Hsin-Chun Lee

Clinical and Economic Impact of Multidrug Resistance in Nosocomial Acinetobacter baumannii Bacteremia

OBJECTIVE To investigate the impact of antimicrobial resistance on clinical and economic outcomes among hospitalized patients with multidrug-resistant (MDR) Acinetobacter baumannii bacteremia. DESIGN A retrospective, matched-cohort study. SETTING A tertiary care university teaching hospital. METHODS A matched case-control (1 : 1) study was conducted to compare the differences in clinical and economic outcomes of patients with MDR A. baumannii bacteremia and patients with non-MDR A. baumannii bacteremia. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness, and length of hospital stay before onset of bacteremia. RESULTS Forty-six (95.8%) of 48 cases with MDR A. baumannii bacteremia were eligible for the study and matched with appropriate controls. The sepsis-related mortality rate was 34.8% among cases and 13.0% among controls, for an attributable mortality rate of 21.8% (adjusted odds ratio, 4.1 [95% confidence interval, 1.1-15.7]; P=.036). After the onset of bacteremia, cases and controls had a significantly different length of hospital stay (54.2 vs 34.1 days; P=.006), hospitalization cost (US

Seroprevalence of viral hepatitis and sexually transmitted disease among adults with recently diagnosed HIV infection in Southern Taiwan, 2000-2005: upsurge in hepatitis C virus infections among injection drug users.

9,349 vs US

Community-Acquired Klebsiella pneumoniae Complicated Skin and Soft-Tissue Infections of Extremities: Emphasis on Cirrhotic Patients and Gas Formation

4,865; P=.001), and antibiotic therapy cost (US

Serotyping and Antimicrobial Susceptibility of Group B Streptococcus Over an Eight-Year Period in Southern Taiwan

2,257 vs US

Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in taiwan.

1,610; P=.014). Thus, bacteremia due to MDR A. baumannii resulted in 13.4 days of additional hospitalization and US

Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Enterobacter cloacae: Role of Carbapenem Therapy

3,758 of additional costs, compared with bacteremia due to non-MDR A. baumannii. CONCLUSIONS Patients with MDR A. baumannii bacteremia had a higher mortality rate and incurred greater medical costs than patients with non-MDR A. baumannii bacteremia.

Jarisch-Herxheimer Reaction after Penicillin Therapy among Patients with Syphilis in the Era of the HIV Infection Epidemic: Incidence and Risk Factors

BACKGROUND/PURPOSE The purpose of this study was to compare the seroprevalence of viral hepatitis and sexually transmitted disease (STD) co-infections among three populations at risk recently diagnosed with HIV infection. METHODS A retrospective review of medical records was performed to determine the prevalence of several co-infections among adults recently diagnosed with HIV infection between 2000 and 2005 at National Cheng Kung University Hospital in Tainan, Taiwan. RESULTS Among a total of 484 adults, 124 (25.6%) were men having sex with men (MSM), 105 (21.7%) were heterosexual adults, and 255 (52.7%) were injection drug users (IDUs). The case number of adults with recently diagnosed HIV infection increased annually, from 27 in 2000 to 142 in 2005 (p < 0.001). This trend appeared to be attributable to the upsurge in HIV infection among IDUs beginning in 2003. At the time of HIV diagnosis, mean CD4+ counts were significantly higher and plasma HIV-1 RNA loads were lower in the IDU group than the MSM or heterosexual groups. The hepatitis B virus (HBV) carrier rate was similar in all three groups, with an average rate of 16.5%. The prevalence of treponemal antibody and Entamoeba histolytica indirect hemagglutination antibody was higher in MSM (37.5% and 9.4%, respectively) than in heterosexuals (19.6% and 7.3%, respectively) or IDUs (3.2% and 2.1%). The seroprevalence of hepatitis A virus infection increased with age, with 94.2% (97/103) of patients who were older than 40 years. Hepatitis C virus (HCV) or HBV-HCV co-infections were noted more often in IDUs (97.9% and 16.9%, respectively) than in heterosexuals (10.9% and 2.2%, respectively) and MSM (5.3% and 3.6%, respectively). CONCLUSION There was a recent upsurge in HIV-HCV co-infected IDUs in southern Taiwan. A higher rate of co-infection with STDs among HIV-infected MSM highlights the need for integrated STD control efforts in current HIV prevention programs.

Seroprevalence of chronic hepatitis B virus infection among taiwanese human immunodeficiency virus type 1-positive persons in the era of nationwide hepatitis B vaccination.

