No abstract available.
Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cefotaxime/analogs & derivatives/therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde ; Gallstones/surgery ; Gram-Negative Anaerobic Bacteria/drug effects/genetics/*isolation & purification ; Gram-Negative Bacterial Infections/*diagnosis/drug therapy/microbiology ; Humans ; Male ; Metronidazole/therapeutic use ; Microbial Sensitivity Tests ; RNA, Ribosomal, 16S/chemistry/genetics/metabolism ; Sequence Analysis, DNA ; Tomography, X-Ray Computed

OBJECTIVETo study the clinical characteristics, pathogenic bacteria, and antibiotics resistance of neonatal purulent meningitis in order to provide the guide for early diagnosis and appropriate treatment.

METHODA retrospective review was performed and a total of 112 cases of neonatal purulent meningitis (male 64, female 58) were identified in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical University seen from January 1, 2004 to December 31, 2013. The clinical information including pathogenic bacterial distribution, drug sensitivity, head imageology and therapeutic outcome were analyzed. Numeration data were shown in ratio and chi square test was applied for group comparison.

RESULTAmong 112 cases, 46 were admitted from 2004 to 2008 and 66 from 2009 to 2013, 23 patients were preterm and 89 were term, 20 were early onset (occurring within 3 days of life) and 92 were late onset meningitis (occurring after 3 days of life). In 62 (55.4%) cases the pathogens were Gram-positive bacteria and in 50 (44.6%) were Gram-negative bacteria. The five most frequently isolated pathogens were Escherichia coli (32 cases, 28.6%), coagulase-negative staphylococcus (CNS, 20 cases, 17.9%), Streptococcus (18 cases, 16.1%, Streptococcus agalactiae 15 cases), Enterococci (13 cases, 11.6%), Staphylococcus aureus (9 cases, 8.0%). Comparison of pathogenic bacterial distribution between 2004-2008 and 2009-2013 showed that Gram-positive bacteria accounted for more than 50% in both period. Escherichia coli was the most common bacterium, followed by Streptococcus in last five years which was higher than the first five years (22.7% (15/66) vs. 6.5% (3/46), χ(2) = 5.278, P < 0.05). Klebsiella pneumoniae was more common isolate in preterm infants than in term infants (13.0% (3/23) vs. 1.1% (1/89), χ(2) = 7.540, P < 0.05). Streptococcus (most were Streptococcus agalactiae) was the most common bacteria in early onset meningitis and higher than those in late onset meningitis (35.0% (7/20) vs. 12.0% (11/92), χ(2) = 4.872, P < 0.05). Drug sensitivity tests showed that all the Gram-positive bacterial isolates were sensitive to linezolid. Staphylococci were resistant to penicillin, and most of them were resistant to erythromycin, oxacillin and cefazolin; 77.8%of CNS isolates were methicillin-resistant staphylococcus. No Streptococcus and Enterococcus faecalis was resistant to penicillin. None of enterococci was resistant to vancomycin. Among the Gram-negative bacterial isolates, more than 40% of Escherichia coli were resistant to commonly used cephalosporins such as cefuroxime, cefotaxime and ceftazidime, and all of them were sensitive to amikacin, cefoperazone sulbactam and imipenem. Isolates of Klebsiella pneumoniae were all resistant to ampicillin, cefuroxime, cefotaxime and ceftazidime, but none of them was resistant to piperacillin tazobactam and imipenem. Of the 112 patients, 69 were cured, 23 improved, 9 uncured and 11 died. There were 47 cases (42.0%) with poor prognosis, they had abnormal head imageology, severe complications and some cases died, 13 of 18 (72.2%) patients with meningitis caused by Streptococcus died.

CONCLUSIONEscherichia coli, CNS and Streptococcus are the predominant pathogens responsible for neonatal purulent meningitis over the past ten years. There were increasing numbers of cases with Streptococcus meningitis which are more common in early onset meningitis with adverse outcome, therefore careful attention should be paid in clinic. Linezolid should be used as a new choice in intractable neonatal purulent meningitis cases caused by gram positive bacteria.

