Primary pyomyositis is increasingly recognized in non-tropical areas, its incidence seeming to mirror the increase in immunocompromised populations. In this study, we sought to analyze the ...differences in clinical characteristics, causative organisms, treatment and outcome between pyomyositis patients with and without underlying diseases.
Thirty five patients with a diagnosis of primary pyomyositis seen in our hospital between July 1989 and July 2006 were enrolled. Descriptive information concerning age, gender, clinical features, underlying comorbid diseases, results of blood tests, blood culture, muscle or pus culture, disease severity and clinical stages at the time of diagnosis, therapy, and outcome were collected by review of medical charts.
Of the 23 cases with underlying diseases, the mean age was 47.8 years (range, 24 to 79 years). Of the 12 patients without underlying diseases, the mean age was 26.2 years (range, 2 to 72 years). The lower extremities was the most common site of involvement. Staphylococcus aureus was the most frequent causative organism. Gram-negative organisms were isolated in 30.4% of patients with underlying diseases and in none of the patients without underlying diseases (p=0.07). Positive blood culture was significantly more common in patients with underlying diseases than in patients without underlying diseases (52.2% vs 8.3%, p=0.013). The mortality rate was higher in patients with underlying diseases than in patients without underlying diseases (39.1% vs 0.0%, p=0.015). White blood cell count (p=0.017), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p<0.001), recurrence (p=0.004), and presence of underlying diseases (p=0.015) were significant prognostic factors for mortality by univariate analysis. APACHE II score (odds ratio, 1.57; 95% confidence interval, 1.13 to 2.20; p=0.008) was found to be a significant independent risk factor for mortality in multivariate logistic regression analysis. For prediction of mortality, the best cut-off point in APACHE II score was 16 (sensitivity, 77.8%; specificity, 92.3%; accuracy, 88.6%).
Patients with primary pyomyositis should be treated with appropriate broad-spectrum antibiotics and be monitored closely for complications. This study found that patients who suffered from primary pyomyositis with underlying diseases had a higher rate of Gram-negative bacterial infections, bacteremia and mortality. The APACHE II score at diagnosis was found to be an independent prognostic factor for mortality.
Background/Purpose Increased mortality has been reported in patients treated with vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with high minimum inhibitory ...concentration (MIC) values within the susceptibility range. However, this finding has not been verified in hemodialysis patients, who have much higher invasive MRSA infection rates than nondialysis patients. We aimed at comparing vancomycin MICs between hemodialysis and nondialysis patients, and identifying predictors of high vancomycin MICs and infection-related mortality in hemodialysis patients with MRSA bacteremia. Methods Patients with MRSA bacteremia from January 2008 through December 2009 were enrolled. Vancomycin MIC was determined for each first isolate using the Etest method. Clinical characteristics and vancomycin MICs were compared between hemodialysis and nondialysis patients. Factors associated with high vancomycin MIC (2 μg/mL) and infection-related mortality in hemodialysis patients were analyzed. Results A total of 162 MRSA bacteremia episodes were identified. Forty-four (27.0%) isolates were obtained from hemodialysis patients and 118 (73.0%) from nondialysis patients. Diabetes (63.3% vs. 39.8%, p = 0.007) and prior vancomycin exposure in 30 days (31.8% vs. 12.7%, p = 0.005) were more prevalent in hemodialysis group than in nondialysis group. A higher prevalence of vancomycin MIC of 2 μg/mL was observed in hemodialysis group in comparison with nondialysis group (11.4% vs. 1.7%, p = 0.016). In following analyses of hemodialysis group, patients with initial presentation of septic shock had a higher risk of vancomycin MIC of 2 μg/mL than nonseptic shock patients (100.0% vs. 38.5% p = 0.014). Infection-related mortality was associated with age, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score >15, presence of septic shock, receipt of mechanical ventilation, and failure to remove source of bacteremia in univariate analysis. Conclusion Hemodialysis patients with MRSA bacteremia are more likely to have a high vancomycin MIC (2 μg/mL) compared with nondialysis patients. Infection-related mortality is associated with the patient's clinical manifestations, including age, APACHE-II score >15, presence of septic shock, receipt of mechanical ventilation, and failure to remove source of bacteremia. Treatment selection should be tailored according to the patient's clinical condition.
Summary Pyomyositis is an infection of skeletal muscle that involves the formation of intramuscular abscesses. It occurs most commonly in immunocompromised patients. Pyomyositis caused by ...extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has never been reported in the literature. A 48-year-old female patient developed ESBL-producing E. coli bacteremia and pyomyositis on the twelfth day of cefpirome therapy for neutropenic fever after chemotherapy due to acute myeloid leukemia. She recovered completely after a three-week course of meropenem and surgical excision. Pyomyositis should be included in the differential diagnosis when fever and muscular swelling develop in a patient with neutropenic status after chemotherapy. Early recognition of symptoms and proper diagnostic procedures are key to diagnosing pyomyositis. Both adequate antibiotics and surgical intervention are important for the successful treatment of pyomyositis caused by ESBL-producing E. coli.
