Fang Lan Yu

Clinical and epidemiological features of Chryseobacterium indologenes infections: Analysis of 215 cases *

PURPOSE This study investigates the clinical and epidemiological features of Chryseobacterium indologenes infections and antimicrobial susceptibilities of C indologenes. METHODS With 215 C indologenes isolates between January 1, 2004 and September 30, 2011, at a medical center, we analyzed the relationship between the prevalence of C indologenes infections and total prescription of colistin and tigecycline, clinical manifestation, antibiotic susceptibility, and outcomes. RESULTS Colistin and tigecycline were introduced into clinical use at this medical center since August 2006. The increasing numbers of patients with C indologenes pneumonia and bacteremia correlated to increased consumption of colistin (p = 0.018) or tigecycline (p = 0.049). Among patients with bacteremia and pneumonia, the in-hospital mortality rate was 63.6% and 35.2% (p = 0.015), respectively. Administration of appropriate antibiotics showed significant benefit in 14-day survival in patients with C indologenes bloodstream infection (p = 0.040). In bacteremic patients, old cardiovascular accident (p = 0.036) and cancer (p = 0.014) were the most common comorbidity. The most common co-infection pathogen in patients with C indologenes pneumonia was Acinetobacter baumannii (36/91, 39.6%), followed by Pseudomonas aeruginosa (23/91, 25.3%), carbapenem-resistant A baumannii (22/91, 24.2%), and Klebseilla pneumoniae (13/91, 14.3%). Antimicrobial susceptibility testing of the 215 isolates showed that trimethoprim-sulfamethoxazole was the most active agent (susceptibility rate: 87.4%), followed by cefoperazone-sulbactam (48.0%). CONCLUSION The present study showed a trend of increasing prevalence of C indologenes infection after introduction of colistin and tigecycline usage. The bacteremia group had higher mortality rate than the pneumonia group. Increasing resistance to piperacillin-tazobactam, ceftazidime, cefepime, and newer fluoroquinolone were noticed in our analysis. Trimethoprim-sulfamethoxazole was a potential antimicrobial agent in vitro for C indologenes. To avoid collateral damage, we emphasize the importance of antibiotic stewardship program.

Comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii bacteremia: Impact on empiric therapy and antibiotic resistance

OBJECTIVE Acinetobacter baumannii (AB) bacteremia has increasingly emerged as a nosocomial pathogen in healthcare settings, associated with high patient morbidity and mortality. The objective of this study was to compare clinical features, risk factors, treatment outcome, and antibiotic resistance in patients with pneumonia- and non-pneumonia-related AB bacteremia. METHODS We conducted a retrospective study in a tertiary teaching hospital in northern Taiwan. The medical records of the 141 episodes of hospital-acquired AB bacteremia between July 1, 2006 and June 30, 2012 were reviewed, and sorted into groups of AB bacteremia with (n = 59) and without pneumonia (n = 82). RESULTS The hospital-acquired pneumonia-related AB bacteremia group were found to be significantly more frequently treated in intensive care units (49.2%, p < 0.001), but the AB bacteremia without pneumonia group were significantly more frequently treated on general wards (85.4%, p < 0.001). Patients with pneumonia tended to be older than the nonpneumonia group (72.8 years vs. 65.2 years in mean age, p < 0.01), and more likely to use mechanical ventilators (62.7% vs. 15.9 %, p < 0.001). Pneumonia patients were found to receive broad-spectrum antibiotics significantly earlier than nonpneumonia patients (p < 0.001). Compared to those without pneumonia, the patients with pneumonia had significantly higher incidence of antibiotic-resistance (p < 0.05), longer hospital stay (p < 0.01), and higher mortality rate (p < 0.001). The incidence of multidrug-resistant AB was significantly higher in patients with pneumonia (p < 0.05), and only colistin (p < 0.01) and tigecycline (p < 0.01) were significantly active against multidrug-resistant AB isolates. CONCLUSION Pneumonia-related AB bacteremia has a worse outcome, more antibiotic resistance, and more comorbidity than the nonpneumonia group.

Evaluation of a modified direct agar proportion method for testing susceptibility of Mycobacterium tuberculosis from MGIT samples

BACKGROUND/PURPOSE The emergence of resistance to anti-tuberculosis (TB) drugs has become an obstacle to effective TB control. Thus, there is an urgent need to identify patients and initiate adequate treatment for drug-resistant cases in a timely manner. The BACTEC MGIT 960 system is well known for its rapid culturing time, and is in widespread use in Taiwan. In this study, we evaluated the possibility of replacing the traditional indirect agar proportion method with a modified direct agar proportion method (MDAPM), as a technique for rapid testing the drug susceptibility of Mycobacterium tuberculosis without additional cost. METHODS In this study, 432 positive MGIT 960 samples that were identified as M. tuberculosis complex using the MeDiPro M. tuberculosis Antigen Rapid Test or the Cobas Amplicor MTB test were evaluated. Each sample was tested separately by the MDAPM and indirect agar proportion method, between July 2008 and December 2008, to compare the consistency and total turnaround time. RESULTS Four first-line anti-TB drugs-rifampin, isoniazid, ethambutol, and streptomycin-were tested. For the MDAPM and indirect agar proportion method, the respective consistencies for each drug were 99.31%, 98.38%, 98.38%, and 97.22%. Our results also indicated that the MDAPM leads to an average saving in working time of 2 weeks, compared with the traditional indirect agar proportion method. CONCLUSION In addition to having the potential to shorten turnaround time without compromising diagnostic quality, the MDAPM also provides a more efficient and cost-effective procedure. This modified procedure presents potential benefits for TB diagnosis in laboratories already equipped with the MGIT 960 system.

