Prognostic Factors and Adequacy of Empirical Antibiotic Therapy for Patients with Bloodstream Infection in the Emergency Department

PURPOSE: To characterize the prognostic factors and evaluate the inadequate empirical antibiotic therapy for patients with bloodstream infection. METHODS: We reviewed retrospectively the medical records of all adult patients with bloodstream infections detected from November 1, 2002, to June 30, 2003. Clinical and microbiological characteristics were recorded, and the adequacy of empirical antimicrobial therapy was determined in each case. A multiple logistic regression analysis with SPSS 11.5 was used to determine the prognostic factors for mortality related to bloodstream infections. RESULTS: Escherichia coliand Klebsiella spp. were the most commonly isolated organisms, and the main sources were the intra-abdominal (40.4%), the urinary tract (28.7%), and pneumonia (36.8%). Approximately 19.1% of the patients died. Statistical analysis of independent risk factors showed that mortality was significantly related to inadequate empirical antibiotic therapy (OR 34.72, p=0.019), renal insufficiency (OR 10.54, p=0.011), the rapidity of fatal diseases (OR 4.77, p=0.018), and the severity of sepsis (OR 3.58, p=0.031). Patients with inadequate empirical antibiotic therapy had a 50% survival rate. The main reason for the administration of an inadequate antibiotic therapy was the presence of antibiotic-resistant bacteria and/or fungal infections. CONCLUSION: Better understanding of the correlation between mortality and prognostic factors may improve the outcome for patients with bloodstream infections. Inadequate antibiotic therapy is the most important influence on the outcome for such patients. Our data suggest that clinical efforts aimed at reducing the occurrence of inadequate antibiotic therapy could improve the outcomes for bacteremic patients.

Rupture of Ureter due to Ureter Stone

The spontaneous rupture of the ureter is a rare condition. Two cases are reported with a spontaneous rupture caused by ureteral calculi. The diagnosis was suspected by delayed post-CT KUB and confirmed by ureteroscopy. On the basis of the clinical evolution the authors discuss the diagnosis and pathogenesis of the observed ureteral rupture. Rupture of ureter must be considered as differential diagnosis of acute flank pain, especially when there is change of pain character or severity.

Aortic Dissection Presenting as Lower Leg Ischemia: A Case Report / 대한구급학회지

We report a 47-year-old man who presented with acute right leg pain without any other symptoms on visit to ER. But he had the severe back pain when the leg pain developed. Contrast CT revealed no enhancement on right common iliac artery and aortic dissection from the lower level of right renal artery to the iliac artery bifurcation. Angiographic stent insertion was performed immediately, but the patient showed reperfusion syndrome and died after 3 days. Aortic dissection with the isolated peripheral vascular complications is rare. Aortic dissection should be included in the differential diagnosis of patients with acute lower leg ischemia like peripheral arterial occlusive disease.

Paradoxical Cerebral Air Embolism Immediately after Ingestion of 5% Hydrogen Peroxide

We report the case of a 58-year-old man who developed multiple cerebral infarctions after ingesting accidently a 5% hydrogen-peroxide detergent solution. A 3~5% hydrogen peroxide solution is commercially available as an oxidant and detergent. Neurologic examination of this patient revealed grade III weakeness in both upper and lower limbs and bilateral positive Babinski signs. CT and MRI revealed bilateral multiple brain infarctions in the anterior and the middle vascular territories. The likely mechanism of pathogenesis must be paradoxical cerebral air embolism. Decompression through Nasogastric tube and hyperbaric oxygenation therapy were used to treating this patient. In spite of our intensive care, the patient expired 21days after ICU admission.