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Victor L Yu - One of the best experts on this subject based on the ideXlab platform.
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combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal Bacteremia
American Journal of Respiratory and Critical Care Medicine, 2004Co-Authors: Larry M Baddour, Victor L Yu, Keith P Klugman, Charles Feldman, Ake Ortqvist, Jordi Rello, Arthur J Morris, Carlos M Luna, David R Snydman, Wen Chien KoAbstract:Retrospective studies have suggested that combination antibiotic therapy for severe bacteremic pneumococcal pneumonia may reduce mortality. We assessed this issue in a prospective, multicenter, international observational study of 844 adult patients with Bacteremia due to Streptococcus pneumoniae. The effect of combination antibiotic therapy versus monotherapy on mortality was examined by univariate analyses and by logistic regression models. The 14-day mortality was not significantly different for the two groups. However, among critically ill patients, combination antibiotic therapy was associated with lower 14-day mortality (23.4 versus 55.3%, p = 0.0015). This improvement in survival was independent of country of origin, intensive care unit support, class of antibiotics, or in vitro activity of the antibiotics prescribed. Combination antibiotic therapy improved survival among critically ill patients with bacteremic pneumococcal illness.
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staphylococcus aureus Bacteremia recurrence and the impact of antibiotic treatment in a prospective multicenter study
Medicine, 2003Co-Authors: Feng-yee Chang, Patricia Triplett, Brent B. Macdonald, Joseph M. Mylotte, Marilyn M. Wagener, James E. Peacock, Daniel M Musher, Alice Odonnell, Victor L YuAbstract:Staphylococcus aureus Bacteremia is associated with substantial morbidity. Recurrence is common, but incidence and risk factors for recurrence are uncertain. The emergence of meth- icillin resistance and the ease of administering vancomycin, espe- cially in patients who have renal insufficiency, have led to reliance on this drug with the assumption that it is as effective as b-lactam antibiotics, an assumption that remains open to debate. We initiated a multicenter, prospective observational study in 6 university hospitals and enrolled 505 consecutive patients with S. aureus Bacteremia. All patients were monitored for 6 months and patients with endocarditis were followed for 3 years. Recurrence was defined as return of S. aureus Bacteremia after documentation of negative blood cultures and/or clinical improvement after com- pleting a course of antistaphylococcal antibiotic therapy. All blood isolates taken from patients with recurrent Bacteremia underwent pulsed-field gel electrophoresis testing. Recurrence was subclas- sified as reinfection (different pulsed-field gel electrophoresis patterns) or relapse (same pulsed-field gel electrophoresis pattern). Forty-two patients experienced 56 episodes of recurrence (79% were relapses and 21% were reinfection). Relapse occurred earlier than reinfection (median, 36 versus 99 d, p < 0.06). Risk factors for relapse of S. aureus Bacteremia included valvular heart disease, cirrhosis of the liver, and deep-seated infection (including endo- carditis). Nafcillin was superior to vancomycin in preventing bacteriologic failure (persistent Bacteremia or relapse) for methicil- lin-susceptible S. aureus (MSSA) Bacteremia. Failure to remove infected intravascular devices/catheters and vancomycin therapy were common factors in patients experiencing multiple (greater than 2) relapses. However, by multivariate analysis, only endocar- ditis and therapy with vancomycin (versus nafcillin) were signifi- cantly associated with relapse. Recurrences occurred in 9.4% of S. aureus Bacteremias following antistaphylococcal therapy, and most were relapses. Duration of antistaphylococcal therapy was not associated with relapse, but type of antibiotic therapy was. Nafcillin was superior to vancomycin in efficacy in patients with MSSA Bacteremia. (Medicine 2003;82:333-9)
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Staphylococcus aureus Bacteremia