Pulmonary empyema caused by co-infections of Mycoplasma pneumoniae and Fusobacterium necrophorum: A rare case of lemierre syndrome

Lemierre syndrome, also known as post-anginal septicemia or necrobacillosis, It is characterized by bacteremia, internal jugular vein (IJT) thrombosis, and metastatic septic emboli secondary to acute pharyngeal infections. The disease is easily forgotten by modern physicians. The causative agents of Lemierre syndrome include anaerobic bacteria, Streptococcus, Staphylococcus, and Klebsiella pneumoniae. Here, we reported a rare case of Lemierre syndrome in a patient with acute pharyngitis, who was complicated by bilateral otitis media and pulmonary empyema caused by co-infections of Mycoplasma pneumoniae and Fusobacterium necrophorum. The patient was proved by imaged study and successfully treated by chest tube drainage and antibiotic combination therapy. A 19-year-old male patient was admitted to our hospital with a 3-day history of fever, sore throat and dyspnea. On admission, consciousness was clear and his temperature was 39.2 C. Physical examination showed redness, swelling of pharyngeal mucosa. White blood cell count (WBC) was 32020/mm with 89% neutrophils. Serum level of C-reactive protein was 36.2 mg/dL, GOT 65 U/L, GPT 123 U/L, LDH 423 U/L. The rapid test of influenza A & B showed negative finding. Initially, he received amoxicillin/clavulanate 1000 mg/200 mg intravenously q 6 h as empiric therapy. But on the admission Day 2, the fever persisted and bilateral ear canal had purulent discharge. On the admission Day 3, the chest X-ray and CT scan showed infiltration of right lower lobe of lung with pleural effusion (Fig. 1A and B) and left internal jugular vein thrombosis (Fig. 1C). The patient received thoracocentesis and the pleural fluid analysis showed exudate and turbid color, which revealed WBC count 760/mm with 97% neutrophils, LDH 2107 U/L, total protein 5.4 g/dL (serum 6.4 g/dL), glucose 10 mg/dL (serum

Co-occurrence of Leriche syndrome and antiphospholipid syndrome in a man with refractory ulcers of the lower limbs

Leriche syndrome is a rare variant of atherosclerotic occlusive disease characterized by total occlusion of abdominal aorta and/or common iliac arteries. The antiphospholipid syndrome is a prothrombotic disorder that can affect both venous and arterial thrombosis. Co-occurrence of antiphospholipid syndrome and Leriche syndrome is extremely rare. Here, we report a male patient with refractory ulcers of the right foot; he received antibiotic therapy and surgical debridement during hospitalization, however, the ulcer wound did not heal well. The results of image study and laboratory data finally proved the above syndromes. A 52-year-old male patient complained of chronic ulcer wound of the right foot without any trauma history. He also had claudication of the legs, body weight loss with a body mass index of 17.6 kg/m, and erectile dysfunction for many years. The physical examination revealed that his bilateral femoral pulses were absent. The extremities showed bilateral lower legs muscle atrophy, and an ulcer wound with peripheral tissue gangrene on the right foot and barely palpable pulses of bilateral dorsalis pedis arteries. He received empiric antibiotic therapy with oxacillin 2 g intravenous drip q. 6 hours and gentamicin 80 mg intravenous drip q. 12 hours for 7 days, and received local surgical debridement. The aerobic and anaerobic culture all revealed negative finding, however, the ulcer wound still did not heal. Computed tomography and angiography showed total occlusion of infrarenal abdominal aorta (Figure 1), and bilateral common iliac arteries with subsequent collateral circulation. Many small collaterals vessels were reconstituted in the bilateral lower extremities. Antiphospholipid antibodies detected by enzyme-linked immunosorbent assay showed 640 RU/mL (positive), and the anticardiolipin immunoglobulin G detected by lupus

Streptococcus sanguis bacteremia complicating endocarditis associated with colonic adenocarcinoma

Streptococcus bovis bacteremia is well known to be associated with colorectal tumor. But most physicians are unaware of the association between Streptococcus sanguis bacteremia and colorectal malignancy. In this case report, we highlight this association and discuss a case of Streptococcus sanguis bacteremia complicating endocarditis associated with a late stage invasive colonic adenocarcinoma