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1.
BMC Infect Dis ; 20(1): 254, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228480

RESUMO

BACKGROUND: To evaluate nasal carriage, antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan. METHODS: From September 2014 to November 2015, HIV-infected patients seeking outpatient care at four hospitals were eligible for this study. A nasal specimen was obtained from each subject for the detection of S. aureus and a questionnaire was completed by each subject. MRSA isolates once identified were characterized. RESULTS: Of 553 patients surveyed, methicillin-susceptible S. aureus (MSSA) was detected in 119 subjects (21.5%) and MRSA in 19 subjects (3.4%). Female gender, injection drug use, smoking, hepatitis C virus carrier, cancer and antibiotic use within 1 year were positively associated with MRSA colonization. By multivariate analysis, only cancer (adjust odds ratio (aOR) 7.78, [95% confidence interval (CI), 1.909-31.731]) and antibiotic use within 1 year (aOR 3.89, [95% CI, 1.219-12.433]) were significantly associated with MRSA colonization. Ten isolates were characterized as sequence type (ST) 59/staphylococcal chromosome cassette (SCC) IV or VT, endemic community strains in Taiwan, four isolates as ST 8/SCCmec IV (USA 300) and one isolate as ST 239/SCCmec IIIA, a hospital strain. All the community-associated MRSA isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX). CONCLUSIONS: Nasal MRSA carriage in HIV-infected patients seeking outpatient care was low (3.4%) in northern Taiwan. Most of the colonizing isolates were genetically endemic community strains and exhibited high susceptibility to TMP-SMX and fluoroquinolones. Cancer and antibiotic use within 1 year were associated with MRSA colonization.

2.
Medicine (Baltimore) ; 97(50): e13607, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558035

RESUMO

The accuracy of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for identifying viridans group streptococcus (VGS) was improving. However, the clinical impact of identifying VGS had not been well recognized. Our study had comprehensively studied the clinical manifestations and outcome of VGS blood stream infection by using MALDI-TOF MS for identification.This retrospective study enrolled 312 adult patients with a monomicrobial blood culture positive for VGS. Blood culture was examined through MALDI-TOF MS.The most common VGS species were the Streptococcus anginosus group (38.8%) and Streptococcus mitis group (22.8%). Most species showed resistance to erythromycin (35.6%), followed by clindamycin (25.3%) and penicillin (12.5%). Skin and soft tissue infection and biliary tract infection were significantly related to S. anginosus group bacteremia (P = .001 and P = .005, respectively). S. mitis group bacteremia was related to infective endocarditis and bacteremia with febrile neutropenia (P = .005 and P < .001, respectively). Infective endocarditis was also more likely associated with S. sanguinis group bacteremia (P = .009). S. anginosus group had less resistance rate to ampicillin, erythromycin, clindamycin, and ceftriaxone (P = .019, <.001, .001, and .046, respectively). A more staying in intensive care unit, underlying solid organ malignancy, and a shorter treatment duration were independent risk factors for 30-day mortality. This study comprehensively evaluated different VGS group and their clinical manifestations, infection sources, concomitant diseases, treatments, and outcomes. Categorizing VGS into different groups by MALDI-TOF MS could help clinical physicians well understand their clinical presentations.


Assuntos
Bacteriemia/etiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Estreptococos Viridans/patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Bacteriemia/mortalidade , Hemocultura/métodos , Hemocultura/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/estatística & dados numéricos , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/mortalidade , Taiwan/epidemiologia , Estreptococos Viridans/crescimento & desenvolvimento
3.
J Microbiol Immunol Infect ; 51(6): 821-828, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30201132

RESUMO

BACKGROUND/PURPOSES: Vancomycin resistance increased significantly to 31.3% among Enterococcus faecium in 2006 and remained high thereafter at a university hospital in Taiwan. A longitudinal study was retrospectively conducted to characterize these vancomycin-resistant E. faecium (VRE-fm). METHODS: A total of 378 non-repetitive VRE-fm blood isolates collected during 2002-2015 were studied. Multilocus sequence typing, pulsed-field gel electrophoresis, analysis of van genes and the Tn1546 structure, and conjugation experiments were performed. RESULTS: The majority (78.0%) of the isolates were associated with hospital-acquired infections. Molecular typing revealed nine major pulsotypes and five predominant sequence types (STs): ST17 (33.9%), ST78 (18.3%), ST414 (14.6%), ST18 (10.6%), and ST203 (7.4%). Fluctuation of these prevailing STs among the study years in association with some major pulsotypes was noted. All isolates carried vanA genes, except that in four isolates vanB genes were found. Among the vanA-carrying Tn1546-like elements, one predominant structure type (Type I, 55.9%) was noted throughout the study years. Since 2009, another predominant structure type (Type II, 40.1%) has emerged firstly in ST414 and gradually spread to other 11 STs in subsequent years. Isolates carrying these Type II Tn1546-like elements have become the most predominant population since 2014, majorly found in ST78 and ST17. Preliminary experiments indicated that plasmids carrying the Type II Tn1546-like elements demonstrated ten-fold higher efficiency than those carrying the Type I Tn1546-like elements. CONCLUSION: Dissemination of some major STs and horizontal transfer of plasmids carrying two major structure types of Tn1546-like elements may have together contributed to the increase of VRE-fm infection.


