Elif Tukenmez Tigen

Unusual causes of peritonitis in a peritoneal dialysis patient: Alcaligenes faecalis and Pantoea agglomerans

An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients.

Outcomes of fecal carriage of extended-spectrum β-lactamase after transrectal ultrasound-guided biopsy of the prostate.

OBJECTIVE To determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (PE) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy (TRUSbx) and its relationship with post-biopsy infections. METHODS A prospective clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted. Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy. Rectal swab culture specimens were acquired immediately before the procedure. Demographic data, prophylaxis choice, quinolone or any other antibiotic consumption within the past 2 months, history of prostatitis, repeat biopsy, intensive care unit admission, hospitalization, urethral catheterization, diabetes mellitus (DM), and steroid usage were recorded. RESULTS ESBL carriage was detected in 19% of patients and quinolone use within the last 2 months; other antibiotic use within the last 2 months and DM were found to be significantly associated (P <.05). Symptomatic urinary tract infection (UTI) on the third day after biopsy was seen in 9% of patients and was associated with fluoroquinolone (FQ) consumption before biopsy. Although ESBL-PE carriage was associated with post-biopsy UTI symptoms, it was not found to be associated with post-biopsy symptomatic UTI. Urosepsis was seen in 2 patients (0.5%) after biopsy, and both the patients were ESBL-PE carriers. CONCLUSION The presence of ESBL-PE was associated with DM and FQ consumption before biopsy. ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation; however, it was not associated with microbiologically proven infections. FQ consumption before TRUSbx was also associated with post-biopsy infections.

Delftia Acidovorans: A Rare Pathogen in Immunocompetent and Immunocompromised Patients

Delftia acidovorans is usually a nonpathogenic environmental organism, which is rarely clinically significant. This article documents a case of D acidovorans-associated pneumonia in a B cell lymphoblastic leukemia patient. The authors also provide a review of the literature regarding D acidovorans infection and discuss how unusual pathogens may be clinically significant in both immunocompromised and immunocompetent patients.

Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey

HighlightsThis brief report shows risk factors of candidemia in the intensive care unit in our country.Determining the risk factors associated with candidemia may lead to the quick diagnosis, identification of prevention measures and early antifungal therapy that may reduce mortality rates.All countries should know their risk factors for candidemia especially in the intensive care unit and they should apply many prevention measure to reduce this infection. &NA; Thirty‐six patients with candidemia and 37 control patients were included consecutively to determine the characteristics of candidemia episodes. The patients with candidemia had higher mortality with higher Sequential Organ Failure Assessment scores and frequency of use of a central venous catheter, total parenteral nutrition, and broad‐spectrum antibiotics; chronic renal failure with replacement therapy; and longer stay in an intensive care unit. Candida albicans was the predominant species followed by Candida glabrata, Candida tropicalis, and Candida parapsilosis. All isolates of C glabrata were itraconazole‐resistant.

Hepatitis B, Hepatitis C and human immunodeficiency virus prevalences among first time blood donors in Istanbul, Turkey, 2004–2011

OBJECTIVE This study aims to determine the yearly change rates of the HBsAg, anti-HCV and anti-HIV test results and their positivity rates obtained from the 68,393 donors who applied and donated blood for the first time at the Blood Center of the hospital. MATERIALS AND METHODS Using the ELISA method, screening tests were applied to the blood samples obtained from blood donors, and the HBsAg, anti-HCV and anti-HIV positivity rates were calculated at the end of year eight. However, HBsAg and anti-HCV positivities showed a decreased tendency of positivity in years. RESULTS A total of 68,393 donations were received within eight years. Seroprevalences for anti-HIV, HBsAg and anti-HCV tests were, respectively 0.01%, 1.54% and 0.38%. HBsAg and anti-HCV positivities showed a decreased tendency of positivity in years.

Peritoneal Dialysis-Related Peritonitis With Acinetobacter Ursingii.

