BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
Anti-Bacterial Agents ; beta-Lactamases* ; Drug Resistance, Multiple* ; Female ; Hospital Mortality ; Humans ; Intensive Care Units* ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Sepsis* ; Urinary Tract ; Urinary Tract Infections

PURPOSE: Although there are many treatment options for managing epistaxis, little is known about their outcomes in the emergency department (ED). In this study, we evaluated the management of epistaxis, especially comparing the efficacy between Rapidrhino® and Merocel®. METHODS: A retrospective review of patients with epistaxis visiting the ED between January 2010 and June 2016 was performed. Haemostatic properties of packs were initially measured in the ED, and after the removal of packs in the otorhinolaryngology clinic. Subgroup analyses were performed in a similar fashion for patients receiving and not receiving anticoagulants or the antiplatelet. RESULTS: The initial success rates for Rapidrhino® and Merocel® were both high (90.3%, 86.3%, respectively). Rebleeding rates for Rapidrhino® and Merocel® were 41.4% and 56.3%, respectively. Overall, there was a significant difference between the two types of packs in recurrence (p=0.032). Particularly, in patients with anticoagulants, the initial success rates of Rapidrhino® were higher than that of Merocel® (88.6%, 76.2%, respectively, p=0.222). The rebleeding rate of Rapidrhino® was much lower than that of Merocel® (54.3%, 85.7%, respectively, p=0.016). In the Rapidrhino® group, the rebleeding rate varied according to the packing removal date (p=0.001). CONCLUSION: Rapidrhino® and Merocel® are equally effective in the initial arrest of epistaxis in the ED. Rapidrhino® may be more effective in controlling haemorrage on removal, particularly in patients with anticoagulants. Patients with epistaxis could be treated with Rapidrhino® in the ED, which could be removed in the outpatient clinic one day later.
Ambulatory Care Facilities ; Anticoagulants ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Epistaxis* ; Hemostasis ; Humans ; Otolaryngology ; Platelet Aggregation Inhibitors ; Recurrence ; Retrospective Studies

BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
Anti-Bacterial Agents ; beta-Lactamases ; Drug Resistance, Multiple ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Sepsis ; Urinary Tract ; Urinary Tract Infections