Background: The clinical impact of ST (sequence type) 131 in adults with community-onset Escheric... more Background: The clinical impact of ST (sequence type) 131 in adults with community-onset Escherichia coli bacteremia remains controversial. Methods: Clinical data of 843 adults presenting with community-onset monomicrobial E. coli bacteremia at a medical center between 2008 and 2013 were collected. E. coli isolates were genotyped by a multiplex polymerase chain reaction to detect ST131 and non-ST131 clones. Results: Of 843 isolates from 843 patients with a mean age of 69 years, there were 102 (12.1%) isolates of ST131. The ST131 clone was more likely to be found in the elderly (76.5% vs. 64.0%; p = 0.01) and in nursing-home residents (12.7% vs. 3.8%; p < 0.001) than non-ST131 clones. Furthermore, the ST131 clone was associated with a longer time to appropriate antibiotic therapy (2.6 vs. 0.8 days; p = 0.004) and a higher 28-day mortality rate (14.7% vs. 6.5%, p = 0.003). In the Cox regression analysis with an adjustment of independent predictors, the ST131 clone exhibited a signi...
Escherichia coli is one major cause of bacterial infections and can horizontally acquire antimicr... more Escherichia coli is one major cause of bacterial infections and can horizontally acquire antimicrobial resistance and virulence genes through conjugation. Because conjugative plasmids can rapidly spread among bacteria of different species, the plasmids carrying both antimicrobial resistance and virulence genes may pose a significant threat to public health. Therefore, the identification and characterization of these plasmids may facilitate a better understanding of E. coli pathogenesis and the development of new strategies against E. coli infections. Because iron uptake ability is a potential virulence trait of bacteria, we screened for E. coli conjugative plasmids able to confer both iron uptake ability and ampicillin resistance. The plasmid pEC41, which was derived from the bacteremia clinical isolate EC41, was identified. EC41, which carried the fimH27 allele, belonged to sequence type (ST) 405 and phylogroup D. According to the sequencing analyses, pEC41 was 86 kb in size, and i...
Sequence type (ST) 131 is a multidrug-resistant pandemic lineage of E. coli responsible for extra... more Sequence type (ST) 131 is a multidrug-resistant pandemic lineage of E. coli responsible for extraintestinal infections. Few surveillance data of ST131 included all antimicrobial-susceptible and -resistant isolates or focused on community-acquired urinary tract infection (UTI). From a population-based surveillance pool of 2997 outpatient urine E. coli isolates, 542 were selected for detection of ST131 based on ciprofloxacin and/or cefotaxime resistance. Pulsed-field gel electrophoresis (PFGE) was performed on all ST131 isolates to further determine their relatedness. The estimated overall ST131 prevalence in this community UTI cohort increased from 11.2% (in 2002–2004), 12.2% (in 2006–2008), 13.6% (in 2010–2012), to 17.4% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-resistant group, ST131 increased from 33.3% in 2002–2004 to 72.1% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-susceptible group, ST131 was found in 24.3% overall without ...
Both fluoroquinolones (FQs) and third-generation cephalosporins (3 rd -GCs) are commonly prescrib... more Both fluoroquinolones (FQs) and third-generation cephalosporins (3 rd -GCs) are commonly prescribed to treat bloodstream infections, but comparative efficacies between them were rarely studied. Demographics and clinical characteristics of 733 adults with polymicrobial or monomicrobial community-onset bacteremia empirically treated by an appropriate FQ ( n = 87) or 3 rd -GC ( n = 646) were compared. A critical illness (8.0% vs. 19.0%, P = 0.01), an initial syndrome with severe sepsis (33.3% vs. 50.3%, P = 0.003), or a fatal outcome at 28 days (4.6% vs. 10.5%, P = 0.08) was less common in the FQ group. Of them, 645 (88.0%) patients were febrile at initial presentation and the FQ group with (7.6 days vs. 12.0 days, P = 0.04) and without (3.8 days vs. 5.4 days, P = 0.001) a critical illness had shorter time to defervescence than the 3 rd -GC group. By the propensity scores, 87 patients with appropriate FQ therapy were matched with 435 treated by 3 rd -GC therapy at a ratio of 1:5, and t...
