Eun Hee Song

Diagnostic Performance of the Cytomegalovirus (CMV) Antigenemia Assay in Patients with CMV Gastrointestinal Disease

Of 149 patients with suspected cytomegalovirus (CMV) gastrointestinal disease, 51 (36%) confirmed cases, 6 (4%) probable cases, and 64 (45%) instances of non-CMV gastrointestinal disease were analyzed using the CMV antigenemia assay; 22 patients (5%) with indeterminate gastrointestinal disease were excluded. The sensitivity and specificity of the CMV antigenemia assay (defined as detection of > or =1 positive cells per 200,000 leukocytes) for diagnosis of CMV gastrointestinal disease were 54% (95% confidence interval, 41%-68%) and 88% (95% confidence interval, 77%-94%), respectively.

Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis

OBJECTIVES We evaluated the clinical characteristics and risk factors for the paradoxical response (PR) in non-HIV-infected patients with peripheral lymph node tuberculosis (TB). METHODS Medical records of non-HIV-infected patients aged > or =16 years with peripheral lymph node TB treated in a tertiary hospital between January 1997 and August 2007 were analysed. PR was defined as clinical or radiological worsening of pre-existing TB lesions, or development of new lesions in a patient who had received anti-TB therapy for at least 2 weeks. RESULTS Three hundred patients with lymph node TB were included. Of these, 235 patients (78%) had confirmed TB; the remaining 65 (22%) had probable TB and were excluded from the final analysis. Among the 235 study patients, their mean age (+/-standard deviation) was 37.6 (+/-13.9) years and 175 (75%) were female. PR occurred in 54 (23%; 95% confidence interval 18-28%) patients, at a median onset time of 8 weeks (interquartile range, 4-14 weeks) after starting anti-TB medication. In multivariate analysis, younger age (OR 0.96), male gender (OR 2.60), and the presence of local tenderness at the time of diagnosis (OR 2.90) were independently associated with PR. CONCLUSION PR was relatively common, occurring in one-fifth of non-HIV-infected patients with peripheral lymph node TB, and was associated with younger age, male gender, and the presence of local tenderness.

Incidence, Characteristics, and Outcomes of Staphylococcus lugdunensis Bacteremia

ABSTRACT Of 63 patients with Staphylococcus lugdunensis bacteremia, 15 (23.8%) had clinically significant bacteremia, with an incidence of 1.3 cases per 100,000 admissions. Of the five patients with community-acquired S. lugdunensis bacteremia, three had endocarditis. Catheters were the most common portal of entry for health-care-associated or hospital-acquired bacteremia. Only one patient died of bacteremia-related causes.

Development of bacteraemia or fungaemia after removal of colonized central venous catheters in patients with negative concomitant blood cultures

There are limited data on the clinical significance of positive central venous catheter (CVC) tip cultures associated with concomitant negative blood cultures performed at the time of CVC removal. A retrospective cohort study of all patients who yielded isolated positive CVC tip cultures was conducted in a tertiary-care hospital with 2200 beds during a 10-year period. All patients with isolated positive CVC tip cultures were observed for the development of subsequent bacteraemia or fungaemia between 2 and 28 days after CVC removal. An isolated positive CVC tip culture was defined as a case in which (i) a CVC tip culture yielded > or = 15 colonies using a semiquantitative culture method and (ii) at least two sets of blood samples revealed no organism at, or close to, the time of CVC removal (48 h before to 48 h after CVC removal). During the study period, 312 patients with isolated positive CVC cultures were enrolled. Eight (2.6%; 95% CI 1.2-5.1) of the 312 patients yielding isolated bacterial or fungal CVC tip cultures developed subsequent bloodstream infection (BSI) caused by the same species as that isolated from the tip culture (Staphylococcus aureus, 1: Enterococcus spp.; 2: Pseudomonas aeruginosa; and 3: Candida spp.). Among 125 patients from whose CVC tips the above four organisms were grown, seven (12.3%) of 57 patients who did not receive appropriate antibiotic therapy within 48 h after CVC removal subsequently developed BSI, but only one (1.5%) of 68 patients who did receive appropriate therapy developed BSI (OR 0.11, p 0.02).

