ABSTRACT
Background and Objectives: Lung cancer remains the most common malignancy worldwide. As the global population ages, the prevalence of epidermal growth factor receptor (EGFR)-mutation-positive non-small cell lung cancer (NSCLC) is increasing. Materials and Methods: We performed a meta-analysis and a systematic review of randomized, controlled trials to evaluate the efficacy of EGFR TKIs on progression-free survival (PFS) and overall survival (OS) in older adult patients with advanced EGFR-mutated NSCLC. A total of 1327 patients were included; among these, 662 patients were >65 years of age. Results: A pooled analysis indicated (1) an overall improvement in higher PFS for dacomitinib and osimetinib than that for other drugs (hazard ratio [HR] = 0.654, 95% CI: 0.474 to 0.903; p = 0.01) and (2) and no significant difference in the OS between the EGFR TKIs (HR = 0.989, 95% CI: 0.796 to 1.229; p = 921). Conclusion: Our study found that osimertinib achieved a higher PFS than all other EGFR TKIs did. Osimertinib is the preferred EGFR TKI for treatment of older adult patients with advanced EGFR-mutated NSCLC.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Humans , Aged , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , ErbB Receptors/genetics , Protein Kinase Inhibitors/therapeutic use , Protein Kinase Inhibitors/pharmacologySubject(s)
Liver Abscess/complications , Anti-Bacterial Agents/therapeutic use , Chills/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/physiopathology , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Fever/etiology , Humans , Klebsiella Infections/drug therapy , Klebsiella Infections/physiopathology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/pathogenicity , Liver Abscess/physiopathology , Male , Middle Aged , Portal Vein/abnormalities , Portal Vein/diagnostic imaging , Portal Vein/physiopathology , Tomography, X-Ray Computed/methodsABSTRACT
A 58-year-old man with a history of diabetes mellitus and end-stage renal disease acquired pneumonia with acute respiratory failure during his stay in an intensive care unit (ICU). Empirical antimicrobial therapy with ceftazidime and vancomycin was initiated, and imipenem replaced ceftazidime 2 days later due to the patients pulmonary condition failed to improve. However, within 5 days, pulmonary consolidation rapidly progressed to necrotizing pneumonia complicated by lung abscess, empyema, pyopneumothorax, and tension pneumothorax, leading to the patient's death. After the patient had died, all bacterial isolates from cultures of pleural effusion, blood, and tracheal aspirate were identified as Enterobacter cloacae (E. cloacae), which was susceptible to imipenem but resistant to ceftazidime. E. cloacae should be considered in the differential diagnosis of complicated necrotizing pneumonia with lung abscess, empyema, pyopneumothorax, and tension pneumothorax. Carbapenem therapy should be immediately initiated until the pathogen in such rapidly progressive ICU-acquired pneumonia is confirmed. Increased awareness among physicians regarding E. cloacae-induced complicated necrotizing pneumonia acquired in ICUs could enable earlier detection and appropriate antimicrobial therapy for this invasive disease.
Subject(s)
Melioidosis/diagnostic imaging , Rupture, Spontaneous/diagnostic imaging , Splenic Infarction/diagnostic imaging , Splenic Rupture/diagnostic imaging , Diabetes Complications/diagnostic imaging , Female , Humans , Melioidosis/complications , Middle Aged , Rupture, Spontaneous/etiology , Splenic Infarction/etiology , Splenic Rupture/etiologyABSTRACT
Staphylococcus lugdunensis, a strain of coagulase-negative staphylococci, is part of the normal flora of human skin but can cause multiple infections at various sites. This microorganism has emerged as a major human pathogen. However, no study has reported primary lung abscess caused by S. lugdunensis. A 54-year-old alcoholic man without relevant past medical history was admitted because of primary lung abscesses. Empirical amoxicillin/clavulanate therapy was initially administered; however, the patient had persistent pleuritic chest pain and fever. He subsequently underwent resection of the lung abscess and removal of exudative pleural effusion on the fourth hospital day. Histopathologic examination confirmed the diagnosis of lung abscess, and colonies of gram-positive bacteria were identified. The culture specimen from the abscess was positive for S. lugdunensis, which was susceptible to amoxicillin/clavulanate, cefazolin, ciprofloxacin, clindamycin, erythromycin, oxacillin, teicoplanin, tetracycline, and vancomycin. Following resection and 3 weeks of amoxicillin/clavulanate therapy, the patient eventually recovered well without relapse. This case report is the first to describe S. lugdunensis as a cause of primary lung abscess; this microorganism should be considered a potential monomicrobial pathogen in primary lung abscess.