Visual and empirical assessments do not enable the early detection of wound deterioration or necr... more Visual and empirical assessments do not enable the early detection of wound deterioration or necroses. No suitable objective indicator for predicting poor wound-healing is currently available. We used infrared thermography to determine the association between wound temperature and pressure-wound healing. We examined patients with grades 2–4 pressure ulcers from a medical center in southern Taiwan and recorded the temperatures of the wound bed, periwound, and normal skin using infrared thermographic cameras. A total of 50 pressure ulcers and 248 infrared-thermography temperature records were analyzed. Normal skin temperature was not related to pressure ulcer wound healing. In a multivariate analysis, higher malnutrition universal-screening-tool scores were associated with poor wound-healing (p = 0.020), and higher periwound-temperature values were associated with better wound-healing (p = 0.028). In patients who had higher periwound-skin temperature than that of the wound bed, that r...
Background: Colistin is one of the last-line antimicrobial agents against life-threatening infect... more Background: Colistin is one of the last-line antimicrobial agents against life-threatening infections. The distribution of the colistin resistance gene mcr-1 has been reported worldwide. However, most studies have focused on the distribution of mcr-1-positive bacteria in humans, animals, food, and sewage; few have focused on their distribution in natural environments. Method: We conducted a large spatial survey of mcr-1-positive Escherichia coli at 119 sites in 48 rivers, covering the entire island of Taiwan. We investigated the relationship between the livestock or poultry density in the surveyed riverine area and the number of mcr-1-positive E. coli in the river water. We then sequenced and characterized the isolated mcr-1-positive plasmids. Results: Seven mcr-1 positive E. coli were isolated from 5.9% of the sampling sites. The mcr-1-positive sites correlated with high chicken and pig stocking densities but not human population density or other river parameters. Four of the mcr-1...
International Journal of Environmental Research and Public Health
Background: Data have not been reported to explore the relation between COVID-19 severity and BCG... more Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established a web-based National Immunization Information System (NISS) in 2003 and included all citizens’ BCG vaccination records in NISS for those born after 1985. We identified COVID-19 Taiwanese patients born after 1985 between 21 January and 19 March 2021. Study participants were further classified into ages 4–24 years (birth year 1996–2016) and 25–33 years (birth year 1986–1995). We described their clinical syndrome defined by the World Health Organization and examined the relation between the COVID-19 severity and BCG vaccination status. Results: In the 4–24 age group, among 138 BCG vaccinated individuals, 80.4% were asymptomatic or had mild disease, while 17.4% had moderate disease, 1.5% had severe...
BACKGROUND Healthcare workers (HCWs) are recommended to measure their body temperature every 8 ho... more BACKGROUND Healthcare workers (HCWs) are recommended to measure their body temperature every 8 hours to reduce the risk of cross infections during the COVID-19 pandemic in Taiwan. However, temperature reporting accuracy among HCWs is difficult to attain due to busy working schedules and high chances of human errors. OBJECTIVE This study describes the application of a continuous temperature monitoring system (HEARThermo Care AI.) based on the Internet of Things (IoT) among HCWs in hospitals during the COVID-19 outbreak. METHODS A prospective cohort study was conducted among HCWs in a major tertiary hospital in southern Taiwan. HCWs participated in this study wore HEARThermo, an innovative wearable device used to measure body surface temperature and heart rate every 10s, to continue monitoring their body surface temperature and heart rate during working hours. The HEARThermo Care AI. system combined with the routine body temperature measurement flow were used to automatedly notify the...
Objective This study investigated whether the incidence of opportunistic infection differed in sy... more Objective This study investigated whether the incidence of opportunistic infection differed in systemic lupus erythematosus patients who received different doses of corticosteroids. Methods We included patients with diagnosed systemic lupus erythematosus from 1997 to 2010 using Taiwan national health insurance data. The index day for systemic lupus erythematosus patients was 3 months after the systemic lupus erythematosus diagnosis. A non-steroid cohort was matched 4:1 with the steroid cohort according to age, sex and index day. The end of the follow-up period was the day of opportunistic infection diagnosis, 1 year after the index day, or death. Results The overall cumulative incidence of opportunistic infection was 136-fold higher in the steroid cohort than in the non-steroid cohort. The adjusted hazard ratio for developing mycobacterium infection in the steroid cohort was 11, and the adjusted hazard ratio for developing herpes zoster was 43.6 compared to the non-steroid cohort af...
Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) ma... more Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) may play an important role in immunomodulation. We aimed to examine the association between thiazolidinediones, PPAR-γ agonists and incidence of bacterial abscess among patients with type 2 diabetes. This retrospective cohort study between 2000 and 2010 included 46 986 propensity (PS)-matched patients diagnosed with type 2 diabetes. We compared the incidence of bacterial abscess, including liver and non-liver abscesses, between patients treated with metformin plus a thiazolidinedione (M + T, N = 7831) or metformin plus a sulfonylurea (M + S, N = 39 155). Data were retrieved from a population-based Taiwanese database. We applied Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), comparing M + T and M + S after PS matching. During a median follow-up of 4.5 years, the incidence rate of bacterial abscess was lower with M + T than with ...
International journal of antimicrobial agents, Jan 7, 2017
The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no... more The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no-switch strategy in bacteremic patients. Adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia treated empirically using broad-spectrum beta-lactams, including third-generation cephalosporins (GCs), fourth-GC or carbapenems, were treated definitively with first- or second-GCs (de-escalation group), the same regimens as empirical antibiotics (no-switch group), or antibiotics with a broader-spectrum than empirical antibiotics (escalation group). The eligible 454 adults were categorized as the de-escalation (231 patients, 50.9%), no-switch (177, 39.0%), and escalation (46, 10.1%) groups. Patients with de-escalation therapy were more often female, had less critical illness and fatal comorbidity, and had a higher survival rate than patients in the other two groups. After propensity score matching in the de-escalation and no-switch grou...
Diagnosis and management of infective endocarditis (IE) in elderly patients remains a difficult p... more Diagnosis and management of infective endocarditis (IE) in elderly patients remains a difficult problem. This study evaluated the clinical and microbiologic characteristics and outcome of IE in elderly patients. From 1996 to 2002, clinical and microbiologic data from 67 patients with IE aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 65 years at National Taiwan University Hospital were reviewed and analyzed. The median age of the 67 patients was 74 years (range, 66 to 95 years). Staphylococci and streptococci were the 2 leading etiologies of IE. Forty seven of the cases were defined as community-acquired. IE had not been diagnosed at admission in nearly two-thirds of cases. Of the 20 episodes of nosocomial IE, the median interval to development of IE after hospitalization was 30 days. Staphylococci constituted 90% of causative pathogens in nosocomial IE. The in-hospital mortality rate was 29.9%. Univariate analysis revealed that staphylococci as the causative pathogen and nosocomial IE were predictors of fatal outcome (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). When significant variables related to a fatal outcome on univariate analysis, i.e., staphylococcal IE, nosocomial IE, acute renal failure and cardiac complications, were entered in the multivariate analysis, acute renal failure and development of congestive heart failure or new conduction disturbance were both significantly associated with in-hospital death. Diagnosis of IE in the elderly was often delayed and a substantial proportion of patients died during hospitalization. Staphylococcal IE and nosocomial IE were significant predictors of in-hospital death.
The number of infections caused by Acinetobacter baumannii has increased in recent years and the ... more The number of infections caused by Acinetobacter baumannii has increased in recent years and the emergence of pandrug-resistant A. baumannii (PDRAB) has been observed in Taiwan. The aim of this study was to evaluate the clinical features and outcomes of patients with bacteremia due to PDRAB. From January 1999 to April 2002, 30 patients with PDRAB bacteremia were treated. We analyzed the clinical characteristics of these patients, including gender, underlying diseases, clinical manifestations, antibiotic treatment, and outcome. Bacteremia developed an average of 33 days after hospitalization and was hospital acquired in all cases. The source of bacteremia was identified in 19 patients (63.3%) and was most commonly from the respiratory tract. The overall mortality was 60% (18 patients). Among these, the cause of death was directly related to PDRAB bacteremia in 12. Underlying heart disease, shock, resuscitation, acute respiratory distress syndrome, mechanical ventilation, and multiple organ dysfunction score (MODS) were significant predictors of mortality after the development of PDRAB bacteremia. No specific antimicrobial therapy appeared to be effective. Clinical outcomes of patients with PDRAB bacteremia were related to the medical conditions of the patients at the time of development of bacteremia and could be predicted by the MODS. The only way to limit the spread is through strict preventive measures for nosocomial infection and antibiotic control.