Assuntos
Infecção Hospitalar/epidemiologia , Elementos de DNA Transponíveis/genética , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Enterococos Resistentes à Vancomicina/genética , Enterococos Resistentes à Vancomicina/isolamento & purificação , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Infecção Hospitalar/microbiologia , Enterococcus faecium/classificação , Enterococcus faecium/genética , Genótipo , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais Universitários , Humanos , Estudos Longitudinais , Plasmídeos , Estudos Retrospectivos , Taiwan/epidemiologia , Resistência a Vancomicina/genética , Enterococos Resistentes à Vancomicina/classificação
4.
J Microbiol Immunol Infect ; 51(6): 839-846, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30190232

RESUMO

BACKGROUND/PURPOSE: Bacteremia portends high rates of morbidity and mortality. Although 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) imaging has clinical value in assessing fever of unknown origin, its usefulness in bacteremia has not been entirely elucidated. We therefore designed the current single-center retrospective study to investigate 1) the clinical value of 18F-FDG PET/CT imaging in assessing bacteremia and 2) the association between laboratory data and imaging findings. METHODS: We examined 102 patients with bacteremia who had undergone 18F-FDG PET/CT imaging. The patients' clinical and laboratory data were reviewed and analyzed in relation to 18F-FDG PET/CT findings. Patients showing positive results underwent quantitative measurements of 18F-FDG uptake. RESULTS: Positive 18F-FDG PET/CT findings were identified in 74 (72.5%) patients, and 40 (54.1%) underwent modified treatment or management because of the imaging results (p = 0.003). Positive 18F-FDG PET/CT findings were significantly associated with higher white blood cell (WBC) counts and C-reactive protein (CRP) levels (p = 0.012 and < 0.001, respectively). Notably, CRP levels accurately predicted (area under curve = 0.752; p < 0.001) positive 18F-FDG PET/CT findings (optimal cut-off point: 54.025 mg/L). CONCLUSION: A majority (54.1%, n = 40) of the patients with positive 18F-FDG PET/CT results underwent treatment modifications; they accounted for most cases (87%) of management changes in our cohort. Leukocytosis and increased CRP levels are significantly associated with positive 18F-FDG PET/CT findings in patients with bacteremia. CRP levels >54.025 mg/L were accurate predictors of positive 18F-FDG PET/CT results.


Assuntos
Bacteriemia/sangue , Bacteriemia/diagnóstico por imagem , Proteína C-Reativa/análise , Fluordesoxiglucose F18/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/terapia , Biomarcadores/análise , Criança , Feminino , Hospitais Universitários , Humanos , Leucocitose/sangue , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Taiwan , Adulto Jovem
5.
J Chin Med Assoc ; 81(11): 935-941, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30017810

RESUMO

BACKGROUND: Prokinetics have been shown to improve intestinal bacterial overgrowth and dysmotility in cirrhotic patients. Antibiotics are suggested for high risk patients for prophylaxis of spontaneous bacterial peritonitis (SBP). However, limited studies have investigated the association of SBP and these medications. We examined the association of prokinetics or antibiotics use and the first episode of SBP development in patients with cirrhosis. METHODS: We conducted a case-crossover study using the Taiwanese National Health Insurance Research Database from 2001 to 2010. A total of 129 cirrhotic patients with SBP were identified (defined as International Classification of Disease-Ninth Revision-CM codes: 571.xx for cirrhosis; 567.2, 567.8, and 567.9 for ascites; 789.5 for SBP). We investigated the short term (defined as 14-day period) effect of prokinetic agents or antibiotics use on SBP development using conditional logistic regressions with the adjustment of potential confounders. RESULTS: The results suggested that prokinetic agents or antibiotics use during the 14 days before SBP were associated with an increased risk of SBP [adjusted odds ratio (OR) = 3.2, 95% confidence interval (CI): 1.02-10.04 for prokinetic agents; and adjusted OR = 2.95, 95% CI: 1.05-5.23 for antibiotics]. In dose analysis, the use of prokinetic agents more than 0.5 defined daily dose was more commonly found in the case period without a statistical difference (adjusted OR = 3.637; 95% CI: 0.69-19.13). CONCLUSION: The results demonstrated an increased risk of primary SBP development among cirrhotic patients with prokinetic agents or antibiotics use. It is important to closely monitor those patients for the occurrence of SBP.


