BACKGROUND/AIMS: Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. METHODS: Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. RESULTS: Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level > or = 15 mg/dL, and patients with a leukocyte count > or = 15,000/mm3 in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). CONCLUSIONS: Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.
Acute Disease ; Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/therapeutic use ; Community-Acquired Infections/*diagnosis/drug therapy/microbiology ; Electronic Health Records ; Enterobacteriaceae Infections/*diagnosis/drug therapy/microbiology ; Female ; Hospitalization ; Hospitals, University ; Humans ; Middle Aged ; Pyelonephritis/*diagnosis/drug therapy/microbiology ; Remission Induction ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Sex Factors ; Time Factors ; Treatment Outcome ; Urinary Tract Infections/*diagnosis/drug therapy/microbiology

Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.
Anti-Bacterial Agents/therapeutic use ; Anticoagulants/therapeutic use ; C-Reactive Protein/analysis ; Cranial Nerve Diseases/complications/diagnosis ; Diagnosis, Differential ; Enterobacter aerogenes/isolation & purification ; Enterobacteriaceae Infections/diagnosis/drug therapy ; Humans ; Lung/pathology/radiography ; Magnetic Resonance Imaging ; Male ; Mastoiditis/complications/diagnosis ; Middle Aged ; Osteomyelitis/complications/*diagnosis/drug therapy ; Pulmonary Embolism/complications/*diagnosis/microbiology ; Sinus Thrombosis, Intracranial/complications/diagnosis ; Skull Base ; Sputum/microbiology ; Tomography, X-Ray Computed

Necrotizing pancreatitis is one of the rare complications of transcatheter arterial chemoembolization (TACE). Necrotizing pancreatitis after TACE may result from the development of ischemia caused by regurgitation of embolic materials into the vessels supplying the pancreas. We report a case of post-TACE necrotizing pancreatitis with abscess formation in a patient with hepatocellular carcinoma. The patient had suffered hepatic artery injury due to repetitive TACE; during his 25th TACE procedure he had submitted to selective catheterization of the feeding vessel from the dorsal pancreatic artery with a cytotoxic agent and Gelfoam particles. The patient complained of abdominal pain after the TACE procedure, and a CT scan led to a diagnosis of necrotizing pancreatitis with abscess formation. The pancreatic abscess progressed despite general management of the pancreatitis, including antibiotics. Percutaneous catheter drainage was performed, and the symptoms of the patient improved.
Abscess/microbiology ; Aged ; Anti-Bacterial Agents/therapeutic use ; Carcinoma, Hepatocellular/*complications/*therapy ; Chemoembolization, Therapeutic/*adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; Citrobacter freundii/isolation & purification ; Drainage ; Drug Resistance, Multiple, Bacterial ; Enterobacteriaceae Infections/drug therapy ; Hepatitis B/complications ; Humans ; Klebsiella/isolation & purification ; Klebsiella Infections/drug therapy ; Liver Cirrhosis/etiology ; Liver Neoplasms/*complications/*therapy ; Male ; Necrosis/*diagnosis/etiology ; Pancreatitis/*diagnosis/etiology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Providencia species frequently colonize urinary catheters and cause urinary tract infections (UTIs); however, bacteremia is uncommon and not well understood. We investigated the clinical features of Providencia bacteremia and the antibiotic susceptibility of Providencia species. METHODS: We identified cases of Providencia bacteremia from May 2001 to April 2013 at a tertiary care hospital. The medical records of pertinent patients were reviewed. RESULTS: Fourteen cases of Providencia bacteremia occurred; the incidence rate was 0.41 per 10,000 admissions. The median age of the patients was 64.5 years. Eleven cases (78.6%) were nosocomial infections and nine cases (64.3%) were polymicrobial bacteremia. The most common underlying conditions were cerebrovascular/neurologic disease (n = 10) and an indwelling urinary catheter (n = 10, 71.4%). A UTI was the most common source of bacteremia (n = 5, 35.7%). The overall mortality rate was 29% (n = 4); in each case, death occurred within 4 days of the onset of bacteremia. Primary bacteremia was more fatal than other types of bacteremia (mortality rate, 75% [3/4] vs. 10% [1/10], p = 0.041). The underlying disease severity, Acute Physiologic and Chronic Health Evaluation II scores, and Pitt bacteremia scores were significantly higher in nonsurvivors (p = 0.016, p =0.004, and p = 0.002, respectively). Susceptibility to cefepime, imipenem, and piperacillin/tazobactam was noted in 100%, 86%, and 86% of the isolates, respectively. CONCLUSIONS: Providencia bacteremia occurred frequently in elderly patients with cerebrovascular or neurologic disease. Although Providencia bacteremia is uncommon, it can be rapidly fatal and polymicrobial. These characteristics suggest that the selection of appropriate antibiotic therapy could be complicated in Providencia bacteremia.
APACHE ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/diagnosis/drug therapy/*microbiology/mortality ; Child ; Cross Infection/diagnosis/drug therapy/*microbiology/mortality ; Cross-Sectional Studies ; Drug Resistance, Bacterial ; Enterobacteriaceae Infections/diagnosis/drug therapy/*microbiology/mortality ; Female ; Hospital Mortality ; Humans ; Incidence ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Predictive Value of Tests ; Providencia/drug effects/*isolation & purification ; Republic of Korea ; Retrospective Studies ; Risk Factors ; *Tertiary Care Centers ; Treatment Outcome ; Young Adult