Subject(s)
Lung Abscess/microbiology , Pleural Effusion/microbiology , Staphylococcal Infections/microbiology , Staphylococcus lugdunensis/isolation & purification , Alcoholics , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Chest Pain/drug therapy , Chest Pain/etiology , Humans , Lung Abscess/complications , Lung Abscess/pathology , Lung Abscess/therapy , Male , Middle Aged , Pleural Effusion/complications , Pleural Effusion/pathology , Pleural Effusion/therapy , Pneumonectomy , Radiography , Staphylococcal Infections/complications , Staphylococcal Infections/pathology , Staphylococcal Infections/therapy , Staphylococcus lugdunensis/pathogenicityABSTRACT
OBJECTIVES:: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS:: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS:: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS:: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.
Subject(s)
Bacteremia/diagnostic imaging , Bacteremia/therapy , Critical Care/methods , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/therapy , Adult , Aged , Aged, 80 and over , Bacteremia/microbiology , Bacteremia/mortality , Bacteria/isolation & purification , Female , Hospital Mortality , Humans , Intensive Care Units , Liver Abscess/diagnostic imaging , Liver Abscess/microbiology , Liver Abscess/mortality , Liver Abscess/therapy , Lung/diagnostic imaging , Lung/pathology , Male , Medical Records , Middle Aged , Multidetector Computed Tomography/methods , Multiple Organ Failure/microbiology , Multiple Organ Failure/mortality , Pneumonia/diagnostic imaging , Pneumonia/microbiology , Pneumonia/mortality , Pneumonia/therapy , Pulmonary Embolism/microbiology , Pulmonary Embolism/mortality , Retrospective Studies , Statistics, NonparametricABSTRACT
OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Bacteremia/diagnostic imaging , Bacteremia/therapy , Critical Care/methods , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/therapy , Bacteremia/microbiology , Bacteremia/mortality , Bacteria/isolation & purification , Hospital Mortality , Intensive Care Units , Liver Abscess/diagnostic imaging , Liver Abscess/microbiology , Liver Abscess/mortality , Liver Abscess/therapy , Lung/diagnostic imaging , Lung/pathology , Medical Records , Multidetector Computed Tomography/methods , Multiple Organ Failure/microbiology , Multiple Organ Failure/mortality , Pneumonia/diagnostic imaging , Pneumonia/microbiology , Pneumonia/mortality , Pneumonia/therapy , Pulmonary Embolism/microbiology , Pulmonary Embolism/mortality , Retrospective Studies , Statistics, NonparametricSubject(s)
Emphysema/diagnostic imaging , Emphysema/etiology , Pressure Ulcer/complications , Soft Tissue Infections/diagnostic imaging , Soft Tissue Infections/etiology , Emphysema/therapy , Female , Humans , Middle Aged , Pressure Ulcer/therapy , Soft Tissue Infections/therapy , Tomography, X-Ray ComputedSubject(s)
Catheter-Related Infections/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Thromboembolism/diagnostic imaging , Aged , Catheter-Related Infections/microbiology , Diagnosis, Differential , Female , Humans , Kidney Failure, Chronic/therapy , Lung/diagnostic imaging , Pulmonary Embolism/microbiology , Renal Replacement Therapy , Staphylococcal Infections/microbiology , Thromboembolism/microbiology , Vena Cava, Superior/diagnostic imagingABSTRACT
OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.