Assuntos
Antibacterianos/efeitos adversos , Infecções Bacterianas/etiologia , Fármacos Gastrointestinais/efeitos adversos , Cirrose Hepática/complicações , Peritonite/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Intestinos/microbiologia , Masculino , Pessoa de Meia-Idade
6.
Eur J Nucl Med Mol Imaging ; 45(3): 462-470, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28951990

RESUMO

BACKGROUND: Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP. METHODS: Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results. RESULTS: Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%). CONCLUSIONS: FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Pielonefrite/diagnóstico por imagem , Doença Aguda , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/complicações , Estudos Retrospectivos
7.
J Microbiol Immunol Infect ; 51(6): 705-716, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29046248

RESUMO

BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE-fm) bacteremia causes significant mortality in hospitalized patients. We sought to investigate clinical characteristics, treatment outcomes, and microbiological eradication associated with VRE-fm bacteremia. METHODS: A retrospective cohort study was conducted and included 210 adult patients admitted between January 1, 2011 and December 31, 2015. RESULTS: The mean Pitt bacteremia score was 4.7. ICU stay (48.6%) and mechanical ventilation (46.2%) were common. Diabetes mellitus was the most common concomitant disease (43.3%), followed by malignancies, including hematologic malignancies (14.3%) and solid cancers (28.1%). The 14-day and 28-day mortality rates were 37.1% and 50.5%, respectively. Linezolid or daptomycin treatment for at least 10 days and higher Pitt bacteremia scores were independently associated with 14-day and 28-day mortality. Longer treatment duration of linezolid or daptomycin predicted microbiological eradication independently. Daptomycin-treated patients tended to have higher 14-day and 28-day mortality, and lower microbial eradication rates (20.8% versus 8.7%; 40.6% versus 26.1%; 14.1% versus 26.1%; respectively) than linezolid-treated patients, and cumulative survival rates at 14 and 28 days tended to be lower in patients who received low-dose daptomycin (<10 mg/kg/day) than that in those who received linezolid and high-dose daptomycin (≥10 mg/kg/day); however, the differences were not statistically significant. CONCLUSION: Higher disease severity and inappropriate treatment were associated with increased mortality and longer treatment duration of linezolid or daptomycin was associated with microbial eradication for the patient with VRE-fm bacteremia.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/mortalidade , Daptomicina/administração & dosagem , Daptomicina/farmacologia , Feminino , Humanos , Linezolida/administração & dosagem , Linezolida/farmacologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Taiwan , Centros de Atenção Terciária , Resultado do Tratamento , Enterococos Resistentes à Vancomicina/isolamento & purificação
8.
J Antimicrob Chemother ; 72(12): 3258-3262, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28962025

RESUMO

Objectives: Staphylococcus lugdunensis, a species of CoNS, has become an important hospital pathogen because of increasing resistance to ß-lactam antibiotics such as methicillin and oxacillin. Methicillin resistance is mainly due to the acquisition of the staphylococcal cassette chromosome (SCC) mec (SCCmec). Little is known about the structure of SCCmec in methicillin- or oxacillin-resistant CoNS. Methods: WGS was performed to determine the structure of SCCmec elements of two clinical S. lugdunensis isolates: CMUH-22 and CMUH-25. Results: These elements were found to be flanked by DRs and IRs with unique mosaic structures and a common integration site in the 3' end of the rlmH gene. The sequences of the regions located between rlmH and the ISSau4-like transposase genes of both elements were similar to those of SCCmec Vt of Staphylococcus aureus PM1. The SCCmec (type V, 5C2&4) of CMUH-25 harboured a novel ccrC complex and a C2-like mec complex in opposite orientations, similar to the type V SCCmec of S. aureus WIS. The sequences of the ccrA4B4 genes and J1 and J2 regions of CMUH-25 were similar to those of the SCC element of Staphylococcus haemolyticus NCTC 11042. In contrast, portions of the sequence of the J1 region of type Vt (5C2) SCCmec in strain CMUH-22 were highly similar to portions of those of Staphylococcus epidermidis RP62A and the composite SCCmec type V of S. aureus WAMRSA40. Conclusions: These observations suggest that the SCCmec elements of CMUH-25 and CMUH-22 evolved separately and assembled through different recombination events.


