This study was to analyze the infectious complications after hematopoietic stem cell transplantation (HSCT) according to the recent changes of HSCT. Medical records of 379 adult patients who underwent HSCT consecutively at Catholic HSCT Center from January 2001 to December 2002 were reviewed retrospectively. Allogeneic HSCT accounted for 75.7% (287/379) and autologous HSCT for 24.3% (92/379). During pre-engraftment period, bacterial infection was predominant, and E. coli was still the most common organism. After engraftment, viral infection was predominant. The incidence of invasive fungal infection showed bimodal distribution with peak correlated with neutropenia and graft-versus-host disease (GVHD). The overall mortality and infection-related mortality rates according to 3 periods were as follows; during pre-engraftment, 3.16% (12/379) and 1.8% (7/379); during midrecovery period, 7.9% (29/367) and 4.1% (15/367); during late-recovery period, 26.9% (91/338), and 15.9% (54/338). Risk factors for infection-related mortality were as follows; during pre-engraftment period, fungal infection and septic shock; during the mid-recovery period, hemorrhagic cystitis and delayed engraftment; during the late-recovery period, fungal infection, chronic GVHD, and relapse. In conclusion, infection was still one of the main complications after HSCT and highly contributes to mortality. The early diagnosis and the effective vaccination strategy are needed for control of infections.
Time Factors ; Risk Factors ; Retrospective Studies ; Mycoses/etiology ; Middle Aged ; Male ; Korea/epidemiology ; Infection/epidemiology/*etiology/mortality ; Humans ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Graft vs Host Disease/etiology ; Female ; Adult ; Adolescent

OBJECTIVETo define the influence clinically related factors in the prognosis of ventilated pneumonia (VAP).

METHODSA prospective clinical study involving 120 patients with VAP was carried ont. Etiologic diagnosis was established under quantitative culture of endotracheal aspiration, a protected specimen brush and bronchoalveolar lavage. Prognostic using a statistical software package (SPSS) factors were examined for univariate and multivariate analyses.

RESULTSCase fatality directly related to the infection was 14 percent. From univariate analysis, variables that significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, in-hospital days of VAP over as follows 9, antecedent chronic obstructive pulmonary disease, and a prior antibiotic use. Through step-forward logistic regression analysis, only prior antibiotic use (P < 0.000 1, OR = 9.2) was defined as a significant factor influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation.

CONCLUSIONSDistribution of microorganisms that responsible for VAP shown different in patients who had received prior antimicrobial therapy, and this factor caused higher mortality rate. We suggested a restrictive antibiotic use strategy among mechanically ventilated patients to reduce the risk of death from VAP.

Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; adverse effects ; China ; epidemiology ; Cross Infection ; drug therapy ; etiology ; mortality ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Pneumonia, Bacterial ; drug therapy ; etiology ; mortality ; Prognosis ; Prospective Studies ; Respiration, Artificial ; adverse effects ; Risk Factors

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

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

The aim of this study was to describe in more detail the predisposition, natural course, and clinical impact of post-transplantation diabetes mellitus (PTDM) after heart transplantation (HT). The characteristics and clinical outcomes of 54 patients with PTDM were compared with those of 140 patients without PTDM. The mean age of PTDM patients was significantly higher than controls (48.9 +/- 9.3 vs 38.6 +/- 13.3 yr, respectively, P = 0.001), and ischemic heart disease was a more common indication of HT (20.4% [11/54] vs 7.1% [10/140], respectively, P = 0.008). In multivariate analysis, only recipient age (odds ratio, 1.80; 95% confidence interval, 1.35-2.40; P = 0.001) was associated with PTDM development. In 18 patients (33%), PTDM was reversed during the follow-up period, and the reversal of PTDM was critically dependent on the time taken to develop PTDM (1.9 +/- 1.0 months in the reversed group vs 14.5 +/- 25.3 months in the maintained group, P = 0.005). The 5-yr incidence of late infection (after 6 months) was higher in the PTDM group than in the control group (30.4% +/- 7.1% vs 15.4% +/- 3.3%, respectively, P = 0.031). However, the 5-yr overall survival rate was not different (92.9% +/- 4.1% vs 85.8% +/- 3.2%, respectively, P = 0.220). In conclusion, PTDM after HT is reversible in one-third of patients and is not a critical factor in patient survival after HT.
Adult ; Cohort Studies ; Diabetes Mellitus/epidemiology/*etiology/mortality ; Female ; Follow-Up Studies ; Heart Transplantation/*adverse effects ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Infection/etiology ; Male ; Middle Aged ; Registries ; Survival Rate ; Transplantation, Homologous ; Treatment Outcome