OBJECTIVE: To observe the clinical characteristics and impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonized or infected patients with hematological disorders in order to provide evidence for the prevention and treatment of CRPA. METHODS: The patients who were colonized or infected with CRPA in the Department of Hematology of The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2020 to March 2021 were selected as the research subjects, the clinical data such as hospitalization time, primary disease treatment regimen, granulocyte count, previous infection and antibiotic regimen of these patients were analyzed, meanwhile, antibiotic regimen and efficacy during CRPA infection, 30-day and long-term survival were also analyzed. RESULTS: A total of 59 patients were included in this study, and divided into CRPA infection group (43 cases) and CRPA colonization group (16 cases). Univariate logistic regression analysis showed that ECOG score (P =0.003), agranulocytosis (P <0.001), and exposure to upper than 3^rd generations of cephalosporins and tigecycline within 30 days (P =0.035, P =0.017) were the high-risk factors for CRPA infection. Multivariate logistic regression analysis showed that ECOG score of 3/4 ( OR=10.815, 95%CI: 1.260-92.820, P =0.030) and agranulocytosis ( OR=13.82, 95%CI: 2.243-85.176, P =0.005) were independent risk factors for CRPA infection. There was a statistically significant difference in cumulative survival rate between CRPA colonization group and CRPA infection group ( χ²=14.134, P < 0.001). Kaplan-Meier survival analysis showed that the influencing factors of 30-day survival in patients with CRPA infection were agranulocytosis (P =0.022), soft tissue infection (P =0.03), and time of hospitalization before CRPA infection (P =0.041). Cox regression analysis showed that agranulocytosis was an independent risk factor affecting 30-day survival of patients with CRPA infection (HR=3.229, 95%CI :1.093-3.548, P =0.034). CONCLUSIONS Patients with hematological disorders have high mortality and poor prognosis after CRPA infection. Bloodstream infection and soft tissue infection are the main causes of death. Patients with high suspicion of CRPA infection and high-risk should be treated as soon as possible.
Humans ; Carbapenems/therapeutic use* ; Pseudomonas aeruginosa ; Soft Tissue Infections/drug therapy* ; Anti-Bacterial Agents/therapeutic use* ; Hematologic Diseases ; Survival Analysis

PURPOSE: Infection with Nocardia species is an uncommon yet important cause of morbidity and mortality in renal transplant recipients. METHODS: We experienced 6 cases of nocardiosis among 239 renal transplant recipients maintained on tacrolimus- or cyclosporine-based immunosuppression from May 1999 to February 2001. RESULTS: All the six patients had pulmonary nocardiosis from 36 to 220 (mean 82) days after renal transplantation. Due to a multiplicity of infection sites, cerebral abscess was detected in 2 patients, soft tissue abscess in 2, allograft abscess in 1 and subretinal abscess in 1. Comparing the routine trimethoprim/ sulfamethoxazole (TMP/SMX) prophylaxis after transplantation, 5 out of 6 patients took TMP/SMX for a mean of 1.8 months due to an increased AST/ALT. All the cases required invasive diagnostic procedures such as percutaneous needle aspiration (PC NA) or stereotactic aspiration. In the antimicrobial susceptibility test, isolates were sensitive to TMP/SMX, amikacin and imipenem. In the early stage of infection, we used triple chemotherapy (TMP/SMX, amikacin, imipenem) for cerebral nocardiosis and dual therapy (TMP/SMX, amikacin) for localized pulmonary infection. There were no mortality and all the graft maintained stable function. CONCLUSION: After organ transplantation, pneumonia accompanied with satellite soft tissue infection should be considered as a nocardiosis. Pro- phylactic use of TMP/SMX is crucial for effective prevention of nocardiosis.
Abscess ; Allografts ; Amikacin ; Brain ; Brain Abscess ; Drug Therapy ; Humans ; Imipenem ; Immunosuppression ; Kidney Transplantation* ; Mortality ; Needles ; Nocardia ; Nocardia Infections* ; Organ Transplantation ; Pneumonia ; Soft Tissue Infections ; Sulfamethoxazole ; Transplantation ; Transplants

Mycobacterium abscessus (formerly M. chelonae sub-species abscessus) is an acid-fast bacillus classified as pathogenic "rapid growing" nontuberculous mycobacteria. Even though these organisms are ubiquitous in the environment, it is an uncommon cause of human diseases. M. abscessus can cause skin and soft tissue infection associated with a penetrating wound or a foreign body but it can spread to viscera other than the lungs leading to a variety of infections. The single most important factor determining the course and prognosis of M. abscessus infection is the underlying immune status of the hosts. There have been no reports of skin and soft tissue infection caused by M. abscessus in Korea. We experienced a case of skin and soft tissue infection with M. abscessus. A 43-year-old female patient developed necrotizing infection in the skin, soft tissue and fascia in the lower extremity without a definite preceding cause. She was treated successfully with prolonged drug therapy including clarithromycin, and surgical debridement.
Adult ; Bacillus ; Clarithromycin ; Debridement ; Drug Therapy ; Fascia ; Female ; Foreign Bodies ; Humans ; Korea ; Lower Extremity ; Lung ; Mycobacterium* ; Nontuberculous Mycobacteria ; Prognosis ; Skin* ; Soft Tissue Infections* ; Viscera ; Wounds, Penetrating

INTRODUCTIONSingapore saw a resurgence of dengue infections in 2005. Concurrent bacterial co-infections in dengue is rare.