Assuntos
Antibacterianos/farmacologia , Cromossomos Bacterianos , Ordem dos Genes , Oxacilina/farmacologia , Staphylococcus lugdunensis/efeitos dos fármacos , Staphylococcus lugdunensis/genética , Resistência beta-Lactâmica , Evolução Molecular , Genes Bacterianos , Humanos , Recombinação Genética , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/isolamento & purificação , Sequenciamento Completo do Genoma
9.
Ann Clin Microbiol Antimicrob ; 16(1): 52, 2017 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-28738848

RESUMO

BACKGROUND: We assessed the influence of current cefepime minimal inhibitory concentration (MIC) breakpoints and the maximal cefepime dose on treatment outcomes in patients with bacteremia caused by cefepime-susceptible Pseudomonas aeruginosa. METHODS: Adult patients hospitalized between July 2010 and June 2014 with a positive blood culture for cefepime-susceptible P. aeruginosa and receipt of cefepime as the primary therapy throughout the course were reviewed. Cefepime Etest® MICs and clinical outcomes for P. aeruginosa bacteremia were reviewed to identify the MIC breakpoint influencing treatment outcomes. RESULTS: Of the 90 patients enrolled, 49 (54.4%) were male (mean age = 66.8 years). The mean Acute Physiology and Chronic Health Evaluation II score was 22.01. Sixty patients (66.7%) received a maximal cefepime dose, and the 30-day crude mortality rate was 36.7%. MIC90 of cefepime for P. aeruginosa was 8 mg/L. The cumulative survival rate at 30 days revealed that a lower cefepime MIC (<4 mg/L) for P. aeruginosa was associated with a higher survival rate than a higher MIC (≥4 mg/L) (72.6% vs. 23.5%, p < 0.0001). A cefepime MIC of ≥4 mg/L and age were independent risk factors for mortality, whereas the maximal cefepime dose was the independent protective factor. The use of a maximal cefepime dose did not improve the outcomes of patients with P. aeruginosa bacteremia at a MIC of ≥4 mg/L. CONCLUSIONS: A cefepime MIC of 4 mg/L may predict an unfavorable outcome among patients with serious infections caused by P. aeruginosa, even the MICs still within the CLSI susceptibility breakpoint.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Cefalosporinas/administração & dosagem , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Cefepima , Relação Dose-Resposta a Droga , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Antimicrob Chemother ; 72(9): 2489-2495, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28535274

RESUMO

Objectives: Pan-susceptible Pseudomonas aeruginosa (PSPA) clinical isolates carrying an OprD with loop 7 shortening (the group-1A allele) were found to rapidly develop carbapenem resistance under continuous selection pressure. We further studied whether OprD polymorphisms are associated with the potential to develop carbapenem resistance. Methods: OprD amino acid sequences of 126 PSPA clinical isolates were analysed to determine their STs using P. aeruginosa strain PAO1 as the control strain. Site-directed mutagenesis was performed in PAO1 to generate polymorphisms of interest. A disc diffusion method was used to select carbapenem-resistant variants from the mutant strains. Expression levels of oprD were determined by quantitative RT-PCR. MICs of carbapenems were determined by Etest. Results: Forty-eight (38.1%) of the tested isolates carried the group-1A allele. Another two major STs, C1 and C2, both of which harboured an F170L polymorphism, were found in 21 (16.7%) and 39 (31.0%) isolates, respectively. The PAO1 type was also found in 14 (11.1%) isolates. Under continuous selective pressure, isolates of most STs developed carbapenem resistance at different numbers of passaging events; only those belonging to the PAO1 type remained susceptible. However, PAO1 mutants carrying either the oprD group-1A allele or the OprD-F170L polymorphism were able to develop carbapenem resistance. Reduced oprD expression triggered by continuous imipenem challenge was found in PAO1 mutants, but not in the PAO1 WT strain. Conclusions: OprD polymorphisms, particularly the F170L substitution and the specific shortening in loop 7, appear to determine the potential for P. aeruginosa to develop carbapenem resistance.


Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana/genética , Polimorfismo Genético , Porinas/genética , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Alelos , Substituição de Aminoácidos , Proteínas de Bactérias/genética , Humanos , Testes de Sensibilidade Microbiana , Mutação , Infecções por Pseudomonas/microbiologia
11.
BMC Musculoskelet Disord ; 18(1): 175, 2017 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-28449655

RESUMO

BACKGROUND: Pyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone. METHODS: All patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disability Index and visual analogue pain scale were analyzed. RESULTS: Of 90 enrolled patients, Group 1 (n = 47) received only antibiotic therapy and Group 2 (n = 43) received early surgery with post-surgery antibiotics for 2 to 4 weeks. Group 2 exhibited significantly better results than Group 1 for mean antibiotic administration period, mean hospitalization period, kyphotic angle correction. Of 61 patients who participated in telephone follow-up after discharge, Group 2 (n = 26) had significant lower mean ODI score, and mean back pain score than Group 1 (n = 35). CONCLUSIONS: While infection control was similar for both groups, patients treated with early surgery and antibiotics were hospitalized for fewer days and required less antibiotics than those treated with antibiotics alone, also having better functional outcomes. In short, early surgical treatment of pyogenic spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.


Assuntos
Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/cirurgia , Discite/tratamento farmacológico , Discite/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis/diagnóstico por imagem , Discite/diagnóstico por imagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
J Microbiol Immunol Infect ; 50(5): 662-668, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27426930

RESUMO

BACKGROUND: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been widely used in microbial identification. This study evaluated the performance of MALDI-TOF MS and investigated the economic and medical impact of MALDI-TOF MS implementation. METHODS: A total of 12,202 clinical isolates collected from April to September 2013 were identified using MALDI-TOF MS, and the success rates in identifying isolates were analyzed. The differences in the processing time, cost of consumables, weight of waste, and clinical impact between MALDI-TOF MS and biochemical reaction were compared. RESULTS: MALDI-TOF MS successfully identified 96% of 12,202 isolates, including 96.8% of 10,502 aerobes, 90.5% of 1481 anaerobes, 93.8% of 81 yeasts, and 90.6% of 138 nontuberculous mycobacteria at the genus level. By using MALDI-TOF MS, the processing time for aerobes decreased from 32.5 hours to 4.1 hours, and that for anaerobes decreased from 71.5 hours to 46 hours. For detection of aerobes and anaerobes, the cost of consumables was estimated to decrease by US$0.9 per isolate, thus saving US$94,500 in total annual isolation. Furthermore, the weight of waste decreased six-fold, resulting in a reduction of 350 kg/month or 4.2 tons/year. MALDI-TOF MS also increased the percentage of correct antibiotics treatment for Escherichia coli and Klebsiella pneumonia from 56.1% to 75% and shortened the initiation time of the correct antibiotic action from 3.3 hours to 2.5 hours. CONCLUSIONS: MALDI-TOF MS is a rapid, reliable, economical, and environmentally friendly method for routine microbial identification and may contribute to early appropriate antibiotic treatment in clinical settings.


Assuntos
Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/economia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Bactérias/classificação , Bactérias/isolamento & purificação , Infecções Bacterianas/diagnóstico , Redução de Custos , DNA Bacteriano/análise , Hospitais , Humanos , Micoses/diagnóstico , Micoses/microbiologia , Micobactérias não Tuberculosas/isolamento & purificação , Reprodutibilidade dos Testes , Taiwan , Fatores de Tempo , Leveduras/classificação , Leveduras/isolamento & purificação
13.
J Microbiol Immunol Infect ; 50(5): 677-683, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26188977

RESUMO

BACKGROUND/PURPOSE: Carbapenem-resistant Pseudomonas aeruginosa infections have been a challenge and issue in hospital settings. However, the clinical impact of P. aeruginosa blood isolates resistant only to carbapenems has never been discussed previously. METHODS: To assess the risk factors and clinical significance of bacteremia caused by carbapenem resistance only P. aeruginosa (CROPA), a 6-year retrospective case-control study was conducted. The CROPA strains were defined as isolates susceptible to ciprofloxacin, antipseudomonal penicillins and cephalosporins, and aminoglycosides but resistant to one antipseudomonal carbapenem (imipenem or meropenem) or both. The controls were selected among patients with bacteremia due to P. aeruginosa susceptible to all above classes of antipseudomonal antibiotics, which was defined as all-susceptible P. aeruginosa. RESULTS: Twenty-five patients had at least one blood culture positive for CROPA, and 50 controls had all-susceptible P. aeruginosa bacteremia. CROPA bacteremia had a high 30-day mortality rate (72.0%), as compared to 26.0% for the controls (p < 0.001). Through multivariate analysis, carbapenem exposure was the only risk factor for developing CROPA bacteremia (p = 0.002). A comparison between the surviving and deceased patients with CROPA bacteremia showed that nine (50%) of those who died, but none of the survivors, received carbapenems as the initial empirical therapy (p = 0.027). CONCLUSION: Carbapenem exposure was associated with emergence of CROPA infections. Repeated carbapenem use in such patients might increase rates of inappropriate initial empirical treatment and mortality. Prudent carbapenem use is important to reduce the emergence of CROPA.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Carbapenêmicos/farmacologia , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Adulto , Idoso , Aminoglicosídeos/farmacologia , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Hemocultura , Enterobacteriáceas Resistentes a Carbapenêmicos/patogenicidade , Estudos de Casos e Controles , Cefalosporinas/farmacologia , Ciprofloxacino/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Feminino , Hospitais , Humanos , Imipenem/farmacologia , Masculino , Meropeném , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mortalidade , Análise Multivariada , Razão de Chances , Penicilinas/farmacologia , Infecções por Pseudomonas/sangue , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/patogenicidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taiwan , Tienamicinas/farmacologia
14.
BMC Infect Dis ; 16: 374, 2016 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-27496018

