Demographics and clinical characteristics of patients with extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR-PA) and non-XDR-PA infection.

<p>Demographics and clinical characteristics of patients with extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR-PA) and non-XDR-PA infection.</p

Independent predictors of mortality attributable to infection.

<p>Independent predictors of mortality attributable to infection.</p

Treatment, and clinical and microbiological outcomes, of patients with <i>Pseudomonas aeruginosa</i> infections.

<p>Treatment, and clinical and microbiological outcomes, of patients with <i>Pseudomonas aeruginosa</i> infections.</p

Independent predictors of XDR-PA infections.

<p>Independent predictors of XDR-PA infections.</p

Epidemiology and risk factors of extensively drug-resistant <i>Pseudomonas aeruginosa</i> infections

<div><p>Background</p><p>The incidence of nosocomial infections from extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.</p><p>Methods</p><p>We retrospectively studied a cohort of adult, hospitalized patients with <i>P</i>. <i>aeruginosa</i> (PA) infections between April and December 2014.</p><p>Results</p><p>Of the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant <i>Pseudomonas aeruginosa</i> (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05–36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36–10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44–7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66–28.82), admission to a medical department (aOR 4.67; 95% CI 1.81–12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50–9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05–7.08).</p><p>Conclusion</p><p>The prevalence of XDR-PA infections represented almost a quarter of <i>Pseudomonas aeruginosa</i> hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.</p></div

Serological Response of Patients with Influenza A (H1N1) pdm09-Associated Pneumonia: An Observational Study

<div><p>Background</p><p>Little is known about the dynamics or magnitude of antibody response in patients with influenza A (H1N1) pdm09-associated pneumonia. We described and compared the antibody response to influenza A (H1N1) pdm09 in patients with and without pneumonia.</p> <p>Methods</p><p>We collected serum samples and determined antibody titers by the hemagglutination inhibition (HI) and microneutralization (mNT) assays from patients with RT-PCR confirmed influenza A (H1N1) pdm09 virus at baseline, 1, 2 and 6 months after onset of illness. </p> <p>Results</p><p>Fifty-nine patients were enrolled, 45 (76.3%) were between 15 and 60 years of age, 49 (83.1%) were hospitalized and 25 (42.4%) had complications with pneumonia. Ninety-four percent of patients had HI titers ≥ 1: 40 and 90% had mNT titers ≥ 1: 160 at 2 months after illness. Geometric mean titers (GMT) of HI and mNT increased significantly (<i>p</i><0.001) between baseline and months 1 or 2, then declined significantly (<i>p</i><0.001) at month 6 by the HI assay, but dropped to an insignificant level (<i>p</i>=0.24) by the mNT assay. The mNT-GMT was at least twice as high as corresponding HI antibodies over a 6 month period. The GMT of HI and mNT in those with pneumonia (1 mo) peaked earlier than that of those without pneumonia (2 mo). When adjusted by age and gender, those with pneumonia had a higher HI-GMT than those without pneumonia at 1 month (264 vs. 117, <i>p</i>=0.007), 2 months (212 vs. 159, <i>p</i>=0.013), and 6 months (160 vs. 82, <i>p</i>=0.018). </p> <p>Conclusions</p><p>The patients recovered from influenza A (H1N1) pdm09-associated pneumonia, clearly developed an earlier and more robust antibody response until 6 months after onset of illness. The results in our study are useful to determine an appropriate donor and timing to obtain convalescent plasma for adjunctive treatment of seriously ill patients with pandemic H1N1 influenza.</p> </div

CONSORT diagram shows the flow of the study participants through 6 months period.

<p>The patients who had at least one follow-up visit remained including in the study. </p

Geometric mean titers (GMT) of antibodies among different age groups.

<p>A) GMT of hemagglutination inhibition antibodies (HI-GMT) and B) GMT of neutralization antibodies (NT-GMT) among three age groups (Age < 15, 15-59 and ≥ 60) of 59 patients infected with influenza A (H1N1) pdm09 virus.</p

Geometric mean titers of hemagglutination inhibition (HI) and neutralization (NT) antibodies over 6 months.

<p>Geometric mean titers of hemagglutination inhibition (HI) and neutralization (NT) antibodies over 6 months.</p