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

Alcaligenes xylosoxidans bacteremia: clinical features and microbiological characteristics of isolates.

Bacteremia caused by Alcaligenes xylosoxidans is rare. Between 1999 and 2002, 12 cases of bacteremia caused by A. xylosoxidans were diagnosed at a tertiary referral center in central Taiwan. The clinical features of these patients and the antimicrobial susceptibilities and pulsed-field gel electrophoresis (PFGE) pattern of their blood isolates were studied. All infections were acquired nosocomially. All of the adult patients had underlying diseases, and 10 (83%) had undergone an invasive procedure. The clinical syndrome included primary bacteremia in 7 patients (58%), and catheter-associated bacteremia, surgical wound infection, pneumonia, urinary tract infection, and empyema in 1 each. Polymicrobial bacteremia was found in 1 patient. The case-fatality rate was 17% (2/12). All isolates were susceptible to piperacillin and ceftazidime and resistant to aminoglycoside, ciprofloxacin and cefepime. Susceptibility to imipenem (67%), ampicillin-sulbactam (75%) and trimethoprim-sulfamethoxazole (92%) was variable. Genetic fingerprints obtained by PFGE showed identical pattern in the isolates from 2 neonates, indicating the epidemiologic relatedness of these infections. We conclude that A. xylosoxidans isolates are multi-resistant and A. xylosoxidans bacteremia should be considered as a possible etiology of infection after invasive procedures in patients with underlying diseases. Strict infection control is needed to prevent this infection.

Behavior, attitudes and knowledge about antibiotic usage among residents of Changhua, Taiwan.

This study surveyed the behavior, attitudes, and knowledge about antibiotic usage among residents of Changhua County, Taiwan. A questionnaire designed to evaluate general knowledge and attitudes towards antibiotic usage was administered to a total of 1024 adults. The male-to-female ratio was 0.75. All of the 1024 adults were aware of the term "antibiotics". Only 39.2% of subjects had knowledge about basic antibiotic terminology, 69.7% expected that physicians should educate people about antibiotics. There were 7 main findings of this study: (1) 52.7% of subjects considered that physicians advice about the need for compliance was poor; (2) 15.3% of subjects always requested an antibiotics prescription when they suffered from flu-like symptoms; (3) 49.8% failed to comply with prescribed antibiotic regimens; (4) 53.1% of subjects were not aware that antibiotic syrup should be stored in the refrigerator; (5) 27.1% of subjects lacked knowledge about how to deal with the misuse of antibiotics; (6) 9.3% of pregnant and breast-feeding subjects did not have adequate knowledge of the safety of using antibiotics during pregnancy; and (7) 30% of subjects did not know how to obtain information about antibiotic usage. Residents of Changhua County had inadequate or incorrect knowledge about antibiotic usage. The findings of this study imply the need for programs to promote greater education about antibiotics usage in the general population of Taiwan.

Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection.

BACKGROUND: Although several epidemiological surveys of Klebsiella clinical isolates have been performed, few studies have correlated the clinical isolate with disease. OBJECTIVE: To compare the clinical and bacteriological characteristics of Klebsiella pneumoniae bacteremia acquired as community or nosocomial infections. METHODS: We prospectively enrolled 158 consecutively hospitalized patients with K pneumoniae bacteremia. Clinical data were reviewed. Antimicrobial susceptibility testing and capsular serotyping were performed. We used the chi(2) test, the Fisher exact test, or the t test for statistic analysis. RESULTS: Underlying diabetes mellitus was more common in community-acquired than in nosocomial infection (46/94 [49%] vs. 8/64 [12%]; P<.001). On the other hand, neoplastic disease (34/64 [53%] vs. 13/94 [14%]; P<.001) and antibiotic resistance (P<.01) were more frequent in patients with nosocomial compared with community-acquired infections. Klebsiella pneumoniae liver abscesses, which were all community acquired, accounted for the source of 22 (23%) of 94 community-acquired K pneumoniae infections. No attributable source of infection was found for 37 (58%) of the 64 nosocomial infections vs. 15 (16%) of the 94 community-acquired infections. Only 58 isolates (36.7%) could be serotyped; of these, capsular serotypes K1, K2, and K28 accounted for 37 (23.4%), 8 (5.1%), and 6 (3.8%), respectively, of all strains. However, typeable isolates were significantly more common among community-acquired than nosocomial isolates (42/94 [45%] vs. 16/64 [25%]; P =.01), especially for serotype K1 (28/94 [30%] vs. 9/64 [14%]; P =.02). Significant risk factors for mortality included nosocomial infection, lung infection, thrombocytopenia, leukopenia, ceftazidime resistance, inappropriate antimicrobial therapy, and septic shock. CONCLUSIONS: Significant differences were identified between community-acquired and nosocomial K pneumoniae bacteremia. Ceftazidime resistance in nosocomial K pneumoniae bacteremia carried a high risk for mortality, and serotype K1 in K pneumoniae was more prevalent in community-acquired infection, suggesting more virulence.

