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Background Context: Postoperative vertebral osteomyelitis (PVO) after spinal surgery is a clinical challenge. However, there is a paucity of evidence regarding the most likely etiologic organisms to guide the choice of empirical antibiotic therapy, and previous reports of treatment outcomes for PVO are scarce.Purpose: To compare the microbiology, clinical characteristics, and outcomes of pyogenic PVO with native vertebral osteomyelitis (NVO).Study Design: Retrospective comparative study.Patient Sample: Patients with microbiologically proven vertebral osteomyelitis from three university-affiliated hospitals in South Korea between January 2005 and December 2015 with follow-up of at least 12 months after completion of antibiotics or until the patient was transferred. Patients who had a spine operation in the same location within 1 year of diagnosis, and all patients with remnant implants at the time of the vertebral osteomyelitis diagnosis, were defined as having PVO. The remainder of the patients was considered to have NVO. Spinal operations included discectomy, laminectomy, arthrodesis, and instrumentation for stabilization of the spine.Outcome Measures: Overall mortality, neurologic outcomes, treatment failure, and relapse of infection.Methods: Demographic data, comorbidities, presenting symptoms, microbiological data, radiographic characteristics, laboratory data (including white blood cell counts, erythrocyte sedimentation rate, and C-reactive protein), surgical treatment, and neurologic outcomes for each patient were reviewed from electronic medical records and analyzed. Mortality rate, treatment failure, and relapse of infection were calculated for the two groups. Factors associated with treatment outcome were evaluated using univariate and multivariate logistic regression analyses.Results: The study evaluated 104 patients with PVO and 441 patients with NVO. In PVO, the most common isolate was Staphylococcus aureus (34%, n=35), followed by coagulase-negative staphylococci (31%, n=32). In NVO, the most common isolates were S. aureus (47%, n=206) and streptococci (21%, n=94). Of the staphylococci, the proportion of methicillin-resistant strains was significantly higher in PVO than that in NVO (75% vs. 39%, p<.001). The proportion of patients with gram-negative bacilli was 14% in PVO and 20% in NVO. Pre-existing or synchronous nonspinal infection was observed more frequently in NVO than in PVO (33% vs. 13%, p<.001). Although the duration of antibiotic use was similar in both groups, surgery for infection control was performed more frequently in PVO. The mortality rate was similar in both groups. However, the treatment failure and relapse rates at 12 months were higher in the PVO group (23% vs. 13%, p=.009; 14% vs. 7%, p=.028, respectively). Methicillin-resistant S.aureus was significantly associated with treatment failure or relapse via logistic regression (odds ratio 3.01, 95% confidence interval [1.71-5.32], p<.001; odds ratio 2.78, 95% confidence interval [1.40-5.49], p=.003).Conclusions: Coverage of methicillin-resistant staphylococci should be considered when prescribing empirical antibiotics for PVO. Although surgery was performed more often in PVO than NVO, the treatment failure and relapse rates at 12 months were higher in PVO. [ABSTRACT FROM AUTHOR]

Background: We investigated the clinical characteristics and risk factors for mortality in adults with persistent candidemia.Methods: All patients ≥18 years old with candidemia in two Korean tertiary hospitals from 2007 to 2014 were investigated. Persistent candidemia was defined as isolation of the same Candida species ≥5 days after initiation of antifungal therapy. Non-persistent candidemia was defined as candidemia persisting for ≤3 days after initiation of antifungal therapy.Results: Candida tropicalis (29.2%) was the most common pathogen in persistent candidemia, and Candida albicans (35.9%) was the most common in non-persistent candidemia. Central venous catheter (CVC) (OR, 1.99; 95% CI, 1.05-3.78; P = 0.034), longer hospital stay (OR 1.01; 95% CI, 1.01-1.02; P = 0.025), and severe sepsis (OR 2.25; 95% CI, 1.11-4.56; P = 0.024) were independent risk factors for persistent candidemia. C. tropicalis was independently related to 30-day mortality (OR, 4.12; 95% CI, 1.27-13.36; P = 0.018), together with septic shock (OR, 5.81; 95% CI, 1.32-24.70; P = 0.017) and use of a corticosteroids (OR, 5.31; 95% CI, 1.07-26.29; P = 0.041) in persistent candidemia.Conclusion: C. tropicalis is the predominant pathogen and cause of death in patients with persistent candidemia. [ABSTRACT FROM AUTHOR]

