[Show abstract][Hide abstract] ABSTRACT: Polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS) was compared with culture for pathogen detection in peritoneal dialysis (PD)-related peritonitis. Of 21 samples of PD effluent, PCR/ESI-MS identified microorganisms in 18 (86%) samples, including Mycobacterium tuberculosis in 1 culture-negative sample. Of 15 double-positive samples, PCR/ESI-MS and culture reached levels of agreement of 100% (15/15) and 87.5% (7/8) at the genus and species levels, respectively. PCR/ESI-MS can be used for rapid pathogen detection in PD-related peritonitis.
[Show abstract][Hide abstract] ABSTRACT: Gram-negative peritonitis is a frequent and serious complication of peritoneal dialysis (PD). No previous reports have focused on Klebsiella pneumoniae infection. The aim of this study was to investigate the host and bacterial factors associated with K. pneumoniae PD-related peritonitis.
We retrospectively studied K. pneumoniae PD-peritonitis cases treated at a university hospital in southern Taiwan during 1990-2011, and analyzed the clinical features and outcomes and bacterial characteristics of serotypes, hypermucoviscosity (HV), and virulence-associated genes such as wabG, uge, and rmpA in K. pneumoniae PD-related peritonitis. Fifty-four isolates of K. pneumoniae-related community-acquired urinary tract infection (UTI) and 76 morphologically different nonpathogenic K. pneumoniae isolates from healthy adults were used as controls.
K. pneumoniae was the second most common monomicrobial pathogen causing Gram-negative PD-related peritonitis (n = 13, 2.7%), and the most common pathogen involved in polymicrobial peritonitis (16/43, 37.2%) and associated with high catheter removal rate (7/16, 43.8%). Compared with Escherichia coli peritonitis cases, patients with monomicrobial K. pneumoniae peritonitis also had insignificantly higher incidence of sepsis/bacteremia [n = 5 (38%), p = 0.11] and a higher mortality rate [n = 3 (23%), p = 0.36]. The prevalence of K1/K2 (n = 1, 7.7%) serotypes was low, but there was a higher prevalence of serotype K20 (n = 3, 23.1%) in K. pneumoniae isolates derived from monomicrobial PD-related peritonitis compared with control groups. HV phenotype (p < 0.001) and rmpA genotype (p = 0.007) were absent in the peritonitis group.
This is the first study focused on clinical and microbiological characteristics of K. pneumoniae PD-related peritonitis. K. pneumoniae was a common Gram-negative pathogen causing monomicrobial and polymicrobial PD-related peritonitis in southern Taiwan. The bacterial characteristics with low percentage of capsular serotype K1/K2, no significant HV, and absence of rmpA suggest a different pathogenesis in K. pneumoniae PD-related peritonitis compared with that in UTI and liver abscess.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 11/2013; 48(3). DOI:10.1016/j.jmii.2013.10.002 · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Patients with diabetes mellitus have an increased risk of infection. The roles of bacterial characteristics and glycemic control in diabetic patients with Escherichia coli infection have not been well investigated. The aims of this study were to examine the bacterial characteristics and glycemic control in diabetic patients with E. coli infections arising in the urinary tract. METHODS: A total of 271 E. coli isolates were collected from urine and bloodstream. Phylogenetic groups, the presence of virulence genes, and antimicrobial susceptibility of E. coli isolates were determined. RESULTS: There were few differences in E. coli bacterial characteristics between 190 diabetic and 81 nondiabetic patients. In diabetic patients with urosepsis, there was a higher hemoglobin A(1C) level, and the related E. coli strains had more neuA, papG II, afa and hlyA genes, and a lower prevalence of antimicrobial resistance to cephalosporins and fluoroquinolones than those with asymptomatic bacteriuria and urinary tract infection. Multivariate logistic regression analysis revealed that increased hemoglobin A(1C) and presence of papG II and afa genes were independent factors associated with development of urosepsis in diabetic patients. CONCLUSION: This study demonstrated that more virulent E. coli isolates, especially with papG II and afa genes, and poorer glycemic control were important determinants for development of urosepsis in diabetic patients.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2012; 46(1). DOI:10.1016/j.jmii.2011.12.024 · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Most Staphylococcus lugdunensis strains (49/59, 83%) were related to clinical infections, were susceptible to most antimicrobial agents with an overall oxacillin-resistant rate of 5% (3/58), and carried relatively great genetic diversity. Community-acquired infections (41/49, 84%) were dominant, often developed in patients with comorbidity, and had rather benign clinical courses without mortality.