Bloodstream infections caused by qnr-positive Enterobacteriaceae: clinical and microbiologic characteristics and outcomes

The clinical significance of plasmid-mediated quinolone resistance determinant qnr has not been well characterized. We investigated the clinical and microbiologic characteristics and outcomes of bloodstream infections (BSIs) caused by qnr-positive Enterobacteriaceae. We prospectively collected 351 nonduplicate consecutive blood isolates of Enterobacter spp. and Klebsiella pneumoniae. qnr genes were detected by polymerase chain reaction and confirmed by sequencing. The medical records of patients were retrospectively reviewed. qnr genes were detected in a total of 26 isolates. A comparison of these 26 qnr-positive and 297 qnr-negative Enterobacteriaceae BSIs in adult patients showed that the population characteristics and clinical features of BSIs were similar between the qnr-positive and qnr-negative groups. However, patients with hematologic malignancies, solid organ transplant recipients, and BSIs caused by strains with multiple antimicrobial resistance, including extended-spectrum beta-lactamase (ESBL) resistance, were more common in the qnr-positive group. Previous antibiotic therapy and prior use of trimethoprim-sulfamethoxazole or aminoglycosides were significantly associated with BSIs caused by qnr-positive strains. In the multivariate analysis, prior use of trimethoprim-sulfamethoxazole (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.47-20.94) and having an underlying disease other than solid tumor (OR, 4.06; 95% CI, 15.07) were independently associated with qnr-positive Enterobacteriaceae BSIs. There was no significant difference in 30-day mortality rates between the qnr-positive and qnr-negative groups (15.4% [4/26] versus 13.8% [41/297], P = 0.77). Although qnr determinants were significantly associated with multiple antimicrobial resistance including ESBL resistance, they did not affect clinical outcomes of BSIs.

Comparison of the clinical and microbiologic characteristics of patients with Enterobacter cloacae and Enterobacter aerogenes bacteremia: a prospective observation study

We compared the characteristics and outcomes of 172 Enterobacter cloacae bacteremia and 67 Enterobacter aerogenes bacteremia (EAB) cases. Antimicrobial resistance rates to E. cloacae were higher than those to E. aerogenes. However, EAB more frequently presented as septic shock and was associated with poorer outcomes.

Clinical and Economic Consequences of Failure of Initial Antibiotic Therapy for Patients with Community-Onset Complicated Intra-Abdominal Infections

Objectives Complicated intra-abdominal infection (cIAI) is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI. Methods A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week. Results A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14%) had health care-associated infection, and 48 (9%) experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred

Quinupristin-dalfopristin versus linezolid for the treatment of vancomycin-resistant Enterococcus faecium bacteraemia: efficacy and development of resistance.

3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13. Conclusions To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

Comparison of the clinical characteristics and outcomes of Klebsiella pneumoniae and Streptococcus pneumoniae meningitis.

Abstract Quinupristin–dalfopristin and linezolid are widely used for the treatment of vancomycin-resistant Enterococcus faecium (VREF) infections. Increasing resistance of VREF to quinupristin–dalfopristin and linezolid is a cause for concern. To determine the efficacy of and the rate of development of resistance to quinupristin–dalfopristin and linezolid, we analyzed all episodes of clinically significant VREF bacteraemia at a tertiary-care hospital from January 2003 to June 2007. The main outcomes were rates of 30-day mortality, microbiological response, and development of resistance. Fifty-two patients were treated with quinupristin–dalfopristin and 61 were treated with linezolid. Baseline demographic and clinical characteristics were similar between the 2 groups. There were no significant between-group differences in 30-day mortality (48% in the quinupristin–dalfopristin group vs 41% in the linezolid group; p = 0.45) or microbiological response (60% vs 66%; p = 0.51). However, prolonged bacteraemia (18% of 45 evaluable cases vs 4% of 55 evaluable cases; p = 0.04) and development of resistance in blood isolates (11% vs 0%; p = 0.02) were more frequently observed in the quinupristin–dalfopristin group than in the linezolid group. There was no significant difference between the efficacy of quinupristin–dalfopristin and linezolid. However, prolonged bacteraemia and the development of resistance were more common in quinupristin–dalfop ristin-treated patients.

Postoperative Nonpathologic Fever After Spinal Surgery: Incidence and Risk Factor Analysis

This multicenter, retrospective cohort study compared the clinical characteristics and outcomes of community-acquired Klebsiella pneumoniae meningitis (CA-KPM) with those of community-acquired Streptococcus pneumoniae meningitis (CA-SPM). Eighty-three adult patients, 27 with CA-KPM and 56 with CA-SPM, were included. Diabetes mellitus (48.1% versus 21.4%; P=0.01) and liver cirrhosis (22.2% versus 5.4%; P=0.05) were more commonly associated with CA-KPM. Comatose mental status (40.7% versus 12.5%; P=0.01), septic shock (44.4% versus 8.9%; P<0.001), and concomitant extrameningeal infections (40.7% versus 7.1%; P=0.001) were also more common in the CA-KPM group. The 28-day mortality (44.4% versus 10.7%; P<0.001) and inhospital mortality (51.9% versus 14.3%; P<0.001) were higher in the CA-KPM group. In conclusion, diabetes mellitus and liver cirrhosis are more common in the CA-KPM patients who were also more likely to present with severe manifestations and poor outcomes.