Abstract: Age can affect the clinical features and severity of infectious disorders, such as scrub typhus. We performed this study to examine differences between elderly and non-elderly scrub typhus patients, and to identify risk factors predictive of disease outcomes. This retrospective study included patients admitted to a tertiary hospital with scrub typhus between 2001 and 2011. A total of 615 patients were enrolled in this study, 328 of which were >65 years of age. Of the elderly patients, 46.0% (151/328) experienced at least one complication compared to only 23.0% (66/287) in younger patients. A linear trend was observed between age and complication rates (p =0.002). The most common complication in elderly patients was acute kidney injury (75, 22.9%). Treatment failure was reported in 10 elderly patients (3.0%) compared to one non-elderly patient (0.3%). Mental confusion and dyspnea of clinical manifestations at admission were common in elderly patients. Frequency of fever, rash, and eschar were similar in both groups. The following four factors were significantly associated with severe scrub typhus in elderly patients: (1) white blood cell (WBC) counts>10,000/mm3 (OR=2.569, CI=1.298–5.086), (2) MDRD GFR<60mL/min (OR=3.525, CI=1.864–6.667), (3) albumin≤3.0g/dL (OR=4.976, CI=2.664–9.294), and (4) acute physiology and chronic health evaluation II (APACHE II) score>10 points (OR=3.304, CI=1.793–60.87). Complications and mortality were more common in elderly patients, often associated with delays in diagnosis and treatment. [Copyright &y& Elsevier]

• Complications occurred in 4.4% of adults with candidaemia. • C. albicans was an independent risk factor for complicated candidaemia in adults. • Complications of candidaemia might need prolonged treatment and additional procedures or surgery. This study evaluated the incidence, risk factors, and clinical characteristics of complications of candidaemia in adults, with a focus on endophthalmitis, endocarditis, and osteoarticular infections. All patients ≥18 years old with candidaemia in two Korean tertiary hospitals from 2007 to 2016 were investigated. Complications of candidaemia were defined as the presence of endophthalmitis, endocarditis, or osteoarticular infections documented in patients with candidaemia. The clinical characteristics and risk factors for candidaemia with complications were analysed in the patients who underwent ophthalmological examinations. Of 765 adult patients with candidaemia, 34 (4.4%) met the definition of complications, including endophthalmitis in 29 (3.8%), endocarditis in 4 (0.5%), and osteoarticular infections in 3 (0.4%). Of the 225 patients who underwent ophthalmological examinations, 29 (12.9%) had endophthalmitis. Candida albicans was an independent risk factor for complicated candidaemia (OR, 5.12; 95% CI, 2.17–12.09; P < 0.001). Although the mortality rate was no higher in complicated candidaemia, the duration of antifungal therapy was longer (23.1 ± 17.6 vs. 16.4 ± 10.8 days, P = 0.042), and 13 patients (39.3%) underwent additional procedures or surgery. Complications of candidaemia occurred in 4.4% of adult patients. C. albicans was an independent risk factor for complicated candidaemia in adults. Complications of candidaemia might need prolonged treatment and additional procedures or surgery. Therefore, careful evaluation and active treatment of candidaemia with complications should be encouraged. [ABSTRACT FROM AUTHOR]

• There are carriers of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the asymptomatic population. • The duration of viral shedding may be short in asymptomatic carriers. • Fourteen days of isolation after diagnosis may be sufficient in entirely asymptomatic cases. From a total of 71 laboratory-confirmed cases, three presymptomatic patients and 10 patients with entirely asymptomatic infections were identified. In two of the three incubation period patients, the viral titer in the presymptomatic period was very high (Ct value < 20). The median number of days to first negative RT-PCR in the asymptomatic carriers was 4.5 (range 2.5–9), and all asymptomatic carriers reached a first RT-PCR Ct > 35 within 14 days after diagnosis. Patients who have COVID-19 may already be infectious before there are symptoms, and 14 days of isolation after diagnosis may be sufficient in entirely asymptomatic cases. [ABSTRACT FROM AUTHOR]

We investigated susceptibility to antimicrobials of 89 staphylococcal species from PJIs and analyzed fluoroquinolone (FQ)-resistance mechanisms. Staphylococcal isolates showed high resistance to oral antimicrobials, with the exception of TMP-STX and linezolid. The main mechanism of resistance to FQ was mutations in quinolone-resistance-determining-regions. Fifteen percent of Staphylococcus aureus overexpressed efflux-pump genes. • We tested in vitro activity of oral available antimicrobials against staphylococci from prosthetic joint infection and analyzed resistance mechanisms of fluoroquinolone. • Isolates were 72 S. aureus (58%, MRSA) and 17 S. epidermidis (100%, MRSE). • The MRSA isolates exhibited high rates of resistance to ciprofloxacin (50%) and rifampin (22%). All of the MRSA isolates were susceptible to TMP-STX and linezolid. • Eleven strains of S. aureus (15%, 11/72 strains) overexpressed efflux pump genes, mainly nor B. • S84L of gyrA (16/23, 70%) and S80F of parC (19/23, 82%) were the most common mutations. [ABSTRACT FROM AUTHOR]