Background: The clinical impact of ST (sequence type) 131 in adults with community-onset Escheric... more Background: The clinical impact of ST (sequence type) 131 in adults with community-onset Escherichia coli bacteremia remains controversial. Methods: Clinical data of 843 adults presenting with community-onset monomicrobial E. coli bacteremia at a medical center between 2008 and 2013 were collected. E. coli isolates were genotyped by a multiplex polymerase chain reaction to detect ST131 and non-ST131 clones. Results: Of 843 isolates from 843 patients with a mean age of 69 years, there were 102 (12.1%) isolates of ST131. The ST131 clone was more likely to be found in the elderly (76.5% vs. 64.0%; p = 0.01) and in nursing-home residents (12.7% vs. 3.8%; p < 0.001) than non-ST131 clones. Furthermore, the ST131 clone was associated with a longer time to appropriate antibiotic therapy (2.6 vs. 0.8 days; p = 0.004) and a higher 28-day mortality rate (14.7% vs. 6.5%, p = 0.003). In the Cox regression analysis with an adjustment of independent predictors, the ST131 clone exhibited a signi...
Escherichia coli is one major cause of bacterial infections and can horizontally acquire antimicr... more Escherichia coli is one major cause of bacterial infections and can horizontally acquire antimicrobial resistance and virulence genes through conjugation. Because conjugative plasmids can rapidly spread among bacteria of different species, the plasmids carrying both antimicrobial resistance and virulence genes may pose a significant threat to public health. Therefore, the identification and characterization of these plasmids may facilitate a better understanding of E. coli pathogenesis and the development of new strategies against E. coli infections. Because iron uptake ability is a potential virulence trait of bacteria, we screened for E. coli conjugative plasmids able to confer both iron uptake ability and ampicillin resistance. The plasmid pEC41, which was derived from the bacteremia clinical isolate EC41, was identified. EC41, which carried the fimH27 allele, belonged to sequence type (ST) 405 and phylogroup D. According to the sequencing analyses, pEC41 was 86 kb in size, and i...
Sequence type (ST) 131 is a multidrug-resistant pandemic lineage of E. coli responsible for extra... more Sequence type (ST) 131 is a multidrug-resistant pandemic lineage of E. coli responsible for extraintestinal infections. Few surveillance data of ST131 included all antimicrobial-susceptible and -resistant isolates or focused on community-acquired urinary tract infection (UTI). From a population-based surveillance pool of 2997 outpatient urine E. coli isolates, 542 were selected for detection of ST131 based on ciprofloxacin and/or cefotaxime resistance. Pulsed-field gel electrophoresis (PFGE) was performed on all ST131 isolates to further determine their relatedness. The estimated overall ST131 prevalence in this community UTI cohort increased from 11.2% (in 2002–2004), 12.2% (in 2006–2008), 13.6% (in 2010–2012), to 17.4% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-resistant group, ST131 increased from 33.3% in 2002–2004 to 72.1% in 2014–2016 (p < 0.01). In the ciprofloxacin-resistant/cefotaxime-susceptible group, ST131 was found in 24.3% overall without ...
Both fluoroquinolones (FQs) and third-generation cephalosporins (3 rd -GCs) are commonly prescrib... more Both fluoroquinolones (FQs) and third-generation cephalosporins (3 rd -GCs) are commonly prescribed to treat bloodstream infections, but comparative efficacies between them were rarely studied. Demographics and clinical characteristics of 733 adults with polymicrobial or monomicrobial community-onset bacteremia empirically treated by an appropriate FQ ( n = 87) or 3 rd -GC ( n = 646) were compared. A critical illness (8.0% vs. 19.0%, P = 0.01), an initial syndrome with severe sepsis (33.3% vs. 50.3%, P = 0.003), or a fatal outcome at 28 days (4.6% vs. 10.5%, P = 0.08) was less common in the FQ group. Of them, 645 (88.0%) patients were febrile at initial presentation and the FQ group with (7.6 days vs. 12.0 days, P = 0.04) and without (3.8 days vs. 5.4 days, P = 0.001) a critical illness had shorter time to defervescence than the 3 rd -GC group. By the propensity scores, 87 patients with appropriate FQ therapy were matched with 435 treated by 3 rd -GC therapy at a ratio of 1:5, and t...