[Show abstract][Hide abstract] ABSTRACT: Streptococcus pyogenes isolated from adult patients during a 12-year period in southern Taiwan were analyzed to estimate the distribution of emm types and their correlation with disease manifestations and patient age.
Three hundred thirty-four invasive and noninvasive isolates collected from patients older than 20 years between 1997 and 2008 at National Cheng Kung University Hospital were included for emm typing. A correlation between emm type, disease manifestations, and patient ages was analyzed.
The nine most prevalent types were emm11, emm12, emm4, emm1, Sp9458/VT8, emm81, emm106, emm13, and emm75. Formerly rare emm types, including emm11, emm81, and emm102, emerged dramatically after 2004 in southern Taiwan. Type emm11 was significantly associated with both superficial infections and cellulitis. In addition, types emm13, emm81, and emm106 were more prevalent in patients older than 50 years and significantly associated with specific invasive disease manifestation.
These results suggest new emm types (emm11, emm81, and emm102) of S pyogenes were introduced into the adult population in southern Taiwan after 2004. The rarely reported emm types, including emm13, emm81, and emm106, caused invasive diseases more often in adult patients.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2011; 44(6):424-9. DOI:10.1016/j.jmii.2011.04.005 · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Progression of atherosclerosis with increased arterial stiffness is associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). Compliance index (CI) derived from digital volume pulse (DVP), measuring the relationship between volume and pressure changes in fingertip, can evaluate the local arterial stiffness. The purpose of this study was to measure the stiffness of different arteries and determine the relationships of CI-DVP with clinical characteristics and renal function in CKD patients.
This cross-sectional pilot study included 186 CKD and 46 healthy subjects. Evaluation of different arterial stiffness was performed by DVP using dual-channel photoplethysmography and measured as CI (CI-DVP) and pulse wave velocity (PWV)-DVP.
CKD patients had lower CI-DVP and higher PWV-DVP than that in the healthy group. There was a trend of stepwise decrease in CI-DVP and increase in PWV-DVP related to the advance of CKD from early to late stage. Decrease of CI-DVP was associated with the increase in number of cardiovascular risk factors. Multivariate linear regression analysis revealed that CI-DVP (B = 4.59, P < 0.01) was independently associated with estimated glomerular filtration rate (eGFR). Male gender, eGFR, and systolic blood pressure (BP) were independent determinants for CI-DVP (B = -0.25, P = 0.01; B = 0.007, P = 0.03; and B = -0.03, P < 0.0001; whole model R(2) = 0.28, P < 0.0001).
Our data demonstrate a significant association between CI-DVP, a new surrogate marker of arterial stiffness different from PWV, and renal function and cardiovascular risk factors in CKD patients.
American Journal of Hypertension 05/2011; 24(5):544-9. DOI:10.1038/ajh.2010.266 · 3.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The optimal mode of dialysis for end-stage renal disease (ESRD) patients with spontaneous intracerebral hemorrhage (ICH) remains controversial. We compared the outcomes of ESRD patients who received continuous peritoneal dialysis (CPD) or extended hemodialysis (EHD) after ICH, and investigated the factors determining prognosis.
We incorporated our ICH patients with ESRD, requiring dialysis from January 2005 to December 2009. Patients were allocated to the CPD or EHD group according to the dialysis mode after ICH. We compared the 30-day mortality rate and modified Rankin Scale (mRS) of the two groups and analyzed the factors associated with mortality.