Subject(s)
Klebsiella Infections/complications , Klebsiella pneumoniae , Liver Abscess/complications , Pulmonary Embolism/microbiology , Shock, Septic/complications , Adult , Aged , Aged, 80 and over , Diabetes Complications/complications , Dyspnea/etiology , Female , Fever/etiology , Humans , Klebsiella Infections/diagnosis , Klebsiella Infections/microbiology , Liver Abscess/microbiology , Male , Middle Aged , Multiple Pulmonary Nodules/diagnosis , Pleural Effusion/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Retrospective Studies , Shock, Septic/diagnosis , Shock, Septic/microbiology , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis. .
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Klebsiella pneumoniae , Klebsiella Infections/complications , Liver Abscess/complications , Pulmonary Embolism/microbiology , Shock, Septic/complications , Diabetes Complications/complications , Dyspnea/etiology , Fever/etiology , Klebsiella Infections/diagnosis , Klebsiella Infections/microbiology , Liver Abscess/microbiology , Multiple Pulmonary Nodules/diagnosis , Pleural Effusion/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Retrospective Studies , Shock, Septic/diagnosis , Shock, Septic/microbiology , Tomography, X-Ray Computed/methodsSubject(s)
Bronchopulmonary Sequestration/etiology , Coronary Angiography , Coronary Vessel Anomalies/complications , Radiography, Thoracic , Tomography, X-Ray Computed , Aged , Bronchopulmonary Sequestration/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Diagnosis, Differential , Diagnostic Errors , Female , HumansABSTRACT
Prototheca wickerhamii, an environmental alga, rarely causes human infections. We present a case of Prototheca wickerhamii cutaneous and systemic infections in an 85-year-old male with adrenal insufficiency. This organism was identified by morphological features and microbiological tests. The patient was successfully treated with ketoconazole.
Subject(s)
Adrenal Insufficiency/complications , Cytochrome P-450 CYP3A/therapeutic use , Infections/drug therapy , Ketoconazole/therapeutic use , Prototheca/isolation & purification , Skin Ulcer/diagnosis , Aged, 80 and over , Fever , Humans , Infections/complications , Infections/diagnosis , Male , Skin Ulcer/complications , Skin Ulcer/drug therapy , Sporangia , Treatment OutcomeSubject(s)
Diaphragmatic Eventration/etiology , Imaging, Three-Dimensional , Kidney Diseases/congenital , Kidney/abnormalities , Radiography, Abdominal/methods , Tomography, X-Ray Computed/methods , Aged, 80 and over , Diagnosis, Differential , Diaphragmatic Eventration/diagnostic imaging , Female , Humans , Kidney/diagnostic imaging , Kidney Diseases/diagnostic imagingABSTRACT
Ten patients with intensive care unit (ICU)-acquired Chryseobacterium indologenes bacteremia between January 2004 and December 2008 were studied. The primary site of infection was unknown for 80% of the cases. The known primary sites of infection were empyema (10%) and catheter-related bacteremia (10%). Eight patients (80%) had polymicrobial bacteremia, spent more than 21 days in the ICU, and received more than 14 days of broad-spectrum antibiotic therapy prior to the onset of C. indologenes bacteremia. All isolates were 100% susceptible to minocycline and trimethoprim/sulfamethoxazole. Vancomycin, imipenem, piperacillin/tazobactam, ciprofloxacin, and levofloxacin exhibited 0%, 10%, 20%, 30%, and 30%, respectively, susceptibility against this pathogen. All isolates were 100% resistant to ceftazidime, cefepime, meropenem, piperacillin, and amikacin. The 14-day mortality rate was 40%. Our findings suggest that this pathogen should be included among the causes of ICU-acquired bacteremia, especially in patients with a prolonged stay in an ICU or who had received long-term broad-spectrum antibiotic therapy. Extended-spectrum penicillins, third- and fourth-generation cephalosporins, and quinolones had very little or no effect against this pathogen. Therefore, choosing an appropriate antibiotic therapy for this pathogen is very difficult.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacteremia/drug therapy , Bacteremia/pathology , Chryseobacterium/isolation & purification , Flavobacteriaceae Infections/drug therapy , Flavobacteriaceae Infections/pathology , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Chryseobacterium/drug effects , Cross Infection/drug therapy , Cross Infection/microbiology , Cross Infection/pathology , Drug Resistance, Bacterial , Female , Flavobacteriaceae Infections/microbiology , Humans , Intensive Care Units , Male , Microbial Sensitivity Tests , Middle Aged , Treatment OutcomeABSTRACT