Anti-Bacterial Agents ; pharmacology ; Cefotaxime ; Child ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Intensive Care Units, Neonatal ; Male ; Meningitis, Bacterial ; diagnosis ; drug therapy ; microbiology ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Penicillins ; Retrospective Studies ; Staphylococcus ; Staphylococcus aureus ; Streptococcal Infections ; Streptococcus ; Streptococcus agalactiae

Spontaneous bacterial peritonitis (SBP) is the most common infection in liver cirrhosis patients, and is not a result of surgery or intra abdominal infection. Argon plasma coagulation (APC) is an endoscopic procedure used with a high-frequency electrical current for control of bleeding from gastrointestinal vascular ectasias including angiodysplasia and gastric antral vascular ectasia. This procedure is known to be safe because it uses a noncontact method. Therefore, tissue injury is minimal and up to two to three millimeters. However, we experienced a case of SBP occurring immediately after performance of APC for control of severe bleeding from angiodysplasia in the colon in a patient with liver cirrhosis and hepatocellular carcinoma.
Aged ; Angiodysplasia/complications/*diagnosis ; Anti-Bacterial Agents/therapeutic use ; *Argon Plasma Coagulation ; Bacterial Infections/*diagnosis/drug therapy/microbiology ; Carcinoma, Hepatocellular/complications/diagnosis ; Colonic Diseases/complications/*diagnosis ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/therapy ; Gram-Negative Bacteria/isolation & purification ; Humans ; Liver Cirrhosis/complications/diagnosis ; Liver Neoplasms/complications/diagnosis ; Peritonitis/*diagnosis/drug therapy/microbiology

No abstract available.
Acupuncture Therapy ; Ampicillin/pharmacology/therapeutic use ; Ankle/ultrasonography ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cellulitis/complications/diagnosis/drug therapy/*microbiology ; Diabetes Mellitus, Type 2/complications ; Gram-Negative Bacterial Infections/complications/diagnosis/drug therapy/*microbiology ; Humans ; Hypertension/complications ; Magnetic Resonance Imaging ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prevotella nigrescens/drug effects/*genetics/isolation & purification ; RNA, Ribosomal, 16S/*analysis ; Sulbactam/pharmacology/therapeutic use ; Tomography, X-Ray Computed

To report on Achromobacter xylosoxidans keratitis in two healthy patients who had worn contact lenses foran extended period of time. A 36-year-old female and a 21-year-old female visited our hospital with ocular pain and blurred vision. Both patients had a history of wearing soft contact lenses for over fve years with occasional overnight wear. At the initial presentation, a slit lamp examination revealed corneal stromal infiltrations and epithelial defects with peripheral neovascularization in both patients. Microbiological examinations were performed from samples of corneal scrapings, contact lenses, contact lens cases, and solution. The culture resulting from the samples taken from the contact lenses, contact lens cases, and solution were all positive for Achromobacter xylosoxidans. Confrming that the direct cause of the keratitis was the contact lenses, the frst patient was prescribed ceftazidime and amikacin drops sensitive to Achromobacter xylosoxidans. The second patient was treated with 0.3% gatifoxacin and fortifed tobramycin drops. After treatment, the corneal epithelial defects were completely healed, and subepithelial corneal opacity was observed. Two cases of Achromobacter xylosoxidans keratitis were reported in healthy young females who wore soft contact lenses. Achromobacter xylosoxidans should be considered a rare but potentially harmful pathogen for lens-induced keratitis in healthy hosts.
Achromobacter denitrificans/*isolation & purification ; Adult ; Amikacin/administration & dosage ; Anti-Bacterial Agents/*administration & dosage ; Ceftazidime/administration & dosage ; Contact Lenses, Extended-Wear/*adverse effects ; Female ; Fluoroquinolones/administration & dosage ; Gram-Negative Bacterial Infections/diagnosis/*drug therapy/*microbiology ; Humans ; Keratitis/diagnosis/*drug therapy/*microbiology ; Tobramycin/administration & dosage

