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The bacteriology of empyema fluid and the clinical background of 23 cases from July 1987 through July 1992 were studied. Nineteen cases were male and 4 female, with a mean age of 59.6 years (range; 33 to 84 y.o.). There were 15 cases of community-acquired infection and 8 of nosocomial infection. Acute pneumonia and/or lung abscess developed into empyema in 19 cases. Sixteen cases had associated predisposing conditions, such as diabetes, chronic bronchitis, disorders with dysphagia, and excess alcohol intake. Forty-one strains were isolated from empyema in 22 cases. The predominant organisms, in order of prevalence, were "Streptococcus milleri" group (11 strains), Peptostreptococcus spp. (6), Prevotella spp. (6), Fusobacterium spp. (5) and other viridans streptococci (3). The majority of streptococcal infections, which were primarily caused by "S. milleri" group, were mixed with anaerobes and/or aerobes/facultatives. These results demonstrate that oral streptococci, especially "S. milleri" group, and anaerobes play a significant role as pathogens in empyema.
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PMID:[Bacteriological and clinical studies in 23 cases of thoracic empyema--the role of oral streptococci and anaerobes]. 851 22

To understand the clinical features, antimicrobial therapy, and epidemiology of Chryseobacterium indologenes infections, the medical records of 36 patients with nosocomial Chryseobacterium indologenes infections seen over a three-year period at National Taiwan University Hospital were reviewed. The 36 isolates recovered from these patients were studied by molecular typing and determination of antimicrobial susceptibility patterns. Nine patients had underlying neoplastic diseases, seven had diabetes mellitus, five had burn wounds, and four had uremia. The clinical syndrome included ten patients with intraabdominal infections, nine with wound sepsis, six with intravascular catheter-related bacteremia, and four with ventilator-associated pneumonia. Thirteen patients had monomicrobial bacteremia, and four had polymicrobial bacteremia. Nineteen patients (53%) developed infections associated with various indwelling devices. The deaths of five patients (14%) were directly attributable to infection with Chryseobacterium indologenes. All isolates recovered showed a wide range of resistance to commonly used antimicrobial agents. The random amplified polymorphic DNA (RAPD) patterns of the isolates differed from each other, indicating the absence of epidemiological relatedness among these isolates. Nosocomial infection caused by multiresistant Chryseobacterium indologenes appears to be an emerging problem in Taiwan and should be studied further.
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PMID:Increasing incidence of nosocomial Chryseobacterium indologenes infections in Taiwan. 932 67

In developed countries the incidence of tuberculosis is higher in patients aged 65 and over than in any other age group, with the exception of HIV positive subjects. This high incidence is a consequence of the very high rate of infection in our countries in the first part of the century, and of the diminished efficiency of the aging immune system. In this age group, most cases of tuberculosis are reactivations of dormant mycobacteria. However, the possibility of a newly acquired infection must be kept in mind, especially in institutionalized patients. The clinical presentation is often insidious and non-specific, as is the radiological presentation (i.e. infiltrates in middle or lower lobes); the large number of cases discovered at autopsy illustrates the difficulty of clinical diagnosis. Extra-thoracic involvement is less frequent than in younger adults (15% of cases). Mortality is high, even in treated patients, and increases with age. The frequency of drug-induced hepatitis under tuberculostatic treatment increases with age: signs of hepatic toxicity should be monitored regularly; furthermore, compliance with treatment may be jeopardized by cognitive impairment: directly observed treatment should be set up when there is the slightest doubt as to compliance. Prophylactic treatment with isoniazid is indicated in recent tuberculin converters (after exclusion of active disease), in patients with diabetes or on immunosuppressive therapy, and in patients with radiological fibrotic lesions without serious co-morbidities. In institutionalized subjects regular tuberculin testing is warranted to detect nosocomial infection.
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PMID:[Clinical epidemiology and treatment of tuberculosis in elderly patients]. 1006 11

The objectives of this paper are to assess whether two indices of intrinsic infection risk (the SENIC and the NNIS index) predict in-hospital mortality and the attributable in-hospital mortality due to nosocomial infection in surgical patients. A prospective study on 4714 patients admitted to three hospitals has been carried out. The relative risk and its 95% confidence interval (CI) were estimated. Multiple-risk factors adjusted for odds ratios (OR) were yielded by logistic regression analysis. Overall, 119 patients (2.5%) died before hospital discharge. Both the SENIC and the NNIS indices were related to in-hospital mortality in crude data. After controlling for several variables (age, sex, ASA score, cancer, renal failure, diabetes mellitus, stay at the ICU), the SENIC index did not show any significant trend with mortality (P = 0.252), whereas the trend was significant for the NNIS index (P < 0.001). Risk of death in patients with one nosocomial infection was 7.5%, and in patients developing more than one nosocomial infection was 17.1%. After adjusting for several confounding variables, the development of an organ/space surgical site infection was significantly related to mortality (OR = 4.5, 95% CI 1.5-15.6) as was blood infection (OR = 17.3, 95% CI 3.5-87.0). The association of a surgical site infection and either a respiratory tract infection or a blood infection also increased significantly the risk of in-hospital mortality (OR = 3.3, 95% CI 1.2-8.7). In conclusion, the NNIS index is a good predictor of in-hospital mortality. Patients developing an organ/space surgical site infection and/or a blood infection have an increased risk of in-hospital mortality.
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PMID:Nosocomial infection, indices of intrinsic infection risk, and in-hospital mortality in general surgery. 1020 22

