was diagnosed with paroxysmal supraventricular tachycardia (PSVT) associated with WPW syndrome, and underwent radiofrequency ablation. We reported the first case of situs solitus dextrocardia coexisting with persistent left SVC, PA sling and right tracheal bronchus presented with WPW and PSVT in a middle-aged adult. In patients with a cardiovascular anomaly, clinicians should consider thorough evaluation of possibly combined cardiovascular and airway malformations and cardiac dysrhythmia.

Colistin Plus Carbapenem versus Colistin Monotherapy in the Treatment of Carbapenem-Resistant Acinetobacter baumannii Pneumonia.

PURPOSE: Colistin alone may not be sufficient for treating carbapenem-resistant Acinetobacter baumannii (CRAB); thus, efforts are needed to increase treatment success rates. We compared the effects of colistin plus carbapenem therapy versus colistin monotherapy in treating pneumonia caused by CRAB and attempted to identify specific populations or factors that could benefit from combination therapy. METHODS: We retrospectively collected data on cases of CRAB pneumonia. The patients were divided into colistin plus carbapenem therapy and colistin monotherapy groups. The primary outcome was 14-day mortality. The secondary outcomes were in-hospital mortality, clinical improvement at days 2 and 14, and microbiological improvement at day 14. RESULTS: Of 160 cases meeting criteria for CRAB pneumonia, 83 (52%) and 77 (48.0%) were treated with carbapenem combination therapy or colistin monotherapy, respectively. Among these patients, 50 (63.3%) in the combination group and 27 (39.7%) in the monotherapy group had Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scores >24 points (p=0.010). Overall, there was no significant difference in 14-day mortality between the combination and monotherapy groups (24.1% vs 20.8%, p=0.616). Clinical improvement and sputum-negative conversion also showed no significant difference. After adjusting for disease severity according to APACHE II score, the 14-day mortality was significantly lower in the combination group than in the monotherapy group among patients with APACHE II scores of 25-29 points (9.1% vs 53.8%, P=0.020). CONCLUSION: Despite more severe conditions, compared with colistin monotherapy, colistin plus carbapenem combination therapy showed equivalent primary mortality outcome in treating CRAB pneumonia. Combination therapy was more effective in patients with APACHE II score ranging from 25 to 29 points.

Mixed Infection of Mycobacterium abscessus subsp. abscessus and Mycobacterium tuberculosis in the Lung.

A mixed infection of Mycobacterium abscessus subsp. abscessus (Mab) and Mycobacterium tuberculosis (MTB) in the lung is an unusual clinical manifestation and has not yet been reported. A 61-year-old woman had been treated for Mab lung disease and concomitant pneumonia, and was diagnosed with pulmonary tuberculosis (PTB). Despite both anti-PTB and anti-Mab therapy, her entire left lung was destroyed and collapsed. She underwent left pneumonectomy and received medical therapy. We were able to successfully treat her mixed infection by pneumonectomy followed by inhaled amikacin therapy. To the best of our knowledge, thus far, this is the first description of a mixed Mab and MTB lung infection.