Successful Treatment of Prostatic Abscess Accompanied by Methicillin-Resistant Staphylococcus aureus Bacteremia Using a Percutaneous Fine-Needle Aspiration under the Computed Tomography Guidance / 이화의대지

Prostatic abscess is not a common entity which is characterized by non-specific clinical presentations. This poses a diagnostic challenge for clinicians. Clinicians routinely consider antibiotic treatments concomitantly with drainage for the treatment of prostatic abscess. But there are no established guidelines for its optimal timing, methods and indications. Surgical drainage procedures include transurethral resection of the prostate and perineal incision and drainage. But there is variability in the prognosis of patients between the procedures. We have treated a 48-year-old diabetes patient with prostatic abscess accompanied by MRSA bacteremia using a percutaneous fine-needle aspiration under the computed tomography (CT) guidance. The patient achieved improvement of the symptoms and in follow up CT findings. A percutaneous drainage under the CT guidance is advantageous in that it causes fewer complications. However, Further studies are warranted to establish the optimal timing, methods and indications in patients with prostate abscess.

The risk factors and prognosis of methicillin-resistant staphylococcus aureus bacteremia: focus on nosocomial acquisition / 대한내과학회지

BACKGROUND: Staphylococcus aureus is the most common pathogen causing nosocomial infection; it contributes significantly to patient morbidity and mortality. The incidence of S. aureus bacteremia in hospitals as well as communities has significantly increased during the past decade. The purpose of this study was to determine the risk factors and prognosis of methicillin-resistant S. aureus bacteremia. METHODS: We reviewed the medical records of 164 cases of S. aureus bacteremia during 1999-2003 at the Ewha Womans University MokDong hospital. We retrospectively analyzed the cases, which satisfied the definition of clinically significant bacteremia and whose medical records were available. RESULTS: The number of methicillin-sensitive Staphylococcus aureus infections (MSSA) was 87 cases and methicillin-resistant Staphylococcus aureus (MRSA) 77 cases. There were 65 cases (84.4%) of nosocomial infection, 9 cases (11.7%) of health-care associated and 3 cases (3.9%) of community-acquired MRSA bacteremia. The risk factors associated with nosocomial MRSA were previous use of antibiotics (OR 15.6, p<0.001) and advanced age (OR 4.9, p=0.017). The risk factor for increased mortality in patients with nosocomial S. aureus bacteremia was septic shock (Hazard ratio 13.2, p<0.001). CONCLUSIONS: MRSA bacteremia was more frequent in patients with previous antibiotic therapy and advanced age. In addition, the risk factor for mortality in patients with S. aureus bacteremia was septic shock. Additional prospective randomized trials to assess the efficacy and initiation of empirical antibiotics in a well matched cohort study are necessary.

Pleural Effusion Caused by Central Catheter-Related Infection in a Hemodialysis Patient / 대한신장학회잡지

Central catheterization for temporary vascular access in hemodialysis patients may cause serious catheter-related infection such as bacteremia, osteomyelitis, and septic shock. We here report a case of unusual complication of catheter-related infection in a hemodialysis patient with internal jugular catheter. A 44-year old man was admitted due to intermittent fever and right chest discomfort. Five weeks ago, right internal jugular catheter was inserted for hemodialysis. Three weeks ago, He stopped hemodialysis treatment and exit site skin care of the catheter by himself. Chest X-ray showed massive right pleural effusion. But the catherter was normally positioned in superior vena cava. Both blood and pleural fluid cultures demonstrated Staphylococcus aureus. After prompt removal of the catheter and drainage of the pleural fluid, and adequate antibiotic treatment, catheter-related bacteremia and pleural effusion improved.