An endemic outbreak of melioidosis developed in southern Taiwan following a flood caused by a typhoon in July 2005. A total of 27 patients were diagnosed with the acute and indigenous form of pulmonary melioidosis. Parapneumonic pleural effusions were noted on chest X-rays in six patients. Thoracentesis was done in three patients and all revealed lymphocyte predominance in differential cell count. Burkholderia pseudomallei was isolated in the pleural effusion in one of them. All three patients survived after antibiotic treatment. Lymphocytic pleural effusion is generally seen in tuberculosis or malignancy. However, our findings suggest that melioidosis should be considered in the differential diagnosis of lymphocytic pleural effusion.
Subject(s)
Lymphocytosis/microbiology , Melioidosis/epidemiology , Pleural Effusion/microbiology , Pleural Effusion/pathology , Acute Disease , Aged , Disasters , Disease Outbreaks , Female , Humans , Male , Melioidosis/complications , Middle Aged , Taiwan/epidemiologyABSTRACT
BACKGROUND/PURPOSE: In recent years, the number of cases of melioidosis has increased substantially in Taiwan. However, there have been no publications specifically studying patients who have bacteremic melioidosis in Taiwan. This study aimed to determine the clinical characteristics and outcome of patients with bacteremic melioidosis in Taiwan. METHODS: We retrospectively reviewed the records of 30 patients (mean age, 65 years) with blood culture-confirmed melioidosis who were managed at Tainan Municipal Hospital between June 2004 and January 2007. Nineteen out of 30 patients were identified within 1 month after Typhoon Haitang struck in mid-July 2005. A comparison of demographic characteristics, underlying conditions, biochemistry results, and clinical presentations between survivors (n = 21) and non-survivors (n = 9) was analyzed. RESULTS: Underlying conditions were identified in 90% of patients, diabetes mellitus being the commonest (50%). The most common site of infection was the lung (70%), followed by the genitourinary tract (13.3%), peritoneum (6.7%), meninges (3.3%), skin (3.3%), and aorta (3.3%). There were also 20% of cases without a primary site of infection being identified. Twenty percent of patients had multiple sites of infection. The number of bacteremic melioidosis with pneumonia was significantly higher in the post-typhoon outbreak (p = 0.001). Comparing survivors and non-survivors, there were no significant differences in age, gender, underlying conditions, and presence of pneumonia. Significant differences were evident in elevated serum creatinine (p = 0.038) and pH (p = 0.004). Fifty-six percent (5/9) of deaths occurred within 48 hours after presentation to hospital and 67% (6/9) of deaths occurred in the post-typhoon outbreak. Patients with septic shock (p < 0.001), acute renal failure (p = 0.013), and respiratory failure (p = 0.001) had significantly higher mortality. The in-hospital mortality rate was 27% and the relapse rate was 14%. CONCLUSION: The lungs were the most common site of infection in patients with bacteremic melioidosis and rapidly progressive community-acquired pneumonia (CAP) was the major cause leading to mortality. Patients with septic shock, acute renal failure, and acute respiratory failure had a much higher mortality rate. Typhoon Haitang was associated not only with higher numbers of cases and deaths but also with pneumonic presentations. Locally adapted guidelines need to be developed for the treatment of CAP in an endemic area of melioidosis in southern Taiwan and after extreme weather events such as typhoons or heavy rains.