Medicine, 2003Co-Authors: Feng-yee Chang, Patricia Triplett, Brent B. Macdonald, Joseph M. Mylotte, Alice O’donnell, Marilyn M. Wagener, James E. Peacock, Daniel M Musher, Victor L YuAbstract:Staphylococcus aureus Bacteremia is associated with substantial morbidity. Recurrence is common, but incidence and risk factors for recurrence are uncertain. The emergence of methicillin resistance and the ease of administering vancomycin, especially in patients who have renal insufficiency, have led to reliance on this drug with the assumption that it is as effective as beta-lactam antibiotics, an assumption that remains open to debate. We initiated a multicenter, prospective observational study in 6 university hospitals and enrolled 505 consecutive patients with S. aureus Bacteremia. All patients were monitored for 6 months and patients with endocarditis were followed for 3 years. Recurrence was defined as return of S. aureus Bacteremia after documentation of negative blood cultures and/or clinical improvement after completing a course of antistaphylococcal antibiotic therapy. All blood isolates taken from patients with recurrent Bacteremia underwent pulsed-field gel electrophoresis testing. Recurrence was subclassified as reinfection (different pulsed-field gel electrophoresis patterns) or relapse (same pulsed-field gel electrophoresis pattern).Forty-two patients experienced 56 episodes of recurrence (79% were relapses and 21% were reinfection). Relapse occurred earlier than reinfection (median, 36 versus 99 d, p < 0.06). Risk factors for relapse of S. aureus Bacteremia included valvular heart disease, cirrhosis of the liver, and deep-seated infection (including endocarditis). Nafcillin was superior to vancomycin in preventing bacteriologic failure (persistent Bacteremia or relapse) for methicillin-susceptible S. aureus (MSSA) Bacteremia. Failure to remove infected intravascular devices/catheters and vancomycin therapy were common factors in patients experiencing multiple (greater than 2) relapses. However, by multivariate analysis, only endocarditis and therapy with vancomycin (versus nafcillin) were significantly associated with relapse. Recurrences occurred in 9.4% of S. aureus Bacteremias following antistaphylococcal therapy, and most were relapses. Duration of antistaphylococcal therapy was not associated with relapse, but type of antibiotic therapy was. Nafcillin was superior to vancomycin in efficacy in patients with MSSA Bacteremia.
Feng-yee Chang - One of the best experts on this subject based on the ideXlab platform.
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Acinetobacter baumannii nosocomial pneumonia: is the outcome more favorable in non-ventilated than ventilated patients?
BMC Infectious Diseases, 2013Co-Authors: Ya-sung Yang, Te-li Chen, Tsai-wang Huang, Chin-hsuan Yang, Chang-phone Fung, Feng-yee ChangAbstract:Background Acinetobacter baumannii hospital-acquired pneumonia (HAP) is associated with a high mortality worldwide. Non-ventilated patients with HAP (NVHAP) caused by nosocomial pathogens are reported to have a more favorable outcome than those with ventilator-associated pneumonia (VAP). The current study was designed to determine whether bacteremic patients with A. baumannii NVHAP also have a lower mortality than those receiving assisted ventilation. Methods This retrospective 10-year study was conducted at a 2900-bed teaching hospital located in Northern Taiwan. The population consisted of 144 patients with A. baumannii Bacteremia and HAP. Of these 96 had VAP and 48 had NVHAP. Charts were reviewed for demographic characteristics, comorbidities, clinical manifestations, antimicrobial susceptibility, and 14-day mortality. Clonal relationships were determined by molecular typing. Results There were no significant differences between the two groups in comorbidities (Charlson scores). Patients with NVHAP were more likely to have developed Bacteremia earlier, outside the ICU and undergone fewer invasive procedures. They had significantly lower APACHE II scores, fewer bilateral pneumonias and lower rates of antimicrobial resistance. No specific clones were identified in either group. The unadjusted (crude) 14-day mortality rates were not significantly different between the groups (NVHAP 43.8% vs. VAP 31.3%, p = 0.196). The adjusted 14-day mortality risk was significantly lower in ventilator-assisted patients (odds ratio = 0.201; 95% confidence interval = 0.075-0.538; p = 0.001). Conclusions Patients with bacteremic NVHAP and VAP caused by A. baumannii had similar crude mortality rates, but on logistic regression analysis those receiving ventilator assistance had a significantly lower mortality. This may have been due to better airway protection, more intensive monitoring with earlier diagnosis and treatment in patients with VAP, greater innate susceptibility to infection in those with NVHAP and differences in the virulence of A. baumannii .