Background:Klebsiella pneumoniae was rarely reported to cause complicated skin and soft tissue infections (cSSTIs). Our study was to delineate clinical characteristics and outcome of cSSTIs involving extremities caused by K. pneumoniae.Patients and Methods:Adult patients aged 16 years or more with community-acquired cSSTIs, which involved the extremities and were caused by four common aerobic pathogens at a medical center in southern Taiwan during a 54-month period, were reviewed.Results:Of 76 cases enrolled, Staphylococcus aureus was the most common pathogen (52 cases, 68%), followed by K. pneumoniae (16, 21%), β-hemolytic streptococci (5, 7%), and Escherichia coli (3, 4%). Forty-six (61%) had underlying conditions, and diabetes mellitus was most common among K. pneumoniae and non-K. pneumoniae groups (63% and 45%, respectively). Compared to patients with cSSTIs caused by other bacteria, those with K. pneumoniae cSSTIs were predominantly male, more often had liver cirrhosis, malignant neoplasm and alcoholism. In addition, they were more likely to have fever, shock, bacteremia, gas formation, pyomyositis, metastatic infections, as well as longer durations of hospitalization. Using multivariate analysis, liver cirrhosis (adjusted odds ratio [aOR] 12.5, 95% confidence interval [CI] 2.0–79.1, p = 0.007) and male gender (aOR 11.5, 95% CI 1.1–116.8, p = 0.039) were significantly associated with K. pneumoniae cSSTIs.Conclusions:We highlight the role of K. pneumoniae in Taiwanese patients with cSSTIs involving extremities, and its potential for gas and pus formation, and metastatic infections. Empiric antimicrobial coverage of K. pneumoniae and close monitoring of metastatic infections are mandatory for patients with risk factors.

Clinical manifestations and prognostic factors in cancer patients with bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae

Abstract The increase in penicillin resistance among pneumococci and viridans streptococci and the development of serotype-specific conjugate vaccine have increased the need for knowledge of the antimicrobial susceptibility and the capsular serotypes of group B streptococci. Over an 8-year period, 351 group B streptococcal isolates from southern Taiwan were tested for antimicrobial susceptibility and serotype determination. Eighty-seven percent of the isolates were typeable. Types III (28.5%) and V (27.1%) were the most common serotypes. The occurrence of type V isolates increased with age, while that of type III isolates decreased with age, showing a predominance in children less than 1 year of age. Of 118 isolates from cases of invasive infection, types Ia, Ib, II, III, IV, and V accounted for 12.7, 11.9, 0.8, 33, 1.7, and 26.3%, respectively. Using the agar dilution method, all isolates were found to be susceptible to penicillin, cefotaxime, and vancomycin, 99.4% to ofloxacin, 78.1% to chloramphenicol, 63.2% to azithromycin, 62.6% to erythromycin, 57.3% to clindamycin, and 2.8% to tetracycline. Chloramphenicol resistance was associated with type III isolates (59 of 100, 59%) and erythromycin and azithromycin resistance with type Ib isolates (25 of 33 [76%], and 21 of 33 [64%], respectively). Thus, 72% of the isolates from invasive infections were serotype III, V, or Ia, and penicillin remains the drug of choice for treatment or prophylaxis of group B streptococcal infections in southern Taiwan, despite the high prevalence of penicillin resistance among Streptococcus pneumoniae and viridans streptococci.

Effects of structural intervention on increasing condom availability and reducing risky sexual behaviours in gay bathhouse attendees

Objectives: This study aimed to investigate the prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and predictors of risky sexual behaviors among men visiting gay bathhouses. Study Design: A cross-sectional study was conducted at 8 gay bathhouses in Taiwan. Bathhouse attendees were invited to complete a questionnaire and to be screened for HIV/STIs. Results: Of 451 men recruited for the study, 339 (75%) completed the questionnaire and were screened for HIV/STIs. The study indicated that seroprevalence rates of anti-HIV-1 antibody, specific Treponema pallidum antibodies detected by hemagglutination assay, surface antigen of hepatitis B virus, IgG antibodies for hepatitis A virus, antibody for hepatitis C virus, and indirect hemagglutination antibody for Entamoeba histolytica (serum titer ≥1:128) were 8%, 18%, 16%, 38%, 3%, and 6%, respectively. Prevalence rates for chlamydial and gonococcal infections reflected by nucleic acid amplification tests in urine samples were 7% and 4%, respectively. Irregular use of condoms during oral sex, condom inaccessibility at bathhouses, unprotected sex at public venues, no prior HIV test, and 5 or more visits to bathhouses every month were independently associated with unprotected anal intercourse. Conclusion: Men attending gay bathhouses report engaging in unsafe sex practices and are at substantial risk of acquisition of HIV/STIs. These findings highlight the need for more comprehensive prevention efforts at gay bathhouses.