A 70-year-old man with a long history of diabetes mellitus presented to our hospital (Department of Ophthalmology, Sahm Yook Medical Center, Seoul, Korea) complaining of severe ocular pain and visual disturbance in his left eye that had started three days prior to admission. A round 3.7 x 5.0 mm dense central stromal infiltrate with an overlying epithelial defect was noted on slit-lamp examination. Following corneal scrapings and culture, topical 0.5% moxifloxacin and 0.5% tobramycin were administered hourly. A few days later, Stenotrophomonas maltophilia was isolated in a bacterial culture from a corneal specimen. According to the results of susceptibility tests, topical 0.5% moxifloxacin was given every hour and 0.5% tobramycin was stopped. The patient's clinical features improved steadily with treatment. The corneal epithelium healed rapidly, and the infiltrate resolved within four weeks of the initiation of treatment. The patient's best corrected visual acuity improved from hand motion to 20 / 25.
Aged ; Anti-Infective Agents/administration & dosage ; Aza Compounds/*administration & dosage ; Cornea/*microbiology/pathology ; Diagnosis, Differential ; Eye Infections, Bacterial/diagnosis/*drug therapy/microbiology ; Follow-Up Studies ; Gram-Negative Bacterial Infections/diagnosis/*drug therapy/microbiology ; Humans ; Keratitis/diagnosis/*drug therapy/microbiology ; Male ; Ophthalmic Solutions ; Quinolines/*administration & dosage ; Stenotrophomonas maltophilia/*isolation & purification ; Visual Acuity

A 70-year-old man with a long history of diabetes mellitus presented to our hospital (Department of Ophthalmology, Sahm Yook Medical Center, Seoul, Korea) complaining of severe ocular pain and visual disturbance in his left eye that had started three days prior to admission. A round 3.7 x 5.0 mm dense central stromal infiltrate with an overlying epithelial defect was noted on slit-lamp examination. Following corneal scrapings and culture, topical 0.5% moxifloxacin and 0.5% tobramycin were administered hourly. A few days later, Stenotrophomonas maltophilia was isolated in a bacterial culture from a corneal specimen. According to the results of susceptibility tests, topical 0.5% moxifloxacin was given every hour and 0.5% tobramycin was stopped. The patient's clinical features improved steadily with treatment. The corneal epithelium healed rapidly, and the infiltrate resolved within four weeks of the initiation of treatment. The patient's best corrected visual acuity improved from hand motion to 20 / 25.
Aged ; Anti-Infective Agents/administration & dosage ; Aza Compounds/*administration & dosage ; Cornea/*microbiology/pathology ; Diagnosis, Differential ; Eye Infections, Bacterial/diagnosis/*drug therapy/microbiology ; Follow-Up Studies ; Gram-Negative Bacterial Infections/diagnosis/*drug therapy/microbiology ; Humans ; Keratitis/diagnosis/*drug therapy/microbiology ; Male ; Ophthalmic Solutions ; Quinolines/*administration & dosage ; Stenotrophomonas maltophilia/*isolation & purification ; Visual Acuity

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.
Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Combined Modality Therapy ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; *Phacoemulsification ; *Postoperative Complications ; Sphingomonas/*isolation & purification ; Visual Acuity ; Vitrectomy ; Vitreous Body/microbiology

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.
Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Combined Modality Therapy ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; *Phacoemulsification ; *Postoperative Complications ; Sphingomonas/*isolation & purification ; Visual Acuity ; Vitrectomy ; Vitreous Body/microbiology

PURPOSE: To report 2 cases of Comamonas acidovorans keratitis in immunocompromised cornea. METHODS: A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. RESULTS: We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. CONCLUSIONS: Comamonas acidovorans is known as a less virulent organism. However it can cause an indolent infection that responds slowly even to adequate antibiotics therapy in immunocompromised corneas.
Amikacin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Ciprofloxacin/therapeutic use ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Delftia acidovorans/*isolation & purification ; Drug Therapy, Combination ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; *Immunocompromised Host ; Male ; Microbial Sensitivity Tests ; Middle Aged