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staphylococcus aureus Bacteremia recurrence and the impact of antibiotic treatment in a prospective multicenter study
Medicine, 2003Co-Authors: Feng-yee Chang, Patricia Triplett, Brent B. Macdonald, Joseph M. Mylotte, Marilyn M. Wagener, James E. Peacock, Daniel M Musher, Alice Odonnell, Victor L YuAbstract:Staphylococcus aureus Bacteremia is associated with substantial morbidity. Recurrence is common, but incidence and risk factors for recurrence are uncertain. The emergence of meth- icillin resistance and the ease of administering vancomycin, espe- cially in patients who have renal insufficiency, have led to reliance on this drug with the assumption that it is as effective as b-lactam antibiotics, an assumption that remains open to debate. We initiated a multicenter, prospective observational study in 6 university hospitals and enrolled 505 consecutive patients with S. aureus Bacteremia. All patients were monitored for 6 months and patients with endocarditis were followed for 3 years. Recurrence was defined as return of S. aureus Bacteremia after documentation of negative blood cultures and/or clinical improvement after com- pleting a course of antistaphylococcal antibiotic therapy. All blood isolates taken from patients with recurrent Bacteremia underwent pulsed-field gel electrophoresis testing. Recurrence was subclas- sified as reinfection (different pulsed-field gel electrophoresis patterns) or relapse (same pulsed-field gel electrophoresis pattern). Forty-two patients experienced 56 episodes of recurrence (79% were relapses and 21% were reinfection). Relapse occurred earlier than reinfection (median, 36 versus 99 d, p < 0.06). Risk factors for relapse of S. aureus Bacteremia included valvular heart disease, cirrhosis of the liver, and deep-seated infection (including endo- carditis). Nafcillin was superior to vancomycin in preventing bacteriologic failure (persistent Bacteremia or relapse) for methicil- lin-susceptible S. aureus (MSSA) Bacteremia. Failure to remove infected intravascular devices/catheters and vancomycin therapy were common factors in patients experiencing multiple (greater than 2) relapses. However, by multivariate analysis, only endocar- ditis and therapy with vancomycin (versus nafcillin) were signifi- cantly associated with relapse. Recurrences occurred in 9.4% of S. aureus Bacteremias following antistaphylococcal therapy, and most were relapses. Duration of antistaphylococcal therapy was not associated with relapse, but type of antibiotic therapy was. Nafcillin was superior to vancomycin in efficacy in patients with MSSA Bacteremia. (Medicine 2003;82:333-9)
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Staphylococcus aureus Bacteremia
Medicine, 2003Co-Authors: Feng-yee Chang, Patricia Triplett, Brent B. Macdonald, Joseph M. Mylotte, Alice O’donnell, Marilyn M. Wagener, James E. Peacock, Daniel M Musher, Victor L YuAbstract:Staphylococcus aureus Bacteremia is associated with substantial morbidity. Recurrence is common, but incidence and risk factors for recurrence are uncertain. The emergence of methicillin resistance and the ease of administering vancomycin, especially in patients who have renal insufficiency, have led to reliance on this drug with the assumption that it is as effective as beta-lactam antibiotics, an assumption that remains open to debate. We initiated a multicenter, prospective observational study in 6 university hospitals and enrolled 505 consecutive patients with S. aureus Bacteremia. All patients were monitored for 6 months and patients with endocarditis were followed for 3 years. Recurrence was defined as return of S. aureus Bacteremia after documentation of negative blood cultures and/or clinical improvement after completing a course of antistaphylococcal antibiotic therapy. All blood isolates taken from patients with recurrent Bacteremia underwent pulsed-field gel electrophoresis testing. Recurrence was subclassified as reinfection (different pulsed-field gel electrophoresis patterns) or relapse (same pulsed-field gel electrophoresis pattern).Forty-two patients experienced 56 episodes of recurrence (79% were relapses and 21% were reinfection). Relapse occurred earlier than reinfection (median, 36 versus 99 d, p < 0.06). Risk factors for relapse of S. aureus Bacteremia included valvular heart disease, cirrhosis of the liver, and deep-seated infection (including endocarditis). Nafcillin was superior to vancomycin in preventing bacteriologic failure (persistent Bacteremia or relapse) for methicillin-susceptible S. aureus (MSSA) Bacteremia. Failure to remove infected intravascular devices/catheters and vancomycin therapy were common factors in patients experiencing multiple (greater than 2) relapses. However, by multivariate analysis, only endocarditis and therapy with vancomycin (versus nafcillin) were significantly associated with relapse. Recurrences occurred in 9.4% of S. aureus Bacteremias following antistaphylococcal therapy, and most were relapses. Duration of antistaphylococcal therapy was not associated with relapse, but type of antibiotic therapy was. Nafcillin was superior to vancomycin in efficacy in patients with MSSA Bacteremia.