RESUMO

BACKGROUND: The treatment options for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (MDR Acb) complex are limited, and the optimal treatment has not been established. METHODS: To compare the efficacy of tigecycline-based with sulbactam (or ampicillin/sulbactam)-based therapy for pneumonia involving MDR Acb complex, we conducted a retrospective study comparing 84 tigecycline-treated adult patients during the period August 2007 to March 2010 with 84 sulbactam or ampicillin/sulbactam-treated adult patients during the period September 2004 to July 2007. Both groups had the matched Acute Physiology and Chronic Health Evaluation (APACHE) II score and received treatment for at least 7 days. RESULTS: The mean APACHE II score was 20.1 for both groups. More patients in sulbactam group had ventilator use (89.3 % versus 69.0 %), bilateral pneumonia (79.8 % versus 60.7 %) and combination therapy (84.5 % versus 53.6 %), particularly with carbapenems (71.4 % versus 6.0 %), while more patients in tigecycline group had delayed treatment (41.7 % versus 26.2 %) (P <0.05). At the end of treatment, more patients in sulbactam group had airway MDR Acb complex eradication (63.5 % versus 33.3 %, P <0.05). The clinical resolution rate was 66.7 % for both groups. The mortality rate during treatment was 17.9 % in sulbactam group, and 25.0 % in tigecycline group (P = 0.259). The multivariate analysis showed that bilateral pneumonia was the only independent predictor for mortality during treatment (adjusted odds ratio, 2.717; 95 % confidence interval, 1.015 to 7.272). CONCLUSIONS: Patients treated with either tigecycline-based or sulbactam-based therapy had a similar clinical outcome, but tigecycline group had a lower microbiological eradiation rate.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Acinetobacter calcoaceticus , Antibacterianos/administração & dosagem , Farmacorresistência Bacteriana Múltipla , Minociclina/análogos & derivados , Pneumonia Bacteriana/tratamento farmacológico , Sulbactam/administração & dosagem , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Acinetobacter calcoaceticus/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minociclina/administração & dosagem , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/mortalidade , Estudos Retrospectivos , Taiwan/epidemiologia , Tigeciclina , Resultado do Tratamento
15.
PLoS One ; 10(8): e0134859, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26248332

RESUMO

OBJECTIVES: Staphylococcus lugdunensis can cause community- and healthcare-associated infections. This study investigated the molecular characteristics of S. lugdunensis isolates collected at our hospital and compared the characteristics of the infectious and commensal isolates. METHODS: We collected the S. lugdunensis isolates between 2003 and 2013. The antimicrobial resistance test, SCCmec typing, accessory gene regulator (agr) typing, pulsed-field gel electrophoresis (PFGE), and δ-like hemolysin activity were performed. RESULTS: In total, 118 S. lugdunensis isolates were collected, of which 67 (56.8%) were classified into the infection group and 51 (43.2%) into the commensal group. The oxacillin resistance rate was 36.4%. The most common SCCmec types were SCCmec types V (51.4%) and II (32.6%). In total, 34 pulsotypes were identified. The PFGE typing revealed five clones (pulsotypes A, J, M, N, and P) at our hospital. Pulsotypes A and N caused the spread of high oxacillin resistance. In total, 10.2% (12 of 118) of the isolates lacked δ-like hemolysin activity. Compared with the infection group, the commensal group showed a higher percentage of multiple drug resistance and carried a higher percentage of SCCmec type II (11 of 22, 50% and 3 of 21, 14.3%) and a lower percentage of SCCmec type V (8 of 22, 36.4% and 14 of 21, 66.7%). The commensal group (27 PFGE types) showed higher genetic diversity than did the infection group (20 PFGE types). No difference was observed in the distribution of the five main pulsotypes, agr typing, and the presence of δ-like hemolysin activity between the two groups. CONCLUSIONS: Five main clones were identified at our hospital. The commensal group showed higher genetic diversity, had a higher percentage of multidrug resistance, and carried a higher percentage of SCCmec type II and a lower percentage of SCCmec type V than did the infection group.


