Prognostic factors of candidemia among nonneutropenic adults with total parenteral nutrition

BackgroundImmediate removal of central venous catheters (CVCs) is not possible in patients with candidemia requiring total parenteral nutrition (TPN). This study analyzed the possible prognostic factors for survival time after onset of candidemia among nonneutropenic adults requiring TPN.MethodsWe conducted a retrospective analysis from September 2003 to August 2005.ResultsA total of 59 nonneutropenic adults with candidemia and requiring TPN were identified retrospectively. All Candida isolates were susceptible to flucytosine and amphotericin B. With the exception of one C glabrata isolate, all other isolates were susceptible to fluconazole and itraconazole. The only predictor of 30-day survival rate after onset of candidemia identified in our analysis was an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 23 points or less. Adults with higher APACHE II scores, who did not have their CVCs changed, did not receive antifungal treatment, or who had thrombocytopenia had shorter survival times after the onset of candidemia.ConclusionsAPACHE II scores, thrombocytopenia, antifungal agents, and CVCs changes are associated with survival time in nonneutropenic adults requiring TPN after the onset of candidemia

Polymicrobial bloodstream infection involving Aeromonas species: Analysis of 62 cases

AbstractObjectiveTo better understand Aeromonas-involved polymicrobial bacteremia (AIPMB).Materials and MethodsWe conducted a retrospective analysis of patients with AIPMB admitted to three large referral hospitals in Taiwan between 2001 and 2008.ResultsOf a total of 62 patients with AIPMB, 22 had healthcare-associated infection and 40 had community-acquired infection. Enterobacteriaceae was the most common concurrent pathogen (82%). The leading underlying diseases/conditions in the affected patients were solid cancers (45%), recent gastric acid suppressant therapy (39%) and liver cirrhosis (26%). More than 95% of the Aeromonas isolates were susceptible to an aminoglycoside, a third- or fourth-generation cephalosporin, imipenem or ciprofloxacin. Antibiotic susceptibilities did not significantly differ between Aeromonas isolates in patients with healthcare-associated AIPMBs and those in patients with community-acquired AIPMBs. Coinfection with Enterobacteriaceae occurred more commonly in community-acquired AIPMB (93% vs. 64%; p=0.012).ConclusionsAIPMB occurred commonly in patients with liver cirrhosis, solid cancers or recent gastric acid suppressant therapy. Enterobacteriaceae were the most common concurrent pathogens. Similar antibiotic profiles were found in Aeromonas isolates of healthcare-associated and community-acquired AIPMBs

Characteristics of nontyphoidal Salmonella gastroenteritis in Taiwanese children: A 9-year period retrospective medical record review

Nontyphoidal Salmonella is among the most common causes of acute pediatric gastroenteritis in Taiwan. It is important to study antibiotic resistance patterns in nontyphoidal Salmonella isolated from children. Therefore, the objective of this study was to investigate the prevalence of serogroups and susceptibility to antimicrobial nontyphoidal Salmonella isolated from Taiwanese children with gastroenteritis. A retrospective review of the medical records of patients aged under 18 years with a diagnosis of acute gastroenteritis at a regional hospital located in southern Taiwan from August 2000 to August 2009 was conducted. Patients whose records documented stool cultures positive for nontyphoidal Salmonella underwent serogrouping and antimicrobial susceptibility testing. Of the 1938 patients diagnosed with acute gastroenteritis, 100 (5.2%) had nontyphoidal Salmonella infections. Most of the cases of nontyphoidal Salmonella gastroenteritis occurred during the summer months of July and August. The most common Salmonella strains isolated were classified as belonging to serogroup B (51%). Three cases had blood cultures that tested positive for nontyphoidal Salmonella, all of which were classified as belonging to serogroup C2. Isolates from the stool cultures of 23 cases that occurred between 2007 and 2009 were further tested to determine their antimicrobial susceptibility profiles, and 87% of these isolates were sensitive to two common third-generation cephalosporins (cefotaxime and ceftriaxone). In conclusion, the results of this nine-year period medical record review study suggested that although extended-spectrum cephalosporins were more effective than ampicillin and ciprofloxacin in treating childhood nontyphoidal Salmonella gastroenteritis, only 87% of isolates were susceptible to these agents. Prevention through proper hygienic practices to minimize potential exposure to nontyphoidal Salmonella is clearly a better strategy than treating patients with antibiotics following the incidence of infection. Keywords: Gastroenteritis, Salmonella, Bacteremia, Drug resistance, Cephalosporin

Demographic characteristics of cirrhotic patients with and without renal function impairment.

<p>Demographic characteristics of cirrhotic patients with and without renal function impairment.</p

Cumulative survival plot for ARF cirrhotic patients with and without hepatorenal syndrome.

<p>Cumulative survival plot for ARF cirrhotic patients with and without hepatorenal syndrome.</p

Adjusted hazard ratios of hepatorenal syndrome group for the 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortality of cirrhotic patients with acute renal failure, compared to non-hepatorenal syndrome group.

<p>Adjusted hazard ratios of hepatorenal syndrome group for the 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortality of cirrhotic patients with acute renal failure, compared to non-hepatorenal syndrome group.</p

Cumulative survival plot for cirrhotic patients with acute renal failure, chronic kidney disease, and end stage renal disease, and without renal function impairment.

<p>Cumulative survival plot for cirrhotic patients with acute renal failure, chronic kidney disease, and end stage renal disease, and without renal function impairment.</p