Chingtai Huang - One of the best experts on this subject based on the ideXlab platform.
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clinical experience and microbiologic characteristics of invasive staphylococcus lugdunensis infection in a tertiary center in northern taiwan
Journal of Microbiology Immunology and Infection, 2015Co-Authors: Chunwen Cheng, Chingtai Huang, Chienchang Yang, Jangjih LuAbstract:Background/Purpose Staphylococcus lugdunensis is a coagulase-negative staphylococcus that cannot be ignored. This study is a comprehensive analysis of the clinical and microbiological characteristics of S. lugdunensis Bacteremia and sterile site infection during hospitalization. Methods This retrospective study included 48 patients with invasive S. lugdunensis infection. During the period of March 2002 to July 2012, they had been hospitalized in a tertiary center of northern Taiwan. Demographics, clinical characteristics, and risk factors of mortality were analyzed. All isolates were tested for antimicrobial susceptibility. We identified the staphylococcal cassette chromosome mec (SCCmec) gene for oxacillin nonsusceptible isolates. Results The incidence of S. lugdunensis in coagulase-negative staphylococci Bacteremia was 0.87%. Forty-eight patients were enrolled: S. lugdunensis was present in 41 patients with Bacteremia, in the ascites of three patients, in the synovial fluid of two patients, in the pleural effusion of one patient, and in the amniotic fluid of one patient. The three most common sources of infection were primary Bacteremia (43.8%), catheter-related infection (18.8%), and vascular graft infection (12.5%). All-cause mortality during hospitalization was 20.8% (10/48). All deceased patients were bacteremic. Risk factors associated with in-hospital mortality included a Pittsburgh Bacteremia score of 2 or greater, infective endocarditis, and end-stage renal disease. Ten (20.8%) isolates were resistant to oxacillin, and 8 isolates were classified as SCCmec type V. Conclusion The clinical significance of S. lugdunensis should not be ignored, especially in patients with severe comorbidities. An aggressive search for endocarditis is strongly suggested in S. lugdunensis bacteremic cases.
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characteristics of achromobacter xylosoxidans Bacteremia in northern taiwan
Journal of Microbiology Immunology and Infection, 2005Co-Authors: Shiansen Shie, Chingtai HuangAbstract:Abstract There were 40 cases of Achromobacter xylosoxidans Bacteremia during a 6-year period in a medical center in northern Taiwan. Males outnumbered females (72.5% vs 27.5%). Common underlying diseases and conditions in these 40 bacteremic patients were malignancies (57.5%), central venous catheter implants (55%), surgery (35%), neutropenia (30%) and use of steroids (25%). Recurrent Bacteremia occurred in 4 patients (10%), all of whom had a central venous catheter implant which was considered the most probable source of infection. More than one-quarter (27.5%) of the cases were community acquired. The mortality rate due to A. xylosoxidans Bacteremia was 47.5%. Risk factors significantly associated with mortality were nosocomial acquisition and polymicrobial Bacteremia. Disk susceptibility testing showed that these isolates were resistant to aminoglycosides and most cephalosporins but were susceptible to piperacillin, imipenem, ceftazidime and trimethoprim-sulfamethoxazole.
Chunyu Lin - One of the best experts on this subject based on the ideXlab platform.
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proteus mirabilis urinary tract infection and Bacteremia risk factors clinical presentation and outcomes
Journal of Microbiology Immunology and Infection, 2012Co-Authors: Chiyu Chen, Yenhsu Chen, Poliang Lu, Weiru Lin, Tunchieh Chen, Chunyu LinAbstract:Background/Purpose Proteus mirabilis is a common pathogen responsible for complicated urinary tract infections (UTIs) that sometimes causes Bacteremia. Most cases of P. mirabilis Bacteremia originate from a UTI; however, the risk factors for Bacteremia and mortality rates from P. mirabilis UTI have not been determined. Methods A retrospective, case-control study was performed between May 2008 and November 2010 to identify the risk factors and markers for P. mirabilis bacteremic UTI. Each subject in the case group (all patients were diagnosed with P. mirabilis Bacteremia from a urinary tract source) was matched by age and gender to two subjects in the control group (patients diagnosed with P. mirabilis UTI but with negative blood culture results). Clinical presentation and laboratory data were analyzed to determine the risk factors and markers of P. mirabilis bacteremic UTI. Results Sixty-seven bacteremic UTIs and 124 nonbacteremic UTIs were included in this study. Community-acquired infection ( p =0.017), hydronephrosis ( p =0.017), band neutrophils accounting for >10% of the white blood cell count ( p =0.001), hyperthermia or hypothermia ( p =0.047), and a serum C-reactive protein concentration >100mg/L ( p =0.002) were identified as independent risk factors for P. mirabilis bacteremic UTI. Seventeen patients died in hospital, including 11 in the bacteremic group and 6 in the nonbacteremic group. The bacteremic group had a higher mortality rate ( p =0.016). Bacteremic UTI ( p =0.049), shock ( p =0.014), and a low body mass index (BMI) 2 ( p =0.033) were identified as independent risk factors for mortality. Conclusion Because bacteremic P. mirabilis UTIs are associated with higher mortality, clinicians should carefully manage cases that present with the risk factors for Bacteremia, including community-acquired infection, hydronephrosis, band neutrophils accounting for >10% of the white blood cell count, hyperthermia or hypothermia, and a high level of C-reactive protein.