Nosocomial infections are one of the most feared complications after open heart surgery. A large retrospective study was conducted to evaluate the nature and scope of the problem. Between 1992 and 1998, 9352 patients who had undergone open heart surgery were evaluated. Bloodstream infections, pneumonia, and deep sternal wound infections were included. Univariate and logistic regression analyses were conducted to identify the high-risk patients that were likely to become infected. Three hundred forty-six infections in 276 patients were diagnosed. Age, preoperative albumin level, banked blood requirement, duration of operation, diabetes mellitus, previous open heart surgery, moderate or severe pericardial adhesions, obesity, postoperative low cardiac output, and postoperative cerebrovascular accident were found to be significant in univariate and logistic regression analyses for infectious outcome. Univariate analysis also revealed additional significant factors: fresh frozen plasma requirement, duration of cardiopulmonary bypass and cross-clamp, preoperative high levels of blood urea and glucose, presence of occlusive peripheral arterial disease, preoperative history of hypertension, and nasal carriage of Staphylococcus aureus. Methicillin resistant S. aureus was involved in 58.4% of the infections. Risk factors should be individualized for patients and every effort should be carried out to minimize infectious outcome.
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PMID:Bloodstream, respiratory, and deep surgical wound infections after open heart surgery. 1022 80

Candiduria is a common nosocomial infection, occurring predominantly in elderly debilitated subjects with frequent co-morbid pathology, especially diabetes mellitus. The majority of candiduric patients are catheterized or have been recently catheterized or instrumented. Physician surveys indicate considerable variation in attitude towards treatment of asymptomatic candiduria. Management of candiduria is seriously limited by lack of understanding of the natural history of this infection as well as reliable data of treatment efficacy based upon controlled studies. The recent availability of oral antifungal agents has strongly influenced physicians in adopting a more interventional role. Most therapeutic studies quoted in the literature compare active intervention with a variety of systemic or local measures. Reference is made to a recent placebo-controlled prospective study, in which fluconazole was significantly more effective than placebo in short-term eradication of asymptomatic candiduria. Nevertheless, follow-up of these asymptomatic patients revealed identical candiduria rates within 1 month of cessation of therapy. In most studies, evidence of clinical benefit in asymptomatic patients by the eradication of candiduria has not been evident. In conclusion, the majority of hospitalized patients, particularly those with continued catheterization, do not require local or systemic antifungal therapy for asymptomatic candiduria.
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PMID:Management of asymptomatic candiduria. 1039 84

From July 1996 to June 1997, 22 adult patients with Serratia marcescens bacteremia were retrospectively studied at China Medical College Hospital. All patients had severe underlying disease, most commonly diabetes mellitus. Eighteen (82%) patients had nosocomial infection. Clinical syndromes included primary bacteremia (68%), pneumonia (14%), urinary tract infection (9%), suppurative thrombophlebitis (5%) and surgical wound infection (5%). Twelve patients had central venous catheters in place at the onset of bacteremia, but only one case met the definition of catheter-related infection. In 14 (64%) patients, portal of entry of S. marcescens infection was unknown. Five (23%) patients had concurrent polymicrobial bacteremia. The overall mortality rate was 50% (11/22). Seven (32%) of the 22 patients died of S. marcescens bacteremia. All isolates were resistant to ampicillin and cephalothin and susceptible to imipenem. Ninety-five percent of strains were susceptible to moxalactam, 68% to amikacin, 55% to ceftazidime, 45% to aztreonam, 32% to ceftriaxone, 27% to gentamicin, 18% to cefoperazone and cefotaxime, and 9% to piperacillin. MICs of various antibiotics demonstrated that ciprofloxacin and imipenem had good activities against S. marcescens, with MIC90 of 0.19 microg/mL and 1.0 microg/mL, respectively. Due to increasing multidrug resistance, choosing appropriate antimicrobial agents such as moxalactam, imipenem, and ciprofloxacin should be highly recommended for the treatment of S. marcescens infections.
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PMID:Serratia marcescens bacteremia: clinical features and antimicrobial susceptibilities of the isolates. 1049 54

Empiri c therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi-recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society.
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PMID:Empiric therapy for pneumonia in the surgical intensive care unit. 1080 57

Empiri c therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi-recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society.
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PMID:Empiric therapy for pneumonia in the surgical intensive care unit. 1087 6

We report the case of a 56-year-old man who developed bacterial mediastinitis with methicillin-resistant Staphylococcus aureus after undergoing heart transplantation. He had a history of insulin-dependent diabetes mellitus and prior cardiac surgery. To find the source of nosocomial infection, we cultured nasal swab specimens from all hospital personnel involved in this operation. We used antibiotic sensitivity profiling and pulsed-field gel electrophoresis to subtype the involved microorganism. The S. aureus isolates from the patient and the perfusionist were identical to each other and were different from the strains previously found in our hospital. It is almost certain that the S. aureus mediastinitis in this patient was transmitted from the perfusionist. We recommend obtaining cultures from hospital staff members when there is an outbreak of staphylococcal infection.
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PMID:Perfusionist-transmitted bacterial mediastinitis in a heart transplant recipient. 1133 Jul 45


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