Dear Editor On-line hemodiafiltration (HDF) has been suggested to improve the global care of end-stage renal disease and has been regarded as “suitable for patients with a variety of pathologies who regularly undergo maintenance dialysis” (1). As such, HDF is expected to become an even more common clinical practice in the near future. However, an ethical issue arises. It is well known that in diabetes patients a dialysis fluid containing glucose should be used to avoid both intradialytic changes in plasma glucose level and hemodialysis-induced hyperglycemia (2). As a result, the glucose concentration in dialysis fluid usually amounts to 100 mg/dL (5.55 mmol/L) (2). In HDF the substitution fluid—the infusate—has the same composition of the dialysis fluid. It is worth noting that in post-dilution HDF the glucose burden would be delivered directly to the patients’ bloodstream as, in fact, is currently done worldwide also in diabetes patients. Furthermore, randomized clinical trials (RCT) aimed at studying themortality reduction byHDFhave provided inconsistent results (3). The researchers are therefore investigating the existence of a convection volume threshold associated with survival advantage, which has been recently reported (4). The mortality reduction is associated with a convective volume close to 20 L per dialysis session.Accordingly, efforts are currently made to reach this threshold in the clinical practice. Obviously, a larger convection volume leads to a larger amount of glucose delivery to patients. In the absence of diabetes this could improve caloric balance and also the survival rates, whereas in diabetes patients it could adversely affect the outcomes. In published RCTs, findings have been always adjusted for diabetes status, but significant differences in outcomes were never found (3); however, they were not focused on intradialytic changes in plasma glucose level or glycemic control. It would be reasonable to deeply investigate the suitability of HDF in diabetes patients because they represent a large percentage of the dialysis population with increasing prevalence. In our opinion, future trials will need unavoidably to take into account both the diabetes status and the infusate composition, in order to avoid the ethical issue of delivery of glucose to diabetes patients. In the meantime, some caution in recommending HDF seems to be needed.

The risk factors of colistin methanesulfonate associated nephrotoxicity.

Purpose: The risk factors of colistin methanesulfonate (CMS) associated nephrotoxicity are important. Our study attempts look into the prevalence of CMS-associated nephrotoxicity in Intensive Care Units (ICUs), and related risk factors. Materials and Methods: The study was conducted between September 2010 and April 2012 on 55 patients who underwent CMS treatment. Nephrotoxicity risk was defined based on the Risk Injury Failure Loss End-stage kidney disease criteria. Results: Fifty-five patients included in the study. A total of 22 (40%) patients developed nephrotoxicity. The correlation was detected between nephrotoxicity and patients over 65 with a high Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score. APACHE II score was revealed an independent risk factor for nephrotoxicity. Conclusion: Advanced age and a high APACHE II score are significant risk factors in the development of nephrotoxicity at ICUs following CMS use. Patient selection and close monitoring are critical when starting CMS treatment.

Dev mitral kapak vejetasyonu

Biz burada klinik durumu cerrahi mudahaleye firsat vermeden kotulesen ve septik emboli ve coklu organ yetmezligine bagli olen 66 yasinda mitral kapakta dev vejetasyonu olan bayan hastayi sunuyoruz. Amacimiz buyuk vejetasyonlari olan vakalarda embolik komplikasyon riskinin ve mortalite oranlarinin yuksek oldugunu, cok hizli mudahale edilmesi gerektigini vurgulamaktir.

Reports of four cyst hydatid cases in different size and location

Hydatid disease/echinococcus is caused by Echinococcus granulosus and it is endemic in many countries. Echinococcus commonly affect the liver but it has propensity to involve any organ or unusal location of the body. Treatment is surgical and medical but in many cases desicion of teatment is hard because of the location and size of cyst hydatid. In the present report, authors presented four patients with echinococcus with different anatomical site, size and desicion of treatment.

Etiology, incidence and risk factors of ventilator associated pneumonia in an intensive care unit of a training and research hospital in Istanbul

SUMMARY In this prospective study, we aimed to identify the factors associated with the development of ventilator- associated pneumonia (VAP) and examine the etiology, and incidence of VAP. Between November 2007 and June 2008, 148 patients who required mechanical ventilation for longer than 48 hours were evaluated. VAP was observed in 54 patients (36 %). Mechanical ventilator utilizationrate was 0.87, and VAP rate in 1000 ventilator days was 22.88. The most common three microorganisms cultured from tracheal aspirates were Pseudomonas aeruginosa (n=19), Acinetobacter spp.(n=11), and Staphylococcus aureus (n=10). Of the 21 risk factors evaluated, 7 factors identified were independently associated with VAP (p<0.05) such as shock, coma (p<0.0006), antibiotic usage for at least 1 month prior to admission (p<0.04), nasogastric tube insertion (p<0.01), invasive procedures such as bronchoscopy, tracheotomy (p<0.0001), reintubation (p<0.017), intubation lasting for more than 5 days (p<0.0001), and smoking (p<0.014). Intensive Care Unit (ICU) clinicians should be aware of the risk factors for VAP to minimize the risk of VAP, patient care should be individualized, and procedures like bronchoscopy, reintubation must be performed and followed up cautiously. Besides these, data about the potential microorganisms and those resistant to antibiotics will guide the empirical therapy.