Drug resistance of Mycobacterium tuberculosis complex in central Taiwan.

The prevalence of drug resistance to Mycobacterium tuberculosis complex (MTBC) shows marked geographic difference and is the key to determining drugs of choice for the initial treatment of tuberculosis (TB). This retrospective study investigated the MTBC resistance rate and its contributing factors based on the review of medical records from a hospital in central Taiwan. TB culture and antimicrobial susceptibility test were performed using the BACTEC MGIT 960 System. Isoniazid, rifampin, ethambutol and streptomycin were tested. Molecular detection of MTBC using BDProbeTec ET kits was conducted in positive culture media containing acid-fast bacilli. Between July 2001 and June 2002, 974 (12.4%) strains of MTBC were isolated from 7892 clinical specimens from 513 patients. They included 348 males and 165 females with mean age of 66.1 +/- 15.6 years and 63.4 +/- 19.2 years, respectively. Sixty one percent of patients were older than 64 years of age. The overall resistance rate to 1 or more drugs was 22.4% (n = 115). The number of strains resistant to individual drugs was 86 (16.8%) to isoniazid, 25 (4.9%) to rifampin, 21 (4.1%) to ethambutol, and 63 (12.3%) to streptomycin. Twenty (3.9%) isolates were resistant to at least isoniazid and rifampin. A history of anti-TB treatment was associated with drug resistance (36.8% vs 20.6%, p=0.0056). Only 22 (4.3%) patients were tested for HIV antibodies and the results were all negative. The prevalence of resistance to anti-TB drugs remains high in Taiwan and is associated with a previous history of anti-TB treatment. Retreatment may contribute to an increased prevalence of multiple drug resistance.

Venous catheter-associated bacteremia caused by rapidly growing mycobacteria at a medical center in central Taiwan.

BACKGROUND AND PURPOSE: Infections due to rapidly growing mycobacteria (RGM) are increasing worldwide, especially in immunocompromised hosts, but data on the clinical features of patients with RGM bacteremia are limited in Taiwan. This study was performed to determine the features associated with RGM. METHODS: The medical records of 12 patients with RGM bacteremia admitted to the Changhua Christian Hospital, Changhua, Taiwan, from April 2001 to March 2003 were retrospectively studied. Clinical data were reviewed and antimicrobial susceptibility testing of blood isolates by the agar disk elution method was performed. RESULTS: RGM bacteremia was caused by Mycobacterium fortuitum in 5 patients, Mycobacterium smegmatis in 3, Mycobacterium flavescens in 2, and Mycobacterium abscessus in 2. There were 5 men and 7 women (age range, 4-75 years). All patients had underlying diseases and all of the infections were associated with an indwelling vascular catheter. The time to onset of bacteremia ranged from 1 to 24 months. Fever (n = 11) was the most common presenting symptom. Susceptibility testing revealed a different antibiogram for each species of RGM. The rate of relapsing bacteremia was significantly higher in patients with delayed catheter removal and for whom the catheter was not removed (6/8; 75%) than in patients with timely catheter removal (0/4; 0%) [p = 0.03]. CONCLUSIONS: RGM bacteremia is rare but should be considered in immunocompromised patients with an indwelling venous catheter and undifferentiated fever. Identifying RGM at the species level and performing susceptibility testing are useful for guiding management. The catheter should be removed as soon as possible.