BACKGROUND: The primary objective of this meta-analysis is aimed at determining whether β-lactams prolonged infusion in patients with nosocomial pneumonia (NP) results in higher cure rate and improved mortality compared to intermittent infusion. MATERIALS AND METHODS: Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL from inception to September 1st, 2015. All published articles which evaluated the outcome of extended/continuous infusion of antimicrobial therapy versus intermittent infusion therapy in the treatment of NP were reviewed. RESULTS: A total of ten studies were included in the analysis involving 1,051 cases of NP. Prolonged infusion of β-lactams was associated with higher clinical cure rate (OR 2.45, 95% CI, 1.12, 5.37) compared to intermittent infusion. However, there was no significant difference in mortality (OR 0.85, 95% CI 0.63-1.15) between the two groups. Subgroup analysis for β-lactam subclasses and for severity of illness showed comparable outcomes. CONCLUSION: The limited data available suggest that reduced clinical failure rates when using prolonged infusions of β-lactam antibiotics in critically ill patients with NP. More detailed studies are needed to determine the impact of such strategy on mortality in this patient population.
Anti-Bacterial Agents ; Critical Illness ; Humans ; Mortality ; Pneumonia*

PURPOSE: Acute respiratory infection, particularly pneumonia, is the most common cause of hospitalization and death among children in developing nations. This study aimed to investigate the characteristics of children and adolescents with pneumonia who visited Emergency Department (ED) in South Korea in 2012. METHODS: We analyzed National Emergency Department Information System (NEDIS) records from 146 EDs in South Korea for all pediatric patients aged ≤18 years who were diagnosed with pneumonia between January and December 2012. RESULTS: Among 38,415 subjects, the male-to-female ratio was 1:0.8. Patients aged <12 months comprised 18.0% of the study population; those aged 1 to 3 years, 54.4%; those aged 4 to 6 years, 16.8%; those aged 7 to 12 years, 7.4%; and those aged 13 to 18 years, 3.4%. Presentation rates were highest in April, followed by January, March, and May. The hospital admission rate was 43.5%, of which 2.6% were in intensive care units. The mortality rate was 0.02%. Based on the International Classification of Diseases, 10th Revision, diagnostic codes, the types of pneumonia according to cause were viral pneumonia (29.0%), bacterial pneumonia (5.3%), Mycoplasmal pneumonia (4.5%), aspiration pneumonia (1.3%), and pneumonia of unknown origin (59.3%). CONCLUSION: Despite the limited data due to the ED data from the NEDIS lacking laboratory results and treatment information, this study reflects well the outbreak patterns among children and adolescents with pneumonia. Our results provide a basis for future studies regarding ED treatment for children and adolescents with pneumonia.
Adolescent* ; Child* ; Developing Countries ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Information Systems ; Intensive Care Units ; International Classification of Diseases ; Korea* ; Mortality ; Pneumonia* ; Pneumonia, Aspiration ; Pneumonia, Bacterial ; Pneumonia, Viral

PURPOSE: Acute respiratory infection, particularly pneumonia, is the most common cause of hospitalization and death among children in developing nations. This study aimed to investigate the characteristics of children and adolescents with pneumonia who visited Emergency Department (ED) in South Korea in 2012. METHODS: We analyzed National Emergency Department Information System (NEDIS) records from 146 EDs in South Korea for all pediatric patients aged ≤18 years who were diagnosed with pneumonia between January and December 2012. RESULTS: Among 38,415 subjects, the male-to-female ratio was 1:0.8. Patients aged <12 months comprised 18.0% of the study population; those aged 1 to 3 years, 54.4%; those aged 4 to 6 years, 16.8%; those aged 7 to 12 years, 7.4%; and those aged 13 to 18 years, 3.4%. Presentation rates were highest in April, followed by January, March, and May. The hospital admission rate was 43.5%, of which 2.6% were in intensive care units. The mortality rate was 0.02%. Based on the International Classification of Diseases, 10th Revision, diagnostic codes, the types of pneumonia according to cause were viral pneumonia (29.0%), bacterial pneumonia (5.3%), Mycoplasmal pneumonia (4.5%), aspiration pneumonia (1.3%), and pneumonia of unknown origin (59.3%). CONCLUSION: Despite the limited data due to the ED data from the NEDIS lacking laboratory results and treatment information, this study reflects well the outbreak patterns among children and adolescents with pneumonia. Our results provide a basis for future studies regarding ED treatment for children and adolescents with pneumonia.
Adolescent* ; Child* ; Developing Countries ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Information Systems ; Intensive Care Units ; International Classification of Diseases ; Korea* ; Mortality ; Pneumonia* ; Pneumonia, Aspiration ; Pneumonia, Bacterial ; Pneumonia, Viral