Unusual Soft Tissue Mass of the Left Lower Leg Hsu, Shun-Neng; Hsu, Yi-Chih; Lin, Cheng-Hui ...
Journal of clinical rheumatology,
2013-January, 2013-Jan, 2013-01-00, 20130101, Letnik:
19, Številka:
1
Journal Article
Staphylococcal toxic shock syndrome (STSS) is an acute, toxin-mediated febrile illness that rapidly leads to multiple organ dysfunction syndromes, and systemic lupus erythematosus (SLE) is a ...multisystem autoimmune and inflammatory disease. Differential diagnosis in STSS involved a number of common diseases associated with a wide range of nonmenstrual-related conditions, including SLE. Therefore, it is difficult to distinguish from each other initially. We report a case of concurrent fatal STSS and SLE who was treated as sepsis initially, which leads to grave prognosis.
Chryseobacterium indologenes is an uncommon pathogen of human disease and is usually associated with indwelling devices or immunocompromised hosts. We report here an unusual case of C. indologenes ...peritonitis in an oncological patient with malignant ascites. The patient was treated successfully by trimethoprim-sulfamethoxazole without removal of the catheter.
Abstract In the era of target therapy, we face the challenge of the risk of opportunistic infection in patients with B-cell lymphoma who receiving rituximab-based chemotherapy. Opportunistic ...infections such as Pneumocystis jiroveci pneumonia (PJP) and Cytomegalovirus (CMV) pneumonia are life-threatening diseases. However, PJP with CMV coinfection is rare. Here, we report a follicular lymphoma patient who suffered from PJP with CMV coinfection after receiving three cycles of rituximab, cyclophosphamide, vincristine, and prednisone regimen and was successfully rescured after timely identification and treatment. We emphasize that physicians should be alert for the coinfection of PJP and CMV in lymphoma patients receiving rituximab-based chemotherapy and the timely recognition, and treatment that may avoid a deadly outcome.
Patients with septicemia caused by vancomycin-resistant
(VRE) bacteremia have higher mortality rates than patients infected by VSE. Vancomycin or teicoplanin is selected as the antibiotic stewardship ...intervention to cover methicillin-resistant
infections before blood culture reveals VRE bacteremia in critically ill patients with Gram-positive cocci (GPC) bacteremia; this may require linezolid or daptomycin treatment instead. We thus evaluated antibiotic stewardship practices, such as appropriate timing of antibiotic use in GPC bacteremia, and clinical outcomes of critically ill patients with VRE infection.
This retrospective study enrolled 191 critically ill patients with enterococcal bacteremia at the Taipei Tzu Chi Hospital during January 1, 2019-December 31, 2020. Demographic and clinical characteristics, as well as disease outcomes and appropriate antibiotic use after GPC bacteremia diagnosis, were compared between the VRE and VSE groups.
Of 191 patients, 55 had VRE bacteremia (case group) and 136 had VSE bacteremia (control group). The rate of antibiotic change after initial antibiotic use for GPC bacteremia was higher in the VRE bacteremia group (100% vs 10.3%; p<0.001). The time to appropriate antibiotic administration after GPC bacteremia diagnosis was longer in the VRE bacteremia group (3.3±2.1 vs 1.5±1.8 days; p<0.001). Patients with VRE bacteremia had higher 28-day mortality rates (relative risk, 1.997; 95% confidence interval CI, 1.041-3.83). Multivariate Cox regression analysis showed that delayed appropriate antibiotic administration of >3 days after GPC bacteremia diagnosis increased the risks of 28-day all-cause mortality (adjusted hazard ratio, 2.045; 95% CI, 1.089-3.84; p=0.026) in patients with VRE infection.
Patients with VRE bacteremia with delayed appropriate antibiotic administration of >3 days after GPC bacteremia diagnosis had increased 28-day mortality risks. New strategies for early VRE detection in GPC bacteremia may shorten the time to administer appropriate antibiotics and lower mortality rates.
Tubo-ovarian abscess caused by Morganella morganii is unusual. A 54-year-old menopausal woman visited the emergency room with lower abdominal pain, vomiting, and fever for 4 days. Pelvic examination ...revealed lifting tenderness over the right adnexum without motion tenderness of the uterus. Pelvic sonogram revealed a cystic lesion with heterogeneous content in the right ovary. Salpingo-oophoritis was suspected. Clindamycin and gentamicin were administered intravenously after obtaining blood cultures. Laparoscopy was done because of sustained fever, and an ovarian abscess was found. Laparoscopic salpingo-oophorectomy was performed. The patient was discharged 5 days later and oral clindamycin was prescribed. However, she was readmitted due to intermittent fever. The result of blood culture obtained before surgery disclosed M. morganii, which was resistant to clindamycin and cefazolin. Her symptoms resolved after administration of intravenous flomoxef. This report highlights the fact that antimicrobial resistance of M. morganii may complicate the management and outcome of this infection.
PDF