CLINICAL PICTUREWe report a cluster of serious methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia or severe soft tissue infection in 5 epidemiologically linked construction workers presenting with dengue and non-resolving fever.

TREATMENTSurgical intervention was indicated in 4 of the 5 patients despite appropriate antistaphylococcal therapy.

OUTCOMEAll but 1 patient were eventually discharged. Clonality and Panton-Valentine leucocidin genes were not demonstrated. Epidemiological investigations suggested that occupational contact dermatitis could have predisposed the patients to this opportunistic co-infection.

CONCLUSIONClinicians need to be vigilant to unusual manifestations of dengue which may signal a concomitant aetiology.

Adult ; Cluster Analysis ; Dengue ; complications ; epidemiology ; Humans ; Male ; Methicillin ; pharmacology ; Occupations ; Singapore ; epidemiology ; Soft Tissue Infections ; transmission ; Staphylococcal Infections ; complications ; epidemiology ; therapy ; transmission ; Staphylococcal Skin Infections ; transmission ; Staphylococcus aureus ; drug effects

OBJECTIVEGroup A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes may be encountered in diverse clinical situations in children. A rising incidence of invasive group A streptococcus (IGAS) infections has been noted in children in the past three decades. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IGAS in children, and to raise the level of diagnosis and treatment of this infection.

METHODThe clinical data from 19 cases of IGAS younger than 14 years old seen from January 2004 to December 2011 treated in the authors' hospital were analyzed. IGAS infections are defined as the isolation of GAS from a normally sterile site in patients.

RESULTThe 19 cases were identified as IGAS infections, among whom 15 were male and 4 were female, and the ratio of them was 3.75. The age ranged from 1 day to 14 years, with a median age of 4 years. The course of disease was 4 h-10 days. The average length of stay was 12.2 days. In 13 cases the episodes of the infection occurred in winter and spring. In 18 cases the infection was community-acquired. Overall, 10 cases had neck or foot dorsum abscess, four cases had purulent peritonitis, and 3 cases were diagnosed as streptococcal toxic shock syndrome (STSS) complicated with empyema, pyopneumothorax occurred in 1 case and neonatal septicemia in another. Three cases had an underlying disease, including 2 cases wounded in a car accident and 1 case of congenital esophageal atresia and tracheoesophageal fistula. Before the isolation of GAS, 5 cases had stayed in ICUs, the length of ICU stay was 1-32 days, 4 cases had received intubation and mechanical ventilation, the ventilation time was 8 h-24 days, 2 cases had received major surgery; 5 cases had other pathogen coinfection, including 4 cases of abdominal pus at the same time and Escherichia coli was isolated, and 1 case had parainfluenza virus type I coinfection. Peripheral blood leucocyte increased in 18 cases, one case dropped off. The C-reactive protein (CRP) levels increased in all patients, including 16 cases who had 14-160 mg/L, 3 cases had levels higher than 160 mg/L. Twenty strains of GAS were isolated from 19 cases' sterile sites, of them 10 strains were isolated from abscess, 4 strains were isolated from blood and another 4 from ascites. Two strains were from the same patient at different times of pleural effusion. All 20 strains displayed a full susceptibility to cefazolin, levofloxacin and vancomycin, and the rates of resistance to both cefotaxime and penicillin were 10.0%. The rates of resistance to erythromycin and clindamycin were 55.0% and 70.0% respectively. Among the patients 3 cases were cured, 14 cases improved, and 2 cases died, of whom 1 case died of STSS secondary to multiple organ dysfunction, 1 case died of basic disease secondary to multiple organ dysfunction.

CONCLUSIONSkin and soft tissues were the most common IGAS infection sites in children, and IGAS infection also can lead to serious STSS and even can be life threatening. Penicillin and cephalosporin are still sensitive for children IGAS infections.

Abscess ; drug therapy ; epidemiology ; microbiology ; Adolescent ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Cephalosporins ; therapeutic use ; Child ; Child, Preschool ; Clindamycin ; therapeutic use ; Community-Acquired Infections ; drug therapy ; epidemiology ; microbiology ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Retrospective Studies ; Soft Tissue Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcal Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcus pyogenes ; drug effects ; isolation & purification