Despite its obvious advantages craniofacial surgery still remains a high-risk procedure with major complications. The purpose of this article is to review craniofacial surgery involving the anterior cranial base performed at Severance hospital from 1986 to 2000, focusing on complications and their management. The cases reviewed included not only craniofacial anomalies, but also curative procedures for trauma and tumor resection. This article retrospectively analyzed 136 procedures performed in 126 patients. Patients were classified into 5 groups on a clinical basis : craniosynostosis, craniofacial synostosis syndrome, orbital hypertelorism, tumor, and trauma. There were 58 complications in 36 patients. Complications were most frequent in group 2(craniofacial synostosis syndrome) which showed a complication rate of 50%, followed in order by orbital hypertelorism, trauma, craniosynostosis, and tumor. There were two deaths, and the mortality rate was 1.5% and the complication rate was 26%. Complications were divided into surgical and medical ones. The majority of surgical complications had serious morbidity potential and infection was most frequent. Medical complications were largely minor, with postoperative pneumonia being most common. Infection-related complications were frequently life-threatening and shown to have decisive influence on postoperative results. We therefore propose the following guide lines for the prevention and management of infection-related complications: 1) extensive antibiotics, 2) atraumatic dural dissection around crista gali, 3) water-tight closure of anterior cranial base defect with well vascularized flap, 4) secure bony fixation with minimal miniplate usage, 5) early detection of infection and continuous intracranial irrigation, 6) surgical skill, 7) short operative time.
Anti-Bacterial Agents ; Craniosynostoses ; Humans ; Hypertelorism ; Mortality ; Operative Time ; Orbit ; Pneumonia ; Retrospective Studies ; Skull Base* ; Synostosis

Aspegillosis is a fatal opportunistic disease using immunosupppresive drugs after liver transplantation. Mortality of aspergillosis after liver transplantation reaches 100% and survival rate pulmonary aspergillosis is less than 5% using medical treatment only and pneumonectomy and medical treatment revealed better results. We experienced the invasive pulmonary aspergillosis developed a patient who suffered from bacterial pneumonia and had long peroid of mechanical ventillation after liver transplantation. We performed pneumonectomy and antifungal medical treatment for about 50 days and he recovered from invasive aspergillosis.
Aspergillosis* ; Humans ; Invasive Pulmonary Aspergillosis ; Liver Transplantation* ; Liver* ; Mortality ; Pneumonectomy* ; Pneumonia, Bacterial ; Pulmonary Aspergillosis ; Survival Rate

Massive lung gangrene is a rare but very rapidly progressing fatal complication of lobar pneumonia. Etiologic agents are Klebsiella pneumoniae, Pneumococcus and Aspergillus, etc. Chest X-ray shows firm consolidation of the involved pulmonary lobe and bulging fissure due to the volume expansion of involved lung. CT-scan shows extensive lung parenchymal destructions with multiple small cavitary lesions. Recommended treatment is the early surgical intervention combined with antibiotics. Without surgical intervention, lung gangrene is known to progress toward sepsis, multiorgan failure, and high mortality. We report two cases of rapidly progressing massive lung gangrene by Klebsiella pneumonia treated by the resectional surgery.
Anti-Bacterial Agents ; Aspergillus ; Gangrene ; Klebsiella pneumoniae ; Klebsiella* ; Lung ; Mortality ; Pneumonia* ; Sepsis ; Streptococcus pneumoniae ; Thorax

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

PURPOSE: The present study was undertaken to assess whether the results of cerebrospinal fluid (CSF) culture are related to prognosis. METHODS: Subjected to this study were 51 cases admitted to our department who had been diagnosed as bacterial meningitis. They were divided into two groups, Group l (20) with positive CSF culture and Group ll (31) with negative outcome, then both groups were compared. RESULTS: Group l cases tended to be younger than Group ll cases. The male/female ratio was 1.2 in Group l and 1.6 in Group ll. Laboratory findings of CFS were not significantly different in either groups, except for the glucose level, which was markedly lower in Group l than in Group ll. The causative organisms identified from CSF culture were E. coli (5), group B Streptococcus (4) and S. aureus (1) among the 10 cases aged under 2 months. On the other hand, S. pneumoniae were isolated in 7 and H. influenzae in 3 among the 10 older cases. Mortality rate and the incidence of complications were higher in Group l than in Group ll. Mortality rate as related to the causative organism was highest with E. coli, followed by group B Streptococcus, H. influenzae. CONCLUSION: Bacterial meningitis cases with positive CSF culture have significantly lower glucose concentration in the CSF, and also higher rates of mortality and incidence of serious complications than those with negative culture.
Cerebrospinal Fluid* ; Glucose ; Hand ; Incidence ; Influenza, Human ; Meningitis, Bacterial* ; Mortality ; Pneumonia ; Prognosis* ; Streptococcus

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii ; Acinetobacter ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated ; Sulbactam

Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations.
Acquired Immunodeficiency Syndrome ; Clindamycin ; Epidural Abscess* ; Humans ; Meningitis ; Mortality ; Osteomyelitis* ; Pneumococcal Infections ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Pneumococcal ; Streptococcus ; Streptococcus pneumoniae ; Vaccination