OBJECTIVETo analyze the clinical features of inhalation injury in children, with the aim of improving its management.

METHODSThe incidence of inhalation injury in 333 cases of burned children was analyzed in terms of burn area, shock, infection and prognosis.

RESULTSThe incidences of shock and bacteremia were 41.14% and 18.92%, and those of moderate and severe inhalation injury were 58.76% and 31.96% respectively in burned children with inhalation injury. Bacteremia developed in 24.82% of the patients with shock. Among 67 patients who ultimately died, 58.21% of them were complicated with bacteremia ending in 34.33% of mortality. Early tracheostomy was beneficial in that less fluids were required for resuscitation.

CONCLUSIONBurn infection was an important factor affecting the prognosis of inhalation injury. And inhalation injury and shock were major inducers of burn infection. Early application of wide spectrum antibiotics and shock management were helpful in lowering of burn infection rate. Early tracheostomy might be beneficial to burn shock management.

Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; epidemiology ; etiology ; prevention & control ; Burns ; physiopathology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Shock ; epidemiology ; etiology ; Smoke Inhalation Injury ; mortality ; physiopathology

PURPOSE: Bacteremia is a major infectious complication associated with mortality in liver transplant recipients. The causative organisms and clinical courses differ between medical centers due to variations in regional bacterial epidemiology and posttransplant care. Further, living donors in Korea contribute to 83% of liver transplants, and individualized data are required to improve survival rates. PATIENTS AND METHODS: We retrospectively analyzed 104 subjects who had undergone living-donor liver transplant from 2005 to 2007. RESULTS: Among the 144 consecutive living-donor liver transplant recipients, 24% (34/144) developed bacteremia, 32% (46/144) developed non-bacteremic infections, and 44% (64/144) did not develop any infectious complications. Forty episodes of bacteremia occurred in 34 recipients. The major sources of bacteremia were intravascular catheter (30%; 12/40), biliary tract (30%; 12/40), and abdomen (22.5%; 9/40). Gram-positive cocci were more common (57.5%; 23/40) than Gram-negative rods (32.5 %; 13/40) and fungi (10%; 4/40). The data revealed that the following factors were significantly different between the bacteremia, non-bacteremic infection, and no infection groups: age (p = 0.024), posttransplant hemodialysis (p = 0.002), ICU stay (p = 0.012), posttransplant hospitalization (p < 0.0001), and duration of catheterization (p < 0.0001). The risk factors for bacteremia were older than 55 years (odds ratio, 6.1; p = 0.003), catheterization for more than 22 days (odds ratio, 4.0; p = 0.009), UNOS class IIA (odds ratio, 6.6; p = 0.039), and posttransplant hemodialysis (odds ratio, 23.1; p = 0.001). One-year survival rates in the bacteremic, non-bacteremic infection, and no infection groups were 73.2%, 91.3%, and 93.5%, respectively. CONCLUSION: Early catheter removal and preservation of renal function should focus for improving survival after transplant.
Adult ; Bacteremia/etiology/*mortality ; Catheterization/adverse effects/statistics & numerical data ; Female ; Humans ; Korea/epidemiology ; Liver Transplantation/*mortality/statistics & numerical data ; Living Donors ; Male ; Middle Aged ; Postoperative Complications/etiology/*mortality ; Predictive Value of Tests ; Risk Factors ; Survival Analysis

The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high, which are attributed to invasive procedures, bacteremia, and wound infection after burns. Clinical clues for IE in burns are usually masked by burn-related manifestations, so the diagnosis of IE may be delayed or missed. For burned patients with persistent bacteremia of unknown source, especially Staphylococcus aureus-induced bacteremia, the diagnosis of IE should be considered according to the Duke criteria, and early echocardiography performance is particularly important. Antibiotic therapy is the mainstay initial management, and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns. In order to lower the incidence and mortality of IE in burns, it is very important to take prophylactic procedures along with the whole course of burn management.
Bacteremia ; epidemiology ; Burn Units ; Burns ; complications ; mortality ; surgery ; Endocarditis, Bacterial ; complications ; diagnosis ; microbiology ; mortality ; Humans ; Incidence ; Severity of Illness Index ; Staphylococcal Infections ; complications ; diagnosis ; Staphylococcus aureus ; isolation & purification ; Surgery, Plastic ; Wound Infection ; etiology ; mortality