PURPOSE: To retrospectively analyze the clinical presentations, radiographic findings, and surgical results of type I and II acute necrotizing fasciitis of the low extremity. MATERIALS AND METHODS: From April 1998 to March 2005, 13 patients who underwent surgery for the necrotizing fasciitis were reviewed. At the initial diagnosis, 6 patients were diagnosed with cellulitis and 3 patients were diagnosed correctly with necrotizing fasciitis. The underlying diseases, affected sites, official readings of MRI, the intervals between the onset of symptom and surgery, the duration of admission, and complications were investigated. RESULTS: The underlying diseases were 3 cases of diabetes, 3 cases of liver disease, 1 case of alcoholism and 1 case of cervical cancer with chemotherapy. Regarding the location of the disease, 5 cases were observed below the knees, and 8 cases were observed above the knees. Five out of 9 cases who underwent a preoperative MRI study, were diagnosed correctly as necrotizing fasciitis by the radiologist. The average period between onset of symptoms and surgery was 4.8 days. The complications were hip disarticulation in 1 case, below knee amputation in 1 case, toe amputation in 1 case, and a limited range of motion of the knee joint in 1 case. The 9 patients who healed without complications had no limitation in the range of joint motion and daily activity. CONCLUSION: Type I and II acute necrotizing fasciitis of the low extremity shows variable clinical presentations and radiological findings. Therefore, the possibility of the necrotizing fasciitis needs to be considered when dealing with patients with soft tissue infections in the low extremities.
Alcoholism ; Amputation ; Cellulitis ; Diagnosis ; Disarticulation ; Drug Therapy ; Extremities* ; Fasciitis, Necrotizing* ; Hip ; Humans ; Joints ; Knee ; Knee Joint ; Liver Diseases ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Reading ; Retrospective Studies ; Soft Tissue Infections ; Toes ; Uterine Cervical Neoplasms

Tumors involving the proximal humerus confront the surgeon with the problem of both eradicating the osseous lesions and restoring shoulder joint function. This problem is magnified because of the biomechanical complexity of the shoulder, its anatomic configuration, and its inherent lack of stabillity. With the increased interest in limb-sparing resection for lesions in the area, efforts are being made to improve the reconstructive techniques. These include leaving a flail shoulder, an being made to improve the reconstructive techniques. These include leaving a flail shoulder, an arthrodesis using intercalery graft between the scapula and the remaining humerus, or if the glenoid is preserved, an arthroplasy. From January 1984 to December 1993, 23 patients with a malignant or locally aggressive bone tumor in the proximal humerus were treated by limb-sparing surgery in Seoul National University Hospital. Histologic diagnosis included osteosarcoma(6), chondrosarcoma(2), Ewing's sarcoma(1), metastatic bone tumor(11), and recurred giant cell tumor(3). Options for reconstruction following limb-sparing resection in our cases were 10 prosthetic arthroplasties, 3 arthrodeses with an living fibula graft, and 10 arthroplasties with intramedullary nailing and cementization. We performed a retrospective analysis in view of tumor eradication and performance status with modified functional evaluation system of Musculoskeletal tumor Society. In 7 cases(74%), good or fair performance status was acquired with average 3.6 years follow-up(6 months-11 years). Each option for reconstruction resulted in relatively good outcome but rather better result was acquired in giant cell tumor and chondrosarcoma. Estimated survival rates by Kaplan-Meier's method, 5 year survival rate was 81% in primary malignant bone tumors(12), 76% in stage Ⅱ B malignancies(5) with 4 years and 4 months follow-up. There was no regional recurrence in primary malignant bone tumors but there were three cases in which distant pulmonary metastases were found in follow-up. Complicationss were one soft tissue infection, two nonunions in arthrodesis with a living fibula graft and one dislodgement of prosthesis in prosthetic arthroplasty. In summary, each option for limb-sparing surgery in malignant bone tumor of proximal humerus might result in rather satisfactory outcome in performance and survival rate when effective preoperative and postoperative chemotherapy were performed in adequately selected cases.
Arthrodesis ; Arthroplasty ; Chondrosarcoma ; Diagnosis ; Drug Therapy ; Extremities ; Fibula ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Giant Cell Tumors ; Giant Cells ; Humans ; Humerus ; Methods ; Neoplasm Metastasis ; Prostheses and Implants ; Recurrence ; Retrospective Studies ; Scapula ; Seoul ; Shoulder ; Shoulder Joint ; Soft Tissue Infections ; Survival Rate ; Transplants

BACKGROUNDS: Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor. MATERIALS AND METHODS: We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul. RESULTS: We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor. CONCLUSIONS: Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.
Adolescent ; Bacteremia* ; Central Venous Catheters ; Cohort Studies ; Drug Therapy ; Febrile Neutropenia ; Fever ; Fungi ; Hematologic Neoplasms ; Humans ; Korea ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Mucositis ; Prevalence ; Risk Factors* ; Rivers ; Seoul ; Skin ; Soft Tissue Infections

BACKGROUNDS: Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor. MATERIALS AND METHODS: We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul. RESULTS: We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor. CONCLUSIONS: Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.
Adolescent ; Bacteremia* ; Central Venous Catheters ; Cohort Studies ; Drug Therapy ; Febrile Neutropenia ; Fever ; Fungi ; Hematologic Neoplasms ; Humans ; Korea ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Mucositis ; Prevalence ; Risk Factors* ; Rivers ; Seoul ; Skin ; Soft Tissue Infections