Kim SH, et al. J Korean Med Sci. 2022 Apr;37(18):e134. https://doi.org/10.3346/jkms.2022.37.e134

Kang JS, et al. J Korean Med Sci. 2021 Sep;36(43):e273. https://doi.org/10.3346/jkms.2021.36.e273

The criteria for antibiotic failure in persistent Staphylococcus aureus bacteremia (SAB) are unclear, but treatment response and bacteremia duration are commonly used indicators of antibiotic failure. We evaluated the effects of treatment response and bacteremia duration on mortality in persistent SAB. We retrospectively identified patients with persistent SAB in four university-affiliated hospitals between 2017 and 2021. Bacteremia duration was calculated from the first day of active antibiotic therapy, and persistent SAB was defined as bacteremia lasting for 2 or more days. Defervescence and Pitt bacteremia score (PBS) were used to evaluate treatment response at treatment day 4. The primary outcome was 30-day in-hospital mortality. Time-dependent multivariable Cox regression analysis and subgroup analysis according to methicillin resistance were performed. A total of 221 patients was included in the study, and the 30-day in-hospital mortality was 28.5%. There was no significant difference in bacteremia duration between survived and deceased patients. Independent factors for mortality included age, Charlson comorbidity index, initial PBS, pneumonia, and removal of the eradicable focus. PBS at treatment day 4 ≥ 3 was the strongest risk factor (adjusted hazard ratio [HR] = 4.260), but defervescence was not. Bacteremia duration was not an independent factor except for 13 days or more of methicillin-resistant SAB (adjusted HR = 1.064). In patients with persistent SAB, PBS at treatment day 4 was associated with 30-day in-hospital mortality rather than defervescence and bacteremia duration. The results of this study could help determine early intensified treatment strategies in persistent SAB patients.

Acinetobacter species are major pathogens responsible for hospital-acquired infections. This study aimed to compare the clinical characteristics, outcomes, and antimicrobial resistance between Acinetobacter baumannii (AB) and non-baumannii Acinetobacter (NBA) species. In this retrospective cohort study, we analyzed data from adult patients (aged 18 or older) with Acinetobacter bacteremia treated at two tertiary hospitals from July 2020 to November 2023. Among 260 cases of Acinetobacter bacteremia, 42 (16.2%) involved NBA species. The AB group exhibited higher antimicrobial resistance rates across all tested agents, except for minocycline. Female patients, younger patients, and those with catheter-related infections were more commonly observed in the NBA group than in the AB group, while pneumonia and septic shock were more prevalent in the AB group. In a multivariable analysis of 30-day mortality, factors associated with higher mortality included moderate to severe liver disease, chronic kidney disease, carbapenem resistance, septic shock, and higher Pitt Bacteremia Scores. When stratified by carbapenem resistance (CR) status, only CR-AB exhibited significantly lower 30-day survival rate (33.4%) compared to that of the other groups (non-CR-NBA, 77.3%; CR-NBA, 77.8%; non-CR-AB, 90.1%; p < 0.001). Our findings highlight distinct clinical differences between AB and NBA bacteremia cases; however, the mortality rate for non-CR-AB was comparable to that observed in NBA bacteremia.

Pyometra is a disease characterized by the collection of pus in the uterus. The clinical characteristics and etiology of pyometra have not been sufficiently described. In this study, we investigated the clinical characteristics, epidemiology, outcomes, and risk factors of septic shock in patients with pyometra. Patients with pyometra admitted to one of four university-affiliated hospitals between January 2010 to August 2022 were enrolled. Pyometra cases associated with peripartum infection and surgical site infection were excluded. Clinical characteristics and outcomes of pyometra were described, and pyometra patients with or without septic shock were compared. A total of 192 patients was included. Twenty-eight-day all-cause mortality was 5.0%, and the 1-year recurrence rate was 6.3%. Median patient age was 77.5 years. The two most common symptoms were abdominal pain (49.0%) and vaginal discharge (47.9%). Escherichia coli (40.1%), Klebsiella pneumoniae (16.7%), and Streptococcus spp.(16.0%) were the pathogens most frequently isolated by conventional culture; those isolated from polymerase chain reaction were Mycoplasma hominis (48.0%), and Ureaplasma spp. (32.0%). In multivariable analysis, fever, uterine perforation, and dementia were associated with increased incidence of septic shock, while vaginal discharge was associated with a lower incidence of septic shock. Our findings suggest that pyometra is a unique gynecological infectious syndrome in post-menopausal individuals. The most common associated pathogens are similar to those involved in urinary tract infections rather than those of sexually transmitted diseases. Decreased cognitive function could delay early diagnosis of pyometra and lead to septic shock and higher mortality.

Patients with uncomplicated Staphylococcus aureus primary bacteremia and catheter-related bloodstream infection (CRBSI) should be treated for at least 14 days. However, evidence for oral step-down therapy is lacking in these patients. A retrospective cohort was identified from 2013 to 2018 in a 1,950-bed tertiary hospital. An oral antimicrobial therapy (OAT) group was defined as patients treated with oral antibiotics following less than 10 days of intravenous antimicrobial therapy (IAT). Treatment failure was defined as any case of recurrence or death within 90 days. A total of 103 patients were included in the analysis, including 32 patients treated with OAT. Rates of treatment failure were 3.2% and 12.7% in the OAT and IAT groups (P = 0.113). The length of hospital stay was shorter in the OAT group. OAT was not an independent risk factor for treatment failure. OAT may reduce the duration of hospitalization without adverse effects in these patients.