High-level gentamicin resistance (HLGR) in enterococci has increased since the 1980s, but the clinical significance of the resistance and its impact on outcome have not been established. One hundred and thirty-six patients with bacteremia caused by enterococci with HLGR (HLGR group) were compared with 79 patients with bacteremia caused by enterococci without HLGR (non-HLGR group). Hematologic malignancy, neutropenia, Enterococcus faecium infection, nosocomial infection and monomicrobial bacteremia were more common in the HLGR group than the non-HLGR group, and APACHE II scores were also higher (P<0.05, in each case). Neutropenia, monomicrobial infection, stay in intensive care at culture, and use of 3rd generation cephalosporin, were independent risk factors for acquisition of HLGR enterococcal bacteremia. Fourteen-day and 30-day mortalities were higher in the HLGR group than the non-HLGR group in univariate analysis (37% vs. 15%, P=0.001; 50% vs. 22%, P<0.001). However, HLGR was not an independent risk factor for mortality due to enterococcal bacteremia in multivariate analysis. Therefore, HLGR enterococcal bacteremia is associated with more severe comorbid conditions and higher mortality than non-HLGR enterococcal bacteremia but the HLGR itself does not contribute significantly to mortality.
Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/*pharmacology ; Bacteremia/diagnosis/*etiology/*mortality ; Cephalosporins/pharmacology ; Cross Infection/complications ; Drug Resistance, Bacterial ; Enterococcus/*drug effects/isolation & purification ; Female ; Gentamicins/*pharmacology ; Gram-Positive Bacterial Infections/diagnosis/*etiology/*mortality ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neutropenia/complications/mortality ; Odds Ratio ; Risk Factors ; Severity of Illness Index ; Treatment Outcome

OBJECTIVE: To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections (BSIs). METHODS: A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis. RESULTS: The mean age of the patients was 12-66 (42.3±12.7) years. The majority of infections were nosocomial (78.6%). The BSIs-related mortality rate was 39.8% (41/103). The following variables were identified as risk factors for BSIs-related mortality by univariate analysis: intraabdominal/ biliary focus (P=0.003), polymicrobial infection (P<0.001), liver transplant (P<0.001), platelet count <50000/mm3 (P<0.001), and septic shock (P<0.001). Platelet count < 50000/mm3 (P=0.002) and septic shock (P<0.001) showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis. CONCLUSION Decreased platelet count and septic shock are risk factors for increased
Adolescent ; Adult ; Aged ; Bacteremia ; epidemiology ; etiology ; mortality ; Cause of Death ; Child ; China ; epidemiology ; Female ; Gram-Negative Bacterial Infections ; epidemiology ; etiology ; mortality ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Shock, Septic ; epidemiology ; Thrombocytopenia ; epidemiology ; Young Adult

OBJECTIVETo study the clinical characteristics and preventive measures of liver failure with nosocomial septicemia.

METHODSRetrospective analysis of nosocomial septicemia seen between 2001 and 2002 was carried out in our hospital.

RESULTSIncidence of nosocomial septicemia was 0.61%, mortality was 14.29%, the main pathogen was Escherichia coli, the drug resistance occurred in most pathogens to the commonly used antibiotics.

CONCLUSIONIn order to reduce nosocomial septicemia, antibiotics should be used rationally, should be paid attention to bacterial culture and antibiotic sensitivity, and preventive measures should be taken.

Adolescent ; Adult ; Aged ; Ampicillin ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; epidemiology ; etiology ; mortality ; China ; epidemiology ; Cross Infection ; drug therapy ; epidemiology ; mortality ; Drug Resistance, Bacterial ; Escherichia coli Infections ; Female ; Humans ; Incidence ; Klebsiella Infections ; Klebsiella pneumoniae ; drug effects ; Liver Failure ; complications ; epidemiology ; mortality ; Male ; Middle Aged ; Retrospective Studies

To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.
Acinetobacter Infections/drug therapy/epidemiology/*mortality ; Acinetobacter baumannii/*drug effects ; Adult ; Aged ; Anti-Bacterial Agents/*pharmacology/therapeutic use ; Bacteremia/drug therapy/epidemiology/*mortality ; Carbapenems/*pharmacology/therapeutic use ; Case-Control Studies ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Immunocompromised Host ; Intensive Care Units ; Male ; Middle Aged ; Odds Ratio ; Renal Insufficiency/etiology ; Retrospective Studies ; Risk Factors ; Survival Rate ; Time Factors