Daniel B. Gregson - One of the best experts on this subject based on the ideXlab platform.
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incidence risk factors and outcomes of fusobacterium species Bacteremia
BMC Infectious Diseases, 2013Co-Authors: Kevin Afra, Jenine Leal, Tracie Lloyd, Kevin B Laupland, Daniel B. GregsonAbstract:Fusobacterium species (spp.) Bacteremia is uncommon and has been associated with a variety of clinical presentations. We conducted a retrospective, population based study to determine the relative proportion of species in this genus causing Bacteremia and the risk factors for infection and adverse clinical outcomes. All cases of Fusobacterium spp. Bacteremia detected at a regional microbiology laboratory serving outpatient and acute care for a population of approximately 1.3 million people over 11 years were identified from a computerized database. Clinical data on these cases was extracted from an administrative database and analyzed to determine underlying risk factors for and outcomes of infection. There were 72 incident cases of Fusobacterium spp. Bacteremia over the study period (0.55 cases/100,000 population per annum). F. nucleatum was the most frequent species (61%), followed by F. necrophorum (25%). F. necrophorum Bacteremia occurred in a younger population without underlying comorbidities and was not associated with mortality. F. nucleatum Bacteremia was found in an older population and was associated with underlying malignancy or receiving dialysis. Death occurred in approximately 10% of F. nucleatum cases but causality was not established in this study. Fusobacterium spp. Bacteremia in our community is uncommon and occurs in approximately 5.5 cases per million population per annum. F. necrophorum occurred in an otherwise young healthy population and was not associated with any mortality. F. nucleatum was found primarily in older patients with chronic medical conditions and was associated with a mortality of approximately 10%. Bacteremias from other Fusobacterium spp. were rare.
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Incidence, risk factors, and outcomes of Fusobacterium species Bacteremia
BMC Infectious Diseases, 2013Co-Authors: Kevin Afra, Jenine Leal, Tracie Lloyd, Kevin B Laupland, Daniel B. GregsonAbstract:Background Fusobacterium species (spp.) Bacteremia is uncommon and has been associated with a variety of clinical presentations. We conducted a retrospective, population based study to determine the relative proportion of species in this genus causing Bacteremia and the risk factors for infection and adverse clinical outcomes. Methods All cases of Fusobacterium spp. Bacteremia detected at a regional microbiology laboratory serving outpatient and acute care for a population of approximately 1.3 million people over 11 years were identified from a computerized database. Clinical data on these cases was extracted from an administrative database and analyzed to determine underlying risk factors for and outcomes of infection. Results There were 72 incident cases of Fusobacterium spp. Bacteremia over the study period (0.55 cases/100,000 population per annum). F. nucleatum was the most frequent species (61%), followed by F. necrophorum (25%). F. necrophorum Bacteremia occurred in a younger population without underlying comorbidities and was not associated with mortality. F. nucleatum Bacteremia was found in an older population and was associated with underlying malignancy or receiving dialysis. Death occurred in approximately 10% of F. nucleatum cases but causality was not established in this study. Conclusions Fusobacterium spp. Bacteremia in our community is uncommon and occurs in approximately 5.5 cases per million population per annum. F. necrophorum occurred in an otherwise young healthy population and was not associated with any mortality. F. nucleatum was found primarily in older patients with chronic medical conditions and was associated with a mortality of approximately 10%. Bacteremias from other Fusobacterium spp. were rare.
