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ABSTRACT: Echinocandins are not active against basidiomycetous yeasts, such as Cryptococcus neoformans, Trichosporon, and Rhodotorula species, and zygomycosis. We present a patient with renal failure and candidemia, who developed a breakthrough fungal infection with cryptococcemia and cryptococcuria while receiving micafungin therapy.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 04/2013; · 0.99 Impact Factor
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ABSTRACT: PURPOSE: This study investigates the clinical and epidemiological features of Chryseobacterium indologenes infections and antimicrobial susceptibilities of C indologenes. METHODS: With 215 C indologenes isolates between January 1, 2004 and September 30, 2011, at a medical center, we analyzed the relationship between the prevalence of C indologenes infections and total prescription of colistin and tigecycline, clinical manifestation, antibiotic susceptibility, and outcomes. RESULTS: Colistin and tigecycline were introduced into clinical use at this medical center since August 2006. The increasing numbers of patients with C indologenes pneumonia and bacteremia correlated to increased consumption of colistin (p = 0.018) or tigecycline (p = 0.049). Among patients with bacteremia and pneumonia, the in-hospital mortality rate was 63.6% and 35.2% (p = 0.015), respectively. Administration of appropriate antibiotics showed significant benefit in 14-day survival in patients with C indologenes bloodstream infection (p = 0.040). In bacteremic patients, old cardiovascular accident (p = 0.036) and cancer (p = 0.014) were the most common comorbidity. The most common co-infection pathogen in patients with C indologenes pneumonia was Acinetobacter baumannii (36/91, 39.6%), followed by Pseudomonas aeruginosa (23/91, 25.3%), carbapenem-resistant A baumannii (22/91, 24.2%), and Klebseilla pneumoniae (13/91, 14.3%). Antimicrobial susceptibility testing of the 215 isolates showed that trimethoprim-sulfamethoxazole was the most active agent (susceptibility rate: 87.4%), followed by cefoperazone-sulbactam (48.0%). CONCLUSION: The present study showed a trend of increasing prevalence of C indologenes infection after introduction of colistin and tigecycline usage. The bacteremia group had higher mortality rate than the pneumonia group. Increasing resistance to piperacillin-tazobactam, ceftazidime, cefepime, and newer fluoroquinolone were noticed in our analysis. Trimethoprim-sulfamethoxazole was a potential antimicrobial agent in vitro for C indologenes. To avoid collateral damage, we emphasize the importance of antibiotic stewardship program.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 09/2012; · 0.99 Impact Factor
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ABSTRACT: Corynebacterium striatum (C striatum) has been considered a contaminant of blood culture in past decades. Here we report the case of a patient with acute deterioration of chronic renal failure. She received hemodialysis and died from C striatum bacteremia. By using a randomly amplified polymorphic DNA (RAPD) method, we found that an association existed between C striatum from the bloodstream and that from the central venous catheter. We suggest that C striatum could be a pathogen of bloodstream infection in patients with such a catheter in place.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2011; 45(3):255-8. · 0.99 Impact Factor
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ABSTRACT: A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2011; 45(1):72-4. · 0.99 Impact Factor
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ABSTRACT: Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important nosocomial pathogen. Antibiotic resistance has been increasing during the past decade. A. xylosoxidans may be confused with Pseudomonas spp. but, unlike Pseudomonas spp., this organism has peritrichous flagella. Complicated intra-abdominal infection with A. xylosoxidans has rarely been reported in the literature. This report is of an immunocompetent patient with acute cholecystitis complicated by an intra-abdominal abscess after surgery. Culture of both blood and ascites yielded extended drug-resistant A. xylosoxidans, which was only sensitive to colistin. The clinical and laboratory characteristics of A. xylosoxidans are presented.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2009; 42(2):176-80. · 0.99 Impact Factor
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ABSTRACT: In 2007, an outbreak of vancomycin-resistant enterococci (VRE) occurred at Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan. The aim of this study was to characterize the mechanism of glycopeptide resistance and to investigate the genetic relatedness among isolates of VRE.
Between May and October 2007, bacterial isolates from 16 patients identified as colonized or infected with VRE were collected. Polymerase chain reaction and pulsed-field gel electrophoresis (PFGE) were used to determine resistant genes and molecular typing.
All 16 isolates of VRE presented with the VanA phenotype with the vanA gene except for 1 isolate of Enterococcus faecalis, which had the VanB phenotype with the vanA gene. PFGE analysis revealed a major clone containing 12 isolates, and 4 other distinct clones containing 1 to 2 isolates each. Five patients had VRE colonized in their gastrointestinal tract, the genotype of which was the same as the clinical isolates. Fourteen isolates (87.5%) had the esp gene.
An outbreak of VRE was caused by the simultaneous existence of monoclonal and polyclonal spread. Rigorous infection control, active surveillance, and decreasing pressure of antibiotic use are important for controlling the emergence of VRE.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2009; 42(1):63-8. · 0.99 Impact Factor
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ABSTRACT: The purpose of this study was to determine the degree of bacterial contamination of patients' files, and to compare the colonized bacteria between files from the surgical intensive care unit (ICU) and the surgical ward at the Wan Fang Hospital, Taipei, Taiwan.
180 medical charts were randomly selected from the surgical ICU (n = 90) and the surgical ward (n = 90). The charts were sampled using sterile swabs moistened with sterile normal saline. The swabs were immediately transferred to trypticase soy broth and incubated aerobically for 48 h, then subcultured to separated sheep blood and eosin-methylene blue agars. Microorganisms were identified by the standard methods used in the microbiological laboratory.
Ninety percent of charts in the surgical ICU (n = 81) and 72.2% in the surgical ward (n = 65) were contaminated with pathogenic or potentially pathogenic bacteria (p = 0.0023). Coagulase-negative staphylococci (CoNS) were the most commonly isolated bacteria, both in the surgical ICU (n = 40, 44.44%) and in the surgical ward (n = 48, 53.33%). Several bacteria isolated from the charts, including multidrug-resistant Acinetobacter baumannii, Stenotrophomonas maltophilia, and Klebsiella pneumoniae, had the same antibiogram as the same bacteria isolated from patients.
This study showed that the patients' charts in the ICU were usually contaminated with pathogenic and potentially pathogenic bacteria. Contaminated charts can serve as a source for cross-infection. Health care personnel should wash their hands before and after contact with the chart to reduce the nosocomial infection rate.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2009; 42(1):86-91. · 0.99 Impact Factor
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ABSTRACT: Bacterial endocarditis in pregnancy causes maternal and fetal mortality rates of 22.1% and 14.7%, respectively. The mortality rates differ according to the involved valves, and the size of vegetation has a prognostic correlation. This report is of a pregnant woman with an unrepaired ventricular septal defect and pulmonary valve endocarditis with a vegetation size of 3.29 cm. She and her baby were treated successfully. An emergency surgical plan would be appropriate for pregnant women in the third trimester with a large vegetation in the right side of the heart, and dental disease should be treated aggressively with appropriate prophylactic antibiotics.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2009; 42(1):92-5. · 0.99 Impact Factor