There were 40 patients with 16 episodes in CPD and 27 episodes in EHD group, without significant differences in baseline demographic data. The 30-day mortality rate and mRS were not different between the two groups. The patients who died within 30 days had higher ICH scores (4 +/- 1 vs. 1 +/- 1, p < 0.001) and outcome scores (5 +/- 2 vs. 1 +/- 1, p < 0.001). Dialysis-related complications occurred more frequently in the PD group (p = 0.07), but were unrelated to mortality.
Among ESRD patients with ICH, EHD had a similar 30-day mortality rate and 30-day mRS to those receiving CPD. The mortality was significantly related to the severity of ICH.
American Journal of Nephrology 05/2010; 32(1):31-7. DOI:10.1159/000312228 · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Serum creatinine (SCr) had been considered to be an important predictor of mortality in end-stage renal disease (ESRD) patients at the start of renal replacement therapy (RRT). However, the data were limited about initially extreme azotemia (EA), exclusively defined as blood urea nitrogen (BUN) > or = 300 mg/dL, SCr > or = 30 mg/dL, or both. This retrospective study was conducted to clarify the characteristics and outcome in our EA patients. We had 1682 new ESRD patients from July 1988 to December 1996. With frequency match for age, gender, and starting RRT in the same period, 20 EA patients and 60 controls were included. Fifty percent of our EA patients had unknown etiology. The EA patients had significantly lower prevalence of underlying diabetic nephropathy, and comorbid hypertension. All the EA patients had late referral to nephrologists within 4 weeks before the initiation of RRT, and 90% of them had taken Chinese herbals. The EA group had significantly higher BUN, SCr, and iron storage as well as a higher prevalence of severe anemia, hyperkalemia, hypocalcemia, and acidemia. However, the similar prevalence of cardiomegaly and left ventricular hypertrophy as well as the similar early mortality rate and long-term survival were noted. Age over 40 years, comorbid diabetes mellitus, and hypoalbuminemia were independent predictors of poor survival. Our EA patients had different initial presentations from other uremic ones at the start of RRT. However, the short-term and long-term mortality rates were similar. The lower prevalence of underlying diabetic nephropathy and comorbid hypertension among the EA patients might contribute to their fair outcome.
Hemodialysis International 08/2006; 10(3):294-302. DOI:10.1111/j.1542-4758.2006.00111.x · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Escherichia coli is the major pathogen in many extraintestinal Gram-negative bacillus infections. Both E. coli virulence characteristics and host factors contribute to the development of E. coli bacteremia in urinary tract infection (UTI). The aim of this study was to examine the bacterial virulence characteristics in E. coli infections arising from the urinary tract. METHODS: A total of 186 consecutive E. coli isolates from the urine or bloodstream of patients with urinary tract-related colonization/ infection were collected. They were grouped as asymptomatic bacteriuria (ABU), UTI, and urosepsis. Phylogenetic groups, K1 capsule and 14 virulence factor genes, and antimicrobial susceptibility of E. coli isolates were determined. RESULTS: There were 55 ABU and 67 UTI strains derived from urine, and 64 urosepsis strains derived from the bloodstream. There were more bacterial virulence characteristics of E. coli isolates derived from urosepsis patients. In the overall analysis of 186 E. coli isolates arising from the urinary tract, multivariate logistic regression analysis demonstrated neuA (OR 3.37, 95% CI 1.18-9.64), papG II (OR 12.34, 95% CI 4.47-34.06) and afa (OR 13.20, 95% CI 5.81-29.99) were independently associated with the development of E. coli urosepsis. The prevalence of antimicrobial resistance of E. coli isolates was similar between the immunocompromised and immunocompetent groups, and among the ABU, UTI, and urosepsis subgroups in immunocompromised patients. CONCLUSION: Regarding the bacterial virulence characteristics, this study demonstrated the K1 capsule, PapG II, and Afa adhesins play important roles in the development of E. coli urosepsis.