Assuntos
Infecção Hospitalar/microbiologia , Staphylococcus lugdunensis/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/genética , Infecção Hospitalar/patologia , DNA Bacteriano/análise , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Feminino , Proteínas Hemolisinas/genética , Proteínas Hemolisinas/metabolismo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase Multiplex , Oxacilina/farmacologia , Staphylococcus lugdunensis/efeitos dos fármacos , Staphylococcus lugdunensis/isolamento & purificação , Taiwan , Centros de Atenção Terciária
16.
J Anal Methods Chem ; 2015: 869719, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26101695

RESUMO

Nicotine is a potent chemical that excites the central nervous system and refreshes people. It is also physically addictive and causes dependence. To reduce the harm of tobacco products for smokers, a law was introduced that requires tobacco product containers to be marked with the amount of nicotine as well as tar. In this paper, an online stacking capillary electrophoresis (CE) method with cation-selective exhaustive injection sweeping-micellar electrokinetic chromatography (CSEI-sweeping-MEKC) is proposed for the optimized analysis of nicotine in tobacco. A higher conductivity buffer (160 mM phosphate buffer (pH 3)) zone was injected into the capillary, allowing for the analytes to be electrokinetically injected at a voltage of 15 kV for 15 min. Using 50 mM sodium dodecyl sulfate and 25% methanol in the sweeping buffer, nicotine was detected with high sensitivity. Thus, optimized conditions adapted from a chemometric approach provided a 6000-fold increase in the nicotine detection sensitivity using the CSEI-sweeping-MEKC method in comparison to normal CZE. The limits of detection were 0.5 nM for nicotine. The stacking method in combination with direct injection which matrix components would not interfere with assay performance was successfully applied to the detection of nicotine in tobacco samples.

17.
Int J Infect Dis ; 36: 72-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26051975

RESUMO

OBJECTIVES: The aim of this study was to investigate the molecular epidemiology and clinical characteristics of a major clone of oxacillin-resistant Staphylococcus lugdunensis in a tertiary hospital. METHODS: All S. lugdunensis isolated from sterile sites between June 2003 and May 2013 were collected for analysis. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed to study their genetic relationships. RESULTS: A total of 118 S. lugdunensis isolates were analysed by PFGE. Three major PFGE pulsotypes were found: A, H, and L. Most of the pulsotype A isolates were oxacillin-resistant, and SCCmec type V and type VT. Isolates from another major clonal group that consisted primarily of pulsotype L were oxacillin-resistant and SCCmec type II. These 14 SCCmec type II S. lugdunensis isolates demonstrated high PFGE similarity and were obtained in the study hospital over a period of 40 months. Three of these 14 patients had clinically significant bacteraemia, and all three cases were in the intensive care unit. Further MLST analysis of the isolates identified an endemic S. lugdunensis strain of sequence type 6, clonal complex 1. CONCLUSIONS: This study identified a major endemic clone of S. lugdunensis that is oxacillin-resistant, SCCmec type II, ST6, and capable of long-term persistence in the hospital. Continuous infection control surveillance and monitoring of S. lugdunensis should be considered in endemic areas.


Assuntos
Antibacterianos/farmacologia , Oxacilina/farmacologia , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/classificação , Staphylococcus lugdunensis/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Pré-Escolar , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Staphylococcus lugdunensis/genética , Staphylococcus lugdunensis/isolamento & purificação , Taiwan , Centros de Atenção Terciária
18.
Taiwan J Obstet Gynecol ; 54(2): 183-6, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25951725

RESUMO

OBJECTIVE: This report describes a case of serous ovarian carcinoma with occult serous tubal intraepithelial carcinoma (STIC), which presented as atypical glandular cells favor neoplasia (AGC-FN) with Pap cytology and dermatomyositis. CASE REPORT: A 48-year-old woman presented with symptoms of dermatomyositis. An AGC-FN result from a Pap smear, with an absence of a cervical or endometrial lesion was noted. After cancer surveillance, ovarian high grade serous carcinoma associated with serous tubal intraepithelial carcinoma was diagnosed. Two weeks following surgical excision of the carcinoma, dramatic remission of the dermatomyositis symptoms was evident. CONCLUSION: The patient had serous carcinoma of the ovary with tubal STIC, which presented as dermatomyositis. The AGC-FN identified from a Pap smear hinted at a diagnosis of ovarian carcinoma. These presentations point to an occult malignancy in the genital tract and demand careful diagnostic workup.