Visual and empirical assessments do not enable the early detection of wound deterioration or necr... more Visual and empirical assessments do not enable the early detection of wound deterioration or necroses. No suitable objective indicator for predicting poor wound-healing is currently available. We used infrared thermography to determine the association between wound temperature and pressure-wound healing. We examined patients with grades 2–4 pressure ulcers from a medical center in southern Taiwan and recorded the temperatures of the wound bed, periwound, and normal skin using infrared thermographic cameras. A total of 50 pressure ulcers and 248 infrared-thermography temperature records were analyzed. Normal skin temperature was not related to pressure ulcer wound healing. In a multivariate analysis, higher malnutrition universal-screening-tool scores were associated with poor wound-healing (p = 0.020), and higher periwound-temperature values were associated with better wound-healing (p = 0.028). In patients who had higher periwound-skin temperature than that of the wound bed, that r...
Background: Colistin is one of the last-line antimicrobial agents against life-threatening infect... more Background: Colistin is one of the last-line antimicrobial agents against life-threatening infections. The distribution of the colistin resistance gene mcr-1 has been reported worldwide. However, most studies have focused on the distribution of mcr-1-positive bacteria in humans, animals, food, and sewage; few have focused on their distribution in natural environments. Method: We conducted a large spatial survey of mcr-1-positive Escherichia coli at 119 sites in 48 rivers, covering the entire island of Taiwan. We investigated the relationship between the livestock or poultry density in the surveyed riverine area and the number of mcr-1-positive E. coli in the river water. We then sequenced and characterized the isolated mcr-1-positive plasmids. Results: Seven mcr-1 positive E. coli were isolated from 5.9% of the sampling sites. The mcr-1-positive sites correlated with high chicken and pig stocking densities but not human population density or other river parameters. Four of the mcr-1...
International Journal of Environmental Research and Public Health
Background: Data have not been reported to explore the relation between COVID-19 severity and BCG... more Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established a web-based National Immunization Information System (NISS) in 2003 and included all citizens’ BCG vaccination records in NISS for those born after 1985. We identified COVID-19 Taiwanese patients born after 1985 between 21 January and 19 March 2021. Study participants were further classified into ages 4–24 years (birth year 1996–2016) and 25–33 years (birth year 1986–1995). We described their clinical syndrome defined by the World Health Organization and examined the relation between the COVID-19 severity and BCG vaccination status. Results: In the 4–24 age group, among 138 BCG vaccinated individuals, 80.4% were asymptomatic or had mild disease, while 17.4% had moderate disease, 1.5% had severe...
BACKGROUND Healthcare workers (HCWs) are recommended to measure their body temperature every 8 ho... more BACKGROUND Healthcare workers (HCWs) are recommended to measure their body temperature every 8 hours to reduce the risk of cross infections during the COVID-19 pandemic in Taiwan. However, temperature reporting accuracy among HCWs is difficult to attain due to busy working schedules and high chances of human errors. OBJECTIVE This study describes the application of a continuous temperature monitoring system (HEARThermo Care AI.) based on the Internet of Things (IoT) among HCWs in hospitals during the COVID-19 outbreak. METHODS A prospective cohort study was conducted among HCWs in a major tertiary hospital in southern Taiwan. HCWs participated in this study wore HEARThermo, an innovative wearable device used to measure body surface temperature and heart rate every 10s, to continue monitoring their body surface temperature and heart rate during working hours. The HEARThermo Care AI. system combined with the routine body temperature measurement flow were used to automatedly notify the...
Objective This study investigated whether the incidence of opportunistic infection differed in sy... more Objective This study investigated whether the incidence of opportunistic infection differed in systemic lupus erythematosus patients who received different doses of corticosteroids. Methods We included patients with diagnosed systemic lupus erythematosus from 1997 to 2010 using Taiwan national health insurance data. The index day for systemic lupus erythematosus patients was 3 months after the systemic lupus erythematosus diagnosis. A non-steroid cohort was matched 4:1 with the steroid cohort according to age, sex and index day. The end of the follow-up period was the day of opportunistic infection diagnosis, 1 year after the index day, or death. Results The overall cumulative incidence of opportunistic infection was 136-fold higher in the steroid cohort than in the non-steroid cohort. The adjusted hazard ratio for developing mycobacterium infection in the steroid cohort was 11, and the adjusted hazard ratio for developing herpes zoster was 43.6 compared to the non-steroid cohort af...
Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) ma... more Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) may play an important role in immunomodulation. We aimed to examine the association between thiazolidinediones, PPAR-γ agonists and incidence of bacterial abscess among patients with type 2 diabetes. This retrospective cohort study between 2000 and 2010 included 46 986 propensity (PS)-matched patients diagnosed with type 2 diabetes. We compared the incidence of bacterial abscess, including liver and non-liver abscesses, between patients treated with metformin plus a thiazolidinedione (M + T, N = 7831) or metformin plus a sulfonylurea (M + S, N = 39 155). Data were retrieved from a population-based Taiwanese database. We applied Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), comparing M + T and M + S after PS matching. During a median follow-up of 4.5 years, the incidence rate of bacterial abscess was lower with M + T than with ...
International journal of antimicrobial agents, Jan 7, 2017
The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no... more The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no-switch strategy in bacteremic patients. Adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia treated empirically using broad-spectrum beta-lactams, including third-generation cephalosporins (GCs), fourth-GC or carbapenems, were treated definitively with first- or second-GCs (de-escalation group), the same regimens as empirical antibiotics (no-switch group), or antibiotics with a broader-spectrum than empirical antibiotics (escalation group). The eligible 454 adults were categorized as the de-escalation (231 patients, 50.9%), no-switch (177, 39.0%), and escalation (46, 10.1%) groups. Patients with de-escalation therapy were more often female, had less critical illness and fatal comorbidity, and had a higher survival rate than patients in the other two groups. After propensity score matching in the de-escalation and no-switch grou...
Diagnosis and management of infective endocarditis (IE) in elderly patients remains a difficult p... more Diagnosis and management of infective endocarditis (IE) in elderly patients remains a difficult problem. This study evaluated the clinical and microbiologic characteristics and outcome of IE in elderly patients. From 1996 to 2002, clinical and microbiologic data from 67 patients with IE aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 65 years at National Taiwan University Hospital were reviewed and analyzed. The median age of the 67 patients was 74 years (range, 66 to 95 years). Staphylococci and streptococci were the 2 leading etiologies of IE. Forty seven of the cases were defined as community-acquired. IE had not been diagnosed at admission in nearly two-thirds of cases. Of the 20 episodes of nosocomial IE, the median interval to development of IE after hospitalization was 30 days. Staphylococci constituted 90% of causative pathogens in nosocomial IE. The in-hospital mortality rate was 29.9%. Univariate analysis revealed that staphylococci as the causative pathogen and nosocomial IE were predictors of fatal outcome (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). When significant variables related to a fatal outcome on univariate analysis, i.e., staphylococcal IE, nosocomial IE, acute renal failure and cardiac complications, were entered in the multivariate analysis, acute renal failure and development of congestive heart failure or new conduction disturbance were both significantly associated with in-hospital death. Diagnosis of IE in the elderly was often delayed and a substantial proportion of patients died during hospitalization. Staphylococcal IE and nosocomial IE were significant predictors of in-hospital death.
The number of infections caused by Acinetobacter baumannii has increased in recent years and the ... more The number of infections caused by Acinetobacter baumannii has increased in recent years and the emergence of pandrug-resistant A. baumannii (PDRAB) has been observed in Taiwan. The aim of this study was to evaluate the clinical features and outcomes of patients with bacteremia due to PDRAB. From January 1999 to April 2002, 30 patients with PDRAB bacteremia were treated. We analyzed the clinical characteristics of these patients, including gender, underlying diseases, clinical manifestations, antibiotic treatment, and outcome. Bacteremia developed an average of 33 days after hospitalization and was hospital acquired in all cases. The source of bacteremia was identified in 19 patients (63.3%) and was most commonly from the respiratory tract. The overall mortality was 60% (18 patients). Among these, the cause of death was directly related to PDRAB bacteremia in 12. Underlying heart disease, shock, resuscitation, acute respiratory distress syndrome, mechanical ventilation, and multiple organ dysfunction score (MODS) were significant predictors of mortality after the development of PDRAB bacteremia. No specific antimicrobial therapy appeared to be effective. Clinical outcomes of patients with PDRAB bacteremia were related to the medical conditions of the patients at the time of development of bacteremia and could be predicted by the MODS. The only way to limit the spread is through strict preventive measures for nosocomial infection and antibiotic control.
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Papers by Jiun-Ling Wang