ABSTRACT
BACKGROUND: Genitourinary tuberculosis (GUTB) is rare but fatal if not diagnosed early. The purpose of this study was to investigate the outcomes of GUTB in Taiwan. METHODS: We retrospectively reviewed medical records of 57 patients who were diagnosed as GUTB from January 2002 to December 2016, over a 15-year period. Demographic data and clinical manifestations were recorded for analysis. RESULTS: There were 37 males and 20 females with a median age of 71 years. Kidney (24.6%) was the most involved organ. Fever (56.1%) was the major presentation. Sixteen (28.1%) patients presented unfavorable outcome. Compared with the favorable outcome group, the unfavorable outcome group had more malignancy (p = 0.013), fever (p = 0.020), anemia (p = 0007), thrombocytopenia (p = 0.003), and hypoalbuminemia (p = 0.015). In a multivariate analysis, fever (odds ratio: 42.716, 95% confidence interval: 1.032-1767.569; p = 0.048) was identified as prognostic factors for unfavorable outcome. CONCLUSION: GUTB is often in advanced stages with a high mortality in Taiwan. Establishing a diagnosis is difficult and requires thorough investigation. Fever is associated with unfavorable outcome.
Subject(s)
Hospitals, Teaching , Tuberculosis, Urogenital/drug therapy , Tuberculosis, Urogenital/epidemiology , Tuberculosis, Urogenital/pathology , Tuberculosis, Urogenital/physiopathology , Adult , Aged , Aged, 80 and over , Anemia/epidemiology , Antitubercular Agents/pharmacology , Antitubercular Agents/therapeutic use , Female , Fever/epidemiology , Humans , Hypoalbuminemia/epidemiology , Kaplan-Meier Estimate , Kidney Diseases/epidemiology , Kidney Diseases/microbiology , Logistic Models , Male , Microbial Sensitivity Tests , Middle Aged , Mortality , Multivariate Analysis , Neoplasms/epidemiology , Neoplasms/microbiology , Odds Ratio , Prognosis , Retrospective Studies , Risk Factors , Taiwan/epidemiology , Thrombocytopenia/epidemiology , Treatment Outcome , Urinary Tract/surgeryABSTRACT
BACKGROUND: Antimicrobial resistance has become a major health problem in Taiwan. While some trends in antimicrobial resistance are universal, others appear to be unique for specific regions. METHODS: To determine the distribution and antimicrobial drug resistance of bacterial pathogens in a new hospital in southern Taiwan, surveillance data on major bacterial pathogens isolated from Chang Gung Memorial Hospital at Chia-Yi from January 2002 through December 2002 were retrospectively analyzed. RESULTS: The most common gram-positive isolate was Staphylococcus aureus. Escherichia coli and Klebsiella pneumoniae were the two most common gram negative isolates. Pseudomonas aeruginosa ranked the first among gram-negative, glucose non-fermenting isolates, followed in the order of frequency by Acinetobacter baumannii. Oxacillin resistance rate of S. aureus was 58%, while vancomycin and teicoplanin remained effective against all of the isolates. The penicillin non-susceptibility rate of Streptococcus pneumoniae was 52%, and it is notable that the rate of resistance to erythromycin was 87%. Resistance to various antimicrobial agents for P. aeruginosa, Aeromonas hydrophila, and gram-negative enteric bacilli was very common in our study. Infections caused by multidrug-resistant A. baumannii was not uncommon in this hospital but fortunately, imipenem resistant A. baumannii was rarely encountered. Antimicrobial resistance was common in nontyphoid Salmonella, S. choleraesuis and serogroup B isolates in particular. CONCLUSION: The high rates of antimicrobial resistance among these major bacterial pathogens in this new hospital are impressive and alarming. Judicious use of antimicrobial agents can never be overemphasized. Continued surveillance of the changes of resistance patterns over time is necessary.