Assuntos
Carcinoma in Situ/diagnóstico , Cistadenocarcinoma Seroso/diagnóstico , Dermatomiosite/etiologia , Neoplasias das Tubas Uterinas/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Síndromes Paraneoplásicas/etiologia , Carcinoma in Situ/complicações , Colo do Útero/patologia , Cistadenocarcinoma Seroso/complicações , Dermatomiosite/diagnóstico , Neoplasias das Tubas Uterinas/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Primárias Múltiplas/complicações , Neoplasias Ovarianas/complicações , Teste de Papanicolaou , Síndromes Paraneoplásicas/diagnóstico , Esfregaço Vaginal
19.
Infect Dis (Lond) ; 47(6): 370-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25746600

RESUMO

BACKGROUND: Multidrug-resistant (MDR) Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex has become an important cause of nosocomial pneumonia. Sulbactam is a ß-lactamase inhibitor with antimicrobial activity against MDR Acb complex. METHODS: To investigate outcomes of pneumonia involving MDR Acb complex treated with sulbactam or ampicillin/sulbactam for at least 7 days, we conducted a retrospective study of 173 adult patients over a 34 month period. RESULTS: Of 173 patients, 138 (79.8%) received combination therapy, mainly with carbapenems (119/138, 86.2%). The clinical response rate was 67.6% and the 30 day mortality rate was 31.2%. The independent predictors of clinical failure were malignancy, bilateral pneumonia and shorter duration of treatment. In patients with sulbactam-susceptible strains, there was no difference in clinical and microbiological outcome between combination therapy and monotherapy. Compared to the sulbactam-susceptible group, the sulbactam-resistant group had a lower rate of airway eradication, a longer duration of treatment and a higher rate of combination therapy with predominantly carbapenems (p < 0.05). There was no significant difference between the two groups in clinical resolution and 30 day mortality rates. CONCLUSIONS: Sulbactam could be a treatment option for pneumonia involving MDR Acb complex, and combination therapy with carbapenems could be considered for sulbactam-resistant cases.


Assuntos
Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter calcoaceticus/efeitos dos fármacos , Antibacterianos/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Sulbactam/uso terapêutico , Infecções por Acinetobacter , Acinetobacter baumannii/isolamento & purificação , Acinetobacter calcoaceticus/isolamento & purificação , Adulto , Idoso , Ampicilina/administração & dosagem , Ampicilina/uso terapêutico , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pneumonia Bacteriana/microbiologia , Estudos Retrospectivos , Sulbactam/administração & dosagem , Taiwan , Fatores de Tempo
20.
J Nucl Med ; 56(5): 681-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25766894

RESUMO

UNLABELLED: Patients with end-stage renal disease undergoing maintenance hemodialysis (MHD) are highly prone to infections. The potential clinical usefulness of (18)F-FDG PET/CT for the detection of infections of unknown origin in this patient population remains unclear. This study was designed to investigate this issue. METHODS: Between October 2011 and July 2014, a total of 104 adult MHD patients with sepsis underwent (18)F-FDG PET/CT for the detection of unknown infection foci. Follow-up was continued until October 2014. Positive (18)F-FDG PET/CT findings and mortality served as the main outcome measures. RESULTS: Of the 104 study patients, 73 (70.2%) had positive (18)F-FDG PET/CT findings, and a total of 95 major infection foci were identified. Eighteen patients (24.6%) had at least 2 infection foci on (18)F-FDG PET/CT scans. Seven (53.8%) of the 13 patients with primary vascular access-related infections had concurrent metastatic foci. Twenty-eight patients (26.9%) had their treatments modified by (18)F-FDG PET/CT results. Multivariate logistic regression analysis demonstrated that low hemoglobin and high C-reactive protein levels at diagnosis were the independent predictors of positive (18)F-FDG PET/CT results. Twenty-seven patients (26.0%) died during their hospital stay, and 24 of them had positive (18)F-FDG PET/CT findings (P = 0.014). Positive (18)F-FDG PET/CT results were an independent predictor of mortality (hazard ratio, 3.896; 95% confidence interval, 1.039-14.613; P = 0.044). CONCLUSION: Our results suggest that (18)F-FDG PET/CT may be clinically useful for detecting occult infection foci in end-stage renal disease patients undergoing MHD. In this population, positive (18)F-FDG PET/CT findings may lead to a significant change in clinical management and independently predict mortality.


Assuntos
Fluordesoxiglucose F18 , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Diálise Renal , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade
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